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Moyamoya disease, a rare chronic cerebrovascular disease with a fragile vascular network at the base of the brain, can cause ischemic or hemorrhagic strokes or seizures. Precise blood pressure control and adequate analgesia are important for patients with moyamoya disease to prevent neurological events such as ischemia and hemorrhage. This study aimed to compare the intraoperative mean arterial pressure of pregnant women with moyamoya disease according to the mode of anesthesia (general anesthesia versus spinal anesthesia) used during cesarean delivery.We retrospectively reviewed the medical records of 87 cesarean deliveries in 74 patients who had been diagnosed with moyamoya disease before cesarean delivery. The primary outcome, intraoperative maximum mean arterial pressure during anesthesia, was compared according to the type of anesthesia administered (general versus spinal anesthesia). Other perioperative hemodynamic data (lowest mean arterial pressure, incidence of hypotension, vasopressor use, and antihypertensive agent use), maternal neurologic symptoms, neonatal outcomes (Apgar scores7, ventilatory support, and intensive care unit admission), maternal and neonatal length of stay, postoperative pain scores, and rescue analgesic use were assessed as secondary outcomes.While the lowest blood pressure during anesthesia and incidence of hypotension did not differ between the 2 groups, the maximum mean arterial pressure during anesthesia was lower in the spinal anesthesia group than that in the general anesthesia group (104.8 ± 2.5 vs 122.0 ± 4.6; P = .002). Study data did not support the claim that maternal neurologic symptoms differ according to the type of anesthesia used (5.6% vs 9.3%; P = .628); all patients recovered without any sequelae. The postoperative pain scores were lower, and fewer rescue analgesics were used in the spinal anesthesia group than in the general anesthesia group. Other maternal and neonatal outcomes were not different between the 2 groups.Compared with general anesthesia, spinal anesthesia mitigated the maximum arterial blood pressure during cesarean delivery and improved postoperative pain in patients with moyamoya disease.

Background: With increasing incidence of gestational diabetes mellitus (GDM), newborn infants with perinatal morbidity, including large-for-gestational-age (LGA) or macrosomia, are also increasing. The purpose of this study was to develop a prediction model for LGA infants with GDM mothers. Methods: This was a retrospective case-control study of 660 women with GDM and singleton pregnancies in four tertiary care hospitals from 2006 to 2013 in Korea. Biometric parameters were obtained at diagnoses of GDM and within two weeks before delivery. These biometric data were all transformed retrospectively into Z-scores calculated using a reference. Interval changes of values between the two periods were obtained. Multivariable logistic and stepwise backwards regression analyses were performed to develop the most parsimonious predictive model. The prediction model included pre-pregnancy body mass index (BMI), head circumference (HC), Z-score at 24 + 0 to 30 + 6 weeks’ gestation, and abdominal circumference (AC) Z-score at 34 + 0 to 41 + 6 weeks within 2 weeks before delivery. The developed model was then internally validated. Results: Our model’s predictive performance (area under the curve (AUC): 0.925) was higher than estimated fetal weight (EFW) within two weeks before delivery (AUC: 0.744) and the interval change of EFW Z-score between the two periods (AUC: 0.874). It was internally validated (AUC: 0.916). Conclusions: A clinical model was developed and internally validated to predict fetal overgrowth in Korean women with GDM, which showed a relatively good performance.

We aimed to compare cervical elastographic parameters based on a previous loop electrosurgical excision procedure (LEEP) and to determine whether they can predict preterm delivery in pregnant women with a history of LEEP. This multicenter prospective case–control study included 71 singleton pregnant women at 14–24 weeks of gestation with a history of LEEP and 1:2 gestational age-matched controls. We performed cervical elastography using E-cervix and compared maternal characteristics, delivery outcomes, cervical length (CL), and elastographic parameters between the two groups. The median mid-trimester CL was significantly shorter in the LEEP group. Most elastographic parameters, including internal os (IOS), external os (EOS), elasticity contrast index (ECI), and hardness ratio (HR), were significantly different in the two groups. In the LEEP group, the sPTD group compared to the term delivery (TD) group showed a higher rate of previous sPTD (50% vs. 1.7%, p 0.001), higher IOS and ECI (IOS: 0.28 [0.12–0.37] vs. 0.19 [0.10–0.37], p = 0.029; ECI: 3.89 [1.79–4.86] vs. 2.73 [1.48–5.43], p = 0.019), and lower HR (59.97 [43.88–92.43] vs. 79.06 [36.87–95.40], p = 0.028), but there was no significant difference in CL (2.92 [2.16–3.76] vs. 3.13 [1.50–3.16], p = 0.247). In conclusion, we demonstrated that a history of LEEP was associated with a change in cervical strain measured in mid-trimester as well as with CL shortening. We also showed that cervical elastography can be useful in predicting sPTD in pregnant women with previous LEEP.

This study presents an automatic method for estimating antenatal amniotic fluid (AF) volume from two-dimensional ultrasound (US) images, which is an important indicator of fetal well-being. This automatic estimation of AF volume (AFV) requires automated segmentation of the AF pocket, which is a challenging task due to its amorphous features and US artifacts, such as reverberation, shadowing, particle noise, and signal dropout. Recently, AF-net, a deep-learning method, has been shown to successfully perform AF pocket segmentation. However, we observed that AF-net is prone to misjudging AF pockets containing severe reverberation artifacts. The proposed method addresses this problem by developing a dual path network, which consists of AF-net as the primary path and an auxiliary network as the secondary path. The auxiliary network is designed to focus on the local area that is likely to be contaminated with the reverberation artifacts. It infers this local region and generates a feature map of the artifacts, incorporating it as prior information into a deep neural network, denoted as RVB-net, for segmenting the reverberation-artifact-contaminated AF region. Finally, the segmentation output from the auxiliary network complements the AF-net. Experimental results show that the proposed dual path network effectively reduces misjudgment of the AF pocket caused by severe reverberation artifacts. The proposed dual path network achieved an average Dice similarity coefficient (DSC) of 0.8599 ± 0.1074 (mean ± standard deviation) for AF pocket segmentation on the entire evaluation set.

