研究者詳細 - 牧　尉太

論文 - 牧　尉太

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A case of subclinical Cushing's syndrome in pregnancy with superimposed preeclampsia. 査読国際誌

Eriko Eto, Takashi Mitsui, Shoko Tamada, Jota Maki, Kei Hayata, Hisashi Masuyama

Clinical case reports 8 ( 3 ) 481 - 483 2020年3月

Relationship between Intracellular Signaling of the (Pro)renin Receptor and the Pathogenesis of Preeclampsia. 査読

Shoko Tamada, Takashi Mitsui, Akiko Ohira, Kazumasa Tani, Jota Maki, Takeshi Eguchi, Eriko Eto, Kei Hayata, Hisashi Masuyama

Acta medica Okayama 73 ( 5 ) 433 - 440 2019年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

An association between preeclampsia and (pro)renin was recently reported. Intracellular signaling of the (pro) renin receptor [(P)RR] increases the expressions of TGF-β and PAI-1. In this study we sought to clarify the involvement of (pro)renin in the pathogenesis of preeclampsia via the intracellular signaling of (P)RR on preeclampsia placentas. Activated (pro)renin plasma concentrations were compared between pregnant women with (n=15) and without (n=28) preeclampsia. The placentas were immunohistochemically evaluated with anti-HIF-1α and anti-(P)RR antibodies. HTR-8/SVneo cells were cultured under hypoxic conditions and treated with human recombinant (pro)renin. The mRNA expressions of HIF-1α, (P)RR, PAI-1, TGF-β, and ET-1 were also examined by real-time RCR. The activated (pro)renin plasma concentration was significantly higher in the third vs. the second trimester in the preeclampsia patients. HIF-1α and (P)RR expressions were significantly increased in the preeclampsia placentas. The mRNA expressions of PAI-1, TGF-β, and ET-1 were significantly increased in the experiments using recombinant (pro)renin vs. hypoxic conditions. (P)RR expression in preeclampsia placentas is increased by persistent hypoxia through the second and third trimesters, and PAI-1, TGF-β, and ET-1 production is increased via (P)RR. Our results suggest that ET-1 production via the intracellular signaling of (P)RR is important in the pathogenesis of preeclampsia.

DOI： 10.18926/AMO/57374

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Assessment of glucose kinetics with real-time continuous glucose monitoring during labor. 査読国際誌

Jota Maki, Eriko Eto, Shoko Tamada, Takashi Mitsui, Kei Hayata, Keiichiro Nakamura, Yuji Hiramatsu, Hisashi Masuyama

The journal of obstetrics and gynaecology research 45 ( 9 ) 1851 - 1859 2019年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

AIM: Changes in glucose levels during labor have not been sufficiently investigated in pregnant women. Using real-time continuous glucose monitoring, we aimed to assess glucose kinetics during labor among pregnant women with gestational diabetes mellitus (PwGDM), and those with normal glucose tolerance (PwNGT). METHODS: Japanese PwGDM and PwNGT who had planned a transvaginal delivery at Okayama University Hospital were enrolled. The correlation between changes in glucose levels during labor among the PwGDM and PwNGT groups at four time periods was assessed: (i) active phase of 1st stage of labor; (ii) 2nd stage of labor; (iii) postpartum 0-12 h; and (iv) postpartum 12-48 h. RESULTS: In total, 18 and 22 PwGDM and PwNGT, respectively, were enrolled. During labor, both groups had similar changes in glucose levels over time, which peaked during period 3. The main effect of glucose level changes was the labor period (P < 0.001), not the presence of gestational diabetes mellitus. Furthermore, differences in glucose levels in the PwGDM group were observed between periods 1 and 2 (P = 0.037), 1 and 3 (P = 0.024), 3 and 4 (P = 0.005); differences in glucose levels in the PwNGT group were observed between periods 3 and 4 (P = 0.024). CONCLUSION: During labor, both PwGDM and PwNGT groups showed similar changes in glucose levels over time. During delivery, the PwGDM who regularly measured their own glucose levels could be managed using the same nutritional management methods as those for PwNGT.

