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Campbell LJ, Mummaneni PV, Letchuman V, Langnas E, Agarwal N, Guan LS, Croci R, Vargas E, Reisner L, Bickler P, Chou D, Chang E, Guan Z. Mismatched opioid prescription in patients discharged after neurological surgeries: a retrospective cohort study. Pain 2023; 164:2615-2621. [PMID: 37326642 DOI: 10.1097/j.pain.0000000000002966] [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] [Received: 02/15/2023] [Accepted: 04/22/2023] [Indexed: 06/17/2023]
Abstract
ABSTRACT Although postsurgical overprescription has been well-studied, postsurgical opioid underprescription remains largely overlooked. This retrospective cohort study was to investigate the extent of discharge opioid overprescription and underprescription in patients after neurological surgeries. Six thousand nine hundred forty-nine adult opioid-naive patients who underwent inpatient neurosurgical procedures at the University of California San Francisco were included. The primary outcome was the discrepancy between individual patient's prescribed daily oral morphine milligram equivalent (MME) at discharge and patient's own inpatient daily MME consumed within 24 hours of discharge. Analyses include Wilcoxon, Mann-Whitney, Kruskal-Wallis, and χ 2 tests, and linear or multivariable logistic regression. 64.3% and 19.5% of patients were opioid overprescribed and underprescribed, respectively, with median prescribed daily MME 360% and 55.2% of median inpatient daily MME in opioid overprescribed and underprescribed patients, respectively. 54.6% of patients with no inpatient opioid the day before discharge were opioid overprescribed. Opioid underprescription dose-dependently increased the rate of opioid refill 1 to 30 days after discharge. From 2016 to 2019, the percentage of patients with opioid overprescription decreased by 24.8%, but the percentage of patients with opioid underprescription increased by 51.2%. Thus, the mismatched discharge opioid prescription in patients after neurological surgeries presented as both opioid overprescription and underprescription, with a dose-dependent increased rate of opioid refill 1 to 30 days after discharge in opioid underprescription. Although we are fighting against opioid overprescription to postsurgical patients, we should not ignore postsurgical opioid underprescription.
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Affiliation(s)
- Liam J Campbell
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, United States
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, United States
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Vijay Letchuman
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Erica Langnas
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, United States
| | - Nitin Agarwal
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St Louis, MO, United States
| | - Lucy S Guan
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, United States
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Rhiannon Croci
- UCSF Health Informatics, University of California San Francisco, San Francisco, CA, United States
| | - Enrique Vargas
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Lori Reisner
- Department of Clinical Pharmacology, University of California San Francisco, San Francisco, CA, United States
| | - Phil Bickler
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, United States
| | - Dean Chou
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurosurgery, Columbia University, New York, NY, United States
| | - Edward Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Zhonghui Guan
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, United States
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Vargas E. Erratum. Does surgery for metastatic spinal tumors improve functional outcomes in patients without spinal cord compression but with potentially unstable spines? J Neurosurg Spine 2023:1. [PMID: 37347652 DOI: 10.3171/2023.5.spine221120a] [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: 06/24/2023]
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Vargas E, Shabani S, Mummaneni PV, Park C, Rechav Ben-Natan A, Rivera JJ, Huang J, Berven S, Braunstein S, Chou D. Does surgery for metastatic spinal tumors improve functional outcomes in patients without spinal cord compression but with potentially unstable spines? J Neurosurg Spine 2023:1-8. [PMID: 37148234 DOI: 10.3171/2023.3.spine221120] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/21/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE In the absence of spinal cord compression, it is unclear if surgery is more effective than radiation treatment for improving functional outcomes in metastatic spinal tumor patients with potentially unstable spines. The authors compared functional status outcomes assessed with Karnofsky Performance Status (KPS) and Eastern Cooperative Oncology Group (ECOG) scores after surgery or radiation in patients without spinal cord compression with Spine Instability Neoplastic Score (SINS) values of 7-12 indicating possible instability (SINS 7-12). METHODS A retrospective review was performed of patients with metastatic spinal tumor SINS values of 7-12 at a single institution between 2004 and 2014. Patients were divided into two different groups: 1) those treated with surgery and 2) those treated with radiation. Baseline clinical characteristics were measured, and KPS and ECOG scores were obtained pre- and postradiation or postsurgery. The paired, nonparametric Wilcoxon signed-rank test and ordinal logistic regression analysis were used for statistical analysis. RESULTS A total of 162 patients met inclusion criteria; 63 patients were treated operatively and 99 patients were treated with radiation. The mean follow-up was 1.9 years, with a median of 1.1 years for the surgical cohort (ranging from 2.5 months to 13.8 years) and a mean of 2 years with a median of 0.8 years for the radiation cohort (ranging from 2 months to 9.3 years). After covariates were accounted for, the average posttreatment changes in KPS scores in the surgical cohort were 7.46 ± 17.3 and in the radiation cohort were -2 ± 13.6 (p = 0.045). No significant difference was observed in ECOG scores. KPS scores improved postoperatively in 60.3% of patients in the surgical group and postradiation in 32.3% of patients in the radiation cohort (p < 0.001). Subanalysis within the radiation cohort revealed no differences in fracture rates or local control between patients treated with external-beam radiation therapy versus stereotactic body radiation therapy. In patients initially treated with radiation, 21.2% eventually developed compression fractures at a treated level. Five of the 99 patients in the radiation cohort-all of whom had a fracture-eventually underwent either methyl methacrylate augmentation or instrumented fusion. CONCLUSIONS Patients with SINS values of 7-12 who underwent surgery had greater improvement in KPS scores-but not in ECOG scores-than patients undergoing radiation alone. In patients treated with radiation, treatment was converted to a procedural intervention such as surgery only in patients who sustained fractures. Of the patients with fractures after radiation (21 of 99), 5 patients underwent an invasive procedure and 16 did not.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Steve Braunstein
- 3Radiation Oncology, University of California, San Francisco, California; and
| | - Dean Chou
- Departments of1Neurological Surgery
- 4Department of Neurological Surgery, Columbia University, New York, New York
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Vargas E, Haddad AF, Vasudevan H, Jacques LG, Mummaneni PV. 150 Genetic Markers of Peripheral Nerve Tumors: Results From the UCSF500 Cancer Gene Panel. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_150] [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: 03/18/2023] Open
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Rodríguez-Jiménez P, Reymundo-Jiménez A, Delgado-Jiménez Y, Gallo E, Navarro R, Vargas E, Castillo V, Hernández I, Torres E, Rodríguez-Campo F, Tejera-Vaquerizo A. Sentinel Lymph Node Biopsy in Elderly Melanoma Patients: A Real Practice Cohort. Actas Dermo-Sifiliográficas 2023; 114:T462-T466. [PMID: 37030564 DOI: 10.1016/j.ad.2023.04.009] [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] [Received: 02/09/2022] [Accepted: 05/23/2022] [Indexed: 04/08/2023] Open
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Nunez T, Meyerson G, Alani M, Elahi S, Vargas E. Supersensitivity Psychosis with Acute Dystonia. HCA Healthc J Med 2023; 4:57-60. [PMID: 37426559 PMCID: PMC10327954 DOI: 10.36518/2689-0216.1465] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Introduction Supersensitivity psychosis is a phenomenon that occurs with chronic usage of antipsychotics secondary to treatment resistance. At this time, there are no standardized guidelines regarding the management of supersensitivity psychosis. Case Presentation We present a case of a patient with schizoaffective disorder who developed supersensitivity psychosis and acute dystonia in response to discontinuing psychotropic medications, including high-dose quetiapine and olanzapine. The patient presented with excessive anxiety, paranoia, bizarre thoughts, and generalized dystonia affecting the face, trunk, and extremities. We treated the patient with olanzapine, valproic acid, and diazepam, which alleviated the psychosis back to baseline and significantly improved the dystonia. Despite compliance, the patient returned for inpatient stabilization due to depressive symptoms and worsening of the dystonia. During the second admission, the patient required further modification of psychotropics and supplemental electroconvulsive therapy. Conclusion In this paper, we discuss the proposed treatment of supersensitivity psychosis, including the role that electroconvulsive therapy may play in alleviating supersensitivity psychosis and associated movement disorders. We hope to expand the knowledge of additional neuromotor manifestations in supersensitivity psychosis and the management of this unique presentation.
