1
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Siems CB, Ji Z, Jedeon Z, Schultz J, Teigen L, Allen T, John R, Estep JD, Masotti M, Alexy T, Kamdar F, Maharaj V, Pritzker M, Garry D, Shaffer A, Cogswell R. Validation of the Minnesota Pectoralis Risk Score to predict mortality in the HeartMate 3 population. J Heart Lung Transplant 2024; 43:539-546. [PMID: 37956881 DOI: 10.1016/j.healun.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/20/2023] [Accepted: 11/05/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The Minnesota Pectoralis Risk Score (MPRS) utilizes computed tomography-quantified thoracic muscle and clinical variables to predict survival after left ventricular assist device (LVAD) implantation. The model has not been prospectively tested in HeartMate 3 recipients. METHODS A single-center HeartMate 3 cohort from July 2016 to July 2021 (n = 108) was utilized for this analysis. Cohort subjects with complete covariates for MPRS calculation (pectoralis muscle measures, Black race, creatinine, total bilirubin, body mass index, bridge to transplant status, and presence/absence of contrast) implanted after MPRS development were included. MPRS were calculated on each subject. Receiver operating characteristic curves were generated to test model discrimination at 30-day, 90-day, and 1-year mortality post-LVAD. Next, the performance of the 1-year post-LVAD outcome was compared to the HeartMate 3 survival risk score (HM3RS). RESULTS The mean age was 58 (15 years), 80% (86/108) were male, and 26% (28/108) were destination therapy. The area under the curve (AUC) for the MPRS model to predict post-LVAD mortality was 0.73 at 30 days, 0.78 at 90 days, and 0.81 at 1 year. The AUC for the HM3RS for the 1-year outcome was 0.693. Each 1-unit point of the MPRS was associated with a significant increase in the hazard rate of death after LVAD (hazard ratio 2.1, 95% confidence interval 1.5-3.0, p < 0.0001). CONCLUSIONS The MPRS had high performance in this prospective validation, particularly with respect to 90-day and 1-year post-LVAD mortality. Such a tool can provide additional information regarding risk stratification to aid informed decision-making.
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Affiliation(s)
- Chesney B Siems
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
| | - Ziyu Ji
- Department of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Zeina Jedeon
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Jessica Schultz
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Levi Teigen
- Department of Food Science and Nutrition, University of Minnesota, Minneapolis, Minnesota
| | - Tadashi Allen
- Department of Diagnostic Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Ranjit John
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Jerry D Estep
- Department of Cardiology, Cleveland Clinic Florida, Weston, Florida
| | - Maria Masotti
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Tamas Alexy
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Forum Kamdar
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Valmiki Maharaj
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Marc Pritzker
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Daniel Garry
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Andrew Shaffer
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Rebecca Cogswell
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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2
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Abuzeid O, Abdelrahman A, LaChance J, Herrera K, Garry D, Abuzeid M. O-058 Obstetric outcomes of twin gestation after In-Vitro Fertilization and Embryo Transfer (IVT-ET) treatment in patients who underwent hysteroscopic septoplasty for subseptate uterus. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is there an associated increased risk of preterm birth (PTB) in patients who underwent hysteroscopic septoplasty for subseptate uterus (SSU) with twin gestation through IVF-ET?
Summary answer
This study suggests an increased risk of PTB in patients, who underwent hysteroscopic septoplasty for SSU, and subsequently conceived twins after IVF-ET treatment.
What is known already
In general, the incidence of PTB is higher after IVF-ET treatment. In addition, Müllerian uterine anomalies, such as unicornuate uterus, are considered risk factors for PTB, even with singleton pregnancy. Furthermore, historical data suggest that some patients with uterine anomaly may have cervical incompetence. Twin gestation is associated with PTB in approximately 50% of cases. It is assumed that the obstetric outcome of twin gestation after successful septoplasty should be no different from those with normal uterine cavity. The impact of previous septoplasty for SSU on the obstetric outcomes of twin gestation after IVF-ET treatment has not been adequately studied.
Study design, size, duration
This retrospective cohort study included 377 fertility patients who received treatment between 2006-2019. The study group included 162 patients who underwent hysteroscopic septoplasty for SSU and subsequently conceived dichorionic-diamniotic (DI-DI) twins after IVF-ET treatment (Group 1). The control group included 215 patients who had normal endometrial cavity on hysteroscopy (#109) or Transvaginal 3D ultrasound scan with saline sonohysterogram (#106) and subsequently conceived DI-DI twins after IVF-ET treatment (Group 2).
Participants/materials, setting, methods
This study was conducted at an infertility clinic affiliated with an academic hospital. Demographic, clinical, and obstetric outcome data were collected for both groups and compared using appropriate statistical methods. PTB, severe PTB, extreme PTB, and peri-viable birth were defined as < 37 weeks, <32 weeks, <28 weeks and between 20 weeks-25 weeks 6 days gestation respectively.
Main results and the role of chance
There was no significant difference in mean age, BMI and infertility duration or in the incidence of smoking, primary infertility, tubal factors and unexplained infertility between the two groups. There was significantly lower mean baseline FSH levels (p < 0.01), lower incidence of male infertility (p < 0.001) and higher incidence of ovulatory disorders (p < 0.001) and endometriosis (p < 0.05) in Group 1 compared to Group 2. As expected, there was past history of lower parity rate (p < 0.01) and higher miscarriage rate (p < 0.001) in Group 1 compared to Group 2 prior to septum division. There was significantly higher incidence of PTB (72.8% vs 56.3%, p < 0.01), severe PTB (20.3% vs 8.2%, p < 0.01), extreme PTB (8.3% vs 3.9%, p < 0.05), and peri-viable birth (6.3% vs 1.9%, p < 0.05) in Group 1 compared to Group 2. There was no significant difference in cesarean section rate (82.8% vs 87.5%, p = 0.349) between Group1 and Group 2 respectively. There was significantly lower gestational age at birth in weeks (34.0 + 4.0 vs 35.6 + 3.0, p < 0.001), birth weight of the first newborn (2180.5 + 717.9 vs 2436.4 + 606.6, p < 0.001), and the second newborn (2235.2 + 674.2 vs 2398.0 + 537.9, p < 0.05) in grams in Group 1 compared to Group 2.
