研究者詳細 - 牧　尉太

論文 - 牧　尉太

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改めて考える周産期医療における手術の役割子宮創部菲薄化低減を目指す糸の役割無結紮縫合による子宮再建術の時代へ査読

牧尉太, 増山寿

産婦人科手術 ( 34 ) 39 - 43 2023年6月

帝王切開瘢痕症候群予防的観点から査読

牧尉太, 増山寿

産婦人科手術 ( 34 ) 103 - 111 2023年6月

Therapeutic plasma exchange in postpartum HELLP syndrome: a case report. 査読国際誌

Nana Kojima, Kosuke Kuroda, Makiko Tani, Tomoyuki Kanazawa, Kazuyoshi Shimizu, Jota Maki, Hisashi Masuyama, Hiroshi Morimatsu

JA clinical reports 9 ( 1 ) 9 - 9 2023年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Postpartum hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is more difficult to treat than HELLP syndrome during pregnancy. We describe a case of postpartum HELLP syndrome that responded to plasma exchange (PE) therapy. CASE PRESENTATION: A 30-year-old primipara woman was hospitalized for gestational hypertension at 33 weeks of gestation and underwent an emergent cesarean section at 36 weeks and 6 days of gestation due to rapidly progressing pulmonary edema. After delivery, liver dysfunction and a rapid decrease in platelet count were observed, and the patient was diagnosed with severe HELLP syndrome. She experienced multiple organ failure despite intensive care, and PE therapy was initiated. Her general condition dramatically stabilized within a few hours of PE therapy. CONCLUSION: It is controversial whether PE therapy should be used primarily in the management of HELLP syndrome, but early initiation of PE therapy could be effective for severe HELLP syndrome.

DOI： 10.1186/s40981-023-00602-2

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Protocol for a randomised, placebo-controlled, double-blinded clinical trial on the effect of oestrogen replacement on physical performance to muscle resistance exercise for older women with osteoarthritis of knee joint: the EPOK trial 査読国際誌

Tomohiro Mitoma, Jota Maki, Hikaru Ooba, Eriko Eto, Kasumi Takahashi, Tsunemasa Kondo, Tomohiro Ikeda, Yoko Sakamoto, Toshiharu Mitsuhashi, Hisashi Masuyama

BMC Geriatrics 23 ( 1 ) 104 - 104 2023年2月

担当区分：責任著者記述言語：英語出版者・発行元：Springer Science and Business Media LLC

Abstract

Background

Knee osteoarthritis (KOA) is highly prevalent in older women, and previous studies suggest the involvement of hormonal factors play a role in the pathogenesis of osteoarthritis. KOA causes musculoskeletal impairment, resulting in decreased physical activity, muscle mass, and strength, which leads to sarcopenia and further increases the burden on healthcare systems. Oestrogen replacement therapy (ERT) improves joint pain and muscle performance in early menopausal women. Muscle resistance exercise (MRE) is a non-pharmacological method that preserves the physical functions of patients with KOA. However, data on short-term oestrogen administration combined with MRE in postmenopausal women, especially in those aged > 65 years, are limited. Therefore, this study presents a protocol of a trial aimed to examine the synergistic effect of ERT and MRE on lower-limb physical performance in older women with KOA.

Methods

We will conduct a double-blinded, randomised placebo-controlled trial in 80 Japanese women aged > 65 years living independently with knee pain. The participants will be randomly categorised into two groups: (1) 12-week MRE programme with transdermal oestrogen gel containing 0.54 mg oestradiol per push and (2) 12-week MRE programme with placebo gel. The primary outcome measured using the 30-s chair stand test, and secondary outcomes (body composition, lower-limb muscle strength, physical performance, self-reported measure of knee pain, and quality of life) will be measured at baseline, 3 months, and 12 months, and these outcomes will be analysed based on the intention-to-treat.

