Faculty Profiles - MAKI Jota

Papers - MAKI Jota

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Partner relationships, hopelessness, and health status strongly predict maternal well-being: an approach using light gradient boosting machine. Reviewed International journal

Hikaru Ooba, Jota Maki, Takahiro Tabuchi, Hisashi Masuyama

Scientific reports 13 ( 1 ) 17032 - 17032 2023.10

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

No recent study has explicitly focused on predicting the well-being of pregnant women. This study used data from an extensive online survey in Japan to examine the predictors of the subjective well-being of pregnant women. We developed and validated a light Gradient Boosting Machine (lightGBM) model using data from 400 pregnant women in 2020 to identify three factors that predict subjective well-being. The results confirmed that the model could predict subjective well-being in pregnant women with 84% accuracy. New variables that contributed significantly to this prediction were "partner help", "hopelessness," and "health status". A new lightGBM model was built with these three factors, trained and validated using data from 400 pregnant women in 2020, and predicted using data from 1791 pregnant women in 2021, with an accuracy of 88%. These factors were also significant risk factors for subjective well-being in the regression analysis adjusted for maternal age, region, parity, education level, and the presence of mental illness. Mediation analysis, with "hopelessness" as the mediator, showed that both "partner help" and "health status" directly and indirectly affected the outcome.

DOI： 10.1038/s41598-023-44410-1

Relationship Between Heated Tobacco Products and Placental Abruption: A Prospective Cohort Study Using Online Questionnaire. Reviewed International journal

Hikaru Ooba, Jota Maki, Takahiro Tabuchi, Hisashi Masuyama

Journal of epidemiology and global health 15 ( 1 ) 30 - 30 2025.2

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Placental abruption (PA) is a critical obstetric complication, with maternal smoking recognized as a key risk factor. Despite the increased use of heated tobacco products (HTPs), the impact of HTPs remains unclear. This study investigated whether pregnant women using HTPs are at a higher risk of PA than non-users. METHODS: We analyzed data from "the Japan COVID-19 and Society Internet Survey," a prospective, self-reported online survey cohort. Questionnaires were randomly distributed between July 28, 2021, and August 30, 2021. Pregnant respondents in 2021 were invited to complete an additional survey from February 14, 2022, to February 28, 2022. We set the outcome as the absolute risk difference (aRD) and relative risk ratio (rRR) of PA incidence due to smoking HTPs in the first trimester of pregnancy. The sample size included 12 836 participants. We calculated outcomes using a generalized linear model (GLM) and inverse probability of treatment weighting (IPTW). We also performed a Bayesian approach and multiple-bias analysis for sensitivity analysis. RESULTS: We found the robust aRD of 0.07 (95% confidence interval (CI): 0.06, 0.09) and the rRR of 11.3 (95% CI: 7.5, 17.0). Multiple bias analyses showed that unmeasurable confounders would need to have at least an rRR = 14 relationship with both exposure and outcome to disprove the observed association. There has not been post hoc analysis or secondary use of data. CONCLUSION: Early pregnancy use of HTPs is associated with an increased risk of PA.

DOI： 10.1007/s44197-025-00373-2

Voice analysis and deep learning for detecting mental disorders in pregnant women: a cross-sectional study. Reviewed International journal

Hikaru Ooba, Jota Maki, Hisashi Masuyama

Discover mental health 5 ( 1 ) 12 - 12 2025.2

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Perinatal mental disorders are prevalent, affecting 10-20% of pregnant women, and can negatively impact both maternal and neonatal outcomes. Traditional screening tools, such as the Edinburgh Postnatal Depression Scale (EPDS), present limitations due to subjectivity and time constraints in clinical settings. Recent advances in voice analysis and machine learning have shown potential for providing more objective screening methods. This study aimed to develop a deep learning model that analyzes the voices of pregnant women to screen for mental disorders, thereby offering an alternative to the traditional tools. METHODS: A cross-sectional study was conducted among 204 pregnant women, from whom voice samples were collected during their one-month postpartum checkup. The audio data were preprocessed into 5000 ms intervals, converted into mel-spectrograms, and augmented using TrivialAugment and context-rich minority oversampling. The EfficientFormer V2-L model, pretrained on ImageNet, was employed with transfer learning for classification. The hyperparameters were optimized using Optuna, and an ensemble learning approach was used for the final predictions. The model's performance was compared to that of the EPDS in terms of sensitivity, specificity, and other diagnostic metrics. RESULTS: Of the 172 participants analyzed (149 without mental disorders and 23 with mental disorders), the voice-based model demonstrated a sensitivity of 1.00 and a recall of 0.82, outperforming the EPDS in these areas. However, the EPDS exhibited higher specificity (0.97) and precision (0.84). No significant difference was observed in the area under the receiver operating characteristic curve between the two methods (p = 0.759). DISCUSSION: The voice-based model showed higher sensitivity and recall, suggesting that it may be more effective in identifying at-risk individuals than the EPDS. Machine learning and voice analysis are promising objective screening methods for mental disorders during pregnancy, potentially improving early detection. CONCLUSION: We developed a lightweight machine learning model to analyze pregnant women's voices for screening various mental disorders, achieving high sensitivity and demonstrating the potential of voice analysis as an effective and objective tool in perinatal mental health care.

DOI： 10.1007/s44192-025-00138-0

Effectiveness of Exercise Therapy on Chemotherapy-induced Peripheral Neuropathy in Patients with Ovarian Cancer: A Scoping Review Reviewed

Masanori Konuma, Tomohiro Ikeda, Tomohiro Mitoma, Shinsuke Shirakawa, Jota Maki, Yoshimi Katayama, Masanori Hamada, Shoji Nagao, Toshifumi Ozaki

Gynecologic Oncology 192 155 - 162 2024.12

自然妊娠後に発症した正所異所同時妊娠の1例 Reviewed

高谷優, 大平安希子, 栗山千晶, 坂田周治郎, 大石恵一, 末森彩乃, 中藤光里, 大羽輝, 三苫智裕, 加藤正和, 三島桜子, 桐野智江, 牧尉太, 衛藤英理子, 増山寿

