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Leaving the placenta in situ versus conservative and radical surgery in the treatment of placenta accreta spectrum disorders. EM seems to be an alternative to cesarean HE especially for patients with unfinished family planning or cases of severe placenta percreta with organ invasion [[3], [13]]. 10.1186/s12884-017-1634-8 9 Miyakoshi K, Otani T, Kondoh E. Retrospective multicenter study of leaving the placenta in situ for patients with placenta previa on a cesarean scar. [Extracted from the article]

BackgroundOne life event that requires extensive resilience and adaptation is parenting. However, resilience and perceived support in child-rearing vary, making the real-world situation unclear, even with postpartum checkups. ObjectiveThis study aimed to explore the psychosocial status of mothers during the child-rearing period from newborn to toddler, with a classifier based on data on the resilience and adaptation characteristics of mothers with newborns. MethodsA web-based cross-sectional survey was conducted. Mothers with newborns aged approximately 1 month (newborn cohort) were analyzed to construct an explainable machine learning classifier to stratify parenting-related resilience and adaptation characteristics and identify vulnerable populations. Explainable k-means clustering was used because of its high explanatory power and applicability. The classifier was applied to mothers with infants aged 2 months to 1 year (infant cohort) and mothers with toddlers aged >1 year to 2 years (toddler cohort). Psychosocial status, including depressed mood assessed by the Edinburgh Postnatal Depression Scale (EPDS), bonding assessed by the Postpartum Bonding Questionnaire (PBQ), and sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI) between the classified groups, was compared. ResultsA total of 1559 participants completed the survey. They were split into 3 cohorts, comprising populations of various characteristics, including parenting difficulties and psychosocial measures. The classifier, which stratified participants into 5 groups, was generated from the self-reported scores of resilience and adaptation in the newborn cohort (n=310). The classifier identified that the group with the greatest difficulties in resilience and adaptation to a child’s temperament and perceived support had higher incidences of problems with depressed mood (relative prevalence [RP] 5.87, 95% CI 2.77-12.45), bonding (RP 5.38, 95% CI 2.53-11.45), and sleep quality (RP 1.70, 95% CI 1.20-2.40) compared to the group with no difficulties in perceived support. In the infant cohort (n=619) and toddler cohort (n=461), the stratified group with the greatest difficulties had higher incidences of problems with depressed mood (RP 9.05, 95% CI 4.36-18.80 and RP 4.63, 95% CI 2.38-9.02, respectively), bonding (RP 1.63, 95% CI 1.29-2.06 and RP 3.19, 95% CI 2.03-5.01, respectively), and sleep quality (RP 8.09, 95% CI 4.62-16.37 and RP 1.72, 95% CI 1.23-2.42, respectively) compared to the group with no difficulties. ConclusionsThe classifier, based on a combination of resilience and adaptation to the child’s temperament and perceived support, was able identify psychosocial vulnerable groups in the newborn cohort, the start-up stage of childcare. Psychosocially vulnerable groups were also identified in qualitatively different infant and toddler cohorts, depending on their classifier. The vulnerable group identified in the infant cohort showed particularly high RP for depressed mood and poor sleep quality.

Vertebral hemangiomas are the most common benign lesion of the spine which are often an asymptomatic incidental finding. However, a few hemangiomas are aggressive and characterized by bone expansion and extraosseous extension into the paraspinal and epidural spaces. We report the case of a patient presenting an aggressive vertebral hemangioma causing back pain and bilateral numbness of the legs. Among various treatment modalities, a minimally invasive percutaneous sclerotherapy procedure using ethanolamine oleate under computed tomography and fluoroscopic guidance was safely and successfully performed with good clinical outcomes.

Body dissatisfaction during pregnancy can significantly impact maternal and child health. Therefore, this longitudinal study investigated changes in body dissatisfaction using two figure rating scales developed from photographic digital data of Japanese pregnant women during the sixth and tenth months of pregnancy. Study participants were recruited at their sixth month prenatal visit at a primary maternity clinic in Japan from October 2014 to March 2015. Body dissatisfaction was estimated based on the perceived and ideal body sizes of 135 pregnant women, expressed as body mass index. Data were collected using selfadministered questionnaires. The study found that body dissatisfaction in the tenth month was significantly higher than that in the sixth month. Among the participants, 75 (55.6%) and 79 (58.5%) experienced body dissatisfaction, desiring to be thinner (where perceived body size exceeded ideal body size) during the sixth and tenth months of pregnancy, respectively. Pregnant women who had body dissatisfaction and a desire to be thinner in the sixth month tended to experience an increase in body dissatisfaction by the tenth month compared to those without body dissatisfaction in the sixth month. During the sixth and tenth months, women with body dissatisfaction showed significantly larger perceived body sizes than those without body dissatisfaction. These results indicated that the use of a figure rating scale at the sixth month of pregnancy may help identify women with body dissatisfaction; moreover, perceived body size might be a key factor in preventing an increase in body dissatisfaction from the second to third trimesters. [ABSTRACT FROM AUTHOR]

IntroductionAutism spectrum disorder (ASD) is a neurodevelopmental disorder clinically characterized by abnormalities in eye contact during social exchanges. We aimed to clarify whether the amount of gaze fixation, measured at the age of 6 years using Gazefinder, which is an established eye-tracking device, is associated with ASD symptoms and functioning.MethodsThe current study included 742 participants from the Hamamatsu Birth Cohort Study. Autistic symptoms were evaluated according to the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), and the functioning of the participating children in real life was assessed using the Japanese version of the Vineland Adaptive Behavior Scales, Second Edition (VABS-II). The Gazefinder system was used for gaze fixation rates; two areas of interest (eyes and mouth) were defined in a talking movie clip, and eye gaze positions were calculated through corneal reflection techniques.ResultsThe participants had an average age of 6.06 ± 0.14 years (males: 384; 52%). According to ADOS, 617 (83%) children were assessed as having none/mild ASD and 51 (7%) as severe. The average VABS-II scores were approximately 100 (standard deviation = 12). A higher gaze fixation rate on the eyes was associated with a significantly lower likelihood of the child being assigned to the severe ADOS group after controlling for covariates (odds ratio [OR], 0.02; 95% confidence interval [CI], 0.002–0.38). The gaze fixation rate on the mouth was not associated with ASD symptoms. A higher gaze fixation rate on the mouth was associated with a significantly lower likelihood of the child being assigned to the low score group in VABS-II socialization after controlling for covariates (OR, 0.18; 95% CI, 0.04–0.85). The gaze fixation rate on the eyes was not associated with functioning.ConclusionWe found that children with low gaze fixation rates on the eyes were likely to have more ASD symptoms, and children with low gaze fixation rates on the mouth were likely to demonstrate poorer functioning in socialization. Hence, preschool children could be independently assessed in the general population for clinically relevant endophenotypes predictive of ASD symptoms and functional impairments.