BACKGROUND Spinal anaesthesia-induced hypotension is frequently reported in patients undergoing caesarean section. Mechanistically, sympathetic blockade reduces the systemic vascular resistance and the left ventricular preload, causing hypotension, which is augmented by aortocaval compression. The corrected blood flow time (FTc) is affected by the preload and is inversely related to the afterload. OBJECTIVE We hypothesised that the preanaesthetic carotid artery FTc could predict hypotension after induction in patients undergoing a caesarean section with spinal anaesthesia. DESIGN A prospective observational study. SETTING A tertiary referral centre in South Korea from September 2018 to November 2019. PARTICIPANTS Thirty-eight parturients scheduled for elective caesarean section under spinal anaesthesia. INTERVENTIONS Using carotid ultrasonography, FTc was measured twice prior to inducing spinal anaesthesia. FTc was calculated using both Bazett's (B) and Wodey's (W) formulae. Hypotension was defined as an SBP decrease to less than 80 mmHg, or less than 75% of baseline, or if symptoms consistent with hypotension occurred from the time of injection of the spinal anaesthetic until delivery. MAIN OUTCOME MEASURES The primary endpoint was to determine the predictive value of preanaesthetic FTc for postspinal hypotension during caesarean delivery. RESULTS Among the 35 patients who completed this study, hypotension occurred in 21 (60%). The areas under the receiver-operating characteristic curves for FTc (B) and FTc (W) were 0.905 [95% confidence interval (CI), 0.757 to 0.978, P

Aim Predictive accuracy of cervical funneling for successful vaginal delivery prior to labor induction was compared to that of conventional methods such as Bishop score and cervical length. Methods Prospective observational study was conducted on nulliparous women at 38 gestational weeks or more with intact membranes who delivered vaginally following labor induction. Transvaginal ultrasound was performed prior to labor induction to evaluate the cervix, to determine the cervical length and to check for the presence of funneling. Following pelvic examinations, the Bishop score was calculated. Predictive accuracy of the three different methods, namely cervical funneling, cervical length and Bishop, were compared. Results A total of 235 nulliparous women with intact membranes were recruited. Of these, 194 women (82.6%) had successful vaginal deliveries following induction. Cervical funneling was observed in 105 women (44.7%). The rate of successful vaginal delivery was significantly higher in women with cervical funneling than in those without funneling (90.5% vs 76.2%, P

The current epidemic of non-alcoholic fatty liver disease (NAFLD) is reshaping the field of hepatology all around the world. The widespread diffusion of metabolic risk factors such as obesity, type2-diabetes mellitus, and dyslipidemia has led to a worldwide diffusion of NAFLD. In parallel to the increased availability of effective anti-viral agents, NAFLD is rapidly becoming the most common cause of chronic liver disease in Western Countries, and a similar trend is expected in Eastern Countries in the next years. This epidemic and its consequences have prompted experts from all over the word in identifying effective strategies for the diagnosis, management, and treatment of NAFLD. Different scientific societies from Europe, America, and Asia-Pacific regions have proposed guidelines based on the most recent evidence about NAFLD. These guidelines are consistent with the key elements in the management of NAFLD, but still, show significant difference about some critical points. We reviewed the current literature in English language to identify the most recent scientific guidelines about NAFLD with the aim to find and critically analyse the main differences. We distinguished guidelines from 5 different scientific societies whose reputation is worldwide recognised and who are representative of the clinical practice in different geographical regions. Differences were noted in: the definition of NAFLD, the opportunity of NAFLD screening in high-risk patients, the non-invasive test proposed for the diagnosis of NAFLD and the identification of NAFLD patients with advanced fibrosis, in the follow-up protocols and, finally, in the treatment strategy (especially in the proposed pharmacological management). These difference have been discussed in the light of the possible evolution of the scenario of NAFLD in the next years.

Objectives Individuals delivered from preeclamptic pregnancies exhibit a long-term increased risk of developing cardiovascular and metabolic diseases, likely caused by aberrant fetal cell reprogramming incurred in utero. The present study investigated the functional impairment and epigenetic changes exhibited by endothelial progenitor cells derived from offspring born to preeclamptic pregnancies. Study design The capacity of CD133+/C-kit+/Lin− (CKL−) human umbilical cord blood endothelial progenitor cells (EPCs) derived from gestationally matched normal and preeclamptic (n = 10 each) pregnancies to differentiate to form outgrowth endothelial cells (OECs) was assessed by observing both their morphology, and the number and size of generated OECs colonies. Likewise, OECs angiogenic function was evaluated via migration, adhesion, and tube-formation assays. EPCs from preeclampsia were cultured in normal-, and preeclampsia-derived serum-conditioned media to assess the effects of environmental factors on EPC differentiation potency and OEC angiogenic function, and finally, EPCs H3K4, H3K9, and H3K27 trimethylation levels were assayed. Results The preeclampsia-derived CKL− EPCs exhibited decreased H3K4 and H3K9 trimethylation levels, significantly delayed differentiation times, and a significant reduction in both their number of generated OECs colonies, and exhibited reduced OECs migration, adhesion, and tube formation activities compared to those achieved by the normal-derived EPCs. Interestingly, the reduced differentiation potency of the preeclampsia-derived EPCs was not rescued via exposure to normal serum. Conclusions Exposure to preeclampsia significantly and irreversibly reduced CKL− EPC differentiation potency and OEC angiogenic function, likely reflecting incurred irreversible epigenetic changes.

The aim of this study is to evaluate maternal and neonatal outcomes following immediate delivery or expectant management of preterm premature rupture of membranes (PPROM) during the late preterm period at 34+ 0–36+ 6 weeks of pregnancy. We conducted a retrospective study on singleton pregnancies with PPROM during the late preterm period using medical records at twelve tertiary medical centres in Korea from January 2007 to December 2016. Data on demographic characteristics and outcome measures were collected. The primary outcomes were maternal sepsis for maternal outcome and neonatal sepsis and neonatal death for neonatal outcomes. Of the 1,072 women, 782 cases (72.9%) were assigned to the immediate delivery group, and 290 cases (27.1%) were categorized into the expectant management group. There was a significant difference in the rate of clinical neonatal sepsis (immediate delivery, 3.8% vs expectant management, 15.8%; p

Inflammation is an important part of human response to pathogen to recruit immune cells and remove infected or damaged cells from the system. However, immune response should be fine tuned as uncontrolled proinflammatory response leads to extensive tissue damage and organ failure. Immune homeostasis at the maternal-fetal interface is crucial in the maintenance of healthy pregnancy. TAM receptor tyrosine kinase is known to be present in immune, nervous, and reproductive systems and has been reported to have biological function in the immunological aspect including cell debris clearance, cytokine secretion modulation, and regulation of innate immunity. The presence of TAM receptors at the maternal-fetal interface has been reported and its role in pregnancy has been in question. In the present review, functional aspects of TAM receptors, clinical implications in other diseases in an immunological context, and what is known about association of TAM receptors in complicated pregnancy are discussed with suggestion of potential area of future research.