現代産婦人科 73 ( 1 ) 97 - 101 2024.12

Language：Japanese Publisher：中国四国産科婦人科学会

正所異所同時妊娠(HP;Heterotopic Pregnancy)は,子宮内妊娠と異所性妊娠が共存している状態である。生殖補助医療(ART)が要因の1つと考えられているが,自然妊娠後に発生したHPの1例を経験したので報告する。症例は30歳,4妊1産。自然妊娠にて妊娠成立し前医で妊娠管理していた。妊娠8週2日に急激な右下腹部痛が出現し前医に救急搬送された。子宮内に週数相当の胎芽と,ダグラス窩に液体貯留,右卵巣周囲に血腫像が疑われ,一時的に血圧低下を認めたため当院へ転院。卵巣出血に対して保存的加療を開始した。しかし翌日に血圧低下と腹腔内出血の増悪を認め,循環血液量減少性ショックと診断し緊急手術となった。術中所見より右卵管膨大部妊娠破裂と診断,右卵管切除術が施行された。術後経過良好で術後5日目に退院となった。その後の妊娠経過は良好であり,妊娠40週6日に経腟分娩にて男児を出産した。正所異所同時妊娠は子宮内妊娠の存在により子宮外の嚢胞を黄体嚢胞と間違えやすく,診断が困難である。ART後妊娠の他に骨盤内炎症性疾患,卵管手術歴,卵巣刺激などが正所異所同時妊娠のリスク因子と考えられているが,本症例は該当せず診断に苦慮した1例であった。妊娠初期に子宮内妊娠を確認した後の急性腹症,循環血液量減少性ショックの原因として,正所異所同時妊娠の可能性を考慮する必要があると考えられた。(著者抄録)

胎児超音波検査にて臍帯ヘルニアと両大血管右室起始を認め,出生後にheteropagus twinsと診断した一例 Reviewed

杉原百芳, 谷和祐, 大羽輝, 三苫智裕, 三島桜子, 大平安希子, 桐野智江, 牧尉太, 衛藤英理子, 早田桂, 増山寿

現代産婦人科 73 ( 1 ) 91 - 95 2024.12

Language：Japanese Publisher：中国四国産科婦人科学会

【緒言】Heteropagus twinsは,双胎の一児(自生体)に不完全な個体である他の児(寄生体)が結合したもので,100万出生に1例の頻度とされている極めてまれな先天異常である。今回,胎児超音波検査にて臍帯ヘルニアと両大血管右室起始を認め,出生後にheteropagus twinsと診断した一例を経験したため報告する。【症例】33歳女性,2妊1産。超音波検査にて臍帯ヘルニア及び胎児心構築異常が疑われ妊娠26週に当院紹介となった。妊娠27週時の羊水検査は46,XY正常核型,妊娠34週にMRI施行,肝および腸管の一部が脱出した臍帯ヘルニア,両大血管右室起始,心室中隔欠損症の胎内診断となった。妊娠38週3日に選択的帝王切開を施行した。2764g,Apgar score6点/8点の男児で上腹部に寄生体を認めた。出生時MRI検査等の精査を行い,臍帯ヘルニアと両大血管右室起始,心室中隔欠損症,肺動脈弁狭窄症に加えheteropagus twinsの診断となった。寄生体は下肢,陰茎,陰嚢,精巣様の構造物を有し,日齢11に結合双胎切除術および臍帯ヘルニアに対して一期的閉鎖術を施行した。日齢78に術後経過良好で退院となった。【考案】結合双胎の出生前診断は非常に困難である。しかし多くの症例では臓器や主要な血管の共有は少ないため外科手術は一般的に容易であり,予後は良好である。本症例では出生前診断には至らなかったが,各科と連携していたことで出生後の慎重な管理や家族のサポートが可能であった。非常に稀な疾患ではあるが,臍帯ヘルニアや心構築異常を合併し,染色体異常を伴わない場合にはheteropagus twinsを含めた希少な疾患も念頭に置き,慎重な評価をすることが重要である。(著者抄録)

ADAR1 could be a potential diagnostic target for intrauterine infection patients. Reviewed International journal

Keiichiro Nakamura, Kunitoshi Shigeyasu, Thuy Ha Vu, Jota Maki, Kazuhiro Okamoto, Hisashi Masuyama

Scientific reports 14 ( 1 ) 29419 - 29419 2024.11

Language：English Publishing type：Research paper (scientific journal)

Intrauterine infection (IUI) is mainly an ascending infection in which vaginal and cervical pathogens ascend to the uterus and can affect the fetus. Until now, there is still no effective diagnostic biomarker for IUI, such as chorioamnionitis (CAM) and funisitis (FUN). Deoxyribonucleic acid (DNA)/Ribonucleic acid (RNA) editing molecules such as apolipoprotein-B mRNA-editing complex (APOBEC) 3 families and Adenosine deaminase family acting on RNA (ADAR)1 were examined in chorioamniotic membranes and umbilical cord of 83 patient samples. Furthermore, Ureaplasma parvum induced ADAR1 was investigated in human HTR-8/SVneo EVT cell line. ADAR1 had a significantly higher area under the curve (AUC) (0.721 and 0.745) than other APOBEC3s or cytokines in CAM and FUN patients. In vitro, ureaplasma parvum was demonstrated to activate ADAR1 (p = 0.025) and reduce RIG-I, IRF3, IFN-[Formula: see text], and IFN-β expression in EVT cell line (p = 0.005, p = 0.010, p < 0.001, and p = 0.018, respectively). High expression of ADAR1 was strongly associated with CAM and FUN patients (multivariate analyses; p = 0.035 and p = 0.002). ADAR1 could be a potential diagnostic target for IUI, such as CAM and FUN patients.

DOI： 10.1038/s41598-024-81097-4

地域産婦人科医療における統合的医療DXの推進 Invited Reviewed

牧尉太

Rad Fan(ラドファン) 22 ( 13 ) 68 - 72 2024.11

健康・医療情報のデータ共有基盤構築/デジタル田園健康特区での取組みデジタル田園健康特区での健康医療系サービス実装に関する現状と課題 Reviewed

牧尉太, 那須保友, 櫻井淳, 前田嘉信

医療情報学連合大会論文集 44回 337 - 340 2024.11

Decline in and recovery of fertility rates after COVID-19-related state of emergency in Japan. Reviewed International journal