Background: The guidelines for the requirement of Legionella urinary antigen tests on admission for patients hospitalized with community-acquired pneumonia differ in Japan, the United States, and Europe. We aimed to evaluate the association between the timing of Legionella urinary antigen testing and inhospital mortality in patients with atypical pneumonia. Methods: We identified 654,708 patients with atypical pneumonia from July 2010 to March 2021 using the Japanese national inpatient database. The patients were divided into groups that underwent Legionella urinary antigen tests on the day of admission (test group, n = 229,649) and those that underwent testing after the day of admission or were untested (control group, n = 425,059). A propensity score-stabilized inverse probability of treatment weighting analysis was performed to compare inhospital mortality, length of hospital stay, and total hospitalization costs between the two groups. Odds ratios (ORs) or differences and their 95% confidence intervals (CIs) were calculated using generalized linear models. Results: The tested group had a significantly lower 30-day inhospital mortality than that of the control group (7.7% vs. 9.0%; OR: 0.83 [95% CIs, 0.81–0.86]). The tested group also had a significantly shorter length of stay (difference, −2.3 [−2.6 to − 2.0] days and total hospitalization costs (−396 [−508 to − 285] US dollars) than that of the control group. Conclusions: Legionella urinary antigen testing upon admission is associated with better outcomes in patients with atypical pneumonia. Legionella urinary antigen testing performed on the day of admission is recommended for hospitalized patients with atypical pneumonia.

Abstract Background Traditional menstruation practices in Nepal (Chhaupadi in Nepalese) lack scientific support and undermine women’s health. This study aimed to understand the changes in the traditional menstruation practices due to migration from Nepal to Japan. Methods This study included 104 Nepalese women of reproductive age living in an urban area of western Japan. Participants were recruited using snowball sampling, and the method of data collection was a questionnaire survey. To examine how Nepalese women adapt traditional menstruation practices to their living environment, we compared how women followed frequently 17 traditional practices when they lived in Nepal and later in Japan. We examined the relationships among behavioural changes in traditional practices, education level, and caste. Results The frequency of 14 of the 17 traditional practices decreased after the women moved to Japan. Among women who reduced the frequency of traditional practices after moving from Nepal to Japan, the reduction was not associated with educational level or caste of the participants. Conclusions This study suggests that the attitudes towards the traditional menstruation practices change in response to living circumstances. Future studies should focus on determining living environment factors related to behavioural changes in traditional practices.

Plain Language Summary For sexually mature women, menstruation may be considered burdensome, but its absence may also be a source of concern. Perceptions regarding menstruation are collectively referred to as menstrual attitudes. Previous studies have reported that negative menstrual attitudes are associated with various reproductive health issues in women and vary according to social and cultural backgrounds. To adequately evaluate negative menstrual attitudes among Nepalese women (20–45 years old), we developed a 15-item scale that considers their cultural background and literacy. We observed that attitudes toward menstruation among Nepalese women consisted of three emotions: one positive emotion, including “menstruation is a natural phenomenon”, and two negative emotions, including “menstruation is debilitating” and “menstruation is bothersome”. In several developing countries, menstruating women are considered unclean, and various restrictions are imposed on women during menstruation (traditional menstrual practices). Nepalese women with strong negative menstrual attitudes, as assessed by our scale, engaged in several traditional menstrual practices with higher frequency. We also observed that women with more negative menstrual attitudes presented with more severe menstrual pain. Our scale was developed to be compatible with the values and literacy of Nepalese women and was easy to answer. We believe that reducing negative emotions toward menstruation will contribute to reducing the frequency of traditional menstrual practices and menstrual pain, thereby facilitating school attendance and entry into the workforce among women in Nepal.

Accessory scrotum (AS) is rarely diagnosed antenatally, and its prenatal features remain unknown. Here, we report a case of a prenatally diagnosed accessory scrotum with perineal lipoma. A 33-year-old woman was referred to our hospital at 35 weeks of gestation to evaluate a mass in the fetal perineal region. Prenatal ultrasonography showed a 2.0 × 2.0 cm sized, echogenic, and circular mass located posterior to the left scrotum in a male fetus. Magnetic resonance imaging (MRI) showed a mass containing adipose tissue. A 6.5 cm elastic mass (AS and protruding lipoma) was observed in the perineal region, and surgical excision was performed at 8 months of age. Histological examination confirmed the diagnosis of AS with perineal lipoma, and there was no recurrence at follow-up. The typical prenatal presentation of AS was a circular perineal mass located posterior to the normal scrotum and was associated with perineal lipoma. The prenatal detection of AS was feasible with careful observation via ultrasonography, and prenatal MRI was useful in characterizing perineal tumors and evaluating associated anomalies.

