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BACKGROUND AND AIMS: Gastrocnemius and soleus in the triceps surae have functional and histological differences.We therefore investigated age-related changes in muscle thickness of these two muscles, as well as the difference in these changes between men and women. METHODS: Participants comprised 847 healthy adults aged 20 to 79 years. A B-mode ultrasound scanner, with participants sitting on a chair, was used to measure muscle thickness from the midpoint of the gastrocnemius medialis muscle at the level of maximum girth (target point). The ratio of muscle thickness to height was calculated. The inter-rater and intra-rater reliability of measuring muscle thickness with the ultrasound scanner and the validity of the target point were demonstrated before the examination. RESULTS: Gastrocnemius was significantly thinner in women aged 60 or older and in men aged 50 or older, compared with their counterparts in their 20s. For soleus, no significant differences in thickness were found among the age groups in either sex. Decline in muscle thickness from age 40-79 was greater for gastrocnemius than for soleus. CONCLUSIONS: These results confirm that gastrocnemius starts to deteriorate earlier and atrophies at a faster pace than soleus. A significant sex difference was found only in the onset age of gastrocnemius deterioration, which was earlier in men than in women. [ABSTRACT FROM AUTHOR]

Abstract Background We investigated adaptation changes in dynamic postural control and contingent negative variation (CNV) in 13 young and 12 elderly adults. Subjects repeatedly underwent backward postural disturbance by a forward floor translation (S2) 2 s after an auditory warning signal (S1). Initial and second sets were conducted, each set with 20 trials. Posterior peak position of the center of pressure in the anteroposterior direction (CoPy) after S2 was identified. Electroencephalograms from Cz were averaged for each set, and the CNV negative peak was identified. Results Compared with the first trial, the posterior peak position of CoPy changed significantly forward from the 12th trial in the young and from the 19th trial in the elderly during the initial set. The mean of the posterior peak position was more forward in second set than in the initial set for both groups and was significantly backward in the elderly compared to the young for both sets. These findings indicate that subjects in both groups adapted better to the postural disturbance in the second set than in the initial set, and the adaptation was later in the elderly. Late CNV in the young started to increase negatively from the middle of the S1-S2 period and peaked just before S2. Peak CNV amplitude was larger in the second set than in the initial set. In contrast, late CNV in the elderly exhibited no negative increase as in the young and peaked in the middle of the S1-S2 period, which was followed by gradual decreasing toward S2. No adaptive changes were found in late CNV for the elderly. Conclusions It is conceivable that reduced activation of the frontal lobe may be one of the factors contributing to the decrease in postural adaptability in the elderly. The elderly may use various brain regions for the adaptation of dynamic postural control compared with the young.

Uterine atony is a major contributor to postpartum hemorrhage. We previously proposed the novel histological concept of postpartum acute myometritis (PAM) to elucidate the pathophysiology of uterine atony. This concept involves the infiltration of macrophages and neutrophils, as well as mast cell and complement activation in the myometrium. However, the pathological mechanism underlying uterine atony in the context of PAM remains unclear. Herein, we focused on uterine contraction-associated proteins (CAPs) including connexin 43 (Cx43), oxytocin receptors (OXR), prostaglandin receptors EP1, EP3, FP, and protease-activated receptor (PAR)-1. This follow-up study aimed to compare CAP expression between PAM and control groups. We selected 38 PAM subjects from the cases enrolled in our amniotic fluid embolism registry between 2011 and 2018. Control tissues from 10 parturients were collected during cesarean section. We stained the myometrial tissues with the following CAP markers, inflammatory cell markers, and other markers: Cx43, OXR, EP1, EP3, FP, PAR-1, C5a receptor, tryptase, neutrophil elastase, CD68, β-actin, and Na + /K + -ATPase. The immunostaining-positive areas of Cx43, OXR, EP1, EP3, and FP standardized by β-actin in the PAM tissue were significantly smaller than in the control group, whereas those of PAR-1 and Na + /K + -ATPase increased significantly in the PAM group. The Cx43- and OXR-positive areas correlated negatively with the immunostaining-positive cell numbers of CD68 and tryptase with halo, respectively. PAM may impair individual and synchronized myocyte contraction, leading to uterine atony refractory to uterotonics. Further cell-based studies are needed to elucidate the molecular mechanism by which inflammatory cells suppress CAP expression., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Tomoaki Oda, Naoaki Tamura, Naomi Furuta-Isomura, Naohiro Kanayama, and Hiroaki Itoh report financial support was provided by Japan Society for the Promotion of Science. Hiroaki Itoh reports financial support was provided by Japan Agency for Medical Research and Development. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The placenta is the largest fetal organ, which connects the mother to the fetus and supports most aspects of organogenesis through the transport of nutrients and gases. However, further studies are needed to assess placental pathology as a reliable predictor of long-term physical growth or neural development in newborns. The Consensus Statement of the Amsterdam Placental Workshop Group (APWGCS) on the sampling and definition of placental lesions has resulted in diagnostic uniformity in describing the most common pathological lesions of the placenta and contributed to the international standardization of descriptions of placental pathology. In this narrative review, we reclassified descriptions of placental pathology from previously published papers according to the APWGCS criteria and comparatively assessed the relationship with infantile physical and/or neural development. After reclassification and reevaluation, placental pathology of maternal vascular malperfusion, one of the APWGCS criteria, emerged as a promising candidate as a universal predictor of negative infantile neurodevelopmental outcomes, not only in term and preterm deliveries but also in high-risk groups of very low birthweight newborns. However, there are few studies that examined placental pathology according to the full categories of APWGCS and also included low-risk general infants. It is necessary to incorporate the assessment of placental pathology utilizing APWGCS in the design of future birth cohort studies as well as in follow-up investigations of high-risk infants.

Objective: This study aims to elucidate the complex relationship among social isolation, loneliness, and perception of social isolation and its influence on depressive symptoms by evaluating a hypothetical model. This understanding is essential for the formulation of effective intervention strategies., Methods: We conducted an online survey on Japanese adults (N = 3,315) and used the six-item Lubben Social Network Scale to assess the size of their social networks. We employed a single question to gauge their perception of social isolation. Loneliness was assessed using the three-item UCLA Loneliness Scale, and depressive symptoms were examined using the Patient Health Questionnaire-9. Structural equation modeling was employed to test the hypothesized model., Results: The final model demonstrated satisfactory fit with data (χ2 (1) = 3.73; not significant; RMSEA = 0.03; CFI = 1.00; TLI = 1.00). The size of social network demonstrated a weak negative path to loneliness and depressive symptoms (β = -.13 to -.04). Notably, a strong positive association existed between perception of social isolation and loneliness (β = .66) and depressive symptoms (β = .27). Additionally, a significant positive relationship was found between loneliness and depressive symptoms (β = .40). Mediation analysis indicated that perception of social isolation and loneliness significantly intensified the relationships between social networks and depressive symptoms., Conclusions: Results indicate that interventions of psychological approaches, such as cognitive-behavioral therapy, are effective in reducing the perception of social isolation and loneliness, which may lead to the prevention of depressive symptoms. Future longitudinal studies are expected to refine and strengthen the proposed model., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Kushibiki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Amniotic fluid embolism (AFE) and placental abruption (PA) are typical obstetric diseases associated with disseminated intravascular coagulation (DIC). AFE is more likely to be complicated with enhanced fibrinolysis than PA. AFE may have an additional mechanism activating fibrinolytic cascade. We aimed to compare the coagulation/fibrinolysis factors among AFE, PA, and peripartum controls. We assessed AFE cases registered in the Japanese AFE Registry, and PA cases complicated with DIC (severe PA) and peripartum controls recruited at our hospital. The following factors in plasma were compared: prothrombin fragment 1 + 2 (PF1 + 2), plasmin α2-plasmin inhibitor complex (PIC), tissue factor (TF), tissue plasminogen activator (tPA), annexin A2 (AnnA2), total thrombin activatable fibrinolysis inhibitor (TAFI) including its activated form (TAFIa), and plasminogen activator inhibitor-type 1 (PAI-1). PF1 + 2 and PIC were markedly increased in both AFE (n = 27) and severe PA (n = 12) compared to controls (n = 23), without significant difference between those disease groups; however, PIC in AFE showed a tendency to elevate relative to PF1 + 2, compared with severe PA. AFE had significantly increased tPA and decreased total TAFI levels compared with severe PA and controls, which might be associated with further plasmin production in AFE and underlie its specific fibrinolytic activation pathway., (© 2024. The Author(s).)