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Affiliation(s)
- Tatiana Nunez
- UCF/HCA Healthcare Graduate Medical Education Consortium, Psychiatry Residency Program, Orlando, FL
- HCA Florida Osceola Hospital, Kissimmee, FL
| | - Gabriella Meyerson
- UCF/HCA Healthcare Graduate Medical Education Consortium, Psychiatry Residency Program, Orlando, FL
- HCA Florida Osceola Hospital, Kissimmee, FL
| | - Mays Alani
- HCA Florida Osceola Hospital, Kissimmee, FL
- UCF/HCA Healthcare Graduate Medical Education Consortium, Neurology Residency Program, Orlando, FL
| | - Shahid Elahi
- UCF/HCA Healthcare Graduate Medical Education Consortium, Psychiatry Residency Program, Orlando, FL
- HCA Florida Osceola Hospital, Kissimmee, FL
| | - Enrique Vargas
- UCF/HCA Healthcare Graduate Medical Education Consortium, Psychiatry Residency Program, Orlando, FL
- HCA Florida Osceola Hospital, Kissimmee, FL
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Rodríguez-Jiménez P, Reymundo-Jiménez A, Delgado-Jiménez Y, Gallo E, Navarro R, Vargas E, Castillo V, Hernández I, Torres E, Rodríguez-Campo F, Tejera-Vaquerizo A. Sentinel Lymph Node Biopsy in Elderly Melanoma Patients: A Real Practice Cohort. Actas Dermosifiliogr 2023; 114:462-466. [PMID: 36750157 DOI: 10.1016/j.ad.2022.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/23/2022] [Indexed: 02/07/2023] Open
Affiliation(s)
- P Rodríguez-Jiménez
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain.
| | - A Reymundo-Jiménez
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Y Delgado-Jiménez
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - E Gallo
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - R Navarro
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - E Vargas
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - V Castillo
- Department of Nuclear Medicine, Hospital Universitario de La Princesa, Madrid, Spain
| | - I Hernández
- Department of Nuclear Medicine, Hospital Universitario de La Princesa, Madrid, Spain
| | - E Torres
- Department of General Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | - F Rodríguez-Campo
- Department of Oral and Maxillofacial Surgery, Hospital Universitario de La Princesa, Madrid, Spain
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Vargas E, Mummaneni PV, Rivera J, Huang J, Berven SH, Braunstein SE, Chou D. Wound complications in metastatic spine tumor patients with and without preoperative radiation. J Neurosurg Spine 2023; 38:265-270. [PMID: 36461846 DOI: 10.3171/2022.8.spine22757] [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: 08/06/2022] [Accepted: 08/19/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Wound complications are a common adverse event following metastatic spine tumor surgery. Some patients with spinal metastases may first undergo radiation but eventually require spinal surgery because of either cord compression or instability. The authors compared wound complication rates in patients who had undergone surgery for metastatic disease and received preoperative radiation treatments, postoperative radiation, or no radiation. METHODS Records from patients treated at the University of California, San Francisco, for metastatic spine disease between 2005 and 2017 were retrospectively reviewed. Baseline characteristics were collected, including preoperative Karnofsky Performance Status (KPS), Spine Instability Neoplastic Score, total radiation dose, indication for surgery, diabetes status, time between radiation and surgery, use of perioperative chemotherapy or steroids, estimated blood loss, extent of fusion, and preoperative albumin level. Wound complication was defined as poor healing, dehiscence, or infection per the Centers for Disease Control and Prevention guidelines, within 6 months of surgery. One-way ANOVA was used to compare means across groups. Cumulative incidence analysis with competing risk methodology was used to adjust for risk of death during follow-up. Statistical analysis was performed using R software. RESULTS Two hundred five patients with adequate medical records were identified. Seventy patients had received preoperative radiation, 74 had received postoperative radiation within 6 months after surgery, and 61 had received no radiation at the surgical site. Wound complication rates were similar across the 3 cohorts: 14.3% (n = 10) in the group with preoperative radiation, 10.8% (n = 8) in the group that received postoperative radiation, and 11.5% (n = 7) in the group with no radiation (p = 0.773). Competing risk analysis showed a higher cumulative incidence of wound complications for the preoperative cohort, though this difference was not significant (p = 0.46). Overall, 89 patients were treated with external beam radiation therapy (EBRT), whereas 55 received stereotactic body radiation therapy (SBRT). There was no significant difference in wound complications for patients treated with EBRT (11.2%, n = 10) versus SBRT (14.5%, n = 8; p = 0.825). KPS was the only factor correlated with wound complications on univariate analysis (p = 0.03). CONCLUSIONS Wound complication rates did not differ across the 3 cohorts: patients treated with preoperative radiation, postoperative radiation within 6 months of surgery, or no radiation. The effect size was small for KPS and likely does not represent a clinically significant predictor of wound complications.
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Affiliation(s)
- Enrique Vargas
- Departments of1Neurosurgery
- 4School of Medicine, University of California, San Francisco, California
| | | | | | | | - Sigurd H Berven
- 3Orthopedic Surgery, University of California, San Francisco; and
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Vargas E, Mummaneni PV, Rivera J, Kolluri K, Berven S, Chou D. Adjacent Segment Vertebral Body Bone Density Changes as Measured By Hounsfield Units After Lumbar Spine Fusion. World Neurosurg 2022; 167:e464-e468. [PMID: 35964902 DOI: 10.1016/j.wneu.2022.08.033] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to evaluate Hounsfield units (HU) at the adjacent segment after single-level transforaminal lumbar interbody fusion (TLIF) with preoperative and postoperative computed tomography scans. METHODS We performed a retrospective study on a series of patients who underwent L4-5 TLIF, from 2007 to 2017, by 3 spine surgeons at our institution. One-hundred and forty-three total patients were identified, and 41 patients with minimum 1-year follow-up met inclusion criteria. HU values were measured on preoperative and postoperative computed tomography at the adjacent L3 segment and at L1 as a control arm. Lumbar lordosis, pelvic tilt, pelvic incidence, sacral slope, and sagittal vertical axis were also collected preoperatively and postoperatively. RESULTS Mean preoperative HU value at L3 did not differ from the postoperative value (134.11 ± 47.14 mg/cm3 vs. 141.21 ± 55.14 mg/cm3, P = 0.34). Similarly, the mean preoperative HU value at the L1 control level region of interest did not differ from the postoperative value (150.17 ± 53.91 mg/cm3 vs. 145.78 ± 58.34 mg/cm3, P = 0.634). The interrater reliability of HU measurements was satisfactory with a resulting intraclass correlation coefficient of 0.76. CONCLUSIONS As measured by HU, we did not observe a change in bone density or other signs of adjacent segment disease at the L3 vertebral body 12 months after L4-5 TLIF. Spinopelvic parameters were not shown to be correlated with HU changes.
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Affiliation(s)
- Enrique Vargas
- Department of Neurosurgery, University of California, San Francisco, California, USA.
| | - Praveen V Mummaneni
- Department of Neurosurgery, University of California, San Francisco, California, USA
| | - Joshua Rivera
- Department of Neurosurgery, University of California, San Francisco, California, USA
| | - Kamal Kolluri
- Department of Neurosurgery, University of California, San Francisco, California, USA
| | - Sigurd Berven
- Department of Orthopedic Surgery, University of California, San Francisco, California, USA
| | - Dean Chou
- Department of Neurosurgery, University of California, San Francisco, California, USA
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Canha-Gouveia A, Casas A, Antón A, Vargas E, Salas-Espejo E, Prieto-Sánchez M, Sánchez-Ferrer M, Altmae S, Coy P. P-331 The female upper reproductive tract of fertile women harbour endogenous microbial profiles. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.315] [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
Do the Fallopian Tubes from fertile women harbor microbial communities and are they similar to the endometrial microbiome?
Summary answer
Fallopian tubes have their own microbiome which is greatly shared with endometrial microbial profiles of the same women.
What is known already
The vaginal milieu is known to have an active microbiome (>90% of Lactobacillus), but the microbial composition of the upper reproductive tract is not well established, especially in the Fallopian tubes. The first studies on the Fallopian tubes from women diagnosed with a benign disease or for prophylaxis suggest that this site supports an endogenous microbiome (Pelzer ES et al Oncotarget 2018; Miles SM et al Fertil Steril 2017). However, today we lack the knowledge of the microbial composition in Fallopian tubes in the non-diseased conditions (as biopsing these sites may hamper the tissue and future fertility).
Study design, size, duration
A pilot-study with 6 fertile women with benign uterine pathology submitted to abdominal hysterectomy or tubal ligation at Hospital Universitario Virgen de Arrixaca Murcia were included into the study. The samples were collected between January and July 2019.
Participants/materials, setting, methods
Fallopian tubes and endometrial samples were collected as previously described (Canha-Gouveia A et al Int J Mol Sci 2019) from women submitted to abdominal hysterectomy and women submitted a tubal ligation. After DNA extraction “Ion 16S Metagenomics Kit” (Ion Torrent) was used to exploit the V5 to V9 regions of the 16S rRNA gene. Primary data analysis was performed with Torrent Suite™ Software v5.12.1 and advanced analysis using Ion Reporter™ software v5.18.0.2.
Main results and the role of chance
In our study, distinct microbial community profiles in the Fallopian tubes confirm that this genital tract site harbors an endogenous microbiome and in big part is shared with the endometrial microbial profile (over 60% of the detected taxa). Since in humans the intramural portion of the uterine tube does not allow a real physical separation between the fallopian tube and uterine environments, the obtained results were expected. Nevertheless, 43 bacterial taxa were exclusively detected in the Fallopian tubes (FDR<0.05) that included Abiotrophia, Aeromonas, Aggregatibacter Weissella, Wolinella, and Zoogloea among others.
Limitations, reasons for caution
This is a pilot study with a limited number of samples, and more studies with a bigger sample size are warranted.
Wider implications of the findings
Distinct microbial community profiles in the Fallopian tubes from the uterus suggest that this upper reproductive site supports an endogenous microbiome, which can play a role in the fertilization process.