Abstract Background Adapting to child-rearing is affected by multiple factors, including environmental and individual factors. Previous studies have reported the effect of a single factor on childcare maladjustment; however, to prevent maladaptation in and to support child-rearing, a comprehensive evaluation of factors is necessary. Therefore, this study developed a comprehensive assessment tool for childcare adaptation. Methods We conducted semi-structured interviews with specialists whose jobs entailed supporting parents. Items were extracted from the interview data and used to develop a new questionnaire. Mothers with a child aged 0–3 years completed the Quick Inventory of Depressive Symptomatology as a depression index. We performed both factor and correlation analyses on the collected, data and multiple regression analyses to determine which factors predict depressive tendencies leading to childcare maladaptation. Subsequently, an assessment algorithm model was built. Results 1,031 mothers responded to the questionnaire which had 118 items in five domains. A factor analysis was performed on each domain to develop the Comprehensive Scale for Parenting Resilience and Adaptation (CPRA). The CPRA comprised 21 factors and 81 items in five subcategories: Child’s Temperament and Health (1 factor, 5 items); Environmental Resources (5 factors, 20 items), Perceived Support (4 factors, 15 items); Mother’s Cognitive and Behavioural Characteristics (6 factors, 22 items), and Psychological Adaptation to Parenting (5 factors, 19 items). Correlations between all factors and depressive symptoms were identified. Depressive symptoms were predicted by factors from four subcategories: Environmental Resources, Perceived Support, Mother’s Cognitive and Behavioural Characteristics, and Psychological Adaptation to Parenting. A comprehensive model of mothers’ psychological adjustment was developed using the CPRA’s domain structure. Conclusions The CPRA enables researchers to understand the strengths and weaknesses of mothers. Mother’s maladaptive states can potentially be predicted by understanding the interactions between these multiple factors. The developed model can provide the necessary support to mothers and increase mothers’—and others’—awareness of the support that can prevent childcare maladjustment.

The multimolecular assembly of three-dimensionally structured proteins forms their quaternary structures, some of which have high geometric symmetry. The size and complexity of protein quaternary structures often increase in a hierarchical manner, with simpler, smaller structures serving as units for larger quaternary structures. In this study, we exploited oligomerization of a ribozyme cyclic trimer to achieve larger ribozyme-based RNA assembly. By installing kissing loop (KL) interacting units to one-, two-, or three-unit RNA molecules in the ribozyme trimer, we constructed dimers, open-chain oligomers, and branched oligomers of ribozyme trimer units. One type of open-chain oligomer preferentially formed a closed tetramer containing 12 component RNAs to provide 12 ribozyme units. We also observed large assembly of ribozyme trimers, which reached 1000 nm in size.

Abstract Introduction Postpartum haemorrhage is a major cause of maternal mortality. Although contrast-enhanced computed tomography (CE-CT) is useful to reveal arterial bleeding, its accuracy in postpartum haemorrhage is unclear. The aim of this study was to evaluate the accuracy of CE-CT scanning in detecting postpartum haemorrhage. Methods This was a retrospective observational study. We included patients with postpartum haemorrhage treated by emergency physicians in collaboration with obstetricians. We calculated the sensitivity, specificity, and positive and negative predictive values for CE-CT scanning to detect arterial bleeding. Results CE-CT scanning was performed in 52 patients, and 31 patients had extravasation. The sensitivity of CE-CT scanning to detect arterial extravasation was 100% (15/15), specificity was 28.6% (2/7), positive predictive value was 75% (15/20), and negative predictive value was 100% (2/2). Conclusion We showed the sensitivity of CE-CT scanning to detect arterial extravasation in patients with postpartum haemorrhage to be 100%.

Background: Postpartum mothers may experience psychological stress due to the sudden changes in their bodies and situation. This study investigates the changes in depressive symptoms among nursing mothers and their child-rearing difficulties before and one month after the declared state of emergency due to COVID-19 pandemic in Japan. The study also assesses whether adding the stress induced by the pandemic to parenting difficulties affected women's depressive symptoms. Method: An online survey was conducted with 309 postpartum women. Participants completed questionnaires that included the Quick Inventory of Depressive Symptomatology (QIDS-SR-J), draft version of the Comprehensive Scale for Parenting Resilience and Adaptation (CPRA+α), and original questions about the COVID-19 stress. Results: A factor analysis was performed on CPRA+α, which found five main factors: difficulty in coping with child and oneself, dissatisfaction with husband, distrust in parents, being tired of the child, and distrust in physician. As a result of t-test of these five factors and the QIDS revealed that there was a significant difference in depressive symptoms before and after the COVID-19 outbreak. In addition to these five factors, the COVID-19 stress of impact on income and employment increased depressive symptoms, while the stress of refraining from going out decreased depressive symptoms. Limitation: Differences in the characteristics of children and mothers were not considered in the study. Longitudinal studies focusing on the period after the declaration of a state of emergency in 2020 are considered necessary. Conclusion: Childcare difficulties and the COVID-19 pandemic induced stress are associated with postpartum women's depressive symptoms.

Preeclampsia is one of the most common as well as most severe complications of pregnancy, characterized by new-onset hypertension and proteinuria or other organ dysfunction. It predominantly occurs after 20 weeks of gestation. Very rarely, it can be triggered earlier in some specific situations. Here we report a case of fetal triploidy presenting as an extraordinarily early-onset preeclampsia. A healthy 36-year-old multiparous woman who had conceived naturally was hospitalized due to acute-onset severe hypertension accompanied by proteinuria at 18 weeks of gestation. Laboratory testing ruled out the presence of underlying maternal disease. Ultrasound findings, including multicystic large placenta and multiple fetal anomalies, strongly suggested fetal triploidy. Maternal ovaries showed hyperreactio luteinalis. The soluble fms-like tyrosine kinase-1/ placental growth factor (sFlt-1/PlGF) ratio was elevated, at 270. Medical abortion was carried out at 19 weeks of gestation; thereafter, her symptoms quickly resolved. Fetal triploidy was confirmed by genetic testing. We should be aware that fetal disorders including triploidy as well as pre-existing maternal diseases can provoke such very early-onset preeclampsia. Fetal ultrasound evaluation is critical and the sFlt-1/PlGF ratio is important for prompt diagnosis and management to prevent adverse maternal outcomes associated with atypical preeclampsia before 20 weeks of gestation.

