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This retrospective study was performed to investigate whether certain fetal heart rate patterns were associated with subsequent cerebral palsy (CP) in infants with chorioamnionitis at or near term.We used cases registered by the Japan Obstetric Compensation System for CP, which is a nationwide population-based database. Among them, 133 infants with chorioamnionitis who were born at ≥34 weeks of gestation were enrolled. All infants underwent magnetic resonance imaging (MRI), and all fetal heart rate charts had been interpreted according to the National Institute of Child Health and Human Development criteria, focusing on antepartum and immediately before delivery.The incidence of CP after chorioamnionitis at ≥34 weeks of gestation was 0.3 per 10 000 in Japan. Between the clinical (24%) and subclinical groups (76%), the incidence of abnormal fetal heart rate patterns did not differ. According to the MRI classification, 88% of the infants with CP showed hypoxic-ischemic encephalopathy. Half of the infants with CP experienced terminal bradycardia, leading to severe acidosis and exclusively to hypoxic-ischemic encephalopathy. In another half, who did not experience bradycardia, 80% had moderate acidosis (pH 7.00-7.20) resulting in hypoxic-ischemic encephalopathy, and the remaining 20% showed non-acidosis resulting in brain damage other than hypoxic-ischemic encephalopathy. The fetal heart rate patterns before the terminal bradycardia showed that the incidence rates of late deceleration or decreased variability were high (60%).Fifty percent of pregnant women with chorioamnionitis-related CP had terminal bradycardia that exclusively resulted in hypoxic-ischemic encephalopathy.

Despite the widespread use of amide bond isosteres, there is only a limited understanding of their H-bonding mimicry of amides. With experimental and computational approaches, we have explored the hydrogen bonding acceptor potential of the chlorine substituent in chloroalkene dipeptide isosteres (CADIs). The (Z)-chloroalkene and (E)-methylalkene analogues of peptide catalysts were synthesized and employed as probe molecules to assess the H-bonding acceptor capabilities of CADIs. These peptidomimetic studies provide experimental evidence supporting the existence of an intermolecular H-bonding interaction between the chlorine substituent in CADIs and the amide proton of the carbamate substrate. These findings show the capability of peptide catalysts to experimentally evaluate weak intermolecular forces. DFT calculations elucidated that the chlorine substituent in CADIs prefers to form p-type hydrogen bonding interactions on the lateral portions of the chlorine atom, which is different from the carbonyl oxygen of amides which predominantly forms s-type H-bonds in peptide secondary structures.

Objectives The purpose of this study was to evaluate the internal consistency and factorial validity of the Japanese version of HLS-Q12 health literacy rating scale when used with older adults.Methods A questionnaire-based mail survey was conducted among older adults living in a community. The data collection period was from January to February 2022. The Japanese version of HLS-Q12 was used to obtain data on health literacy of older adults, and the internal consistency and factorial validity of the scale were evaluated using Cronbach's alpha coefficient and confirmatory factor analysis, respectively. In addition, a Rasch model was used to conduct a detailed analysis on each questionnaire item.Results Questionnaires were distributed among 3,572 people, out of which, 1,082 responses were received from older adults (over 65 years of age). Cronbach's alpha coefficient was 0.8 or higher, indicating no internal consistency issues. According to the confirmatory factor analysis, CFI was equal to 0.933, AGFI, 0.876, and RMSEA, 0.092; thus, all indicators met certain evaluation levels. However, deviation from one of the multiple fit criteria was confirmed for the value of RMSEA, indicating that the error between the estimated value calculated by the scale and the true value was relatively large. Analysis of each question item using the Rasch model showed that all the questions met the criteria of Infit MSQ and were suitable in their question structure.Conclusion Following the evaluation of the HLS-Q12 scale in older adults, the scale was found to be reliable and valid at a certain level. However, the value of RMSEA indicated that it was relatively large in terms of the error between the estimated value calculated by the scale and the true value.