DOI： 10.1111/jog.14058

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A Case of Nager Syndrome Diagnosed Before Birth. 査読

Kei Hayata, Hisashi Masuyama, Eriko Eto, Takashi Mitsui, Shoko Tamada, Takeshi Eguchi, Jota Maki, Kazumasa Tani, Akiko Ohira, Yosuke Washio, Junko Yoshimoto, Kosei Hasegawa

Acta medica Okayama 73 ( 3 ) 273 - 277 2019年6月

記述言語：英語

Nager syndrome is a rare disease involving severe micrognathia and upper limb shortening. In this report, we describe a case in which micrognathia of the fetus was suspected based on the observation of upper limb shortening during detailed B mode and 3D/4D ultrasonographic observation, and combined fetal MRI and 3D-CT led to a prenatal diagnosis of Nager syndrome. Upon birth, because severe micrognathia caused airway obstruction and made it difficult to spread the larynx for intubation, effective ventilation could not be carried out and a tracheostomy was necessary. Since a differential diagnosis of Nager syndrome can be made based on the fact that micrognathia typically co-occurs with upper limb shortening, it is possible to diagnose the disease before birth and prepare for life-saving measures accordingly.

DOI： 10.18926/AMO/56872

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Successful Delivery after Abdominal Radical Trachelectomy, Using Transabdominal Cerclage in Early Pregnancy. 査読

Shoko Tamada, Hisashi Masuyama, Kei Hayata, Eriko Eto, Takashi Mitsui, Takeshi Eguchi, Jota Maki, Kazumasa Tani

Acta medica Okayama 73 ( 2 ) 173 - 176 2019年4月

記述言語：英語

Radical trachelectomy (RT) is a fertility-sparing surgery for cervical cancer. Postoperative pregnancies have a high risk of abortion and prematurity. To prevent this, a procedure involving transabdominal cerclage (TAC) was devised for shortened cervical canals post-RT. Here we describe the successful management of a pregnancy after abdominal RT (ART). The 34-year-old patient was gravida 1, para 0. When she was 27, she underwent ART for stage Ib1 cervical cancer, and she became pregnant 7 years later. Because her cervical canal was 16.7 mm during early pregnancy, we performed TAC at 12 weeks of pregnancy. Post-surgery, we administered an infusion of ritodrine hydrochloride for tocolysis. A selective caesarean section was performed at 36 weeks, with the delivery of a healthy infant.

DOI： 10.18926/AMO/56653

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Upregulation of Angiogenic Factors via Protein Kinase C and Hypoxia-induced Factor-1α Pathways under High-glucose Conditions in the Placenta. 査読

Takashi Mitsui, Kazumasa Tani, Jota Maki, Takeshi Eguchi, Shoko Tamada, Eriko Eto, Kei Hayata, Hisashi Masuyama

Acta medica Okayama 72 ( 4 ) 359 - 367 2018年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

Abnormal glucose metabolism during pregnancy is an established risk factor for preeclampsia (PE). Disruption of the balance between placental angiogenic factors is linked to PE pathophysiology. We examined whether hypoxia-induced factor-1α (HIF-1α) and protein kinase Cβ (PKCβ) are involved in the regulation of placental angiogenic factors under high-glucose conditions in vitro. The human choriocarcinoma cell lines BeWo and JEG-3, and the human trophoblast cell line HTR-8/SVneo were cultured with 10 and 25 mmol/L glucose [control glucose group (CG) and high-glucose group (HG), respectively]. We examined the changes in HIF-1α, soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and vascular endothelial growth factor (VEGF) expression in the CG and HG by real-time PCR and ELISA. PKC activation was also measured by ELISA. The expressions of HIF-1α, sFlt-1, PlGF, and VEGF were significantly higher in the HG than in the CG. PKC activity was significantly increased in the HG. High glucose affected the expression of angiogenic factors in choriocarcinoma cells via the PKCβ and HIF-1α pathways, suggesting their involvement in PE pathogenesis.