Tomohiro Mitoma, Jota Maki, Hikaru Ooba, Hisashi Masuyama

BMJ open 14 ( 10 ) e087657 2024.10

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: The COVID-19 pandemic led to a decline in fertility rates worldwide. Although many regions have experienced a temporary drop in fertility rates with the spread of the infection, subsequent recovery has varied across countries. This study aimed to evaluate the impact of COVID-19 infection rates and regional sociodemographic factors on the recovery of fertility rates in Japan following the state of emergency. METHODS: This study examined prefectural fertility data from before the COVID-19 pandemic to forecast fertility rates up to 2022 using a seasonal autoregressive integrated moving average model. A regression analysis was conducted on fertility rates during the first state of emergency and the subsequent recovery rate with respect to the number of new COVID-19 cases and sociodemographic factors specific to each prefecture. RESULTS: During the first state of emergency, the monthly fertility rate decreased by an average of -13.8% (SD: 6.26, min: -28.78, max: 0.15) compared with the previous year. Over the following 22 months, the average fertility recovery rate was +2.31% (SD: 3.57; min: -8.55, max: 19.54). Multivariate analysis of the impact of the pandemic on fertility changes during the first emergency indicated a negative correlation between new COVID-19 cases per capita and the proportion of nuclear households. No significant correlation was found between fertility recovery rate and new COVID-19 cases or emergency duration. When classifying fertility rate fluctuation patterns before and after the emergency into four clusters, variations were noted in the proportion of the elderly population, marriage divorce rate and the number of internet searches related to pregnancy intentions across the clusters. CONCLUSIONS: No association was found between pregnancy intentions related to the spread of infection, such as the number of new cases and the fertility recovery rate following the first state of emergency. Differences in the patterns of decline and recovery during the pandemic were observed based on population composition and internet searches for infection and pregnancy across different prefectures.

DOI： 10.1136/bmjopen-2024-087657

Evaluating the impact of a trial of labor after cesarean section on labor duration: a retrospective cohort study. Reviewed International journal

Hikaru Ooba, Jota Maki, Hisashi Masuyama

BMC pregnancy and childbirth 24 ( 1 ) 542 - 542 2024.8

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Cesarean section (C-section) rates are increasing globally, and repeated C-sections are associated with increased maternal morbidity. Trial of labor after C-section (TOLAC) is an approach to reduce the recurrence of C-sections. However, limited research exists on the impact of cesarean scars on labor duration in TOLAC, considering the termination of labor through C-section and selection bias. This study aimed to investigate the impact of cesarean scars on labor duration in TOLAC participants, accounting for potential confounding factors and biases. METHODS: This retrospective cohort study included 2,964 women who attempted vaginal birth at a single center in Japan from 2012 to 2021. The study categorized participants into TOLAC (n = 187) and non-TOLAC (n = 2,777) groups. Propensity scores were calculated based on 14 factors that could influence labor duration, and inverse probability of treatment weighting (IPTW) was applied. Cox proportional hazards regression analysis estimated hazard ratios (HRs) for labor duration, with and without IPTW adjustment. Sensitivity analyses used propensity score matching, bootstrapping, and interval censoring to address potential biases, including recall bias in the reported onset of labor. RESULTS: The unadjusted HR for labor duration in the TOLAC group compared to the non-TOLAC group was 0.83 (95% CI: 0.70-0.98, P = 0.027), indicating a longer labor duration in the TOLAC group. After adjusting for confounding factors using IPTW, the HR was 0.98 (95% CI: 0.74-1.30, P = 0.91), suggesting no significant difference in labor duration between the groups. Sensitivity analyses using propensity score matching, bootstrapping, and interval censoring yielded consistent results. These findings suggested that the apparent association between TOLAC and longer labor duration was because of confounding factors rather than TOLAC itself. CONCLUSIONS: After adjusting for confounding factors and addressing potential biases, cesarean scars had a limited impact on labor duration in TOLAC participants. Maternal and fetal characteristics may have a more substantial influence on labor duration.

DOI： 10.1186/s12884-024-06744-0

The adenosine deaminase family acting on RNA 1 can be a useful diagnostic biomarker in chorioamnionitis. Reviewed International journal

Keiichiro Nakamura, Kunitoshi Shigeyasu, Jota Maki, Eriko Eto, Hisashi Masuyama

Placenta 153 53 - 58 2024.8

Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Chorioamnionitis (CAM) involves infection and inflammation of the chorion and amniotic membrane, but there are still no effective diagnostic biomarkers for CAM. METHODS: We investigated the correlation between RNA editing enzyme Adenosine deaminase family acting on RNA 1 (ADAR1) and CAM in chorion and amniotic membrane specimens derived from premature rupture of the membrane (PROM), CAM (pathologically diagnosed), and clinical CAM (clinically diagnosed) patients using reverse transcription polymerase chain reaction (RT-PCR). RESULTS: ADAR1 was upregulated in the chorion and amniotic membrane specimens of CAM and clinical CAM patients (p < 0.001 and p = 0.005). ADAR1 had a significantly higher area under the curve (AUC) (0.735 and 0.828) than markers of inflammation characteristics in diagnosing CAM and clinical CAM patients. ADAR1 also had significantly higher AUC (0.701 and 0.837) than clinical characteristics for CAM and clinical CAM patients. DISCUSSION: ADAR1 can be a useful diagnostic biomarker in CAM patients.

DOI： 10.1016/j.placenta.2024.05.133

Multicenter Remote-Access Simulation of Vaginal Delivery for High-Flexibility Medical Education during the Coronavirus Pandemic. Reviewed

Eriko Eto, Jota Maki, Noriyuki Yamashita, Toru Hasegawa, Ayano Suemori, Hikari Nakato, Hikaru Oba, Tomohiro Mitoma, Sakurako Mishima, Satoe Kirino, Akiko Ohira, Hisashi Masuyama

Acta medica Okayama 78 ( 4 ) 313 - 322 2024.8

Language：English Publishing type：Research paper (scientific journal)

During the coronavirus pandemic, face-to-face simulation education became impossible. Therefore, we aimed to develop remote-access simulation education with a sense of realism through Information and Communication Technology (ICT) using a perinatal whole-body management and delivery simulator. In September 2021, we administered a multi-center simultaneous remote simulation based on our developed model. Ten universities in the Chugoku-Shikoku region were connected via a web-conferencing system to a live broadcast of a virtual vaginal birth in which a fictional hospitalized pregnant woman experienced accelerated labor and gave birth through vacuum delivery for fetal distress. A Video on Demand (VOD) was made beforehand using a new simulator that allowed for a visual understanding of the process of the inter-vaginal examination. We provided a participatory program that enhanced the sense of realism by combining VOD and real-time lectures on each scenario, with two-way communication between participants and trainee doctors using a chat function. Most participants answered "satisfied" or "very satisfied" with the content, level of difficulty, and level of understanding. From November 2021, we have used the videos of all processes in face-to-face classes. Our construction of a high-flexibility education system using remote simulation in the field of obstetrics and gynecology, especially in the vaginal delivery module, is unique, creative, and sustainable.