Aim: Suicide prevention for depressive patients is an important clinical issue in psychiatry. However, not all depressive patients plan or attempt suicide. In this study, we investigated the differences of functional brain networks between a high-risk group and a low-risk group for suicide by comparing resting-state functional connectivity (rsFC)., Methods: The subjects were 29 patients with major depressive disorder, nine of whom had attempted suicide. The suicidal ideation of all subjects was assessed with the Columbia-Suicide Severity Rating Scale, then the subjects were divided into two groups based on the most severe suicidal ideation (MSI) in their lifetime. We compared rsFC between the two groups., Results: Of the 29 subjects, 16 were in the severe MSI group. We found that the severe MSI group members had significantly smaller rsFC in two networks: one comprised the right dorsolateral prefrontal cortex and the default-mode network, and the other comprised the left rostrolateral prefrontal cortex and the striatum, amygdala, and hippocampus. These regions are reported to be associated with rumination, retrieval suppression, and delay discounting (DD)., Conclusion: Our results suggest that functional networks related to rumination, retrieval suppression, and DD might be impaired in depressive patients with severe suicidal ideation. It might be beneficial for psychiatrists to assess these characteristics in terms of suicide prevention for depressive patients., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. Psychiatry and Clinical Neurosciences Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.)

The aim of present study was to investigate the association of placental pathological findings with infantile neurodevelopment during the early 40 months of life. 258 singleton infants were enrolled in the Hamamatsu Birth Cohort for Mothers and Children (HBC Study) whose placentas were saved in our pathological division. To assess the infantile neurodevelopment, we used Mullen Scales of Early Learning (gross motor, visual reception, fine motor, receptive language, expressive language) at 10, 14, 18, 24, 32, and 40 months. For obtaining placental blocks, we carried out random sampling and assessed eleven pathological findings using mixed modeling identified 'Accelerated villous maturation', 'Maternal vascular malperfusion', and 'Delayed villous maturation' as significant predictors of the relatively lower MSEL composite scores in the neurodevelopmental milestones by Mullen Scales of Early Learning. On the other hand, 'Avascular villi', 'Thrombosis or Intramural fibrin deposition', 'Fetal vascular malperfusion', and 'Fetal inflammatory response' were significant predictors of the relatively higher MSEL composite scores in the neurodevelopmental milestones by Mullen Scales of Early Learning. In conclusion, the present study is the first to report that some placental pathological findings are bidirectionally associated with the progression of infantile neurodevelopment during 10-40 months of age., (© 2022. The Author(s).)

Pulmonary thromboembolism (PTE) is one of the leading causes of maternal mortality. We previously reported that possible contamination of amniotic fluid (AF) into maternal circulation accelerated thrombin production and activated platelet function in maternal blood through the extrinsic pathway, which may be associated with the high incidence of PTE in early puerperium. However, it remains unclear whether the maternal anticoagulation system, e.g., the activated protein C (APC) pathway, contributes to the hypercoagulable condition induced by AF. Our previous study using an endogenous thrombin potential (ETP)-based assay revealed that sensitivity to APC was reduced during the postpartum first day, i.e., immediately after delivery, when parturients were supposed to be exposed to AF. Our aim is to investigate the susceptibility of maternal plasma to APC when mixed with AF. We collected plasma from 51 pregnant females and mixed with AF as well as APC. APC-sensitivity ratio (APC-sr) was calculated using the ETP-based assay. Addition of AF to maternal plasma showed a significant increase of ETP in the presence of APC. APC-sr was significantly increased, indicating decreased sensitivity to APC, after AF mixture to maternal plasma. The present APC-sr difference with AF contamination was smaller than that we reported previously in venous thromboembolism cases. The inhibitory effects of AF on the APC anticoagulation pathway may contribute, at least partly, to further promotion of thrombin production induced by AF. Combined with other classical thrombophilic risk factors, the present findings support possible involvements of AF exposure in the high incidence of PTE in early puerperium., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Neonatal respiratory disorders, such as transient tachypnea of the newborn and respiratory distress syndrome, occur frequently after an elective cesarean delivery. Although conventional pulse oximetry is recommended for neonatal resuscitation, it often requires several minutes after birth to obtain a reliable signal. In a previous study, we used novel tissue oximetry equipment to detect fetal and neonatal early tissue oxygen saturation (StO 2 ) before and immediately after vaginal delivery. Therefore, we hypothesized that low neonatal StO 2 levels measured by tissue oximetry may lead to neonatal respiratory disorder after a scheduled cesarean delivery. Hence, this study aimed to evaluate the StO 2 levels measured by tissue oximetry in neonates with or without a respiratory disorder subsequently diagnosed after an elective cesarean delivery. Materials and methods: We enrolled 78 pregnant Japanese women who underwent an elective cesarean section at ≥36 weeks' gestation. After combined spinal and epidural anesthesia were administered to the mother, fetal StO 2 levels were measured by tissue oximetry using an examiner's finger-mounted sensor during a pelvic examination immediately before the cesarean section. We measured the neonatal StO 2 levels at 1, 3, and 5 minutes after birth and retrospectively compared the fetal and neonatal StO 2 levels with the incidence of subsequent diagnoses of neonatal respiratory disorders. Results: The data of StO 2 levels in 35 neonates were collected. Seven neonates (respiratory disorder (RD) group) were subsequently diagnosed with respiratory disorders by neonatal medicine specialists, whereas the 28 remaining neonates (NR group) were not. The median fetal StO 2 (interquartile range) of the RD and NR groups was 52.0% (41.8%-60.8%) and 42.5% (39.0%-52.5%), respectively ( P = 0.12). The median neonatal StO 2 (interquartile range) of the RD and NR groups at 1 minute after birth was 42.0% (39.0%-44.0%) and 46.0% (42.0%-49.0%), respectively ( P = 0.091). At 3 minutes after birth, the median neonatal StO 2 (interquartile range) of the RD and NR groups was 41.0% (39.0%-46.0%) and 47.0% (44.3%-53.5%), respectively ( P = 0.004). Finally, at 5 minutes after birth, the median neonatal StO 2 (interquartile range) of the RD and NR groups was 45.0% (44.0%-52.0%) and 54.0% (49.3%-57.0%), respectively ( P = 0.007). Conclusions: The StO 2 values in the RD group were lower than those in the NR group at 3 and 5 minutes after birth, suggesting that neonates with low StO 2 levels soon after birth may be predisposed to clinically diagnosed neonatal respiratory disorders., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Objectives: Amniotic fluid embolism is a rare disease that induces fatal coagulopathy; however, due to its rarity, it has not yet been examined in detail. The strict diagnostic criteria by Clark for amniotic fluid embolism include severe coagulopathy complicated by cardiopulmonary insufficiency, whereas the Japanese criteria also include postpartum hemorrhage or Disseminated Intravascular Coagulation in clinical practice. Amniotic fluid embolism cases with preceding consumptive coagulopathy may exist and are potential clinical targets for earlier assessments and interventions among amniotic fluid embolism cases fulfilling the Japanese, but not Clark criteria. The present study was performed to compare coagulopathy in the earlier stage between the amniotic fluid embolism patients diagnosed by Clark criteria (Clark group, n = 6), those by the Japanese criteria (Non-Clark group, n = 10), and peripartum controls and identify optimal clinical markers for earlier assessments of amniotic fluid embolism-related consumptive coagulopathy., Design: Retrospective case-control study., Setting: A single university-based center. Our amniotic fluid embolism registry program has accumulated clinical information and blood samples since 2003., Patients: Amniotic fluid embolism patients in the Clark and Non-Clark groups between 2009 and 2017 and peripartum controls., Interventions: None., Measurements and Main Results: Clinical information was collected on hemoglobin levels, platelet counts, and coagulation- and fibrinolysis-related variables. Fibrinolytic parameters were also measured and compared among the three groups before blood transfusion. Fibrinogen levels in all patients in the Clark group and most in the Non-Clark group decreased earlier than hemoglobin levels, which was consistent with the high hemoglobin/fibrinogen ratio and, thus, is a promising clinical marker for the earlier assessment of amniotic fluid embolism-related consumptive coagulopathy., Conclusions: Earlier evaluations of consumptive coagulopathy and hyperfibrinolysis using the hemoglobin/fibrinogen ratio following preemptive treatment may reduce the occurrence or prevent the aggravation of severe coagulopathy in amniotic fluid embolism patients.

