The 'Clinical Guidelines for Obstetrical Practice, 2011 edition' were revised and published as a 2014 edition (in Japanese) in April 2014 by the Japan Society of Obstetrics and Gynecology and the ...Japan Association of Obstetricians and Gynecologists. The aims of this publication include the determination of current standard care practices for pregnant women in Japan, the widespread use of standard care practices, the enhancement of safety in obstetrical practice, the reduction of burdens associated with medico-legal and medico-economical problems, and a better understanding between pregnant women and maternity-service providers. The number of Clinical Questions and Answers items increased from 87 in the 2011 edition to 104 in the 2014 edition. The Japanese 2014 version included a Discussion, a List of References, and some Tables and Figures following the Answers to the 104 Clinical Questions; these additional sections covered common problems and questions encountered in obstetrical practice, helping Japanese readers to achieve a comprehensive understanding. Each answer with a recommendation level of A, B or C was prepared based principally on 'evidence' or a consensus among Japanese obstetricians in situations where 'evidence' was weak or lacking. Answers with a recommendation level of A or B represent current standard care practices in Japan. All 104 Clinical Questions and Answers items, with the omission of the Discussion, List of References, and Tables and Figures, are presented herein to promote a better understanding among English readers of the current standard care practices for pregnant women in Japan.
This study describes a highly sensitive electrochemical immunosensor for the detection of human chorionic gonadotropin (hCG) that uses gold nanoparticles (AuNP) as the electrochemical label and ...graphene as electrode material. The primary antibody was first immobilized on the graphene working electrode surface by physical adsorption. Antigen hCG was then added and sandwiched with a secondary antibody labelled with AuNPs. After this, a series of sandwich-type immunoreactions were performed on the electrode, AuNPs were quantified by subjecting the immunocomplex to a preoxidation process of high potential at 1.2 V for 40 s and immediately reduced and scanned by differential pulse voltammtery (DPV). Electrodeposition of gold during the reduction stage of the redox reaction was determined by cyclic voltammetry (CV) that showed a linear relationship with the different hCG concentrations. In this study, a linear relationship between reduction peak current signals and hCG concentration from 0 to 500 pg mL
−1
(correlation coefficient of 0.97351) with a detection limit of 5 pg mL
−1
was obtained.
This study describes a highly sensitive electrochemical immunosensor for the detection of human chorionic gonadotropin (hCG) that uses gold nanoparticles (AuNP) as the electrochemical label and graphene as electrode material.
To clarify the differences in toxin selectivity between marine and freshwater pufferfish, we conducted experiments in artificially reared nontoxic specimens of
(marine) and
(freshwater) using ...tetrodotoxin (TTX) and paralytic shellfish poison (PSP; decarbamoylsaxitoxin (dcSTX) or saxitoxin (STX)).
specimens were administered feed homogenate containing TTX or dcSTX (dose of toxin, 55.2 nmol/fish) and
specimens were administered feed homogenate containing TTX + STX (dose of each toxin, 19.2 nmol/fish) by oral gavage. The toxin content in the intestine, muscle, skin, liver, and gonads was quantified after 24 and 48 or 72 h. In
, TTX administered into the intestine was absorbed into the body and transferred and retained mainly in the skin and liver, while dcSTX was hardly retained in the body, although it partly remained in the intestine. In strong contrast, in
, little TTX remained in the body, whereas STX was absorbed into the body and was transferred and retained in the ovary and skin. The findings revealed that TTX/PSP selectivity differs between the marine species
and the freshwater species
.
, which naturally harbors TTX, selectively accumulates TTX, and
, which naturally harbors PSP, selectively accumulates PSP.
Examination of the dorsal spinule patch in
Lagocephalus spadiceus
specimens revealed the existence of two intraspecific forms, the “
wheeleri
”-form, characterized by an elliptical patch, and the “
...spadiceus
”-form, with a rhomboidal patch with a continuous or intermittent posterior extension. The forms were not indicative of sexual dimorphism, although the appearance of a posterior extension of the dorsal patch was apparently growth-related. Ontogenetic studies of both forms, including genetic analyses and cross breeding experiments, should be future considerations.