Group B streptococcus (GBS) is an important pathogen that causes neonatal sepsis and meningitis, which have high mortality and morbidity. Cellulitis is a rare presentation of late-onset neonatal GBS infection. We report the case of an extremely low birthweight infant with facial cellulitis caused by late-onset GBS infection. A 590-g male neonate was delivered by Cesarean section at 23 gestational weeks due to intrauterine GBS infection. Although he was effectively treated with 2 weeks of antimicrobial therapy for early-onset GBS sepsis, he subsequently developed facial and submandibular cellulitis caused by GBS at 44 days of age. He was treated with debridement and antibiotic therapy, and after 2 months his facial involvement had improved, but cosmetic issues remained. Neonatal GBS infection requires a prompt sepsis workup followed by the initiation of empiric antibiotic therapy. Additionally, lifesaving surgical debridement is sometimes necessary for cellulitis, even in premature infants.

Preeclampsia, a multisystem pregnancy-specific hypertensive disorder, results in significant maternal and perinatal morbidity and mortality. This condition is associated with placental histopathological abnormalities and particularly affects the decidual spiral arteries. Reportedly, aspirin prevents preeclampsia, specifically early-onset preeclampsia, although findings in decidual arteries in women treated with aspirin therapy remain unclear. We compared the clinical and histopathological placental findings between women with a history of preeclampsia, who did and did not receive low-dose aspirin therapy (LDA and non-LDA groups, respectively). We identified 26 women with a history of preeclampsia; 9 women received LDA (aspirin ≤ 100 mg/day, initiated at 16 weeks, LDA group), and 17 women did not receive LDA (non-LDA group). The mean gestational age was higher (36.7 weeks vs. 32.3 weeks, P = 0.0221) and the incidence of preeclampsia was lower (11% vs. 59%, P = 0.0362) in the LDA than in the non-LDA group. Histopathologically, the incidence of decidual arteriopathy, particularly that of fibrinoid necrosis and thrombosis, was lower in the LDA than in the non-LDA group (44% vs. 88%, P = 0.0283). Immunohistologically, endothelial marker (CD31 and CD39) expression was stronger in the LDA than in the non-LDA group. Notably, we observed no significant intergroup differences in inflammatory changes (chronic perivasculitis, protease-activated receptor 1 expression, and CD3-positive cells). This study highlights that LDA inhibits hypertension-induced endothelial injury and thrombosis, and thereby protects maternal placental perfusion and prevents preeclampsia.

Near‐infrared photoimmunotherapy (NIR‐PIT) is a novel therapy for cancers that uses NIR light and antibody‐photosensitizer (IR700) conjugates. However, it is difficult to deliver NIR light into the bile duct for cholangiocarcinoma (CCA) from the conventional extracorporeal apparatus. Thus, in this study, we developed a dedicated catheter with light emitting diodes (LEDs) that supersedes conventional external irradiation devices; we investigated the therapeutic effect of NIR‐PIT for CCA using the novel catheter. The new catheter was designed to be placed in the bile duct and a temperature sensor was attached to the tip of the catheter to avoid thermal burn. An anti‐epidermal growth factor receptor (EGFR) antibody, Panitumumab‐IR700 conjugate or anti‐human epidermal growth factor receptor type 2 (HER2) antibody, Trastuzumab‐IR700 conjugate, was used with EGFR‐ or HER2‐expressing cell lines, respectively. The in vitro efficacy of NIR‐PIT was confirmed in cultured cells; the capability of the new catheter for NIR‐PIT was then tested in a mouse tumor model. NIR‐PIT via the developed catheter treated CCA xenografts in mice. NIR‐PIT had an effect in Panitumumab‐IR700 conjugate‐ and Trastuzumab‐IR700 conjugate‐treated CCA cells that depended on the receptor expression level. Tumor growth was significantly suppressed in mice treated with NIR‐PIT using the novel catheter compared with controls (P, A new catheter with light emitting diodes for photoimmunotherapy for cholangiocarcinoma was developed. The new catheter was designed to be placed in the bile duct and a temperature sensor was attached to the tip of the catheter to avoid thermal burn. Tumor growth was significantly suppressed in mice treated with NIR‐PIT using the novel catheter.