Naturally occurring ribozymes with a modular architecture are promising platforms for construction of RNA nanostructures because modular redesign enables their oligomerization. The resulting RNA nanostructures can exhibit the catalytic function of the parent ribozyme in an assembly dependent manner. In this study, we designed and constructed open-form oligomers of a bimolecular form of an RNase P ribozyme. The ribozyme oligomers were analyzed biochemically and by atomic force microscopy (AFM).

The micrometer-scale assembly of various DNA nanostructures is one of the major challenges for further progress in DNA nanotechnology. Programmed patterns of 1D and 2D DNA origami assembly using specific DNA strands and micrometer-sized lattice assembly using cross-shaped DNA origami were performed on a lipid bilayer surface. During the diffusion of DNA origami on the membrane surface, the formation of lattices and their rearrangement in real-time were observed using high-speed atomic force microscopy (HS-AFM). The formed lattices were used to further assemble DNA origami tiles into their cavities. Various patterns of lattice–tile complexes were created by changing the interactions between the lattice and tiles. For the control of the nanostructure formation, the photo-controlled assembly and disassembly of DNA origami were performed reversibly, and dynamic assembly and disassembly were observed on a lipid bilayer surface using HS-AFM. Using a lipid bilayer for DNA origami assembly, it is possible to perform a hierarchical assembly of multiple DNA origami nanostructures, such as the integration of functional components into a frame architecture.

Background and Objectives: Since spontaneous uterine rupture in the mid-trimester is rare, maternal and fetal outcomes in subsequent pregnancies remain unclear. Therefore, this study aimed to examine the maternal and fetal outcomes of subsequent pregnancies after prior mid-trimester uterine rupture. Materials and Methods: A systematic review using PubMed, the Cochrane Central Register of Controlled Trials, and Scopus until 30 September 2021, was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The studies that clarified the maternal and fetal outcomes after prior mid-trimester uterine rupture and our case (n = 1) were included in the analysis. Results: Among the eligible cases, there were five women with eight subsequent pregnancies after prior mid-trimester uterine rupture. The timing of prior mid-trimester uterine rupture ranged from 15 to 26 weeks of gestation. The gestational age at delivery in subsequent pregnancies was 23–38 gestational weeks. Among the included cases (n = 8), those involving prior mid-trimester uterine rupture appeared to be associated with an increased prevalence of placenta accreta spectrum (PAS) (n = 3, 37.5%) compared with those involving term uterine rupture published in the literature; moreover, one case exhibited recurrent uterine rupture at 23 weeks of gestation (12.5%). No maternal deaths have been reported in subsequent pregnancies following prior mid-trimester uterine rupture. Fetal outcomes were feasible, except for one pregnancy with recurrent mid-trimester uterine rupture at 23 weeks of gestation, whose fetus was alive complicated by cerebral palsy. Conclusions: Our findings suggest that clinicians should be aware of the possibility of PAS and possible uterine rupture in pregnancies after prior mid-trimester uterine rupture. Further case studies are warranted to assess maternal and fetal outcomes in pregnancies following prior mid-trimester prior uterine rupture.

Background: Fetal ovarian cysts are the most frequently diagnosed intra-abdominal cysts; however, the evidence for perinatal management remains controversial. Methods: We retrospectively reviewed cases of fetal ovarian cysts diagnosed by prenatal ultrasonography at our institution between January 2010 and January 2020. The following were investigated: gestational age at diagnosis, cyst size, appearance, prenatal ultrasound findings, and postnatal outcomes. Prior to 2018, expectant management was applied in all cases; after 2018, in utero aspiration (IUA) of simple cysts ≥40 mm was performed. Results: We diagnosed 29 and seven simple and complex cysts, respectively. Fourteen patients had simple cysts with a maximum diameter

Background: Centralization of cancer care increases survival but increases the travel burden (i.e., travel durations, distances, and expenditures) in visiting hospitals. This study investigated the travel burdens to access cancer care for children aged 18 years and younger in Japan. Methods: The study population comprised 10,709 patients diagnosed between 2016 and 2019 obtained from a national population-based cancer registry in Japan. Their residences were classified as urban or rural. We counted the number of patients treated at specialized hospitals and investigated the treatment centralization across diagnostic groups by Pareto plot. Travel burdens to access care were estimated using a route-planner web service and summarized using median values. A multivariable logistic model was performed to investigate factors associated with the events of car travel duration exceeding 1 h. Results: Of the patients, 76.7% lived in urban areas, and 82.5% received treatment in designated hospitals for childhood cancer. The Pareto plot suggested that the top five hospitals treated 63.5% of patients with retinoblastoma. The estimated travel burdens for all patients were 0.62 h (0.57 h in urban areas and 1.00 h in rural areas), 16.9 km, and 0.0 dollars of toll charges. Regarding travel duration, 21.7% of patients had travel exceeding 1 h, and rural areas, retinoblastoma, malignant bone tumors, and childhood cancer-hub hospitals were associated with travel duration exceeding 1 h (adjusted odds ratios of 6.93, 3.59, 1.94, and 1.91, respectively). Conclusions: Most patients were treated in specialized hospitals and the treatments for specific diseases were centralized. However, most patients were estimated to travel less than 1 h, and the travel burden tended to increase for patients in rural areas, those with specific diseases, and those going to specialized hospitals. Cancer control measures in Japan have steadily improved centralized treatment while keeping the travel burden relatively manageable. [ABSTRACT FROM AUTHOR]

Background This study aimed to evaluate the efficacy of subtraction computed tomography arteriography (s-CTA) during preoperative embolization in spinal tumors. Methods The study analyzed 17 vertebrae in 13 patients who underwent preoperative embolization before spinal fixation surgery for malignant spinal tumors to decrease blood loss at our hospital from 2019 to 2021. Their ages ranged from 56 to 88 years (average, 73.5 years). Metastatic bone tumors were most common, including five cases originating as lung carcinomas and three as renal cancers. After digital subtraction angiography of selected tumor-feeding arteries and nonsubtraction CTA (ns-CTA) were performed, s-CTA was conducted using data obtained from both procedures. A clarity score of the boundary between the normal bone and tumor was derived for each patient, which was then classified into four grades (good, 3 points; fair, 2 points; faint, 1 point; poor, 0 points) by two experienced radiologists, followed by a comparison between the s-CTA and ns-CTA groups using the Wilcoxon signedrank test. Results Clarity scores were significantly higher in the s-CTA group than in the ns-CTA group (P < 0.001). The agreement of Cohen's coefficients between the two radiologists was = 0.724 in s-CTA scoring and = 0.622 in ns-CTA scoring, which were moderately matched. Seven arteries were not embolized due to insufficient tumor contrast enhancement and their poor relation to the surgical invasion zone. No complications were observed during or after embolization. Conclusion S-CTA successfully distinguished between tumor and normal bone and may help avoid unnecessary embolization. [ABSTRACT FROM AUTHOR]