To obtain baseline data for cervical cancer prevention in Japan, we analyzed human papillomavirus (HPV) data from 5045 Japanese women aged less than 40 years and diagnosed with cervical abnormalities ...at 21 hospitals during 2012‐2017. These included cervical intraepithelial neoplasia grade 1 (CIN1, n = 573), CIN2‐3 (n = 3219), adenocarcinoma in situ (AIS, n = 123), and invasive cervical cancer (ICC, n = 1130). The Roche Linear Array was used for HPV genotyping. The HPV type‐specific relative contributions (RCs) were estimated by adding multiple infections to single types in accordance with proportional weighting attributions. Based on the comparison of type‐specific RCs between CIN1 and CIN2‐3/AIS/ICC (CIN2+), RC ratios were calculated to estimate type‐specific risks for progression to CIN2+. Human papillomavirus DNA was detected in 85.5% of CIN1, 95.7% of CIN2‐3/AIS, and 91.2% of ICC. Multiple infections decreased with disease severity: 42.9% in CIN1, 40.4% in CIN2‐3/AIS, and 23.7% in ICC (P < .0001). The relative risk for progression to CIN2+ was highest for HPV16 (RC ratio 3.78, 95% confidence interval CI 3.01‐4.98), followed by HPV31 (2.51, 1.54‐5.24), HPV18 (2.43, 1.59‐4.32), HPV35 (1.56, 0.43‐8.36), HPV33 (1.01, 0.49‐3.31), HPV52 (0.99, 0.76‐1.33), and HPV58 (0.97, 0.75‐1.32). The relative risk of disease progression was 1.87 (95% CI, 1.71‐2.05) for HPV16/18/31/33/35/45/52/58, but only 0.17 (95% CI, 0.14‐0.22) for HPV39/51/56/59/66/68. Human papillomavirus 16/18/31/33/45/52/58/6/11 included in a 9‐valent vaccine contributed to 89.7% (95% CI, 88.7‐90.7) of CIN2‐3/AIS and 93.8% (95% CI, 92.4‐95.3) of ICC. In conclusion, our data support the Japanese guidelines that recommend discriminating HPV16/18/31/33/35/45/52/58 genotypes for CIN management. The 9‐valent vaccine is estimated to provide over 90% protection against ICC in young Japanese women.
We updated HPV type‐specific risks of and contributions to cervical cancer and precancer in Japan, using a large dataset from young Japanese women with cervical abnormalities. The relative risk for progression to cervical cancer and precancer was the highest for HPV16, followed by HPV31, HPV18, HPV35, HPV33, HPV52 and HPV58. The new 9‐valent vaccine is estimated to provide over 90% protection against invasive cervical cancer among Japanese women up to an age of 40 years.
The fourth edition of the Japan Society of Gynecologic Oncology guidelines for the treatment of ovarian cancer including primary peritoneal cancer and fallopian tube cancer was published in 2015. The ...guidelines contain seven chapters and six flow charts. The major changes in this new edition are as follows—(1) the format has been changed from reviews to clinical questions (CQ), and the guidelines for optimal clinical practice in Japan are now shown as 41 CQs and answers; (2) the ‘flow charts’ have been improved and placed near the beginning of the guidelines; (3) the ‘basic points’, including tumor staging, histological classification, surgical procedures, chemotherapy, and palliative care, are described before the chapter; (4) the FIGO surgical staging of ovarian cancer, fallopian tube cancer, and primary peritoneal cancer was revised in 2014 and the guideline has been revised accordingly to take the updated version of this classification into account; (5) the procedures for examination and management of hereditary breast and ovarian cancer are described; (6) information on molecular targeting therapy has been added; (7) guidelines for the treatment of recurrent cancer based on tumor markers alone are described, as well as guidelines for providing hormone replacement therapy after treatment.
The Japanese government began a human papillomavirus (HPV) vaccination program for girls aged 12‐16 years in 2010 but withdrew its recommendation in 2013 because of potential adverse effects, leading ...to drastically reduced vaccination uptake. To evaluate population‐level effects of HPV vaccination, women younger than 40 years of age newly diagnosed with cervical intraepithelial neoplasia grade 1‐3 (CIN1‐3), adenocarcinoma in situ (AIS), or invasive cervical cancer (ICC) have been registered at 21 participating institutes each year since 2012. A total of 7709 women were registered during 2012‐2017, of which 5045 were HPV genotyped. Declining trends in prevalence of vaccine types HPV16 and HPV18 during a 6‐year period were observed in CIN1 (50.0% to 0.0%, Ptrend < .0001) and CIN2‐3/AIS (83.3% to 45.0%, Ptrend = .07) only among women younger than 25 years of age. Overall, HPV vaccination reduced the proportion of HPV16/18‐attributable CIN2‐3/AIS from 47.7% to 33.0% (P = .003): from 43.5% to 12.5% as routine vaccination (P = .08) and from 47.8% to 36.7% as catch‐up vaccination (P = .04). The HPV16/18 prevalence in CIN2‐3/AIS cases was significantly reduced among female individuals who received their first vaccination at age 20 years or younger (P = .02). We could not evaluate vaccination effects on ICC owing to low incidence of ICC among women aged less than 25 years. We found HPV vaccination to be effective in protecting against HPV16/18‐positive CIN/AIS in Japan; however, our data did not support catch‐up vaccination for women older than 20 years. Older adolescents who skipped routine vaccination due to the government’s suspension of its vaccine recommendation could benefit from receiving catch‐up vaccination before age 20 years.
