INVITED REVIEW ARTICLES
Practical weight management to minimize pregnancy
complications and promote women’s health:
the possibility of interpregnancy care
Tomomi Kotani, Sho Tano, Takafumi Ushida, Kenji Imai and Hiroaki Kajiyama
pg(s) 160 - 168
<Abstract> - < PDF >
Pregnancy is an excellent opportunity to provide medical interventions to women. It is also a stress test
used to predict health. Numerous studies have demonstrated that the pre-pregnancy body mass index (BMI)
and gestational weight gain (GWG) are critical factors for pregnancy complications such as hypertensive
disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), large or small gestational age infants,
and spontaneous preterm birth (sPTB). These complications are associated with an increased risk of
cardiovascular disease (CVD), which is a leading cause of mortality in women. In addition, complications
adversely affect the short- and long-term prognoses of children. Optimal GWG to reduce complications is
recommended based on pre-pregnancy BMI; however, racial differences should also be noted. The values
in the Japanese guidelines are lower than those in the American Institute of Medicine guidelines. The
Asian BMI thresholds for CVD risk are also lower than those in Europe. Therefore, weight management
should be based on racial/genetic background. Interpregnancy weight gain or loss has also been reported
to be associated with the risk of pregnancy complications; however, few studies have been conducted in
Asian populations. Our previous reports suggested that avoiding an excess of 0.6 kg/m2/year of annual
BMI gain may reduce the risk of HDP or GDM, and insufficient gain of < 0.25 kg/m2/year may increase
sPTB recurrence. Annual BMI is useful for practical weight control during interpregnancy. Based on these
findings, effective approaches should be established to improve the health of women and their offspring.
Treatment escalation and de-escalation of de-novo metastatic
castration-sensitive prostate cancer
Shusuke Akamatsu, Yushi Naito, Jun Nagayama, Yuta Sano,
Satoshi Inoue, Kazuna Matsuo, Tomoyasu Sano, Shohei Ishida,
Yoshihisa Matsukawa and Masashi Kato
pg(s) 169 - 180
<Abstract> - < PDF >
Androgen receptor signaling inhibitors combined with androgen deprivation therapy have become the
standard of care for metastatic castration-sensitive prostate cancer (mCSPC), regardless of tumor volume or
risk. However, survival of approximately one-third of these patients has not improved, necessitating further
treatment escalation. On the other hand, for patients with oligometastatic mCSPC, there is an emerging
role for local radiation therapy. Although data remain scarce, it is expected that treatment of both primary
tumor as well as metastasis-directed therapy may improve survival outcomes. In these patients, systemic
therapy may be de-escalated to intermittent therapy. However, precise risk stratification is necessary for
risk-based treatment escalation or de-escalation. In addition to risk stratification based on clinical parameters,
research has been conducted to incorporate genomic and/or transcriptomic data into risk stratification. In
future, an integrated risk model is expected to precisely stratify patients and guide treatment strategies.
Here, we first review the transition of the standard treatment for mCSPC over the last decade and further
discuss the newest concept of escalating or de-escalating treatment using a multi-modal approach based
on the currently available literature.
Hospital-associated complications in frail older adults
Hiroyuki Umegaki
pg(s) 181 - 188
<Abstract> - < PDF >
As the Japanese population continues to age steadily, the number of older adults requiring healthcare
has increased. Evidence demonstrates that hospitalization for acute care has a negative impact on the health
outcomes of older adults. Frail older adults tend to have multifactorial conditions collectively known as
“geriatric syndromes.” When those with these premorbid conditions are hospitalized for acute care, they
tend to develop new problems such as delirium and new functional impairments. Adverse consequences
of hospitalization include the risk of loss of functional independence and chronic disability. In 2019, the
new concept of “hospital-associated complications” (HACs) was proposed to describe these new problems.