DOI： 10.18926/AMO/67547

【周産期(産科)の手術の工夫-筆者はこうしている】帝王切開術筋層縫合法新しい縫合糸による筋層縫合 Invited Reviewed

牧尉太, 増山寿

周産期医学 54 ( 8 ) 1084 - 1088 2024.8

Authorship：Lead author,　Corresponding author Language：Japanese Publisher：(株)東京医学社

＜文献概要＞はじめに帝王切開は,女性の開腹手術のなかで最も施行される基本的な手術の一つである。WHOは,帝王切開による出産を10～15%以内とすることを求めているが,近年,医学的そして社会的な状況の変化に伴い,その頻度は増加している。出産という女性特有のイベントは,女性の社会進出と人生設計の最も重要な節目の時期に訪れる。その時期にわが国では4人に1人の女性が余儀なくされる帝王切開術により生じる子宮筋層の癒合不全や瘢痕部の菲薄化(cesarean scar defect:CSD)に注目が集まっている。

Other Link： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J00621&link_issn=&doc_id=20240829020007&doc_link_id=10.24479%2Fperi.0000001677&url=https%3A%2F%2Fdoi.org%2F10.24479%2Fperi.0000001677&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Barbed versus conventional sutures for cesarean uterine scar defects: A randomized clinical trial. Reviewed International journal

Jota Maki, Tomohiro Mitoma, Hikaru Ooba, Hikari Nakato, Sakurako Mishima, Kazumasa Tani, Eriko Eto, Dan Yamamoto, Risa Yamamoto, Kenji Kai, Takashi Tamada, Kazuyo Akamatsu, Kunihiro Kawanishi, Hisashi Masuyama

American journal of obstetrics & gynecology MFM 6 ( 9 ) 101431 - 101431 2024.7

Authorship：Lead author,　Corresponding author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The role of barbed sutures in preventing myometrial defects and enhancing postpartum outcomes after cesarean section is uncertain. OBJECTIVE: This study compared clinical and ultrasonographic outcomes of uterine scar defects after C-section with barbed and conventional smooth thread sutures. STUDY DESIGN: This was a multicenter, parallel-group, randomized, controlled clinical trial. Four obstetrics and gynecology departments across three Japanese healthcare regions were included. The participants were women requiring their first cesarean delivery between May 2020 and March 2023. Of the 1211 participants enrolled, 298 underwent cesarean section and 253 were followed-up until July 2023. Participants with singleton pregnancies were randomly assigned (1:1 ratio) to receive either conventional or spiral thread sutures with a double-layer continuous suture. The study period comprised the time of consent to the 6- to 7-month examination. The primary endpoint was the rate of scar niches >2 mm evaluated using transvaginal ultrasonography at 6 to 7 months after surgery. Additional metrics included the total operative time, suture application time, operative blood loss, number of additional sutures required for hemostasis, maternal surgical complications, postoperative infections, surgeon's years of experience, and individual subscale scores. RESULTS: All data of the 220 participants (barbed suture group: 110; conventional suture group: 110) were available, thus enabling a full analysis set. A comparison of the barbed and conventional suture groups, respectively, revealed the following: niche length, 2.45±1.65 mm (range: 1.0-6.7) versus 3.79±1.84 mm (range: 1.0-11.0) (P<0.001); niche depth, 1.78±1.07 mm (range: 1.0-5.7) versus 2.70±1.34 mm (range: 1.0-7.3) (P<0.001); residual myometrial thickness, 8.46±1.74 mm (range: 4.8-13.0) versus 7.07±2.186 mm (range: 2.2-16.2) (P<0.001); and niche width, 1.58±2.73 mm (range: 0.0-14.0) versus 2.88±2.36 mm (range: 0.0-11.0) (P<0.001), respectively. The barbed suture group exhibited no defects and a residual myometrial thickness <3 mm. Furthermore, the barbed suture group had a lower rate of uterine niches (29.1%; n=32/110) than the conventional suture group (68.2%; n=75/110). Secondary outcomes showed no significant differences in operative times, maternal surgical complications, or postoperative complications. CONCLUSIONS: Double-layer barbed sutures during cesarean delivery may prevent cesarean section scar defects and postoperative complications.

DOI： 10.1016/j.ajogmf.2024.101431

The problems with information transmission for people with hearing loss during disasters and emergencies and the solution for them Reviewed

Kataoka Y., Kobayashi Y., Noda Y., Ohmori I., Maki J., Hiyoshi K., Honda T.

Japanese Journal of Disaster Medicine 29 ( 2 ) 124 - 130 2024.5

Total laparoscopic wedge resection for an intramural ectopic pregnancy using an intraoperative ultrasound system: A case report. Reviewed

Kotaro Kubo, Atsushi Fujikawa, Tomohiro Mitoma, Sakurako Mishima, Akiko Ohira, Satoe Kirino, Jota Maki, Eriko Eto, Hisashi Masuyama

Asian journal of endoscopic surgery 17 ( 2 ) e13303 2024.4

Language：English

Intramural pregnancy is a rare form of ectopic pregnancy, and the optimal treatment remains uncertain. We describe a 33-year-old woman (gravida 2, para 0) who visited our hospital with suspected ectopic pregnancy. The patient was asymptomatic and hemodynamically stable. Transvaginal ultrasonography revealed pregnancy at 6 weeks of gestation and a gestational sac and fetal heartbeat in the anterior muscular layer of the uterus, away from the endometrium. The fetal sac measured 26 mm. The serum human chorionic gonadotropin (hCG) level had increased to 27 655 mIU/mL. Accordingly, the patient was diagnosed with an intramural ectopic pregnancy and underwent total laparoscopic wedge resection using intraoperative ultrasonography. The postoperative course was uneventful, and she was discharged after 4 days. Her serum hCG level normalized at 26 days postoperatively. This case indicates that intraoperative laparoscopic ultrasonography seems viable for treating intramural pregnancies.

DOI： 10.1111/ases.13303

【産婦人科医のための緊急対応サバイバルブック】産科編妊産褥婦の合併疾患への対応法糖尿病性ケトアシドーシス Reviewed

牧尉太

臨床婦人科産科 78 ( 4 ) 308 - 312 2024.4

帝王切開-疾患構造の変化に対応する新たな取り組み- 子宮創部菲薄化低減を目指す糸の役割 Barbed Sutureによる無結紮子宮再建 Reviewed

牧尉太, 増山寿

日本周産期・新生児医学会雑誌 59 ( 4 ) 479 - 481 2024.4

【帝王切開のネガティブ・インパクトの克服と新たな取り組み】ネガティブ・インパクトの回避に向けた取り組み有棘糸を用いた子宮筋層縫合法 Reviewed

牧尉太

産婦人科の実際 73 ( 3 ) 243 - 248 2024.3

Authorship：Lead author,　Last author,　Corresponding author Language：Japanese Publisher：金原出版(株)

