Publications by authors named "Keisuke Ishii"

166 Publications

Accuracy and reliability of a smartphone application for measuring the knee joint angle.

J Phys Ther Sci 2021 May 15;33(5):417-422. Epub 2021 May 15.

Department of Rehabilitation Medicine, Teikyo University School of Medicine, Japan.

[Purpose] Recently, a photo-based smartphone application for angle measurement-"Grid line imaging application Professional"-was developed to evaluate joint disease treatments. The aim of this study was to determine the accuracy and reliability of the application. [Participants and Methods] We measured the knee joint of a mannequin using an application and a universal goniometer. Twelve examiners measured eight knee joints of mannequins at different arbitrary angles using the application and a universal goniometer. Correlations between the application and universal goniometer measurements were examined using scatter plots and correlation coefficients. Systematic errors of the application were visually confirmed using the Bland-Altman method. Intra-class correlation coefficients were used to evaluate the inter-examiner reliability of the application. [Results] The application and universal goniometer measurements showed a good correlation (=0.99) and no systematic error. The intra-class correlation coefficient for inter-examiner reliability was 0.999. Furthermore, to evaluate intra-examiner reliability, six examiners measured six different knee joints twice using the application on a 2-day interval. The intra-class correlation coefficient for intra-examiner reliability was 0.982. [Conclusion] The accuracy of the application was equivalent to that of a universal goniometer, and both the inter- and intra-examiner reliabilities of the application were almost perfect.
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http://dx.doi.org/10.1589/jpts.33.417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165359PMC
May 2021

Near-infrared photoimmunotherapy targeting GPR87: Development of a humanised anti-GPR87 mAb and therapeutic efficacy on a lung cancer mouse model.

EBioMedicine 2021 May 13;67:103372. Epub 2021 May 13.

Respiratory Medicine, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8560, Aichi, Japan; Nagoya University Institute for Advanced Research, Advanced Analytical and Diagnostic Imaging Center (AADIC) / Medical Engineering Unit (MEU), B3 Unit, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8560, Aichi, Japan; FOREST- Souhatsu, CREST, JST; Nagoya University Institute for Advanced Research, S-YLC, Furo-cho, Chikusa-ku, Nagoya 464-8601, Aichi,, Japan. Electronic address:

Background: GPR87 is a G-protein receptor that is specifically expressed in tumour cells, such as lung cancer, and rarely expressed in normal cells. GPR87 is a promising target for cancer therapy, but its ligand is controversial. Near-infrared photoimmunotherapy (NIR-PIT) is a novel cancer therapy in which a photosensitiser, IRDye700DX (IR700), binds to antibodies and specifically destroys target cells by irradiating them with near-infrared-light. Here, we aimed to develop a NIR-PIT targeting GPR87.

Methods: We evaluated the expression of GPR87 in resected specimens of lung cancer and malignant pleural mesothelioma (MPM) resected at Nagoya University Hospital using immunostaining. Humanised anti-GPR87 antibody (huGPR87) was generated by introducing CDRs from mouse anti-GPR87 antibody generated by standard hybridoma method. HuGPR87 was conjugated with IR700 and the therapeutic effect of NIR-PIT was evaluated in vitro and in vivo using lung cancer or MPM cell lines.

Findings: Among the surgical specimens, 54% of lung cancer and 100% of MPM showed high expression of GPR87. It showed therapeutic effects on lung cancer and MPM cell lines in vitro, and showed therapeutic effects in multiple models in vivo.

Interpretation: These results suggest that NIR-PIT targeting GPR87 is a promising therapeutic approach for the treatment of thoracic cancer.

Funding: This research was supported by the Program for Developing Next-generation Researchers (Japan Science and Technology Agency), KAKEN (18K15923, 21K07217, JSPS), FOREST-Souhatsu, CREST (JST).
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http://dx.doi.org/10.1016/j.ebiom.2021.103372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138482PMC
May 2021

Prevalence of umbilical artery Doppler waveform abnormality during the early second trimester and the subsequent variation of waveforms in monochorionic diamniotic twin pregnancies: A prospective cohort study.

J Obstet Gynaecol Res 2021 Apr 25. Epub 2021 Apr 25.

Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan.

Aim: To investigate the prevalence of qualitative abnormal umbilical artery Doppler waveforms (Abnormal UA) during the early second trimester and the subsequent variation of waveforms in monochorionic diamniotic (MCDA) twin pregnancies.

Methods: This prospective cohort study included 153 MCDA twin pregnancies. Pulsed Doppler examinations for UA were performed at four points, including the free-loop (FL) and near the placental cord insertion site (CI) of each UA, between 16 and 17 weeks' gestation. Cases were classified into positive diastolic waveforms (Type I), persistent Abnormal UA (Type II), and intermittent Abnormal UA (Type III). When the diastolic velocity in UA Doppler was positive twice after different sequential recordings, the cases were determined to have achieved normalization. Follow-up Doppler examinations of the UA were performed at 24, 28, and 32 weeks' gestation.

Results: Of all 153 cases, 38 (25%; 19 Type II and 19 Type III cases) showed Abnormal UA at the first examination. Abnormal UA was detectable at FL in all selective intrauterine growth restriction (sIUGR) cases, whereas it was noted only at CI site in some non-sIUGR cases. Abnormal UA normalized in 12 (63%) Type II and 15 (79%) Type III cases.

Conclusions: A quarter of MCDA twin pregnancies in the early second trimester demonstrated Abnormal UA. In MCDA twins with Abnormal UA between 16 and 17 weeks' gestation, it is preferable to follow them up to consider the possibility of normalization of Abnormal UA as well as features of UA waveforms specific to FL and CI.
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http://dx.doi.org/10.1111/jog.14799DOI Listing
April 2021

Nationwide survey of intrauterine blood transfusion for fetal anemia in Japan.

J Obstet Gynaecol Res 2021 Jun 15;47(6):2076-2081. Epub 2021 Mar 15.

Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.

Aim: The present study investigated the current situation regarding intrauterine blood transfusion (IUT) for fetal anemia in Japan.

Methods: We conducted a nationwide, multicenter, retrospective cohort questionnaire survey for cases that underwent IUT from 2011 to 2015. The questionnaire required perioperative information, indications, details of the procedure, procedure-related complications, and neonatal morbidity.