The effects of prenatal particulate matter with an aerodynamic diameter ranging from 0.1 μm to 2.5 μm (PMTo determine the critical windows of prenatal PMMother-child pairs were enrolled from the birth cohort of the Cohort for Childhood Origin of Asthma and allergic diseases (COCOA) study. PMPMHigher PM

PURPOSE: This study compared clinical and radiologic differences between cystic biliary atresia (cBA) and choledochal cyst (CC) type Ia/b. METHODS: Infants (≤12 months old) who were diagnosed with cBA or CC type Ia/b from 2005 to 2019 were retrospectively reviewed. Imaging features on preoperative ultrasonography (US) and magnetic resonance imaging (MRI) were compared between the cBA and CC groups. Logistic regression and area under the receiver operating characteristic curve (AUC) analyses were performed for the diagnosis of cBA. Changes in cyst size were also evaluated when prenatal US exams were available. RESULTS: Ten patients (5.5% of biliary atresia cases) with cBA (median age, 48 days) and 11 infants with CC type Ia/b (Ia:Ib=10:1; median age, 20 days) were included. Triangular cord thickness on US (cutoff, 4 mm) showed 100% sensitivity and 90.9% specificity (AUC, 0.964; 95% confidence interval [CI], 0.779 to 1.000) and cyst size on MRI (cutoff, 2.2 cm) had 70% sensitivity and 100% specificity (AUC, 0.900; 95% CI, 0.690 to 0.987) for diagnosing cBA. Gallbladder mucosal irregularity on US and an invisible distal common bile duct on MRI were only seen in the cBA group (10 of 10). Only the CC group showed prenatal cysts exceeding 1 cm with postnatal enlargement. CONCLUSION: Small cyst size (

The maternal-fetal interface possesses innate immune strategies to protect against infections. We previously reported that prior viral infection of human fetal membranes (FMs) in vitro and mouse FMs in vivo sensitized the tissue to low dose bacterial LPS leading to augmented inflammation. The objective of this study was to examine FM production of type I interferons (IFNs) and IFN-stimulated genes (ISGs) in the context of this polymicrobial model. Human FM explants and pregnant C57BL/6 mice were treated with or without low dose LPS following exposure to media or the γ-herpes virus, MHV-68. FM RNA was analyzed by qRT-PCR for type I IFNs, ISGs, upstream signaling, and MHV-68 open reading frames (ORFs). Pre-exposure to MHV-68 followed by LPS treatment inhibited the ability of LPS to induce human FM type I IFNs (IFNA, IFNB); ISGs (OAS, MxA, APOBEC3G) and upstream signaling mediators (RIG-I, TBK-1). Signaling mediators IRF-3 and IRF-7 were also reduced. In mouse FMs, pre-exposure to MHV-68 followed by LPS treatment reduced the ability of LPS to upregulate Ifna, Ifnb, Mxa, Irf7, and also reduced Irf3. MHV-68 infection of FMs induced ORF45 which targets IRF-7, and this was further augmented in response to a combination of MHV-68 and LPS. Together, these findings indicate that a viral infection blunts FM type I IFN production and signaling in response to LPS leading to a suppressed ISG response. Our studies suggest that a viral infection inhibits this protective FM response by negatively regulating IRF-7 through ORF45, leaving the maternal-fetal interface vulnerable to further viral attack.

Prenatal particulate matter

High-mobility group box-1 (HMGB-1) is expressed in almost all cells, and its dysregulated expression correlates with inflammatory diseases, ischemia, and cancer. Some of these conditions accompany HMGB-1-mediated abnormal angiogenesis. Thus far, the mechanism of HMGB-1-induced angiogenesis remains largely unknown. In this study, we performed time-dependent DNA microarray analysis of endothelial cells (ECs) after HMGB-1 or VEGF treatment. The pathway analysis of each gene set upregulated by HMGB-1 or VEGF showed that most HMGB-1-induced angiogenic pathways were also activated by VEGF, although the activation time and gene sets belonging to the pathways differed. In addition, HMGB-1 upregulated some VEGFR signaling-related angiogenic factors including EGR1 and, importantly, novel angiogenic factors, such as ABL2, CEACAM1, KIT, and VIPR1, which are reported to independently promote angiogenesis under physiological and pathological conditions. Our findings suggest that HMGB-1 independently induces angiogenesis by activating HMGB-1-specific angiogenic factors and also functions as an accelerator for VEGF-mediated conventional angiogenesis. [BMB Reports 2017; 50(11): 590-595].

Chorioamnionitis, premature rupture of fetal membranes (FMs), and subsequent preterm birth are associated with local infection and inflammation, particularly IL-1β production. Although bacterial infections are commonly identified, other microorganisms may play a role in the pathogenesis. Because viral pandemics, such as influenza, Ebola, and Zika, are becoming more common, and pregnant women are at increased risk for associated complications, this study evaluated the impact that viral infection had on human FM innate immune responses. This study shows that a herpes viral infection of FMs sensitizes the tissue to low levels of bacterial LPS, giving rise to an exaggerated IL-1β response. Using an ex vivo human FM explant system and an in vivo mouse model of pregnancy, we report that the mechanism by which this aggravated inflammation arises is through the inhibition of the TAM receptor, MERTK, and activation of the inflammasome. The TAM receptor ligand, growth arrest specific 6, re-establishes the normal FM response to LPS by restoring and augmenting TAM receptor and ligand expression, as well as by preventing the exacerbated IL-1β processing and secretion. These findings indicate a novel mechanism by which viruses alter normal FM immune responses to bacteria, potentially giving rise to adverse pregnancy outcomes.

There have been few studies investigating the association between atopic dermatitis (AD) and prenatal exposure to heavy metals. We aimed to evaluate whether prenatal exposure to heavy metals is associated with the development or severity of AD in a birth cohort study. A total of 331 subjects were followed from birth for a median duration of 60.0 months. The presence and severity of AD were evaluated at ages 6 and 12 months, and regularly once a year thereafter. The concentrations of lead, mercury, chromium, and cadmium in umbilical cord blood were measured by inductively coupled plasma mass spectrometry. Cord blood mononuclear cells (CBMCs) were isolated and stimulated for analysis of cytokine production using ELISA. Heavy metal levels in cord blood were not associated with the development of AD until 24 months of age. However, a positive correlation was observed between the duration of AD and lead levels in cord blood (p=0.002). AD severity was also positively associated with chromium concentrations in cord blood (p=0.037), while cord blood levels of lead, mercury, and cadmium were not significantly associated with AD severity (p=0.562, p=0.054, and p=0.055, respectively). Interleukin-13 production in CBMCs was positively related with lead and chromium levels in cord blood (p=0.021 and p=0.015, respectively). Prenatal exposure to lead and chromium is associated with the persistence and severity of AD, and the immune reaction toward a Th2 polarization.