Trial registration number
not applicable
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Affiliation(s)
- A Canha-Gouveia
- Faculty of Sciences- University of Granada-, Department of Biochemistry and Molecular Biology I , Granada 18071, Spain
| | - A Casas
- Faculty of Sciences- University of Granada-, Department of Biochemistry and Molecular Biology I , Granada 18071, Spain
| | - A.I Antón
- Institute for Biomedical Research of Murcia IMIB-Arrixaca, Genomics Unit , Murcia 30120, Spain
| | - E Vargas
- Faculty of Sciences- University of Granada-, Department of Biochemistry and Molecular Biology I , Granada 18071, Spain
- Systems Biology Unit- Faculty of Experimental Sciences- University of Jaen, Department of Experimental Biology , Jaen 23071, Spain
- Instituto de Investigación Biosanitaria ibs., Instituto de Investigación Biosanitaria ibs. , Granada 18014, Spain
| | - E Salas-Espejo
- Faculty of Sciences- University of Granada-, Department of Biochemistry and Molecular Biology I , Granada 18071, Spain
| | - M.T Prieto-Sánchez
- Institute for Biomedical Research of Murcia IMIB-Arrixaca, Institute for Biomedical Research of Murcia IMIB-Arrixaca , Murcia 30120, Spain
- “Virgen de la Arrixaca” University Clinical Hospital, Department of Obstetrics and Gynecology , Murcia 30120, Spain
| | - M.L Sánchez-Ferrer
- Institute for Biomedical Research of Murcia IMIB-Arrixaca, Institute for Biomedical Research of Murcia IMIB-Arrixaca , Murcia 30120, Spain
- “Virgen de la Arrixaca” University Clinical Hospital, Department of Obstetrics and Gynecology , Murcia 30120, Spain
| | - S Altmae
- Faculty of Sciences- University of Granada-, Department of Biochemistry and Molecular Biology I , Granada 18071, Spain
- Instituto de Investigación Biosanitaria ibs., Instituto de Investigación Biosanitaria ibs. , Granada 18014, Spain
- Competence Centre on Health Technologies, Competence Centre on Health Technologies- , Tartu 50410, Estonia
| | - P Coy
- Institute for Biomedical Research of Murcia IMIB-Arrixaca, Institute for Biomedical Research of Murcia IMIB-Arrixaca , Murcia 30120, Spain
- Faculty of Veterinary- University of Murcia, Department of Physiology , Murcia 30100, Spain
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Molina N, Sola-Leyva A, Vargas E, Canha-Gouveia A, Sáez-Lara M, Romero B, Sánchez R, Fontes J, Mozas-Moreno J, Martínez L, Castilla J, Aguilera C, Altmäe S. P-423 Metabolomic profiles of receptive-phase endometrium in women with different infertility diagnosis. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.400] [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
What is the entire metabolomic profile of receptive-phase human endometrium and does the metabolic composition differ between women with different infertility diagnosis?
Summary answer
Human endometrium contains 925 different metabolites from diverse chemical classes, and the metabolomic signature varies between women with different infertility diagnosis.
What is known already
Different metabolites have been identified in human endometrium, including amino acids, nucleosides/nucleotides, organic acids, lipids, and sugars, with main focus on lipid profiles in endometriosis. Metabolic dysregulation in the uterus has been shown to provoke complex effects in the endometrium, leading to a low rate of embryo implantation and endometriosis. These are the first studies highlighting the importance of metabolites (metabolic routes) in endometrial functions and more research in the field is warranted. Further, the previous studies have focussed on specific metabolite classes, and we lack the knowledge of the whole metabolome composition in human uterus.
Study design, size, duration
This cross-sectional study included in total 47 women (age= 34.7±3.8 years, BMI= 24.5±4.2 kg/m²) who attended the Reproduction Unit at the University Hospital Granada from March 2019 to April 2021. Women with endometriosis (n = 13), unexplained infertility (n = 10), recurrent implantation failure (RIF) (n = 15) and male factor infertility (n = 9) were included. The study was approved by the Ethics Committee of Investigación Biomédica de Andalucia.
Participants/materials, setting, methods
Endometrial biopsies were collected at the mid-secretory phase (LH + 7) of a natural cycle using Pipelle curette. The complete metabolome from endometrial samples was analysed by Ultrahigh Performance Liquid Chromatography-Tandem Mass Spectroscopy (UPLC-MS/MS). Raw data were extracted, peak-identified and quality control processed using Metabolon’s hardware and software (metabolon.com). Multiple regression models controlling for age and BMI were applied using R software.
Main results and the role of chance
We provide the whole metabolome profile of endometrium, where 925 different metabolites were identified. Among these metabolites, lipid metabolites comprised the largest percentage (44%), where long chain fatty acids such as myristate (14:0), palmitoleate (16:1n7), nonadecanoate (19:0), arachidate (20:0), and dihomo-linolenate (20:3n3 or n6) prevailed. The endometrial metabolomic profiles differed significantly between women with different infertility diagnosis (p <0.05). Overall, the metabolites of the lipid and protein metabolism were less present, while carbohydrates, nucleotides, and xenobiotics were predominant in the uterus of women with unexplained infertility, endometriosis, and RIF when compared to women with male factor infertility. Specifically, the metabolites linoleate (18:2n6), linolenate (18:3n3 or n6), and dihomo-linolenate (20:3n3 or n6) were less abundant in women with indication of dysfunctional endometrium (endometriosis and RIF) (FDR p -value<0.05).
Limitations, reasons for caution
This is the first study presenting the complete metabolome of human endometrium on a limited sample size, which might have been underpowered to detect all differences in metabolite composition between groups.
Wider implications of the findings
This study identifies a metabolomic profiles associated with infertility diagnoses where altered endometrial functions are suspected (RIF and endometriosis). Our study findings could help to understand the molecular background of female infertility and lead to identification of potential molecular biomarkers of endometrial functions involved in embryo implantation and infertility.
Trial registration number
not applicable
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Affiliation(s)
- N.M Molina
- University of Granada, Department of Biochemistry and Molecular Biology- Faculty of Sciences , Granada, Spain
- ibs.GRANADA, Instituto de Investigación Biosanitaria , Granada, Spain
| | - A Sola-Leyva
- University of Granada, Department of Biochemistry and Molecular Biology- Faculty of Sciences , Granada, Spain
- ibs.GRANADA, Instituto de Investigación Biosanitaria , Granada, Spain
| | - E Vargas
- University of Granada, Department of Biochemistry and Molecular Biology- Faculty of Sciences , Granada, Spain
- ibs.GRANADA, Instituto de Investigación Biosanitaria , Granada, Spain
- University of Jaen, Department of Experimental Biology- Faculty of Experimental Sciences , Jaen, Spain
| | - A Canha-Gouveia
- University of Granada, Department of Biochemistry and Molecular Biology- Faculty of Sciences , Granada, Spain
| | - M.J Sáez-Lara
- University of Granada, Department of Biochemistry and Molecular Biology- Faculty of Sciences , Granada, Spain
- ibs.GRANADA, Instituto de Investigación Biosanitaria , Granada, Spain
- University of Granada, Institute of Nutrition and Food Technology “José Mataix”- Centre of Biomedical Research , Granada, Spain
| | - B Romero
- ibs.GRANADA, Instituto de Investigación Biosanitaria , Granada, Spain
- HU Virgen de las Nieves, Unidad Reproducción- UGC Laboratorio clínico y UGC Obstetricia y Ginecología , Granada, Spain
| | - R Sánchez
- HU Virgen de las Nieves, Unidad Reproducción- UGC Laboratorio clínico y UGC Obstetricia y Ginecología , Granada, Spain
| | - J Fontes
- ibs.GRANADA, Instituto de Investigación Biosanitaria , Granada, Spain
- HU Virgen de las Nieves, Unidad Reproducción- UGC Laboratorio clínico y UGC Obstetricia y Ginecología , Granada, Spain
| | - J Mozas-Moreno
- ibs.GRANADA, Instituto de Investigación Biosanitaria , Granada, Spain
- HU Virgen de las Nieves, Unidad Reproducción- UGC Laboratorio clínico y UGC Obstetricia y Ginecología , Granada, Spain
| | - L Martínez
- ibs.GRANADA, Instituto de Investigación Biosanitaria , Granada, Spain
- HU Virgen de las Nieves, Unidad Reproducción- UGC Laboratorio clínico y UGC Obstetricia y Ginecología , Granada, Spain
| | - J.A Castilla
- ibs.GRANADA, Instituto de Investigación Biosanitaria , Granada, Spain
- HU Virgen de las Nieves, Unidad Reproducción- UGC Laboratorio clínico y UGC Obstetricia y Ginecología , Granada, Spain
- CEIFER, Nextclinics , Granada, Spain
| | - C.M Aguilera
- ibs.GRANADA, Instituto de Investigación Biosanitaria , Granada, Spain
- University of Granada, Institute of Nutrition and Food Technology “José Mataix”- Centre of Biomedical Research , Granada, Spain
- University of Granada, Department of Biochemistry and Molecular Biology- Faculty of Pharmacy , Granada, Spain
- Instituto de Salud Carlos III, CIBEROBN CIBER Physiopathology of Obesity and Nutrition , Madrid, Spain
| | - S Altmäe
- University of Granada, Department of Biochemistry and Molecular Biology- Faculty of Sciences , Granada, Spain
- Karolinska Institute, Division of Obstetrics and Gynaecology- CLINTEC , Stockholm, Sweden
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12
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Vargas E, García-Moreno E, Aghajanova L, Salumets A, Horcajadas JA, Esteban FJ, Altmäe S. The mid-secretory endometrial transcriptomic landscape in endometriosis: a meta-analysis. Hum Reprod Open 2022; 2022:hoac016. [PMID: 35464885 PMCID: PMC9022214 DOI: 10.1093/hropen/hoac016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 03/16/2022] [Indexed: 12/01/2022] Open
Abstract