Discussion

The EPOK trial is the first study to focus on the efficacy of ERT on MRE among women aged > 65 years with KOA. This trial will provide an effective MRE to prevent KOA-induced lower-limb muscle weakness, confirming the benefit of short-term oestrogen administration.

Trial registration

Japan Registry of Clinical Trials: jRCTs061210062. Registered 17th December 2021, https://jrct.niph.go.jp/en-latest-detail/jRCTs061210062.

DOI： 10.1186/s12877-023-03828-y

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その他リンク： https://link.springer.com/article/10.1186/s12877-023-03828-y/fulltext.html

Postpartum pyomyoma due to Mycoplasma hominis: A case report. 査読国際誌

Tomohiro Mitoma, Hikaru Oba, Sakurako Mishima, Akiko Ohira, Satoe Kirino, Kazumasa Tani, Jota Maki, Eriko Eto, Kei Hayata, Hisashi Masuyama

Case reports in women's health 36 e00456 2022年10月

記述言語：英語

Pyomyoma is a rare condition that causes fever and abdominal pain associated with pregnancy, especially in the postpartum period. An appropriate diagnosis and early medical intervention are required to prevent serious complications. A 38-year-old primigravida with uterine fibroids had fever from the 11th day after cesarean section. The fever did not resolve despite repeated daily administration of broad-spectrum β-lactam antibiotics for 2 weeks. Although the physical examination did not show any lower abdominal pain, a pelvic magnetic resonance scan revealed degenerative fibroids, and myomectomy was performed. Yellow-greenish odorless pus inside the uterus was detected, and Mycoplasma hominis was detected in the pus culture. Mycoplasma species are resistant to broad-spectrum penicillin antibiotics and can cause pyomyoma. Pyomyomas may not cause uterine tenderness, and the causative organism may be difficult to identify; therefore, additional imaging studies should be considered.

DOI： 10.1016/j.crwh.2022.e00456

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糖代謝異常妊婦における母体体組成量および安静時代謝量と出生児体重の関係招待査読

衛藤英理子, 横畑理美, 牧尉太, 増山寿

糖尿病と妊娠 22 ( 2 ) S - 112 2022年8月

吉備中央町が本邦発の革新的事業連携型国家戦略特区指定を受けて―デジタル田園健康特区と規制改革の実現に向けた大学の役割ー招待査読

那須保友, 牧, 尉太, 櫻井, 淳, 増山, 寿, 前田嘉信

岡山医学会雑誌 134 ( 2 ) 115 - 118 2022年8月

Diffuse myometrium thinning and placenta accreta spectrum in a patient with systemic lupus erythematosus (SLE): a case report and review of the literature. 査読国際誌

Tomohiro Mitoma, Kei Hayata, Satomi Yokohata, Akiko Ohira, Chiaki Kashino, Satoe Kirino, Kazumasa Tani, Jota Maki, Eriko Eto, Hisashi Masuyama

BMC pregnancy and childbirth 22 ( 1 ) 535 - 535 2022年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Cases of uterine wall thinning and placental abnormalities complicated with systemic lupus erythematosus (SLE) during pregnancy have been reported in Asian countries for ten years. Long-term steroid use can cause muscle degeneration, but the mechanism of myometrium thinning was not known. Through the review of published articles, this report is the first review of cases to discuss the pathogenesis and clinical features of thinned myometrium and placenta accreta spectrum (PAS) in pregnant patients with SLE. CASE PRESENTATION: A twenty-nine-year-old primigravida with a history of lupus enteritis and paralytic ileus had a natural conception after less than two years of steroid treatment. An ultrasonographic study showed a thin uterine wall with a widespread thick placenta on the entire surface of the uterine cavity in the third trimester. At the 39th gestational week, she underwent a cesarean section due to the failure of the uterus to contract, even though the injection of oxytocin. There were several engorged vessels on the surface of the anterior uterine wall at the time of laparotomy. We decided to perform a hysterectomy because diffuse PAS replaced her uterus. CONCLUSION: A review of reported cases and our case shows an unusual complication of SLE that might be related to the particular condition of the estrogen-mediated immune system. Clinicians should always pay attention to the possibility of uterine wall thinning as uterine atony and the structural abnormality of the placenta for SLE patients with the unscarred uterus.