Results: A total of 100 IUT procedures were performed in 66 cases at 19 institutions during the study period. The most frequent indication of IUT was complicated monochorionic diamniotic (MCDA) twins in 28 (42.4%) cases, followed by 16 (24.2%) cases of red-cell alloimmunization, and 10 (15.2%) cases of parvovirus B19 infection. IUT was performed through the umbilical cord in the vast of majority cases (92%). Bleeding from the IUT site was the most common adverse event (40%). Two cases (2%) underwent emergency cesarean section after the procedure. There were no cases of rupture of membrane or intrauterine infection after IUT. The neonatal survival rate was 77.3% in the 66 total cases and 64% in the hydrops cases. The neonatal survival rates in MCDA twins, red-cell alloimmunization, and parvovirus B19 infection were 75%, 93.8%, and 70%, respectively.

Conclusions: IUT was performed for mainly three indications in Japan: MCDA twins, red-cell alloimmunization, and parvovirus B19 infection. The incidences of severe adverse events seemed very low. The outcomes after IUT were favorable with variations in survival rates according to indications. However, further studies with long-term follow-up will be required to assess the effectiveness of IUT, especially for complicated MCDA twins.
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http://dx.doi.org/10.1111/jog.14746DOI Listing
June 2021

Impact of the COVID-19 pandemic on a trauma center of a university hospital in Japan.

J Orthop Sci 2020 Dec 29. Epub 2020 Dec 29.

Trauma and Reconstruction Center, Teikyo University Hospital, 2-11-1, Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan.

Background: The Coronavirus disease 2019 pandemic caused the Japanese government to declare a State of Emergency on April 7, 2020. The aim of this study is to provide an overview of the effects of the pandemic on surgical cases at a university hospital trauma center.

Methods: An observational study was performed at a trauma center in a tertiary hospital in Tokyo, Japan. The number of surgeries was compared between two periods: a historical control period (Tuesday April 9 to Monday May 27, 2019) and the period of the Japan State of Emergency due to COVID-19 (Tuesday April 7-Monday May 25, 2020). Information on patient age, gender, and surgical diagnosis, site, and procedure was collected for cases operated on in each period. The number of trauma surgeries was compared between the two periods. Data from the two periods were compared statistically.

Results: The total number of surgical cases was 151 in the control period and 83 in the COVID-19 period (including no cases with COVID-19), a decrease of 45.0%. There were significantly more surgeries for patients with hip fractures in the COVID-19 period (9 vs. 19, P < 0.001 by Fisher exact test).

Conclusions: During the State of Emergency in Japan, the number of operations for trauma patients at the trauma center decreased, but surgeries for hip fracture increased.
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http://dx.doi.org/10.1016/j.jos.2020.11.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834403PMC
December 2020

Fetal Outcomes Associated with the Sequence of Doppler Deterioration in Severely Growth-Restricted Fetuses.

J Ultrasound Med 2021 Jan 13. Epub 2021 Jan 13.

Osaka Women's and Children's Hospital, Department of Maternal-Fetal Medicine, Osaka, Japan.

Objectives: Various patterns of Doppler deterioration exist in fetal growth restriction (FGR). However, the factors that differentiate these patterns are still unknown. The purpose of this study was to clarify the perinatal outcomes and factors to determine the pattern of Doppler deterioration in severe FGR.

Materials And Methods: We conducted a retrospective cohort study of preterm severe FGR with Doppler abnormality, wherein the clinical features, including maternal characteristics, medical history, and sonographic findings, were compared between the patterns of Doppler deterioration. We used the multivariable logistic regression analyses to identify the factors associated with the pattern of Doppler deterioration.

Results: Of 322 eligible fetuses, 143 had Doppler abnormalities. Fetuses with Doppler deterioration from ductus venosus uniquely featured fetal and placental-umbilical abnormalities detected after birth. Gestational age (GA) at diagnosis of FGR and at the first diagnosis of Doppler abnormality in fetuses with Doppler deterioration from middle cerebral artery (MCA) were later than those from umbilical artery. In addition, the factor associated with Doppler deterioration from MCA was 31-week GA at the first diagnosis of Doppler abnormality (adjusted odds ratio [aOR]: 26.7; 95% CI: 8.35-103), not GA at diagnosis of FGR (aOR: 1.82; 95% CI: 0.50-5.96).

Conclusions: Characteristics of each Doppler deterioration pattern might reflect FGR etiology. Undetectable anomalies and umbilical-placental abnormalities were found in fetuses with Doppler deterioration from the ductus venosus. Doppler deterioration from the MCA was observed after 31 weeks of gestation not only in the late-onset FGR but also in the early-onset FGR with normal umbilical artery Doppler findings.
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http://dx.doi.org/10.1002/jum.15614DOI Listing
January 2021

Pregnancy Outcomes in 2 Women Born with Complex Anorectal Malformations: Challenges and Considerations.

J Pediatr Adolesc Gynecol 2021 Jun 31;34(3):424-426. Epub 2020 Dec 31.

Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan.

Background: Complex anorectal malformations (ARMs) are a group of rare congenital malformations involving numerous anomalies that require reconstruction and can affect sexuality, fertility, and pregnancy outcomes. Few cases of pregnancy in complex ARM patients have been reported.

Cases: We report on 2 patients with ARMs who delivered 3 term infants, all by cesarean section with successful collaboration between pediatric urologists and obstetricians. Both patients fully recovered with no long-term consequences after experiencing maternal morbidities including urinary infections, clitoral abscesses, vaginal lacerations, extensive adhesive disease, bladder injury, and maternal hemorrhage.

Summary And Conclusion: In managing pregnancies and deliveries in women with complex ARMs, coordination between obstetricians, pediatric urologists, and pediatric surgeons is crucial.
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http://dx.doi.org/10.1016/j.jpag.2020.12.017DOI Listing
June 2021

Efficacy and safety of controlled-release dinoprostone vaginal delivery system (PROPESS) in Japanese pregnant women requiring cervical ripening: Results from a multicenter, randomized, double-blind, placebo-controlled phase III study.