AIM To investigate intrapartum fetal heart rate (FHR) patterns in women with chorioamnionitis at or beyond 34 weeks of gestation in relation to neonatal outcome and to compare clinical and subclinical chorioamnionitis. METHODS A retrospective questionnaire survey on deliveries during 2015 was conducted by the Perinatology Committee of the Japan Society of Obstetrics and Gynecology from 2016 to 2018. A total of 498 singleton births complicated by chorioamnionitis delivered at ≥34 weeks of gestation without major congenital malformations were included. The subjects were divided into clinical and subclinical chorioamnionitis groups based on Lencki's criteria. Poor perinatal outcome was defined as death or brain damage. We analyzed clinical features, FHR patterns in the last 2 h before delivery, gestational age, birthweight, Apgar score, umbilical arterial blood gas analysis, and infant's outcome. RESULTS Incidence of chorioamnionitis at ≥34 weeks of gestation was 0.59% (522/87827). Clinical and subclinical chorioamnionitis comprised 240 and 258 cases, respectively. Abnormal FHR patterns (late deceleration or decreased baseline variability) were significantly associated with poor perinatal outcome. Combined late deceleration and decreased variability showed low positive predictive value (12.8%) and high negative predictive value (99.5%), and was significantly associated with long-term poor outcome in clinical chorioamnionitis only (odds ratio: 29.4, p

Described here is the synthetic, spectroscopic, crystallographic, and computational analysis of a series of peptidomimetics containing l-Xaa-d-Yaa-type (

To evaluate the coagulative performance of a 21-gauge (G) internally cooled radiofrequency (RF) electrode using ex vivo and in vivo rat liver. We developed a prototype of 21-G internally cooled monopolar RF electrode with 5.0 mm active tip length. The ablative zone size created by this electrode was evaluated in ex vivo and in vivo rat liver. Five RF powers (3 W, 5 W, 7 W, 9 W, and 11 W) were applied with and without circulation of chilled water within the electrode. The ablation zone sizes were compared. Histopathological evaluation of the ablation zone was also performed at 24 h and at 7 days after RF ablation. From ex vivo experiments, the ablation volume was found to increase significantly when RF energy was applied with the chilled water circulation. Results of in vivo experiments demonstrate that the ablation volume reached its maximum value when RF power of 7 W was applied (532.3 ± 110.3 mm3). Histopathological examination showed delineated coagulation necrosis at 24 h after RF ablation, which clarified the ablation zone border. Fibrotic change was also observed at 7 days after RF ablation. RF ablation using a 21-gauge electrode produced coagulation necrosis in the rat liver. The ablation volume became maximum when RF power of 7 W was applied with chilled water circulation.

Little is known about psychological distress and its associated factors during the COVID-19 pandemic among nursing students, especially during the initial spread. The present study aimed to investigate the prevalence of psychological distress among Japanese nursing students after the first semester of 2020 with shifted classes and practice online. Furthermore, we examined whether factors such as health issues and resilience were associated with psychological distress. The data were obtained from a cross-sectional, self-administered questionnaire survey at a Japanese nursing college from September to November 2020 (n = 289). We collected data such as sociodemographic variables, medical history, insomnia, and resilience (Bidimensional Resilience Scale). Psychological distress was measured using the K6 scale (scores ≥ 5). The prevalence of psychological distress was 58.5%. The multivariate Poisson regression analysis found a negative association between innate resilience factors, and positive associations between medical history, insomnia, and psychological distress. The present study showed that more than half of the study participants experienced high levels of psychological distress. Our results suggest the importance of monitoring mental health among nursing students, focusing not only on health issues, but also personality components such as innate resilience during the prolonged COVID-19 pandemic.