STUDY QUESTION Do women with endometriosis have a different endometrial gene expression profile at the time of embryo implantation than women without endometriosis? SUMMARY ANSWER The endometrial gene expression profile of women with endometriosis differs from that of women without endometriosis at the mid-secretory phase, although the differences are small. WHAT IS KNOWN ALREADY About 50% of women with endometriosis suffer infertility. Several molecular studies have suggested impaired endometrial receptivity in women with endometriosis, while others have detected no dysregulation of endometrial receptivity. Nevertheless, the previous endometrial transcriptome studies comparing women with and without endometriosis have been performed in small sample size with limited statistical power. We set out to systematically search and compile data of endometrial gene expression signatures at the receptive phase in women with endometriosis versus control women. Based on the obtained data, we conducted a meta-analysis of differentially expressed genes in order to raise the power of the analysis for identifying the molecular profiles of receptive phase endometria in endometriosis. STUDY DESIGN, SIZE, DURATION A systematic literature search was conducted up to February 2022 following PRISMA criteria and included PubMed, Cochrane and Web of Science databases. For the systematic search, the term ‘endometriosis’ was paired with the terms ‘transcriptomics’, ‘transcriptome’, ‘gene expression’, ‘RNA-seq’, ‘sequencing’ and ‘array’, by using the Boolean operator ‘AND’ to connect them. Articles written in English were screened and interrogated for data extraction. PARTICIPANTS/MATERIALS, SETTING, METHODS A meta-analysis was performed on the selected studies to extract the differentially expressed genes described at the mid-secretory phase in women with endometriosis versus women without endometriosis in natural cycles, using the robust rank aggregation method. In total, transcriptome data of 125 women (78 patients and 47 controls) were meta-analysed, with a special focus on endometrial receptivity-specific genes based on commercial endometrial receptivity tests. MAIN RESULTS AND THE ROLE OF CHANCE In total, 8 studies were eligible for the quantitative meta-analysis, gathering transcriptome data from the mid-secretory phase endometria of 125 women. A total of 7779 differentially expressed transcripts between the study groups were retrieved (3496 up-regulated and 4283 down-regulated) and were meta-analysed. After stringent multiple correction, there was no differential expression of any single molecule in the endometrium of women with endometriosis versus controls, while enrichment analysis detected that the pathways of chemotaxis and locomotion are dysregulated in endometriosis. Further analysis of endometrial receptivity-specific genes highlighted dysregulation of C4BPA, MAOA and PAEP and enrichment of immune and defence pathways in women with endometriosis. LIMITATIONS, REASONS FOR CAUTION Most of the studies included into the meta-analysis were relatively small and had different study designs, which might have contributed to a bias. WIDER IMPLICATIONS OF THE FINDINGS The current meta-analysis supports the hypothesis that endometrial receptivity is altered in women with endometriosis, although the changes are small. The molecules and pathways identified could serve as future biomarkers and therapeutical targets in detecting and treating endometriosis-associated infertility. STUDY FUNDING/COMPETING INTEREST(S) The authors declare no competing interests. This work was supported by the Spanish Ministry of Education, Culture and Sport [grant FPU15/01193] and the Margarita Salas program for the Requalification of the Spanish University system [grant UJAR01MS]; Spanish Ministry of Economy, Industry and Competitiveness (MINECO) and European Regional Development Fund (FEDER): grants RYC-2016-21199 and ENDORE SAF2017-87526-R; Programa Operativo FEDER Andalucía (B-CTS-500-UGR18; A-CTS-614-UGR20); the Junta de Andalucía [BIO-302; and PAIDI P20_00158]; the University of Jaén [PAIUJA-EI_CTS02_2017]; the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES), and by the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades and European Regional Development Fund (ERDF), ref. SOMM17/6107/UGR; the Estonian Research Council (grant PRG1076); Horizon 2020 innovation (ERIN, grant no. EU952516) of the European Commission and Enterprise Estonia (grant EU48695). TRIAL REGISTRATION NUMBER The systematic review was registered at PROSPERO (identifier: CRD42020122054).
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Affiliation(s)
- E Vargas
- Systems Biology Unit, Department of Experimental Biology, Faculty of Experimental Sciences, University of Jaén, Jaén, 23003, Spain
- Department of Biochemistry and Molecular Biology, Faculty of Sciences, University of Granada, Granada, 18071, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, 18014, Spain
| | - E García-Moreno
- Immunology Unit,Hospital Universitario Puerta del Mar, Cádiz, Cádiz, 11009, Spain
| | - L Aghajanova
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford School of Medicine, Sunnyvale, CA, 94305, USA
| | - A Salumets
- Competence Centre on Health Technologies, Tartu, 50410, Estonia
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, 17177, Sweden
- Department of Obstetrics and Gyneaecology, Institute of Clinical Medicine, University of Tartu, Tartu, 50406, Estonia
| | - J A Horcajadas
- University Pablo de Olavide, Sevilla, Sevilla, 41013, Spain
| | - F J Esteban
- Systems Biology Unit, Department of Experimental Biology, Faculty of Experimental Sciences, University of Jaén, Jaén, 23003, Spain
| | - S Altmäe
- Department of Biochemistry and Molecular Biology, Faculty of Sciences, University of Granada, Granada, 18071, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, 18014, Spain
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford School of Medicine, Sunnyvale, CA, 94305, USA
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Abstract
Proton pump inhibitors (PPIs) are medications that are frequently prescribed for gastroesophageal reflux disease. However, a few case reports have described neuropsychiatric symptoms following PPI use. In this report, we present a case of visual hallucinations secondary to PPI usage and propose possible mechanisms. In this case, a 65-year-old man with no psychiatric history developed acute visual hallucinations following initiation of omeprazole, in the absence of delusions, paranoia, and other psychotic symptoms. The visual hallucinations began after the patient started treatment with omeprazole and resolved almost immediately upon discontinuation of omeprazole. To treat symptoms of gastroesophageal reflux disease, omeprazole was replaced with famotidine, and the visual hallucinations did not recur after the omeprazole had been discontinued. No other psychotic signs or symptoms were present in this patient throughout the duration of his hospitalization. Although the scientific literature provides limited information on psychosis related to PPI use, a growing number of case reports and studies in recent years have suggested that neuropsychiatric symptoms may occur after PPI use. It is our hope that this case report adds to the scientific and medical knowledge in this area.
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Affiliation(s)
- Grace S Kim
- KIM, NUNEZ, and VARGAS: Osceola Regional Medical Center, Kissimmee, FL; and University of Central Florida College of Medicine, Orlando, FL
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14
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Pinto L, Santos A, Vargas E, Madureira F, Faria A, Augusti R. Validation of an analytical method based on QuEChERS and LC-MS/MS to quantify nine mycotoxins in plant-based milk. WORLD MYCOTOXIN J 2021. [DOI: 10.3920/wmj2020.2656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Plant-based beverages (popularly known as vegetable milk) have become increasingly important in recent years. However, the nonexistence of information on mycotoxin contamination is noticeable. We herein describe the development and validation of an analytical methodology that employs QuEChERS and LC-MS/MS for the simultaneous determination of nine mycotoxins (aflatoxins B1, B2, G1, and G2, fumonisins B1 and B2, ochratoxin A, zearalenone, and citreoviridin) in seven types of vegetable milk (peanut, oat, rice, cashew, maize, soybean, and coconut). The method provided the following quantification limits, recoveries at the lowest validated concentration and relative standard deviations under repeatability conditions at the lowest validated concentration, respectively: aflatoxin B1 (0.023 μg/l, 84.98 and 9.23%); aflatoxin B2 (0.024 μg/, 93.00 and 4.85%); aflatoxin G1 (0.057 μg/l, 98.85 and 5.53%); aflatoxin G2 (0.031 μg/l, 96.64 and 4.08%); fumonisin B1 (2.166 μg/l, 75.55 and 16.78%); fumonisin B2 (1.105 μg/l, 70.47 and 11.89%); ochratoxin A (0.104 μg/l, 72.05 and 5.12%); zearalenone (8.093 μg/l, 107.10 and 6.37%); citreoviridin (1.305 μg/l, 97.25 and 7.28%). The method uses small amounts of samples, solvents, and other inexpensive reagents with no need for laborious clean-up and pre-concentration steps. Its attractive characteristics (simplicity, low cost compared to procedures that use immunoaffinity columns, and full compatibility with routine analyses) make it potentially valuable. As a proof-of-principle, the validated methodology was applied to seven commercial samples of different compositions showing that some were contaminated with aflatoxins and ochratoxin A.
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Affiliation(s)
- L. Pinto
- Department of Chemistry, Institute of Exact Sciences, Federal University of Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte/MG, 31270-901, Brazil
| | - A. Santos
- Department of Chemistry, Institute of Exact Sciences, Federal University of Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte/MG, 31270-901, Brazil
| | - E. Vargas
- Laboratory of Quality Control and Food Safety, Av. Raja Gabaglia 245, Belo Horizonte/MG, 30380-103, Brazil
| | - F. Madureira
- Laboratory of Quality Control and Food Safety, Av. Raja Gabaglia 245, Belo Horizonte/MG, 30380-103, Brazil
| | - A. Faria
- Department of Chemistry, Institute of Exact Sciences, Federal University of Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte/MG, 31270-901, Brazil
| | - R. Augusti
- Department of Chemistry, Institute of Exact Sciences, Federal University of Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte/MG, 31270-901, Brazil
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15
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Molina NM, Sola-Leyva A, Pérez-Prieto I, Vargas E, Molina M, Yoldi A, Vaquero A, Navas P, Clavero-Gilabert A, Gonzalvo-López MC, Morales N, Ramírez JP, Castilla JA, Aguilera CM, Altmäe S. O-147 Differential seminal metabolomic signature is related to sperm quality. Hum Reprod 2021. [DOI: 10.1093/humrep/deab127.015] [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
What is the entire metabolomic profile of human semen and does the metabolic composition differ between men with good-quality and low-quality semen?
Summary answer
Human semen contains ∼700 different metabolites, and the metabolomic signature differs between normozoospermic men and men with altered seminal parameters.
What is known already
Semen contains a wide diversity of metabolites as has been identified in single and targeted metabolite studies. The full composition of metabolites in human semen, however, is not known. The knowledge of the complete metabolic signature in semen and whether there are differences between metabolic composition and seminal quality could enhance our knowledge of possible factors involved in reduced sperm quality and male infertility.
Study design, size, duration
Case-control study, where a total of 100 men (age= 29.73±8.9 years) from March 2019 to March 2020 participated. The study was approved by the Ethics Committee of Investigación Biomédica de Andalucia.
