Maternal weight gain ranges for optimal fetal growth in Japanese women.

OBJECTIVE: To identify adequate weight gain ranges during pregnancy in Japanese women. METHOD: Obstetric records from 2001 to 2002 for 46,659 term, singleton, vaginally delivered live births was used to estimate IUGR and macrosomia risk. Total maternal weight gain was grouped according to gestational age-specific percentile values of weight gain as follows: "very low" (under the 25th), "low" (25th to 49th), "moderate" (50th to 74th), "high" (75th to 89th), and "very high" (90th and over). RESULTS: About 6% of infants were identified as having IUGR and 0.9% as macrosomia. IUGR risk was elevated with low weight gains. Macrosomia risk was related to high weight gains and previous spontaneous abortions. CONCLUSION: Achieving weight gains between the 50th and 75th percentiles for gestational age was considered adequate for optimal fetal growth in Japanese pregnant women.     

Agonist of proteinase-activated receptor 2 increases painful behavior produced by alpha, beta-methylene adenosine 5'-triphosphate

Proteinase-activated receptor (PAR) 2 is expressed in a subset of primary afferent neurons and is involved in inflammatory nociception. The P2X3 ion channel is localized on nociceptors of sensory neurons. Using immunohistochemistry, we showed that many P2X3s are co-expressed with the PAR2 in rat dorsal root ganglia neurons. Nocifensive behavior induced by alphabeta-methylene adenosine 5'-triphosphate (ATP) injection to the hind paw was significantly augmented after the application of PAR2 agonists. Fos expression induced by the alphabeta-methylene ATP injection in dorsal horn neurons was also increased after the pre-application of PAR2 agonists. These findings indicate that PAR2 agonists may potentiate the sensitivity of P2X3 ion channel to noxious stimuli, and the interaction between PAR2 and P2X3 may be an important mechanism underlying inflammatory pain.     

Neurons and glial cells differentially express P2Y receptor mRNAs in the rat dorsal root ganglion and spinal cord

We examined the precise distribution of mRNAs for six cloned rat P2Y receptor subtypes, P2Y1, P2Y2, P2Y4, P2Y6, P2Y12, and P2Y14, in the dorsal root ganglion (DRG) and spinal cord by in situ hybridization histochemistry (ISHH) with 35S-labeled riboprobes. In the DRG, P2Y1 and P2Y2 mRNAs were expressed by 15% and 24% of all neurons, respectively. Although each receptor was evenly distributed between neurofilament-positive and -negative neurons, P2Y2 was rather selectively expressed by TrkA-positive neurons. Schwann cells expressed P2Y2 mRNA, and the nonneuronal cells around the DRG neurons, perhaps the satellite cells, expressed P2Y12 and P2Y14 mRNAs. No ISHH signals for P2Y4 or P2Y6 were seen in any cellular components of the DRG. In the spinal cord, P2Y1 and P2Y4 mRNAs were expressed by some of the dorsal horn neurons, whereas the motor neurons in the ventral horn had P2Y4 and P2Y6 mRNAs. In addition, astrocytes in the gray matter had P2Y1 mRNA, and the microglia throughout the spinal cord expressed P2Y12 mRNA. P2Y14 mRNA was weakly expressed by putative microglia. These findings should provide useful information in interpreting pharmacological and electrophysiological studies in this field given the lack of highly selective antagonists for each P2Y receptor subtype.     

An unusual manifestation of Sjögren syndrome encephalitis

Sjögren syndrome (SS) is a systemic inflammatory and autoimmune disease characterized by systemic disorders of the exocrine glands, predominantly the salivary and lacrimal glands. Here, we report a 4-year-old boy who presented with the repetition of generalized tonic-clonic seizures for 1–2?min. Initially, he was diagnosed with idiopathic autoimmune encephalitis and was treated with steroids. He was eventually diagnosed with SS based on the examination results, such as inflammatory cell infiltration into the minor salivary glands and positive serum anti-SSA/Ro antibody. Although central nervous system complications are rare in pediatric SS, this condition should be considered in the differential diagnosis when a patient presents with idiopathic autoimmune encephalitis of unknown cause. Furthermore, SS can occur in relatively young children and can present without imaging abnormalities.     