The estimation of antenatal amniotic fluid (AF) volume (AFV) is important as it offers crucial information about fetal development, fetal well-being, and perinatal prognosis. However, AFV measurement is cumbersome and patient specific. Moreover, it is heavily sonographer-dependent, with measurement accuracy varying greatly depending on the sonographer's experience. Therefore, the development of accurate, robust, and adoptable methods to evaluate AFV is highly desirable. In this regard, automation is expected to reduce user-based variability and workload of sonographers. However, automating AFV measurement is very challenging, because accurate detection of AF pockets is difficult owing to various confusing factors, such as reverberation artifact, AF mimicking region and floating matter. Furthermore, AF pocket exhibits an unspecified variety of shapes and sizes, and ultrasound images often show missing or incomplete structural boundaries. To overcome the abovementioned difficulties, we develop a hierarchical deep-learning-based method, which consider clinicians' anatomical-knowledge-based approaches. The key step is the segmentation of the AF pocket using our proposed deep learning network, AF-net. AF-net is a variation of U-net combined with three complementary concepts - atrous convolution, multi-scale side-input layer, and side-output layer. The experimental results demonstrate that the proposed method provides a measurement of the amniotic fluid index (AFI) that is as robust and precise as the results from clinicians. The proposed method achieved a Dice similarity of 0.877±0.086 for AF segmentation and achieved a mean absolute error of 2.666±2.986 and mean relative error of 0.018±0.023 for AFI value. To the best of our knowledge, our method, for the first time, provides an automated measurement of AFI.

Background The effects of prenatal particulate matter with an aerodynamic diameter ranging from 0.1 μm to 2.5 μm (PM2.5) and vitamin D on atopic dermatitis (AD) phenotypes have not been evaluated. DNA methylation and cord blood (CB) vitamin D could represent a plausible link between prenatal PM2.5 exposure and AD in an offspring. Objective To determine the critical windows of prenatal PM2.5 exposure on the AD phenotypes, if vitamin D modulated these effects, and if placental DNA methylation mediated these effects on AD in offspring. Methods Mother–child pairs were enrolled from the birth cohort of the Cohort for Childhood Origin of Asthma and allergic diseases (COCOA) study. PM2.5 was estimated by land-use regression models, and CB vitamin D was measured by chemiluminescence immunoassay. AD was identified by the parental report of a physician’s diagnosis. We defined the following 4 AD phenotypes according to onset age (by the age of 2 years) and persistence (by the age of 3 years): early-onset transient and persistent, late onset, and never. Logistic regression analysis and Bayesian distributed lag interaction model were used. DNA methylation microarray was analyzed using an Infinium Human Methylation EPIC BeadChip (Illumina, San Diego, California) in placenta. Results PM2.5 exposure during the first trimester of pregnancy, especially during 6 to 7 weeks of gestation, was associated with early-onset persistent AD. This effect increased in children with low CB vitamin D, especially in those with PM2.5 exposure during 3 to 7 weeks of gestation. AHRR (cg16371648), DPP10 (cg19211931), and HLADRB1 (cg10632894) were hypomethylated in children with AD with high PM2.5 and low CB vitamin D. Conclusion Higher PM2.5 during the first trimester of pregnancy and low CB vitamin D affected early-onset persistent AD, and the most sensitive window was 6 to 7 weeks of gestation. Placental DNA methylation mediated this effect.

GC/MS ingredient analysis and TD GC/MS analysis was performed to identify the components causing insecticidal activity among the variable components contained in jasmine tea. In the results, it was identified that the caffeine of 86.73% contained in the jasmine tea and the major essential oils in jasmine tea were delta-3-carene(23.61%), dllimonene(16.35%), 2-beta-pinene(14.70%) and alpha-pinene, (-)-(12.17%). It was examined the insecticidal effect of the ethanolic extracts of jasmine tea on house dust mites by concentrations(1.0, 0.5, 0.25, 0.125, 0.0625 ㎎/40㎕). At the concentration of extract 1 ㎎/40 ㎕ and 0.5 ㎎/40 ㎕, a mortality rate of 100% was observed. At the concentration of extract 0.25 ㎎/40㎕, the mortality rate of 91.25% was observed. At the concentration of extract 0.125 ㎎/40㎕, the mortality rate of 40% was observed. These results suggest that jasmine tea ethanol extract shows a high insecticidal effect (>91.25%) at concentrations of 0.25 ㎎/40 ㎕ or higher. The insecticidal effects of the caffeine standard and 9 kinds of essential oil standards contained in the jasmine tea were measured in order to verify the insecticidal effect of jasmine tea. The caffeine showed a high insecticidal effect (>74.09%) at concentrations of 0.125 ㎎/40 ㎕ or higher. The delta-3-carene showed a high insecticidal effect (>94%) at concentrations of 0.125 ㎎/40 ㎕ or higher and a 70.84% insecticidal effect at a concentration of 0.0625㎎/40㎕. 2-beta-pinene, trans-caryophyllene, and gamma-terpinene showed high insecticidal effects (>80%) at concentrations of 0.25㎎/40㎕ or higher.

Recent evidence suggests that mononuclear cells (MNCs) derived from bone marrow and cord blood can differentiate into mesenchymal stem cells (MSCs) or outgrowth endothelial cells (OECs). However, controversy exists as to whether MNCs have the pluripotent capacity to differentiate into MSCs or OECs or are a mixture of cell lineage-determined progenitors of MSCs or OECs. Here, using CD133+/C-kit+/Lin− mononuclear cells (CKL− cells) isolated from human umbilical cord blood using magnetic cell sorting, we characterized the potency of MNC differentiation. We first found that CKL− cells cultured with conditioned medium of OECs or MSCs differentiated into OECs or MSCs and this differentiation was also induced by cell-to-cell contact. When we cultured single CKL− cells on OEC- or MSC-conditioned medium, the cells differentiated morphologically and genetically into OEC- or MSC-like cells, respectively. Moreover, we confirmed that OECs or MSCs differentiated from CKL− cells had the ability to form capillary-like structures in Matrigel and differentiate into osteoblasts, chondrocytes, and adipocytes. Finally, using microarray analysis, we identified specific factors of OECs or MSCs that could potentially be involved in the differentiation fate of CKL− cells. Together, these results suggest that cord blood-derived CKL− cells possess at least bipotential differentiation capacity toward MSCs or OECs.

