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Uterine rupture rarely occurs during pregnancy, but it is a critical situation if so. It is already known that a history of uterine surgeries, such as cesarean section or myomectomy, is a risk factor for uterine rupture. Currently, the laparoscopic adenomyomectomy is a widely performed procedure, but associated risks have not been defined. We observed a case of spontaneous uterine rupture in a patient during the 35th week of gestation, after a laparoscopic adenomyomectomy. A 42-year-old, gravida 2, para 0 woman became pregnant after a laparoscopic adenomyomectomy and her pregnancy was conventional. At a scheduled date in the 35th week of gestation, after combined spinal epidural anesthesia and frequent uterine contractions, a weak pain suddenly ensued. After 13 minutes of uterine contractions, vaginal bleeding was evident. A cesarean section was performed, and the uterine rupture was found in the scar. After a laparoscopic adenomyomectomy, a pregnant uterus can easily rupture by rather weak and short uterine contractions, and is characterized by vaginal bleeding. When uterine bleeding is observed in pregnant women that have a history of adenomyomectomy, one should consider uterine rupture. [ABSTRACT FROM AUTHOR]

Aerodynamics of cambered airfoils are investigated numerically, using a NACA four-digit series of 6 % thickness at low Reynolds number Re = 10,000 and moderate Mach number M = 0.2, by focusing on the relation of aeroacoustic effects and hydrodynamic flow unsteadiness. Two-dimensional numerical simulations show that the onset of an acoustic feedback loop leads to an abrupt increase in lift force. Associated with the feedback process, the evolution of two-dimensional vortices in the suction-side boundary layer shifts a separation bubble toward the leading edge, which causes a relatively steep pressure recovery near the trailing edge. Through a parametric study on airfoil shape, the aerodynamically favorable feature of aft camber is further enhanced with the presence of an acoustic feedback loop. In addition, the aft camber airfoil successfully forms a laminar separation bubble in three-dimensional calculations at the present Reynolds number, developing transitional behavior on the suction side, supposedly prompted by the airfoil tones. Although the boundary layer shows three-dimensional complexity, still the formation of an acoustic feedback loop is strongly suggested, via the comparison of spanwise correlations. [ABSTRACT FROM AUTHOR]

Background To clarify whether the use of balloons for cervical ripening is associated with the incidence of umbilical cord prolapse. Methods A postal questionnaire survey was distributed in Japan. Cases of umbilical cord prolapse occurring during labor in association with the use of balloons for cervical ripening between 2007 and 2011 in Japan were analyzed. Results Answers from 942 institutions were obtained. The subjects included 369 patients with forelying or prolapse of the umbilical cord among a total of 2,037,460 deliveries. Among the singleton vertex cases, fore-lying or prolapse of the umbilical cord during labor were observed in 88 (0.005%) of 1,891,189 deliveries not associated with the use of balloons for cervical ripening and in 93 (0.064%) of 146,271 deliveries associated with the use of balloons for cervical ripening (Odds ratio 13.67, 95% confidence interval 10.21, 18.30). All types of balloons were significantly associated with the occurrence of fore-lying or prolapse of the umbilical cord. A total of 39% of cases of umbilical cord prolapse occurred during manual or spontaneous balloon removal, while 53% of cases occurred after a while not directly associated with balloon removal. Conclusion The risk of umbilical cord prolapse was significantly increased during the use of balloons for cervical ripening, especially in cases involving the use of disk-type and ball-type balloons filled with large amounts of water. [ABSTRACT FROM AUTHOR]

Mesenchymal stem cells (MSC) have been reported to be an attractive therapeutic cell source for the treatment of renal diseases. Recently, we reported that transplantation of allogenic fetal membrane-derived MSC (FM-MSC), which are available noninvasively in large amounts, had a therapeutic effect on a hindlimb ischemia model (Ishikane S, Ohnishi S, Yamahara K, Sada M, Harada K, Mishima K, Iwasaki K, Fujiwara M, Kitamura S, Nagaya N, Ikeda T. Stem Cells 26: 2625-2633, 2008). Here, we investigated whether allogenic FM-MSC administration could ameliorate renal injury in experimental glomerulonephritis. Lewis rats with anti-Thy1 nephritis intravenously received FM-MSC obtained from major histocompatibility complex-mismatched ACI rats (FM-MSC group) or a PBS (PBS group). Nephritic rats exhibited an increased urinary protein excretion in the PBS group, whereas the FM-MSC group rats had a significantly lower level of increase (P 0.05 vs. PBS group). FM-MSC transplantation significantly reduced activated mesangial cell (MC) proliferation, glomerular monocyte/ macrophage infiltration, mesangial matrix accumulation, as well as the glomerular expression of inflammatory or extracellular matrixrelated genes including TNF-α, monocyte chemoattractant protein 1 (MCP-1), type I collagen, TGF-β, type 1 plasminogen activator inhibitor (PAI-1) (P < 0.05 vs. PBS group). In vitro, FM-MSCderived conditioned medium significantly attenuated the expression of TNF-α and MCP-1 in rat MC through a prostaglandin E2-dependent mechanism. These data suggest that transplanted FM-MSC contributed to the healing process in injured kidney tissue by producing paracrine factors. Our results indicate that allogenic FM-MSC transplantation is a potent therapeutic strategy for the treatment of acute glomerulonephritis. [ABSTRACT FROM AUTHOR]