Limitations, reasons for caution
Our study has limitations being retrospective in nature. Data on cervical length measurements via ultrasound, if performed, was not available. However, recall bias was prevented by retrieving data from that submitted to the Society of Assisted Reproductive Technology. Additionally, procedural variation was reduced as this was a single-center study.
Wider implications of the findings
Our study suggests that twin gestation after IVF-ET in patients who underwent successful hysteroscopic septoplasty for SSU may increase the likelihood of PTB. Such patients may require increased surveillance with ultrasound cervical length and signs for preterm labor. Future research should focus on measures to reduce PTB in such patients.
Trial registration number
Not Applicable
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Affiliation(s)
- O Abuzeid
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine , Nesconset, U.S.A
| | - A Abdelrahman
- St. Joseph Mercy Oakland Hospital, Maternal Fetal Medicine , Pontiac, U.S.A
| | - J LaChance
- Hurley Medical Center/Michigan State University, Department of Research , Flint, U.S.A
| | - K Herrera
- Renaissance School of Medicine at Stony Brook University, Department of Obstetrics and Gynecology , Stony Brook , U.S.A
| | - D Garry
- Renaissance School of Medicine at Stony Brook University, Department of Obstetrics and Gynecology , Stony Brook , U.S.A
| | - M Abuzeid
- Department of Obstetrics and Gynecology- Hurley Medical Center/Michigan State University, Division of Reproductive Endocrinology and Infertility , Rochester, U.S.A
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3
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Rousset F, Depardieu F, Miele S, Dowding J, Laval AL, Lieberman E, Garry D, Rocha EPC, Bernheim A, Bikard D. Phages and their satellites encode hotspots of antiviral systems. Cell Host Microbe 2022; 30:740-753.e5. [PMID: 35316646 PMCID: PMC9122126 DOI: 10.1016/j.chom.2022.02.018] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 01/27/2022] [Accepted: 02/23/2022] [Indexed: 11/18/2022]
Abstract
Bacteria carry diverse genetic systems to defend against viral infection, some of which are found within prophages where they inhibit competing viruses. Phage satellites pose additional pressures on phages by hijacking key viral elements to their own benefit. Here, we show that E. coli P2-like phages and their parasitic P4-like satellites carry hotspots of genetic variation containing reservoirs of anti-phage systems. We validate the activity of diverse systems and describe PARIS, an abortive infection system triggered by a phage-encoded anti-restriction protein. Antiviral hotspots participate in inter-viral competition and shape dynamics between the bacterial host, P2-like phages, and P4-like satellites. Notably, the anti-phage activity of satellites can benefit the helper phage during competition with virulent phages, turning a parasitic relationship into a mutualistic one. Anti-phage hotspots are present across distant species and constitute a substantial source of systems that participate in the competition between mobile genetic elements.
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Affiliation(s)
- François Rousset
- Institut Pasteur, Université de Paris, CNRS UMR 6047, Synthetic Biology, 75015 Paris, France.
| | - Florence Depardieu
- Institut Pasteur, Université de Paris, CNRS UMR 6047, Synthetic Biology, 75015 Paris, France
| | - Solange Miele
- Institut Pasteur, Université de Paris, CNRS UMR 6047, Synthetic Biology, 75015 Paris, France
| | - Julien Dowding
- Institut Pasteur, Université de Paris, CNRS UMR 6047, Synthetic Biology, 75015 Paris, France
| | - Anne-Laure Laval
- Institut Pasteur, Université de Paris, CNRS UMR 6047, Synthetic Biology, 75015 Paris, France
| | | | | | - Eduardo P C Rocha
- Institut Pasteur, Université de Paris, CNRS UMR 3525, Microbial Evolutionary Genomics, 75015 Paris, France
| | - Aude Bernheim
- Université de Paris, INSERM, IAME, 75006 Paris, France
| | - David Bikard
- Institut Pasteur, Université de Paris, CNRS UMR 6047, Synthetic Biology, 75015 Paris, France.
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4
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Abuzeid O, Heiselman C, Fuchs A, La Chance J, Herrera K, Garry D, Abuzeid M. P-746 Obstetric outcomes of singleton birth after hysteroscopic division of septate uterus. Hum Reprod 2021. [DOI: 10.1093/humrep/deab128.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
The aim of this study is to determine the obstetric outcomes in patients with a singleton birth after hysteroscopic division of septate uterus.
Summary answer
The data suggest excellent obstetric outcomes for singleton gestation after hysteroscopic division of a septate uterus reaching either the internal or the external cervical os.
What is known already
Septate uterus is a rare Müllerian anomaly with major impact on reproductive outcomes, particularly with a septum over 10mm. Controversy still exists over the need for surgical correction of the septum due to conflicting data on outcomes, particularly in women with histories of good obstetric outcomes and incidental septum findings. Placental location in relation to the septum may account for such conflicting reports. Most data on reproductive outcomes after hysteroscopic surgical correction combine both septate and subseptate uteri. There is limited published data on obstetric outcomes after hysteroscopic surgical correction of septate uteri, especially septate uteri reaching the external os.
Study design, size, duration
This retrospective cohort study included 107 patients with infertility and/or recurrent pregnancy loss (RPL) who received treatment between 2002 -2019. The study group included 24 patients with a singleton birth after hysteroscopic correction of septate uterus (Class Va; ASRM classification) that was diagnosed on trans-vaginal 3D ultrasound. The control group included 83 patients with a singleton birth who had normal endometrial cavity on hysteroscopy during the same period of time, before starting treatment.
Participants/materials, setting, methods
This study was conducted at an infertility clinic affiliated with a teaching hospital. In the study group the septum reached the internal or the external cervical os in 14 and 10 patients respectively. After hysteroscopic correction, all patients were offered various infertility treatments depending on the underlying etiology. The inclusion criterion in this study was to have a singleton birth after hysteroscopy. Demographic and clinical data and obstetric outcomes were compared between the two groups.
