Current status and future prospects of the Japanese orthopaedic association national registry (JOANR), Japan's first national registry of orthopaedic surgery.

The Japanese Orthopaedic Association National Registry (JOANR) is Japan's first national registry of orthopaedic surgery, which has been developed after having been selected for the Project for Developing a Database of Clinical Outcome approved by the Health Policy Bureau of the Ministry of Health, Labour and Welfare. Its architecture has two levels of registration, one being the basic items of surgical procedure, disease, information on surgeons, surgery-related information, and outcome, and the other being detailed items in the affiliated registries of partner medical associations. It has a number of features, including the facts that, because it handles medical data, which constitute special care-required personal information, data processing is conducted entirely in a cloud environment with the imposition of high-level data security measures; registration of the implant data required to assess implant performance has been automated via a bar code reader app; and the system structure enables flexible collaboration with the registries of partner associations.

The enhancement of CCL2 and CCL5 by human bone marrow-derived mesenchymal stem/stromal cells might contribute to inflammatory suppression and axonal extension after spinal cord injury.

Human bone marrow-derived mesenchymal stem/stromal cells (hMSCs) have shown potential in facilitating recovery from spinal cord injury (SCI) through communicating with microglia/macrophages (MG/MΦ). We here focused on chemokines as a candidate for the communication. Selected MG/MΦ-related chemokines were determined gene expression after SCI and further focused CCL2/CCR2 and CCL5/CCR5 to estimate role of the chemokines by hMSCs.

Pituitary adenylate cyclase-activating polypeptide (PACAP) contributes to the proliferation of hematopoietic progenitor cells in murine bone marrow via PACAP-specific receptor.

Pituitary adenylate cyclase-activating polypeptide (PACAP, encoded by adcyap1) plays an important role in ectodermal development. However, the involvement of PACAP in the development of other germ layers is still unclear. This study assessed the expression of a PACAP-specific receptor (PAC1) gene and protein in mouse bone marrow (BM).

Human mesenchymal stem/stromal cells suppress spinal inflammation in mice with contribution of pituitary adenylate cyclase-activating polypeptide (PACAP).

Background: Adult human mesenchymal stem/stromal cells (hMSCs) from bone marrow have been reported to exhibit beneficial effects on spinal cord injury (SCI). A neuropeptide, pituitary adenylate cyclase-activating polypeptide (PACAP) is known to decrease neuronal cell death and inflammatory response after ischemia, SCI, and other neuronal disorders. Recently, we found that expression of the gene for mouse PACAP (Adcyap1) was greater in animals receiving hMSCs with neural injury such as ischemia.

The anti-inflammatory property of human bone marrow-derived mesenchymal stem/stromal cells is preserved in late-passage cultures.

Human mesenchymal stem/stromal cells (hMSCs) have been reported to improve neural damage via anti-inflammation and multi-differentiation abilities. Here, we investigated immunosuppression effects of hMSCs by mixed-culturing with interferon-γ (IFNγ) stimulated BV-2 mouse microglial cells. We show that hMSCs decreased nitrite oxide (NO) production from BV-2 cells in cell density dependent manner.

Establishment and characterization of primary adult microglial culture in mice.

Microglial cells account for approximately 12-15 % of the cells in the central nervous system (CNS). Microglial cells are polarized by pathological stimuli such as cytokines, chemokines, and growth factors, and play important roles in the deterioration and repair of the CNS. Here, we established cultures of primary microglial cells isolated from the brains of adult C57/BL6 mice using Percoll density gradients.

Perinatal outcomes of low-risk planned home and hospital births under midwife-led care in Japan.

Aim: It has not been extensively studied whether planned home and planned hospital births under primary midwife-led care increase risk of adverse events among low-risk women in Japan.

Methods: A retrospective cohort study was performed to compare perinatal outcome between 291 women who were given primary midwife-led care during labor and 217 women who were given standard obstetric shared care. Among 291 women with primary midwife-led care, 168 and 123 chose home deliver and hospital delivery, respectively.

Perinatal outcomes of failed vacuum extraction.

The aims of this study were to compare the perinatal outcomes of successful vacuum extraction (VE) or failed VE and to compare the perinatal outcomes of failed VE followed by forceps delivery (FD) or Cesarean section (CS) from 2000 through 2007. Compared with cases of successful VE, cases of failed VE followed by CS had a significantly higher incidence of neonatal complications, whereas cases of failed VE followed by FD had a significantly higher incidence of maternal injury. Both CS and FD remain important yet distinct treatments for emergency cases of failed VE.

Risk factors for postpartum hemorrhage requiring transfusion in cesarean deliveries for Japanese twins: comparison with those for singletons.

Objective: The aim of this study was to identify the factors associated with the increased risk of postpartum hemorrhage requiring transfusion in Japanese twin pregnancies in comparison with those in Japanese singleton pregnancies.