DOI： 10.1186/s12884-022-04864-z

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COVID-19 妊産婦緊急搬送補助システム"iPicss"を用いた救急隊との搬送連携/災害発生後やCOVID-19妊婦の連携体制の構築査読

牧尉太, 三苫智裕, 横畑理美, 三島桜子, 大平安希子, 谷和祐, 衛藤英理子, 早田桂, 増山寿

日本周産期・新生児医学会雑誌 57 ( 4 ) 826 - 828 2022年4月

Obesity's Influence on Insulin Resistance in Pregnant Women with Polycystic Ovary Syndrome. 査読

Eriko Eto, Kazumasa Tani, Jota Maki, Kei Hayata, Hisashi Masuyama

Acta medica Okayama 76 ( 1 ) 51 - 56 2022年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

Polycystic ovary syndrome (PCOS) is a common endocrine metabolic disorder that is associated with high insulin resistance and obesity. However, ~70% of women with PCOS in Japan are non-obese. We retrospectively analyzed the cases of 163 Japanese women with PCOS who visited our Ob/Gyn department in 2006-2018 to determine which has a greater effect on insulin resistance: PCOS or obesity. We reviewed the women's medical records and calculated their insulin resistance and insulin secretion. The women's mean age and pre-pregnancy body mass index (BMI) were 30±5.8 years and 24.8±5.6 kg/m2, respectively; their mean ± SD fasting plasma glucose, 94.1±13.7 mg/dL; HOMA-IR, 2.1±2.0; QUICKI, 0.4±0.0; and HOMA-β, 108.9±88.0%. Sixtyeight women were pregnant, and 37% (n=25) were obese (BMI ≥ 25 kg/m2). Obesity had a greater effect on insulin resistance: fasting plasma glucose F(1, 53)=6.134, p<0.05; fasting insulin F(1, 53)=31.606, p<0.01; HOMA-IR F(1, 53)=31.670, p<0.01; QUICKI F(1, 53)=16.156, p<0.01. There was no significant difference in values other than QUICKI and testosterone between the women with and without PCOS. Obesity thus had a greater effect on increased insulin resistance in pregnant women with PCOS. Further studies of the insulin resistance of non-obese women with PCOS is needed, as non-obese women with PCOS are common in Asia.

DOI： 10.18926/AMO/63209

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A case report of successful vaginal delivery in a patient with severe uterine prolapse and a review of the healing process of a cervical incision. 査読国際誌

Jota Maki, Tomohiro Mitoma, Sakurako Mishima, Akiko Ohira, Kazumasa Tani, Eriko Eto, Kei Hayata, Hisashi Masuyama

Case reports in women's health 33 e00375 2022年1月

担当区分：筆頭著者,　責任著者記述言語：英語

Background: The incidence of severe uterine prolapse during childbirth is approximately 0.01%. Moreover, to the best of our knowledge, no reports detail the healing process of the cervix during uterine involution. This report describes successful vaginal delivery and the healing process of postpartum uterine prolapse and cervical tears in a patient with severe uterine prolapse. Case presentation: A patient in her 40s (gravida 3, para 1, abortus 1) with severe uterine prolapse successfully delivered a live female baby weighing 3190 g at 38 + 5 weeks of gestation by assisted vaginal delivery. Uterine prolapse had improved to approximately 2° by 2 months postoperatively. On postpartum day 4, during the healing process of cervical laceration, the thread loosened in a single layer of continuous sutures due to uterine involution, and poor wound healing was observed. The wound was subsequently re-sutured with a two-layer single ligation suture (Gambee suture + vertical mattress suture). However, on postpartum day 11, a large thread ball was hindering the healing of the muscle layer, which improved with re-suturing. Conclusion: Although vaginal delivery in a patient with severe uterine prolapse is possible in some cases, the cervix should be sutured, while considering cervical involution after delivery.