Antioxidative effects of azelnidipine on mesangial cell proliferation induced by highly concentrated insulin

Insulin resistance combined with hyperinsulinemia is involved in the generation of oxidative stress. There is known to be a relationship between increased production of reactive oxygen species and the diverse pathogenic mechanisms involved in diabetic vascular complications including nephropathy. The present study found that high doses of insulin affect mesangial cell proliferation through the generation of intracellular reactive oxygen species and the activation of cell signaling pathways. We also examined whether azelnidipine, a dihydropyridine-based calcium antagonist with established antioxidant activity, has the potential to inhibit mesangial cell proliferation. Cell proliferation was increased in a dose-dependent manner by high doses of insulin (0.1-10 microM), but was inhibited by 0.1 microM azelnidipine. Phosphorylation of extracellular signal-regulated kinase (ERK)-1/2 was found to be increased by insulin in a dose-dependent manner (0.1-10 microM). This increased phosphorylation of ERK-1/2 was inhibited by treatment with 0.1 microM azelnidipine. Intracellular oxidative stress was also increased by insulin stimulation in a dose-dependent manner (0.01-10 microM), and 0.1 microM azelnidipine was found to block intracellular reactive oxygen species production more effectively than 0.1 microM nifedipine. The NAD(P)H oxidase inhibitor, apocynin (0.01-0.1 microM), prevented insulin-induced mesangial cell proliferation. Taken together, these results suggest that azelnidipine inhibits insulin-induced mesangial cell proliferation by inhibiting the production of reactive oxygen species. Given these pharmacological characteristics, azelnidipine may have the potential to protect against the onset of diabetic nephropathy and slow its progression.     

Ampulla cardiomyopathy induced by meningitis: two case reports

Two patients presented with ampulla cardiomyopathy induced by meningitis. A 71-year-old man with meningitis was admitted to our neurosurgery division. Emergent coronary angiography was performed, because of sudden blood pressure fall and ST elevation in the precordial leads. Left ventriculography and coronary angiography revealed apical ballooning without coronary stenosis. A 73-year-old woman with meningitis was admitted to another hospital. She felt chest pain. Electrocardiography showed ST elevation in the precordial leads. She was transferred to our division. Echocardiography revealed apical ballooning and hyperkinesis of the base. Creatine kinase level showed no elevation on admission or 8 hr later. Ampulla cardiomyopathy with cerebrovascular disease is common, but rare with meningitis, which needs intensive care because of the risk of respiratory arrest.     

Endometrioid adenocarcinoma of the vagina with a microglandular pattern arising from endometriosis after hysterectomy

Primary endometrioid adenocarcinoma rarely occurs in the vagina. Occasionally, endometrioid adenocarcinoma has a microglandular pattern. Herein, a case of primary endometrioid adenocarcinoma of the vagina with a microglandular pattern arising from pre‐existing endometriosis long after a hysterectomy, is described. A 57‐year‐old postmenopausal woman developed a vaginal discharge over one decade after undergoing a hysterectomy. Microscopic examination of the vaginal smear and a biopsy specimen demonstrated an atypical glandular proliferation composed of columnar cells with occasional intracytoplasmic mucin and bland nuclear morphology, showing microcysts and numerous neutrophils within and around cysts. Immunohistochemically, the neoplastic cells were diffusely positive for CK7, MUC1, ER, and PR, and focally positive for vimentin, CEA, CK5/6, p63, p16^INK4a, and p53. A portion of residual endometrioid adenocarcinoma was identified adjacent to foci of endometriosis in the vaginectomy specimen. The patient has done well without evidence of recurrent disease for 1 year after surgery. Pathologists are encouraged to be aware of the occurrence of endometrioid adenocarcinoma associated with endometriosis in the vaginal stump after hysterectomy, and microglandular morphology which might be a source of misinterpretation.     

An essential dose of cisplatin for super-selective intra-arterial infusion concomitant with radiotherapy in patient with maxillary squamous cell carcinoma

The present study investigated the efficacy and safety of using a lower dose of cisplatin (CDDP) in super-selective intra-arterial concurrent chemoradiotherapy (SSIACRT) to treat maxillary squamous cell carcinoma. 10 patients with maxillary squamous cell carcinoma (T3 n?=?6, T4a n?=?4) without regional or distant metastasis were treated by SSIACRT. The CDDP dose per course was 100?mg/body, i.e. 50–80?mg/m². 6–9?weeks after SSIACRT, partial maxillectomy was performed on all patients. Clinical and histological responses, survival rates, and adverse events were investigated. 10 (100%) of 10 patients achieved both clinical and pathological complete or partial remission. The 3-year overall and disease-free survival rates were 100 and 90%, respectively. Grade 3 toxicity was experienced by two patients. In conclusion, the SSIACRT regimen with a lower dose of CDDP (100?mg/body) had an equivalent therapeutic outcome and lower toxic outcome compared to a higher dose of CDDP. This regimen could be an effective and safe therapeutic modality for maxillary squamous cell carcinoma except T4b and N1/2 disease.