An opaque fetal membrane based on gross appearance is traditionally indicative of histological chorioamnionitis; however, to the best of our knowledge, there is currently no supportive evidence, and its diagnostic efficiency has not yet been scientifically demonstrated. The present study aimed to provide scientific insights into the traditional concept of an opaque fetal membrane based on gross appearance being an indicator of histological chorioamnionitis. We examined the placental pathology after screening of the placental gross appearance and perinatal complications and did not examine uncomplicated deliveries. We investigated the relationship between the presence of an opaque fetal membrane and histological chorioamnionitis (Cohort 1, 571 placentas) or the outcomes of neonates delivered at term (Cohort 2, 409 placentas) at Hamamatsu University School of Medicine between 2010 and 2017. The judgment of a positive opaque fetal membrane based on gross appearance correlated with histological chorioamnionitis (Cohort 1). Its sensitivity and specificity were 66.7 and 89.9%, respectively, while positive and negative predictive values were 86.8 and 73.0%, respectively. The judgment of a positive opaque fetal membrane based on gross appearance significantly correlated with chorioamnionitis-related complications in term newborns after adjustments for confounding factors (OR;1.82 [1.07-3.11], P<0.05) (Cohort 2). A correlation was observed even after adjustments for confounding factors. The present study is the first to demonstrate that the judgment of a positive opaque fetal membrane based on gross appearance correlated with histological chorioamnionitis as well as chorioamnionitis-related complications in newborns delivered at term. The present results provide support for the traditionally-described importance of gross inspections for an opaque fetal membrane soon after birth., Competing Interests: No authors have competing interests.

Uterine atony is a major cause of postpartum hemorrhage. We recently proposed the new histological concept of postpartum acute myometritis (PAM) for the pathophysiology of refractory uterine atony of unknown etiology, which is characterized by the diffuse activation of mast cells and the complement system as well as the massive infiltration of macrophages and neutrophils into the uterine body. We herein focused on the uterine isthmus just adjacent to the body. The isthmus becomes significantly elongated throughout pregnancy. It is composed of myocytes and fibroblasts with an extracellular matrix that forms a passive lower segment during labor. The aim of this study was to histologically examine the uterine isthmus in cases of PAM in the uterine body. Under the amniotic fluid embolism-registry program in Japan, we selected PAM cases from uterine samples obtained by cesarean hysterectomy and delivered to us for analyses between 2011 and 2017. Control tissues were collected during elective cesarean section. We investigated the isthmus tissues of these cases and performed immunohistochemistry for inflammatory cell markers, i.e. neutrophil elastase, mast cell tryptase, CD68, CD3, and C5a receptor (C5aR). The numbers of tryptase-positive degranulating mast cells, elastase-positive neutrophils, CD68-positive macrophages, and C5aR-positive cells in the isthmus were significantly higher in uteri with PAM in the body than in controls without PAM. CD3 was negative in both groups. In conclusion, inflammation and an anaphylactoid reaction were histologically detected not only in the uterine body, but in the isthmus among cases of refractory PPH of unknown etiology after cesarean section., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Among atopic diseases, atopic dermatitis is the most common allergic disease in children and influences both infantile and parental quality of life., Objective: The present study investigated the sex-specific relationship between the fetal/placental weight ratio and The incidence of atopic dermatitis in infants during the first 14 months of life., Methods: Study participants were 922 infants (462 female and 460 male) from singleton pregnancies enrolled in the Hamamatsu Birth Cohort for Mothers and Children (HBC Study) after the exclusion of 298 with missing data on atopic dermatitis. The enrollment of infants with atopic dermatitis was based on a positive response from parents regarding whether a physician had ever diagnosed their child with atopic dermatitis by 14 months of age. The two-sample Wilcoxon rank-sum test or χ 2 test was adopted for descriptive analyses where appropriate. Unadjusted odds ratios and 95% confidence intervals for the infantile incidence of atopic dermatitis were compared using logistic regression analyses., Results: Maternal and perinatal factors did not correlate with the incidence of infantile atopic dermatitis. Fetal/placental weight ratio, but not birth or placental weight, correlated with the incidence of atopic dermatitis in female, but not male, infants. A correlation was still observed after adjustments for maternal allergies, gestational age at birth, maternal smoking during pregnancy, and household income at birth (odds ratio: 1.57; 95% confidence interval, 1.05-2.33)., Conclusion: We speculated that the intrauterine fetal environment, represented by a relatively small placenta, programs a predisposition in only female infants to atopic dermatitis during the first 14 months of life., (© 2020 The Authors. Published by Elsevier Inc. on behalf of Women's Dermatologic Society.)

Aim: Uterine atony is a major cause of postpartum hemorrhage. We recently proposed a new concept for the histopathophysiology of refractory uterine atony, postpartum acute myometritis (PAM), characterized by acute inflammatory changes with massive stromal edema, increased numbers of complement C5a receptors and diffuse mast cell activation in the myometrium. We herein focused on the possible involvement of the kinin-kallikrein system in the rapid development of interstitial edema in PAM, particularly bradykinin receptor type 1 (B1R), which is up-regulated under inflammatory conditions. The present study investigated B1R expression with uterine interstitial edema in PAM., Methods: Our institution plays an important role in a Japanese amniotic fluid embolism registry project. We selected PAM cases from uterine samples delivered to us for further analyses between 2012 and 2017. Control tissues were collected during cesarean section and planned hysterectomy. B1R expression was semi-quantitatively measured by immunohistochemistry, while uterine interstitial edema was estimated by semi-quantitative measurements of the alpha smooth muscle actin-negative area using immunohistochemistry., Results: There were 36 and 8 cases in the PAM and control groups, respectively. The alpha smooth muscle actin-negative area was increased in the PAM group, concomitant with the significant up-regulation of B1R expression in uterine smooth muscle cells, vascular endothelial cells, and neutrophils. A positive correlation was observed between these two factors., Conclusion: We demonstrated the up-regulated expression of B1R in the myometrium and its positive correlation with histologically estimated interstitial edema, suggesting the contribution of the kinin-kallikrein-B1R system to the development of interstitial edema in PAM cases., (© 2019 Japan Society of Obstetrics and Gynecology.)