Purpose This study aimed to elucidate the effects of neuraxial analgesia on labor in women classified based on the Robson classification system. Methods We retrospectively reviewed the clinical data of singleton cephalic nulliparous deliveries in labor at term between January 2018 and December 2021 and compared obstetrical outcomes between deliveries with and without neuraxial analgesia in women of Robson group 1 (spontaneous labor) and group 2a (induced labor). Statistical analyses were performed using the Wilcoxon ranked-sum test, Fisher's exact test, and logistic regression model. Statistical significance was set at p < 0.05. Results We identified 2726 deliveries during the period, of which 387 deliveries (215 with analgesia and 172 without analgesia) were in Robson group 1 and 502 deliveries (258 with analgesia and 244 without analgesia) in Robson 2a. In Robson group 1 pregnancies, the cesarean section (CS) rate was higher in those who received analgesia (15%) than in those who did not (3%) (p = 0.0001). Multivariate analysis revealed that labor with analgesia was a significant risk factor for CS (p < 0.0001). Similarly, in Robson group 2a pregnancies, we observed a higher CS rate in those with analgesia than in those without analgesia (18 vs. 11%, p = 0.042). Conclusion A higher CS rate was observed in deliveries with analgesia than in those without analgesia both in the Robson group 1 and group 2a pregnancies., Author(s): Taro Yagi [sup.1], Yasuto Kinose [sup.1], Michiko Bun [sup.1], Megumi Horai [sup.1], Chie Matsuda [sup.2], Tatsuya Miyake [sup.1], Kazuya Mimura [sup.1], Chiyo Otaki [sup.2], Masayuki Endo [sup.1] [sup.3], Tadashi [...]

The multimolecular assembly of three-dimensionally structured proteins forms their quaternary structures, some of which have high geometric symmetry. The size and complexity of protein quaternary structures often increase in a hierarchical manner, with simpler, smaller structures serving as units for larger quaternary structures. In this study, we exploited oligomerization of a ribozyme cyclic trimer to achieve larger ribozyme-based RNA assembly. By installing kissing loop (KL) interacting units to one-, two-, or three-unit RNA molecules in the ribozyme trimer, we constructed dimers, open-chain oligomers, and branched oligomers of ribozyme trimer units. One type of open-chain oligomer preferentially formed a closed tetramer containing 12 component RNAs to provide 12 ribozyme units. We also observed large assembly of ribozyme trimers, which reached 1000 nm in size. [ABSTRACT FROM AUTHOR]

This systematic review and meta‐analysis aimed to review the optimal timing of delivery at term for neonates with prenatally diagnosed congenital diaphragmatic hernia (CDH). We reviewed the literature up to December 19, 2022 using MEDLINE and the Cochrane Library databases. The inclusion criteria were original articles, comparative studies of CDH neonates delivered at an early term (37–38 weeks of gestation) and at full term (39 weeks of gestation or later), and comparative studies investigating outcomes of CDH neonates. Six studies met the inclusion criteria, including 985 neonates delivered at an early term and 629 delivered at full term. The cumulative rate of survival to discharge showed no significant difference between CDH neonates delivered at an early term (395/515; 76.7%) or at full term (345/467; 73.9%) (risk ratio [RR] 1.01; 95% confidence interval [CI], 0.89–1.16; p = 0.85). Furthermore, the number of neonates requiring oxygen therapy at discharge was not significantly different between CDH neonates delivered at an early term (32/370; 8.6%) and at full term (14/154; 9.1%) (RR, 0.99; 95% CI, 0.36–2.70; p = 0.99). Therefore, the optimal timing of delivery at term for neonates with CDH remains unclear. Key points: What's already known about this topic? The optimal timing of delivery at term to improve the prognosis of neonates with prenatally diagnosed congenital diaphragmatic hernia (CDH) remains controversial. What does this study add? Survival rates and need for oxygen therapy at discharge were not significantly different between neonates with CDH delivered at an early term and those delivered at full term.Therefore, there is insufficient evidence to determine the optimal timing of delivery at term. [ABSTRACT FROM AUTHOR]

Background: The guidelines for the requirement of Legionella urinary antigen tests on admission for patients hospitalized with community-acquired pneumonia differ in Japan, the United States, and Europe. We aimed to evaluate the association between the timing of Legionella urinary antigen testing and inhospital mortality in patients with atypical pneumonia. Methods: We identified 654,708 patients with atypical pneumonia from July 2010 to March 2021 using the Japanese national inpatient database. The patients were divided into groups that underwent Legionella urinary antigen tests on the day of admission (test group, n = 229,649) and those that underwent testing after the day of admission or were untested (control group, n = 425,059). A propensity score-stabilized inverse probability of treatment weighting analysis was performed to compare inhospital mortality, length of hospital stay, and total hospitalization costs between the two groups. Odds ratios (ORs) or differences and their 95% confidence intervals (CIs) were calculated using generalized linear models. Results: The tested group had a significantly lower 30-day inhospital mortality than that of the control group (7.7% vs. 9.0%; OR: 0.83 [95% CIs, 0.81-0.86]). The tested group also had a significantly shorter length of stay (difference, -2.3 [-2.6 to - 2.0] days and total hospitalization costs (-396 [-508 to -285] US dollars) than that of the control group. Conclusions: Legionella urinary antigen testing upon admission is associated with better outcomes in patients with atypical pneumonia. Legionella urinary antigen testing performed on the day of admission is recommended for hospitalized patients with atypical pneumonia. [ABSTRACT FROM AUTHOR]

