Research activity information

• 周産期感染症の最前線 先天性サイトメガロウイルス感染

  谷村 憲司, 内田 明子, 今福 仁美, 平久 進也, 藤岡 一路, 森岡 一朗, 峰松 俊夫, 山田 秀人

  日本産婦人科・新生児血液学会, Mar. 2023, 日本産婦人科・新生児血液学会誌, 32(2) (2), 27 - 33, Japanese


• Fetal Ultrasound and Magnetic Resonance Imaging Abnormalities in Congenital Cytomegalovirus Infection Associated with and without Fetal Growth Restriction.

  Kenji Tanimura, Akiko Uchida, Mizuki Uenaka, Hitomi Imafuku, Shinya Tairaku, Hiromi Hashimura, Yoshiko Ueno, Takumi Kido, Kazumichi Fujioka

  Congenital cytomegalovirus infection (cCMV) can cause fetal growth restriction (FGR) and severe sequelae in affected infants. Clinicians generally suspect cCMV based on multiple ultrasound (US) findings associated with cCMV. However, no studies have assessed the diagnostic accuracy of fetal US for cCMV-associated abnormalities in FGR. Eight FGR and 10 non-FGR fetuses prenatally diagnosed with cCMV were examined by undergoing periodic detailed US examinations, as well as postnatal physical and imaging examinations. The diagnostic accuracy of prenatal US for cCMV-associated abnormalities was compared between FGR and non-FGR fetuses with cCMV. The diagnostic sensitivity rates of fetal US for cCMV-related abnormalities in FGR vs. non-FGR fetuses were as follows: ventriculomegaly, 66.7% vs. 88.9%; intracranial calcification, 20.0% vs. 20.0%; cysts and pseudocysts in the brain, 0% vs. 0%; ascites, 100.0% vs. 100.0%; hepatomegaly, 40.0% vs. 100.0%; splenomegaly, 0% vs. 0%. The diagnostic sensitivity of fetal US for hepatomegaly and ventriculomegaly in FGR fetuses with cCMV was lower than that in non-FGR fetuses with cCMV. The prevalence of severe long-term sequelae (e.g., bilateral hearing impairment, epilepsy, cerebral palsy, and severe developmental delay) in the CMV-infected fetuses with FGR was higher, albeit non-significantly. Clinicians should keep in mind the possibility of overlooking the symptoms of cCMV in assessing fetuses with FGR.

  Jan. 2023, Diagnostics (Basel, Switzerland), 13(2) (2), English, International magazine

  Scientific journal

  Link to Kobe Univ. Repository (Kernel)


• Uterine rupture in intramural ectopic pregnancy: A case report.

  Keiichi Washio, Masato Komatsu, Masako Tomimoto, Akiko Uchida, Yuki Sasagawa, Masashi Nishimoto, Satoshi Nagamata, Yui Yamasaki, Kenji Tanimura, Yoshito Terai

  Intramural pregnancy is a rare form of ectopic pregnancy. It is defined by a gestation within the uterine wall, completely surrounded by myometrium and separated from the uterine cavity and the fallopian tube. We report a rare case of intramural ectopic pregnancy. If a patient has a history of intrauterine surgery or myomectomy, the possibility of intramural pregnancy, although rare, should not be ruled out.

  Jan. 2023, Asian journal of endoscopic surgery, English, Domestic magazine

  [Refereed]


• The Current Challenges in Developing Biological and Clinical Predictors of Congenital Cytomegalovirus Infection.