Short-chain fatty acids (SCFAs) produced by fermentation from prebiotics not only provide energy but also activate cell membrane receptors, thereby contributing to the maintenance of homeostasis in the human body. Recently, free fatty acid receptor 2 (FFAR2), which uses SCFAs as ligands, was found to exert oncoprotective effects on several types of neoplasia. This study examined whether SCFAs have oncoprotective effects on uterine cervical neoplasia. Immunohistochemical analysis revealed that FFAR2 was expressed in atypical cells and cancer cells of cervical neoplasia. Moreover, reverse transcription polymerase chain reaction showed that FFAR2 was expressed in a human cervical cancer cell line, HeLa. We also found that SCFAs inhibited the proliferation of HeLa cells, and a FFAR2 antagonist, GLPG0974, used to suppress the binding of SCFAs significantly restored the cell viability of HeLa cells blocked by acetic acid treatment. These results suggest that ingestion of prebiotics and the resulting production of SCFAs may play an oncoprotective role against uterine cervical neoplasia via FFAR2 expression.

Introduction: Pulmonary thromboembolism (PTE) is a leading cause of maternal death and frequently occurs during early puerperium. Amniotic fluid components are frequently observed in the maternal circulation in parturition; however, it currently remains unclear whether amniotic fluid contamination in maternal blood is related to the high incidence of PTE in early postpartum., Objectives: To examine the influence of amniotic fluid on blood coagulation and fibrinolysis systems with thromboelastometry., Materials and Methods: Twenty-one pregnant women were recruited. We used whole citrated blood in ROTEM® (Tem Innovations GmbH, Munich, Germany), including the non-activated assay (NATEM), assessments for extrinsic (EXTEM) and intrinsic pathways (INTEM), fibrin polymerization (FIBTEM), and hyperfibrinolysis (APTEM), with amniotic fluid contamination, and measured the clotting time (CT), clot formation time (CFT), alpha, amplitude at 10 min (A10), maximum clot firmness (MCF), and lysis indices at 30 min (LI30) and 60 min (LI60)., Results: Short CT in all assays as well as short CFT, high alpha, and increased A10 and MCF in NATEM were observed with amniotic fluid contamination. A10 and MCF as well as LI30 and LI60 decreased in EXTEM. Decreased LI60 with the mixture of amniotic fluid was not improved by tranexamic acid in APTEM., Conclusions: Amniotic fluid accelerated thrombin production and activated platelet aggregation without inducing hyperfibrinolysis in whole blood. The activated tissue factor pathway with amniotic fluid produced soft and fragile clots due to its influence on platelets, which may be associated with, at least partly, the high incidence of PTE in early puerperium, particularly after cesarean section., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: To examine the effects of rebamipide ophthalmic solution on the symptoms, signs, and cytokine concentrations in tear fluid among soft contact lens (SCL) wearers with Dry eye disease (DED)., Methods: From November 2015 to June 2017, this open-label, single-arm study examined 40 eyes of 20 SCL wearers with DED who had been using daily disposable SCLs for >3 months (mean age, 30.0±8.33 years; range, 20-47 years). Signs, symptoms, and cytokine concentrations were assessed before and 4 weeks after starting 2% rebamipide ophthalmic solution 4 times/day. Dry eye disease was diagnosed according to: compromised tear dynamics (Schirmer test ≤5 mm or tear break-up time (TBUT) ≤5 sec); ocular surface abnormalities (positive vital staining with fluorescein or lissamine green); and presence of symptoms. Touch thresholds using a Cochet-Bonnet anesthesiometer were also determined for the cornea and conjunctivae. Symptoms were assessed using the 12-item Ocular Surface Disease Index questionnaire. Concentrations of cytokines in tear fluid were measured., Results: Significant improvements in signs were seen for TBUT, surface abnormalities, and touch thresholds. Ocular Surface Disease Index scores likewise improved significantly in all the 12 items. Of the cytokines measured, only interleukin-1β, interleukin-8, and monocyte chemotactic protein-1 were found in ≥60% of tear samples, with no significant differences in concentrations before and after rebamipide use., Conclusions: Rebamipide significantly improved all signs and symptoms in patients with DED who wore daily disposable SCLs. Rebamipide is effective for DED treatment with SCL wear.

The present study aimed to investigate the relationship between placental pathological findings and physiological development during the neonate and infantile periods. Study participants were 258 infants from singleton pregnancies enrolled in the Hamamatsu Birth Cohort for Mothers and Children (HBC Study) whose placentas were stored in our pathological division. They were followed up from birth to 18 months of age. Physiological development (body weight and the ponderal index [PI]) was assessed at 0, 1, 4, 6, 10, 14, and 18 months. Placental blocks were prepared by random sampling and eleven pathological findings were assessed, as follows: 'Accelerated villous maturation', 'Decidual vasculopathy', 'Thrombosis or Intramural fibrin deposition', 'Avascular villi', 'Delayed villous maturation', 'Maternal inflammatory response', 'Fetal inflammatory response', 'Villitis of unknown etiology (VUE)', 'Deciduitis', 'Maternal vascular malperfusion', and 'Fetal vascular malperfusion'. Mixed model analysis with the use of the xtmixed command by the generic statistical software, Stata version 13.1., identified 'Accelerated villous maturation' and 'Maternal vascular malperfusion' as significant predictors of a lower body weight and 'Deciduitis' as a significant predictor of a small PI, throughout the first 18 months of life. In conclusion, the present study is the first to demonstrate that some pathological findings of the placenta are associated with changes in infantile physical development during the initial 18 months of life in the Japanese population.

Objective: Few studies have correlated the placental vasculature with fetal cardiac function other than umbilical artery Doppler assessment in low-risk pregnancies. We assessed the contribution of the placental vasculature to fetal echocardiographic parameters using histopathological and morphometric analyses of placental resistance arteries., Study Design: Thirty-four low-risk singleton term pregnancies were assessed, including 24 thrombosis-negative cases (no/minimal gross and histological placental abnormalities) and 10 thrombosis-positive cases (histologically identified chorionic plate/stem vessel thrombosis). Fetal ventricular Doppler inflow velocities (E and A waves) and myocardial systolic (S'), early (E'), and late diastolic (A') tissue Doppler velocities were measured within three days before birth. The myocardial performance index (MPI') was calculated. Morphometric variables of placental stem villi arterioles (external diameter 10-150 μm) were examined, including the mean arteriolar density, total cross-sectional lumen area, and wall area/total vessel area (WA/TVA) ratio., Results: The thrombosis-positive group had a higher umbilical artery pulsatility index and a lower tricuspid E'/A' ratio compared to the thrombosis-negative group. The WA/TVA ratio of stem villi arterioles was negatively correlated with tricuspid E, A, and S' velocities as well as the E/E' ratio (n = 34). The tricuspid MPI' was positively correlated with the total cross-sectional lumen area of stem villi arterioles (n = 34)., Conclusion: We conclude that changes in several fetal echocardiographic parameters are associated with placental vascular histopathological and morphological characteristics in a low-risk population. Further studies are needed to assess whether fetal echocardiographic assessment is a promising prenatal predictor of placental vascular histopathological and morphological characteristics in the general population., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: We investigated developmental changes in shortening of pro-saccade reaction time while maintaining neck flexion., Methods: Subjects comprised 135 children (3-14 years) and 29 young adults (19-23 years). Children were divided into six groups in 2-year age strata. Pro-saccade reaction tasks for 30 s were performed in neck rest and flexion positions. Reaction times under each position were averaged in every 10-s period., Results: Under neck rest position, reaction time in the 0-10 s period was significantly longer in the 3- to 4-year-old group than in the 5- to 6-year-old group and above. No significant age effect was found for reaction time in the 0-10 s period in the 5- to 6-year-old group and above. Although a significant effect of neck flexion was not observed until the 9- to 10-year-old group, significant shortening of reaction time with neck flexion was found in the 11- to 12-year-old group and above. Furthermore, this shortening was maintained until the first 20-s period in the 11- to 12-year-old group and during the entire 30 s in the 13- to 14-year-old and above., Conclusions: These results suggest that brain activation with the maintenance of neck flexion, related to shortening of the pro-saccade reaction time, was found from a later age of approximately 11 years and above, compared with the age at which information-processing function in the pro-saccade was enhanced. In addition, brain activation with the maintenance of neck flexion was sustained longer with age.