Background: Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is caused by anti-HPA alloantibody, and anti-HPA-4b is the most common cause in Japanese. Anti-HPA-5b is frequently detected in pregnant women, but it is still controversial whether anti-HPA-5b causes severe FNAIT. Case presentation: A Japanese woman with anti-HPA-4b and anti-HPA-5b alloantibodies delivered a baby with severe FNAIT who was both HPA-4b and HPA-5b incompatible. We carefully monitored the patient's following three pregnancies (the second and the fourth siblings were HPA-4b incompatible and HPA-5b compatible; the third sibling was both HPA-4b and HPA-5b compatible). FNAIT was not observed in all three siblings, although a modest decrease in cord blood platelet count was observed in the HPA-4b incompatible siblings compared to the HPA-4b compatible sibling. Serial monitoring of anti-HPA titer showed that anti-HPA-4b markedly decreased in late pregnancy and recovered after delivery of the HPA-4b incompatible siblings, but these decreases were not observed during the mother's pregnancy with the HPA-4b compatible sibling. In contrast, anti-HPA-5b remained at a high titer during pregnancy with all three siblings. Conclusion: Our data indicate that dynamic changes of anti-HPA-4b occur during pregnancy and strongly suggest that anti-HPA-5b was mainly responsible for severe FNAIT in this case. [ABSTRACT FROM AUTHOR]

I JCM i was able to uphold its high standards for published papers due to the outstanding efforts of our reviewers. Regardless of whether the articles they examined were ultimately published, the editors would like to express their appreciation and thank the following reviewers for the time and dedication that they have shown I JCM i : ht Footnotes 1 B Disclaimer/Publisher's Note: b The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). Thanks to the efforts of our reviewers in 2022, the median time to first decision was 20 days and the median time to publication was 41 days. [Extracted from the article]

Purpose: This study aimed to evaluate prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia (CDH). Methods: A systematic literature search was performed to identify relevant observational studies that evaluated the ability of lung-to-head ratio (LHR), observed-to-expected LHR (o/e-LHR), observed-to-expected total fetal lung volume (o/e-TFLV), lung-to-thorax transverse area ratio (L/T ratio), intrathoracic herniation of the liver and the stomach, and side of diaphragmatic hernia, using a threshold for the prediction of mortality in fetuses with CDH. Study quality was assessed using the QUADAS-2 tool. Hierarchical summary receiver operating characteristic curves were constructed. Results: A total of 50 articles were included in this meta-analysis. The QUADAS-2 tool identified a high risk of bias in more than one domain scored in all parameters. Among those parameters, the diagnostic odds ratio of mortality with o/e-LHR < 25%, o/e-TFLV < 25%, and L/T ratio < 0.08 were 11.98 [95% confidence interval (CI) 4.65–30.89], 11.14 (95% CI 5.19–23.89), and 10.28 (95% CI 3.38–31.31), respectively. The predictive values for mortality were similar between the presence of liver herniation and retrocardiac fetal stomach position. Conclusions: This systematic review suggests that o/e-LHR, o/e-TFLV, and L/T ratio are equally good predictors of neonatal mortality in fetuses with isolated CDH. [ABSTRACT FROM AUTHOR]

Naturally occurring ribozymes with a modular architecture are promising platforms for construction of RNA nanostructures because modular redesign enables their oligomerization. The resulting RNA nanostructures can exhibit the catalytic function of the parent ribozyme in an assembly dependent manner. In this study, we designed and constructed open-form oligomers of a bimolecular form of an RNase P ribozyme. The ribozyme oligomers were analyzed biochemically and by atomic force microscopy (AFM). [ABSTRACT FROM AUTHOR]

The micrometer-scale assembly of various DNA nanostructures is one of the major challenges for further progress in DNA nanotechnology. Programmed patterns of 1D and 2D DNA origami assembly using specific DNA strands and micrometer-sized lattice assembly using cross-shaped DNA origami were performed on a lipid bilayer surface. During the diffusion of DNA origami on the membrane surface, the formation of lattices and their rearrangement in real-time were observed using high-speed atomic force microscopy (HS-AFM). The formed lattices were used to further assemble DNA origami tiles into their cavities. Various patterns of lattice–tile complexes were created by changing the interactions between the lattice and tiles. For the control of the nanostructure formation, the photo-controlled assembly and disassembly of DNA origami were performed reversibly, and dynamic assembly and disassembly were observed on a lipid bilayer surface using HS-AFM. Using a lipid bilayer for DNA origami assembly, it is possible to perform a hierarchical assembly of multiple DNA origami nanostructures, such as the integration of functional components into a frame architecture. [ABSTRACT FROM AUTHOR]

Background: Traditional menstruation practices in Nepal (Chhaupadi in Nepalese) lack scientific support and undermine women's health. This study aimed to understand the changes in the traditional menstruation practices due to migration from Nepal to Japan. Methods: This study included 104 Nepalese women of reproductive age living in an urban area of western Japan. Participants were recruited using snowball sampling, and the method of data collection was a questionnaire survey. To examine how Nepalese women adapt traditional menstruation practices to their living environment, we compared how women followed frequently 17 traditional practices when they lived in Nepal and later in Japan. We examined the relationships among behavioural changes in traditional practices, education level, and caste. Results: The frequency of 14 of the 17 traditional practices decreased after the women moved to Japan. Among women who reduced the frequency of traditional practices after moving from Nepal to Japan, the reduction was not associated with educational level or caste of the participants. Conclusions: This study suggests that the attitudes towards the traditional menstruation practices change in response to living circumstances. Future studies should focus on determining living environment factors related to behavioural changes in traditional practices. [ABSTRACT FROM AUTHOR]