J Obstet Gynaecol Res 2021 Jan 22;47(1):216-225. Epub 2020 Oct 22.

Ferring Pharmaceuticals Co. Ltd., Minato-ku, Tokyo, Japan.

Aim: To evaluate the efficacy and safety of dinoprostone vaginal insert (PROPESS) in pregnant post-term Japanese women requiring cervical ripening.

Methods: This randomized, double-blind, placebo-controlled study included 114 pregnant Japanese women at term (41 weeks of gestation) requiring cervical ripening (baseline Bishop score (BS) ≤ 4). The primary end-point was the proportion of subjects with successful cervical ripening defined as BS ≥ 7 or vaginal delivery in 12 h. The secondary end-points were changes in BS, proportion of women with vaginal delivery, proportion of women receiving mechanical cervical ripening procedure and use of oxytocic drugs.

Results: PROPESS administration for a maximum of 12 h showed significantly higher successful cervical ripening rate (47.4% vs 14.3%, respectively; treatment contrast [TC]: 33.1%; P = 0.0002). The median time from administration to vaginal delivery was significantly shorter in the PROPESS group than in the placebo group (26.18 h vs 33.02 h; OR 2.51; 95% CI [1.60-3.92]; P < 0.0001). In the PROPESS group, the dosage of uterotonic drugs, such as oxytocin, decreased, and the number of patients who used these drugs also decreased.

Conclusion: PROPESS administration for a maximum of 12 h was an effective and well-tolerated treatment for pregnant Japanese women post-term requiring cervical ripening.
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http://dx.doi.org/10.1111/jog.14472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820955PMC
January 2021

Prevalence of Extraplacental Anastomoses in Monochorionic Twin Pregnancies.

Fetal Diagn Ther 2021 15;48(1):24-27. Epub 2020 Oct 15.

Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan.

Objectives: To evaluate the prevalence of extraplacental anastomoses (EPA) and the factors associated.

Methods: A retrospective study including 144 placentas from monochorionic diamniotic (MCDA) twins delivering at one institution was performed. EPA were defined as any intertwin anastomosis located outside the chorionic plate on macroscopic inspection. The association with perinatal factors and with umbilical cord insertion site was analyzed.

Results: The prevalence of EPA was 4.9% (7/144). Velamentous cord insertion of both twins was significantly associated with the presence of EPA in the multivariate logistic regression model (p = 0.045).

Discussion: EPA was found in ≈5% of MCDA twin pregnancies.
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http://dx.doi.org/10.1159/000510636DOI Listing
October 2020

Reelin-Nrp1 Interaction Regulates Neocortical Dendrite Development in a Context-Specific Manner.

J Neurosci 2020 10 2;40(43):8248-8261. Epub 2020 Oct 2.

Department of Biomedical Science, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Aichi 467-8603, Japan

Reelin plays versatile roles in neocortical development. The C-terminal region (CTR) of Reelin is required for the correct formation of the superficial structure of the neocortex; however, the mechanisms by which this position-specific effect occurs remain largely unknown. In this study, we demonstrate that Reelin with an intact CTR binds to neuropilin-1 (Nrp1), a transmembrane protein. Both male and female mice were used. Nrp1 is localized with very-low-density lipoprotein receptor (VLDLR), a canonical Reelin receptor, in the superficial layers of the developing neocortex. It forms a complex with VLDLR, and this interaction is modulated by the alternative splicing of VLDLR. Reelin with an intact CTR binds more strongly to the VLDLR/Nrp1 complex than to VLDLR alone. Knockdown of Nrp1 in neurons leads to the accumulation of Dab1 protein. Since the degradation of Dab1 is induced by Reelin signaling, it is suggested that Nrp1 augments Reelin signaling. The interaction between Reelin and Nrp1 is required for normal dendritic development in superficial-layer neurons. All of these characteristics of Reelin are abrogated by proteolytic processing of the six C-terminal amino acid residues of Reelin (0.17% of the whole protein). Therefore, Nrp1 is a coreceptor molecule for Reelin and, together with the proteolytic processing of Reelin, can account for context-specific Reelin function in brain development. Reelin often exhibits a context-dependent function during brain development; however, its underlying mechanism is not well understood. We found that neuropilin-1 (Nrp1) specifically binds to the CTR of Reelin and acts as a coreceptor for very-low-density lipoprotein receptor (VLDLR). The Nrp1/VLDLR complex is localized in the superficial layers of the neocortex, and its interaction with Reelin is essential for proper dendritic development in superficial-layer neurons. This study provides the first mechanistic evidence of the context-specific function of Reelin (>3400 residues) regulated by the C-terminal residues and Nrp1, a component of the canonical Reelin receptor complex.
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http://dx.doi.org/10.1523/JNEUROSCI.1907-20.2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577592PMC
October 2020

Association between maternal height and mode of delivery in nulliparous Japanese women.

J Obstet Gynaecol Res 2020 Oct 1. Epub 2020 Oct 1.

Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan.

Aim: The primary aim of this study was to examine the association between maternal height and mode of delivery in nulliparous Japanese women. The secondary aim was to examine the association between maternal height and maternal and neonatal morbidities.

Methods: This retrospective cohort study included women who gave birth at Osaka Women's and Children's Hospital, a tertiary perinatal center in Japan, from January 2015 to December 2017. Nulliparous Japanese women with singleton gestation, who went into labor at term were included in the study. The primary outcome was mode of delivery, and the secondary outcomes were maternal and neonatal morbidities. The relationships between maternal height and the outcomes were evaluated using multivariate logistic regression analysis adjusted for potential confounders. Maternal height was categorized into five groups with 5-cm increments for the analysis.

Results: A total of 1593 women were analyzed in this study. Shorter women had higher rate of cesarean delivery (CD) than taller women. There were no significant differences in the rates of operative vaginal delivery, maternal morbidity and neonatal morbidity among the maternal-height groups. The adjusted odds ratios (95% confidential interval) of maternal heights of <150 cm, 150-154 cm, 160-164 cm and ≥165 cm for CD, compared with a maternal height of 155-159 cm, were 3.56 (1.79-7.09), 1.68 (1.06-2.64), 0.63 (0.40-1.00) and 0.57 (0.30-1.01), respectively.