DOI： 10.1016/j.crwh.2021.e00375

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EG-VEGF Induces Invasion of a Human Trophoblast Cell Line via PROKR2. 査読

Kazumasa Tani, Takashi Mitsui, Sakurako Mishima, Akiko Ohira, Jota Maki, Eriko Eto, Kei Hayata, Keiichiro Nakamura, Hisashi Masuyama

Acta medica Okayama 75 ( 6 ) 677 - 684 2021年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

Extravillous trophoblast (EVT) invasion is important for embryo implantation, placental development, and successful remodeling of the uterine spiral artery. Endocrine gland derived-vascular endothelial growth factor (EG-VEGF) and matrix metalloproteinases (MMPs) are implicated in EVT invasion; however, the high con-centrations found in pregnancy pathologies have not been investigated in non-tumor trophoblasts. The roles of EG-VEGF, prokineticin receptors (PROKR1/2), MMP-2, and MMP-9 in EVT invasion during spiral artery remodeling were evaluated using human EVT from HTR-8/SVneo cell lines. The expression of MMP-2, MMP-9, and mitogen-activated protein kinase (MAPK), and Akt pathways in HTR-8/SVneo cells treated with recom-binant EG-VEGF alongside anti-PROKR1 and/or anti-PROKR2 antibodies was evaluated using quantitative reverse transcription-PCR and western blotting. Wound-healing and cell invasion assays were performed to assess the migration and invasion of these treated cells. Interestingly, 20 nM EG-VEGF activated ERK1/2 sig-naling and upregulated MMP-2 and MMP-9. This effect was suppressed by anti-PROKR2 antibody via ERK1/2 downregulation. Anti-PROKR2 antibody inhibited the migration and invasion of EG-VEGF-stimulated HTR-8/SVneo cells. Elevated concentrations of EG-VEGF enhance EVT invasion in a human trophoblast cell line by upregulating MMP-2 and MMP-9 via PROKR2. These new insights into the regulation of epithelial cell invasion may help in developing therapeutic interventions for placental-related diseases during pregnancy.

DOI： 10.18926/AMO/62806

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Non-Invasive Prenatal Genetic Testing (NIPT) Leading to Prenatal Diagnosis of Trisomy 21 Mosaicism and 18q Deletion Syndrome: Two Cases. 査読

Kei Hayata, Sakurako Mishima, Akiko Ohira, Kazumasa Tani, Jota Maki, Eriko Eto, Chikako Ogawa, Hisashi Masuyama

Acta medica Okayama 75 ( 6 ) 745 - 750 2021年12月

記述言語：英語

NIPT is non-definitive testing to estimate the possibility that fetuses have trisomy 21, trisomy 18, or trisomy 13. However, in NIPT-positive and indeterminate cases, rare chromosomal disease may become apparent, requiring advanced genetic considerations and counseling skills. We experienced two such cases, a trisomy 21 mosaicism case triggered by NIPT-positive status and 18q deletion syndrome triggered by NIPT-indeterminate status. These cases have two clinical implications for NIPT. First, it was revealed that trisomy mosaicism might be found in NIPT-positive cases that have lower Z-Scores than those inferred from the fraction of fetal cfDNA in the case of standard trisomy. Second, it is possible that microdeletion syndrome could be the reason for an indeterminate NIPT result. Today's genetic counseling requires more expertise in ethics and communication as well as genetic science because NIPT can lead to totally unexpected results.

DOI： 10.18926/AMO/62816

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治療に難渋した巨大子宮筋腫に対する筋腫核出術査読

川西貴之, 石原剛, 藤原晴菜, 牧尉太, 平松祐司, 増山寿

現代産婦人科 70 ( 1 ) 215 - 219 2021年12月

妊娠糖尿病・糖尿病合併妊娠のマネジメント血糖コントロールと助産ケア　最新ガイド招待査読

牧尉太

ぺリネイタル・ケア 40 ( 11 ) 2021年11月

Clinical Course of 60 Cesarean Scar Pregnancies.