HACs comprise five conditions: hospital-associated falls, delirium, functional decline, incontinence, and
pressure injuries. This review discusses the important issues of HACs in relation to their classification,
prevalence, risk factors, prevention, and management in older adults hospitalized for acute care. Robust
prevention and management are imperative to address the serious consequences and escalating medical
costs associated with HACs, and a multidimensional and multidisciplinary approach is key to achieving
this goal. Comprehensive geriatric assessment (CGA) is the cornerstone of geriatric medicine and offers a
holistic approach involving multidisciplinary and multidimensional assessments. Considerable evidence is
accumulating regarding how CGA and coordinated care can improve the prognosis of hospitalized older
adults. Further research is needed to understand the occurrence of HACs in this population and to develop
effective preventive measures.
ORIGINAL PAPERS
Tissue characteristics of residual lesion in patients with acute
coronary syndrome caused by plaque rupture versus plaque
erosion: a single-center, retrospective, observational study
Wataru Suzuki, Hirofumi Ohashi, Hirohiko Ando, Yusuke Nakano,
Hiroaki Takashima, Masanobu Fujimoto, Hiroaki Sawada, Reiji Goto,
Akihiro Suzuki, Shinichiro Sakurai and Tetsuya Amano
pg(s) 189 - 200
<Abstract> - < PDF >
Patients with acute coronary syndrome (ACS), frequently caused by plaque rupture (PR), often have
vulnerable plaques in residual lesions as well as in culprit lesions. However, whether this occurs in patients
with plaque erosion (PE) as well is unknown. We retrospectively analyzed the data of 88 patients with
ACS who underwent both optimal coherence tomography (OCT) and intravascular ultrasound (IVUS).
Based on plaque morphology of the culprit lesions identified using OCT, patients were classified into
PE (n=23) and PR (n=35) groups. The tissue characteristics of residual lesions evaluated using integrated
backscatter IVUS were compared between both groups after percutaneous coronary intervention. The PE
group had a significantly lower percent lipid volume and a higher percent fibrous volume than the PR
group (35.0±17.8% vs 49.2±13.4%, p<0.001; 63.2±17.1% vs 50.3±13.1%, p=0.002, respectively). Receiver
operating characteristic curve analysis revealed that percent lipid volume in the residual lesions was a
significant discriminant factor in estimating the plaque morphology of the culprit lesion (optimal cut-off
value, <43.5%; sensitivity and specificity values were 73.9% and 68.6%, respectively). In conclusion,
patients with PE had a significantly lower percent lipid volume and a significantly higher percent fibrous
volume in the residual lesions than those with PR, suggesting that the nature of coronary plaques in
patients with PE is different from that of those with PR.
Development and validation of the chronic obstructive
pulmonary disease self-care assessment scale:
a concise and comprehensive instrument to assess
self-management, decision-making, and coping
Sanae Iwaya
and Kazuki Sato
pg(s) 201 - 215
<Abstract> - < PDF >
The purpose of this study was to develop and test the reliability and validity of a brief and comprehensive
instrument to assess self-management, decision-making, and coping by chronic obstructive pulmonary
disease (COPD) patients. A web-based questionnaire was administered to 300 COPD patients and a retest
was administered to 100 COPD patients. Cronbach’s alpha was used to assess internal consistency, and
an intraclass correlation coefficient was calculated to test the reliability of the retest. The convergent
and discriminant validities were also examined. Valid responses were obtained from 279 participants in
the first survey and 70 participants in the retest. From our analysis, a COPD self-care assessment scale
(CSCS) was developed, consisting of seven subscales and 14 items. Cronbach’s alpha for the total CSCS
score, intraclass correlation coefficient, and scale success rate were 0.80, 0.79, and 100%, respectively. A
multivariate analysis showed that CSCS was associated with current smoking (standardized partial regression
coefficient [std β] = −0.30; p < 0.001), long-term oxygen therapy (std β = 0.23; p < 0.001), and social
support (std β = 0.24; p < 0.001), but not psychological symptoms or quality of life. The CSCS is also
useful in assessing self-management, decision-making, and coping in Japanese COPD patients, and the
scale has high reliability and validity.
Study of the genetic association between selected
3q29 region genes and schizophrenia and
autism spectrum disorder in the Japanese population
Gantsooj Otgonbayar, Tzuyao Lo, Yu Hayashi, Sho Furuta,
Branko Aleksic, Yoshihiro Nawa, Itaru Kushima, Hidekazu Kato,
Hiroki Kimura and Norio Ozaki
pg(s) 216 - 222
<Abstract> - < PDF >
Psychiatric disorders are highly inheritable, and most psychiatric disorders exhibit genetic overlap.