Methods: We reviewed the obstetric records of all singleton and twin deliveries after 22 weeks' gestation at the Japanese Red Cross Katsushika Maternity Hospital from 2003 through 2011. Potential risk factors for transfusion due to hemorrhage after cesarean delivery were selected according to previous studies of postpartum hemorrhage or transfusion or both after delivery: maternal age, parity, previous cesarean deliveries, history of infertility therapies such as in vitro fertilization, gestational age at delivery, neonatal birth weight, placenta previa, uterine myoma≥6 cm, hypertensive disorders, placental abruption, emergency cesarean deliveries and general anesthesia.

Birth before arrival at a hospital in eastern Tokyo, Japan.

Delivery before arrival at a hospital did not cause major perinatal complications; however, it may reflect a serious problem of perinatal medicine in eastern Tokyo, Japan.

The hospitalization assistance policy system in Japan.

In Japan, the hospitalization assistance policy (HAP) system helps pregnant women who, for financial reasons, cannot give birth at medical institutions. The HAP system allows these women to deliver at specified midwifery institutions. We compared women with singleton pregnancies who gave birth with the HAP system (n=150) or without (control; n=2,869) .

Does the use of labor-inducing drugs cause adverse perinatal outcomes?

There have been several studies of adverse perinatal outcomes associated with the indiscriminate use of labor-inducing drugs. However, the present results indicate that the appropriate use of labor-inducing drugs is not unsafe and improves neonatal outcomes in abnormal deliveries.

A case of tumor lysis syndrome following chemotherapy for a uterine epithelioid leiomyosarcoma with focal rhabdomyosarcomatous differentiation.

Tumor lysis syndrome (TLS) is a potential complication characterized by hyperuricemia, hyperphosphatemia, hyperkalemia and hypocalcemia due to massive necrosis of malignant cells after cytotoxic therapy. This fatal complication occurs frequently in tumors with hematological malignancies, such as acute lymphoblastic leukemia and Burkitt's lymphoma, and in other tumors with high proliferative rates and tumor burdens. TLS is rarely associated with the treatment of solid tumors.

Midwife-led care unit for 'low risk' pregnant women in a Japanese hospital.

Objectives: To examine the obstetric outcomes of our 'low risk' pregnant women under the midwife-led delivery care compared with those under the obstetric shared care.

Methods: A retrospective cohort study compared outcomes of labor under midwife 'primary' care with those under obstetric shared care. The factors examined were: maternal age, parity, gestational age at delivery, length of labor, augmentation of labor pains, delivery mode, episiotomy, perineal laceration, postpartum hemorrhage, neonatal birth weight, Apgar score, and umbilical artery pH.

Maternal risk factors for small-for-gestational age newborns in Japanese dichorionic twins.

Aim: To investigate the maternal risk factors for small-for-gestational age (SGA) newborns in Japanese dichorionic (DC) twins.

Methods: A retrospective study was conducted from 2003 to 2008 on 340 DC twin pregnancies resulting in two live births. Newborns were classified as SGA if their birth weight was below the 10th percentile according to Japanese singleton norms.

Time of delivery and perinatal outcome.

The purpose of this study was to examine the association between time of delivery and perinatal outcomes in singleton deliveries at Japanese Red Cross Katsushika Maternity Hospital. We performed a retrospective cohort study of all singleton deliveries at ≥ 22 weeks' gestation from 2002 through 2009 at our hospital. During the nighttime period (12 midnight to 8 am), although the rate of delivery of high-risk pregnancies was low, the rate of low umbilical artery pH (< 7) was higher than that during the daytime periods (8 am to 4 pm) (odds ratio 1.

Clinical significance of singleton pregnancies complicated by placental abruption associated with histological chorioamnionitis.

The aim of this study was to determine the perinatal outcomes of placental abruption associated with the presence of histological chorioamnionitis. We reviewed the obstetric records of 96 singleton deliveries complicated by placental abruption after 22 weeks' gestation. Of these 96 cases, 37 cases (39%) were diagnosed as having histological chorioamnionitis in the placenta.

Increased rate of elective cesarean delivery and neonatal respiratory disorders in twin pregnancies.

We examined whether the incidence of neonatal respiratory disorders has increased with the increased rate of elective cesarean delivery in twin pregnancies. We reviewed the obstetric records of 292 twin deliveries with vertex presentation of the first twin after 37 weeks' gestation at our hospital from 2000 through 2008. The study period was divided into 3 parts as follows: period 1: 2000 through 2002 (n=76); period 2: 2003 through 2005 (n=104); and period 3: 2006 through 2008 (n=112).

Clinical significance of singleton pregnancies complicated by placental abruption occurred at preterm compared with those occurred at term.

Objective: This study investigated the clinical significance of placental abruption occurred at preterm compared with those that occurred at term.

Methods: We reviewed the obstetric records of 102 singleton deliveries complicated by placental abruption after 22 weeks of gestation. The χ(2) test for categorical variables was used and differences with p < 0.