Takashi Mitsui, Sakurako Mishima, Kazumasa Tani, Jota Maki, Eriko Eto, Kei Hayata, Hisashi Masuyama

Acta medica Okayama 75 ( 4 ) 439 - 445 2021年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

Early diagnosis and therapy are important in a cesarean scar pregnancy (CSP), which can cause uterine rupture with resultant massive bleeding. However, there are some reports of CSPs continued to term. The optimal management of CSPs remains unclear; therefore, we investigated the clinical courses of CSPs diagnosed and treated at perinatal institutions in the Chugoku and Shikoku regions of Japan. We enrolled 60 women diag-nosed with CSP at 21 institutions from January 2006 to December 2015. Of the 60 women diagnosed with CSP, 57 were treated. Pregnancy was terminated in 48 women and continued in 9. Thirteen women underwent transabdominal hysterectomy; they experienced no postoperative complications or allogeneic blood transfu-sion. Nine women received therapies such as dilation and curettage, and 26 received non-surgical therapies such as methotrexate and topical administration of potassium chloride. Among 9 women who chose to con-tinue with their CSP, 7 successfully delivered newborns, 2 had uterine ruptures in the second trimester, and all women required transabdominal hysterectomy. Diagnosis and therapy in the first trimester of pregnancy are important in the management strategy of a CSP. When continuing a CSP, the risk of uterine rupture and trans-abdominal hysterectomy must be considered.

DOI： 10.18926/AMO/62395

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High-Dose Corticosteroids for a Pregnant Woman Critically Ill With Coronavirus Disease 2019. 査読国際誌

Koichiro Yamamoto, Hideharu Hagiya, Jota Maki, Shuji Okahara, Kou Hasegawa, Fumio Otsuka

Cureus 13 ( 8 ) e17398 2021年8月

記述言語：英語

Pregnancy was reported to be a risk factor for coronavirus disease 2019 (COVID-19), with an increased risk for premature birth. Corticosteroids and remdesivir are used for patients with COVID-19; however, there is no established treatment for these patients. In particular, the effective management of pregnant, critically ill patients with COVID-19 remains unknown. We describe a 34-year-old, critically ill woman at 30 weeks of gestation with COVID-19, who was successfully treated with remdesivir and combined high-dose betamethasone (12 mg/day for two days) and methylprednisolone (125 mg/day for three days) followed by steroid tapering. During treatment, fetal biophysical profile scores on obstetric ultrasound were normal; her pregnancy course progressed well. Since high-dose corticosteroids improve fetal lung maturation and as well as cytokine storm due to COVID-19, this case provides an insight into the management of pregnant COVID-19 patients.

DOI： 10.7759/cureus.17398

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The Spiral Trial: A multicenter, randomized, controlled trial of Spiral thread sutures versus conventional thread sutures to prevent thinning of uterine scars following elective cesarean section. 査読国際誌

Jota Maki, Hikari Nakatou, Kazumasa Tani, Eriko Eto, Kei Hayata, Dan Yamamoto, Kenji Kai, Takashi Tamada, Kazuyo Akamatsu, Kunihiro Kawanishi, Keiichiro Nakamura, Hisashi Masuyama