  Kenji Tanimura, Akiko Uchida, Hitomi Imafuku, Shinya Tairaku, Kazumichi Fujioka, Ichiro Morioka, Hideto Yamada

  Congenital cytomegalovirus (CMV) infection may cause severe long-term sequelae. Recent studies have demonstrated that early antiviral therapy for infants with symptomatic congenital CMV (cCMV) infection may improve neurological outcomes; thus, accurate identification of newborns at high risk of cCMV infection may contribute to improved outcomes in affected children. However, maternal serological screening for cCMV infection by diagnosing primary infection during pregnancy, which is a popular screening strategy, is inefficient, because the number of cCMV infections with nonprimary causes, including reactivation of or reinfection with CMV, is larger than that of cCMV infections with primary causes. Low levels of neutralizing antibodies against pentameric complex and potent CMV-specific T cell-mediated immune responses are associated with an increased risk of cCMV infection. Conversely, our prospective cohort studies revealed that the presence of maternal fever/flu-like symptoms, threatened miscarriage/premature delivery, or actual premature delivery are risk factors for cCMV infection among both women with normal pregnancies and those with high-risk ones, regardless of whether the infection is primary or nonprimary. This review focused on host immune responses to human CMV and current knowledge of potential biological and clinical factors that are predictive of cCMV infection.

  Dec. 2021, International journal of molecular sciences, 22(24) (24), English, International magazine

  Scientific journal

  Link to Kobe Univ. Repository (Kernel)


• Clinical factors associated with a placenta accreta spectrum.

  Hitomi Imafuku, Kenji Tanimura, Yutoku Shi, Akiko Uchida, Masashi Deguchi, Yoshito Terai

  INTRODUCTION: Placenta accreta spectrum (PAS) is a life-threating obstetric complication, and prenatal prediction of PAS can decrease maternal morbidity and mortality. The aim of this prospective cohort study was to determine the clinical factors associated with PAS. METHODS: Pregnant women who delivered at a university hospital were enrolled. Clinical data were collected from medical records, and logistic regression analyses were performed to determine which clinical factors were associated with PAS. RESULTS: Eighty-seven (2.1%) of the 4146 pregnant women experienced PAS. Multivariable analyses revealed that a prior history of cesarean section (CS) (OR 3.3; 95% CI 1.9-5.7; p < 0.01), dilation and curettage (D&C) (OR 2.8; 95% CI 1.7-4.6; p < 0.01), hysteroscopic surgery (OR 5.7; 95% CI 2.3-14.4; p < 0.01), uterine artery embolization (UAE) (OR 44.1; 95% CI 13.8-141.0; p < 0.01), current pregnancy via assisted reproductive technology (ART) (OR 4.1; 95% CI 2.4-7.1; p < 0.01), and the presence of placenta previa in the current pregnancy (OR 13.1; 95% CI 7.9-21.8; p < 0.01) were independently associated with the occurrence of PAS. CONCLUSION: Pregnant women who have a prior history of CS, D&C, hysteroscopic surgery, UAE, current pregnancy via ART, and the presence of placenta previa in the current pregnancy are high risk for PAS.

  Sep. 2021, Placenta, 112, 180 - 184, English, International magazine

  [Refereed]

  Scientific journal

  Link to Kobe Univ. Repository (Kernel)


• Immunoglobulin fetal therapy and neonatal therapy with antiviral drugs improve neurological outcome of infants with symptomatic congenital cytomegalovirus infection.

  Kenji Tanimura, Yutoku Shi, Akiko Uchida, Mizuki Uenaka, Hitomi Imafuku, Toshihiko Ikuta, Kazumichi Fujioka, Ichiro Morioka, Masashi Deguchi, Toshio Minematsu, Hideto Yamada

  Infants with symptomatic congenital cytomegalovirus infection (cCMV) suffer from long-term sequelae. This study aimed at evaluating the efficacy of combining immunoglobulin (Ig) fetal therapy (FT) and neonatal therapy (NT) with antiviral drugs to improve neurological outcomes of affected infants. Women whose fetuses had symptomatic cCMV received Ig injection into the fetal peritoneal cavity and/or maternal blood as FT, while affected newborns received oral valganciclovir or intravenous ganciclovir as NT. We compared the neurological outcomes at ≥18 months old between infants receiving FT with or without NT (FT group) and those receiving NT only (NT group). From 2009-2019, 15 women whose fetuses had symptomatic cCMV received FT, while 19 newborns received NT only. In FT group, two newborns died, and two were <18 months old. Neurological outcomes of the remaining 11 infants in FT group were as follows: normal 45.5 %, mild impairments 36.4 %, and severe impairments 18.2 %. In NT group, one newborn died, one's parents refused the follow-up, one was <18 months old, and two had only chorioretinitis as symptoms. Neurological outcomes of the remaining 14 infants in NT group were as follows: normal 21.4 %, mild impairments 14.3 %, and severe impairments 64.3 %. The proportion of infants with severe impairments in FT group was significantly lower than that in NT group (18.2 % vs 64.3 %, p < 0.05). This is the first trial demonstrating that the combination of Ig FT and NT with antiviral drugs may be more effective in improving neurological outcomes of newborns with symptomatic cCMV as compared to NT only.