Recent studies associated the 3q29 recurrent deletion with schizophrenia (SCZ) and autism spectrum
disorder (ASD). In this study, we investigated the association of genes in the 3q29 region with SCZ and
ASD. TM4SF19 and PAK2 were chosen as candidate genes for this study based on evidence from previous
research. We sequenced TM4SF19 and PAK2 in 437 SCZ cases, 187 ASD cases and 524 controls in the
Japanese population. Through targeted sequencing, we identified 6 missense variants among the cases (ASD
& SCZ), 3 missense variants among controls, and 1 variant common to both cases and controls; however,
no loss-of-function variants were identified. Fisher’s exact test showed a significant association of variants
in TM4SF19 among cases (p=0.0160). These results suggest TM4SF19 variants affect the etiology of SCZ
and ASD in the Japanese population. Further research examining 3q29 region genes and their association
with SCZ and ASD is thus needed.
Protective effect of Sasa veitchii extract against
all-trans-retinoic acid-induced inhibition of proliferation
of cultured human palate cells
Yosuke Tsukiboshi, Yurie Mikami, Hanane Horita, Aya Ogata,
Azumi Noguchi, Satoshi Yokota, Kenichi Ogata and Hiroki Yoshioka
pg(s) 223 - 236
<Abstract> - < PDF >
Cleft palate is the most common facial birth defect worldwide. It is caused by environmental factors or
genetic mutations. Environmental factors such as pharmaceutical exposure in women are known to induce
cleft palate. The aim of the present study was to investigate the protective effect of Sasa veitchii extract
against medicine-induced inhibition of proliferation of human embryonic palatal mesenchymal cells. We
demonstrated that all-trans-retinoic acid inhibited human embryonic palatal mesenchymal cell proliferation
in a dose-dependent manner, whereas dexamethasone treatment had no effect on cell proliferation.
Cotreatment with Sasa veitchii extract repressed all-trans-retinoic acid-induced toxicity in human embryonic
palatal mesenchymal cells. We found that cotreatment with Sasa veitchii extract protected all-trans-retinoic
acid-induced cyclin D1 downregulation in human embryonic palatal mesenchymal cells. Furthermore, Sasa
veitchii extract suppressed all-trans-retinoic acid-induced miR-4680-3p expression. Additionally, the expression
levels of the genes that function downstream of the target genes (ERBB2 and JADE1) of miR-4680-3p
in signaling pathways were enhanced by cotreatment with Sasa veitchii extract and all-trans-retinoic acid
compared to all-trans-retinoic acid treatment. These results suggest that Sasa veitchii extract suppresses
all-trans-retinoic acid-induced inhibition of cell proliferation via modulation of miR-4680-3p expression.
Evaluation of demographic/clinical features and hemorrhagic
complications in patients with ischemic stroke who
underwent reperfusion therapy
Hatice Ferhan Kömürcü, Eren Gözke, Işıl Kalyoncu Aslan,
Pelin Doğan Ak and Irmak Salt
pg(s) 237 - 251
<Abstract> - < PDF >
The relationship between demographic/clinical characteristics, clinical outcomes and the development of
hemorrhagic complications in patients with ischemic stroke who underwent reperfusion therapy has not been
studied sufficiently. We have aimed to compare genders and age groups in terms of clinical features and
outcome; and types of reperfusion treatments and clinical features regarding the development of hemorrhagic
complications in patients with ischemic stroke who underwent recombinant tissue plasminogen activator
(rtPA) and/or thrombectomy. Patients with acute ischemic stroke undergoing rtPA and/or thrombectomy
were divided into six age groups. Parameters including hemorrhagic complications, anticoagulant and antiaggregant
use, hyperlipidemia, smoking status, biochemical parameters, and comorbidities were documented.
