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AIM To evaluate the efficacy and safety of dinoprostone vaginal insert (PROPESS) in pregnant post-term Japanese women requiring cervical ripening. METHODS This randomized, double-blind, placebo-controlled study included 114 pregnant Japanese women at term (41 weeks of gestation) requiring cervical ripening (baseline Bishop score (BS) ≤ 4). The primary end-point was the proportion of subjects with successful cervical ripening defined as BS ≥ 7 or vaginal delivery in 12 h. The secondary end-points were changes in BS, proportion of women with vaginal delivery, proportion of women receiving mechanical cervical ripening procedure and use of oxytocic drugs. RESULTS PROPESS administration for a maximum of 12 h showed significantly higher successful cervical ripening rate (47.4% vs 14.3%, respectively; treatment contrast [TC]: 33.1%; P = 0.0002). The median time from administration to vaginal delivery was significantly shorter in the PROPESS group than in the placebo group (26.18 h vs 33.02 h; OR 2.51; 95% CI [1.60-3.92]; P

In this paper, various modern power engines developed by the American, Japanese, and European automobile industries will be compared. Specific data, including the efficiency, emission rate of nitrogen oxides (NOx), fuel consumption, and electronic vehicle technology, will be developed. Since the first invention of the automobile engine in the late 19th century, companies came up with unique innovations, including its structure, control systems, and additional mechanical installations to improve efficiency and reduce emissions. Numerous companies, including Ford, Toyota, and Mercedes-Benz, compete in the automobile industry to improve their engine’s efficiency and emission rates to create a clean environment. In addition, each country has its regulations on emission rates and automobile structure. Therefore, to meet these regulations, the structure and the system of the engines vary between companies in different countries. A variety of variable valve timing (VVT) systems, which is a mechanical part installed in the engine, are being developed by several companies. The VVT controls the opening and closing of the air inlet valve and the exhaust valve, which improves the reduction of fuel consumption and thermal efficiency. Furthermore, changing the engine structure is also another method that automobile companies are developing. Changing the engine’s shape can improve the vehicle’s performance (e.g., the engine vibration while running, the power output, and the smoothness of driving). Due to the emissions caused by petrol and diesel engines, the electrified vehicles have been developing to achieve a cleaner environment. This includes battery electric vehicles, hybrid electric vehicles, plug-in hybrid electric vehicles, and fuel cell electric vehicles. By comparing these features in the engine, it is possible to understand what the companies in the US, Japan, and the European countries are working on to improve their engines and provide a clean environment.

The disruption of adaptive immune response has adverse effects on the establishment and maintenance of pregnancy. The adaptive immune system is regulated by several types of immune cells. However, there is limited information about cell hierarchy in the adaptive immune response to the establishment and maintenance of pregnancy in women. The assessment of the outcome of pregnancy in primary immunodeficiency diseases could help in understanding the cell hierarchy in the adaptive immune system during pregnancy. Common variable immunodeficiency (CVID) is a heterogeneous adaptive immune system disorder characterized by primary hypogammaglobulinemia. A few studies have previously reported the assessment of the T and B cell subpopulations in CVID patients. However, an assessment of the subpopulations of T and B cells and the outcome of pregnancy in women with CVID has not been reported till date. Most CVID patients show a general decrease in the expression of CD27 in B cells. The assessment of pregnancy and the subpopulations of T and B cells in CVID women with severe reduction in the naive T and switched B cells could help understand whether these cells are essential for the establishment and maintenance of pregnancy in women.

This chapter deals with the contribution of regulatory T cells (Tregs) in maintaining the immunological balance during pregnancy. We discuss the discovery of Treg cells and their role in a healthy pregnancy, in rodents and humans. We describe the relationship between obstetrical complications such as preeclampsia and Tregs function. We emphasize the relationship between pregnancy and autoimmune diseases and discuss the critical role that Tregs play in the progress of the autoimmune disease during pregnancy.

Aim To evaluate the efficacy and safety of dinoprostone vaginal insert (PROPESS) in pregnant post‐term Japanese women requiring cervical ripening. Methods This randomized, double‐blind, placebo‐controlled study included 114 pregnant Japanese women at term (41 weeks of gestation) requiring cervical ripening (baseline Bishop score (BS) ≤ 4). The primary end‐point was the proportion of subjects with successful cervical ripening defined as BS ≥ 7 or vaginal delivery in 12 h. The secondary end‐points were changes in BS, proportion of women with vaginal delivery, proportion of women receiving mechanical cervical ripening procedure and use of oxytocic drugs. Results PROPESS administration for a maximum of 12 h showed significantly higher successful cervical ripening rate (47.4% vs 14.3%, respectively; treatment contrast [TC]: 33.1%; P = 0.0002). The median time from administration to vaginal delivery was significantly shorter in the PROPESS group than in the placebo group (26.18 h vs 33.02 h; OR 2.51; 95% CI [1.60–3.92]; P