We found human papillomavirus (HPV) vaccination to be effective in protecting against HPV16/18‐positive cervical intraepithelial neoplasia (CIN)/adenocarcinoma in situ (AIS) in Japan. Over the 6‐year period of analysis, we found declining prevalence among women aged less than 25 years of HPV16 and HPV18 in CIN1 and CIN2‐3/AIS. The prevalence of HPV/16/18 in CIN2‐3/AIS was also lower overall for both national and catch‐up vaccination, and this was significant in women who were first vaccinated at age 20 years or younger. Our data did not support the effectiveness of catch‐up vaccination in women over age 20 years.
SERS‐active screen‐printed electrodes (SPEs) are extensively applied for electrochemical SERS biosensors with the advantages of portable, inexpensive cost, fast measurement, and sensitive detection. ...In our work, a useful fabrication method of sputtering deposition for SERS‐active SPEs was proposed. Two kinds of working electrodes of SPE which were carbon electrode and gold electrode were successfully deposited by silver nanoparticles. Besides, the sputtering experiments of different substrates (paper, glass epoxy and polyethylene terephthalate) of the SPE were also conducted. The comparison of SERS enhancement of rhodamine 6G (R6G) on different kinds of SERS‐active SPEs was introduced. In addition, the relationship between the surface roughness and SERS enhancement has been investigated. The enhancement factor (EF) of Ag/carbon and Ag/gold electrode were estimated as 2.8×105 and 2.2×107, respectively. From the SERS experiments, the lower background noise of SERS signals could be observed through sputtering deposition method compared with the citrate reduction method. Furthermore, spectro‐electrochemical analysis of uric acid was studied. The SERS signals were strongly increased upon the modulation of the applied voltage. These results demonstrated the applicability of this mass producible fabrication method for producing SERS‐active SPEs, as well as, highlighting the future potential of commercial bio‐applications.
To assess the efficacy of fertility-sparing treatment using medroxyprogesterone acetate (MPA) for endometrial carcinoma (EC) and atypical endometrial hyperplasia (AH) in young women.
This multicenter ...prospective study was carried out at 16 institutions in Japan. Twenty-eight patients having EC at presumed stage IA and 17 patients with AH at younger than 40 years of age were enrolled. All patients were given a daily oral dose of 600 mg of MPA with low-dose aspirin. This treatment continued for 26 weeks, as long as the patients responded. Histologic change of endometrial tissue was assessed at 8 and 16 weeks of treatment. Either estrogen-progestin therapy or fertility treatment was provided for the responders after MPA therapy. The primary end point was a pathologic complete response (CR) rate. Toxicity, pregnancy rate, and progression-free interval were secondary end points.
CR was found in 55% of EC cases and 82% of AH cases. The overall CR rate was 67%. Neither therapeutic death nor irreversible toxicities were observed; however, two patients had grade 3 body weight gain, and one patient had grade 3 liver dysfunction. During the 3-year follow-up period, 12 pregnancies and seven normal deliveries were achieved after MPA therapy. Fourteen recurrences were found in 30 patients (47%) between 7 and 36 months.
The efficacy of fertility-sparing treatment with a high-dose of MPA for EC and AH was proven by this prospective trial. Even in responders, however, close follow-up is required because of the substantial rate of recurrence.
The third version of the Japan Society of Gynecologic Oncology guidelines for the treatment of uterine body neoplasms was published in 2013. The guidelines comprise nine chapters and nine algorithms. ...Each chapter includes a clinical question, recommendations, background, objectives, explanations, and references. This revision was intended to collect up-to-date international evidence. The highlights of this revision are to (1) newly specify costs and conflicts of interest; (2) describe the clinical significance of pelvic lymph node dissection and para-aortic lymphadenectomy, including variant histologic types; (3) describe more clearly the indications for laparoscopic surgery as the standard treatment; (4) provide guidelines for post-treatment hormone replacement therapy; (5) clearly differentiate treatment of advanced or recurrent cancer between the initial treatment and the treatment carried out after the primary operation; (6) collectively describe fertility-sparing therapy for both atypical endometrial hyperplasia and endometrioid adenocarcinoma (corresponding to G1) and newly describe relapse therapy after fertility-preserving treatment; and (7) newly describe the treatment of trophoblastic disease. Overall, the objective of these guidelines is to clearly delineate the standard of care for uterine body neoplasms in Japan with the goal of ensuring a high standard of care for all Japanese women diagnosed with uterine body neoplasms.
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