Conclusion: Shorter nulliparous Japanese women were more likely to undergo intrapartum CD. However, the rates of maternal and neonatal morbidities in shorter women were similar to those in taller women.
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http://dx.doi.org/10.1111/jog.14511DOI Listing
October 2020

Placental histopathological features of fetoscopic laser photocoagulation for monoaminotic diamniotic twin pregnancies.

Placenta 2020 10 12;100:159-163. Epub 2020 Jul 12.

Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, 840, Murodo, Izumi, Osaka, 594-1101, Japan. Electronic address:

Introduction: This study aimed to compare the histopathological placental features of monochorionic diamniotic (MCDA) twins who did and did not undergo fetoscopic laser photocoagulation (FLP).

Methods: This was a retrospective single-institution cohort study on MCDA twins who underwent FLP between October 2010 and December 2018. The control group included MCDA twins who did not undergo FLP and were delivered during the same period in the institute. The incidence of chorioamnionitis (CAM), funisitis, and other pathological findings was compared between the FLP and control groups after matching by gestational age at delivery.

Results: In total, 292 MCDA pregnant women who underwent FLP and 356 controls gave birth during the study period. After matching the two groups in the ratio 1:1 by gestational age at delivery, each group comprised 194 subjects. The incidence of histological CAM with Blanc association (stage I, 6.2% vs. 3.1%, crude odds ratio (cOR) = 3.1, P = 0.052; stage II, 7.2% vs. 5.7%, cOR = 1.6, P = 0.30; stage III, 2.1% vs. 2.6%, cOR = 0.66, P = 0.52) and funisitis (artery, 5.2% vs. 3.6%, cOR = 1.3, P = 0.63; vein 7.2% vs. 4.1%, cOR = 1.6, P = 0.29) was not statistically significant difference between the FLP and control groups. The FLP group demonstrated a higher incidence of partial placental infarction than the control group (10.3% vs. 3.1%, cOR = 4.3, P = 0.004, adjusted OR = 2.8, P = 0.031).

Discussion: FLP did not appear to increase the incidence of histological CAM or funisitis in subjects matched by gestational age at delivery. The FLP group demonstrated a higher incidence of partial placental infarction than the control group.
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http://dx.doi.org/10.1016/j.placenta.2020.07.002DOI Listing
October 2020

Early postoperative Barthel index score and long-term walking ability in patients with trochanteric fractures walking independently before injury: a retrospective cohort study.

Arch Orthop Trauma Surg 2020 Jul 23. Epub 2020 Jul 23.

Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan.

Introduction: Trochanteric fractures are one of the most common fragility fractures, and the number of the patients is increasing worldwide. Identifying prognostic factors is important to manage and minimize the social losses caused by postoperative walking impairment. The purpose of this retrospective study is to clarify the association between early postoperative Barthel index score and postoperative long-term walking ability among patients with trochanteric fractures who could walk independently before injury.

Materials And Methods: Consecutive patients with trochanteric fractures aged ≥ 65 years who were walking independently before injury were included. Patients were divided into two groups according to the Barthel index score measured within 1 week after surgery; the cut-off value was set at 20 points. The prevalence of walking impairment after 1 year was compared between these two groups after adjusting for confounding factors in a complete case analysis and using the data introduced by the multiple imputation method.

Results: Among the 758 eligible patients, 254 patients (34%) had their walking ability evaluated after 1 year from injury. The patients in the lower Barthel index group showed a significantly impaired walking ability in both analyses (adjusted odds ratio 5.5 and 2.4, 95% confidence intervals 2.4-13 and 1.5-3.8, respectively).

Conclusions: The present results suggested that the Barthel index score measured in the early postoperative period after trochanteric fractures was associated with the level of long-term walking impairment in patients who could walk independently before injury.
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http://dx.doi.org/10.1007/s00402-020-03548-7DOI Listing
July 2020

Interdigitating percutaneous screw fixation for Rommens type IIIa fragility fractures of the pelvis: technical notes and preliminary clinical results.

Int Orthop 2020 11 16;44(11):2431-2436. Epub 2020 Jun 16.

Department of Orthopaedic Surgery, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan.

Purpose: Fragility fractures of the pelvis (FFPs) type IIIa in the Rommens classification include unilateral iliac fractures as well as pubic rami fractures. We devised a new, less-invasive fixation technique to achieve increased stability for FFPs type IIIa. The aim of this study was to describe this procedure and report the preliminary clinical results.

Methods: A total of 14 geriatric patients (> 60 years old) who sustained FFP type IIIa caused by low-energy trauma were surgically treated with interdigitating screw fixation including a trans-pubic screw in a retrograde manner and two trans-iliac screws from the anterior inferior iliac spine toward the posterior inferior iliac spine. All iliac fractures were displaced with external rotation, and closed reduction was performed. Percutaneous screw fixation, in which fully threaded screws were in contact with each other, provided stable fixation allowing early mobilization.

Results: A median decrease in pain levels by post-operative day two was 4.5 compared with pre-operatively using a numerical rating scale. While full weight-bearing was allowed from four weeks post-operatively in the initial five patients, immediate full weight-bearing was instructed as tolerated for the subsequent nine patients. No complications were encountered during the peri-operative period. At the final follow-up, all fractures were united without fixation loss, screw dislodgment, or hardware failure.

Conclusions: This procedure of closed reduction and interdigitating screw fixation for FFP type IIIa appears to represent a safe, reliable technique. Our experience suggests that interdigitating fixation for FFP type IIIa is effective for relieving pain and promoting early mobilization in elderly patients.
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http://dx.doi.org/10.1007/s00264-020-04664-0DOI Listing
November 2020

Successful treatment of left subclavian artery penetration due to ingestion of a safety pin by an elderly person.

Acute Med Surg 2020 Jan-Dec;7(1):e526. Epub 2020 Jun 11.

Advanced Trauma Emergency and Critical Care Center Oita University Oita Japan.

Background: Ingestion cases are increasing in elderly persons. Herein, we report a rare case of ingestion of a safety pin by an elderly person.