AIM Diabetes mellitus (DM) is a major complication in pregnancy. Placental lesions with DM remain unclear and controversial. Recently, the terms of placental pathological findings, such as maternal and fetal vascular malperfusions (MVM and FVM, respectively) were introduced by the Amsterdam Placental Workshop Group Consensus Statement (APWGCS). FVM cases were classified as the partial obstruction type (global FVM) and the complete obstruction type (segmental FVM). The aim of this study was to clarify the pathological characteristics of the placenta with pregestational DM/gestational DM; GDM according to APWGCS. METHODS We studied the placentas of 182 DM women (27 pregestational DM and 155 GDM) and control placentas of 460 women without DM during 2011-2018. We excluded cases of intrauterine fetal death or multiple pregnancies. We reviewed microscopical findings including, MVM, FVM, chorioamnionitis with the slides according to the APWGCS. RESULTS Microscopically, the incidence of FVM was significantly higher in GDM patients than control (17% vs. 10%, p = 0.0138), but not significant in pregestational DM (11%, p = 0.7410). Segmental FVM (complete obstruction) was significantly more observed in GDM than control group (5% vs. 0.4%, p = 0.0013). Segmental FVM in GDM showed high incidence of light-for-dates infant (three of seven cases, 43%, p = 0.0288). In addition, several segmental FVM findings (villous stromal-vascular karyorrhexis and stem vessel occlusion) were frequently noted in 2 or 3 points positive of 75 g oral glucose tolerance test than 1 point positive GDM. CONCLUSION Our placental findings suggest disorder of carbohydrate metabolism might affect the fetal vascular damage, especially complete fetal vascular obstruction.

Described here is the first stereoselective synthesis of highly functionalized chloroalkene dipeptide isosteres containing an α,α-disubstituted amino acid (ααAA). This synthesis requires the construction of a quaternary carbon center, and this challenge was overcome by the Aza-Darzens condensation of ketimine with α,α-dichloroenolate, producing 2-chloroaziridines with quaternary carbon centers including spirocyclic motifs, which are valuable for the previously elusive synthesis of various ααAA-containing chloroalkene isosteres.

Tooth formation is accomplished under strict genetic programs. Although patients with chromosome 12q14 aberration shows tooth phenotype including the size and eruption timing with bone growth anomaly, its etiology is uncertain. Here, we examined expression of Hmga2, which is encoded at chromosome 12q14, in mouse tooth germs and analyzed the involvement in lower first molar (M1) and mandibular bone development. Hmga2 expression was immunohistochemically detected at enamel organ and the surrounding mesenchyme of the M1 germs. The expression was dynamically changed with gestation and rapidly decreased in postnatal mice. In Hmga2-/- mice, the M1 germs and crowns were diminished in size, and formation and eruption of molars were delayed with mandibular bone growth retardation. Hmga2 cDNA or siRNA transfection showed that Hmga2 transcriptionally up-regulates expression of stem cell factors, Sox2 and Nanog. They were co-localized with Hmga2 in the germs, but differentially distributed at enamel organ and mesenchyme in Hmga2-/- mice. These results demonstrate that Hmga2 expressed in tooth germs regulates the growth, sizing and eruption and stem cell factor expression in different compartment of the germ and associates with mandibular bone growth. Although future studies are needed, the present study demonstrates HMGA2 regulation of tooth genesis with skeletal development.

Orengedokuto (OGT) is a Kampo prescription that has been used for the treatment of inflammation, hypertension, gastrointestinal disorders, and liver and cerebrovascular diseases. It is also used for the treatment of skin diseases such as urticaria and atopic dermatitis. We previously studied its anti-allergic effects of OGT on the murine model of 2,4,6-trinitrochlorobenzene (TNCB)-induced contact hypersensitivity (CHS) and demonstrated that it significantly suppresses ear swelling in a dose-dependent manner. However, the mechanism underlying this activity remained unknown. Here, we sought to identify the mechanism involved. Using a murine model of TNCB-induced CHS, together with adoptive cell transfer experiments, we found that the anti-allergic effects of OGT may be due to the inhibition of effector T cell activation and not the induction and/or activation of regulatory T cells. Flow cytometry analysis revealed that oral administration of OGT suppressed the increase in CD8+CD44highCD62L+ cell number in draining lymph nodes (dLNs) of mice sensitized with 5% TNCB. Additionally, ex vivo experiments confirmed the suppressive effect of OGT on the activation of effector T cells, as interferon-γ (IFN-γ) production by cultured lymphocytes obtained from 5% TNCB-sensitized mice and stimulated with anti-CD3e and anti-CD28 monoclonal antibodies was reduced by OGT administration. In conclusion, our finding suggests that OGT exerts anti-allergic effects by regulating the activation of effector T cells involved in inflammatory skin diseases such as atopic dermatitis.

