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• Shift from Support of Female Doctors to Reform of Work Styles : Will Promoting Diversity Change Organizations?

  Mekaru K.

  Nihon Kikan Shokudoka Gakkai Kaiho ( The Japan Broncho-esophagological Society )  74 ( 2 ) 173 - 175   2023.04

  Type of publication: Research paper (scientific journal)

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• Vaginal Microbiota and Pregnancy Outcomes of Patients with Conization Histories.

  Hashiramoto S, Kinjo T, Tanaka SE, Arai W, Shimada M, Ashikawa K, Sakuraba Y, Yuji O, Yara N, Kinjyo Y, Chinen Y, Nagai Y, Mekaru K, Aoki Y

  Journal of women's health (2002) ( Journal of Women's Health )  32 ( 3 ) 375 - 384   2023.03 [ Peer Review Accepted ]

  Type of publication: Research paper (scientific journal)

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  Background: One of the major risks of preterm birth is a history of conization. However, the risk of infection due to this procedure is still not well known. Using next-generation sequencing, we aimed to reveal the influence of conization on vaginal microbiota in the following pregnancy, and their relationship between spontaneous preterm birth (sPTB). Methods: We conducted a prospective cohort study including 133 pregnant patients, of whom 25 had conization histories and 108 did not. Vaginal microbiome samples were collected using swabs by an obstetrician upon inclusion in the first trimester and during delivery. V1-V2 of the 16S rRNA gene were amplified and analyzed to identify the bacteria. Results: The conization group had a significantly lower delivery week (34 weeks vs. 36 weeks, p = 0.003) and higher sPTB rate (64% vs. 8.3%, p ≤ 0.001) than the control group. In the conization group, alpha (Chao 1, p = 0.02; phylogenetic diversity whole tree, p = 0.04) and beta diversity (permutational multivariate analysis of variance test, p = 0.04) of the vaginal microbiota was significantly higher during delivery in patients who delivered preterm than in those who delivered term. Community-state type IV in the first trimester was significantly associated with sPTB (overall odds ratio 3.80, 95% confidence interval 1.33-10.8, p = 0.01). Conclusions: Conization is a risk factor for sPTB. Increased risk of sPTB in patients after conization may belong to the vulnerable defense mechanism, due to the shortened cervix and decreased cervical mucus.

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• Risk Factors of Preterm Birth in Okinawa Prefecture, the Southernmost Island Prefecture of Japan.

  Kinjyo Y, Kinjo T, Mekaru K, Nagai Y, Moromizato T, Ohata T, Iseki C, Iseki K, Aoki Y

  Maternal and child health journal ( Maternal and Child Health Journal )  27 ( 1 ) 92 - 100   2023.01 [ Peer Review Accepted ]

  Type of publication: Research paper (scientific journal)

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  OBJECTIVES: A high rate of preterm birth has been reported in Okinawa Prefecture, the southernmost island prefecture of Japan. Hence, this study aimed to identify the risk factors for preterm birth in this prefecture. METHODS: This retrospective study included data from January 2013 to December 2019 from three facilities in Okinawa Prefecture. Of 13,468 cases of preterm birth at ≥ 22 weeks of gestation, 11,868 were included in this study. Stillbirth and multiparity cases were excluded. First, we compared the overall preterm and full-term birth groups by categorizing the patient background, obstetric, and fetal risk factors. Further, we categorized preterm births into three groups (22-27, 28-33, and 34-36 weeks of gestation) and examined patient background factors to identify potential risk factors for the occurrence of preterm birth in each group. RESULTS: Preterm births accounted for 21.2% (2,521 cases) of all cases, with the rates of 2.6% (317 cases), 6.7% (800 cases), and 11.8% (1,404 cases) at 22-27, 28-33, and 34-36 weeks of gestation, respectively. To prevent preterm birth in Okinawa Prefecture, the present study specifically focused on patient background characteristics. In the multinomial logistic regression, the risk factors for preterm birth at 22-27 weeks of gestation were previous preterm birth (P < 0.0001) and lower age (P = 0.026); at 28-33 weeks of gestation, the risk factors were previous preterm birth (P < 0.0001) and history of cervical conization (P = 0.009); and at 34-36 weeks of gestation, only previous preterm birth (P < 0.0001) was a risk factor. CONCLUSIONS FOR PRACTICE: Previous preterm birth, younger age, and history of cervical conization were risk factors for Preterm birth in Okinawa. To reduce premature births in Okinawa Prefecture, it is important to pick up women with these risk factors and provide them with appropriate guidance and education on an ongoing basis.

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• Endometrial and vaginal microbiomes influence assisted reproductive technology outcomes.

  Miyagi M, Mekaru K, Tanaka SE, Arai W, Ashikawa K, Sakuraba Y, Nakamura R, Oishi S, Akamine K, Aoki Y

  JBRA assisted reproduction     2022.12 [ Peer Review Accepted ]

  Type of publication: Research paper (scientific journal)

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  OBJECTIVE: The role of Lactobacillus-dominant microbiota in the endometrium in reproductive function is unclear. We therefore aimed to explore the impact of the balance of Lactobacillus and pathological bacteria in the endometrial and vaginal microbiomes on the pregnancy outcomes of women treated with assisted reproductive technology (ART). METHODS: This study included 35 women with infertility submitted to good-quality embryo transfers. The cutoff values for abundance of Lactobacillus species (spp.) and pathological bacteria in the endometrium and vagina were calculated. Women with Lactobacillus spp. and pathological bacteria abundance above the cutoff values were categorized in the high-abundance group, whereas those with abundance below cutoff values were categorized in the low abundance group. We divided the patients into four groups based on the combination of high/low abundance of Lactobacillus spp. and pathological bacteria. RESULTS: The 35 cases of good-quality embryo transfer resulted in 21 pregnancies. Pregnant women were present in significantly higher proportions in the high Lactobacillus spp. abundance and low pathological bacteria abundance group, whereas the opposite combination (i.e., low Lactobacillus spp. abundance and high pathological bacteria abundance) saw a significantly higher proportion of nonpregnant women (p=0.022). CONCLUSIONS: The balance between Lactobacillus and pathological bacterial abundance in the endometrial and vaginal microbiomes is associated with pregnancy from ART.