National Institutes of Health Stroke Scale (NIHSS) scores, modified Rankin Score (mRS) and Glasgow
Coma Scale scores were recorded. Etiological classification of stroke was done. These parameters were
compared in terms of age groups, genders, and hemorrhagic complications. Significant differences were
found between age groups concerning hypertension, coronary artery disease, smoking status, and antiaggregant
use. Rate of hemorrhagic complications in rtPA group was significantly lower when compared with
other treatment groups. Hemorrhagic complications developed mostly in the rtPA+thrombectomy group.
Among the patients who developed hemorrhagic complications, NIHSS scores on admission were found
to be significantly lower in men than women. Admission, discharge, and 3rd month mRS values in men
were significantly lower than those of women. Knowing demographic and clinical features of patients that
may have an impact on the clinical course of ischemic stroke managed with reperfusion therapy will be
useful in predicting the hemorrhagic complications and clinical outcomes.
Comparison of the influenza vaccination coverage among
high-risk people between the online registration system and
walk-in service system in Bangkok, Thailand
Ranai Sairuk, Kimihiro Nishino, Souphalak Inthaphatha,
Nobuyuki Hamajima and Eiko Yamamoto
pg(s) 252 - 261
<Abstract> - < PDF >
Until recently, the Thai national program of seasonal influenza vaccination for high-risk people has
been using a walk-in service system. However, in 2020, an online registration system was introduced in
Bangkok to improve vaccine coverage. This study aimed to compare the coverage of influenza vaccination
between the walk-in service and online registration systems. The study participants included 374,710 Thai
individuals who obtained an influenza vaccination from the national program in the Bangkok health region
in 2018 (n = 162,214) and in 2020 (n = 212,496). The registration systems that were examined were the
walk-in service system in 2018 and the online registration system in 2020. The characteristics of vaccine
recipients and the vaccine coverage in each risk group and health facility level were compared between
the two systems. Coverage comparison in Bangkok between the years 2018 and 2020 showed an increase
in coverage, particularly among individuals who had an influenza vaccination at health facilities of the
primary level and in the elderly and obesity groups. The coverage among children was lowest among all
high-risk groups. To improve coverage in Thailand, the online registration system should be introduced in
all regions. Additionally, information about influenza vaccination for children should be disseminated to
parents using handbooks or by word-of-mouth from healthcare workers.
Gender and age variations in the association between
multigenerational cohabitation and self-rated health among
middle-aged and older adults in Japan
Akane Nogimura, Takahiro Otani, Taiji Noguchi,
Hiroko Nakagawa-Senda, Miki Watanabe, Tamaki Yamada
and Sadao Suzuki
pg(s) 262 - 279
<Abstract> - < PDF >
Despite encouraging multi-generational cohabitation, the population of Japanese people living alone has
increased. However, little is known about the association between health and multigenerational cohabitation.
This study examined the relationship between self-rated health and living arrangements among Japanese
adults using data from the Japan Multi-Institutional Collaborative Cohort Study (2013–2017). The analysis
employed multivariate logistic regression to examine the associations. Our results showed no association
between living arrangements and self-rated health when stratified by gender. Living alone was found to
be associated with poor self-rated health among women aged 65 and above. A similar association may
exist among men in the same age group. Among women aged < 65 years, two-generation cohabitation was
associated with a good self-rated health, similar to those living alone. Among men aged < 65 years, neither
living alone nor two-generation cohabitation was significantly associated with good self-rated health. We
found no association between three- or plus-generation cohabitation and self-rated health. Therefore, our
findings indicate associations between multigenerational cohabitation and self-rated health, but they vary
by gender and age. Invested stakeholders in the public health field should consider the potential impact
of living arrangements on health based on gender and age.