BACKGROUND Intestinal disorders are common in very low-birthweight infants. The purpose of this study was to evaluate the impact of prophylactic oral Gastrografin® (diatrizoate acid) on meconium-related ileus (MRI) in extremely preterm infants. METHODS This was a retrospective case-control study of infants born extremely preterm at

Here we report a case of fetal left ventricular non-compaction cardiomyopathy with ascites and cardiac dysfunction at a gestational age of 34+5 weeks. Laboratory tests did not reveal any sign of viral infection in utero. A female neonate weighing 2436 g was delivered by emergency cesarean section due to non-reassuring fetal status. Postnatal echocardiography confirmed left ventricular non-compaction cardiomyopathy with severe cardiac failure. Although she was treated effectively during the acute period by continuous flow peritoneal dialysis, surgical ligation of a patent ductus arteriosus, and inhaled nitric oxide, she died on day 41 of life. Symptoms of severe cardiac dysfunction appeared antenatally in this patient and the outcome was poor.

Neonatal and perinatal mortality has decreased dramatically in the past few decades. Neonatal mortality rate among all infants accounted for 1.26 per 1000 births in our region between 1998 and 2012. Of these, the mortality rate of preterm infants was 13.0 per 1000, while that of term infants was 0.51 per 1000 births. Compared with term infants, preterm infants have several more serious medical complications throughout the neonatal period, with the possibility of subsequent neurodevelopmental disorders. Most complications during the neonatal period arise from the underdevelopment of organs; these include conditions such as respiratory distress syndrome, chronic lung disease, necrotizing enterocolitis, and patent ductus arteriosus, retinopathy of prematurity, intraventricular hemorrhage, and periventricular leukomalacia. Other complications in the long-term include cerebral palsy and other neurodevelopmental disorders such as mental retardation, epilepsy, and sensory impairment (hearing, vision).

AIM To investigate the effects of Mycoplasma/Ureaplasma cultured in amniotic fluid on perinatal characteristics in preterm delivery between 22 and 33 weeks of gestation. METHODS The study was conducted in a tertiary perinatal center and involved 38 pregnant women who had undergone amniocentesis to evaluate intrauterine infection due to preterm labor or premature rupture of membranes. The subjects were divided into three groups based on the culture results: negative (Negative Group, n = 24), positive for Mycoplasma/Ureaplasma (M/U Group, n = 6), and positive for other pathogens (Other Pathogens Group, n = 8). One-way analysis of variance was used to compare the three groups. RESULTS The incidence of histological chorioamnionitis and neonatal sepsis was significantly different among the three groups (the Negative Group and the Other Pathogens Group, P

We report a case of difficult endotracheal intubation in a patient with Treacher Collins syndrome. A sixteen-year-old female patient scheduled for general anesthesia had a displaced palatal tooth that interfered with laryngoscope insertion into the pharyngeal space. To address this problem, we successfully performed endotracheal intubation using a fiberscope while elevating the epiglottic vallecula using a King Vision™ video laryngoscope. A later operation was performed after tooth extraction without difficult laryngoscopy. Our experience stresses the importance of removing obstructions to laryngoscopic inspection prior to general anesthesia.