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• Low-set umbilicus in a pregnant woman with bladder pseudoexstrophy: A case report.

  Taira Y, Yara N, Kinjo Y, Kinjo T, Mekaru K, Aoki Y

  Case reports in women's health ( Case Reports in Women's Health )  36   e00467   2022.10 [ Peer Review Accepted ]

  Type of publication: Research paper (other science council materials etc.)

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  Bladder pseudoexstrophy is a rare form of bladder exstrophy. Bladder exstrophy occurs in 1 in every 30,000 to 50,000 live births. Because bladder pseudoexstrophy is asymptomatic, it may be undiagnosed even in adulthood. A 31-year-old woman with uterus bicornis unicollis and a low-set umbilicus underwent emergency cesarean delivery during the 37th week of pregnancy for chorioamnionitis. Perioperatively, asymptomatic anatomical abnormalities were identified, which included separated rectus abdominis muscles and diastasis of the symphysis pubis. The urinary tract was normal. The patient was diagnosed with bladder pseudoexstrophy. A low-set umbilicus may be a potential marker for the diagnosis of bladder pseudoextrophy.

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• Effects of polyunsaturated fatty acids on fertilization and embryonic development

  Grant-in-Aid for Scientific Research(C)

  Project Year: 2016.04  -  2020.03 

  Investigator(s): Mekaru Keiko 

  Direct: 3,600,000 (YEN)  Overheads: 4,680,000 (YEN)  Total: 1,080,000 (YEN)

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  Objective is to clarify the concentration of polyunsaturated fatty acids (PUFAs) in the follicular fluid affect fertilization and the quality of embryos. A prospective study was conducted on 28 women eligible for in-vitro fertilization and embryo transfer between August 2016 and December 2017. Twenty-eight serum and 140 follicle fluid samples were collected and analysed. PUFAs fractions from the serum and follicular fluid were analysed using gas chromatography. Two milliliters of follicular fluid was collected from six consecutive follicles of each patient. Each individual follicle was aspirated independently and matched to an oocyte gr owing in this particular follicular milieu. Certain PUFAs showed significantly higher or lower levels depending on fertilization. There was no significant difference in the concentration of PUFAS in the follicular fluid between good and poor quality blastocyst. The concentration of PUFAs in the follicular fluid plays an important role in fertilization.

• Effects of polyunsaturated fatty acids on fertilization and embryonic development

  Grant-in-Aid for Scientific Research(C)

  Project Year: 2016.04  -  2020.03 

  Investigator(s): Mekaru Keiko 

  Direct: 3,600,000 (YEN)  Overheads: 4,680,000 (YEN)  Total: 1,080,000 (YEN)

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  Objective is to clarify the concentration of polyunsaturated fatty acids (PUFAs) in the follicular fluid affect fertilization and the quality of embryos. A prospective study was conducted on 28 women eligible for in-vitro fertilization and embryo transfer between August 2016 and December 2017. Twenty-eight serum and 140 follicle fluid samples were collected and analysed. PUFAs fractions from the serum and follicular fluid were analysed using gas chromatography. Two milliliters of follicular fluid was collected from six consecutive follicles of each patient. Each individual follicle was aspirated independently and matched to an oocyte gr owing in this particular follicular milieu. Certain PUFAs showed significantly higher or lower levels depending on fertilization. There was no significant difference in the concentration of PUFAS in the follicular fluid between good and poor quality blastocyst. The concentration of PUFAs in the follicular fluid plays an important role in fertilization.

• Grant-in-Aid for Scientific Research(C)

  Project Year: 2016.04  -  2019.03 

  Direct: 3,600,000 (YEN)  Overheads: 1,080,000 (YEN)  Total: 4,680,000 (YEN)

• Grant-in-Aid for Young Scientists(B)

  Project Year: 2013.04  -  2016.03 

  Direct: 2,900,000 (YEN)  Overheads: 870,000 (YEN)  Total: 3,770,000 (YEN)

• Fatty Acid Concentration of Human Follicular Fluid and Fertilization Rate in Assisted Reproductive Techniques

  Grant-in-Aid for Young Scientists(B)

  Project Year: 2013.04  -  2016.03 

  Investigator(s): MEKARU Keiko, CHIAKI Heshiki, KOZUE Akamine, HITOSHI Sugiyama, CHINATSU Nagata, KEIYA Gibo 

  Direct: 2,900,000 (YEN)  Overheads: 3,770,000 (YEN)  Total: 870,000 (YEN)

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  Polyunsaturated fatty acids(PUFA) are essential fatty acids that are utilized as an energy source for oocyte nuclear maturation to embryonic development; therefore, their concentrations in follicular fluid may be used as an indicator for determining the quality of eggs and embryos. The aim of this study was to clarify the relationship between fertility and embryonic quality and the concentration of each polyunsaturated fatty acid in follicular fluid using in vitro fertilization and embryo transfer (IVF-ET) procedure. Polyunsaturated fatty acid fractions (17 fatty acids) from the serum and follicular fluid during ovulation were analyzed using the gas chromatography method. n-3 polyunsaturated fatty acid / n-6 polyunsaturated fatty acid ratio indicates a positive correlation with fertility, it is suggested that eating fish, including EPA and DHA is related to fertilization.

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