Objective To provide a standardized protocol for the measurement of cervical strain elastography, present its reproducibility, and analyze baseline clinical factors affecting the measurement of elastographic parameters. Methods This study was performed by the Korean Research Group of Cervical Elastography. We enrolled pregnant women according to our study protocol. After measuring the cervical length, elastography was performed using the E-Cervix™ quantification tool to measure the strain of the cervix using intrinsic compression. We evaluated 5 elastographic parameters, namely, the strain of the internal os of the cervix (IOS), strain of the external os of the cervix (EOS), ratio of the strain of IOS and EOS, elasticity contrast index, and hardness ratio. For baseline clinical factors, we examined the maternal body mass index, blood pressure, heart rate, uterine artery Doppler indices, and fetal presentation. Results We established a specific protocol for the measurement of cervical elastography using the E cervix program. For all elastographic parameters, the intra-observer intraclass correlation coefficient (ICC) ranged from 0.633 to 0.723 for single measures and from 0.838 to 0.887 for average measures, and the inter-observer ICC ranged from 0.814 to 0.977 for single measures and from 0.901 to 0.988 for average measures. Regression analysis showed that the measurement of the elastographic parameter was not affected by baseline clinical factors. Conclusion We present a standardized protocol for the measurement of cervical elastography using intrinsic compression. According to this protocol, reproducibility was acceptable and the measurement of elastographic parameters was not affected by the baseline clinical factors studied.

Purpose Prenatal maternal stress affects offspring's atopic dermatitis (AD) development, which is thought to be mediated by the oxidative stress. We aimed to evaluate the difference in leukocyte telomere length (LTL), a marker for exposure to oxidative stress, according to the prenatal stress exposure and the later AD development. Methods From a birth cohort (the COhort for Childhood Origin of Asthma and allergic diseases) that had displayed a good epidemiologic association between the exposure to prenatal stress and AD development in the offspring, we selected 68 pairs of samples from 4 subject groups based on the level of prenatal maternal stress and later AD development. The LTL was measured from both cord blood and 1-year peripheral blood, and their LTLs were compared between subject groups. Finally, the proportion of AD development was examined in the subject groups that are reclassified based on subjects' exposure to prenatal stress and there LTL. Results Cord-blood LTL was shorter in prenatally stressed infants than in unstressed ones (P = 0.026), which difference was still significant when subjects became 1 year old (P = 0.008). LTL of cord blood, as well as one of the 1-year peripheral blood, was not different according to later AD development at 1 year (P = 0.915 and 0.174, respectively). Shorter LTL made no increase in the proportion of later AD development in either prenatally high-stressed or low-stressed groups (P = 1.000 and 0.473, respectively). Conclusions Cord-blood LTL may reflect subjects' exposure to maternal prenatal stress. However, the LTL shortening is not a risk factor of increasing AD development until the age of 1, and a longer investigation may be necessary for validation. Currently, the results doubt the role of LTL shortening as a marker for risk assessment tool for the prenatal stress associated with AD development in the offspring.

Individuals delivered from preeclamptic pregnancies exhibit a long-term increased risk of developing cardiovascular and metabolic diseases, likely caused by aberrant fetal cell reprogramming incurred in utero. The present study investigated the functional impairment and epigenetic changes exhibited by endothelial progenitor cells derived from offspring born to preeclamptic pregnancies.The capacity of CD133The preeclampsia-derived CKLExposure to preeclampsia significantly and irreversibly reduced CKL

Objective In this study, we evaluated the prevalence of allergic disease in offsprings delivered via the delivery modes of vaginal delivery vs. planned Cesarean section vs. Cesarean section with labor. Methods This study included 175 mother-neonate pairs from Severance Hospital who were enrolled in the Cohort for Childhood Origin of Asthma and allergic diseases study. Information regarding prenatal environmental factors, delivery, and diagnosis of allergic diseases was obtained from a questionnaire and medical record review. Patients with at least 3 years of follow-up data were included in this study. Results were adjusted for sex, birth weight, gestational age at birth, season of birth, neonatal intensive care unit admission, parity, breastfeeding, and maternal factors. Results A total of 175 offsprings were eligible for analysis. Among the subjects, 52.0% were delivered by vaginal delivery, 34.3% by planned Cesarean section, and 16.6% by Cesarean section with labor. Fifty-nine offsprings (33.7%) were diagnosed with allergic disease at a median age of 1 year (range 0.5-3 years). The prevalence of allergic disease was not associated with delivery mode after adjusting for confounding variables. Time period from membrane rupture to delivery, duration of the active phase, and the beginning of the pelvic division prior to Cesarean section were not associated with allergic disease development in offsprings. Conclusion Cesarean section, irrespective of the occurrence of labor before surgery, did not increase the prevalence of allergic disease in infants up to 3 years of age.

Pregnancy is a unique immunologic and microbial condition that requires an adequate level of awareness to provide a fast and protective response against pathogens as well as to maintain a state of tolerance to paternal antigens. Dysregulation of inflammatory pathways in the placenta triggered by pathogens is one of the main factors responsible for pregnancy complications. Type I IFNs are key molecules modulating immune responses at the level of the placenta and are crucial for protection of the pregnancy via their antiviral and immune modulatory properties. In this study, we elucidate the mechanisms controlling the basal expression of IFNβ and its negative feedback. Using in vitro and in vivo animal models, we found that TLR signaling maintains basal IFNβ levels through the TLR4-MyD88-independent TBK/IRF3 signaling pathway. We describe the role of the TAM receptor Axl in the regulation of IFNβ function in human and mouse trophoblast cells. The absence of TAM receptors in vivo is associated with fetal demise due to dysregulation of IFNβ expression and its pro-apoptotic downstream effectors. Collectively, our data describe a feedback signaling pathway controlling the expression and function of IFNβ in the trophoblast that is essential for an effective response during viral and microbial infections.

Problem Preeclampsia (PE) is a serious pregnancy complication leading to high maternal, perinatal morbidity, and mortality. We aimed to investigate the clinical effectiveness of the platelet-to-lymphocyte ratio (PLR) in women with PE and compare this measurement to platelet indices as a diagnostic and prognostic marker of PE. Method of study A total of 471 healthy pregnant women, 126 women diagnosed with mild PE, and 227 with severe PE were included in this retrospective study. We analyzed PLR and platelet indices, mainly mean platelet volume (MPV) and platelet distribution width (PDW) among the 3 groups. Results Platelet distribution width, MPV, and PLR levels in women with PE were significantly different from those of healthy pregnant women. PLR was significantly lower in severe PE than mild PE (P = .001), but PDW and MPV increased as severity of PE progressed; however, the differences in PDW and MPV between women with mild and severe PE were not significant. Receiver operating characteristic curve analysis showed that PLR was more predictive of PE than PDW and MPV (Area under the curve = 0.759 vs 0.621, 0.638). Additionally, the time interval from admission to delivery was significantly shorter in women with PLR-positive (≤116) than in women with PDW-positive (>58) and MPV-positive (>9). Conclusion The PLR is an easily accessible and cost-effective parameter, which may be used as a more useful marker for prediction of PE compared to platelet indices. Our study showed that PLR can serve as a useful diagnostic marker of PE.