Outcomes of surgical treatment for enterovesical fistula
in Crohn’s disease
Norifumi Hattori, Goro Nakayama, Shinichi Umeda, Masanao Nakamura,
Takeshi Yamamura, Tsunaki Sawada, Koki Nakanishi, Dai Shimizu,
Mitsuro Kanda, Masamichi Hayashi, Chie Tanaka and Yasuhiro Kodera
pg(s) 280 - 291
<Abstract> - < PDF >
Enterovesical fistula (EVF) in Crohn’s disease (CD) often does not improve with medical treatment and
requires surgical treatment. The surgical treatment strategy for EVF in CD is definitive resection of the
intestinal tract side, and performing a leak test using dye injection into the bladder after EVF dissection
to determine the appropriate surgical procedure for the bladder side. This study aimed to evaluate the
outcomes of surgical treatment for EVF in CD. Twenty-one patients who underwent surgery for EVF
between 2006 and 2021 were included and retrospectively evaluated for clinical background, surgical
procedures, and postoperative complications. The most common origin of EVF was the ileum (17 cases;
81%), and the most common site of EVF formation was the apex (12; 57%). Surgical approaches were
laparotomy in 11 (52%) cases and laparoscopy in 10 (48%). Surgical procedures on the bladder side were
fistula dissection in 13 (62%) cases and sutured closure of fistula in 8 (38%). A comparison of approaches
revealed no significant difference in operative time, but the amount of blood loss was significantly less
in the laparoscopy (p < 0.01). There was no significant difference in the occurrence of postoperative
complications between approaches. Postoperative anti-TNF-α antibody agents were used in 17 (81%) cases,
and there were no cases of recurrent EVF. In conclusion, definitive resection of the intestinal tract and
minimal treatment on the bladder side were sufficient to achieve satisfactory outcomes for EVF in CD.
Clinical usefulness of endothelial progenitor cells
in predicting the efficacy of riociguat in chronic
thromboembolic pulmonary hypertension
Ryo Imai, Shiro Adachi, Masahiro Yoshida, Shigetake Shimokata,
Yoshihisa Nakano, Naoki Okumura, Toyoaki Murohara
and Takahisa Kondo
pg(s) 292 - 303
<Abstract> - < PDF >
Endothelial dysfunction is important in the pathology of pulmonary hypertension, and circulating
endothelial progenitor cells (EPCs) have been studied to evaluate endothelial dysfunction. In patients with
chronic thromboembolic pulmonary hypertension (CTEPH), riociguat reportedly increases the number of
circulating EPCs. However, the relationship between EPC numbers at baseline and changes in clinical
parameters after riociguat administration has not been fully elucidated. Here, we evaluated 27 treatment-naïve
patients with CTEPH and analyzed the relationships between EPC number at diagnosis and clinical
variables (age, hemodynamics, atrial blood gas parameters, brain natriuretic peptide, and exercise tolerance)
before and after riociguat initiation. EPCs were defined as CD45dim CD34+ CD133+ cells and measured by
flow cytometry. A low number of circulating EPCs at diagnosis was significantly correlated with increased
reductions in mean pulmonary arterial pressure (mPAP) (correlation coefficient = 0.535, P = 0.004)
and right atrial pressure (correlation coefficient = 0.618, P = 0.001) upon riociguat treatment. We then
divided the study population into two groups according to the mPAP change: a weak-response group (a
decrease in mPAP of 4 mmHg or less) and a strong-response group (a decrease in mPAP of more than
4 mmHg). The number of EPCs at diagnosis was significantly lower in the strong-response group than in
the weak-response group (P = 0.022), but there were no significant differences in other clinical variables
or in medication profiles. In conclusion, circulating EPC numbers could be a potential predictor of the
therapeutic effect of riociguat in CTEPH patients.
Risk factors for nausea and vomiting requiring the daily
administration of 5-HT3 receptor antagonists in radiotherapy
combined with temozolomide for high-grade glioma
Mai Takagi, Atsunobu Sagara, Yasuo Kumakura, Minako Watanabe,
Rikako Inoue, Masayuki Miyazaki, Fumiharu Ohka, Kazuya Motomura,
Atsushi Natsume, Toshihiko Wakabayashi, Ryuta Saito
and Kiyofumi Yamada
pg(s) 304 - 313
<Abstract> - < PDF >
Radiotherapy combined with temozolomide (TMZ+RT) is the primary treatment for high-grade glioma.