Main results and the role of chance
There was no significant difference in mean age, infertility duration, infertility type and incidence of male infertility or ovulatory disorders between the two groups. There was a significantly higher BMI (0.048), and a higher incidence of history of miscarriage (P=0.002) and history of RPL (P=0.017) in the study group. There was significant lower incidence of tubal factors infertility (P=0.005) and endometriosis (P=0.03) in the study group, therefore there was higher incidence of spontaneous conception (70.8% vs 19.3%; P=0.000) and lower incidence of conception with IVF-ET (20.8% vs 66.3%; P=0.000) in the study group compared to the control group respectively. There was significantly higher incidence of prophylactic cervical cerclage (17.4% vs 0%; P=0.000), and delivery by CS (69.6% vs 41.2%; P=0.019) and lower incidence of vaginal delivery (30.4% vs 58.8%; P=0.019), in the study group compared to the control group. There was no significant difference in gestational age in weeks (38.3 + 1.8 vs 38.6 + 2.0), newborn birth weight in grams (3173.9 + 630.0 vs 3202.1 + 555.6), incidence of premature birth (12.5% vs 12.2%), or other obstetric complications (25% vs 17.6%) between the study and the control groups respectively. For premature births, mean gestational age was 34.3 + 0.47 and 34.6 + 1.2 weeks in the study and control groups respectively.
Limitations, reasons for caution
A retrospective study has its own inherent bias. Furthermore, the small sample size is explained by the fact that a septate uterus is a rare anomaly leading to difficulties finding cases and organizing a prospective study to achieve a larger sample size. A multicenter prospective study is needed.
Wider implications of the findings
Regardless of whether the septum reached the internal or external os, there were excellent obstetric outcomes in singleton gestations after hysteroscopic correction of septate uteri. There was no increased risk with septate uteri involving the cervix. Hysteroscopic surgical correction should be the treatment of choice for patients with septate uteri.
Trial registration number
Not Applicable
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Affiliation(s)
- O Abuzeid
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Nesconset, U.S.A
| | - C Heiselman
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Stony Brook, U.S.A
| | - A Fuchs
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Stony Brook, U.S.A
| | - J La Chance
- Hurley Medical Center/Michigan State University- College of Human Medicine, Department of Research, Flint, U.S.A
| | - K Herrera
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Stony Brook, U.S.A
| | - D Garry
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Stony Brook, U.S.A
| | - M Abuzeid
- - Department of Obstetrics and Gynecology- Hurley Medical Center/Michigan State University- College of Human Medicine, Division of Reproductive Endocrinology and Infertility, Flint, U.S.A
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5
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Abuzeid O, Heiselman C, Fuchs A, Chance JL, Herrera K, Garry D, Abuzeid M. P–746 Obstetric outcomes of singleton birth after hysteroscopic division of septate uterus. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
The aim of this study is to determine the obstetric outcomes in patients with a singleton birth after hysteroscopic division of septate uterus.
Summary answer
The data suggest excellent obstetric outcomes for singleton gestation after hysteroscopic division of a septate uterus reaching either the internal or the external cervical os.
What is known already
Septate uterus is a rare Müllerian anomaly with major impact on reproductive outcomes, particularly with a septum over 10mm. Controversy still exists over the need for surgical correction of the septum due to conflicting data on outcomes, particularly in women with histories of good obstetric outcomes and incidental septum findings. Placental location in relation to the septum may account for such conflicting reports. Most data on reproductive outcomes after hysteroscopic surgical correction combine both septate and subseptate uteri. There is limited published data on obstetric outcomes after hysteroscopic surgical correction of septate uteri, especially septate uteri reaching the external os.
Study design, size, duration
This retrospective cohort study included 107 patients with infertility and/or recurrent pregnancy loss (RPL) who received treatment between 2002 –2019. The study group included 24 patients with a singleton birth after hysteroscopic correction of septate uterus (Class Va; ASRM classification) that was diagnosed on trans-vaginal 3D ultrasound. The control group included 83 patients with a singleton birth who had normal endometrial cavity on hysteroscopy during the same period of time, before starting treatment.
Participants/materials, setting, methods
This study was conducted at an infertility clinic affiliated with a teaching hospital. In the study group the septum reached the internal or the external cervical os in 14 and 10 patients respectively. After hysteroscopic correction, all patients were offered various infertility treatments depending on the underlying etiology. The inclusion criterion in this study was to have a singleton birth after hysteroscopy. Demographic and clinical data and obstetric outcomes were compared between the two groups.
Main results and the role of chance
There was no significant difference in mean age, infertility duration, infertility type and incidence of male infertility or ovulatory disorders between the two groups. There was a significantly higher BMI (0.048), and a higher incidence of history of miscarriage (P = 0.002) and history of RPL (P = 0.017) in the study group. There was significant lower incidence of tubal factors infertility (P = 0.005) and endometriosis (P = 0.03) in the study group, therefore there was higher incidence of spontaneous conception (70.8% vs 19.3%; P = 0.000) and lower incidence of conception with IVF-ET (20.8% vs 66.3%; P = 0.000) in the study group compared to the control group respectively. There was significantly higher incidence of prophylactic cervical cerclage (17.4% vs 0%; P = 0.000), and delivery by CS (69.6% vs 41.2%; P = 0.019) and lower incidence of vaginal delivery (30.4% vs 58.8%; P = 0.019), in the study group compared to the control group. There was no significant difference in gestational age in weeks (38.3 + 1.8 vs 38.6 + 2.0), newborn birth weight in grams (3173.9 + 630.0 vs 3202.1 + 555.6), incidence of premature birth (12.5% vs 12.2%), or other obstetric complications (25% vs 17.6%) between the study and the control groups respectively. For premature births, mean gestational age was 34.3 + 0.47 and 34.6 + 1.2 weeks in the study and control groups respectively.
Limitations, reasons for caution
A retrospective study has its own inherent bias. Furthermore, the small sample size is explained by the fact that a septate uterus is a rare anomaly leading to difficulties finding cases and organizing a prospective study to achieve a larger sample size. A multicenter prospective study is needed.