Background: Menstrual attitudes include negative and positive perceptions of menstruation and are associated with reproductive health, underscoring the importance of its evaluation in women. Given that social and cultural factors affect menstrual attitudes, developing evaluation methods specific to distinct societal cultures is necessary. Methods: We developed a scale based on the menstrual attitude questionnaire, which is the most widely used measure of menstrual attitudes, to evaluate negative menstrual attitudes among Nepalese women in consideration of Nepalese cultural backgrounds and literacy. In total, 352 Nepalese women aged 20–45 years living in urban or suburban areas in Nepal were enrolled in the study. Participants were randomly divided into two groups using the permuted block method. Using the prototype, Group 1 (n = 176) was evaluated with an exploratory factor analysis to develop a reliable scale, and Group 2 (n = 176) was evaluated with a confirmatory factor analysis to confirm the structure of negative menstrual attitudes. Further, we preliminarily examined the relationship of negative menstrual attitudes with the frequency of traditional menstrual practices and intensity of menstrual pain, which are significant reproductive health issues in Nepal, in Group 2. Results: We developed a 15-item, 3-factor scale to evaluate negative menstrual attitudes among Nepalese women using exploratory factor analysis. The first, second, and third factors were "Natural event" (α = 0.82), "Debilitating event" (α = 0.76), and "Bothersome event" (α = 0.69), respectively. Confirmatory factor analysis revealed that negative menstrual attitudes comprised a 3-factor structure. Participants who performed three traditional menstrual practices ("stay in their own house", "go to public spaces", and "contact with others generally") demonstrated significantly higher scores for negative menstrual attitudes than did non-performers. Negative menstrual attitudes were positively correlated with the intensity of menstrual pain (r = 0.558). Conclusions: This study is the first to evaluate menstrual attitudes and analyse its factor structure among Nepalese women. In the future, the relationship between accurately evaluated negative menstrual attitudes and reproductive health issues should be examined more comprehensively. Plain Language Summary: For sexually mature women, menstruation may be considered burdensome, but its absence may also be a source of concern. Perceptions regarding menstruation are collectively referred to as menstrual attitudes. Previous studies have reported that negative menstrual attitudes are associated with various reproductive health issues in women and vary according to social and cultural backgrounds. To adequately evaluate negative menstrual attitudes among Nepalese women (20–45 years old), we developed a 15-item scale that considers their cultural background and literacy. We observed that attitudes toward menstruation among Nepalese women consisted of three emotions: one positive emotion, including "menstruation is a natural phenomenon", and two negative emotions, including "menstruation is debilitating" and "menstruation is bothersome". In several developing countries, menstruating women are considered unclean, and various restrictions are imposed on women during menstruation (traditional menstrual practices). Nepalese women with strong negative menstrual attitudes, as assessed by our scale, engaged in several traditional menstrual practices with higher frequency. We also observed that women with more negative menstrual attitudes presented with more severe menstrual pain. Our scale was developed to be compatible with the values and literacy of Nepalese women and was easy to answer. We believe that reducing negative emotions toward menstruation will contribute to reducing the frequency of traditional menstrual practices and menstrual pain, thereby facilitating school attendance and entry into the workforce among women in Nepal. [ABSTRACT FROM AUTHOR]

The clinical features of extracranial arteriovenous malformations (AVM) vary from stages I (quiescence) with few symptoms to IV (decompensation) with overt symptoms of cardiac failure. Although the maternal outcomes of pregnant women with extracranial AVM is understudied due to its rarity, previous studies suggested the difficulty in the management of recurrent hemorrhage due to AVM progression during perinatal period; thus, pregnant case of extracranial AVM complicated with cardiac failure were considered challenging. We have reported a woman of stage IV extracranial AVM in the right lower limb with a history of below‐the‐knee amputation, in which two pregnancies and vaginal deliveries under epidural anesthesia were managed successfully. Cardiac failure did not exacerbate throughout the gestational or postpartum periods. Ulceration gradually worsened, with no massive hemorrhage. It is ideal to assess abnormal vascularity, especially in the lower abdomen, vagina, and epidural and subdural spaces, through magnetic resonance imaging to ensure safe delivery. [ABSTRACT FROM AUTHOR]

Background: Adapting to child-rearing is affected by multiple factors, including environmental and individual factors. Previous studies have reported the effect of a single factor on childcare maladjustment; however, to prevent maladaptation in and to support child-rearing, a comprehensive evaluation of factors is necessary. Therefore, this study developed a comprehensive assessment tool for childcare adaptation. Methods: We conducted semi-structured interviews with specialists whose jobs entailed supporting parents. Items were extracted from the interview data and used to develop a new questionnaire. Mothers with a child aged 0–3 years completed the Quick Inventory of Depressive Symptomatology as a depression index. We performed both factor and correlation analyses on the collected, data and multiple regression analyses to determine which factors predict depressive tendencies leading to childcare maladaptation. Subsequently, an assessment algorithm model was built. Results: 1,031 mothers responded to the questionnaire which had 118 items in five domains. A factor analysis was performed on each domain to develop the Comprehensive Scale for Parenting Resilience and Adaptation (CPRA). The CPRA comprised 21 factors and 81 items in five subcategories: Child's Temperament and Health (1 factor, 5 items); Environmental Resources (5 factors, 20 items), Perceived Support (4 factors, 15 items); Mother's Cognitive and Behavioural Characteristics (6 factors, 22 items), and Psychological Adaptation to Parenting (5 factors, 19 items). Correlations between all factors and depressive symptoms were identified. Depressive symptoms were predicted by factors from four subcategories: Environmental Resources, Perceived Support, Mother's Cognitive and Behavioural Characteristics, and Psychological Adaptation to Parenting. A comprehensive model of mothers' psychological adjustment was developed using the CPRA's domain structure. Conclusions: The CPRA enables researchers to understand the strengths and weaknesses of mothers. Mother's maladaptive states can potentially be predicted by understanding the interactions between these multiple factors. The developed model can provide the necessary support to mothers and increase mothers'—and others'—awareness of the support that can prevent childcare maladjustment. [ABSTRACT FROM AUTHOR]