Case Presentation: The patient was an 87-year-old bedridden woman who had fever with left pleural effusion. Chest X-ray revealed a foreign body, confirmed to be a safety pin, in the cervical esophagus. A contrast multidetector row computed tomography scan revealed that the opened safety pin penetrated the left subclavian artery, leading to the diagnosis of an esophageal foreign body penetrating the left subclavian artery. The safety pin was removed, and the subclavian artery aneurysm caused by the penetration was embolized by interventional radiology. After treatment, she was returned to the nursing home on postoperative day 8.

Conclusion: Penetration by ingestion of a safety pin is rare; in this case, safe treatment was possible due to a team of certified specialist physicians and surgeons.
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http://dx.doi.org/10.1002/ams2.526DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7289644PMC
June 2020

Perinatal outcomes of intrauterine transfusion for the surviving twin in monochorionic twin gestation involving a single fetal demise.

J Obstet Gynaecol Res 2020 Aug 2;46(8):1319-1325. Epub 2020 Jun 2.

Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan.

Aim: This study aimed to evaluate the feasibility and outcome of intrauterine transfusion (IUT) for the surviving co-twin in monochorionic diamniotic (MCDA) twin gestations involving single intrauterine fetal death (sIUFD).

Methods: Cases of MCDA twin gestations involving emergent IUT for co-twins experiencing acute feto-fetal hemorrhage (AFFH) subsequent to sIUFD during the second trimester were reviewed. Fetal anemia was confirmed via fetal blood sampling, and perinatal data were retrieved from medical charts to determine the outcomes of surviving co-twins. A poor outcome at 28 days of age was defined as fetal death, neonatal death or neurological impairment such as severe intraventricular hemorrhage or cystic periventricular leukomalacia (PVL).

Results: This study included 16 cases of sIUFD diagnosed at a median of 22.5 weeks of gestation (range: 18-25 weeks). The median interval in hours between diagnosis of fetal demise and IUT was approximately 4.2 (0-22) hours. All cases achieved IUT without significant intraoperative complications. Four cases experienced a fetal loss of the co-twin, whereas 12 co-twins were born alive (including 9 preterm births), with only 1 poor outcome in a preterm infant with PVL.

Conclusion: IUT may be a feasible prenatal intervention for surviving co-twins with AFFH. However, more extensive or pooled studies are needed to determine the efficacy of this intervention.
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http://dx.doi.org/10.1111/jog.14338DOI Listing
August 2020

Open Reduction Is Associated With Greater Hazard of Early Reoperation After Internal Fixation of Displaced Femoral Neck Fractures in Adults 18-65 Years.

J Orthop Trauma 2020 Jun;34(6):294-301

Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA.

Objectives: To determine (1) which factors are associated with the choice to perform an open reduction and (2) by adjusting for these factors, if the choice of reduction method is associated with reoperation.

Design: Retrospective cohort study with radiograph and chart review.

Setting: Twelve Level 1 North American trauma centers.

Patients: Two hundred thirty-four adults 18-65 years of age with an isolated, displaced, OTA/AO type 31-B2 or type 31-B3 femoral neck fracture treated with internal fixation with minimum of 6-month follow-up or reoperation. Exclusion criteria were pathologic fractures, associated femoral head or shaft fractures, and primary arthroplasty.

Intervention: Open or closed reduction technique during internal fixation.

Main Outcome: Cox proportional hazard of reoperation adjusting for propensity score for open reduction based on injury, demographic, and medical factors. Reduction quality was assessed by 3 senior orthopaedic traumatologists as "acceptable" or "unacceptable" on AP and lateral postoperative radiographs.

Results: Median follow-up was 1.5 years. One hundred six (45%) patients underwent open reduction. Reduction quality was not significantly affected by open versus closed approach (71% vs. 69% acceptable, P = 0.378). The propensity to receive an open reduction was associated with study center; younger age; male sex; no history of injection drug use, osteoporosis, or cerebrovascular disease; transcervical fracture location; posterior fracture comminution; and surgery within 12 hours. A total of 35 (33%) versus 28 (22%) reoperations occurred after open versus closed reduction (P = 0.056). Open reduction was associated with a 2.4-fold greater propensity-adjusted hazard of reoperation (95% confidence interval 1.3-4.4, P = 0.004). A total of 35 (15%) patients underwent subsequent total hip arthroplasty or hemiarthroplasty.

Conclusions: Open reduction of displaced femoral neck fractures in nonelderly adults is associated with a greater hazard of reoperation without significantly improving reduction. Prospective randomized trials are indicated to confirm a causative effect of open versus closed reduction on outcomes after femoral neck fracture.

Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.1097/BOT.0000000000001711DOI Listing
June 2020

Comparison of the operative time for open door laminoplasty using titanium plate spacers or hydroxyapatite block spacers: a retrospective study.

J Orthop Surg Res 2019 Dec 30;14(1):475. Epub 2019 Dec 30.

Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.

Background: Titanium plate (TP) and hydroxyapatite (HA) spacers are widely used during open-door laminoplasty, performed with the patient in a prone position. Reducing operative time is an important consideration, particularly to reduce the risk of postoperative complications in older patients. The purpose of this retrospective cohort study was to compare the operative time for open-door laminoplasty using TP or HA spacers.

Methods: Consecutive patients with a spinal cord injury, without bone injury, and ≥ 50 years of age were included. Multivariate regression analysis was used to compare the operative time between patients in the TP and HA group, adjusting for known factors that can influence surgical and postoperative outcomes. Propensity score matching was used to confirm the robustness of the primary outcome. The cumulative incidence of postoperative complications over 1-year after surgery was also compared.

Results: Of the 164 patients forming our study group, TP spacers were used in 62 and HA in 102. Operative time was significantly shorter for the TP (128 min) than HA (158 min) group (p < 0.001). Both multivariate and propensity score matching analyses confirmed a significant reduction in operative time for the TP, compared to HA, group (regression coefficient, - 30 min and - 38 min, p < 0.001 and p < 0.001, respectively). There was no significant difference in the cumulative incidence of postoperative complications.

Conclusions: The use of TP spacers reduced the operative time for cervical open-door laminoplasty by about 30 min, compared to the use of HA spacers, with no difference in the rate of postoperative complications.
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http://dx.doi.org/10.1186/s13018-019-1539-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6936073PMC
December 2019

Prenatally diagnosed congenital hemangioma with elevated middle cerebral artery peak systolic velocity mimicking the Kasabach-Merritt phenomenon: A case report.