Wider implications of the findings: Regardless of whether the septum reached the internal or external os, there were excellent obstetric outcomes in singleton gestations after hysteroscopic correction of septate uteri. There was no increased risk with septate uteri involving the cervix. Hysteroscopic surgical correction should be the treatment of choice for patients with septate uteri.
Trial registration number
Not applicable
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Affiliation(s)
- O Abuzeid
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Nesconset, USA
| | - C Heiselman
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Stony Brook, USA
| | - A Fuchs
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Stony Brook, USA
| | - J L Chance
- Hurley Medical Center/Michigan State University- College of Human Medicine, Department of Research, Flint, USA
| | - K Herrera
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Stony Brook, USA
| | - D Garry
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine, Stony Brook, USA
| | - M Abuzeid
- - Department of Obstetrics and Gynecology- Hurley Medical Center/Michigan State University- College of Human Medicine, Division of Reproductive Endocrinology and Infertility, Flint, USA
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Singh B, Gong W, Das S, Theisen J, Sierra-Pagan J, Yannopoulos D, Skie E, Shah P, Garry M, Garry D. Abstract 374: Etv2 Transcriptionally Regulates
Yes1
and Promotes Cell Proliferation During Embryogenesis. Circ Res 2019. [DOI: 10.1161/res.125.suppl_1.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Etv2, an Ets-transcription factor, governs the specification of the earliest hemato-endothelial progenitors during embryogenesis. While the transcriptional networks during hemato-endothelial development have been well described, the mechanistic details are incompletely defined. In the present study, we described a new role for Etv2 as a regulator of cellular proliferation via
Yes1
in mesodermal lineages. Analysis of an Etv2-ChIPseq dataset revealed significant enrichment of Etv2 peaks in the upstream regions of cell cycle regulatory genes relative to non-cell cycle genes. Our bulk-RNAseq analysis using the doxycycline-inducible Etv2 ES/EB system showed increased levels of cell cycle genes including
E2f4, Gadd45g
and
Ccne1
as early as 6h following Etv2 induction. Further, EdU-incorporation studies demonstrated that the induction of Etv2 resulted in a ~2.5-fold increase in cellular proliferation, supporting a proliferative role for Etv2 during differentiation. Next, we identified
Yes1
as the top-ranked candidate that was expressed in
Etv2-EYFP
+
cells at E7.75 and E8.25 using single cell RNA-seq analysis. Doxycycline-mediated induction of Etv2 led to an increase in
Yes1
transcripts in a dose-dependent fashion. In contrast, the level of
Yes1
was reduced in
Etv2 null
embryoid bodies. Using bioinformatics algorithms, biochemical, and molecular biology techniques, we show that Etv2 binds to the promoter region of
Yes1
and functions as a direct upstream regulator of
Yes1
during embryogenesis. These studies enhance our understanding of the mechanisms whereby Etv2 governs mesodermal fate decisions early during embryogenesis.
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7
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Desai N, Garry D. Assessing dynamic fluid-responsiveness using transthoracic echocardiography in intensive care. BJA Educ 2018; 18:218-226. [PMID: 33456836 DOI: 10.1016/j.bjae.2018.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- N Desai
- Northwick Park Hospital, London, UK
| | - D Garry
- John Radcliffe Hospital, Oxford, UK
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8
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Singh BN, Tahara N, Kawakami Y, Koyano-Nakagawa N, Gong W, Garry M, Garry D. Abstract 448:
Etv2-Mir130a-Jarid2
Cascade Regulates Vascular Patterning During Embryogenesis. Arterioscler Thromb Vasc Biol 2017. [DOI: 10.1161/atvb.37.suppl_1.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Remodeling of the pre-existing primitive vasculature is necessary for the formation of a complex branched vascular architecture. However, the factors that modulate these processes are incompletely defined. Previously, we defined the role of microRNAs (miRNAs) in endothelial specification. In the present study, we further examined the
Etv2-Cre
mediated ablation of
Dicer
L/L
and characterized the perturbed vascular patterning in the embryo proper and yolk-sac. We mechanistically defined an important role for
miR-130a
, an Etv2 downstream target, in the mediation of vascular patterning and angiogenesis
in vitro
and
in vivo
. Inducible overexpression of
miR-130a
resulted in robust induction of vascular sprouts and angiogenesis with increased uptake of acetylated-LDL. Mechanistically,
miR-130a
directly regulates
Jarid2
expression by binding to its
3’-UTR
region. CRISPR/Cas9 mediated knockout of
miR-130a
showed increased levels of
Jarid2
in the ES/EB system. Further, the levels of
Jarid2
transcripts were increased in the
Etv2-null
embryos at E8.5. In the
in vivo
settings, injection of
miR-130a
specific morpholinos in zebrafish embryos resulted in perturbed vascular patterning with reduced levels of endothelial transcripts in the
miR-130a
morphants. qPCR and
in situ hybridization
techniques demonstrated increased expression of
jarid2a
in the
miR-130a
morphants
in vivo
. These findings demonstrate a critical role for
Etv2-miR-130a-Jarid2
in vascular patterning both
in vitro
and
in vivo
.