Chronic intervillositis of unknown etiology (CIUE) is a rare placental lesion associated with infiltration of mononuclear inflammatory cells into the intervillous space, poor perinatal outcomes (intrauterine fetal demise or fetal growth restriction), and high rates of recurrence. CD39 is the ectonucleotidase that protects tissues from inflammatory stress and cell injury, which is localized on the surface of villi in normal placentas; however, its expression and role in CIUE are unknown. The aims of this retrospective study were to determine the expression of CD39 in CIUE and its significance in pregnancy outcomes. We compared the number of CD68- and CD3-positive cells, CD39 expression, and complement 4d (C4d) and fibrin deposition in placental tissues from patients with CIUE (n = 22) and gestational age-matched controls (n = 20), and between CIUE pregnancies with poor and good outcomes. The numbers of CD68- or CD3-positive cells were significantly higher (P

What target is focused on by many people? Analysis of the target is a crucial task, especially in a cinema, a stadium, and so on. However, it is very difficult to estimate the gaze of each person in a crowd accurately and simultaneously with existing image-based eye tracking methods, since the image resolution of each person becomes low when we capture the whole crowd with a distant camera. Therefore, we introduce a new approach for localizing the gaze target focused on by a crowd of people. The proposed framework aggregates the individually estimated results of each person’s gaze. It enables us to localize the target being focused on by them even though each person’s gaze localization from a low-resolution image is inaccurate. We analyze the effects of an aggregation method on the localization accuracy using images capturing a crowd of people in a tennis stadium under the assumption that all of the people are focusing on the same target, and also investigate the effect of the number of people involved in the aggregation on the localization accuracy. As a result, the proposed method showed the ability to improve the localization accuracy as it is applied to a larger crowd of people.

本論文において，我々は野球の打撃フォームの角度解析を行うために初歩的な手法を提案する．我々はデータとして2次元の写真，角度解析には3Dソフトを使う．我々の手法においてキーとなる手続きは，選手の写真と野球場の寸法表から打撃フォームの3次元データを再構築することである．我々の手法を適用してプロ野球と大リーグの選手の打撃フォームの差異を調べる．テイクバック時の肩の方位角を数値で求めることができた．数値結果はプロ野球と大リーグの選手の打撃フォームに異なる特徴があることを示唆している．, In the paper, we propose an elementary method to carry out angle analysis of batting form in baseball. We use 2D photos as data and 3D software for angle analysis. The key procedure is reconstruction of 3D data of batting form by using player's photos and the baseball field dimensions. We apply our method to investigate difference in batting form of NPB(Nippon Professional Baseball) and MLB(Major League Baseball) players. Shoulder azimuth in stance phase is estimated numerically. Numerical results suggest different features of batting form among NPB and MLB players.

The prevalence of cerebral palsy (CP) has not decreased in developed countries over the past 30 years. We examined gestational age-specific trends in the prevalence of CP.This unselected, population-based study was conducted in Miyazaki prefecture, Japan (10,000 deliveries annually), where 102,999 deliveries were registered between 2001 and 2010. Of these, 312 were stillbirths (⩾22 weeks of gestation), 126 were neonatal deaths (28 days of birth), and 214 infants were determined to be at risk of CP at peer-review conferences. Survival and neurological damage were compared for two 5-year periods, 2001-2005 and 2006-2010, and infants were classified according to gestational ages.Stillbirths and neonatal deaths decreased significantly during both periods. Likewise, the number of registered high-risk cases of CP decreased by 30.2%, from 126 to 88 cases. After excluding congenital anomalies, the corrected CP prevalence was 1.5 per 1000 (78/51,889) and 1.3 per 1000 (67/51,110), for the two periods, which was not a significant difference. The number of extremely preterm infants (22-25 weeks) did not change over the 10-year period, whereas that of moderately preterm infants (26-36 weeks) increased, and that of term infants significantly decreased (p0.01). In term infants, asphyxia decreased from 18 to 7 cases (p0.05).Perinatal deaths and CP decreased in prevalence during both 5-year periods, and the CP prevalence was 2.1 per 1000 births. Furthermore, fewer term infants were at high risk for CP mainly because of the reduced prevalence of asphyxia.