Background: Relationships between the timings of attentional switching and postural preparation were investigated using a choice-reaction paradigm with transient floor translation (S2), with the direction indicated by a warning auditory signal (S1)., Methods: Thirteen healthy young adults participated in this study. S2 started 2 s after S1 onset while standing on the platform. The platform moved forward when S1 was a high tone, and backward when S1 was a low tone. In the S1-S2 period, attentional switching was evaluated by P3 component of event-related potential., Results: A shift in the center of pressure in the anteroposterior direction (CoPap) or a continuous increase in postural muscle activation toward S2 was recognized as postural preparation. Changes in postural muscle activation were found just before the CoPap shift. P3 was observed about 250-650 ms after S1. Onset of postural preparation was significantly later (about 200 ms) than latency of P3 (p < 0.001) and correlated strongly with P3 latency (forward: r = 0.81, backward: r = 0.74, p < 0.01)., Conclusion: Postural preparation for S2 was demonstrated to start after attentional switching from S1 to S2.

Background: Activation timings of postural muscles of lower legs and prediction of postural disturbance were investigated in young and older adults during bilateral arm flexion in a self-timing task and an oddball task with different probabilities of target presentation. Arm flexion was started from a standing posture with hands suspended 10 cm below the horizontal level in front of the body, in which postural control focused on the ankles is important., Methods: Fourteen young and 14 older adults raised the arms in response to the target sound signal. Three task conditions were used: 15 and 45% probabilities of the target in the oddball task and self-timing. Analysis items were activation timing of postural muscles (erector spinae, biceps femoris, and gastrocnemius) with respect to the anterior deltoid (AD), and latency and amplitude of the P300 component of event-related brain potential., Results: For young adults, all postural muscles were activated significantly earlier than AD under each condition, and time of preceding gastrocnemius activation was significantly longer in the order of the self-timing, 45 and 15% conditions. P300 latency was significantly shorter, and P300 amplitude was significantly smaller under the 45% condition than under the 15% condition. For older adults, although all postural muscles, including gastrocnemius, were activated significantly earlier than AD in the self-timing condition, only activation timing of gastrocnemius was not significantly earlier than that of AD in oddball tasks, regardless of target probability. No significant differences were found between 15 and 45% conditions in onset times of all postural muscles, and latency and amplitude of P300., Conclusion: These results suggest that during arm movement, young adults can achieve sufficient postural preparation in proportion to the probability of target presentation in the oddball task. Older adults can achieve postural control using ankle joints in the self-timing task. However, in the oddball task, older adults experience difficulty predicting the timing of target presentation, which could be related to deteriorated cognitive function, resulting in reduced use of the ankle joints for postural control.

The retina is an ideal target for gene therapy because of its easy accessibility and limited immunological response. We previously reported that intravitreally injected adeno-associated virus (AAV) vector transduced the inner retina with high efficiency in a rodent model. In large animals, however, the efficiency of retinal transduction was low, because the vitreous and internal limiting membrane (ILM) acted as barriers to transduction. To overcome these barriers in cynomolgus monkeys, we performed vitrectomy (VIT) and ILM peeling before AAV vector injection. Following intravitreal injection of 50 μL triple-mutated self-complementary AAV serotype 2 vector encoding EGFP, transduction efficiency was analyzed. Little expression of GFP was detected in the control and VIT groups, but in the VIT+ILM group, strong GFP expression was detected within the peeled ILM area. To detect potential adverse effects, we monitored the retinas using color fundus photography, optical coherence tomography, and electroretinography. No serious side effects associated with the pretreatment were observed. These results indicate that surgical ILM peeling before AAV vector administration would be safe and useful for efficient transduction of the nonhuman primate retina and provide therapeutic benefits for the treatment of retinal diseases., (Copyright © 2017 The American Society of Gene and Cell Therapy. Published by Elsevier Inc. All rights reserved.)

Background: Adaptation changes in postural muscle activity and anticipatory attention were investigated with the ankle joint fixed to change postural control strategies during transient floor translation., Methods: For 15 healthy young adults, 40 transient floor translations (S2) in the anterior direction were applied 2 s after an auditory warning signal (S1), under conditions with or without fixation of the ankle. Activity of the frontal postural muscles (tibialis anterior (TA), rectus femoris (RF), rectus abdominis) and contingent negative variation (CNV, brain potential) were analyzed for 20 trials each of the early and latter halves under each fixation condition., Results: With fixation, peak amplitude of muscle activity after S2 was significantly decreased in TA and increased in RF. These muscles showed marked adaptive decreases. The early component of CNV reduced with adaptation, particularly under fixation condition. Only in RF, background activity increased just before S2, with adaptation under fixation. A significant correlation was found between timings of CNV peak and RF activation just before S2 only after adaptation under fixation., Conclusion: These results suggest that the main activation muscle changes from TA to RF with fixation. Under such condition, attention would be focused on the knee with adaptation, and the need for heightening attention in the early stage may have declined. Correspondingly, the timing to heighten stiffness of the RF became later, and attention would have been paid to RF activation just before S2.

Background: In this study, a cast brace was used to immobilize the knee, hip, and trunk, and relations between the event-related brain potential (ERP) and postural muscle activity were investigated while standing on an oscillating table., Methods: Twelve healthy young adults maintained a standing posture for 1 min per trial while oscillating in the anteroposterior direction at 0.5 Hz with a 2.5-cm amplitude. Trials were performed without and with the cast brace (no-fixation and fixation condition, respectively) until the subject had adapted to the floor oscillation. The ERP from the Cz electrode, postural muscle activity, and joint movement range were analyzed for the first and last two trials (before and after adaptation, respectively)., Results: Movement range of the hip and knee was lower in the fixation condition than in the no-fixation condition, and postural control was achieved by pivoting at the ankle. Peak muscle activity was largest in the gastrocnemius (GcM) in both conditions. GcM activity significantly increased after fixation and then decreased with adaptation. The time of peak erector spinae (ES) activity in the fixation condition was significantly earlier than in the no-fixation condition and was not significantly different from the time of the anterior reversal and peak of triceps surae activity. The negative ERP peaked approximately 80 ms after the anterior reversal. Significant correlations between the time of the peak negative ERP and the peak GcM, soleus, and ES activity were observed only after the adaptation, and were greater in the fixation condition (r = 0.83, 0.84, and 0.83, respectively) than in the no-fixation condition (r = 0.62, 0.73, and 0.51, respectively)., Conclusion: All joints of the leg and trunk except for the ankle were rigidly fixed by the cast brace, and the phase differences between body segments were very small in the fixation condition. High correlations between the time of the peak negative ERP and the peak GcM, soleus, and ES activity after adaptation in the fixation condition suggest that attention would be more focused on anticipatory processing of muscle sensory information from the triceps surae and/or ES, particularly GcM, which had the greatest activation.

Here, we present a case of right eyelid drooping in a 79-year-old man. Neurological examination revealed ptosis of the right eye without severe painful eyelid swelling and redness. An ocular motility examination of the right eye revealed upward limitation and downward overshoot. The results of routine blood examinations were within normal limits, and no autoantibodies were detected. Orbital magnetic resonance images revealed mild right eyelid swelling and lacrimal gland enlargement, indicating orbital inflammation. The ocular discharge was positive for Staphylococcus hominis by culture and the patient was diagnosed as having acute dacryoadenitis. Treatment with topical and systemic administration of antibiotics rapidly improved symptoms. Ocular infection is not usually suspected in the absence of local severe painful swelling and redness, and painless acute dacryoadenitis presenting as ophthalmoplegia and ptosis may be misdiagnosed. Orbital inflammation may rapidly progress to orbital cellulitis with treatment delay, which may also lead to aggravation of ophthalmic prognosis. Therefore, neurologists should be aware of the possibility of acute dacryoadenitis occurring without the local severe inflammatory findings mimicking neurological diseases, and acute dacryoadenitis should be considered in patients with ophthalmoplegia even in the absence of severe painful eyelid swelling and redness.