DOI： 10.18926/AMO/56171

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Assessment of resting energy expenditure and body composition in Japanese pregnant women with diabetes. 査読

Eriko Eto, Jota Maki, Shoko Tamada, Takashi Mitsui, Kei Hayata, Yuji Hiramatsu, Hisashi Masuyama

Journal of diabetes investigation 9 ( 4 ) 959 - 966 2018年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

AIMS/INTRODUCTION: To measure longitudinal changes in resting energy expenditure and body composition of Japanese pregnant women with or without diabetes. MATERIALS AND METHODS: The study population consisted of women who had delivered a live singleton neonate after 22 weeks' gestation at Okayama University Hospital from July 2013 to June 2017. Resting energy expenditure and body composition were measured in the first trimester, second trimester, third trimester and postpartum. RESULTS: A total of 144 women participated in this study: 103 with normal glucose tolerance and 41 with diabetes. The resting energy expenditure (kcal/day) of pregnant women with normal glucose tolerance was significantly higher in the third trimester (1,644 ± 234) than in the first (1,461 ± 215) and second trimesters (1,491 ± 219), and postpartum (1,419 ± 254), whereas that of pregnant women with diabetes did not significantly change during all periods (1,568 ± 404, 1,710 ± 332, 1,716 ± 251, 1,567 ± 249). The resting energy expenditure of women with good glycemic control was lower than that of women with poor control. Fat-free mass was closely correlated with resting energy expenditure. CONCLUSIONS: The resting energy expenditure of Japanese pregnant women with normal glucose tolerance was significantly increased in the third trimester. The resting energy expenditure of women with good glycemic control was lower than that of women with poor control. Resting energy expenditure and fat-free mass are potential indexes for medical nutrition therapy in pregnant women with diabetes.

DOI： 10.1111/jdi.12795

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帝王切開時筋腫核出術を施行した子宮下部巨大筋腫合併妊娠の一例査読

谷村吏香, 衛藤英理子, 牧尉太, 玉田祥子, 光井崇, 早田桂, 増山寿

現代産婦人科 66 ( 2 ) 243 - 247 2018年6月

記述言語：日本語出版者・発行元：中国四国産科婦人科学会

帝王切開時筋腫核出術を施行した子宮下部巨大筋腫合併妊娠の一例を経験したので報告する。症例は31歳、4妊1産、自然妊娠成立し初期から近医で妊娠管理されていた。妊娠25週5日に性器出血を認め、翌日前医へ母体搬送となった。子宮下部に巨大筋腫を認め、出血も持続するため周産期管理目的に妊娠26週4日当院へ転院となった。初診時の経腟超音波検査では子宮前壁の頸部から体下部にかけて14cm径の子宮筋腫を認め、子宮頸管は圧迫により強く引き延ばされていた。経腹超音波検査では胎児は横位で推定体重970g(+0.04SD)であった。胎盤は子宮後壁に付着し、上縁は子宮底部、下縁は筋腫上端の高さに位置していた。入院後も筋腫は次第に増大し、上腹部圧迫感が増悪していった。妊娠34週5日選択帝王切開術+子宮筋腫核出術を施行した。子宮筋腫の上端から3cm離れた位置で子宮体部横切開を行い、骨盤位で児を娩出した。体重1888gの男児でアプガースコア8/9点であった。晩出部位の子宮筋層を縫合した後、筋腫一塊として核出した。手術時間は1時間58分、出血量は2320mlであった。術後7日目に退院し、産褥1ヵ月健診で異常所見は認めなかった。当院で過去に経験した筋腫合併妊娠症例をあわせて報告する。(著者抄録)

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Maternal body mass index is a better indicator of large-for-gestational-age infants compared with a 75-g oral glucose tolerance test in early pregnancy: The JAGS trial. 査読国際誌