J Obstet Gynaecol Res 2019 Dec 9;45(12):2456-2460. Epub 2019 Sep 9.

Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan.

Congenital hemangioma is a rare vascular tumor that develops prenatally, and a large congenital hemangioma may be accompanied by the Kasabach-Merritt phenomenon. We present a case of prenatally diagnosed fetal congenital hemangioma through ultrasound and maternal anti-Jr(a) antibody alloimmunization with elevated middle cerebral artery peak systolic velocity. To investigate fetal anemia and hemostatic condition, we performed percutaneous umbilical blood sampling, which revealed no symptom of either Kasabach-Merritt phenomenon or sensitization to anti-Jr(a) antibody. Consequently, pregnancy could be continued without further intervention. After birth, congenital hemangioma was found on the infant's left thigh, and Kasabach-Merritt phenomenon was not shown. Percutaneous umbilical blood sampling could provide precise information prenatally in case of congenital hemangioma with maternal alloimmunization.
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http://dx.doi.org/10.1111/jog.14121DOI Listing
December 2019

A disintegrin and metalloproteinase with thrombospondin motifs 2 cleaves and inactivates Reelin in the postnatal cerebral cortex and hippocampus, but not in the cerebellum.

Mol Cell Neurosci 2019 10 3;100:103401. Epub 2019 Sep 3.

Department of Biomedical Science, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Aichi, Japan. Electronic address:

Reelin plays important roles in regulating neuronal development, modulating synaptic function, and counteracting amyloid β toxicity. A specific proteolytic cleavage (N-t cleavage) of Reelin abolishes its biological activity. We recently identified ADAMTS-3 (a disintegrin and metalloproteinase with thrombospondin motifs 3) as the major N-t cleavage enzyme in the embryonic and early postnatal brain. The contribution of other proteases, particularly in the postnatal brain, has not been demonstrated in vivo. ADAMTS-2, -3 and -14 share similar domain structures and substrate specificity, raising the possibility that ADAMTS-2 and -14 may cleave Reelin. We found that recombinant ADAMTS-2 protein expressed in cultured cell lines cleaves Reelin at the N-t site as efficiently as ADAMTS-3 while recombinant ADAMTS-14 hardly cleaves Reelin. The disintegrin domain is necessary for the Reelin-cleaving activity of ADAMTS-2 and -3. ADAMTS-2 is expressed in the adult brain at approximately the same level as ADAMTS-3. We generated ADAMTS-2 knockout (KO) mice and found that ADAMTS-2 significantly contributes to the N-t cleavage and inactivation of Reelin in the postnatal cerebral cortex and hippocampus, but much less in the cerebellum. Therefore, it was suggested that ADAMTS-2 can be a therapeutic target for adult brain disorders such as schizophrenia and Alzheimer's disease.
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http://dx.doi.org/10.1016/j.mcn.2019.103401DOI Listing
October 2019

Clinical Characteristics of Jra Alloimmunization in Pregnancy: A Case Series.

Fetal Diagn Ther 2019 21;46(6):433-439. Epub 2019 Aug 21.

Department of Maternal-Fetal Medicine, Osaka Women's and Children's Hospital, Izumi, Japan.

Only few studies have reported on Jra alloimmunization in pregnancy, and its clinical course remains unclear. We reviewed our cases to clarify the change in the peak systolic velocity of the middle cerebral artery (MCA-PSV) during pregnancy and the critical anti-Jra antibody titer to predict fetal anemia. We collected the data of pregnant women with anti-Jra antibody from two hospitals between 2010 and 2017. We extracted data on maternal information, number of intrauterine blood transfusions (IUT), trend of anti-Jra antibody titer, changes of MCA-PSV, and neonatal outcome. We had 16 cases. IUTs were performed in 6 fetuses with severe anemia between 27 and 32 weeks' gestation. The MCA-PSV did not increase more than 1.5 multiples of the median (MoM) after 32 weeks' gestation. No significant difference was found in the maximum titer between cases with IUT and those without IUT. All pregnancies but one delivered at term. No neonates developed severe anemia or jaundice. MCA-PSV did not increase higher than 1.5 MoM later during the pregnancy. A critical titer to predict fetal anemia did not exist. Spontaneous term delivery could be expected even in fetuses who underwent IUT before 32 weeks' gestation.
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http://dx.doi.org/10.1159/000501517DOI Listing
April 2020

Influence of preoperative light vaginal bleeding for perinatal adverse outcomes on physical examination-indicated cerclage.

J Matern Fetal Neonatal Med 2021 Jul 2;34(13):2047-2052. Epub 2019 Sep 2.

Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan.

Purpose: To clarify the relationship between light vaginal bleeding (LVB) before physical examination-indicated cerclage (PEIC) and perinatal adverse outcomes.

Methods: This was a retrospective cohort study involving 94 singleton pregnancies undergoing PEIC <26 weeks of gestation at a single perinatal medical center between 2008 and 2015. The primary outcome was set as spontaneous preterm birth (sPTB) <34 weeks of gestation. The secondary outcomes were set as the second-trimester loss prior to 22 weeks of gestation, sPTB before 28 weeks of gestation, sPTB before 37 weeks of gestation, and stillbirth or neonatal death. Relationships between LVB and adverse outcomes were evaluated using logistic regression analysis.

Results: Preoperative LVB was detected in 16 cases (17.0%). Multivariate logistic regression analyses revealed that preoperative LVB was an independent risk factor for sPTB <34 weeks of gestation (adjusted odds ratio [aOR]: 8.42; 95% confidence interval [CI]: 1.72-41.1;  < .01), sPTB <28 weeks of gestation (aOR: 5.98; 95% CI: 1.67-21.4;  < .01) and perinatal death (aOR: 8.47; 95% CI: 1.11-64.5;  = .04).

Conclusions: Vaginal bleeding prior to PEIC, even nonsignificant or self-limiting, is associated with sPTB before 28 or 34 weeks of gestation and perinatal death.
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http://dx.doi.org/10.1080/14767058.2019.1656192DOI Listing
July 2021

Current status of percutaneous umbilical cord blood sampling in Japan.

