CONTEXT: Japan's maternal mortality rate is higher than that of other developed countries. OBJECTIVES: To identify causes of maternal mortality in Japan, examine attributes of treating facilities associated with maternal mortality, and assess the preventability of such deaths. DESIGN AND SETTING: Cross-sectional study of maternal deaths occurring in Japan between January 1, 1991, and December 31, 1992. SUBJECTS: Of 230 women who died while pregnant or within 42 days of being pregnant, 197 died in a hospital and had medical records available, 22 died outside of a medical facility, and 11 did not have records available. MAIN OUTCOME MEASURES: Maternal mortality rates per 100,000 live births by cause (identified by death certificate review and information from treating physicians or coroners); resources and staffing patterns of facilities where deaths occurred; and preventability of death, as determined by a 42-member panel of medical specialists. RESULTS: Overall maternal mortality was 9.5 per 100,000 births. Hemorrhage was the most common cause of death, occurring in 86 (39%) of 219 women. Seventy-two (37%) of 197 deaths occurring in facilities were deemed preventable and another 32 (16%) possibly preventable. Among deaths that occurred in a medical facility with an obstetrician on duty, the highest rate of preventable deaths (4.09/100,000 live births) occurred in facilities with 1 obstetrician. Among the 72 preventable deaths, 49 were attributed to 1 physician functioning as the obstetrician and anesthetist. While the unpreventable maternal death rate was highest in referral facilities, the preventable maternal death rate was 14 times lower in referral facilities than in transferring facilities. CONCLUSIONS: Inadequate obstetric services are associated with maternal mortality in Japan. Reducing single-obstetrician only delivery patterns and establishing regional 24-hour inpatient obstetrics facilities for high-risk cases may reduce maternal mortality in Japan. JAMA. 2000;283:2661-2667.

Adolescent↗

PubMedDate not supplied

Endothelium-dependent relaxant action of platelet activating factor in the rat mesenteric artery.

Vasorelaxant action of platelet activating factor (PAF) was examined in perfused mesenteric vascular beds and mesenteric artery strips isolated from rats. PAF caused a dose-dependent vasodilation of norepinephrine-contracted mesenteric vascular bed, which was sensitive to CV-3988, a PAF antagonist, but insensitive to tetrodotoxin, atropine, propranolol and indomethacin. PAF also caused a relaxation of phenylephrine-contracted mesenteric artery strips at above 3 X 10(-12) M. Much higher concentrations of PAF were required to relax the aorta, carotid and pulmonary arteries. The PAF- and acetylcholine (ACh)-induced relaxations of mesenteric artery were dependent on the presence of endothelium and were inhibited by either hydroquinone and methylene blue, which inhibit the action of endothelium-derived relaxing factor (EDRF), or L-canavanine, which inhibits the formation of nitric oxide from L-arginine. Phospholipase A2 inhibitors such as quinacrine and ONO-RS-082 abolished the relaxation induced by ACh but did not affect that by PAF. Thus, PAF induces a vasorelaxation by releasing EDRF from endothelial cells as ACh does, although the pathway to produce the substances by PAF may be different from that by ACh.

Acetylcholine↗

PubMedDate not supplied

Changes in venous flow and intra tracheal flow in fetal breathing movements.

Using pulsed Doppler ultrasound combined with a real-time B-mode image, changes in the central venous blood flow and tracheal fluid flow were recognized during fetal breathing movements. The blood flow in the umbilical vein was increased with fetal inspiration in which the abdominal wall of fetus moved inward, and decreased with expiration in which the abdominal wall moved outward. Velocity in the fetal vena cava revealed a complex blood flow, in accordance with both fetal cardiac motions and breathing movements. The tracheal flow velocity during fetal breathing was measured at a maximum of 40 cm s-1 and the flow volume was estimated at a maximum of 6 ml breath-1 in the matured fetus.

Blood Flow Velocity↗

PubMedDate not supplied

Glomerular charge selectivity in non-insulin-dependent diabetes mellitus.