  Dec. 2020, Journal of reproductive immunology, 143, 103263 - 103263, English, International magazine

  Scientific journal

  Link to Kobe Univ. Repository (Kernel)


• Clinical and ultrasound features associated with congenital cytomegalovirus infection as potential predictors for targeted newborn screening in high-risk pregnancies.

  Hitomi Imafuku, Hideto Yamada, Akiko Uchida, Masashi Deguchi, Tokuro Shirakawa, Yuki Sasagawa, Yutoku Shi, Kazumichi Fujioka, Ichiro Morioka, Kenji Tanimura

  This prospective cohort study aimed to determine clinical factors associated with congenital cytomegalovirus (CMV) infection in pregnancy. Newborns born at a perinatal medical center received PCR analyses for CMV-DNA in their urine with informed consent. Clinical data, including age, maternal fever or flu-like symptoms, complications, ultrasound fetal abnormality, gestational weeks at delivery, and birth weight, were collected. Logistic regression analyses determined clinical findings associated with congenital CMV infection (cCMV). cCMV was diagnosed in 32 of 4380 pregnancies. Univariate and multivariable analyses revealed that age < 25 years old (OR 2.7, 95% CI 1.1-6.6; p < 0.05), the presence of maternal fever or flu-like symptoms (5.4, 2.6-11.2; p < 0.01), ultrasound fetal abnormalities (12.7, 5.8-27.7; p < 0.01), and preterm delivery at less than 34 gestational weeks (2.6, 1.1-6.0; p < 0.05) were independent clinical findings associated with cCMV. A combination of maternal fever/flu-like symptoms, ultrasound fetal abnormalities, or preterm delivery at less than 34 gestational weeks as optimal predictive factors showed 90.6% sensitivity, 66.4% specificity, and a maximum Youden index of 0.57. CMV-DNA tests in the urine of newborns born to mothers with these clinical manifestations may be an effective method in detecting cCMV as a targeted screening with a high sensitivity.

  Nov. 2020, Scientific reports, 10(1) (1), 19706 - 19706, English, International magazine

  Scientific journal

  Link to Kobe Univ. Repository (Kernel)


• 切迫早産から妊娠29週未満で早産となった児の予後に関連する因子の検討

  澤田 茉美子, 谷村 憲司, 施 裕徳, 内田 明子, 笹川 勇樹, 白川 得朗, 森實 真由美, 藤岡 一路, 山田 秀人

  「産婦人科の進歩」編集室, Oct. 2020, 産婦人科の進歩, 72(4) (4), 392 - 394, Japanese


• Clinical factors associated with congenital cytomegalovirus infection: A cohort study of pregnant women and newborns.

  Akiko Uchida, Kenji Tanimura, Mayumi Morizane, Kazumichi Fujioka, Ichiro Morioka, Masanobu Oohashi, Toshio Minematsu, Hideto Yamada