＜文献概要＞帝王切開は,われわれ産婦人科医が最も日常的に行う基本的な手術の1つであるが,難手術ケースも散在するため,術前のシミュレーションや熟達者との修練・指導が重要である。Barbed Sutureを子宮筋層縫合に使用することで,二層連続縫合の手術手順の運針操作を従来どおり行うことができ,かつ術者の習熟度を問わず子宮創部菲薄化予防を達成できる可能性が示唆される。ただし,帝王切開はあくまで手術であり,分娩時期のリスク評価・内診所見・分娩進行・胎児心拍陣痛図の正確な判読を行い,安易な手術選択を避け,帝王切開自体のリスクに鑑みることは言うまでもない。

Assessing the efficacy of simulation-based education for paramedics in extended focused assessment with sonography for trauma under physician guidance. Reviewed International journal

Akiko Ohira, Jota Maki, Kohei Ageta, Hikari Nakato, Hikaru Oba, Tomohiro Mitoma, Sakurako Mishima, Kazumasa Tani, Satoe Kirino, Eriko Eto, Atsunori Nakao, Hisashi Masuyama

Scientific reports 14 ( 1 ) 4190 - 4190 2024.2

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

We investigated the effectiveness of simulation-based education in Focused Assessment with Sonography for Trauma (FAST) to increase the number of Emergency Medical Technicians (EMTs) capable of performing ultrasound examinations in vehicles under the guidance of a physician. Twenty-eight paramedics watched a 14-min video on the features of the ultrasound system, its use, and the scanning method for each part of the body. Each participant performed four FAST examinations using a portable ultrasound device, and the task performance was rated using the Task Specific Checklist (TSC) and Global Rating Scale (GRS). The time required for visualizing each examination site and each FAST was assessed. The mean time required for the first and fourth FAST was 144.6 ± 52.4 s and 90.5 ± 31.0 s, respectively. The time required for each test significantly decreased with repeated testing (p < 0.001). The time to complete FAST was significantly shortened for the pericardial cavity (33.4 ± 23.1/15.3 ± 10.6 s, p < 0.01), right thoracic cavity (25.2 ± 11.8/12.1 ± 8.3 s, p < 0.01), Morrison fossa (19.1 ± 10.8/10.8 ± 6.3 s, p < 0.05), and left thoracic cavity (19.0 ± 8.3/15.6 ± 8.3 s, p < 0.05). TSC and GRS scores were elevated, and all EMTs could obtain valid images. The combination of a brief video lecture and hands-on training significantly reduced the time required for FAST performance. Moreover, repeated practice enabled the EMTs to efficiently obtain accurate and clinically useful images.

DOI： 10.1038/s41598-024-54779-2

Crucial factors for implementing treatment strategies in intractable atonic postpartum haemorrhage: early phase contrast medium extravasation on dynamic CT Reviewed

T. Mitoma, J. Maki, A. Suemori, C. Kuriyama, K. Hayata, H. Masuyama

Clinical Radiology 79 ( 1 ) 73 - 79 2024.1

Association of Regular Cervical Cancer Screening with Socioeconomic, COVID-19 Infection and Vaccine Status Among Japanese Population: Cohort Observational Study. Reviewed International journal

Tomohiro Mitoma, Jota Maki, Hikaru Ooba, Chikako Ogawa, Hisashi Masuyama, Takahiro Tabuchi

International journal of general medicine 17 541 - 551 2024

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

PURPOSE: Among the Organisation for Economic Co-operation and Development countries, Japan has one of the lowest cervical cancer screening coverages. Cancer screening coverage has worsened due to the coronavirus disease of 2019 (COVID-19) pandemic. This study investigated the relationship between socioeconomic background, COVID-19 infection history and vaccine status, and regular cervical cancer screening (CCS) during the two years of the COVID-19 era in Japan. PATIENTS AND METHODS: We used data from the Japan COVID-19 and Society Internet Survey, a nationwide, Internet-based, self-report cohort observational study conducted in 2022. The outcome variable was identified by asking whether the participants had undergone CCS within the last two years. Cervical cytology was performed in Japan by brushing the external cervical os. This study used multivariate log-binomial regression models to evaluate inequalities during regular checkups for CCS. Adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) were estimated to incorporate the socioeconomic background variables. RESULTS: Of the 12,066 participants, 5597 (46.4%) had undergone regular CCS for over two years. The prevalence ratio (PR) of patients who underwent CCS was 0.70 for those in their 20s and 0.78 for those in their 60s, compared to those in their 40s. Socioeconomic inequities were found in the following groups: unemployed/student, unmarried, high school graduate or lower, and household income below 4 million Yen. Our final multivariate analysis revealed that participants who were in their 20s or 60s, had a household income below 4 million Yen, were unmarried, had no annual health check-ups, and were unvaccinated with COVID-19 were at a higher risk of not undergoing CCS. CONCLUSION: The relationship between socioeconomic inequality and CCS hesitancy is prevalent among younger participants. The CCS coverage in Japan during the COVID-19 pandemic year (2020-2022) was not low compared with the pre-pandemic era.

DOI： 10.2147/IJGM.S453675

Conception and development of subsystems to supplement the Net119 emergency call system Reviewed

山下範之, 片岡祐子, 牧尉太

情報処理学会全国大会講演論文集 86th ( 4 ) 2024

帝王切開創部の菲薄化予防の試み Reviewed

牧尉太

日本産婦人科医会報 76 ( 5 ) 2024

Short stature in small-for-gestational-age offspring born to mothers with hypertensive disorders of pregnancy. Reviewed International journal

Sakurako Mishima, Takashi Mitsui, Kazumasa Tani, Jota Maki, Eriko Eto, Kei Hayata, Yosuke Washio, Junko Yoshimoto, Hirokazu Tsukahara, Hisashi Masuyama

Hypertension in pregnancy 42 ( 1 ) 2187623 - 2187623 2023.12

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: To investigate the incidence and risk factors of small-for-gestational age (SGA) short stature at 2 and 3 years of age in SGA offspring born to women with hypertensive disorders of pregnancy (HDP). METHODS: We examined 226 women with HDP whose respective SGA offspring were delivered. RESULTS: Eighty offspring (41.2%) were diagnosed with SGA short stature. The prematurity before 32 weeks of gestation was the most significant factor for catch-up growth failure. CONCLUSION: In SGA offspring born to women with HDP, SGA short stature incidence was high, and the risk factor was prematurity before 32 weeks of gestation.