Chlorella variabilis strain NC64A is an intracellular photobiont of the ciliate Paramecium bursaria. NC64A was isolated from P. bursaria nearly 50 years ago and was thereafter cultivated outside the host. This study was undertaken to detect changes in its infectivity to P. bursaria and its auxotrophy for growth outside the host induced during long-term cultivation. NC64A can grow in Modified Bold's Basal Medium but not in C medium, whereas another symbiotic Chlorella variabilis strain, 1N, that was recently isolated from the host grew in C medium but not in Modified Bold's Basal Medium. With regards infectivity, NC64A in the logarithmic phase of growth showed low infectivity to alga-removed P. bursaria cells, whereas those in the early stationary phase showed high infectivity of about 30%. Those in the decay phase of growth showed no infectivity. Results show that NC64A has infectivity, but the infection rate depends on their culture age in the growth curve. Furthermore, NC64A that had been re-infected to P. bursaria for more than one year and isolated from the host showed a nearly 100% infection rate, which indicates that NC64A can recover its infectivity by re-infection to P. bursaria., Summary: This study was undertaken to detect changes in infectivity induced during long-term cultivation of Chlorella variabilis to alga-free Paramecium bursaria, and its auxotrophy for growth outside the host.

Neonatal jaundice is a yellowish discoloration of skin and eyes that commonly occurs in newborn babies. It is a physiological phenomenon in neonates and it occurs due to the overproduction of bilirubin, reduction of bilirubin treatment function. The quick and accurate treatment is required for neonatal jaundice because it can lead to nuclear jaundice, cerebral palsy, intellectual disturbance and various sequelae. The investigation methods for examining neonatal jaundice include examination using jaundice meter and blood sampling. However, these methods require continuous monitoring and can cause burden on newborn babies. In this paper, we propose the non-contact and non-invasive detection method for neonatal jaundice using image processing and computer vision technology. The experiments are performed on the data collected by University Hospital, University of Miyazaki. According to the experiments, we confirmed about the usefulness of proposed method which can work effectively for infants.

We report a case of marked elevation of the procalcitonin level in umbilical blood and neonatal blood at birth. The mother did not perceive fetal motion. Antepartum fetal heart rate monitoring showed a loss of variability and absence of acceleration. No fetal breathing movement, fetal movement, or fetal tone were observed by ultrasonography. The female neonate was delivered by cesarean section at 25 weeks of gestation, with birthweight 774 g. The umbilical arterial pH value at birth was 7.29. Mild elevation in interleukin-6 and tumor necrosis factor-α in umbilical blood were observed. Cytochrome c showed a high level in umbilical and neonatal blood at birth. Placental histopathology revealed multiple fetal vessel thrombosis in the large stem villi and chorionic vessels. The neonate showed no infectious signs throughout the neonatal period. Computed tomography at 3 months of age revealed atrophy in the cerebrum and cerebellum. At 1 year after birth, the infant showed spastic quadriplegia. In this case, antepartum asphyxia due to fetal vessel thrombosis may have influenced the elevation of procalcitonin level in umbilical blood and neonatal blood at birth.

Aim Intrapartum fetal bradycardia necessitates immediate operative delivery. Our aim was to investigate the hypothesis that some non-reassuring fetal heart rate (FHR) patterns were present before the onset of terminal bradycardia in infants who developed subsequent brain damage. Material and Methods From a population-based study of 65 197 deliveries, 190 stillbirths, 115 neonatal deaths, and 136 neurologically high-risk infants were registered by the Miyazaki Perinatal Conference. There were 15 cases of neurologically high-risk infants born at >34 weeks of gestation exhibiting intrapartum terminal bradycardia. Focusing on the brain-damaged infants, we retrospectively analyzed FHR patterns for at least 1 h prior to the bradycardia. Results Brain damage (cerebral palsy [n = 11] and mental retardation [n = 2]) was diagnosed at 2 years old in 13 out of 15 neurologically high-risk infants. Two infants had bradycardia on admission. In the remaining 11 infants, FHR patterns were reassuring in six (55%) and non-reassuring in five (45%), including late decelerations (n = 4) and variable decelerations (n = 2). Clinically relevant factors in the non-reassuring group included intrauterine infection (n = 3), malpresentation with umbilical cord coiling (n = 1), and unknown causes (n = 1). Clinically relevant features in the reassuring group included cord prolapse (n = 1), vaginal breech delivery (n = 1), shoulder dystocia (n = 1), rupture of membranes (n = 1), and unknown causes (n = 2). Conclusion More than half of the brain-damaged infants born at >34 weeks of gestation who exhibited intrapartum terminal bradycardia had unremarkable FHR patterns before abrupt-onset bradycardia. For those with non-reassuring patterns preceding bradycardia, intrauterine infection was the major sentinel event.

