Objective To investigate time intervals of the ductus venosus (DV) flow velocity waveform (FVW) and those of the cardiac cycle that correspond with each DV-FVW component in fetuses with intrauterine growth restriction (IUGR) due to placental insufficiency. Methods
To gain insight into the mechanisms by which hepatocytes release lipids and proteins into bile, we studied extended, steady-state secretion of bile, lipids, and lysosomal and canalicular membrane proteins in freely moving, unanesthetized rats with chronic bile fistulas. We found circadian rhythms of biliary secretion for all measured constituents. In the basal state (nocturnal feeding), two distinct secretory patterns emerged: type 1, characterized by a peak at midnight and a nadir at noon; and type 2, characterized by a peak at 8 A.M. and a nadir at 8 P.M. We observed parallel, type 1 circadian rhythms of excretion for bile, biliary lipids (bile acid, cholesterol, phospholipid), and a canalicular membrane enzyme (alkaline phosphodiesterase I). In contrast, a type 2 circadian rhythm was observed for the outputs of two lysosomal enzymes. Hepatic lysosomal enzyme concentrations and the number of pericanalicular lysosomes decreased (P less than 0.05) by 15 and 35%, respectively, at the nadir of their biliary output relative to the time of their peak outputs. In response to daytime feeding, major shifts in the circadian rhythms of excretion of biliary constituents occurred such that secretion of bile, lipids, and the canalicular membrane protein adopted a type 2-like rhythm, whereas the biliary secretion of the lysosomal proteins exhibited a type 1-like pattern. These results indicate that bile flow and biliary excretion of individual lipids and proteins exhibit distinct circadian rhythms that are altered by feeding. Secretory events at the canaliculus that depend on the transmembrane flux of bile acids, such as water and lipid movement or the solubilization of membrane proteins, display a common rhythm.(ABSTRACT TRUNCATED AT 250 WORDS)
Aim: Incarcerated gravid uterus is a rare obstetrical complication that leads to adverse outcomes, especially if the uterus remains incarcerated and the condition goes undiagnosed until delivery. However, there is no consensus regarding the optimal management of this complication because of its rarity. In this study, we aimed to elucidate the incidence of incarcerated gravid uterus, as well as its natural courses and perinatal outcomes. Methods: We retrospectively reviewed medical records of patients who had incarcerated gravid uterus and managed at Osaka City University Hospital between April 2011 and March 2021. Incarcerated gravid uterus was defined as a retroverted or retroflexed uterus after 16 weeks of gestation. Results: There were 14 incarcerated cases among 6958 pregnant women, and 13 of them had some kind of gynecological complication and/or history. Spontaneous resolution of incarcerated gravid uterus after 16 gestational weeks was observed in six cases before the late second trimester and five cases at the late second trimester to early third trimester. Three cases remained incarcerated at term or near-term. One case with adenomyosis had severe abdominal pain, although it was difficult to ascertain whether the cause of pain was triggered by adenomyosis and/or incarceration. One case was misdiagnosed as placenta previa, and the uterine cervix was subsequently injured during cesarean delivery, resulting in massive hemorrhaging. Conclusions: Approximately 1 in 2300 pregnancies continued to be in an incarcerated condition at term or near-term, and 78.5% of cases showed a spontaneous resolution after 16 weeks of gestation. Expectant management with careful attention to the incarcerated gravid uterus may be one option in situations where there are no severe symptoms related to the incarceration itself.
Background Esophageal eosinophilia (EE) is a basal condition of eosinophilic esophageal disorders including eosinophilic esophagitis (EoE) and asymptomatic EE. EoE is considered as an allergic disorder, while it is unclear whether other non-allergic conditions are involved in the pathophysiology of EE. The aim of this study is to investigate the non-allergic risk factors for EE. Methods This cross-sectional study included subjects who underwent esophagogastroduodenoscopy on a medical health checkup. We compared clinical characteristics between subjects with EE (n=27) and those without EE (n=5,937). Results The detection rate of EE was 0.45% (27/5,964 persons). Of 27 subjects with EE, 20 subjects were symptomatic and 7 were asymptomatic. On univariate analysis, subjects with EE significantly had higher body mass index (BMI) compared to those without EE; 23.4 (4.4) vs 22.3 (4.5) kg/m 2 , median (interquartile range), p=0.005. Endoscopic findings revealed that subjects with EE had significantly higher proportion of hiatal hernia (29.6% vs 14.7%; p=0.049). Subjects with EE were significantly younger and had higher proportion of bronchial asthma; 45 (11.5) vs 51 (18) years, p=0.013; 25.9% vs 5.2%, p<0.001, respectively. Multivariate analysis showed that subjects with EE were positively associated with BMI (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.03-1.20; p=0.010) and hiatal hernia (OR, 2.63; 95% CI, 1.12-6.18; p=0.026) compared to those without EE. On trend test, advanced BMI classification had significant trend for increased prevalence of EE (p=0.002). Conclusions Obesity and hiatal hernia may be non-allergic risk factors for EE in Japanese adults.
Background: We aimed to identify clinical characteristics and outcomes for each placental type of vasa previa (VP). Methods: Placental types of vasa previa were defined as follows: Type 1, vasa previa with velamentous cord insertion and non-type 1, vasa previa with a multilobed or succenturiate placenta and vasa previa with vessels branching out from the placental surface and returning to the placental cotyledons. Results: A total of 55 cases of vasa previa were included in this study, with 35 cases of type 1 and 20 cases of non-type 1. Vasa previa with type 1 showed a significantly higher association with assisted reproductive technology, compared with non-type 1 (p = 0.024, 60.0% and 25.0%, respectively). The diagnosis was significantly earlier in the type 1 group than in the non-Type 1 group (p = 0.027, 21.4 weeks and 28.6 weeks, respectively). Moreover, the Ward technique for anterior placentation to avoid injury of the placenta and/or fetal vessels was more frequently required in non-type 1 cases (p < 0.001, 60.0%, compared with 14.3% for type 1). Conclusion: The concept of defining placental types of vasa previa will provide useful information for the screening of this serious complication, improve its clinical management and operative strategy, and achieve more preferable perinatal outcomes.
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