DOI： 10.1080/10641955.2023.2187623

救急救命士へのタスクシフト内閣府デジタル田園健康特区での取り組み Reviewed

上田浩平, 平山隆浩, 牧尉太, 増山寿, 那須保友, 中尾篤典

日本在宅救急医学会誌 7 ( 1 ) 9 - 11 2023.10

Successful myomectomy using barbed sutures at 15 weeks of gestation: A case report. Reviewed International journal

Yui Negoro, Michihisa Shiro, Jota Maki, Tsubasa Kokehara, Hisashi Masuyama, Shigeki Yoshida

Case reports in women's health 39 e00550 2023.9

Language：English

To date, there are no reports on the use of barbed sutures in myomectomy during pregnancy. Herein, successful laparotomic myomectomy at 15 weeks of gestation using barbed sutures is described. A 38-year-old pregnant woman with a large myoma (16 × 11 cm) underwent myomectomy at 15 weeks and 4 days of gestation because of strong pain at the myoma site, a high level of inflammatory markers with degeneration of uterine fibroids, and severe anemia caused by denaturation of myoma. The uterine wall was reconstructed using monofilament absorbable 0 barbed sutures. Unlike conventional sutures, barbed sutures do not retract, so an assistant does not need to hold onto it during reconstruction of the uterine wall, resulting in less pressure and damage to the gravid uterus while maintaining resistance and the ability to hold the tissue under tension. The pregnancy continued with no evidence of myometrial thinning or symptoms of preterm labor. The patient delivered a healthy baby via cesarean section due to partial placenta previa at 36 weeks. The case shows the satisfactory outcome of perinatal myomectomy using barbed sutures during pregnancy.

DOI： 10.1016/j.crwh.2023.e00550

多角的視点から考えるライフステージと喫煙の影響～大規模データから得た新知見～喫煙と小児期、妊娠期、うつへの影響など加熱式タバコ使用による胎盤早期剥離リスク Reviewed

大羽輝, 牧尉太, 田淵貴大, 増山寿

日本女性栄養・代謝学会誌 29 ( 1 ) 84 - 85 2023.8

Endothelin-1 production via placental (pro)renin receptor in a mouse model of preeclampsia. Reviewed International journal

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

Placenta 138 44 - 50 2023.7

Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Preeclampsia (PE) pathogenesis is explained by the two-stage disorder theory. However, mechanisms underlying hypertension and proteinuria in PE remain unclear. The role of (pro)renin receptor (PRR) in PE pathology has received special attention. We examined endothelin-1 (ET-1) production via placental PRR in a PE mouse model. METHODS: At 14.5 day-post-coitum (DPC), we performed a reduced uterine perfusion pressure (RUPP) operation, ligating the uterine arteriovenous vessels in female mice. We also infused these mice with a PRR inhibitor, decoy peptide in the handle region of prorenin (HRP) for mice (NH2-RIPLKKMPSV-COOH). At 18.5 DPC, blood, urine, and placenta were collected; fetus and placenta were weighed. We evaluated placental hypoxia using quantitative polymerase chain reaction (PCR), with hypoxia-inducible factor-1α (HIF-1α) as index. We also evaluated PRR, transforming growth factor-β1 (TGF-β1), and ET-1 expression in the placenta using quantitative PCR and western blotting. ET-1 concentration in blood plasma was assessed using enzyme-linked immunosorbent assay. RESULTS: Blood pressure and proteinuria significantly increased, and fetal and placental weights decreased in RUPP mice. HIF-1α, PRR, TGF-β1, and ET-1 expressions considerably increased in RUPP mice placentas. ET-1 concentration in RUPP mice blood plasma was markedly increased. PRR inhibitor suppressed these changes. DISCUSSION: In PE model mice that underwent RUPP treatment, placental hypoxia increased PRR and ET-1 expression suggesting a causative relationship between ET-1 and intracellular PRR signaling. RUPP treatment, when combined with HRP, reversed the effect of elevated ET-1 levels in the model. This study may help to elucidate the pathogenesis of PE considering PRR and ET-1.

DOI： 10.1016/j.placenta.2023.05.002

【ここまで進んだ産婦人科領域の検査法-先制医療に向けて-】周産期・生殖内分泌妊婦の糖代謝異常の評価 Reviewed

増山寿, 衛藤英理子, 牧尉太

産科と婦人科 90 ( 7 ) 732 - 736 2023.7

Authorship：Last author Language：Japanese Publisher：(株)診断と治療社

＜文献概要＞糖代謝異常のスクリーニング法は,妊娠前に糖尿病と診断されていない全妊婦に対して妊娠初期(8～12週)に随時血糖測定(95または100mg/dL)および中期(24～28週)に随時血糖測定(100mg/dL以上)または50gGCT(140mg/dL以上)で異常を認めた場合に75gOGTTを行う.血糖管理のおもな目標は,母体面からみると糖尿病性腎症,網膜症,ケトアシドーシスなどの糖尿病合併症や妊娠高血圧症候群,児の予後からみると妊娠初期の高血糖による胎児奇形および妊娠中後期の早産,巨大児・難産や低血糖,黄疸や呼吸窮迫症候群などの新生児合併症などの発症抑制である.

Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00525&link_issn=&doc_id=20230622010008&doc_link_id=10.34433%2Fog.0000000298&url=https%3A%2F%2Fdoi.org%2F10.34433%2Fog.0000000298&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

帝王切開瘢痕症候群予防的観点から Invited Reviewed

牧尉太, 増山寿

産婦人科手術 ( 34 ) 103 - 111 2023.6

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 Invited Reviewed

牧尉太, 増山寿

産婦人科手術 ( 34 ) 39 - 43 2023.6

帝王切開瘢痕症候群予防的観点から Reviewed

牧尉太, 増山寿

産婦人科手術 ( 34 ) 103 - 111 2023.6

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 Reviewed

牧尉太, 増山寿

産婦人科手術 ( 34 ) 39 - 43 2023.6

Therapeutic plasma exchange in postpartum HELLP syndrome: a case report. Reviewed International journal

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

JA clinical reports 9 ( 1 ) 9 - 9 2023.2

Language：English Publishing type：Research paper (scientific journal)

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

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 Reviewed International journal

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 2023.2

Authorship：Corresponding author Language：English Publisher：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

Other Link： https://link.springer.com/article/10.1186/s12877-023-03828-y/fulltext.html

Postpartum pyomyoma due to Mycoplasma hominis: A case report. Reviewed International journal