J Obstet Gynaecol Res 2019 Sep 25;45(9):1821-1827. Epub 2019 Jun 25.

Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan.

Aim: The aim of the survey is to investigate current practice and complications of percutaneous umbilical cord blood sampling (PUBS) in Japan.

Methods: In this retrospective survey, data including perioperative information, indications, details of the procedure and procedure-related complications were collected for patients who underwent PUBS between 2012 and 2016 in Japanese perinatal care centers.

Results: One hundred and fifty-three patients underwent PUBS and a total of 223 procedures were analyzed in this study. Fetal anemia was the most common indication for PUBS, representing greater than 70% of all cases. Anemia specific to monochorionic twins, such as acute feto-fetal hemorrhage subsequent to single intrauterine fetal death (IUFD) and twin anemia-polycythemia sequence, were the leading causes of suspected fetal anemia. Maternal anesthetics were given during the procedure in 70% of cases. The PTC needle (Hakko, Japan) was most commonly used in the procedure. The most frequent complication was bleeding from the umbilical cord puncture site; however, it did not require immediate delivery during or after the procedure in any case. IUFD occurred in 11 (4.9%) procedures, 7 of which appeared to be related to the underlying fetal disease. The overall completion rate of the procedure was 97%.

Conclusion: Percutaneous umbilical cord blood sampling was most commonly performed for the evaluation of fetal anemia, usually due to complications of monochorionic twins, followed by the measurement of fetal thyroid function. The safety and the completion rate of the procedure in Japan appear satisfactory.
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http://dx.doi.org/10.1111/jog.14047DOI Listing
September 2019

Risk factors for a kyphosis recurrence after short-segment temporary posterior fixation for thoracolumbar burst fractures.

J Clin Neurosci 2019 Aug 11;66:138-143. Epub 2019 May 11.

Department of Orthopedic Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006, Japan.

Short-segment temporary posterior spinal instrumentation has been widely used to treat thoracolumbar burst fractures. However, kyphosis recurrence without hardware failure has become a concern. Therefore, we investigated risk factors for kyphosis recurrence after short-segment temporary fixation for thoracolumbar burst fractures. Our prospective multicenter study involved 76 consecutive patients with thoracolumbar burst fractures who underwent short-segment temporary posterior fixation using ligamentotaxis with Schanz screws and without fusion. Patients were divided into two groups -kyphosis recurrence and no kyphosis recurrence- according to correction loss of the kyphotic angle. Clinical and radiographic data were examined to reveal the risk factors for postoperative kyphosis recurrence. After surgery, all patients experienced fracture union. Kyphotic deformity was reduced significantly, and maintenance of the reduced vertebra was successful. However, mean 9.1° loss of correction in kyphotic angle was observed. Statistical analysis revealed that a high ratio of canal compromise before surgery, as seen on computed tomography scanning, and a large preoperative kyphotic angle influenced kyphosis recurrence. In conclusion,short-segment temporary posterior fixation yields satisfactory results regarding reduction and maintenance of fractured vertebrae. However, correction loss after implant removal is associated with a high compromised canal ratio before surgery and a large preoperative kyphotic angle.
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http://dx.doi.org/10.1016/j.jocn.2019.04.035DOI Listing
August 2019

Differential binding of anti-Reelin monoclonal antibodies reveals the characteristics of Reelin protein under various conditions.

Biochem Biophys Res Commun 2019 06 10;514(3):815-820. Epub 2019 May 10.

Department of Biomedical Science, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Aichi, 467-8603, Japan. Electronic address:

Reelin is a large secreted protein that is essential for the development and function of the central nervous system. Dimerization and/or oligomerization is required for its biological activity, but the underlying mechanism is not fully understood. There are several widely used anti-Reelin antibodies and we noticed that their reactivity to monomeric or dimeric Reelin protein is different. We also found that their reactivity to Reelin in the solution or in fixed brain tissues also differs. Our results provide the information regarding how the N-terminal region of Reelin folds and contributes to the formation of higher order structure. We also provide a caveat that appropriate use of anti-Reelin antibody is necessary for quantitative analyses.
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http://dx.doi.org/10.1016/j.bbrc.2019.05.005DOI Listing
June 2019

Prevalence and distribution of air in the leg on preoperative multidetector high-resolution computed tomography in closed and low-grade open tibial shaft fractures.

J Orthop Surg (Hong Kong) 2019 Jan-Apr;27(1):2309499019825585

Trauma and Reconstruction Center, Teikyo University Hospital, Tokyo, Japan.

Purpose: The prevalence and distribution of air present in the leg in closed and low-grade open tibial shaft fractures are unknown on multidetector high-resolution computed tomography (CT). The purpose of this study was to determine the rate of surgical site infection (SSI) in cases where debridement was not performed in the area of air infiltration.

Methods: Eighty-one closed and low-grade open tibial shaft fractures that underwent multidetector high-resolution CT on admission and were treated with an intramedullary nail were examined retrospectively.

Results: Of the 36 Gustilo type I or II open fractures, all had local air around the fracture site (within 5 cm proximal and distal from the fracture center). Of these, 25 showed remote air (more than 5 cm away from the fracture center). The most frequent site of remote air was in the subcutaneous tissue, followed by the anterior compartment and deep posterior compartment. All open fractures were treated with local irrigation and debridement, regardless of the presence of remote air, followed by a reamed intramedullary nail. No SSI developed until bone union. Of the 45 closed fractures, 3 patients showed air in the leg on the CT. No debridement was performed for closed fractures. One patient who did not have air in the leg developed SSI. All fractures united eventually.

Conclusions: In low-grade open tibial shaft fractures, air can spread far from the fracture site. Even in closed tibial shaft fractures, air can be identified in the leg. The debridement of the area of air infiltration, however, is not necessary for prevention of SSI.
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http://dx.doi.org/10.1177/2309499019825585DOI Listing
March 2020

The incidence of unexpected critical complications in monochorionic diamniotic twin pregnancies according to the interval period between ultrasonographic evaluations.

J Obstet Gynaecol Res 2019 Feb 10;45(2):318-324. Epub 2018 Oct 10.

Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan.