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Affiliation(s)
| | | | | | | | | | - Mary Garry
- Lillehei Heart Institute, Minneapolis, MN
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9
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Lemire RL, Coble KF, Garry D, Thomas LL, Hastad CW, Burnett DD. 127 Effect of double stocking and nursery split-out age on wean-to-finish growth performance and economic parameters of growing pigs. J Anim Sci 2017. [DOI: 10.2527/asasmw.2017.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Cogswell R, Smith E, Hamel A, Bauman L, Herr A, Duval S, John R, Roman D, Adatya S, Colvin-Adams M, Garry D, Martin C, Missov E, Pritzker M, Roberts J, Eckman P. Substance abuse at the time of left ventricular assist device implantation is associated with increased mortality. J Heart Lung Transplant 2014; 33:1048-55. [DOI: 10.1016/j.healun.2014.06.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 05/05/2014] [Accepted: 06/18/2014] [Indexed: 11/28/2022] Open
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12
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Lu F, Eckman P, Liao K, Apostolidou I, John R, Chen T, Meyer P, Das G, Benditt D, Garry D. CATHETER ABLATION OF HEMODYNAMICALLY UNSTABLE VENTRICULAR TACHYCARDIA WITH MECHANICAL CIRCULATORY SUPPORT. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bosworth A, Garry D. An unusual cause of ‘failure to ventilate’. Anaesthesia 2011; 66:950-1. [DOI: 10.1111/j.1365-2044.2011.06877.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
A 33-year-old primipara with a previous low transverse Cesarean delivery underwent labor induction at 41 weeks' gestation with a 10-mg dinoprostone vaginal insert. Eleven hours later, with the cervix fully dilated, an emergency Cesarean delivery was performed because of repetitive variable decelerations followed by fetal bradycardia. A posterior uterine wall rupture extending from the fundus to the vagina was repaired in layers. The neonate had an Apgar score of 2 and 4 and expired on the 7th day of life.
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Affiliation(s)
- R Figueroa
- Department of Obstetrics and Gynecology, Winthrop-University Hospital, Mineola, New York, USA
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Putterman S, Figueroa R, Garry D, Maulik D. Comparison of obstetric outcomes in twin pregnancies after in vitro fertilization, ovarian stimulation and spontaneous conception. J Matern Fetal Neonatal Med 2009; 14:237-40. [PMID: 14738169 DOI: 10.1080/jmf.14.4.237.240] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare the outcomes of liveborn twin gestations conceived after in vitro fertilization (IVF) or ovarian stimulation with spontaneously conceived twin pregnancies. METHODS A review of all twin gestations delivered at Winthrop-University Hospital from 1 January 1999 to 31 December 2000. Women who underwent fetal reduction or had a demise of one twin were excluded. Maternal demographics, antepartum complications, mode of delivery and perinatal outcome were compared. RESULTS Sixty pregnancies were conceived after IVF, 34 were conceived by ovarian stimulation and 101 were spontaneously conceived. Women in the IVF group were older (p < 0.001), were more often 35 years or older (p < 0.001) and primiparous (p = 0.005). More women in the ovarian stimulation group had a poor obstetric history (p = 0.04). Spontaneous gestations had a higher incidence of monochorionic placentations (p = 0.002). There were no differences in gestational age at delivery, antepartum complications, or mode of delivery. There were fewer low-birth-weight neonates in the IVF group (odds ratio 0.59, 95% confidence interval 0.35-0.98; p = 0.03) than in the spontaneous group, but the difference disappeared when only the dichorionic pregnancies were compared. Other neonatal outcomes studied were the same among groups. CONCLUSION Twin gestations conceived following IVF and ovarian stimulation appear to have similar outcomes to spontaneously conceived twin gestations.
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Affiliation(s)
- S Putterman
- Department of Obstetrics and Gynecology, Winthrop-University Hospital, Mineola, New York, USA
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Elimian A, Lawlor P, Figueroa R, Wiencek V, Garry D, Quirk JG. Intrapartum assessment of fetal well-being: any role for a fetal admission test? J Matern Fetal Neonatal Med 2003; 13:408-13. [PMID: 12962267 DOI: 10.1080/jmf.13.6.408.413] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine whether the fetal admission test is predictive of intrapartum complications. METHODS We studied the fetal heart rate tracings of women in spontaneous labor at 37-42 weeks' gestation from 1 November 2001 to 31 March 2002. The study population was subdivided based on reactivity defined as > or = 15 beats/min for > or = 15 s, reactivity redefined as > or = 10 beats/min for > or = 10 s, variability, presence of late and/or variable decelerations, and reassuring fetal admission test; and compared for various labor outcome variables. Student's t test, the chi2 test and Fisher's exact test were used for analysis. RESULTS A total of 426 women met our inclusion criteria. There were no differences between groups when compared for maternal age, parity, gestational age, birth weight, labor analgesia and length of labor. Irrespective of the definition of reactivity, women with a non-reactive fetal admission test were more likely to be delivered by Cesarean section, to have fetal distress resulting in Cesarean section and to have a longer neonatal hospital stay. In addition, redefining reactivity improved the specificity, positive and negative predictive values, accuracy, relative risk and likelihood ratio with regard to development of fetal distress. Similar results were obtained when variability and decelerations were used as criteria for comparisons. CONCLUSION The fetal admission test is useful in predicting the absence of intrapartum fetal distress irrespective of the criterion used for evaluation. Redefined reactivity appears to be most predictive of intrapartum fetal distress.
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Affiliation(s)
- A Elimian
- Department of Obstetrics, Gynecology and Reproductive Medicine, State University of New York at Stony Brook, Stony Brook, New York 11794-8091, USA
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Garry D, Figueroa R, Kalish RB, Catalano CJ, Maulik D. Randomized controlled trial of vaginal misoprostol versus dinoprostone vaginal insert for labor induction. J Matern Fetal Neonatal Med 2003; 13:254-9. [PMID: 12854927 DOI: 10.1080/jmf.13.4.254.259] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare the safety and efficacy of vaginal misoprostol versus dinoprostone vaginal inserts for cervical ripening and labor induction. METHODS Two hundred singleton gestations with an indication for cervical ripening and induction of labor were randomized to receive either 50 microg of misoprostol intravaginally every 3 h or a 10-mg dinoprostone vaginal insert every 12 h for a maximum of 24 h. Statistical analysis included Student's t test, the Mann-Whitney U test, chi2 analysis and Fisher's exact test. RESULTS Ninety-seven women received vaginal misoprostol while 89 women received the dinoprostone vaginal insert. Fourteen women were removed from the study after randomization. The interval from start of induction to vaginal delivery (794.5 +/-408 min vs. 1005.3 +/- 523 min; p < 0.02) was significantly shorter in the misoprostol group. Women receiving misoprostol were more likely to deliver vaginally both in < 12 h (44% vs. 12%; p < 0.0001) and < 24 h (68% vs. 38%; p < 0.001). A non-reassuring fetal heart rate tracing was the indication for 71.4% (20/28) of Cesarean deliveries in the misoprostol group compared to 40% (14/35) in the dinoprostone group (p = 0.03). There were no significant differences in neonatal outcomes. CONCLUSION Intravaginal misoprostol and dinoprostone are safe and effective medications for use in cervical ripening before labor induction. Misoprostol results in a shorter interval from induction to delivery. However, Cesarean delivery for a non-reassuring fetal heart rate tracing was more common with misoprostol.