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 2022.10

Language：English

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

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 Invited Reviewed

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 2022.8

Language：Japanese Publisher：(一社)日本糖尿病・妊娠学会

糖代謝異常妊婦はheavy for date(HFD;在胎不当過体重児)のハイリスクである。糖代謝異常妊婦の体組成量や安静時代謝量の変化が出生児体重の予測因子となるかを研究した。その結果、糖代謝異常群では妊娠前期の安静時代謝量1520kcal/day以上(OR=6.1)と妊娠後期の除脂肪量47.0kg以上(OR=6.8)が出生児体重3500g以上の予測因子として抽出された。糖代謝異常妊婦における除脂肪量や安静時代謝量の変化は出生児体重の予測因子となり得ることより、母体体組成量測定を実施することが、HFD予測の一助となる可能性が示唆された。(著者抄録)

Kibichuo Town is the first National Stragic Special Zone for innovative business collaboration in Japan: The role of universites in archiving regulatory reform with a vison toward a Digital Gareden City Nation Invited Reviewed

134 ( 2 ) 115 - 118 2022.8

Diffuse myometrium thinning and placenta accreta spectrum in a patient with systemic lupus erythematosus (SLE): a case report and review of the literature. Reviewed International journal

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 2022.7

Language：English Publishing type：Research paper (scientific journal)

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

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 Reviewed

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 2022.4

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

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

Acta medica Okayama 76 ( 1 ) 51 - 56 2022.2

Language：English Publishing type：Research paper (scientific journal)

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

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. Reviewed International journal

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

Case reports in women's health 33 e00375 2022.1

Authorship：Lead author,　Corresponding author Language：English

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

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

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 2021.12

Language：English Publishing type：Research paper (scientific journal)

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

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

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

Acta medica Okayama 75 ( 6 ) 745 - 750 2021.12

Language：English

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

治療に難渋した巨大子宮筋腫に対する筋腫核出術 Reviewed

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 2021.12

Language：Japanese Publisher：中国四国産科婦人科学会

子宮筋腫は婦人科の日常診療において最も遭遇する頻度の高い疾患ではあるが、近年婦人科検診の普及により巨大子宮筋腫を診る機会は稀となってきている。本邦において巨大子宮筋腫の定義は一定していないが3kgを超える巨大子宮筋腫に対する子宮筋腫核出術の報告例は散見される程度である。今回我々が報告するのは、4kgを超える巨大子宮筋腫を有し、妊孕性温存を切望する女性患者に対して、本人と家族へ十分に説明を行い、手術操作の対策を慎重に熟考した上で、子宮筋腫核出術を施行した症例である。最終的には子宮を温存することができたが、初回手術後に重度の腹腔内出血と出血性貧血、開腹止血術、腸閉塞、開腹腸切除術といった合併症を来し、長期療養を要する結果となった。本稿では、本症で生じた周術期合併症を避けるために反省すべき点を考察するとともに、可能な限り早期に受診することや手術が安全に施行できる時期に医療介入することがいかに重要かについて論じる。(著者抄録)

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J05038&link_issn=&doc_id=20211220410039&doc_link_id=%2Fcv0mtrob%2F2021%2F007001%2F039%2F0215-0219%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcv0mtrob%2F2021%2F007001%2F039%2F0215-0219%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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 Invited Reviewed

牧尉太

ぺリネイタル・ケア 40 ( 11 ) 2021.11

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 2021.8

Language：English Publishing type：Research paper (scientific journal)

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

High-Dose Corticosteroids for a Pregnant Woman Critically Ill With Coronavirus Disease 2019. Reviewed International journal

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

Cureus 13 ( 8 ) e17398 2021.8

Language：English

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

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. Reviewed International journal

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 2021.8

Authorship：Lead author,　Corresponding author Language：English Publishing type：Research paper (scientific journal)

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

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 2021.8

hCG values and gestational sac size as indicators of successful systemic methotrexate treatment in cesarean scar pregnancy. Reviewed International journal

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 2021.5

Language：English Publishing type：Research paper (scientific journal)

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

Renal capsular vein thrombosis. Reviewed

Katsuyuki Tanabe, Jota Maki, Hikari Nakatou

Clinical and experimental nephrology 25 ( 4 ) 439 - 440 2021.4

Language：English Publishing type：Research paper (scientific journal)

A 30-year-old pregnant woman developed postpartum HELLP syndrome. Abdominal computed tomography revealed a high-density vessel structure in contact with the right kidney and connected to the right ovarian vein, suggesting thrombosis in the right inferior renal capsular vein (RCV). RCV thrombosis is a rare thrombotic disorder in postpartum women, and hypercoagulability related to the pregnancy complications may be the predisposing factor. The potential risk for pulmonary embolism in the rare pregnancy-related thrombosis should be recognized.

DOI： 10.1007/s10157-020-01998-2

【助産力アップ!周産期のガイドライン深掘りドリル200問『産婦人科診療ガイドライン:産科編2020』に準拠難易度別助産ケア&最新エビデンスが満載!】(第1章)妊娠期妊娠糖尿病『妊婦の糖代謝異常診療・管理マニュアル』より出題 Reviewed

牧尉太, 増山寿

ペリネイタルケア ( 2021新春増刊 ) 89 - 102 2021.1

治療に難渋した巨大子宮筋腫に対する筋腫核出術 Reviewed

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 ) 381 - 385 2021

The assessment of the fetal heart function using two-dimensional speckle tracking with a high frame rate. Reviewed International journal

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

Early human development 151 105160 - 105160 2020.12

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Two-dimensional (2D) speckle tracking echography (STE) is a new diagnostic modality that allows for the assessment of myocardial deformation. The present study assessed the feasibility of fetal 2D-STE at a high frame rate and determined the reference values for left ventricular (LV)- and right ventricular (RV)- global longitudinal strain (GLS). METHODS: In this prospective study, 109 fetuses with gestational ages ranging from 18 to 38 weeks underwent 2D echocardiography between August 2018 and December 2019. All recordings were performed using the Aplio i800 (CANON Medical Systems Corporation, Tochigi, Japan) and a convex probe (4 MHz) for fetuses. RESULTS: Longitudinal peak systolic strain measurements were obtained in 98 of 109 healthy fetuses (90%). All ultrasound videos were recorded with a median frame rate of 172 (range, 100-274) frames/s. The LV-GLS was almost constant, regardless of the number of weeks since the second trimester (r = -0.0087, p = ns). The RV-GLS decreased significantly with gestational age (r = 0.39, p < 0.01). CONCLUSIONS: STE may be useful for quantifying the systolic myocardial function in a fetus.