In order to investigate the possible involvement of endoplasmic reticulum (ER) stress in the developmental origins of hepatic steatosis associated with undernourishment in utero, we herein employed a fetal undernourishment mouse model by maternal caloric restriction in three cohorts; cohort 1) assessment of hepatic steatosis and the ER stress response at 9 weeks of age (wks) before a high fat diet (HFD), cohort 2) assessment of hepatic steatosis and the ER stress response on a HFD at 17 wks, cohort 3) assessment of hepatic steatosis and the ER stress response at 22 wks on a HFD after the alleviation of ER stress with a chemical chaperone, tauroursodeoxycholic acid (TUDCA), from 17 wks to 22 wks. Undernourishment in utero significantly deteriorated hepatic steatosis and led to the significant integration of the ER stress response on a HFD at 17 wks. The alleviation of ER stress by the TUDCA treatment significantly improved the parameters of hepatic steatosis in pups with undernourishment in utero, but not in those with normal nourishment in utero at 22 wks. These results suggest the pivotal involvement of the integration of ER stress in the developmental origins of hepatic steatosis in association with undernourishment in utero.

Placental villi play pivotal roles in feto-maternal transportation and phospholipids constitute a major part of the villous membrane. We have been developing and optimizing an imaging system based on a matrix-assisted laser desorption/ionization (MALDI)-based mass spectrometer, which provides clear two-dimensional molecular distribution patterns using highly sensitive mass spectrometry from mixtures of ions generated on tissue surfaces. We recently applied this technology to normal human uncomplicated term placentas and detected the specific distribution of sphingomyelin (SM) (d18:1/16:0) in stem villi and phosphatidylcholine (PC) (16:0/20:4) in terminal villi. In the present study, we applied this technology to nine placentas with maternal or fetal complications, and determined whether a relationship existed between these specific distribution patterns of phospholipid molecules and the six representative pathological findings of placentas, i.e., villitis of unknown etiology (VUE), thrombus, atherosis, chorioamnionitis (CAM), immature terminal villi, and multiple branched terminal villi. In two placentas with the first and second largest total number of positive pathological findings, i.e., five and three positive findings, the specific distribution of SM (d18:1/16:0) in stem villi and PC (16:0/20:4) in terminal villi disappeared. The common pathological findings in these two placentas were atherosis, immature terminal villi, and multiple branched terminal villi, suggesting the possible involvement of the underperfusion of maternal blood into the intervillous space. On the other hand, the number of pathological findings were two or less in the seven other placentas, in which no specific relationships were observed between the differential expression patterns of these two phospholipids in stem and terminal villi and the pathological findings of the placentas; however, the specific distribution pattern of SM (d18:1/16:0) in stem villi disappeared in four placentas, while that of PC (16:0/20:4) in terminal villi was preserved. These results suggested that the absence of the specific distribution of PC (16:0/20:4) in terminal villi, possibly in combination with the absence of SM (d18:1/16:0) in stem villi, was linked to placental morphological changes in response to maternal underperfusion of the placenta.

The aim of this study was to evaluate the histological characteristics of the myometrium obtained in postpartum hemorrhage (PPH) of unknown etiology secondary to uterine atony. These characteristics were selected from among registered cases of clinically suspected amniotic fluid embolism (AFE) and classified as PPH of unknown etiology because of no obvious cause of PPH at Hamamatsu University School of Medicine, a registration center for clinical AFE in Japan. Immunohistochemical studies were performed on myometrium using anti-mast cell tryptase, anti-neutrophil elastase, anti-CD68, anti-CD88, anti-CD3, and anti-ZnCP-1 antibodies. Massive infiltrations of inflammatory cells with mast cell degranulation within the myometrium secondary to complement activation were observed in PPH of unknown etiology (n=34), but not in control pregnant women (n=15) or after delivery in women without PPH (n=18). The concomitant immunohistochemical detection of meconium in myometrium suggests that amniotic fluids or fetal materials are one of the candidates for inducing maternal local immune activation in the PPH of unknown etiology. Postpartum acute myometritis in the absence of an infective etiology may be a histological characteristic of PPH of unknown etiology., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

The aim of the present study was to investigate the relationship between assisted reproductive technology procedures, the morphology of the basal plate of placentas, and amount of bleeding in deliveries. Fifty-five whole placentas (fresh-embryo transfer in the in vitro fertilization cycle [n = 6], frozen-thawed embryo transfer in the natural cycle [n = 13] or in the hormonal cycle [n = 10], and age-matched spontaneously conceived pregnancies [n = 26]) were retrospectively enrolled and histologically analyzed. The whole placentas were stored in our pathological division among 512 singleton pregnancies with vaginal deliveries (34-41 weeks of gestation) at Hamamatsu University Hospital. The morphology of the placental basal plate was examined using Azan staining. A total of 20 digital images (each 0.53 mm(2)) of microscopic fields were analyzed per placenta to measure the mean values of the vertical maximum thickness of Rohr and Nitabuch fibrinoid layers and % loss of decidua. The thickness of Rohr fibrinoid layer and % loss of decidua were significantly higher in the frozen-thawed embryo transfer in the hormonal cycle group than in the frozen-thawed embryo transfer in the natural cycle and spontaneously conceived pregnancy groups (each P < .01). The z scores for both the thickness of Rohr fibrinoid layer and % loss of decidua positively correlated with those for the amount of bleeding in deliveries (P < .05 each). Assisted reproductive technology procedures changed the morphology of the placental basal plate, suggesting a possible association with an increase in the amount of bleeding in deliveries., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: The effect of time pressure on attentional shift and anticipatory postural control was investigated during unilateral shoulder abduction reactions in an oddball-like paradigm., Methods: A cue signal (S1) - imperative signal (S2) sequence was repeated with various S2-S1 intervals (1.0, 1.5, and 2.0 s). S2 comprised target and non-target stimuli presented at the position (9° to the left or the right) indicated by S1. Right shoulder abduction was performed only in response to target stimuli, which were presented with a 30% probability. The P1, N1, N2, and P3 components of event-related potentials were analyzed, and onset times of postural muscles (electromyographic activity of erector spinae and gluteus medius) were quantified with respect to middle deltoid activation., Results: There was no significant effect of S2-S1 interval on the latency or amplitude of P1, N1, or N2. The percentage of subjects with bimodal P3 peaks was significantly smaller and the slope of the P3 waveform in the 100 ms after the first peak was significantly steeper with a 1.0-s S2-S1 interval than with a 1.5- or 2.0-s S2-S1 interval. The onset of postural muscle activity was significantly later in the shorter interval conditions., Conclusions: These results suggest that with a shorter S2-S1 interval, that is, higher time pressure, attention was allocated to hasten the latter part of cognitive processing that may relate to attentional shift from S2 to next S1, which led to insufficient postural preparation associated with arm movement and anticipatory attention directed to S2.