As a novel type of anticancer reagent, imatinib inhibits not only BCR-ABL oncogenic protein but also LCK in T cells as an off-target, being able to selectively deplete mature T reg cells and thereby evoke effective immune responses to various cancers., This report addresses whether small molecules can deplete FoxP3-expressing regulatory T (T reg) cells, thereby augmenting antitumor immunity. Imatinib, a tyrosine kinase inhibitor of oncogenic BCR-ABL protein expressed by chronic myelogenous leukemia (CML) cells, possesses off-targets including LCK expressed in T cells. We showed that imatinib-treated CML patients in complete molecular remission (CMR) exhibited selective depletion of effector T reg (eT reg) cells and significant increase in effector/memory CD8+ T cells while non-CMR patients did not. Imatinib at CML-therapeutic concentrations indeed induced apoptosis specifically in eT reg cells and expanded tumor antigen–specific CD8+ T cells in vitro in healthy individuals and melanoma patients, and suppressed colon tumor growth in vivo in mice. Mechanistically, because of FoxP3-dependent much lower expression of LCK and ZAP-70 in T reg cells compared with other T cells, imatinib inhibition of LCK further reduced their TCR signal intensity, rendering them selectively susceptible to signal-deprived apoptotis. Taken together, eT reg cell depletion by imatinib is instrumental in evoking effective immune responses to various cancers.

The disruption of adaptive immune response has adverse effects on the establishment and maintenance of pregnancy. The adaptive immune system is regulated by several types of immune cells. However, there is limited information about cell hierarchy in the adaptive immune response to the establishment and maintenance of pregnancy in women. The assessment of the outcome of pregnancy in primary immunodeficiency diseases could help in understanding the cell hierarchy in the adaptive immune system during pregnancy. Common variable immunodeficiency (CVID) is a heterogeneous adaptive immune system disorder characterized by primary hypogammaglobulinemia. A few studies have previously reported the assessment of the T and B cell subpopulations in CVID patients. However, an assessment of the subpopulations of T and B cells and the outcome of pregnancy in women with CVID has not been reported till date. Most CVID patients show a general decrease in the expression of CD27 in B cells. The assessment of pregnancy and the subpopulations of T and B cells in CVID women with severe reduction in the naïve T and switched B cells could help understand whether these cells are essential for the establishment and maintenance of pregnancy in women.

Severe micrognathia can lead to death shortly after birth without a proper resuscitation. However, it is difficult to develop an effective resuscitation strategy without a prenatal diagnosis of the severity of micrognathia. In the present case, we used fetal three-dimensional computed tomography (3D-CT) to assess the severity of micrognathia. Its images clearly demonstrated bony framework of mandible and suggested that mandibular hypoplasia was too severe to allow for oral intubation. We therefore decided that the ex utero intrapartum treatment (EXIT) procedure would be more appropriate to establish the airway at birth. The prenatal 3D-CT is useful to evaluate the mandibular anatomy in utero if the severity of the micrognathia is not confirmed by the ultrasound or magnetic resonance imaging (MRI).

Background: Yolk sac tumors arising from the omentum in women are very rare. There is no established treatment strategy for them. We report the first case of a yolk sac tumor arising from the omentum, which was successfully removed with secondary surgery after chemotherapy. Case: A 34-year-old Japanese woman visited our hospital with a large, solid, pelvic mass detected by magnetic resonance imaging (MRI) and a highly elevated serum alpha-fetoprotein. At primary laparotomy, a large, friable, and hemorrhagic mass adhered to the omentum was found. Histopathological examination of the resected specimen from the mass revealed a yolk sac tumor. Four cycles of bleomycin, etoposide, and cisplatin (BEP) combination chemotherapy were administered every 3 weeks. After chemotherapy, an MRI showed a residual pelvic mass 8cm in diameter. We performed secondary cytoreductive surgery and completely resected the residual tumor. At secondary laparotomy, a residual omental mass was found. Conclusions: Secondary cy...

Retroperitoneal cysts are a rare disease. Most retroperitoneal cysts of vascular origin have been reported as hemangiomas. However, according to the recent classification of vascular anomalies accepted by the International Society for Study of Vascular Anomalies (ISSVA), these previously reported retroperitoneal hemangiomas should rather have been classified as vascular malformations. A 65-year-old woman visited our hospital complaining of a sense of unexplained abdominal fullness. Magnetic resonance imaging suggested a uterine leiomyoma and bilateral ovarian cystic tumors. However, abdominal surgery revealed normal bilateral ovaries, but huge cystic masses in the retroperitoneum. Postoperative histological diagnosis of the retroperitoneal cysts demonstrated that they were venous malformations. This is a rare case in which large cystic retroperitoneal venous malformations were preoperatively diagnosed as ovarian cystic tumors. Retroperitoneal hemangiomas should be renamed as vascular malformations following the ISSVA classification.