Problem The lymphatic vasculature controls leukocytes trafficking and limits the adaptive immune response. In previous models of preeclampsia (PE), defective immune function caused by disruption of lymphangiogenesis was shown to be involved in the disease pathophysiology. Especially, the dysfunction of regulatory T cells (Treg) at the maternal-fetal interface may be one of the causes of severe PE. In particular, activation of Tregs to obtain immune tolerance requires adequate antigen presentation through the lymphatic system. We hypothesized that impaired lymphangiogenesis and imbalanced Tregs at the maternal-fetal interface are associated with the pathophysiology of severe PE. However, the current research addressing this hypothesis is limited. Therefore, to compare differences in lymphangiogenesis in severe PE and normal conditions, we aimed to examine the location of lymphatics at the maternal-fetal interface and to investigate the association between lymphangiogenesis and Tregs in severe PE. Method of study We obtained entire uterus from normal pregnant mice. Placental and fetal membranes, including decidua, were obtained from 10 pregnant women with severe PE and 10 gestational age-matched controls. Immunohistochemistry for LYVE1 was used to localize the distribution of lymphatic vessels and CD4, CD25, and FOXP3 for Treg. Results LYVE1-positive vessels were present in the uterine wall of mice. LYVE1-positive lymphatic vessels were localized on the human decidua. Tubular lymphatics were abundant in the control decidua, but significantly reduced in severe PE. Furthermore, lymphatic vessel density correlated with the number of decidual Tregs. Conclusion Abnormal decidual lymphangiogenesis is associated with reduced numbers of decidual Tregs in severe PE.

The implications of low values on the 50 g glucose challenge test (GCT) in pregnancy are not clearly defined. Few studies have evaluated the influence of maternal low GCT values on obstetrical outcomes. This study aimed to compare pregnancy outcomes between women with low 50 g GCT values and those with normal values.Women undergoing gestational diabetes mellitus screening at 24-28 weeks of gestational age between January 2010 and December 2016 were retrospectively evaluated. Women with multifetal pregnancies, prepregnancy type I or II diabetes, GCT performed before 24 or after 28 weeks of gestational age, and women undergoing multiple GCTs in the same pregnancy were excluded. Low GCT values and normal GCT values were defined as ≤85 mg/dL and 86-130 mg/dL, respectively.Of 3875 screened subjects, 519 (13.4%) women were included in the low GCT group and 3356 (86.6%) in the normal GCT group. Low GCT women had a significantly higher rate of small for gestational age (SGA) infants than normal GCT women (10.8% vs. 7.9%, p = 0.02). Cesarean section and postpartum hemorrhage (PPH) were less frequent in low GCT women than in normal women (32.6% vs. 42.8%, p 0.01 and 0.2% vs. 1.2%, p = 0.03, respectively). Low GCT women had a 1.38-fold increased risk of bearing SGA infants (95% confidence intervals: 1.01-1.88, p = 0.04).Rate of SGA infants was significantly higher and cesarean delivery and PPH rates were significantly lower in women with low GCT values. Low GCT values were independently associated with an increased risk of SGA.

Objective To compare the outcomes of postpartum hemorrhage (PPH) episodes before and after the introduction of a clinical pathway known as the Severance Protocol to save postpartum bleeding through Expeditious care Delivery (SPEED). Design This study was designed as a retrospective analysis. Setting The study was conducted in a hospital implementing SPEED. Participants The non-SPEED group included 74 patients with PPH who were treated before the introduction of SPEED, whereas the SPEED group included 155 patients. Methods Differences in outcomes were compared between groups. Main Outcome Measures Reduction in treatment duration was the primary outcome measure, whereas uterus preservation was the secondary. Results No significant intergroup differences were observed for hemoglobin levels, hematocrit values and vital signs upon patients' emergency room arrival. The turnaround time for hemoglobin, mean duration until treatment by obstetricians and gynecologists and duration between chest radiography ordering and performance significantly differed between the two groups (SPEED, 10.0 [1.0–30.0], 3.0 [0–25.0] and 23.0 [1.0–86.0] min, respectively; non-SPEED, 17.0 [1.0–37.0], 12.0 [0–62.0] and 46.0 [1.0–580.0] min, respectively; P < 0.001). Similarly, the mean duration until transfusion of cross-matched red blood cells (SPEED, 77.6 ± 58.6 min; non-SPEED, 103.4 ± 64.4 min; P = 0.015) and uterus preservation rate (SPEED, 90.1% [136/151]; non-SPEED, 81.7% [58/71]; P = 0.043) also differed significantly between the groups. Conclusions Clinical pathways enable prompt and efficient care for patients experiencing PPH through faster evaluation and access to red blood cell transfusion, resulting in a decrease in maternal mortality.

OBJECTIVES To evaluate the potential value of uterine artery Doppler velocimetry in diagnosing placenta accreta. METHODS Clinical records of all deliveries between April 1991 and March 2013 were retrospectively analyzed. Cases of intrauterine growth restriction, pregnancy-induced hypertension, multiple pregnancies, fetal anomalies, chromosomal abnormalities, and maternal medical illnesses such as cardiovascular disease, renal disease, and diabetes mellitus were excluded. A total of 11,210 cases were evaluated, including 403 cases of placenta previa without accreta (placenta previa) and 39 cases of placenta previa with accreta (placenta accreta). All patients underwent uterine artery Doppler velocimetry to measure the mean resistive index and pulsatility index (PI) in the third trimester. The analysis included participant characteristics such as age, parity, abortion history, previous cesarean delivery, gestational age at delivery, neonatal sex, and birth weight. RESULTS The mean uterine artery PI was significantly lower in the placenta accreta group compared to previa alone (0.51 versus 0.57; P = .002). The odds ratios for placenta accreta were 2.4 for 2 or more previous abortions (P = .011) and 5.3 and 7.0 for 1 and 2 or more previous cesarean deliveries (P = .001 and .005). With an increase in the mean PI by 0.01, the odds ratio for placenta accreta decreased by 0.94 (P < .001). The area under the receive operating characteristic curve was 0.72 for previous cesarean delivery alone, increasing to 0.77 with the combination of the mean PI and previous cesarean delivery (P = .047). CONCLUSIONS This study suggests that the mean PI measured by uterine artery Doppler velocimetry is reduced in patients with placenta accreta compared to those without accreta. The diagnostic accuracy of placenta accreta can be potentially improved if uterine artery Doppler values and the history of cesarean delivery are combined.