Purpose: To assess the feasibility of a gene therapeutic approach to treating choroidal neovascularization (CNV), we generated an adeno-associated virus type 8 vector (AAV2/8) encoding an siRNA targeting vascular endothelial growth factor (VEGF), and determined the AAV2/8 vector's ability to inhibit angiogenesis., Methods: We initially transfected 3T3 cells expressing VEGF with the AAV2/8 plasmid vector psiRNA-VEGF using the H1 promoter and found that VEGF expression was significantly diminished in the transfectants. We next injected 1 μl (3 × 10(14) vg/ml) of AAV2/8 vector encoding siRNA targeting VEGF (AAV2/8/SmVEGF-2; n = 12) or control vector encoding green fluorescent protein (GFP) (AAV2/8/GFP; n = 14) into the subretinal space in C57BL/6 mice. One week later, CNV was induced by using a diode laser to make four separate choroidal burns around the optic nerve in each eye. After an additional 2 weeks, the eyes were removed for flat mount analysis of the CNV surface area., Results: Subretinal delivery of AAV2/8/SmVEGF-2 significantly diminished CNV at the laser lesions, compared to AAV8/GFP (1597.3 ± 2077.2 versus 5039.5 ± 4055.9 µm(2); p<0.05). Using an enzyme-linked immunosorbent assay, we found that VEGF levels were reduced by approximately half in the AAV2/8/SmVEGF-2 treated eyes., Conclusions: These results suggest that siRNA-VEGF can be expressed across the retina and that long-term suppression of CNV is possible through the use of stable AAV2/8-mediated siRNA-VEGF expression. In vivo gene therapy may thus be a feasible approach to the clinical management of CNV in conditions such as age-related macular degeneration.

Background: Adaptation changes in postural control and contingent negative variation (CNV) for the elderly were investigated during repeated forward floor translation., Methods: Fifteen healthy elderly persons, living in the suburban area of Kanazawa City, Japan, underwent backward postural disturbance by a forward-floor translation (S2) 2 s after an auditory warning signal (S1). A set with 20 trials was repeated until a negative peak of late CNV was recognized in the 600-ms period before S2, and the last set was defined as the final set. Electroencephalograms, center of foot pressure in the anteroposterior direction (CoPap), and electromyograms of postural muscles were analyzed., Results: CoPap displacement generated by the floor translation was significantly decreased until the twelfth trial in the first set, and mean CoPap displacement was smaller in the second and final sets than in the first set. The mean displacement was significantly smaller in the final set than the previous set. A late CNV with a negative peak was not recognized in the first and second sets. However, most subjects (13/15) showed a negative peak by the fourth set, when the late CNV started to increase negatively from about 1,000 ms after S1 and peaked at about 300 ms before S2. At about 160 ms before the CNV peak, the CoPap forward shift started. The increase in timing of the gastrocnemius activity related to the CoPap shift was significantly correlated with the CNV peak timing (r = 0.64). After S2, peak amplitudes of the anterior postural muscles were significantly decreased in the final set compared to the first set., Conclusions: It was demonstrated that even for the elderly, with so many repetitions of postural disturbance, a late CNV with a negative peak was recognized, leading to accurate postural preparation. This suggests the improvement of frontal lobe function (e.g., anticipatory attention and motor preparation) in the elderly.

In bilateral shoulder flexion with the arms moving from the sides of the body to the horizontal level while standing, no preceding activation of the triceps surae (TS) with respect to focal muscles has been found. Considering that preceding activation would offer a useful indicator of anticipatory postural control, it was attempted to induce preceding activation by limiting the anterior displacement range of the center of foot pressure in the anteroposterior direction (CoPap). Subjects were 13 healthy young adults. The 50% anterior range of CoPap displacement caused by shoulder flexion was calculated, and the floor inclined by the subject's weight when CoPap extended beyond that range. Subjects were instructed not to incline the floor during shoulder flexion. Under the limitation condition, the ankle and knee joints plantarflexed and extended at 1.1°, respectively, with no hip movement; that is, the whole body inclined backward by pivoting at the ankle. This limitation resulted in preceding muscle activation of TS as well as erector spinae and biceps femoris, and no significant differences in onset time were seen between these muscles. These results demonstrated that by limiting CoPap anterior displacement, preceding activation of TS could be induced with backward inclination of the whole body., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Rapid growth in infancy considerably increases the risk of obesity and metabolic disorders in adulthood especially among neonates born small. To investigate the mechanism involved, we developed an animal model of undernourishment in utero by maternal caloric restriction, in which the Z scores of body weight at weaning (19.5 days) positively correlated with parameters of obesity, metabolic disorders, and remodeling of subcutaneous adipose tissue, such as numbers of macrophages in adipose tissue, the ratio of inflammatory M1 to anti-inflammatory M2 macrophages, estimated by gene expression of specific antigens, and the relative ratio of small adipocytes less than 30 μm in diameter, on a high-fat diet at 17 weeks of age. To our knowledge, this is the first report of a possible connection between infantile body weight and adipose tissue remodeling in obesity after undernourishment in utero.

Introduction: Zinc coproporphyrin I (ZnCP-I) is a photosensitive molecule and a major component of meconium. Here, we examined the effects of ZnCP-I as a potential photosensitizer in photodynamic therapy for tumors., Materials and Methods: (1) Aqueous ZnCP-I was irradiated with a pulsed YAG-SHG laser (wavelength: 532 nm)/YAG-SHG dye laser (wavelength: 566 nm). (2) HeLa cells were incubated in 200 mM ZnCP-I, and accumulation of ZnCP-I in HeLa cells was evaluated with ZnCP-I-specific fluorescence over 500 nm. (3) Aqueous ZnCP-I was administered intravenously to HeLa tumor-bearing mice at a dose of 10.2 mg/kg body weight. The tumors were irradiated with a filtered halogen lamp (wavelength: 580 nm) at 100 J/cm(2) 20 min after administration., Results: (1) An intense near-infrared emission spectrum was observed at around 1,270 nm after irradiation. The emission intensity was proportional to the laser power between 10 and 80 mW and was completely inhibited by addition of NaN3, a singlet oxygen scavenger. (2) ZnCP-I-specific fluorescence was detected in the HeLa cell cytoplasm. (3) Irradiated tumors treated with ZnCP-I were mostly necrotized., Conclusion: ZnCP-I accumulated in tumor cells, produced singlet oxygen upon irradiation, and necrotized the tumor cells. These results suggest that ZnCP-I may be an effective photosensitizer., (Copyright © 2013 S. Karger AG, Basel.)

Objective: We investigated effects of attentional dispersion on sensory-motor processing of anticipatory postural control during unilateral arm abduction., Methods: Thirteen adults performed arm abduction under two types of attentional dispersion conditions. A target stimulus was presented with 30% probability in two- or three-positions. By cue signal presentation, subjects either focused their attention on one position or divided attention for two or three positions and abducted right arm for target stimulus. Event-related potentials and onset time of postural muscles were measured., Results: P1-N1 and N2 amplitudes decreased with attentional dispersion in both conditions, but P3 did not change. With attentional dispersion to three-positions, N2 latency increased and start of late CNV was delayed, and also the onset time of gluteus medius was late in correlation to the late CNV changings, with no changings in two-positions., Conclusions: With attentional dispersion, brain activation decreased in the area related to the sensory processing and especially in the stimulus discrimination area. With increasing attentional dispersion, the delay in motor preparation or anticipatory attention to target stimuli was related to the delay in stimulus discrimination and onset time of postural muscle activation., Significance: Effects of attentional dispersion on sensory-motor processing of anticipatory postural control were experimentally demonstrated., (Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)

We investigated the effect of neck flexion on discriminative and cognitive processing in postural control during bilateral arm movement while standing, using event-related potential (ERP) and electromyogram. Fourteen healthy subjects flexed their arms to the target stimuli with a 20% probability in neck resting and flexion positions. Amplitude and latency of N2 and P3, anterior deltoid (AD) reaction time, onset time of postural muscles with respect to AD activation, and peak amplitude and latency of all muscles were measured. With neck flexion, N2 and P3 amplitudes increased, N2 and P3 latencies and AD reaction time shortened, and onset times of all postural muscles became earlier. No significant differences in peak amplitude and latency of each muscle were found between neck positions. Significant positive correlations were found in changes with neck flexion between P3 latency and AD reaction time, and between N2 latency and onset time of erector spinae. These suggest that with neck flexion, attention allocation to discriminative and cognitive processing increased, and the processing speed increased with shortening of reaction time in focal muscles. In addition, the onset time of postural muscles became earlier without changing the activation pattern, which was associated with the hastened discriminative processing., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Aim: Primary elective cesarean sections are being carried out in considerable numbers in both developed and developing countries; however, little information is available concerning differences in maternal physiological responses associated with the mode of delivery. The aim of the present study was to compare the changes in the maternal complement and contact systems between delivery by cesarean section and vaginal delivery at term., Methods: Maternal levels of complement 3 (C3), complement 4 (C4) and coagulation factor XII (FXII) were measured during primary elective cesarean (n=70) and vaginal (n=140) deliveries., Results: The C3, C4 and FXII levels decreased significantly during delivery by cesarean section and remained low for two hours. By contrast, C3 levels, but not C4 levels, increased temporally during normal term delivery and FXII levels decreased two hours later., Conclusions: The changes in maternal C3, C4 and FXII levels during cesarean section were very different from those during delivery at term, suggesting that the maternal complement and contact systems respond differently., (© 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.)