Participants/materials, setting, methods
Semen samples from 69 normozoospermic and 31 oligozoospermic men were collected at the University Hospital and sperm biobank (Ceifer Biobank - NextClinics). The complete metabolome from unprocessed seminal samples was analysed by Ultrahigh Performance Liquid Chromatography-Tandem Mass Spectroscopy (UPLC-MS/MS). Raw data were extracted, peak-identified and quality control processed using Metabolon’s hardware and software (metabolon.com). Multiple regression models controlling for age and sample collection centres were applied using R software.
Main results and the role of chance
In total, 695 different metabolites were detected in the seminal samples, where docosahexaenoate (DHA; 22:6n3, PubChem ID 445580), choline phosphate (1014), dihomo-linolenate (20:3n3 or n6, 5280581), docosapentaenoate (n6 DPA; 22:5n6, 6441454), adenosine 3’,5’-cyclic monophosphate (cAMP, 6076) and N-acetylalliin (122164824) metabolites were the most prevalent. The seminal metabolomic profiles differed significantly between men with normal and low sperm parameters. The most abundant metabolites in normozoospermic men belonged to Lipid Super-Pathway, while Nucleotide Super-Pathway was predominant in semen samples with low quality (p < 0.05). More specifically, the leading Sub-Pathway in normozoospermic men was Long Chain Polyunsaturated Fatty Acid (n3 and n6), whereas Purine and Pyrimidine Metabolism Sub-Pathway prevailed in low-quality semen samples, where DHA and cAMP dominated in men with normal and low seminal quality parameters, respectively (p < 0.05 in all comparisons).
Limitations, reasons for caution
This is the first study presenting the entire metabolome signature of unprocessed human semen, and these preliminary results need to be confirmed in a bigger sample size.
Wider implications of the findings
Semen analyses applied in clinics do not evaluate the functional status of sperm, leaving the infertility causes due to male factor frequently unknown. Our study results could help to understand the molecular background of reduced seminal quality and male infertility and lead to identification of molecular biomarkers of functional sperm.
Trial registration number
not applicable
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Affiliation(s)
- N M Molina
- University of Granada, Faculty of Sciences- Department of Biochemistry and Molecular Biology, Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain
| | - A Sola-Leyva
- University of Granada, Faculty of Sciences- Department of Biochemistry and Molecular Biology, Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain
| | - I Pérez-Prieto
- University of Granada, Faculty of Sciences- Department of Biochemistry and Molecular Biology, Granada, Spain
| | - E Vargas
- University of Jaen, Faculty of Experimental Sciences- Department of Experimental Biology- Systems Biology Unit, Jaen, Spain
| | - M Molina
- CEIFER, Nextclinics, Granada, Spain
| | - A Yoldi
- CEIFER, Nextclinics, Granada, Spain
| | | | - P Navas
- CEIFER, Nextclinics, Granada, Spain
| | - A Clavero-Gilabert
- HU Virgen de las Nieves, Unidad Reproducción- UGC Laboratorio clínico y UGC Obstetricia y Ginecología, Granada, Spain
| | - M C Gonzalvo-López
- HU Virgen de las Nieves, Unidad Reproducción- UGC Laboratorio clínico y UGC Obstetricia y Ginecología, Granada, Spain
| | - N Morales
- HU Virgen de las Nieves, Unidad Reproducción- UGC Laboratorio clínico y UGC Obstetricia y Ginecología, Granada, Spain
| | | | - J A Castilla
- Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain
- CEIFER, Nextclinics, Granada, Spain
- HU Virgen de las Nieves, Unidad Reproducción- UGC Laboratorio clínico y UGC Obstetricia y Ginecología, Granada, Spain
| | - C M Aguilera
- Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain
- University of Granada, Faculty of Pharmacy- Department of Biochemistry and Molecular Biolog, Granada, Spain
- University of Granada, Centre of Biomedical Research- Institute of Nutrition and Food Technology “José Mataix”, Granada, Spain
- Instituto de Salud Carlos III, CIBEROBN CIBER Physiopathology of Obesity and Nutrition, Madrid, Spain
| | - S Altmäe
- University of Granada, Faculty of Sciences- Department of Biochemistry and Molecular Biology, Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain
- Competence Centre on Health Technologies, University of Tartu, Tartu, Estonia
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16
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Vargas E, Lockney DT, Mummaneni PV, Haddad AF, Rivera J, Tan X, Jamieson A, Mahmoudieh Y, Berven S, Braunstein SE, Chou D. An analysis of tumor-related potential spinal column instability (Spine Instability Neoplastic Scores 7-12) eventually requiring surgery with a 1-year follow-up. Neurosurg Focus 2021; 50:E6. [PMID: 33932936 DOI: 10.3171/2021.2.focus201098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Within the Spine Instability Neoplastic Score (SINS) classification, tumor-related potential spinal instability (SINS 7-12) may not have a clear treatment approach. The authors aimed to examine the proportion of patients in this indeterminate zone who later required surgical stabilization after initial nonoperative management. By studying this patient population, they sought to determine if a clear SINS cutoff existed whereby the spine is potentially unstable due to a lesion and would be more likely to require stabilization. METHODS Records from patients treated at the University of California, San Francisco, for metastatic spine disease from 2005 to 2019 were retrospectively reviewed. Seventy-five patients with tumor-related potential spinal instability (SINS 7-12) who were initially treated nonoperatively were included. All patients had at least a 1-year follow-up with complete medical records. A univariate chi-square test and Student t-test were used to compare categorical and continuous outcomes, respectively, between patients who ultimately underwent surgery and those who did not. A backward likelihood multivariate binary logistic regression model was used to investigate the relationship between clinical characteristics and surgical intervention. Recursive partitioning analysis (RPA) and single-variable logistic regression were performed as a function of SINS. RESULTS Seventy-five patients with a total of 292 spinal metastatic sites were included in this study; 26 (34.7%) patients underwent surgical intervention, and 49 (65.3%) did not. There was no difference in age, sex, comorbidities, or lesion location between the groups. However, there were more patients with a SINS of 12 in the surgery group (55.2%) than in the no surgery group (44.8%) (p = 0.003). On multivariate analysis, SINS > 11 (OR 8.09, CI 1.96-33.4, p = 0.004) and Karnofsky Performance Scale (KPS) score < 60 (OR 0.94, CI 0.89-0.98, p = 0.008) were associated with an increased risk of surgery. KPS score was not correlated with SINS (p = 0.4). RPA by each spinal lesion identified an optimal cutoff value of SINS > 10, which were associated with an increased risk of surgical intervention. Patients with a surgical intervention had a higher incidence of complications on multivariable analysis (OR 2.96, CI 1.01-8.71, p = 0.048). CONCLUSIONS Patients with a mean SINS of 11 or greater may be at increased risk of mechanical instability requiring surgery after initial nonoperative management. RPA showed that patients with a KPS score of 60 or lower and a SINS of greater than 10 had increased surgery rates.
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Affiliation(s)
- Enrique Vargas
- Departments of1Neurosurgery.,4School of Medicine, University of California, San Francisco, California
| | | | | | - Alexander F Haddad
- Departments of1Neurosurgery.,4School of Medicine, University of California, San Francisco, California
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17
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Ammanuel SG, Edwards CS, Chan AK, Mummaneni PV, Kidane J, Vargas E, D’Souza S, Nichols AD, Sankaran S, Abla AA, Aghi MK, Chang EF, Hervey-Jumper SL, Kunwar S, Larson PS, Lawton MT, Starr PA, Theodosopoulos PV, Berger MS, McDermott MW. Are preoperative chlorhexidine gluconate showers associated with a reduction in surgical site infection following craniotomy? A retrospective cohort analysis of 3126 surgical procedures. J Neurosurg 2021; 135:1889-1897. [PMID: 33930864 PMCID: PMC9448162 DOI: 10.3171/2020.10.jns201255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical site infection (SSI) is a complication linked to increased costs and length of hospital stay. Prevention of SSI is important to reduce its burden on individual patients and the healthcare system. The authors aimed to assess the efficacy of preoperative chlorhexidine gluconate (CHG) showers on SSI rates following cranial surgery. METHODS In November 2013, a preoperative CHG shower protocol was implemented at the authors' institution. A total of 3126 surgical procedures were analyzed, encompassing a time frame from April 2012 to April 2016. Cohorts before and after implementation of the CHG shower protocol were evaluated for differences in SSI rates. RESULTS The overall SSI rate was 0.6%. No significant differences (p = 0.11) were observed between the rate of SSI of the 892 patients in the preimplementation cohort (0.2%) and that of the 2234 patients in the postimplementation cohort (0.8%). Following multivariable analysis, implementation of preoperative CHG showers was not associated with decreased SSI (adjusted OR 2.96, 95% CI 0.67-13.1; p = 0.15). CONCLUSIONS This is the largest study, according to sample size, to examine the association between CHG showers and SSI following craniotomy. CHG showers did not significantly alter the risk of SSI after a cranial procedure.