본 연구는 자녀실종이후 실종아동부모가 경험한 가족의 삶을 현상학적 연구방법을 통해 심층적으로 이해하였다. 이를 위해 8명의 실종아동가족의 부모를 연구참여자로 선정하였고, 자녀실종이후 부모의 가족생활경험을 자녀의 실종당시, 자녀 찾기와 남아있는 가족 사이, 가족을 지키기 위한 노력과 앞으로의 삶을 중심으로 살펴보았다. 연구참여자들은 모두 갑작스런 자녀의 행방불명으로 ‘청천벽력의 생이별’의 자녀실종을 경험하였다. 이후 실종자녀를 찾는 과정에서 연구참여자들의 삶의 터전은 황무지화되고, 가족의 삶은 자녀가 실종된 그 때의 시간에 갇히게 되고, 부부관계의 파국과 심신의 황폐화에 이르는 위기에 맞닥뜨리게 되는데 이는 ‘생지옥의 아비규환’으로 체험되고 있었다. 결국 연구참여자들은 생지옥 속에서 살아내기 위한 노력을 하게 된다. 이 과정에서 연구참여자들은 가족 스스로 ‘자력갱생’의 노력과 자조모임, 가족지원서비스를 이용하는데 이는 ‘지옥에서 붙잡은 지푸라기’로 체험되고 있었다. 연구참여자의 현재와 앞으로의 삶은 ‘놓을 수 없는 손’인 실종자녀를 찾는 일과 ‘놓칠 수 없는 손’인 남아 있는 가족과의 ‘공존공생’으로 체험되고 있었다. 마지막으로 위기에 노출되어 있는 실종아동가족을 지원하기 위한 가족사회복지에 대한 함의를 논의하였다.

As the ability to control the differentiation of endothelial stem/progenitor cells (EPCs) into vascular endothelial cell lineages could be useful for promoting neovascularization, it is important to obtain a deeper understanding of the epigenetic mechanisms that regulate EPC differentiation and neovascularization. Heterochromatin protein 1α (HP1α) is known to be involved in the epigenetic regulation of gene silencing. However, recent reports demonstrate that HP1α can also activate gene expression during cell differentiation. In this study, microarray analysis revealed that HP1α expression was induced during EPC differentiation and is associated with the expression of outgrowing endothelial cell (OEC)-specific protein markers. To explore the role of HP1α in the differentiation of EPCs to OECs, its expression was knocked-down or over-expressed in differentiating EPCs. Overexpression of HP1α promoted the differentiation and angiogenic activity of EPCs in vitro and in vivo, whereas knockdown of HP1α led to a defect in OEC migration, tube formation, and angiogenic sprouting activity. Gene expression profiling showed increased expression of angiogenic genes, including NOTCH1, cadherin-5, and angiopoietin-like-2, and decreased expression of progenitor cell marker genes, including CD133, CXCR4, and C-KIT, in HP1α-overexpressing EPCs. Also, increased HP1α at an early stage of EPC differentiation may regulate angiogenic gene transcription by interacting with chromatin that modifies epigenetic factors such as the methyl-CpG binding domain, Polycomb group ring finger 2, and DNA methyltransferases. Our findings demonstrate, for the first time, that HP1α plays an important role in the differentiation and angiogenic function of EPCs by regulating endothelial gene expression. Stem Cells 2015;33:1512–1522

The purpose of this study is to develop a natural functional material with insecticidal properties and antimicrobial activity for the application of emotional robot development for the early treatment use of children with autism spectrum disorder. As a part of the study, I investigate the antimicrobial activity of silk fabrics dyed with jasmine tea and jasmine petal tea extracts. Bacteria used for the test of antimicrobial activity were Staphylococcus aureus ATCC 6538 and Klebsiella pneumoniae ATCC 4352. The presence of phenol, known as an antimicrobial component, was measured from jasmine tea and jasmine petal tea extracts. UVVis analysis and FT-IR analysis were also employed. Silk fabrics dyed with jasmine tea extracts appeared to have significant antimicrobial activity of 99.9% for S. aureus, regardless of dyeing concentration. On K. pneumoniae, silk fabrics dyed with stock solution and one­half­fold diluted solution of jasmine tea extracts presented significantly high antimicrobial activity of 99.9%. In contrast, no antimicrobial activity was observed from all silk fabrics dyed with jasmine petal tea extracts, regardless of the type of bacteria. On S. aureus following 20 hours of irradiation, silk fabrics dyed with jasmine tea extracts presented high antimicrobial activity of 93.3%, regardless of dyeing concentration. On K. pneumoniae after 20 hours of irradiation, only the silk fabric dyed with a stock solution of jasmine tea extracts appeared to have any antimicrobial activity (40.6%). On S. aureus after dry cleaning, silk fabrics dyed with jasmine tea extract had significantly higher antimicrobial activity of 99.9%, identical to its effectiveness before dry cleaning, regardless of the dyeing concentration. On K. pneumoniae after dry cleaning, silk fabrics dyed with stock solution and one­half­fold diluted solution of jasmine tea extracts had significantly higher antimicrobial activity of 99.9%, identical to their effectiveness before dry cleaning. The total phenol content was higher in the jasmine tea than in the jasmine petal tea. From the results of UV-Vis analysis, the ethanol extraction solution of jasmine tea and jasmine petal tea had absorption maximums of λ max at 272 ㎚ and 277㎚ (λ max of tannin is 272­285 nm), respectively. From the results of FT-IR analysis, jasmine tea and jasmine petal tea showed three main common absorption bands in the 1750­700 ㎝ -1 range: 1615­1606, 1518­1507, and 1043­ 1030㎝ -1 . Therefore, it was able to be determined that the form of tannin obtained in jasmine

Aim: To assess whether maternal serum C-reactive protein (CRP) and genital mycoplasmas measured can help predict imminent preterm delivery or chorioamnionitis in patients with preterm labor (PL) or preterm premature rupture of membranes (PPROM). Methods: The study group consisted of 165 women with PL or PPROM. Vaginal cultures for genital mycoplasmas and maternal blood for CRP were obtained when they were admitted for the management of PL or PPROM. An elevated level of serum CRP was defined as ≥0.8 mg/dL. Histologic evaluation of the placenta was performed after delivery. Results: The prevalence of positive vaginal fluid cultures for Ureaplasma urealyticum (UU) was 63.0%, and elevated maternal serum CRP was 32.7%. No outcome variables were associated with vaginal UU infection in patients with lower CRP levels. However, among women with elevated CRP, the mean gestational age at birth was significantly reduced, and low Apgar score, neonatal intensive care unit admission, histologic chorioamnionitis, and delivery within 7 days of admission were significantly more common in patients with vaginal UU. Conclusions: Although vaginal UU in PL or PPROM cannot act as the sole predictor of imminent preterm delivery or chorioamnionitis, it can provide predictive information in patients with elevated maternal serum CRP levels.