TMZ is classified as a moderate emetic risk agent and, thus, supportive care for nausea and vomiting is
important. In Nagoya University Hospital, all patients are treated with a 5-hydroxy-tryptamine 3 receptor
antagonist (5-HT3RA) for the first 3 days. The daily administration of 5-HT3RA is resumed after the 4th
day based on the condition of patients during TMZ+RT. Therefore, the present study investigated risk
factors for nausea and vomiting in patients requiring the daily administration of 5-HT3RA. Patients with
high-grade glioma who received TMZ+RT between January 2014 and December 2019 at our hospital were
included. Patients were divided into two groups: a control group (patients who did not resume 5-HT3RA)
and resuming 5-HT3RA group (patients who resumed 5-HT3RA after the 4th day), and both groups were
compared to identify risk factors for nausea and vomiting during TMZ+RT. There were 78 patients in the
control group (68%) and 36 in the resuming 5-HT3RA group (32%). A multivariate analysis of patient
backgrounds in the two groups identified age <18 years, PS 2 or more, and occipital lobe tumors as risk
factors for nausea and vomiting. Nausea and vomiting were attenuated in 30 patients (83%) in the resuming
5-HT3RA group following the resumption of 5-HT3RA. The results obtained highlight the importance of
extracting patients with these risk factors before the initiation of therapy and the early resumption or daily
administration of 5-HT3RA according to the condition of each patient.
Relationship between locomotive syndrome and advanced
glycation end products measured by skin autofluorescence
in community-dwelling patients: the Yakumo Study
Yuto Ozawa, Yasuhiko Takegami, Taisuke Seki, Yusuke Osawa,
Hiroki Iida, Msanori Okamoto, Hiroaki Nakashima, Shinya Ishizuka,
Yukiharu Hasegawa and Shiro Imagama
pg(s) 314 - 325
<Abstract> - < PDF >
Advanced glycation end products (AGEs) have been reported to be associated with osteoporosis, aging,
sarcopenia, and frailty. This study aimed to investigate the association AGEs with locomotive syndrome
(LS). Participants were Japanese individuals aged 39 years or older who participated in the Yakumo Study
(n=230). AGEs were measured by skin autofluorescence (SAF) using an AGE reader. We investigated
SAF values for each locomotive stage. Multivariate logistic regression models were used to calculate
the odds ratios of LS-associated factors. The relationships between SAF and physical performance and
bone mineral density (BMD) were investigated. A receiver operating characteristic (ROC) curves were
generated to determine the optimal cut-off value of SAF for predicting LS. SAF values tended to increase
correspondingly with LS severity. SAF was an independently explanatory factor for LS (odds ratio 2.70;
95% confidence interval [CI] 1.040–6.990). SAF was positively correlated with the 10-m walking speed,
The Timed Up and Go test results, and was negatively correlated with BMD. ROC curve represented by
SAF for the presence or absence of LS risk had an area under the curve of 0.648 (95% CI: 0.571–0.726).
High SAF values were identified as an independent risk factor for LS. AGEs could be a potential screening
tool for people for LS.
SHORT COMMUNICATION
Clonal evolution process from essential thrombocythemia to
acute myeloid leukemia in the original patient from whom
the CALR-mutated Marimo cell line was established
Yoko Ushijima, Yuichi Ishikawa, Takahiro Nishiyama,
Naomi Kawashima, Takashi Kanamori, Masashi Sanada
and Hitoshi Kiyoi
pg(s) 326 - 332
<Abstract> - < PDF >
We previously reported the Marimo cell line, which was established from the bone marrow cells of
a patient with essential thrombocythemia (ET) at the last stage after transformation to acute myeloid
leukemia (AML). This cell line is widely used for the biological analysis of ET because it harbors CALR
mutation. However, genetic processes during disease progression in the original patient were not analyzed.
We sequentially analyzed the genetic status in the original patient samples during disease progression.
The ET clone had already acquired CALR and MPL mutations, and TP53 and NRAS mutations affected
the disease progression from ET to AML in this patient. Particularly, the variant allele frequency of the
NRAS mutation increased along with the disease progression after transformation, and the NRAS-mutated
clone selectively proliferated in vitro, resulting in the establishment of the Marimo cell line. Although
CALR and MPL mutations co-existed, MPL was not expressed in Marimo cells or any clinical samples.