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Affiliation(s)
- Simon G. Ammanuel
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Caleb S. Edwards
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Andrew K. Chan
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Praveen V. Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Joseph Kidane
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Enrique Vargas
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Sarah D’Souza
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Amy D. Nichols
- Department of Hospital Epidemiology and Infection Control, University of California, San Francisco, California
| | - Sujatha Sankaran
- Department of Hospital Medicine, University of California, San Francisco, California
| | - Adib A. Abla
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Manish K. Aghi
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Edward F. Chang
- Department of Neurological Surgery, University of California, San Francisco, California
| | | | - Sandeep Kunwar
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Paul S. Larson
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Michael T. Lawton
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Philip A. Starr
- Department of Neurological Surgery, University of California, San Francisco, California
| | | | - Mitchel S. Berger
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Michael W. McDermott
- Department of Neurological Surgery, University of California, San Francisco, California
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Vargas E, Mummaneni PV, Duan P, Berven S, Chou D. Does the Stress From a Single-level Spinal Fusion Affect the Bone Mineral Density at the Adjacent, Non-fused Segment? Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_771] [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: 11/14/2022] Open
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19
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Ammanuel SG, Edwards CS, Chan AK, Mummaneni PV, Kidane J, Vargas E, D’Souza S, Nichols AD, Sankaran S, Abla AA, Aghi MK, Chang EF, Her vey-Jumper SL, Kunwar SM, Larson PS, Lawton MT, Starr PA, Theodosopoulos PV, Berger MS, McDermott MW. Preoperative Chlorhexidine Showers Are Not Associated With a Reduction in Surgical Site Infection Following Craniotomy. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_139] [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: 11/14/2022] Open
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20
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Grant I, Soria R, Julian CG, Vargas E, Moore LG, Aiken CE, Giussani DA. Parental ancestry and risk of early pregnancy loss at high altitude. FASEB J 2020; 34:13741-13749. [PMID: 32856356 DOI: 10.1096/fj.202001257r] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 11/11/2022]
Abstract
High altitude pregnancy is associated with increased frequency of low birth weight infants and neonatal complications, the risks of which are higher in women of low-altitude ancestry. Does ancestry also influence the risk of miscarriage (pregnancy loss <20 weeks) in high-altitude pregnancy? To answer this, 5386 women from La Paz, Bolivia (3300-4150 m) with ≥1 live-born infant were identified. Data were extracted from medical records including maternal and paternal ancestry, demographic factors, and reproductive history. The risk of miscarriage by ancestry was assessed using multivariate logistic regression, adjusting for parity, and maternal age. Andean women experienced first live-births younger than Mestizo or European women (21.7 ± 4.6 vs 23.4 ± 8.0 vs 24.1 ± 5.1, P < .001). Andeans experienced more pregnancies per year of reproductive life (P < .001) and had significantly higher ratios of live-births to miscarriages than women of Mestizo or European ancestry (P < .001). Andean women were 24% less likely to have ever experienced a miscarriage compared to European women (OR:0.76; CI:0.62-0.90, P < .001). The woman's partner's ancestry wasn't a significant independent predictor of miscarriage. In conclusion, the risk of miscarriage at high altitude is lower in Andean women. The lack of a paternal ancestry effect suggests underlying mechanisms relate more to differential maternal adaptation in early pregnancy than fetal genetics.
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Affiliation(s)
- I Grant
- Department of Obstetrics and Gynaecology, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - R Soria
- Instituto Boliviano de Biología de Altura, La Paz, Bolivia
| | - C G Julian
- Department of Medicine, University of Colorado, Denver, CO, USA
| | - E Vargas
- Instituto Boliviano de Biología de Altura, La Paz, Bolivia
| | - L G Moore
- Department of Obstetrics/Gynecology, University of Colorado, Denver, CO, USA
| | - C E Aiken
- Department of Obstetrics and Gynaecology, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - D A Giussani
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
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Vargas E, Susko MS, Mummaneni PV, Braunstein SE, Chou D. Vertebral body fracture rates after stereotactic body radiation therapy compared with external-beam radiation therapy for metastatic spine tumors. J Neurosurg Spine 2020:1-7. [PMID: 32796141 DOI: 10.3171/2020.5.spine191383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 05/11/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereotactic body radiation therapy (SBRT) is utilized to deliver highly conformal, dose-escalated radiation to a target while sparing surrounding normal structures. Spinal SBRT can allow for durable local control and palliation of disease while minimizing the risk of damage to the spinal cord; however, spinal SBRT has been associated with an increased risk of vertebral body fractures. This study sought to compare the fracture rates between SBRT and conventionally fractionated external-beam radiation therapy (EBRT) in patients with metastatic spine tumors. METHODS Records from patients treated at the University of California, San Francisco, with radiation therapy for metastatic spine tumors were retrospectively reviewed. Vertebral body fracture and local control rates were compared between SBRT and EBRT. Ninety-six and 213 patients were identified in the SBRT and EBRT groups, respectively. Multivariate analysis identified the need to control for primary tumor histology (p = 0.003 for prostate cancer, p = 0.0496 for renal cell carcinoma). The patient-matched EBRT comparison group was created by matching SBRT cases using propensity scores for potential confounders, including the Spinal Instability Neoplastic Score (SINS), the number and location of spine levels treated, sex, age at treatment, duration of follow-up (in months) after treatment, and primary tumor histology. Covariate balance following group matching was confirmed using the Student t-test for unequal variance. Statistical analysis, including propensity score matching and multivariate analysis, was performed using R software and related packages. RESULTS A total of 90 patients met inclusion criteria, with 45 SBRT and 45 EBRT matched cases. Balance of the covariates, SINS, age, follow-up time, and primary tumor histology after the matching process was confirmed between groups (p = 0.062, p = 0.174, and 0.991, respectively, along with matched tumor histology). The SBRT group had a higher 5-year rate of vertebral body fracture at 22.22% (n = 10) compared with 6.67% (n = 3) in the EBRT group (p = 0.044). Survival analysis was used to adjust for uneven follow-up time and showed a significant difference in fracture rates between the two groups (p = 0.044). SBRT also was associated with a higher rate of local control (86.67% vs 77.78%). CONCLUSIONS Patients with metastatic cancer undergoing SBRT had higher rates of vertebral body fractures compared with patients undergoing EBRT, and this difference held up after survival analysis. SBRT also had higher rates of initial local control than EBRT but this difference did not hold up after survival analysis, most likely because of a high percentage of radiosensitive tumors in the EBRT cohort.
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Affiliation(s)
- Enrique Vargas
- Departments of1Neurosurgery and.,3School of Medicine, University of California, San Francisco, California
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Neumann G, Lombaert GA, Kotello S, Fedorowich N, Abdelaal E, Cea J, Kurz K, Malone B, Marley E, Mischke C, Panzarini G, Patel S, Roscoe M, Savard M, Solfrizzo M, Trelka R, Vargas E. Determination of Deoxynivalenol in Soft Wheat by Immunoaffinity Column Cleanup and LC-UV Detection: Interlaboratory Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/92.1.181] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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]
Abstract
Abstract
An interlaboratory study was conducted to assess the applicability of a previously validated method for the analysis of deoxynivalenol (DON) in cereal and cereal products to soft wheat in the range of >0.13.0 g/g. The study evaluated a generic method to determine DON at levels that bracket the existing Canadian guidelines for DON in soft wheat destined for use in baby foods and nonstaple foods. Collaborators selected one of 2 approved brands of DON immunoaffinity column for cleanup and their choice of qualified C18 liquid chromatographic (LC) column. Separation was by LC with UV detection. Blind duplicates from 5 levels of naturally contaminated wheat and a pair of spiked wheat samples were successfully analyzed by 12 laboratories in 8 countries. For samples naturally contaminated with DON from <0.12.2 g/g, the relative standard deviation of repeatability (RSDr) ranged from 3.1 to 14.8. For reproducibility, the RSDR ranged from 21.0 to 32.9 and the HorRat range was 1.0 to 1.9. Recoveries of 0.5 g/g DON spiked into wheat ranged from 66 to 98, with an average of 84. The RSDr was 5.4, the RSDR was 12.6, and the HorRat value was 0.7.
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Affiliation(s)
- Gary Neumann
- Health Canada, Health Products and Food Program, 510 Lagimodiere Blvd, Winnipeg, Manitoba, R2J 3Y1 Canada
| | - Gary A Lombaert
- Health Canada, Health Products and Food Program, 510 Lagimodiere Blvd, Winnipeg, Manitoba, R2J 3Y1 Canada
| | - Susan Kotello
- Health Canada, Health Products and Food Program, 510 Lagimodiere Blvd, Winnipeg, Manitoba, R2J 3Y1 Canada
| | - Nicole Fedorowich
- Health Canada, Health Products and Food Program, 510 Lagimodiere Blvd, Winnipeg, Manitoba, R2J 3Y1 Canada
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Vargas E, Braunstein S, Susko M, Mummaneni PV, Chou D. Stereotactic Radiation Therapy (SBRT) Versus External Beam (EB) Radiation for Metastatic Spine Disease: Comparing Fracture Rates and Local Control. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_174] [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: 11/14/2022] Open
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Boeckmann M, Roux T, Robinson M, Areal A, Durusu D, Wernecke B, Manyuchi A, Pham MD, Wang C, Hetem R, Harden L, Vargas E, Wright CY, Erasmus BFN, Rees H, Vogel C, Wang S, Black V, Mabhikwa M, Chersich Climate Change And Heat-Health Study Group MF. Climate change and control of diarrhoeal diseases in South Africa: Priorities for action. S Afr Med J 2019; 109:359-361. [PMID: 31266553 DOI: 10.7196/samj.2019.v109i6.14075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- M Boeckmann
- Department of Environment and Health, School of Public Health, Bielefeld University, Germany.