Noriyuki Iwama, Takashi Sugiyama, Hirohito Metoki, Hideto Kusaka, Jota Maki, Hidekazu Nishigori, Nobuo Yaegashi, Norimasa Sagawa, Yuji Hiramatsu, Nagayasu Toyoda

Diabetes research and clinical practice 132 10 - 18 2017年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

AIMS: There is no previous study comparing the predictive ability of maternal pre-pregnancy body mass index (BMI) versus a 75-g oral glucose tolerance test (OGTT) in early pregnancy for large-for-gestational-age (LGA) infants. METHODS: This multi-institutional prospective cohort study included 966 pregnant Japanese women. A multiple logistic regression model was applied to compare the effect size of pre-pregnancy BMI, fasting plasma glucose (PG), and 1- and 2-h PG levels after a 75-g OGTT performed before 22weeks gestation for LGA. After these variables were included separately into the model as per continuous variables 1 standard deviation (SD) increase, they were included simultaneously. RESULTS: When pre-pregnancy BMI, fasting PG, and 1- and 2-h PG after a 75-g OGTT were separately included in the model, the adjusted odds ratios (ORs) for LGA per 1 SD increase in pre-pregnancy BMI, fasting, and 1- and 2-h PG were 1.55 (95% confidence interval [CI]: 1.26-1.91), 1.26 (95% CI: 1.03-1.54), 0.99 (95% CI: 0.78-1.25), and 1.17 (95% CI: 0.93-1.49), respectively. When these variables were included simultaneously, the adjusted ORs per 1 SD increase in pre-pregnancy BMI, fasting, and 1- and 2-h PG were 1.52 (95% CI: 1.23-1.88), 1.19 (95% CI: 0.96-1.46), 0.77 (95% CI: 0.57-1.03), and 1.30 (95% CI: 0.96-1.76), respectively. CONCLUSIONS: Maternal pre-pregnancy BMI was more strongly associated with LGA compared with a 75-g OGTT in early pregnancy. Health-care providers should recognize that women with a higher pre-pregnancy BMI carry a higher risk for having LGA infants regardless of the results of a 75-g OGTT.

DOI： 10.1016/j.diabres.2017.07.017

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Successful pregnancy located in a uterine cesarean scar: A case report. 査読国際誌

Shoko Tamada, Hisashi Masuyama, Jota Maki, Takeshi Eguchi, Takashi Mitsui, Eriko Eto, Kei Hayata, Yuji Hiramatsu

Case reports in women's health 14 8 - 10 2017年4月

記述言語：英語

Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy. Because CSP carries a high risk of uterine rupture and life-threatening bleeding, the pregnancy should be terminated upon confirmation of diagnosis. There have been few reports of CSP with successful delivery. We present a case of CSP under expectant management, with delivery via planned cesarean section at 35 weeks of gestation. This report suggests that successful pregnancy outcome can be achieved in some women with uterine cesarean scar, but further analysis and additional studies are required in order to describe the optimal protocol of expectant management in CSP.

DOI： 10.1016/j.crwh.2017.03.003

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Comparison of Kidney Function between Gestational Hypertension and Preeclampsia. 査読

Etsuko Nobumoto, Hisashi Masuyama, Jota Maki, Takeshi Eguchi, Shoko Tamada, Takashi Mitsui, Eriko Eto, Kei Hayata, Yuji Hiramatsu

Acta medica Okayama 71 ( 2 ) 161 - 169 2017年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

Although gestational hypertension (GH) is thought to be different from preeclampsia (PE), in Japan GH and PE are usually treated as the same disease (i.e., pregnancy-induced hypertension). Here we sought to determine whether there are any differences in fetal growth and maternal kidney function between pregnancies with PE and those with GH. We retrospectively analyzed 61 GH patients and 60 PE patients with singleton pregnancies who delivered at Okayama University Hospital (2008-2015). We compared maternal and perinatal outcomes and maternal kidney function parameters between the GH and PE pregnancies. The mean values of maternal age (p=0.01), gestational age at delivery (p<0.0001), placental weight (p=0.002), birth weight and height (p<0.0001, p=0.0001), and head circumference standard deviation score (p=0.007) of newborns of the GH group were significantly higher than those of the PE group. The duration until termination of PE or GH was not significantly correlated with kidney function. The birth weight percentile was significantly correlated with kidney function in PE but not GH. However, GH patients with poor kidney function and small-for-gestational age infants showed perinatal outcomes similar to those of the PE group. Monitoring kidney function is thus important for determining the severity of PE and GH.