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Affiliation(s)
- D Garry
- Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York, USA
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Villella J, Garry D, Levine G, Glanz S, Figueroa R, Maulik D. Postpartum angiographic embolization for vulvovaginal hematoma. A report of two cases. J Reprod Med 2001; 46:65-7. [PMID: 11209635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Puerperal hematomas can become a life-threatening obstetric emergency. Their incidence is 1 or 2/1,000 deliveries. When mainstay methods of suture and packing fail, arterial embolization becomes an excellent alternative to definitive treatment, laparotomy. CASES A 32-year-old woman, para 2-0-2-2, developed extreme rectal and vulvar pain one hour postpartum. A 12 x 10-cm vulvovaginal hematoma was identified, drained, sutured and packed. Bleeding continued, blood products were administered, and selective angiographic embolization of the pudendal and inferior gluteal arteries was successfully performed. A 31-year-old woman, para 1-0-1-1, developed a left vaginal hematoma immediately postpartum. She failed vaginal packing and underwent angiographic arterial embolization successfully. The patient was discharged on the fourth postpartum day. At six weeks postpartum, neither patient had evidence of hematoma formation. CONCLUSION In the setting of a puerperal hematoma refractory to conventional first-line therapy, arterial embolization provides a rational, effective alternative for achieving hemostasis with minimal morbidity.
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Affiliation(s)
- J Villella
- Departments of Obstetrics and Gynecology and of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY 11501, USA
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Stapfer M, Selby RR, Stain SC, Katkhouda N, Parekh D, Jabbour N, Garry D. Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. Ann Surg 2000; 232:191-8. [PMID: 10903596 PMCID: PMC1421129 DOI: 10.1097/00000658-200008000-00007] [Citation(s) in RCA: 263] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the authors' experience with periduodenal perforations to define a systematic management approach. SUMMARY BACKGROUND DATA Traditionally, traumatic and atraumatic duodenal perforations have been managed surgically; however, in the last decade, management has shifted toward a more selective approach. Some authors advocate routine nonsurgical management, but the reported death rate of medical treatment failures is almost 50%. Others advocate mandatory surgical exploration. Those who favor a selective approach have not elaborated distinct management guidelines. METHODS A retrospective chart review at the authors' medical center from June 1993 to June 1998 identified 14 instances of periduodenal perforation related to endoscopic retrograde cholangiopancreatography (ERCP), a rate of 1.0%. Charts were reviewed for the following parameters: ERCP findings, clinical presentation of perforation, diagnostic methods, time to diagnosis, radiographic extent and location of duodenal leak, methods of management, surgical procedures, complications, length of stay, and outcome. RESULTS Fourteen patients had a periduodenal perforation. Eight patients were initially managed conservatively. Five of the eight patients recovered without incident. Three patients failed nonsurgical management and required extensive procedures with long hospital stays and one death. Six patients were managed initially by surgery, with one death. Each injury was evaluated for location and radiographic extent of leak and classified into types I through IV. CONCLUSIONS Clinical and radiographic features of ERCP-related periduodenal perforations can be used to stratify patients into surgical or nonsurgical cohorts. A selective management scheme is proposed based on the features of each type.
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Affiliation(s)
- M Stapfer
- Department of Surgery, University of Southern California-Los Angeles County and the University of Southern California Medical Center, Los Angeles, California 90033, USA
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Garry D, Figueroa R, Guillaume J, Cucco V. Use of castor oil in pregnancies at term. Altern Ther Health Med 2000; 6:77-9. [PMID: 10631825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
CONTEXT Despite wide use of castor oil to initiate labor, the obstetric literature contains few references to this botanical laxative. Derived from the castor plant Ricinus communis, castor oil may possess properties that are useful in post-term pregnancies. OBJECTIVE To evaluate the relationship between the use of castor oil and the onset of labor. DESIGN Prospective evaluation. SETTING A community hospital in Brooklyn, NY. PATIENTS A total of 103 singleton pregnancies with intact membranes at 40 to 42 weeks referred for antepartum testing. Inclusion criteria included cervical examination, Bishop score of 4 or less, and no evidence of regular uterine contractions. INTERVENTION Patients were alternately assigned to 1 of 2 study groups: a single oral dose of castor oil (60 mL) or no treatment. MAIN OUTCOME MEASURES Castor oil was considered successful if labor began within 24 hours after dosing. Groups were compared for onset of labor in 24 hours, method of delivery, presence of meconium-stained amniotic fluid, Apgar score, and birth weight. RESULTS Fifty-two women received castor oil and 48 were assigned no treatment. Following administration of castor oil, 30 of 52 women (57.7%) began active labor compared to 2 of 48 (4.2%) receiving no treatment. When castor oil was successful, 83.3% (25/30) of the women delivered vaginally. CONCLUSIONS Women who receive castor oil have an increased likelihood of initiation of labor within 24 hours compared to women who receive no treatment. Castor oil use in pregnancy is underreported worldwide. This small series represents the first attempt to evaluate the medication.
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Affiliation(s)
- D Garry
- Winthrop University Hospital in Mineola, NY, USA
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Abstract
BACKGROUND Biliopancreatic gallstone disorders (BPD) manifesting during pregnancy are relatively rare. The management of these conditions remains controversial. Although perioperative problems and fetal loss have been reported, recent publications have advocated an early surgical approach. PATIENTS AND METHODS Thirty-two pregnant women underwent operation for BPD between January 1993 and December 1997. The mean age was 29 years and ranged from 18 to 41 years. RESULTS Twelve patients underwent a laparoscopic cholecystectomy (LC), and 20 open cholecystectomies (OC), including two conversions from laparoscopic. Seven of the OC patients required additional open CBD exploration and intraoperative choledochoscopy for CBD stones. No maternal mortality was observed. A single fetal demise (3%) occurred for a patient with gallstone pancreatitis who underwent open cholecystectomy during her 14th week of gestation. CONCLUSIONS Early involvement of the obstetric team, with preoperative and postoperative fetal monitoring, and adequate management of anesthetic and tocolytic agents make cholecystectomy a safe procedure at any stage of pregnancy.