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DeStephano C, Gajarawala S, Heckman M, Vargas E, Pettit P, Robertson M. 41: Factors associated with readiness for discharge from the hospital following robotic and laparoscopic hysterectomy. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.12.060] [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: 11/28/2022]
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Vargas E, Cifuentes A, Alvarado S, Cabrera H, Delgado O, Calderón A, Marín E. Thermal diffusivity measurement in thin metallic filaments using the mirage method with multiple probe beams and a digital camera. Rev Sci Instrum 2018; 89:024904. [PMID: 29495871 DOI: 10.1063/1.5006942] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Photothermal beam deflection is a well-established technique for measuring thermal diffusivity. In this technique, a pump laser beam generates temperature variations on the surface of the sample to be studied. These variations transfer heat to the surrounding medium, which may be air or any other fluid. The medium in turn experiences a change in the refractive index, which will be proportional to the temperature field on the sample surface when the distance to this surface is small. A probe laser beam will suffer a deflection due to the refractive index periodical changes, which is usually monitored by means of a quadrant photodetector or a similar device aided by lock-in amplification. A linear relationship that arises in this technique is that given by the phase lag of the thermal wave as a function of the distance to a punctual heat source when unidimensional heat diffusion can be guaranteed. This relationship is useful in the calculation of the sample's thermal diffusivity, which can be obtained straightforwardly by the so-called slope method, if the pump beam modulation frequency is well-known. The measurement procedure requires the experimenter to displace the probe beam at a given distance from the heat source, measure the phase lag at that offset, and repeat this for as many points as desired. This process can be quite lengthy in dependence of the number points. In this paper, we propose a detection scheme, which overcomes this limitation and simplifies the experimental setup using a digital camera that substitutes all detection hardware utilizing motion detection techniques and software digital signal lock-in post-processing. In this work, the method is demonstrated using thin metallic filaments as samples.
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Affiliation(s)
- E Vargas
- Instituto Politécnico Nacional, Centro de Investigación en Ciencia Aplicada y Tecnología Avanzada, Legaria 694, Colonia Irrigación, 11500 Ciudad de México, Mexico
| | - A Cifuentes
- Instituto Politécnico Nacional, Centro de Investigación en Ciencia Aplicada y Tecnología Avanzada, Legaria 694, Colonia Irrigación, 11500 Ciudad de México, Mexico
| | - S Alvarado
- Instituto Politécnico Nacional, Centro de Investigación en Ciencia Aplicada y Tecnología Avanzada, Legaria 694, Colonia Irrigación, 11500 Ciudad de México, Mexico
| | - H Cabrera
- Multidisciplinary Laboratory, International Centre for Theoretical Physics, Trieste 34151, Italy
| | - O Delgado
- Universidad Politécnica Metropolitana de Hidalgo, Boulevard Acceso a Tolcayuca # 1009, Exhacienda de San Javier, 43860 Tolcayuca, Hidalgo, Mexico
| | - A Calderón
- Instituto Politécnico Nacional, Centro de Investigación en Ciencia Aplicada y Tecnología Avanzada, Legaria 694, Colonia Irrigación, 11500 Ciudad de México, Mexico
| | - E Marín
- Instituto Politécnico Nacional, Centro de Investigación en Ciencia Aplicada y Tecnología Avanzada, Legaria 694, Colonia Irrigación, 11500 Ciudad de México, Mexico
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Hassan N, Cordero ML, Sierpe R, Almada M, Juárez J, Valdez M, Riveros A, Vargas E, Abou-Hassan A, Ruso JM, Kogan MJ. Peptide functionalized magneto-plasmonic nanoparticles obtained by microfluidics for inhibition of β-amyloid aggregation. J Mater Chem B 2018; 6:5091-5099. [DOI: 10.1039/c8tb00206a] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Synthesis of magneto-plasmonic nanoparticles for the inhibition of β-amyloid fibril formation.
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Hosseini P, Mundis GM, Eastlack RK, Bagheri R, Vargas E, Tran S, Akbarnia BA. Preliminary results of anterior lumbar interbody fusion, anterior column realignment for the treatment of sagittal malalignment. Neurosurg Focus 2017; 43:E6. [DOI: 10.3171/2017.8.focus17423] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVESagittal malalignment decreases patients’ quality of life and may require surgical correction to achieve realignment goals. High-risk posterior-based osteotomy techniques are the current standard treatment for addressing sagittal malalignment. More recently, anterior lumbar interbody fusion, anterior column realignment (ALIF ACR) has been introduced as an alternative for correction of sagittal deformity. The objective of this paper was to report clinical and radiographic results for patients treated using the ALIF-ACR technique.METHODSA retrospective study of 39 patients treated with ALIF ACR was performed. Patient demographics, operative details, radiographic parameters, neurological assessments, outcome measures, and preoperative, postoperative, and mean 1-year follow-up complications were studied.RESULTSThe patient population comprised 39 patients (27 females and 12 males) with a mean follow-up of 13.3 ± 4.7 months, mean age of 66.1 ± 11.6 years, and mean body mass index of 27.3 ± 6.2 kg/m2. The mean number of ALIF levels treated was 1.5 ± 0.5. Thirty-three (84.6%) of 39 patients underwent posterior spinal fixation and 33 (84.6%) of 39 underwent posterior column osteotomy, of which 20 (60.6%) of 33 procedures were performed at the level of the ALIF ACR. Pelvic tilt, sacral slope, and pelvic incidence were not statistically significantly different between the preoperative and postoperative periods and between the preoperative and 1-year follow-up periods (except for PT between the preoperative and 1-year follow-up, p = 0.018). Sagittal vertical axis, T-1 spinopelvic inclination, lumbar lordosis, pelvic incidence–lumbar lordosis mismatch, intradiscal angle, and motion segment angle all improved from the preoperative to postoperative period and the preoperative to 1-year follow-up (p < 0.05). The changes in motion segment angle and intradiscal angle achieved in the ALIF-ACR group without osteotomy compared with the ALIF-ACR group with osteotomy at the level of ACR were not statistically significant. Total visual analog score, Oswestry Disability Index, and Scoliosis Research Society–22 scores all improved from preoperative to postoperative and preoperative to 1-year follow-up. Fourteen patients (35.9%) experienced 26 complications (15 major and 11 minor). Eleven patients required reoperation. The most common complication was proximal junctional kyphosis (6/26 complications, 23%) followed by vertebral body/endplate fracture (3/26, 12%).CONCLUSIONSThis study showed satisfactory radiographic and clinical outcomes at the 1-year follow-up. Proximal junctional kyphosis was the most common complication followed by fracture, complications that are commonly associated with sagittal realignment surgery and may not be mitigated by the anterior approach.
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Affiliation(s)
| | - Gregory M. Mundis
- 1San Diego Spine Foundation, San Diego
- 2Department of Orthopaedic Surgery, Scripps Clinic Torrey Pines, La Jolla, California; and
| | - Robert K. Eastlack
- 2Department of Orthopaedic Surgery, Scripps Clinic Torrey Pines, La Jolla, California; and
| | - Ramin Bagheri
- 2Department of Orthopaedic Surgery, Scripps Clinic Torrey Pines, La Jolla, California; and
| | - Enrique Vargas
- 3Department of Orthopedics, Centro Medico Puerta de Hierro, Zapopan, Jalisco, Mexico
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Naksuk N, Schleifer W, Kancharla K, Padmanabhan D, Kella D, Chacko P, Vargas E, Hodge D, Monahan K, Packer D. P197Longer duration of persistent atrial fibrillation episodes prior to catheter ablation is associated with lower freedom of atrial arrhythmias after catheter ablation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p197] [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: 11/12/2022] Open
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Sarlo R, Pereira G, Surica M, Almeida D, Araújo C, Figueiredo O, Rocha E, Vargas E. Impact of Introducing Full-time In-house Coordinators on Referral and Organ Donation Rates in Rio de Janeiro Public Hospitals: A Health Care Innovation Practice. Transplant Proc 2017; 48:2396-2398. [PMID: 27742307 DOI: 10.1016/j.transproceed.2015.11.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 11/11/2015] [Indexed: 11/24/2022]
Abstract
Establishing an organization to promote organ donation and a good organ procurement team assure quality and improve performance on organ donation rates. Brazil's organ procurement structure is based on 2 models disseminated worldwide: the "Spanish model," based on in-house coordinators, and the "American organ procurement organization (OPO) model," with extra-hospital coordinators. In 2006, Brazil's Federal Government had formally introduced the in-house coordination model for every hospital equipped with a mechanical ventilator bed. In January 2012, the Rio de Janeiro State OPO, Programa Estadual de Transplantes, introduced an innovation in the organization of the in-house coordination model in 4 selected public hospitals with high organ donation potential. It consisted in launching full-time in-house coordination teams, with ≥1 physician and 2 nurses per hospital fully dedicated to organ procurement. The objectives were to observe the impact of this innovation in referral and organ donor conversion rates and to analyze the importance of middle managers in health care innovation implementation. Comparing the year before implementation (2011) and the year of 2014 showed that this innovation led to an overall increase in referrals-from 131 to 305 per year (+132%) and conversion rates-from 20% to 42% per year-resulting in an increase in number of donors from 26 to 128 per year (+390%). Despite wide variations among hospitals in the outcomes, our results seem very encouraging and express a positive impact of this model, suggesting that dissemination to other hospitals may increase the number of donors and transplants in our region.