AbstractCase report??We report a complicated extremely low-birth-weight (ELBW) infant with posthemorrhagic hydrocephalus after intraventricular hemorrhage and preceding stoma creation after bowel perforation who was treated with staged operations, including shunting and external ventricular drainage. The first operation was a temporary valveless ventriculoperitoneal (VP) shunt placement until the time of the stoma closure. The stoma was successfully closed 3?months after the first operation when the peritoneal tube was drawn out from the chest wall and the VP shunt system was temporarily used as an external drainage with a long subcutaneous tunnel. One month after the second operation, final VP shunt placement was performed after good healing of bowel anastomosis was surely confirmed. The previous peritoneal shunt tube was cut behind the ear, removed, and replaced with a valve-regulated VP shunt system.Conclusion??This staged strategy is a safe and feasible option for complicated ELBW infants with preceding stoma and hydrocephalus. [ABSTRACT FROM AUTHOR]

In this study, we performed simulations of turbulent flow over rectangular ribs transversely mounted on one side of a plane in a channel, with the other side being smooth. The separation between ribs is large enough to avoid forming stable vortices in the spacing, which exhibits $k$-type, or sand-grain roughness. The Reynolds number ${\it Re}_{\tau}$ of our representative direct numerical simulation case is 460 based on the smooth-wall friction velocity and the channel half-width. The roughness height $h$ is estimated as 110 wall units based on the rough-wall friction velocity. The velocity profile and kinetic energy budget verify the presence of an equilibrium, logarithmic layer at $y \gtrsim 2h$. In the roughness sublayer, however, a significant turbulent energy flux was observed. A high-energy region is formed by the irregular motions just above the roughness. Visualizations of vortical streaks, disrupted in all three directions in the roughness sublayer, indicate that the three-dimensional flow structure of sand-grain roughness is replicated by the two-dimensional roughness, and that this vortical structure is responsible for the high energy production. The difference in turbulence structure between smooth- and rough-wall layers can also be seen in other flow properties, such as anisotropy and turbulence length scales. [ABSTRACT FROM AUTHOR]

Objective Effect of free radical scavenger, 3-methyl-lphenyl2pyrazolin-5 one (MCI-186), on perinatal hypoxic-ishchemic brain injury was studied. Methods Seven-day-old Wistar rats (n = 48) were subjected to modified Levine's procedure (left carotid artery ligation with 2 hr 8% hypoxia), then given either vehicle or MCI-186 at the dosage of 9 mg/kg intraperitonealy. Thiobarbituric Acid Reactive substances (TBARS) was used as an index of lipid peroxidation. Brain hemispheres were homogenized. TBARS was measured at 2 (n = 12), 5 (n = 12), 24 (n = 12) and 48 (n = 12) hr after injection by spectroflurometry. Data are presented as mean ± SEM. Results The TBARS level (µmol/mg brain tissue) of the ligated side (vehicle vs. MCI-186) was 55.3 ± 14.1 vs. 35.4 ± 5.2 at 2 h (ns, unpaired t test), 227.7±67.2 vs. 20.3 ± 8.4 at 5 hr (P < 0.001), 238.4 ± 75.4 vs. 55.0 ± 9.8 at 24 hr (P < 0.001), and 103.8 ± 23.8 vs. 97.8 ± 12.1 at 48 hr (ns). Thus, MCI-186 significantly reduced TBARS levels at 5 and 24 hr after injection. Conclusion This result shows that MCI-186 has a free radical scavenging effect on hypoxic-ischemic brain damage in neonatal rat model. [ABSTRACT FROM AUTHOR]

Objective We investigated the effects of lipopolysaccharide (LPS) on neonatal rat brain damage after intermittent hypoxia Methods On postnatal day 7, Wistar rats were separated into 3 groups: (1) LPS administration with hypoxia-ischemia (i. p. 1 mg/kg, n = 46, LPS/HI) G2) sahne administration with hypoxia-ischemia (n = 42, saline/HI) and (3) LPS administration alone (n = 16, LPS alone). At 4 h after injection rats from LPS/HI and saline/HI group were exposed to unilateral carotid artery ligation followed by repeating a 10 minutes of experimental period (2min of hypoxia and 8min of recovery) for 10 times at 33°C. All rats were sacrificed after 7 days and the brains were histologically studied by HE staining Results Mortality rate during the experiment was not different among the groups. Neuronal loss was detected in the cerebral cortex and the hippocampus. Animals with neuronal loss were significantly increased in LPS/HI group (21%), compared with saline/HI group (0%, P < 0.003) Conclusion LPS administration worsened hypoxic-ischemic brain damage in the newborn rats exposed to intermittent hypoxia. It may give some clinical relevances that repetitive uterine contractions would affect neonatal neurological outcomes with intrauterine infection. [ABSTRACT FROM AUTHOR]