To elucidate the stage of the charge selectivity defect in diabetic nephropathy, urinary excretions of IgG1 and IgG4 were measured in patients with non-insulin-dependent diabetes mellitus (NIDDM) and healthy controls. The molecular weights of IgG1 and IgG4 were the same but their isoelectric points were different. Therefore, by measuring both urinary IgG1 and IgG4 excretions, the stage of charge selectivity impairment in the nephropathy of NIDDM may be elucidated. Results were expressed as urinary excretion rate (IgG1 ER, IgG4 ER) and compared between diabetic patients with different urinary excretion rates of albumin (AER). IgG4 ER increased to the stage in which AER was more than 10 micrograms/min, whereas IgG1 ER did not increase to the stage of AER between 10 and 100 micrograms/min. This finding suggests that the charge selectivity defect in the kidney of the NIDDM patient is present at the stage when AER is more than 10 micrograms/min.

Albuminuria↗

PubMedDate not supplied

Acute loading with proteins from different sources in healthy volunteers and diabetic patients.

To evaluate the effects of protein loading on glomerular filtration rate (GFR), urinary excretion rate of albumin (AER), and plasma concentration of amino acids, 10 healthy volunteers and six diabetics were studied before and after eating tuna fish, egg white, cheese, or tofu. Furthermore, to study the possible role of glucagon, growth hormone (GH), atrial natriuretic peptide (ANP), or kallikrein in the responses of GFR, these substances were measured before and after protein loading. GFR increased significantly (p less than .001) after ingestion of tuna fish. No significant differences were seen between the GFR before and that after ingestion of the other foods. AER was unchanged following protein loading. Plasma concentrations of alanine, glycine, and arginine increased to a greater degree after ingestion of tuna fish than after digestion of the other foods. This result suggests that the response of GFR after protein loading may differ from one protein to another, and that these responses may not be directly mediated by glucagon, GH, ANP, or kallikrein.

Adult↗

PubMedDate not supplied

Hypercalciuria and hematuria in non-insulin-dependent diabetes mellitus.

This study was undertaken to examine whether patients with non-insulin-dependent diabetes (NIDDM) are hypercalciuric and whether there is a pathophysiologic relationship between urinary calcium excretion (UCE) and the degree of diabetic nephropathy. Although UCE did not parallel the increase of urinary albumin excretion rate (AER) and the presence of hematuria was not corrected with the degree of UCE, we confirmed that 36% of diabetic patients have hypercalciuria and that the prevalence of hypercalciuria is more frequent in diabetic patients with normo- or microalbuminuria than in the controls. In 6 months, the AER of two hypercalciuric patients increased. However, the blood pressure and HbA1c of these two patients increased during the same 6 months. Therefore, it remains unclear whether hypercalciuria induced an increase in the AER of these patients.

Albuminuria↗

PubMedDate not supplied

Elevated nitric oxide synthase activity concurrent with antigen-induced airway hyperresponsiveness in rats.

To characterize the airway nitric oxide synthase (NOS) activities concurrent with airway hyperresponsiveness (AHR), a common feature of allergic asthma, the NOS activities of airway tissue homogenates from the antigen-induced AHR rats were determined by the ability of tissue homogenates to convert L-arginine to L-citrulline (Cit). A significantly higher level of total NOS activities was found in homogenates from the AHR rats (19.9 +/- 1.3 pmol Cit/min/mg protein) compared to those from sensitized control and normal control groups (9.8 +/- 1.2 and 8.8 +/- 1.2 pmol Cit/min/mg protein, respectively; P < .01). The nitrite concentration in bronchoalveolar lavage fluids, which indicates the in vivo generation of NO in airways, from the AHR rats (7.40 +/- 0.71 microM) was significantly greater than that from nonsensitized normal animals (1.45 +/- 1.12 microM, P < .01). Although the protein levels of endothelial (eNOS) and neuronal type NOS (nNOS) determined by immunoblotting were within normal levels, the amount of inducible NOS (iNOS) protein was markedly and significantly elevated in airway tissue homogenates from the AHR rats. Immunohistochemical staining of airway tissues with specific antibody against iNOS demonstrated a distinct localization of iNOS on epithelial cells and infiltrated inflammatory cells in the bronchi of the hyperresponsive rats, but only negligible staining of epithelia was observed in the nonsensitized normal group. No difference in constitutive NOS (eNOS and nNOS) localization was observed between groups. The present findings indicate that the NOS activities in airway tissues are elevated in antigen-induced AHR rats, which is mainly derived from the induction of iNOS in the airways. Downregulation of constitutive eNOS and nNOS is not found in this animal model of AHR.

Airway Obstruction↗