DOI： 10.1016/j.earlhumdev.2020.105160

妊娠性エプーリスからの大量出血で母体管理のため帝王切開を選択した一例 Reviewed

白河伸介, 牧尉太, 三島桜子, 大平安希子, 谷和祐, 玉田祥子, 光井崇, 衛藤英理子, 早田桂, 増山寿

現代産婦人科 68 ( 2 ) 139 - 143 2020.6

Authorship：Corresponding author Language：Japanese Publisher：中国四国産科婦人科学会

今回、我々は妊娠性エプーリスが急性増悪し、口腔内大量出血をきたしたため、耳鼻咽喉科による姑息的な止血手術を一時的に施行した。その後、母体管理のために選択的帝王切開術を施行した一例を経験した。【症例】19歳、女性。1妊0産。自然妊娠成立し妊娠11週に近医受診。同時期に歯肉腫脹を自覚した。近医歯科で歯肉炎と診断され、終診となっていた。妊娠25週に歯肉腫脹が増悪し、当院口腔外科を紹介受診となった。当院口腔外科にて腫脹箇所の切除の選択肢も提示されたが希望されず、経過観察の方針となった。妊娠35週0日、歯肉腫脹の増悪と持続的な強出血を認め、止血困難で救急搬送となった。来院時ショックバイタルであり、右下5舌側歯肉臼後部から動脈性の出血を認めた。病変は3cm程度で臨床所見から妊娠性エプーリスを疑った。緊急腫瘍摘出術を施行し止血は得られたが、根治手術は難しく姑息的手術となった。ICU入室後、再出血を認めず経過した。病変の再出血時は止血困難となる可能性を考慮し、早期の妊娠終了を協議の上決定し、妊娠35週4日に選択的帝王切開術を施行した。女児、2308g、アプガースコア9点/9点(1分/5分)の生児を得た。術後口腔内出血を認めず、残存腫脹は消退し産後9日目に退院した。【結語】妊娠性エプーリスは妊婦の1%程度に認め、その程度・出現時期・形態は多岐に渡る。本例では母体適応で35週の帝王切開術の方針としたが、分娩後は自然に縮小・消失することが特徴で正期産まで経過観察する選択肢も上げられる。母児両方の状態を考慮し治療方針を決定する必要性がある。(著者抄録)

【妊娠糖尿病の理解を深めよう】持続血糖測定を用いた血糖測定の実際 Reviewed

増山寿, 牧尉太

産科と婦人科 87 ( 5 ) 577 - 584 2020.5

Authorship：Last author Language：Japanese Publisher：(株)診断と治療社

インスリン療法中の患者の血糖変動は大きく、血糖自己測定を行わない時間帯の血糖値および、血糖変動傾向などの把握が困難で高血糖や低血糖に対する事前の対策の困難さが臨床的な問題である。持続血糖測定(CGM)は、昨今見過ごされていた高血糖や低血糖などの血糖変動を視覚化でき、とりわけ妊娠期間中はCGMを用いると母体の血糖変動が改善し、母児の周産期合併症の発症リスクも減少させることが報告されている。本稿では持続血糖測定とデータの見方、今後の見通しについて解説する。(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00525&link_issn=&doc_id=20200511100015&doc_link_id=%2Fae4sanke%2F2020%2F008705%2F016%2F0577-0584%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fae4sanke%2F2020%2F008705%2F016%2F0577-0584%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Pregnancy with Fontan circulation: A report of case series in Japan. Reviewed

Eriko Eto, Jota Maki, Teiji Akagi, Hiroshi Ito, Hisashi Masuyama

Journal of cardiology cases 21 ( 4 ) 161 - 163 2020.4

Language：English

Owing to new surgical procedures and medications, more women who have undergone the Fontan procedure reach childbearing ages. We report five cases of pregnancy with Fontan circulation. Case 1 had subchorionic hematoma (SCH), fetal growth restriction (FGR), and preterm labor (PTL). She delivered a 1073 g infant via cesarean section at gestation week 28 because of hemorrhagic shock. Case 2 delivered 2142 g and 2232 g infants at gestation weeks 37 and 36, respectively. She had FGR, PTL, and postpartum hemorrhage (PPH). Case 3 had SCH, PTL, and heart failure. At 36 weeks, labor was induced and she delivered a 2546 g infant by vacuum extraction with epidural analgesia. Cases 4 and 5 resulted in miscarriage. All subjects experienced obstetrical complications. This report discusses pregnant women with Fontan circulation by focusing on affected Japanese women. <Learning objective: More women who have undergone the Fontan procedure reach childbearing ages due to the new surgical procedures and medications. We report five cases and all of them experienced obstetrical complications. Anticoagulation might be one of the causes of postpartum hemorrhage. Labor epidural analgesia could contribute to minimized dynamic circulatory changes during labor. This report can be the literature regarding pregnant women with Fontan circulation in Japan.>.

DOI： 10.1016/j.jccase.2019.12.005

A case of subclinical Cushing's syndrome in pregnancy with superimposed preeclampsia. Reviewed International journal

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

Clinical case reports 8 ( 3 ) 481 - 483 2020.3

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

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 2019.10

Language：English Publishing type：Research paper (scientific journal)

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

Assessment of glucose kinetics with real-time continuous glucose monitoring during labor. Reviewed International journal

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 2019.9

Language：English Publishing type：Research paper (scientific journal)

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

A Case of Nager Syndrome Diagnosed Before Birth. Reviewed

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 2019.6

Language：English

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

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

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

Acta medica Okayama 73 ( 2 ) 173 - 176 2019.4

Language：English

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

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

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

Acta medica Okayama 72 ( 4 ) 359 - 367 2018.8

Language：English Publishing type：Research paper (scientific journal)

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

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

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

Journal of diabetes investigation 9 ( 4 ) 959 - 966 2018.7

Language：English Publishing type：Research paper (scientific journal)

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

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 Reviewed

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 2018.6

Language：Japanese Publisher：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)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J05038&link_issn=&doc_id=20180704460007&doc_link_id=%2Fcv0mtrob%2F2017%2F006602%2F007%2F0243-0247%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcv0mtrob%2F2017%2F006602%2F007%2F0243-0247%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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. Reviewed International journal

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 2017.10

Language：English Publishing type：Research paper (scientific journal)

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

Successful pregnancy located in a uterine cesarean scar: A case report. Reviewed International journal

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 2017.4

Language：English

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

Comparison of Kidney Function between Gestational Hypertension and Preeclampsia. Reviewed

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 2017.4

Language：English Publishing type：Research paper (scientific journal)

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

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

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 2016.10

Language：English Publishing type：Research paper (scientific journal)

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

Dimethylesculetin ameliorates maternal glucose intolerance and fetal overgrowth in high-fat diet-fed pregnant mice via constitutive androstane receptor. Reviewed International journal

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

Molecular and cellular biochemistry 419 ( 1-2 ) 185 - 92 2016.8

Language：English Publishing type：Research paper (scientific journal)

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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