Aim Noninvasive blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) has recently been used to evaluate placental oxygenation. However, this method still has unresolved problems, such as long testing times and lack of normal values set. In the present study, we used a shorter protocol in BOLD-MRI and established normal values for placental oxygenation in late pregnancy. Methods We recruited 18 healthy singleton pregnant women (>32 weeks of gestation) who had a normal body size before pregnancy and a normal course of pregnancy. They underwent BOLD-MRI with three consecutive 4-min periods of different oxygenation: normoxia (21% O2), hyperoxia (10 L O2/min), and then normoxia. Placental time–activity curves were presented as signal intensity change relative to baseline (ΔR2*). The time from starting maternal oxygen administration to peak ΔR2*. To assess the relationship between peak ΔR2* values and placenta-related parameters and fetal development, the correlation between peak ΔR2*, placental weight, and neonatal birth weight was evaluated using Spearman’s rank correlation test. Results In all cases, the BOLD signal was elevated by maternal oxygen administration, with the peak resolving within 4 min after the end of oxygen administration. Peak ΔR2* and time to peak ΔR2* during oxygenation were 7.99 ± 2.58, and 458.1 ± 73.9 s, respectively. There was a significant correlation between peak ΔR2* and neonatal birth weight (percentile) (r = 0.537, p = .022), and between placental weight and neonatal birth weight (r = 0.769, p < .01). Conclusions In all cases, the BOLD signal increased with maternal hyperoxia using this protocol. So, 4 min observation following maternal oxygen administration is sufficient for peak ΔR2* evaluation. These reference values set in this study may be one of the indicators of BOLD signal changes in normal pregnancies after 32 weeks of gestation. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to measure the blood levels of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) before and after tadalafil treatment in patients with fetal growth restriction. Materials and methods Maternal blood was collected from 13 women before and 2 weeks after tadalafil administration in the TADAFER II trial. The tadalafil treatment was conducted in addition to the conventional FGR treatment. As a control, maternal blood was also collected from 11 women before and 2 weeks after conventional treatment for fetal growth restriction. Blood sFlt-1 and PlGF were measured and the sFlt-1/PlGF ratio was calculated. Student’s t-test was used to statistically analyze differences in the sFlt-1 and PlGF levels, and in the sFlt-1/PlGF ratios. Results In both treatment groups, the levels of sFlt-1 and PlGF before and after treatment were not significantly different from each other. The sFlt-1/PlGF ratio was 2.0 ± 1.0 before and 17.6 ± 11.3 after treatment in the control group (p=.04). The sFlt-1/PlGF ratio was 2.2 ± 1.1 before and 22.2 ± 10.6 after tadalafil treatment in the tadalafil group (p=.06). The sFlt-1/PlGF ratios before and after tadalafil treatment were significantly increased in the control group. In both treatment groups, the sFlt-1/PlGF ratios before and after treatment were less than 38. Conclusions We conclude that the levels of sFlt-1 and PlGF were not significantly different as a result of tadalafil treatment. Further studies are needed to understand the mechanism of action of tadalafil in the treatment of fetal growth restriction. [ABSTRACT FROM AUTHOR]

Species distribution and antifungal susceptibility of Candida isolates at one institution were evaluated. Detection rates of fungi were examined for 5 years between 2007 and 2011. Sensitivities of fungi to amphotericin B, flucytosine, fluconazole, micafungin, itraconazole, and voriconazole were evaluated in blood culture-positive patients. A total of 3,832 fungal isolates were detected, including Candida albicans 66.5%, Candida glabrata 20.3%, Candida parapsilosis 6.2%, Candida tropicalis 5.5%, and others 1.5%. Candidemia was diagnosed in 131 patients, and C. albicans, C. parapsilosis, C. glabrata, C. tropicalis, and others were present in 42.0%, 27.5%, 16.0%, 8.4%, and 6.1% of these patients, respectively. Voriconazole had the lowest MIC90S against C. albicans and C. parapsilosis (0.015 and 0.25). Micafungin had a low MIC90 against C. glabrata and C. tropicalis. C. albicans was the most common fungus in patients with candidemia. Voriconazole and micafungin were effective against C. albicans. Amphotericin B was effective for C. parapsilosis, and micafungin showed good efficacy against C. glabrata and C. tropicalis. [ABSTRACT FROM AUTHOR]