Our hospital is the only medical institution in Ibaraki Prefecture designated as a Type I infectious disease center and a regional perinatal maternal and child health care center, and we have been actively accepting COVID-19-positive pregnant women. In this report, we describe the perinatal outcomes of 58 pregnant women who were polymerase chain reaction/antigen positive for COVID-19 and were managed at our hospital between July 2020 and September 2022. The severity of illness was mild in 49 patients (84.5%), moderate I in 5 (8.6%), moderate II in 2 (3.4%), and false positive in 2 (3.4%). Obstetric complications included 5 cases of impending preterm delivery, 3 cases of gestational diabetes mellitus, and 1 case of impending miscarriage. Among 22 of the women who gave birth while positive for COVID-19, the mode of delivery was vaginal delivery in 18 cases, cesarean section in 3 cases, and emergency cesarean section in 1 case after transfer to another hospital. Four cases were delivered on day 4 of illness, 3 on day 5, and 1 each on days 1, 3, 7, 8, 14, 16, 21, 25, and 29; 4 cases were asymptomatic at delivery but had tested positive on admission or screening at the time of family positive identification. The mean gestational age was 38 weeks 4 days (range, 34 weeks 2 days to 40 weeks 6 days; standard deviation [SD], 10.164 days), mean birth weight was 3042 g (range, 2000-3680 g; SD, 401.268 g), mean Apgar scores at 1 and 5 min were respectively 7.90 (range, 6-9; SD, 0.514) and 8.86 (8-9, SD, 0.343), and umbilical arterial pressure (UVC) was 7.90 mmHg (range, XX-XX; SD, X.343), and umbilical artery blood gas pH was 7.304 (range, 7.120-7.360; SD, 0.058). In the 44 COVID-19-positive pregnant women managed from the sixth wave onward, 43 (97.7%) had mild disease and 1 (2.3%) was a false positive. Since COVID-19-positive pregnant women are considered to be at high risk during the perinatal period and require careful management, many medical institutions initially performed elective Cesarean sections. However, the perinatal outcomes were good in the 18 patients who delivered vaginally at our hospital, and it is not essential to choose cesarean section because of COVID-19 positivity alone, unless the patient is severely ill. The reason for the significant decrease in the disease severity from the sixth wave onward may be the influence of widespread vaccination or changes in the disease caused by mutant strains. While continuing to recommend vaccination of pregnant women, it is necessary to flexibly change the response according to the disease status of COVID-19 in the future.

Smooth muscle tumor of uncertain malignant potential (STUMP) is a type of uterine tumor that does not meet criteria for benign or malignant disease and can recur even after hysterectomy. Recently, loss of the ATRX gene, which encodes a chromatin remodeling protein, has been reported as a factor in recurrence. In this case, the patient underwent a simple abdominal hysterectomy and bilateral adnexectomy for a pelvic mass at the age of 59 years with a diagnosis of STUMP. At age 62 years, multiple masses were found in the thoracic cavity and the patient was diagnosed with recurrent uterine STUMP. Comprehensive genomic profiling revealed mutations in the ATRX gene. No treatment was effective, and the patient died 6 months after recurrence. Additional immunostaining of the surgical specimen was performed retrospectively and ATRX(-) status was confirmed. This case suggests that ATRX expression on immunostaining can be a prognostic factor.

Objective: To clarify whether early mobilization is a predictive factor for ambulation recovery in elderly patients and/or patients with severe subarachnoid hemorrhage (SAH).Methods: This multicenter retrospective observational study included 471 patients with treated SAH (Group 1). We focused on SAH patients with a poor prognosis, including a subgroup of elderly SAH patients (age>65 years: n=203) (Group 2) and patients with severe SAH (World Federation of Neurological Societies [WFNS] grade IV or V: n=117) (Group 3). The chi-square test and Mann-Whitney U test were used to compare the differences between the ambulation recovery group and the non-recovery group. Multivariable logistic regression analysis modeling was used to estimate odds ratios and 95% confidence intervals of early mobilization for the ambulation-recovered group within 30 days of onset compared with the unrecovered group. Other covariates examined as possible confounders of the outcome were age, sex, location of the ruptured aneurysm, modified Fisher scale score, WFNS grade, mode of treatment (surgical vs. endovascular), duration of cerebrospinal fluid drainage, days on mechanical ventilation, intracerebral hemorrhage, symptomatic cerebral vasospasm, complications, shunt placement for hydrocephalus, and time to start mobilization.Results: Early mobilization was an independent predictive factor for gait recovery in all groups. Furthermore, location of the ruptured aneurysm (anterior circulation), absence of complications, and absence of shunt placement were independent factors for ambulation recovery in all groups.Conclusion: Early mobilization in elder or/and sever patients with SAH may be a predictive factor for ambulation recovery within 30 days of onset.

Objective: To clarify whether early mobilization is a predictive factor for ambulation recovery in elderly patients and/or patients with severe subarachnoid hemorrhage (SAH).Methods: This multicenter retrospective observational study included 471 patients with treated SAH (Group 1). We focused on SAH patients with a poor prognosis, including a subgroup of elderly SAH patients (age>65 years:n=203) (Group 2) and patients with severe SAH (World Federation of Neurological Societies [WFNS] grade IV or V:n=117) (Group 3). The chi-square test and Mann-Whitney U test were used to compare the differences between the ambulation recovery group and the non-recovery group. Multivariable logistic regression analysis modeling was used to estimate odds ratios and 95% confidence intervals of early mobilization for the ambulation-recovered group within 30 days of onset compared with the unrecovered group. Other covariates examined as possible confounders of the outcome were age, sex, location of the ruptured aneurysm, modified Fisher scale score, WFNS grade, mode of treatment (surgical vs. endovascular), duration of cerebrospinal fluid drainage, days on mechanical ventilation, intracerebral hemorrhage, symptomatic cerebral vasospasm, complications, shunt placement for hydrocephalus, and time to start mobilization.Results: Early mobilization was an independent predictive factor for gait recovery in all groups. Furthermore, location of the ruptured aneurysm (anterior circulation), absence of complications, and absence of shunt placement were independent factors for ambulation recovery in all groups.Conclusion: Early mobilization in elder or/and sever patients with SAH may be a predictive factor for ambulation recovery within 30 days of onset.