It is becoming increasingly evident that people with chronic, recurrent low back pain (LBP) exhibit changes in cerebrocortical activity that associate with altered postural coordination, suggesting a need for a better understanding of how the experience of LBP alters postural coordination and cerebrocortical activity. To characterize changes in postural coordination and pre-movement cerebrocortical activity related to the experience of acutely induced LBP, 14 healthy participants with no history of LBP performed sit-to-stand movements in 3 sequential conditions: (1) without experimentally induced LBP; NoPain1, (2) with movement-associated LBP induced by electrocutaneous stimulation; Pain, and (3) again without induced LBP; NoPain2. The Pain condition elicited altered muscle activation and redistributed forces under the seat and feet prior to movement, decreased peak vertical force exerted under the feet during weight transfer, longer movement times, as well as decreased and earlier peak hip extension. Stepwise regression models demonstrated that electroencephalographic amplitudes of contingent negative variation during the Pain condition significantly correlated with the participants' change in sit-to-stand measures between the NoPain1 and Pain conditions, as well as with the subsequent difference in sit-to-stand measures between the NoPain1 and NoPain2 conditions. The results, therefore, identify the contingent negative variation as a correlate for the extent of an individual's LBP-related movement modifications and to the subsequent change in movement patterns from before to after the experience of acutely induced LBP, thereby providing a direction for future studies aimed to understand the neural mechanisms underlying the development of altered movement patterns with LBP.

The effects of low-intensity muscle training with heel-raises on dynamic balance associated with bilateral arm flexion were investigated in postmenopausal elderly women. Twenty-six elderly women were evenly grouped into training and control groups. Training group subjects performed 100 heel raises per day for 2 months. The training was aimed at hypertrophy of the soleus muscle, which has a relatively high proportion (ca. 90%) of slow-twitch muscle fibers and is one of the main postural muscles. Dynamic balance was measured while arm flexion was performed in response to a visual stimulus (simple-reaction condition) or at the subjects' own pace (own-timing condition). The following parameters were compared before and after the training period: plantar flexion strength, thicknesses of the gastrocnemius and soleus (by ultrasound), reaction time of the anterior deltoid in the simple-reaction condition, activation onset timing of postural muscles with respect to the deltoid, movement angles of ankle and hip joints, and postural fluctuation. In the training group only, the following training-related effects were demonstrated: (a) increase in plantar flexor strength and thickness of the soleus, (b) shortening of the deltoid reaction time, (c) earlier activation of the erector spinae in the simple-reaction condition and the soleus in the own-timing condition, and (d) increase in ankle movement in the own-timing condition and a decrease in postural fluctuation. This heel-raise training in the elderly can increase soleus thickness within the triceps surae and improve postural control modality and stability that are effectively contributed to by the leg muscle. This training consists of a low-intensity exercise that requires neither special machines nor a specific environment and can be performed safely for all old-aged groups.

Background: We investigated the effect of time constraint on activation timing of postural muscles during bilateral arm flexion in self-timing, oddball and simple-reaction tasks., Methods: Thirteen healthy adults flexed their arms from a suspended position with maximum speed and stopped at the shoulder level. For erector spinae-longissimus (ES), biceps femoris (BF), and gastrocnemius (GcM), onset timing of burst activation with respect to the anterior deltoid (AD), and the displacement of the center of pressure in the anteroposterior direction (CoPy) were analyzed., Results: AD reaction time was significantly shorter in the simple-reaction task than oddball task, suggesting that time constraint would be lower in the task order noted above and affected the state of postural preparation. The following properties were found in the onset timing of postural muscle: (1) the onset timing of BF and GcM were earlier in the task order noted above, and (2) the earliest activated distal muscle in the self-timing task was activated later in the simple-reaction task. CoPy displacement was smaller in the same task order as the onset timing., Conclusions: It appears that with sufficient postural preparation, the focus of postural control is on the reduction of postural disturbance and earlier lower leg muscle activation., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

We investigated age-related changes and sex differences in adaptability of anticipatory postural control in children. Subjects comprised 449 children (4-12 years old) and 109 young adults (18-29 years old). Subjects stood with eyes closed on a force-platform fixed to a floor oscillator. We conducted five trials of 1-minute oscillation (0.5 Hz frequency, 2.5 cm amplitude) in the anteroposterior direction. Postural steadiness was quantified as the mean speed of the center of pressure in the anteroposterior direction (CoPy). In young adults, CoPy speed decreased rapidly until the third trial for both sexes. Adaptability was evaluated by changes in steadiness. The adaptability of children was categorized as "good," "moderate," and "poor," compared with a standard variation of the mean CoPy speed regression line between the first and fifth trials in young adults. Results were as follows: (1) anticipatory postural control adaptability starts to develop from age 6 in boys and 5 in girls, and greatly improves at age 7-8 in boys and 6 in girls; (2) the adaptability of children at age 11-12 (74% of boys and 63% of girls were categorized as "good") has not yet reached the same level as for young adults; (3) the adaptability at age 11-12 for girls is temporarily disturbed due to early puberty.

Intravenous leiomyomatosis (IVL) is a rare benign tumor. The clinical behavior can be life-threatening due to extension through the pelvic veins. A 70-year-old woman was referred to our hospital with IVL originating from a uterine leiomyoma and extending to the inferior vena cava. The patient was diagnosed on the basis of the results of various studies, and the tumor was resected completely through a single-stage approach. The intravascular tumor was 20 cm long, multinodular and rubbery. Microscopic findings showed benign smooth muscle that was partly hyalinized and fibrous. Immunohistochemical studies revealed that hyaluronan was expressed more prominently in IVL than in uterine leiomyomas. IVL has viscoelastic properties and contains a large amount of hyaluronan, which may promote invasion during pathogenesis.

The soleus, one of the triceps surae muscles, greatly contributes to standing and walking. Strength training focused on the soleus could be important to prevent age-related deterioration in these functions. We therefore investigated the effects of regular heel-raise training focused on the soleus for the elderly. Forty-nine healthy women aged 60 to 79 years trained for at least 40 days in a period of two months. Training consisted of a set of 100 repetitions per day of heel-raise with both legs in a standing position. The training effect was evaluated by changes in each muscle thickness of the soleus and gastrocnemius medialis, which was measured using an ultrasound scanner, as well as plantar flexor strength. The subjects' ability to perform the training and their subjective opinions of its effects were assessed by a questionnaire survey. Plantar flexor strength and thicknesses of the soleus and gastrocnemius medialis were increased significantly by the training. The percentage increase in thickness was significantly greater for the soleus than for the gastrocnemius medialis (12.7% vs. 6.6%). These improvements did not significantly correlate with age. The questionnaire results suggested that the elderly were able to safely and easily perform the heel-raise training at home. This study demonstrated that regular heel-raise training is an effective muscle training method for the elderly, focused on the soleus.