DOI： 10.18926/AMO/54985

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Differences in uterine artery blood flow and fetal growth between the early and late onset of pregnancy-induced hypertension. 査読

Takashi Mitsui, Hisashi Masuyama, Jota Maki, Shoko Tamada, Yumika Hirano, Eriko Eto, Etsuko Nobumoto, Kei Hayata, Yuji Hiramatsu

Journal of medical ultrasonics (2001) 43 ( 4 ) 509 - 17 2016年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: We continuously measured bilateral uterine artery (UA) blood flow and compared differences in UA blood flow to investigate the differences in pathophysiology between early- and late-onset pregnancy-induced hypertension (PIH) and the usefulness of continuous monitoring of UA blood flow for the prediction of early-onset PIH. METHODS: The subjects were 76 PIH patients. The mean pulsatility index of bilateral UA (UAPI), an early diastolic notch in the velocity waveform, and regression curves were retrospectively examined and compared between early- and late-onset groups and the groups with and without fetal growth restriction (FGR). RESULTS: Regression curves of the UAPI in the early-onset group persisted at +2.0 standard deviations or more from the second to third trimester, while the UAPI in the late-onset group stayed within the normal range. A significantly higher mean UAPI with a high frequency of an early diastolic notch was observed in the early-onset group compared with the late-onset group in all pregnancy trimesters. There was a significant difference in UA resistance between the mild and severe groups and between the FGR and non-FGR groups, but to a small extent compared with the onset period. CONCLUSION: There was a difference in pathophysiology between early- and late-onset PIH. Continuous monitoring of UA blood flow might be useful for the prediction of early-onset PIH if high UA resistance has been observed.

DOI： 10.1007/s10396-016-0729-6

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Dimethylesculetin ameliorates maternal glucose intolerance and fetal overgrowth in high-fat diet-fed pregnant mice via constitutive androstane receptor. 査読国際誌

Hisashi Masuyama, Takashi Mitsui, Jota Maki, Kazumasa Tani, Keiichiro Nakamura, Yuji Hiramatsu

Molecular and cellular biochemistry 419 ( 1-2 ) 185 - 92 2016年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

The constitutive androstane receptor (CAR) has been reported to decrease insulin resistance along with obesity. 6,7-dimethylesculetin (DE) is an active component of Yin Zhi Huang which is a traditional Asian medicine used to treat neonatal jaundice via CAR. In this study, we examined whether DE could affect the expression of gluconeogenic and lipogenic genes via human CAR pathway using human HepG2 cells in vitro. We also studied whether DE treatment during pregnancy could prevent maternal hypertension, glucose intolerance and hyperlipidemia, and fetal overgrowth in high-fat diet (HFD)-induced obese pregnant mice. Dimethylesculetin suppressed the mRNA expression of gluconeogenic genes, phosphoenolpyruvate carboxykinase and glucose-6-phosphatase, and lipogenic genes, sterol regulatory element-binding protein 1 and stearoyl-CoA desaturase 1, and enhanced CAR-mediated transcription. Blocking the CAR-mediated pathway abolished the effect of DE in vitro. DE treatment during pregnancy could prevent maternal hypertension, glucose intolerance and hyperlipidemia, and fetal overgrowth in HFD-induced obese pregnant mice in vivo. Our data indicate that DE might be a potential therapeutic agent for obese pregnant patients with insulin resistance through CAR to prevent the perinatal outcomes such as preeclampsia, gestational diabetes, and macrosomia. Further analysis of possible complications and side effects using animal models is required.

DOI： 10.1007/s11010-016-2772-4

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