  BACKGROUND: The aim of this prospective cohort study was to determine clinical factors associated with the occurrence of congenital cytomegalovirus infection (cCMV) in pregnant women. METHODS: Between March 2009 and November 2017, newborns born at a primary maternity hospital received polymerase chain reaction (PCR) analyses for CMV-DNA in their urine with informed consent of the mothers at a low risk. Clinical data, including age, gravidity, parity, body mass index, occupations, maternal fever/flu-like symptoms, pregnancy complications, gestational weeks at delivery, birth weight, and automated auditory brainstem response (AABR), were collected. Logistic regression analyses were performed to determine clinical factors associated with cCMV. RESULTS: cCMV was diagnosed by positive PCR results of neonatal urine in 9 of 4,125 pregnancies. Univariate and multivariable analyses revealed that the presence of fever/flu-like symptoms (odds ratio [OR], 17.9; 95% confidence interval [CI], 3.7-86.7; p<0.001) and threatened miscarriage/premature labor in the second trimester (OR, 6.0; 95%CI 1.6-22.8; p<0.01) were independent clinical factors associated with cCMV. Maternal fever/flu-like symptoms or threatened miscarriage/premature labor in the second trimester had 100% sensitivity, 53.2% specificity, and a maximum Youden index of 0.85. CONCLUSIONS: This cohort study for the first time demonstrated that these clinical factors of pregnant women and newborns were associated with the occurrence of cCMV. This is useful information for targeted screening to assess risks of cCMV in low-risk mothers, irrespective of primary or non-primary CMV infection.

  Dec. 2019, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 71(11) (11), 2833 - 2839, English, International magazine

  [Refereed]

  Scientific journal

  Link to Kobe Univ. Repository (Kernel)


• 症候性先天性サイトメガロウイルス感染症に対する胎児治療と新生児治療の有効性

  谷村 憲司, 内田 明子, 今福 仁美, 森實 真由美, 出口 雅士, 藤岡 一路, 森岡 一朗, 峰松 俊夫, 山田 秀人

  (一社)日本産婦人科感染症学会, Sep. 2019, 日本産婦人科感染症学会誌, 3(1) (1), 87 - 87, Japanese

• トキソプラズマ抗体妊婦スクリーニングに関する前向きコホート研究

  内田 明子, 谷村 憲司, 西川 鑑, 清水 亜由美, 施 裕徳, 田中 恵里加, 森實 真由美, 出口 雅士, 蝦名 康彦, 森岡 一朗, 山田 秀人

  (一社)日本産婦人科感染症学会, Sep. 2019, 日本産婦人科感染症学会誌, 3(1) (1), 88 - 88, Japanese


• A cohort study of maternal screening for congenital Toxoplasma gondii infection: 12 years' experience.

  Hideto Yamada, Kenji Tanimura, Masashi Deguchi, Shinya Tairaku, Mayumi Morizane, Akiko Uchida, Yasuhiko Ebina, Akira Nishikawa

  Primary infection with Toxoplasma gondii (T. gondii) during pregnancy may cause congenital infection of the infant. This study evaluated whether screening using IgG avidity and multiplex-nested polymerase chain reaction (PCR) methods was effective for detecting a high-risk pregnancy for congenital T. gondii infection. In a prospective cohort study serum T. gondii IgG avidity was measured in 469 pregnant women who had a positive test for T. gondii antibody plus a positive or equivocal test for IgM. Multiplex-nested PCR for T. gondii DNA on amniotic fluid, maternal blood, and neonatal blood was performed with informed consent. Low (<30%), borderline (30-35%), and high (>35%) IgG avidity indices were found in 104 (22.2%), 30 (6.4%), and 305 (71.4%), respectively. A total of 12 cases had a positive PCR test for amniotic fluids of the prenatal amniocentesis or at birth, or neonatal blood. Seven of the 12 cases were diagnosed as having congenital T. gondii infection, and they had low IgG avidity indices. Congenital T. gondii infection screening using of IgG avidity and multiplex-nested PCR methods for pregnant women with a positive test for T. gondii antibody plus a positive or equivocal test for T. gondii IgM was useful for detecting a high-risk pregnancy and diagnosing congenital T. gondii infection.

  Jun. 2019, Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy, 25(6) (6), 427 - 430, English, International magazine

  Link to Kobe Univ. Repository (Kernel)

• 日本周産期・新生児医学会

  Aug. 2016 - Present


• 日本産科婦人科学会

  May 2013 - Present