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Affiliation(s)
- C A Cosenza
- Department of Surgery, LAC/USC Medical Center, Los Angeles, California 90003, USA
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Affiliation(s)
- R B Kalish
- Department of Obstetrics and Gynecology, Winthrop-University Hospital, Mineola, New York, USA
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Garry D, Lysikiewicz A, Mays J, Canterino J, Tejani N. Intra-amniotic pressure reduction in twin-twin transfusion syndrome. J Perinatol 1998; 18:284-6. [PMID: 9730198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Our purpose was to measure intra-amniotic pressure before and after decompression amniocentesis in twin-twin transfusion syndrome. STUDY DESIGN Intra-amniotic pressures were measured during decompression amniocentesis on 18 occasions in 5 pregnancies complicated by twin-twin transfusion syndrome. The intra-amniotic pressure was determined with a water manometer before and after removal of amniotic fluid. For comparison, intra-amniotic pressure was determined in 10 uncomplicated gestations. RESULTS Initial intra-amniotic pressures in twin-twin transfusion gestations (mean, 17.2 +/- 5.2 cm H2O; range, 5.5 to 33.0 cm H2O) were higher than those of the uncomplicated gestations (mean, 8.4 +/- 3.3 cm H2O; range, 3.5 to 13.5 cm H2O; p < 0.002). Intra-amniotic pressures following therapeutic amniocentesis (mean, 10.9 +/- 5.1 cm H2O; range, 3.5 to 23.0 cm H2O) were not different from those of the uncomplicated gestations (p = 0.16). CONCLUSION The intra-amniotic pressure in twin-twin transfusion gestations is higher than that of the uncomplicated gestation. Decompression amniocentesis reduces intra-amniotic pressure to that of the uncomplicated gestation.
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Affiliation(s)
- D Garry
- Department of Obstetrics and Gynecology, New York Medical College, Westchester County Medical Center, Valhalla, USA
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Leikin E, Garry D, Visintainer P, Verma U, Tejani N. Correlation of neonatal nucleated red blood cell counts in preterm infants with histologic chorioamnionitis. Am J Obstet Gynecol 1997; 177:27-30. [PMID: 9240578 DOI: 10.1016/s0002-9378(97)70433-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to compare the neonatal nucleated red blood cell counts in preterm infants in the presence and absence of clinical and histologic chorioamnionitis while controlling for gestational age and birth weight percentile. STUDY DESIGN Nucleated red blood cell counts were obtained from preterm infants delivered after preterm labor or preterm premature rupture of membranes. Patients were divided on the basis of clinical and histologic chorioamnionitis. Nucleated red blood cell counts between groups were compared, and regression analysis controlling for gestational age and birth weight percentile was performed. RESULTS Of 359 patients, both measures of infection status were significantly associated with increased nucleated red blood cell counts. In the regression analysis histologic chorioamnionitis retained significance, whereas clinical chorioamnionitis did not. CONCLUSIONS Histologic chorioamnionitis produces an erythropoietic response in the fetus. Whether fetal erythropoiesis is a direct response to mediators of inflammation or whether it is the result of a rise in erythropoietin is unknown.
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Affiliation(s)
- E Leikin
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla 10595, USA
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Leikin E, Garry D, Visintainer P, Verma U, Tejani N. Correlation between nucleated red blood cell counts and histologic chorioamnionitis in preterm infants. Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80252-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Garry D, Figueroa R, Aguero-Rosenfeld M, Martinez E, Visintainer P, Tejani N. A comparison of rapid amniotic fluid markers in the prediction of microbial invasion of the uterine cavity and preterm delivery. Am J Obstet Gynecol 1996; 175:1336-41. [PMID: 8942511 DOI: 10.1016/s0002-9378(96)70051-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate amniotic fluid lactate dehydrogenase level in comparison with other rapid markers in prediction of microbial invasion of the uterine cavity and preterm delivery < or = 36 hours after amniocentesis. STUDY DESIGN One hundred thirty-one women in preterm labor with intact membranes underwent transabdominal amniocentesis. Amniotic fluid was analyzed for leukocyte count, glucose level, lactate dehydrogenase level, and Gram stain. Cultures for aerobes, anaerobes, and Mycoplasma sp. were performed. Amniocentesis-to-delivery interval was calculated. The study group was divided and the findings compared according to amniotic fluid culture results and according to amniocentesis-to-delivery interval. Sensitivity, specificity, and positive and negative predictive value were calculated for lactate dehydrogenase, leukocyte count, glucose, and Gram stain in the prediction of positive amniotic fluid culture and preterm delivery < or = 36 hours after amniocentesis. Receiver-operator characteristic curve analysis, logistic regression analysis, t tests, and nonparametric tests were used. RESULTS The prevalence of positive amniotic fluid cultures was 12% (16 of 131). The median lactate dehydrogenase level (1084 U/L) was significantly greater for women with a positive amniotic fluid culture than for those with a negative culture (median lactate dehydrogenase level 194 U/L; p < 0.0002). The critical values calculated for optimal performance in prediction of a positive amniotic fluid culture were a lactate dehydrogenase level > or = 419 U/L, leukocyte count > or = 50 cells/mm3 (50 x 10(6)/L) and glucose < or = 17 mg/dl (0.94 mmol/L). Lactate dehydrogenase, leukocyte count, glucose, and Gram stain were equally sensitive and specific in prediction of a positive amniotic fluid culture. Thirty-nine women (29.8%) gave birth < or = 36 hours after amniocentesis. The median lactate dehydrogenase level (414 U/L) was significantly greater among women giving birth < or = 36 hours after amniocentesis than among women giving birth > 36 hours after amniocentesis (median lactate dehydrogenase, 173 U/L; p < 0.001). Critical values of lactate dehydrogenase > or = 225 U/L, leukocyte count > or = 10 cells/mm3 (10 x 10(6)/L) and glucose < or = 34 mg/dl (1.9 mmol/L) were selected for optimal performance in prediction of amniocentesis-to-delivery interval < or = 36 hours. Lactate dehydrogenase level had the best sensitivity (74%) in prediction of delivery < or = 36 hours after amniocentesis in contrast to leukocyte count (49%), glucose (62%), and positive Gram stain (26%). Amniotic fluid lactate dehydrogenase values > or = 225 U/L were associated with a fivefold greater risk for delivery < or = 36 hours after amniocentesis (odds ratio 5.46, 95% confidence interval 2.00 to 14.87; p = 0.0006). CONCLUSION Amniotic fluid lactate dehydrogenase level has diagnostic value in prediction of a positive amniotic fluid culture and delivery < or = 36 hours after amniocentesis. Lactate dehydrogenase is a readily available, inexpensive, rapid amniotic fluid marker that can be measured in any hospital laboratory.