Aim: This study aimed to evaluate the incidence of unexpected critical complications (UCC) in monochorionic diamniotic (MCDA) twin pregnancies according to ultrasonographic scan interval.

Methods: This retrospective single-center cohort study, conducted between January 2005 and April 2015, investigated the incidence of UCC in patients with MCDA twin pregnancies undergoing weekly ultrasound (Group A) and those undergoing biweekly ultrasound (Group B). We also examined the incidence of predictable critical complications according to ultrasound interval.

Results: Of all 385 cases, the total incidence of UCC was 20 (5.2%), including 14 cases of twin-twin transfusion syndrome and 6 cases of intrauterine fetal death. The incidence of UCC was 3.9% in Group A and 9.0% in Group B (P = 0.046). In contrast, the incidence of predictable critical complications was 6.7% in Group A and 9.0% in Group B (P = 0.440).

Conclusion: The incidence of UCC in patients with MCDA twin pregnancies was significantly lower in patients undergoing weekly ultrasound. Our results suggest that weekly ultrasound evaluation for patients with MCDA pregnancy is more effective for early detection of UCC such as intrauterine fetal death and twin-twin transfusion syndrome ; however, further investigations are needed to determine whether weekly ultrasound evaluation can improve clinical outcomes.
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http://dx.doi.org/10.1111/jog.13827DOI Listing
February 2019

New terminology for adverse events of fetal therapy: Re-evaluation of the thoraco-amniotic shunting in a Japanese study.

J Obstet Gynaecol Res 2019 Feb 6;45(2):251-257. Epub 2018 Sep 6.

Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan.

Aim: Since fetal therapy has been newly developed, objective evaluation of adverse events (AE), all harmful events that are not always related to the procedures, has not yet been adequately reported. We established new terminology and tried to re-evaluate it based on the Japanese prospective thoraco-amniotic shunting (TAS) study.

Methods: From the literature, all complications that occurred with all fetal therapies were identified as a basis for developing the terminology. Grading was set from 0 to 5. Grade 3 was defined as the need for invasive treatment, such as surgery. Grade 4 was defined as life-threatening, and Grade 5 was defined as death of the mother or fetus. Then, one series of TAS that we had already reported was re-evaluated, including 24 cases with 37 procedures and 200 opportunities those could be evaluated AE after procedures.

Results: Grade 4 preterm rupture of the membranes was reported in only 1 of 24 cases. Catheter displacement was reported in 7, 2 and 11 cases, of Grades 1, 2 and 3, respectively. It was found that the double-basket catheter had some association with catheter displacement, but it was clear that there were no life-threatening AE.

Conclusion: Newly developed AE criteria are now available for fetal therapy. They will contribute to the objective evaluation of AE of new fetal therapies in the future.
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http://dx.doi.org/10.1111/jog.13804DOI Listing
February 2019

Factors associated with emergency cesarean delivery during induction of labor in nulliparous women aged 35 years or older at term.

J Obstet Gynaecol Res 2018 Sep 10;44(9):1747-1751. Epub 2018 Jul 10.

Department of Obstetrics, Osaka Women's and Children's Hospital, Izumi, Japan.

Aim: To examine the intrapartum cesarean delivery rate following failure of induction of labor (IOL) as well as risk factors associated with failed IOL among nulliparous women of advanced maternal age (AMA).

Methods: This was a retrospective cohort study conducted at a single perinatal care center. We retrospectively reviewed the medical records of nulliparous AMA women (aged 35 years or older) with singleton vertex pregnancy who underwent IOL at term. Data regarding maternal baseline characteristics and pregnancy course, including complications during pregnancy and maternal status at time of IOL, were collected. Rate of emergency cesarean section (eCS) as well as risk factors associated with failed IOL were investigated by means of logistic regression analysis.

Results: Among 234 women included in this study, 103 (44%) had failed IOL and delivered by eCS. Hypertensive disorder during pregnancy (adjusted odds ratio [aOR], 2.01; 95% confidence interval [CI], 1.0-4.12; P = 0.025) and unfavorable cervical status (aOR, 1.92; 95% CI, 1.08-3.41; P = 0.038) were identified as independent risk factors for failed IOL.

Conclusion: IOL failed in 44% of nulliparous AMA women. Hypertensive disorder and immature cervical status should be considered as independent risk factors for eCS among such women.
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http://dx.doi.org/10.1111/jog.13708DOI Listing
September 2018

Incidence of and risk factors for severe maternal complications associated with hypertensive disorders after 36 weeks' gestation in uncomplicated twin pregnancies: A prospective cohort study.

J Obstet Gynaecol Res 2018 Jul 19;44(7):1221-1227. Epub 2018 Apr 19.

Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan.

Aim: To elucidate the incidence of and risk factors for severe hypertensive disorders (HD) and related maternal complications in uncomplicated twin pregnancies that reached 36 weeks' gestation.

Methods: We conducted a prospective cohort study of twin pregnancies delivered after 36 weeks' gestation. Cases of twin-twin transfusion syndrome, twin anemia-polycythemia sequence, malformed fetuses, monoamniotic twins, selective reduction, fetal therapy and HD or fetal death before 35 weeks' gestation were excluded. The study's primary outcome was the incidence of severe maternal complications, including severe HD, eclampsia, placental abruption, HELLP (hemolysis, elevated liver enzyme and low platelet) syndrome, pulmonary edema and cerebrovascular disease. Perinatal factors associated with the primary outcome were identified using a multivariate logistic regression model.

Results: In 330 enrolled women, the number of cases with the primary outcome was 28 (8.5%; 95% confidence interval 5.9-12.0), including 25 cases of severe HD and each one case of placental abruption, HELLP syndrome and eclampsia. The rate of severe maternal complications significantly increased with gestational age, demonstrating 1.2% at 36 weeks, 3.9% at 37 weeks and 6.4% at 38 weeks. Only gestational proteinuria was identified as the independent risk factor for severe maternal complications (adjusted odds ratio 17.1 [95% confidence interval 6.71-45.4]).

Conclusion: Severe maternal HD and related complications increased from late preterm to early term; particularly, patients with gestational proteinuria were at high risk.
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http://dx.doi.org/10.1111/jog.13650DOI Listing
July 2018