Helicobacter cinaedi is a rare pathogen but known to cause bacteremia, cellulitis and enterocolitis. Recently, cases of involving various organs are increasingly reported such as endocarditis, meningitis, and kidney cyst infection. We report a case of intrauterine H. cinaedi infection leading preterm birth and neonatal sepsis. A 29-year-old pregnant women who was no underlying disease hospitalized due to threatened preterm labor at 22 weeks of gestation. Clinical findings showed uterine tenderness, fever, leukocytosis and elevated C-reactive protein. H. cinaedi was isolated from amniotic fluid obtained by transabdominal amniocentesis. We diagnosed as intrauterine H. cinaedi infection and administered intravenous ampicillin followed by oxytocin to terminate pregnancy. A live 446 g male infant was delivered. The patient was no signs of infection throughout postpartum course and discharged on post-delivery day 5. The neonate was admitted in neonatal intensive care unit and administered ampicillin and amikacin. H. cinaedi was isolated from umbilical cord blood culture. He has no signs of infection on day 5 but died from uncontrollable hyperglycemia and ketoacidosis on 15 days of age. H. cinaedi can cause intrauterine infection during pregnancy and lead preterm labor and neonatal sepsis.

Aim The aim of this study was to determine whether the new gestational diabetes mellitus (GDM) criteria increase the prevalence of diabetes-mellitus-related stillbirths by using a regional population-based approach. Material and Methods A retrospective, population-based study was conducted to assess 114 036 deliveries from 2000 to 2010 in Miyazaki, Japan. During this period 318 stillbirths occurred after 22 weeks of gestation. Of these cases, 236 were examined to determine the cause of death. The remaining 82 cases were not fully investigated. In particular, we investigated the prevalence of pregestational diabetes mellitus and GDM among the stillbirths. We also applied new GDM criteria to evaluate the impact of these factors on stillbirth. Results Of the 236 stillbirths, 47% were due to an explainable cause. Application of previous criteria indicated two cases of pregestational diabetes mellitus and three GDM cases in the remaining unexplained stillbirths. By applying new GDM criteria, the GDM count increased to 17. Conclusions In an unselected population in southern Japan, the application of new GDM criteria resulted in a 5.7-fold increase (from 2.4% [3/126] to 13.5% [17/126]) in the number of GDM cases in unexplained stillbirths. Even in women with a mild degree of GDM, proper management of both mother and fetus could reduce the number of unexplained stillbirths.

Aims: Severe preterm fetal growth restriction (FGR) remote from term is problematic. We aimed to investigate the effect of maternally-administered antithrombin on maternal and neonatal outcomes. A prospective, one-arm, pilot study was performed in 14 women with severe FGR (≤5th centile) at Results: In group 1 (n=4), their pregnancies were extended for longer periods and the maternal and infant outcomes were good. The prolongation periods were shorter in groups 2 (n=3) and 3 (n=7), which resulted in poor maternal [severe preeclampsia or hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome] and infant outcomes. Conclusions: The evaluation of the maternal sFlt-1 and PlGF at 21–27 weeks of gestation is useful in the managements of severe FGR. Antithrombin treatment could prolong the pregnancies with low sFlt-1 and high PlGF without negatively affecting maternal or fetal health.