Atypical preeclampsia before 20 weeks of gestation without an underlying disease is very rare; however, the soluble Fms‐like tyrosine kinase 1/placental growth factor (sFlt‐1/PlGF) ratios remain unknown. Four pregnant women with no underlying disease, except for a history of childhood IgA vasculitis, developed preeclampsia at 13, 14, 17, and 18 weeks of gestation with sFlt‐1/PlGF ratios of 1589, 1183, 500, and 1460 pg/mL, respectively. Their pregnancies were terminated, and they delivered within 2 weeks. All previously abnormal clinical findings normalized within 3 months. The sFlt‐1/PlGF ratios were elevated in the four patients with atypical preeclampsia without underlying disease before 20 weeks of gestation. A high sFlt‐1/PlGF ratio may be indicative of preeclampsia when no underlying disease is present in pregnancies of less than 20 weeks of gestation. [ABSTRACT FROM AUTHOR]

Introduction: Postpartum haemorrhage is a major cause of maternal mortality. Although contrast-enhanced computed tomography (CE-CT) is useful to reveal arterial bleeding, its accuracy in postpartum haemorrhage is unclear. The aim of this study was to evaluate the accuracy of CE-CT scanning in detecting postpartum haemorrhage.Methods: This was a retrospective observational study. We included patients with postpartum haemorrhage treated by emergency physicians in collaboration with obstetricians. We calculated the sensitivity, specificity, and positive and negative predictive values for CE-CT scanning to detect arterial bleeding.Results: CE-CT scanning was performed in 52 patients, and 31 patients had extravasation. The sensitivity of CE-CT scanning to detect arterial extravasation was 100% (15/15), specificity was 28.6% (2/7), positive predictive value was 75% (15/20), and negative predictive value was 100% (2/2).Conclusion: We showed the sensitivity of CE-CT scanning to detect arterial extravasation in patients with postpartum haemorrhage to be 100%. [ABSTRACT FROM AUTHOR]

While systemic lupus erythematosus is often complicated by preeclampsia, it is difficult to differentiate between its exacerbation and preeclampsia. The soluble fms‐like tyrosine kinase 1 (sFlt‐1)/placental growth factor (PlGF) ratio is unknown in systemic lupus erythematosus with preeclampsia before 20 weeks of gestation. Three nulliparous women with systemic lupus erythematosus developed preeclampsia at 13, 13, and 17 weeks of gestation with sFlt‐1/PlGF ratios of 427, 865, and 525, respectively. Two patients terminated their pregnancies and delivered within 2 weeks, while one experienced intrauterine fetal death 4 weeks after the measurements. Their symptoms gradually improved, and all patients were discharged within 3 months. The sFlt‐1/PlGF ratio may be used in the differential diagnosis of preeclampsia and systemic lupus erythematosus exacerbation before 20 weeks of gestation. [ABSTRACT FROM AUTHOR]

Aim: We aimed to evaluate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of noninvasive prenatal testing (NIPT) in high‐risk pregnant women. Methods: Pregnant women who underwent GeneTech NIPT, the most commonly used NIPT in Japan, between January 2015 and March 2019, at Japan NIPT Consortium medical sites were recruited for this study. The exclusion criteria were as follows: pregnant women with missing survey items, multiple pregnancy/vanishing twins, chromosomal abnormalities in the fetus other than the NIPT target disease, and nonreportable NIPT results. Sensitivity and specificity were calculated from the obtained data, and maternal age‐specific PPV and NPV were estimated. Results: Of the 45 504 cases, 44 263 cases fulfilling the study criteria were included. The mean maternal age and gestational weeks at the time of procedure were 38.5 years and 13.1 weeks, respectively. Sensitivities were 99.78% (95% confidence interval [95% CI]: 98.78–99.96), 99.12% (95% CI: 96.83–99.76), and 100% (95% CI: 88.30–100) for trisomies 21, 18, and 13, respectively. Specificities were more than 99.9% for trisomies 21, 18, and 13, respectively. Maternal age‐specific PPVs were more than 93%, 77%, and 43% at the age of 35 years for trisomies 21, 18, and 13, respectively. Conclusion: The GeneTech NIPT data showed high sensitivity and specificity in the detection of fetal trisomies 21, 18, and 13 in high‐risk pregnant women, and maternal age‐specific PPVs were obtained. These results could provide more accurate and improved information regarding NIPT for genetic counseling in Japan. [ABSTRACT FROM AUTHOR]

The scientific ecosystem relies on citation-based metrics that provide only imperfect, inconsistent and easily manipulated measures of research quality. Here we describe DELPHI (Dynamic Early-warning by Learning to Predict High Impact), a framework that provides an early-warning signal for 'impactful' research by autonomously learning high-dimensional relationships among features calculated across time from the scientific literature. We prototype this framework and deduce its performance and scaling properties on time-structured publication graphs from 1980 to 2019 drawn from 42 biotechnology-related journals, including over 7.8 million individual nodes, 201 million relationships and 3.8 billion calculated metrics. We demonstrate the framework's performance by correctly identifying 19/20 seminal biotechnologies from 1980 to 2014 via a blinded retrospective study and provide 50 research papers from 2018 that DELPHI predicts will be in the top 5% of time-rescaled node centrality in the future. We propose DELPHI as a tool to aid in the construction of diversified, impact-optimized funding portfolios. Biotechnology-related papers predicted to be of long-term impact are identified in a machine learning framework (DELPHI) that analyzes relationships among a range of features from the scientific literature over time. [ABSTRACT FROM AUTHOR]

To the Editors, We read with great interest the article regarding the treatment for disseminated intravascular coagulation (DIC) during conservative management for the placenta accreta spectrum (PAS) by Biele et al. [[1]]. 10.1002/ijgo.12411 7 Licon E, Matsuzaki S, Opara KN, Machida H, Roman LD, Sasso EB. treatment and outcome of placenta percreta: primary cesarean hysterectomy versus conservative management. If the patient develops asymptomatic DIC during the conservative management of placenta percreta, the author believes that the continuation of conservative management with anticoagulant therapy is an option for the management. [Extracted from the article]