Contemporary clinical trials 107 106449 - 106449 2021年8月

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The aim of this randomized controlled trial (RCT) is to investigate whether Spiral-thread sutures are superior to conventional sutures (0-Vicryl) for preventing uterine scar thinning following elective cesarean section. METHODS: This multicenter, parallel-group RCT will be conducted in four hospitals across three medical regions in Japan to assess 200 women (≥20 years old) with singleton pregnancies who are scheduled to undergo cesarean sections. Eligible women will be randomly assigned (1:1 ratio) to receive either the conventional uterine suture continuous absorption thread, which is most commonly used in Japan, or the Spiral thread. The primary endpoint is the degree of scar thinning, measured by transvaginal ultrasonography 6-7 months postoperatively, to evaluate the position of the uterus (anterior or posterior tilt) and myometrial wound thickness. The degree of thinning will be compared between the groups, and four measurements (mm) of the thinning area, including caudal distance, depth of the depression, remaining thickness of the myometrium on the serous side of the most depressed area, and width of the depression, will be recorded in the sagittal view on transvaginal ultrasound. Secondary endpoints will include total operative time, suture application time (from birth to the end of uterine suturing), operative blood loss, number of additional Z-sutures or continuous sutures required to stop bleeding, maternal abnormality frequency (surgical complications and postoperative infections), surgeon's years of experience, and clinical interpretation of individual subscale scores. DISCUSSION: This study shall provide important evidence on the optimal suture for preventing hysterotomy wound thinning after the first cesarean section. TRIAL REGISTRATION: National Institute of Public Health, Japan: jRCT1062200001 (May 7, 2020; https://rctportal.niph.go.jp/en/detail?trial_id=jRCT1062200001) and Okayama University Certified Review Board: CRB6180001 (April 9, 2020, version 3.0).

DOI： 10.1016/j.cct.2021.106449

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院内死戦期帝王切開と院外死戦期帝王切開の最近の症例(Recent cases of in-hospital perimortem cesarean delivery and out-of-hospital perimortem cesarean delivery)

Hayata Kei, Mishima Sakurako, Oohira Akiko, Tani Kazumasa, Maki Jota, Eto Eriko, Masuyama Hisashi

The Journal of Obstetrics and Gynaecology Research 47 ( 8 ) 2920 - 2920 2021年8月

hCG values and gestational sac size as indicators of successful systemic methotrexate treatment in cesarean scar pregnancy. 査読国際誌

Takashi Mitsui, Sakurako Mishima, Akiko Ohira, Kazumasa Tani, Jota Maki, Eriko Eto, Kei Hayata, Hisashi Masuyama

Taiwanese journal of obstetrics & gynecology 60 ( 3 ) 454 - 457 2021年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: To retrospectively investigate cesarean scar pregnancy (CSP) patients who received systemic methotrexate (MTX) and to clarify the criteria for administering systemic MTX to CSP patients. MATERIALS AND METHODS: Fifteen CSP patients who were initially treated with systemic MTX (50 mg/m2/week) were included. Nine patients, who needed a uterine artery embolization (UAE) or a laparotomy, including a transabdominal hysterectomy (TAH), were defined as the unsuccessful MTX group. Six patients who did not require UAE or a laparotomy were defined as the successful MTX group. Furthermore, the hCG cut-off value and the GS cut-off size at the time of CSP diagnosis, which differentiated successful and unsuccessful patients, were defined. MTX success rates were investigated by combining the hCG and gestational sac (GS) size cut-off values. RESULTS: The hCG cut-off value was 17757.0 mIU/mL, and the GS cut-off size was 10.4 mm. In patients with hCG values less than 17757.0 mIU/mL, the MTX success rate was 75.0%. Fewer patients needed UAE or a laparotomy compared to patients with hCG values higher than 17757.0 mIU/mL (P = 0.007). In patients with a GS size less than 10.4 mm, the MTX success rate was 80.0%. Fewer patients among them needed UAE or a laparotomy compared to those among patients with a GS size greater than 10.4 mm (P = 0.089). In patients with hCG values and GS sizes lower than the cut-off values, the MTX success rate was 80.0%. Fewer patients among them needed UAE or a laparotomy compared to those among patients with hCG values and/or GS sizes higher than the cut-off values, respectively (P = 0.010). CONCLUSION: Patients with hCG values less than 17757.0 mIU/mL and GS sizes less than 10.4 mm may have a greater chance of successful systemic MTX treatment when it is used as the first line of treatment for CSP.

DOI： 10.1016/j.tjog.2021.03.011

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