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Affiliation(s)
- D Garry
- Department of Obstetrics and Gynecology, Graduate School of Health Sciences, New York Medical College, Westchester County Medical Center, Valhalla 10595, USA
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Abstract
BACKGROUND Hepatitis A is a common, self-limited disease transmitted by fecal-oral contamination. CASE A 23-year-old woman, para 2-0-0-2, developed hepatitis A at 20 weeks' gestation. At 27 weeks, ultrasound revealed polyhydramnios and fetal ascites. Hepatitis A immunoglobulin M antibody in fetal blood obtained by funipuncture confirmed acute hepatitis A infection in the fetus. Polyhydramnios and ascites persisted until 35 weeks, when the fetus developed ultrasound signs of meconium peritonitis, and delivery was accomplished uneventfully. Meconium peritonitis was diagnosed in the neonatal period and treated surgically. CONCLUSION To our knowledge, this is the first report of intrauterine transmission of hepatitis A. The disease presented with fetal ascites and was confirmed by positive fetal blood serology.
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Affiliation(s)
- E Leikin
- Department of Obstetrics and Gynecology, New York Medical College/Westchester County Medical Center, Valhalla, USA
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Garry D, Leikin E, Fleisher AG, Tejani N. Acute myocardial infarction in pregnancy with subsequent medical and surgical management. Obstet Gynecol 1996; 87:802-4. [PMID: 8677093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Myocardial infarction is a rare event in pregnancy that requires medical stabilization with possible surgical interventions. CASE A 37-year-old woman developed an anterior wall myocardial infarction secondary to severe coronary artery disease during the early third trimester of pregnancy. The patient was managed with multiple modalities to stabilize her condition and prolong the gestation. The salient point in the management included: defibrillation and pharmacologic agents, intra-aortic balloon pump, coronary artery bypass graft surgery using a cardiopulmonary bypass pump while maintaining continuous fetal heart rate monitoring, and delivery of the neonate at term. CONCLUSION Aggressive management of this patient allowed continuation of pregnancy with good outcome for mother and neonate.
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Affiliation(s)
- D Garry
- Department of Obstetrics and Gynecology, New York Medical College, Westchester County Medical Center, Valhalla, USA
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Mays J, Gallousis F, Garry D, Verma U, Tejani N, Jeanty M. Duration of tocolysis and presence of genitourinary pathogens are not risk factors for periventricular leucomalacia (PVL) & major intraventricular hemorrhage (IVH) in preterm neonates. Am J Obstet Gynecol 1995. [DOI: 10.1016/0002-9378(95)91092-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Sixteen of thirty-five large-segment allografts that had been implanted after resection for neoplastic conditions, and had been followed for a minimum of thirty-six months, were found to have fractured at a mean of twenty-six months after the implantation. Thirteen of the fractures were treated operatively, and we found a lack of vascularization and soft-tissue attachments to the graft at the fracture site. For seven fractured grafts, there were radiographic and clinical signs of union with the host bone. Eight of the sixteen grafts that had fractured were salvaged with one or more autogenous bone grafts, and two healed spontaneously. Thus, twenty-nine of the thirty-five grafting procedures were considered to have been successful in that the initial objective--provision of a functional segment for skeletal replacement--had been achieved. Multivariate analysis revealed a significant correlation for fracture in patients who were receiving chemotherapy when internal fixation of the graft had included devices that penetrated the cortices of the graft (p < 0.05).
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Affiliation(s)
- R C Thompson
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis 55455
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Vawter DE, Kearney W, Gervais KG, Caplan AL, Garry D, Tauer C. The use of human fetal tissue: scientific, ethical, and policy concerns (January 1990). J Int Bioethique 1991; 2:189-96. [PMID: 11654900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The use of fetal tissue in transplants for treating illnesses such as Parkinson's disease and juvenile diabetes has raised the hopes of patients, their families, and the biomedical community. But, this practice has created considerable controversy. Concerns arise because tissue is usually obtained from electively aborted fetuses. Despite the controversy, there has been little systematic and sustained examination of the ethical and policy issues posed by the use of fetal tissue in biomedicine. The lack of information and analysis hampers serious discussion. In the Spring of 1988, the Center for Biomedical Ethics began an interdisciplinary research project on the scientific, ethical, and policy issues raised by the use of fetal tissue in biomedicine. Twenty-five scholars, drawn mainly, but not exclusively, from the faculty of the University of Minnesota, met to undertake the study. The members of this research group included experts in neonatology, pediatrics, neurology, neurosurgery, organ transplantation, tissue procurement, cell biology, immunology, epidemiology, law, philosophy, moral theology, and the behavioral sciences. The group met every three weeks over a period of ten months to collect and review information about the use of fetal tissue -- with special attention to transplantation -- the potential sources of fetal tissue, and the relevant laws and guidelines in the U.S. and other nations. Six members of the research group had primary responsibility for writing this report.
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