Abstract Study question Does a novel micro-insemination method, assisted sperm fusion insemination (ASFI), improve fertilization and embryonic development compared to conventional intracytoplasmic sperm injection (C-ICSI)? Summary answer ASFI showed comparable fertilization and blastocyst formation rates to C-ICSI, while achieving significantly higher embryo utilization rates. Furthermore, there were no degenerated oocytes after ASFI. What is known already We have reported that ASFI yielded fertilization and blastocyst rates similar to those obtained with rescue ICSI performed at 6 hours after in vitro fertilization (IVF). In ASFI, fertilization is achieved by pressing a zona pellucida (ZP)-bound sperm onto the oocyte membrane without breaking the oocyte membrane. However, there was a risk of artificial polyspermy because the sperm were pressed against the unfertilized oocytes after IVF. Moreover, it is uncertain whether fertilization occurred with sperm that penetrated into the oocyte via IVF or that were pressed against the oocyte membrane. Clarifying this requires performing ASFI of the oocyte without IVF. Study design, size, duration We prospectively evaluated the effectiveness of ASFI in a sibling oocyte study including 14 subjects from which at least two metaphase II (MII) oocytes and one immature or degenerated oocyte were retrieved. Between December 2022 and October 2023, 119 MII oocytes were obtained in 22 oocyte retrieval cycles and used in the study. Sibling MII oocytes were randomly assigned to a C-ICSI or ASFI group. The present study was approved by the local ethics committee. Participants/materials, setting, methods In the ASFI group, 10,000 motile sperm were incubated with at least one immature or degenerated oocyte for 3 hours in 100 μL of medium per patient. After incubation, the motile sperm bound to the ZP were aspirated directly using an injection pipette. The heads of these ZP-bound sperm were pressed onto the membrane of MII oocytes for 10 seconds using the injection pipette. C-ICSI was conducted using the conventional method. Main results and the role of chance The mean and standard deviation of age of the women and number of MII oocytes per cycle were 39.9 ± 2.2 years and 5.5 ± 1.8, respectively. All sperm collected from the ZP adhered to the MII oocyte membrane after ASFI. Furthermore, time-lapse imaging revealed that all sperm adhering to the MII oocyte membrane were subsequently incorporated into the oocyte. Comparison of the ASFI and C-ICSI groups did not reveal any significant differences in 2 pronuclear embryo rate (ASFI group: 85.4% vs. C-ICSI group: 71.8%), degeneration rate (0% vs. 5.6%), good-quality embryo rate at day 3 (63.4% vs. 52.9%), blastocyst formation rate (67.6% vs. 51.9%), or good-quality blastocyst (Grade 3BB and above by the Gardner criteria) formation rate (29.4% vs. 15.4%). On the contrary, the embryo utilization rate (defined as the total number of embryos transferred and cryopreserved divided by the number of MII oocytes) was significantly higher in the ASFI group compared to the C-ICSI group (47.9% vs. 25.4%, P < 0.05). Limitations, reasons for caution This study was limited by using the ZP for sperm selection. To expand its applicability, a method to identify sperm capable of fusing with an oocyte without using the ZP must be established. Additionally, since our sample size was small, larger studies are required to confirm our findings. Wider implications of the findings ASFI is expected to enhance the survival rate of oocytes and to increase the number of embryos available for implantation, not only compared to rescue ICSI but also C-ICSI. ASFI could aid in understanding fertilization mechanisms by enabling direct observation of oocyte-sperm fusion during the process. Trial registration number UMIN000050184

Purpose of investigation: To compare the need for medical assistance during singleton deliveries between in vitro fertilization (IVF) pregnancy and spontaneous pregnancy (SP). Materials and Methods: A total of 848 women with singleton pregnancy (and who delivered at >= 36 weeks with problem-free pregnancy were divided into two groups. The groups were compared in teens of maternal age, parity, maternal pre-pregnancy body weight, maternal body weight at delivery, maternal weight gain, infant body weight, infant head circumference, and presence or absence of medical intervention (MI) at delivery (induction of labor, instnunental labor, or emergency cesarean section: CS). Results: The proportion of cases with MI was significantly higher in the IVF group (64.8%) than the SP group (39.3%). Clinical features, such as maternal age, parity, maternal body weight at delivery, infant body weight, and infant head circumference, were also extracted and compared between the two groups: MI group and non-medical intervention group. Univariate analysis showed significant differences between the MI group and the non-medical intervention group in terms of maternal age, maternal body weight at delivery, parity, infant body weight, infant head circumference, and presence or absence of IVF. Multivariate analysis of the factors that were significant in the univariate analysis showed similar trends in maternal age, parity, infant body weight, and presence or absence of WE In addition, the IVF group had a higher risk for requiring MI than the spontaneous pregnancy group [adjusted odds ratio (AOR) 1.74; 95% confidence interval (CI), 1.17-2.00, p < 0.01]. In particular, the IVF group had higher risk of needing emergency CS than the SP group (AOR 3.83; 95% CI, 1.87-7.78, p < 0.01). Conclusion: In spite of no problem in pregnancy course, the need for MI during labor increased after IVF regardless of maternal age and parity.