Problem The pathophysiology of preeclampsia (PE) is believed to be associated with a systemic inflammatory response, but few inflammatory markers are currently available to predict PE. Therefore, the aim of this study was to compare the serum delta neutrophil index (DNI) between normal and preeclamptic women. Methods Sixty-five patients with mild preeclampsia (mPE), 147 patients with severe preeclampsia (sPE), and 163 women with normal pregnancy were included in this study. Maternal laboratory values including DNI were compared among the three groups. Results The mean DNI was significantly higher in the sPE group, but there was no significant difference between the normal pregnancy group and mPE. The DNI also showed positive correlation with systolic and diastolic blood pressures, mean arterial pressure, proteinuria during 24 hours, proteinuria in dipstick, and ominous symptoms. Conclusion The serum DNI value was increased in women with severe preeclampsia compared to that in those with normal pregnancy or mild preeclampsia. Further studies are needed to evaluate application of the DNI value as a prognostic marker of preeclampsia.

Differentiation of umbilical cord blood derived mononuclear cells to endothelial cells is accompanied by massive changes in gene expression. Although methylation and demethylation of DNA likely play crucial roles in regulating gene expression, their interplay during differentiation remains elusive. To address this question, we performed deep sequencing of DNA methylation and mRNA expression to profile global changes in promoter methylation and gene expression during differentiation from mononuclear cells to outgrowing cells. We identified 61 downregulated genes with hypermethylation, including CD74, VAV1, TLR8, and NCF4, as well as 21 upregulated genes with hypomethylation, including ECSCR, MCAM, PGF, and ARHGEF15. Interestingly, gene ontology analysis showed that downregulated genes with hypermethylation were enriched in immune-related functions, and upregulated genes with hypomethylation were enriched in the developmental process and angiogenesis, indicating the important roles of DNA methylation in regulating differentiation. We performed polymerase chain reaction analyses and bisulfite sequencing of representative genes (CD74, VAV1, ECSCR, and MCAM) to verify the negative correlation between DNA methylation and gene expression. Further, inhibition of DNA methyltransferase and demethylase activities using 5'-aza-dc and shRNAs, specific for TET1 and TET2 mRNAs, respectively, revealed that DNA methylation was the main regulator of the reversible expression of functionally important genes. Collectively, our findings implicate DNA methylation as a critical regulator of gene expression during umbilical cord blood derived mononuclear cells to endothelial cell differentiation.

Ultrasound diagnosis is routinely used in obstetrics and gynecology for fetal biometry, and owing to its time-consuming process, there has been a great demand for automatic estimation. However, the automated analysis of ultrasound images is complicated because they are patient specific, operator dependent, and machine specific. Among various types of fetal biometry, the accurate estimation of abdominal circumference (AC) is especially difficult to perform automatically because the abdomen has low contrast against surroundings, nonuniform contrast, and irregular shape compared to other parameters. We propose a method for the automatic estimation of the fetal AC from two-dimensional ultrasound data through a specially designed convolutional neural network (CNN), which takes account of doctors' decision process, anatomical structure, and the characteristics of the ultrasound image. The proposed method uses CNN to classify ultrasound images (stomach bubble, amniotic fluid, and umbilical vein) and Hough transformation for measuring AC. We test the proposed method using clinical ultrasound data acquired from 56 pregnant women. Experimental results show that, with relatively small training samples, the proposed CNN provides sufficient classification results for AC estimation through the Hough transformation. The proposed method automatically estimates AC from ultrasound images. The method is quantitatively evaluated and shows stable performance in most cases and even for ultrasound images deteriorated by shadowing artifacts. As a result of experiments for our acceptance check, the accuracies are 0.809 and 0.771 with expert 1 and expert 2, respectively, whereas the accuracy between the two experts is 0.905. However, for cases of oversized fetus, when the amniotic fluid is not observed or the abdominal area is distorted, it could not correctly estimate AC.

The purpose of this research is to design develop an early model for the use of early treatment that will improve the social interactions of children with ASD. Researchers from the department of social welfare, electrical engineering, industrial design, and fashion design carried out a fusion research for this purpose. The department of social welfare conducted a survey with professional therapists in order to first find out the necessary treatment components of the cat robot. The department of electrical engineering gave technical suggestions on the practical functions of the robot such as movements and emotional exchanges with humans. In addition, the department of industrial design proposed the robot’s exterior, movement, and character designs. Considering that the robot will be used as a therapeutic medium for children, they also developed an eco-friendly material in order to prevent infection and other hygienic problems and also improve the therapeutic effects of the robot. According to the result of FGI’s analysis, elements of function and motion have to be prepared for a cat robot was grasped. In consideration of these elements, guidelines to the construction of shape and motions for the design of the cat robot were established. By applying these guidelines, the design of outer shape of the cat robot was developed. And a cat robot’s structures, electrical circuits, and driving program for the treatment of children with ASD were suggested. Design of the cat robot’s Outer shape has to be developed to match inside structure of the cat robot, and the early model of the cat robot has to be completed to match these criteria.

Progress in our understanding of the role of the maternal immune system during healthy pregnancy will help us better understand the role of the immune system in adverse pregnancy outcomes. In this review, we discuss our present understanding of the 'immunity of pregnancy' in the context of the response to cervical and placental infections and how these responses affect both the mother and the fetus. We discuss novel and challenging concepts that help explain the immunological aspects of pregnancy and how the mother and fetus respond to infection.

Background Oxytocin (OXT) has been reported to act as a growth regulator in various tumor cells. However, there is a paucity of data on the influence of OXT on cell proliferation of corticotroph adenomas. This study aimed to examine whether OXT affects cell growth in pituitary tumor cell lines (AtT20 and GH3 cells) with a focus on corticotroph adenoma cells. Methods Reverse transcription polymerase chain reaction and enzyme-linked immunosorbent assay were conducted with AtT20 cells to confirm the effects of OXT on hormonal activity; flow cytometry was used to assess changes in the cell cycle after OXT treatment. Moreover, the impact of OXT on proliferating cell nuclear antigen (PCNA), nuclear factor κB, and mitogen-activated protein kinase signaling pathway was analyzed by Western blot. Results OXT treatment of 50 nM changed the gene expression of OXT receptor and pro-opiomelanocortin within a short time. In addition, OXT significantly reduced adrenocorticotropic hormone secretion within 1 hour. S and G2/M populations of AtT20 cells treated with OXT for 24 hours were significantly decreased compared to the control. Furthermore, OXT treatment decreased the protein levels of PCNA and phosphorylated extracellular-signal-regulated kinase (P-ERK) in AtT20 cells. Conclusion Although the cytotoxic effect of OXT in AtT20 cells was not definite, OXT may blunt cell proliferation of corticotroph adenomas by altering the cell cycle or reducing PCNA and P-ERK levels. Further research is required to investigate the role of OXT as a potential therapeutic target in corticotroph adenomas.