A 34-year-old parous woman developed high fever and threatened preterm labor after a 1-day trip, for which she was receiving prenatal care at a hospital. Three days after onset, at 24 4/7 weeks of gestation, she was transferred to our hospital in an emergency. Soon after the woman's arrival at our hospital, the infant was spontaneously stillborn via a transvaginal delivery. Laboratory tests revealed severe maternal disseminated intravascular coagulation with renal and liver insufficiency. Histopathologic examination of the placenta revealed vast fibrin deposition and remarkable neutrophilic infiltration in the intervillous space, suggesting a rare bacterial infection caused by Arthrobacter spp. The bacteria were predominantly detected in the placenta and maternal blood serum by common bacterial 16S rRNA sequencing after polymerase chain reaction amplification. We report the first case, to our knowledge, of bacteremia with Arthrobacter spp., which may lead to maternal disseminated intravascular coagulation and intrauterine fetal death.

Tubo-ovarian abscess is a rare but potentially serious event that can occur after uterine artery embolization (UAE). We describe herein two cases of severe inflammatory tubo-ovarian abscesses. Two women presented with severe abdominal pain, cramping, and fever several months after UAE. Abdominal computed tomography demonstrated an enlarged tubo-ovarian mass, suggestive of an abscess. Percutaneous catheter drainage was performed. In one patient, tubo-ovarian abscess completely disappeared after the drainage, but the other patient eventually required hysterectomy and salpingo-oophorectomy. It is important for clinicians to be aware of tubo-ovarian abscess as a rare complication. Percutaneous drainage might be a useful treatment option.

Growing teratoma syndrome (GTS) is rare clinical phenomenon occurring as a sequelae of a malignant germ cell tumor. We present the case of a 20-year-old woman who developed GTS after undergoing fertility-sparing surgery and chemotherapy for an immature teratoma. She underwent left salpingo-oophorectomy, right ovarian cystectomy, and disseminated tumor reduction during her primary surgery. The postsurgical histology report identified the tumor as an immature teratoma, grade 3, International Federation of Gynecology and Obstetrics (FIGO) stage IIIb. She subsequently received 3 cycles of chemotherapy consisting of bleomycin, etoposide, and cisplatin. At 17 months after the chemotherapy, follow-up computed tomography (CT) scan revealed an enlarged mass in her right paracolic gutter and a small peritoneal lesion in the pouch of Douglas. Her serum alpha-fetoprotein level was not elevated. These findings were compatible with GTS, but it was difficult to rule out a recurrent immature teratoma. Diagnostic exploratory laparoscopic surgery revealed the enlarged tumors that had been detected by the CT scan. Although there were multiple tumors in the pouch of Douglas, we were able to resect all of them laparoscopically. Histological diagnosis of the surgically resected specimens was of a mature teratoma, and so we concluded that this tumor was a GTS. Our experience suggests that laparoscopic surgery is an effective alternative diagnostic and therapeutic approach in cases suspicious of GTS where the disease is disseminated to the peritoneum.

Cancer patients are at increased risk of thromboembolic events, and the combination of these two pathological conditions is known as Trousseau’s syndrome. Venous thromboembolisms (VTE) and pulmonary embolisms (PE) are the most common clinical features of Trousseau’s syndrome. However, arterial thromboembolisms can also occur. We report the case of a 55-year-old ovarian cancer patient, who developed repeated cerebral infarctions with catastrophic consequences. The initial ischemic stroke developed in the right middle cerebral artery territory 4 days before she was scheduled to undergo surgery. Anticoagulation therapy involving unfractionated heparin was administered, and the patient underwent emergency surgery, during which the right ovarian tumor was completely removed. Under a diagnosis of stage Ic ovarian cancer, postoperative adjuvant chemotherapy consisting of carboplatin plus paclitaxel was initiated. During the course of the adjuvant chemotherapy, the patient developed recurrent ovarian cancer, and second-line chemotherapy involving single agent gemcitabine was scheduled. After two months of second-line chemotherapy, which was not effective, the patient developed a second cerebral infarction in her left middle cerebral artery despite continuing to receive anticoagulation therapy. She died 5 days after the second stroke. Given the fact that recurrent thromboembolic events can occur even during ongoing anticoagulation therapy, intensive cancer treatment, thromboprophylaxis, and careful follow-up for the early detection of recurrent stroke events are recommended.

Clear cell adenocarcinoma (CCC) is generally thought to originate from ovarian, endometrial, or renal tissue. A CCC of the peritoneum (CCAP) is an extremely rare medical condition and is associated with a poor prognosis. To date, only 10 cases of CCAP have been reported, of which half resulted in death or recurrence within 6 months after initial treatment because CCAP is commonly resistant to multiple drugs. In this report, we present a case of CCAP of the pouch of Douglas coexisting with an endometriosis and we offer a review of the related literature.