Most patients with severe motor and intellectual disabilities (SMID) have restricted mobility capability and have been bedridden for long periods because of paralysis of the extremities caused by abnormal muscular tonicity due to cerebral palsy and developmental disabilities. Such patients are associated with a high risk of complications like deep vein thrombosis (DVT). Here, we report twelve patients (42.9%) with DVT among 28 patients with SMID during prolonged bed rest. However, we did not detect thrombosis in the soleal veins, finding it mostly in the femoral and common femoral veins. We applied anticoagulant therapy (warfarin), and carefully followed up the cases with DVT, regulating the warfarin dosage at prothrombin time-international normalized ratio (PT-INR) values around two to prevent recurrence of chronic thrombosis. Regarding laboratory data for the coagulation system, there were no cases above 5 µg/ml for the D-dimer and there were significant differences between the DVT and non-DVT groups in the D-dimer levels. The plasma levels of D-dimer in patients with DVT diminished to less than 1.0 µg/ml after warfarin treatment. Concerning sudden death (4.2%) in patients with SMID, we have to be very careful of the possibility of pulmonary thromboembolism due to DVT. Therefore, we should consider the particularity of the underdeveloped vascular system from underlying diseases for the evaluation of DVT. A detailed study of DVT as a vascular complication is very important for the smooth medical care of SMID, and serial assessment of compression Doppler ultrasonography of the lower extremities, as a noninvasive examination and measurement of D-dimer, is very helpful. (This article is a translation of Jpn J Phlebol 2014; 25: 34-42.).

要旨：下腿型と筋内型で抗凝固療法の治療効果を検討した。対象は，筋内型24 例，下腿型21 例とした。血栓変化では，有効率（消失，縮小）は遠位型63％で，筋内型61％と下腿型65％で有意差がなかった。右心負荷変動では，右室収縮期圧は有意に低下し，40 mmHg 以上の肺高血圧は筋内型と下腿型で，また，30 mmHg 以上の右室負荷は筋内型で有意に減少した。抗凝固療法により，筋内型では下腿型より広範な右心負荷の軽減効果が期待できる。

OBJECTIVE:The relationship between specific distributions of isolated soleal vein thrombosis (SVT) and risk factors was investigated.SUBJECTS AND METHODS:The subjects included 93 patients with SVT diagnosed with ultrasonography.RESULTS:In the acute thrombus distribution, the thrombi of central veins were significantly more frequent than the thrombi of medial veins in the unilateral SVT. The thrombi of central veins were not more significantly frequent than the thrombi of medial veins in the bilateral SVT.CONCLUSION:The risk factors of bilateral SVT are considered to be different from that of the unilateral SVT. (English translation of J Jpn Coll Angiol 2013; 53: 159-166).

(SVT) and pulmonary hypertension was investigated. The subjects were 64 patients with SVT with suspected pulmonary embolism. SVT was diagnosed by ultrasonography and pulmonary hypertension was diagnosed by ultrasonic cardiography. Pulmonary hypertension was diagnosed in 24% of subjects. Among the 28 patients under recurrent surveillance during the 26.1( ± 9.3) months, the recurrence of SVT was 36%; the local recurrence was 36%, the proximal propagation was 21%, pulmonary embolism was 7%, and pulmonary hypertension was 18%. It is necessary to take reasonable measures for the local repeated recurrence and pulmonary hypertension in patients with isolated SVT.

OBJECTIVE:In patients with isolated soleal vein thrombosis (SVT), the relation between acute thrombi and positive anti-nuclear antibody (ANA) was investigated.SUBJECTS AND METHODS:The subjects were 116 lower extremities in 86 patients with SVT. They were diagnosed and examined by ultrasonography and blood serum analysis (D-dimer, ANA), and had been followed up every three months.RESULTS:They had acute SVT in 35 limbs (30%) and chronic SVT in 86 limbs (70%), and they had positive ANA in 63%. They had recurrent SVT in 26%, and all were positive for ANA.CONCLUSION:ANA-positivity might be a risk factor for acute thrombi in patients with SVT. (*English Translation of J Jpn Coll Angiol 2010; 50: 417-422.).

ひらめ筋内静脈群の頻度と正常径を検討した．超音波検査により下肢動脈のドプラ血流波形が正常で，かつ下肢静脈の弁不全や血栓が否定された40症例52肢を対象とした．静脈径2 mm以上の静脈同定率は，近位静脈40％，中央静脈100％，内側静脈42％，外側静脈27％，遠位内側静脈27％，遠位外側静脈10％であった．最大径の静脈同定率は，近位静脈0％，中央静脈90％，内側静脈6％，外側静脈2％，遠位内側静脈2％，遠位外側静脈0％であった．中央静脈の静脈径は6.7±1.8 mmであり，正常範囲を標準偏差の2倍に設定すると，その上限は10.3 mmとなった．ひらめ筋内静脈群において，中央静脈は最も頻度が高く，かつ最大であった．ひらめ筋内静脈の正常径は10 mm以下とするのが妥当である．

The effects of cyclic stretch on mitogen-activated protein kinase (MAPK) and apoptosis in keratinocytes are not well understood. The aim of this study is to compare the effect of high frequency repetitive (HF) stretch to intermittent (I) stretch on human dermal keratinocytes proliferation and survival. Cultured human dermal keratinocytes were exposed to either repetitive HF or I stretch. Cell number was measured by coulter counter, DNA synthesis was assessed by BrdU staining, and apoptosis was assessed by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) staining. The activation of p38 MAPK, ERK 1/2, and AKT was assessed by immunoblotting. p38 MAPK, ERK 1/2, and AKT exhibited no change after HF stretch, while AKT and Homo sapiens BCL-2-antagonist of cell death (BAD) were significantly activated after I stretch. After experiencing I stretch for 2 d, keratinocyte proliferation rates were significantly decreased. This decrease was most likely not due to apoptosis as TUNEL-positive cells only increased for cells treated with an AKT inhibitor.