Furthermore, mitogen-activated protein kinase (MAPK) but not the JAK2-STAT pathway was activated.
These results collectively indicate that MAPK activation is mainly associated with the proliferation ability
of Marimo cells.
CASE REPORTS
Pregnancy co-treated with oral gonadotropin-releasing
hormone antagonist in a woman with premature ovarian
insufficiency: a case report
Daichi Inoue, Manami Kondo, Rie Mizuno, Shinichi Shibuya,
Yoshiki Hashiba and Yoshimasa Asada
pg(s) 333 - 340
<Abstract> - < PDF >
To the best of our knowledge, this is the first case of pregnancy with a healthy baby after treatment
with an oral gonadotropin-releasing hormone (GnRH) antagonist in women with premature ovarian insufficiency.
A 36-year-old female presented at our hospital after being diagnosed with premature ovarian
insufficiency by a previous doctor. We administered clomiphene, human menopausal gonadotropin (hMG),
and GnRH antagonist (injection) together with estrogen replacement for 11 cycles (27 months), but no
follicular development was observed. When the oral GnRH antagonist (relugolix), which has recently
become available, was used in the 12th cycle, follicular growth of 13 mm was confirmed on the 14th day
of stimulation. After stimulation, the use of hMG and GnRH antagonist (injection) was continued, and
a maturation trigger, human chorionic gonadotropin 10000 IU, was administered. Oocyte retrieval was
performed successfully, intracytoplasmic sperm injection and frozen embryo transfer were performed, and
fetal heartbeat was confirmed. The patient was admitted to the perinatal management facility. She delivered
a healthy baby of 3,732 g via cesarean section at 41 weeks +2. This case shows the possibility of using
an oral GnRH antagonist as an option for infertility treatment.
A case of recurrent erythema induratum of Bazin in
a patient with myelodysplastic syndrome
Kei Noro, Chiaki Murase, Ryo Fukaura, Naoki Watanabe,
Keisuke Sunohara, Norihisa Ishii, Masashi Yamazaki
and Masashi Akiyama
pg(s) 341 - 344
<Abstract> - < PDF >
We describe a case of erythema induratum of Bazin (EIB) that presented recurrently on the extremities
during treatment with anti-tuberculosis medications. The anti-tuberculosis medications were effective, so
they were continued despite the occurrence of the EIB lesions, and those lesions disappeared 5 months
after first appearing. EIB is currently considered a multifactorial disorder with many different causes, with
tuberculosis being an example, and it is thought to be a hypersensitive immune response to Mycobacterium
tuberculosis. The clinical manifestations may fluctuate depending on the immune response of the host.
Our patient was affected with myelodysplastic syndrome, and we believe that this was a major factor
that interfered with a normal immune response. This case illustrates the importance of providing intensive
anti-tuberculosis treatment from the start, and in cases where EIB co-presents, to continue this treatment
until the end, in order to prevent relapse.
Uneventful vaginal delivery using epidural anesthesia
in patient with exercise induced anaphylaxis:
a case report and literature review
Kanon Morimoto, Kenichiro Tatsumi, Yoshitsugu Chigusa,
Maya Komatsu, Moritoki Egi, Masaki Mandai
and Haruta Mogami
pg(s) 345 - 350
<Abstract> - < PDF >
Exercise induced anaphylaxis (EIA) is a rare and potentially life-threatening syndrome characterized
by anaphylaxis provoked by exercise. Although vaginal delivery with labor pain is a physical strain for
women and a possible trigger for EIA, no consensus exists on the management strategy of delivery in
patients with EIA. A 28-year-old primigravida was referred to our hospital because of history of EIA,
associated with pruritus, urticaria, and respiratory distress, exacerbated during physical activity. To avoid
physical stress, we chose scheduled labor induction with epidural anesthesia, and administered prophylactic
intravenous hydrocortisone. She delivered vaginally with no symptoms suggestive of EIA during labor.
Since it is quite possible for patients with EIA to develop anaphylaxis during vaginal delivery with labor
pain, epidural anesthesia and prophylactic steroid administration may be the most rational approaches for
delivery in pregnant women with EIA.