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Affiliation(s)
- R Sarlo
- Programa Estadual de Transplantes, Rio de Janeiro, Brazil; COPPEAD Business School, Universidade Federal do Rio de Janeiro, Brazil.
| | - G Pereira
- Programa Estadual de Transplantes, Rio de Janeiro, Brazil
| | - M Surica
- Programa Estadual de Transplantes, Rio de Janeiro, Brazil
| | - D Almeida
- Programa Estadual de Transplantes, Rio de Janeiro, Brazil
| | - C Araújo
- COPPEAD Business School, Universidade Federal do Rio de Janeiro, Brazil
| | - O Figueiredo
- COPPEAD Business School, Universidade Federal do Rio de Janeiro, Brazil
| | - E Rocha
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil
| | - E Vargas
- COPPEAD Business School, Universidade Federal do Rio de Janeiro, Brazil
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Pérez-Plaza A, Solano-López G, Vargas E. A Scar or a Tumor? Actas Dermo-Sifiliográficas (English Edition) 2017. [DOI: 10.1016/j.adengl.2016.12.010] [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: 11/26/2022] Open
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Wolfson GH, Vargas E, Browne VA, Moore LG, Julian CG. Erythropoietin and Soluble Erythropoietin Receptor: A Role for Maternal Vascular Adaptation to High-Altitude Pregnancy. J Clin Endocrinol Metab 2017; 102:242-250. [PMID: 27809650 PMCID: PMC5413104 DOI: 10.1210/jc.2016-1767] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 11/01/2016] [Indexed: 12/11/2022]
Abstract
CONTEXT An imbalance of proangiogenic and antiangiogenic factors is thought to induce the widespread vascular dysfunction characteristic of preeclampsia (PreE). Erythropoietin (Epo), a pleiotropic cytokine, has important angiogenic and vasoactive properties; however, its contribution to maternal vascular dysfunction in PreE is unknown. OBJECTIVES Because high altitude (HA) raises the incidence of PreE, we asked whether HA increased maternal Epo and soluble Epo receptor (sEpoR) levels and whether such effects differed between PreE and normotensive controls at HA. DESIGN, SETTING, AND PARTICIPANTS Longitudinal studies were conducted in pregnant Andean residents at HA (n = 28; 3600 m) or sea level (SL; n = 16; 300 m). Cross-sectional studies included 34 gestational age‒matched Andean PreE cases (n = 17) and controls (n = 17) in La Paz-El Alto, Bolivia (3600 to 4100 m). RESULTS HA augmented the pregnancy-associated rise in Epo relative to SL (P = 0.002), despite similar reductions in hemoglobin (Hb) across pregnancy at each altitude (7% to 9%, P < 0.001 for both). HA PreE cases had circulating Epo levels equivalent to those of controls but greater sEpoR (P < 0.05) and reduced Hb (P = 0.06, trend). CONCLUSION(S) Our findings suggest that an augmented pregnancy-associated rise in Epo may be important for successful vascular adaptation to pregnancy at HA. We further speculate that the elevated sEpoR observed in PreE vs controls at HA impedes the effect of Epo to maintain endothelial function and may, in turn, be of pathological relevance for PreE at HA.
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Affiliation(s)
| | - Enrique Vargas
- Bolivian Institute of High Altitude Biology, La Paz, Bolivia
| | | | - Lorna G. Moore
- Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado 80045; and
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Vargas E, Ruiz M, Ferrero F, Campuzano S, Ruiz-Valdepeñas Montiel V, Reviejo A, Pingarrón J. Automatic bionalyzer using an integrated amperometric biosensor for the determination of L-malic acid in wines. Talanta 2016; 158:6-13. [DOI: 10.1016/j.talanta.2016.05.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/15/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
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Pérez-Plaza A, Solano-López G, Vargas E. A Scar or a Tumor? Actas Dermosifiliogr 2016; 108:158. [PMID: 27085464 DOI: 10.1016/j.ad.2015.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/31/2015] [Accepted: 12/15/2015] [Indexed: 11/19/2022] Open
Affiliation(s)
- A Pérez-Plaza
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España.
| | - G Solano-López
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España
| | - E Vargas
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España
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Vargas E, Ruiz M, Campuzano S, Reviejo A, Pingarrón J. Non-invasive determination of glucose directly in raw fruits using a continuous flow system based on microdialysis sampling and amperometric detection at an integrated enzymatic biosensor. Anal Chim Acta 2016; 914:53-61. [DOI: 10.1016/j.aca.2016.02.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 02/03/2016] [Accepted: 02/10/2016] [Indexed: 11/16/2022]
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Vargas E, Romero-Sáez M, Denardin JC, Gracia F. The ultrasound-assisted synthesis of effective monodisperse nickel nanoparticles: magnetic characterization and its catalytic activity in CO2 methanation. NEW J CHEM 2016. [DOI: 10.1039/c6nj01574c] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
High performance nickel–zirconia nanocatalysts based on monodisperse nickel nanoparticles have been developed via a simple and continuous two-step ultrasonic method.
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Affiliation(s)
- E. Vargas
- Depto. de Ciencia de los Materiales
- FCFM
- Universidad de Chile
- Santiago
- Chile
| | - M. Romero-Sáez
- Depto. de Ingeniería Química y Biotecnología
- FCFM
- Universidad de Chile
- Santiago
- Chile
| | - J. C. Denardin
- Center for the Developed of Nanoscience and Nanotechnology
- CEDENNA. Av. Ecuador 3493
- Santiago
- Chile
- Depto. de Física
| | - F. Gracia
- Depto. de Ingeniería Química y Biotecnología
- FCFM
- Universidad de Chile
- Santiago
- Chile
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Julian CG, Pedersen BS, Salmon CS, Yang IV, Gonzales M, Vargas E, Moore LG, Schwartz DA. Unique DNA Methylation Patterns in Offspring of Hypertensive Pregnancy. Clin Transl Sci 2015; 8:740-5. [PMID: 26546417 PMCID: PMC4703563 DOI: 10.1111/cts.12346] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Epigenomic processes are believed to play a pivotal role for the effect of environmental exposures in early life to modify disease risk throughout the lifespan. Offspring of women with hypertensive complications of pregnancy (HTNPREG ) have an increased risk of developing systemic and pulmonary vascular dysfunction in adulthood. In this preliminary report, we sought to determine whether epigenetic modifications of genes involved in the regulation of vascular function were present in HTNPREG offspring. We contrasted DNA methylation and gene expression patterns of peripheral blood mononuclear cells obtained from young male offspring of HTNPREG (n = 5) to those of normotensive controls (n = 19). In HTNPREG offspring we identified six differentially methylated regions (DMRs) including three genes (SMOC2, ARID1B and CTRHC1) relevant to vascular function. The transcriptional activity of ARID1B and CTRCH1 was inversely related to methylation status. HTNPREG offspring had higher systolic pulmonary artery pressure (sPPA ) versus controls. Our findings demonstrate that epigenetic marks are altered in offspring of HTNPREG with a modest elevation of sPPA and introduce novel epigenomic targets for further study. On the basis of these findings we speculate that epigenomic mechanisms may be involved in mediating the effect of HTNPREG to raise the risk of vascular disease later in life.
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Affiliation(s)
- Colleen G Julian
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Brent S Pedersen
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Ivana V Yang
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Enrique Vargas
- Bolivian Institute of High Altitude Biology, La Paz, Bolivia
| | - Lorna G Moore
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David A Schwartz
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Vargas E, Calv-Rojas G, Avendaño C, Portoles A, Galvez M, Arnau J, Rosso C, Torres F, Gómez de la Camara A, Pavía M. Scren: Spanish Research Netwok; one-Year Experience. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.402] [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: 11/24/2022]
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Orol B, Lagunar J, Sardá J, Salas R, Vargas E. Stopp/Start Criteria 2014: Comparison of Appoach, Pathology and Therapeutic Changes. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.390] [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: 10/23/2022]
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Julian CG, Gonzales M, Rodriguez A, Bellido D, Salmon CS, Ladenburger A, Reardon L, Vargas E, Moore LG. Perinatal hypoxia increases susceptibility to high-altitude polycythemia and attendant pulmonary vascular dysfunction. Am J Physiol Heart Circ Physiol 2015; 309:H565-73. [PMID: 26092986 DOI: 10.1152/ajpheart.00296.2015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/17/2015] [Indexed: 12/22/2022]
Abstract
Perinatal exposures exert a profound influence on physiological function, including developmental processes vital for efficient pulmonary gas transfer throughout the lifespan. We extend the concept of developmental programming to chronic mountain sickness (CMS), a debilitating syndrome marked by polycythemia, ventilatory impairment, and pulmonary hypertension that affects ∼10% of male high-altitude residents. We hypothesized that adverse perinatal oxygenation caused abnormalities of ventilatory and/or pulmonary vascular function that increased susceptibility to CMS in adulthood. Subjects were 67 male high-altitude (3,600-4,100 m) residents aged 18-25 yr with excessive erythrocytosis (EE, Hb concentration ≥18.3 g/dl), a preclinical form of CMS, and 66 controls identified from a community-based survey (n = 981). EE subjects not only had higher Hb concentrations and erythrocyte counts, but also lower alveolar ventilation, impaired pulmonary diffusion capacity, higher systolic pulmonary artery pressure, lower pulmonary artery acceleration time, and more frequent right ventricular hypertrophy, than controls. Compared with controls, EE subjects were more often born to mothers experiencing hypertensive complications of pregnancy and hypoxia during the perinatal period, with each increasing the risk of developing EE (odds ratio = 5.25, P = 0.05 and odds ratio = 6.44, P = 0.04, respectively) after other factors known to influence EE status were taken into account. Adverse perinatal oxygenation is associated with increased susceptibility to EE accompanied by modest abnormalities of the pulmonary circulation that are independent of increased blood viscosity. The association between perinatal hypoxia and EE may be due to disrupted alveolarization and microvascular development, leading to impaired gas exchange and/or pulmonary hypertension.
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Affiliation(s)
- Colleen Glyde Julian
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado;
| | | | | | - Diva Bellido
- Bolivian Institute of High Altitude Biology, La Paz, Bolivia
| | | | - Anne Ladenburger
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Lindsay Reardon
- Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and
| | - Enrique Vargas
- Bolivian Institute of High Altitude Biology, La Paz, Bolivia
| | - Lorna G Moore
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
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Romero-Ganuza J, García-Forcada A, Vargas E, Gambarrutta C. An intermediate respiratory care unit for spinal cord-injured patients. A retrospective study. Spinal Cord 2015; 53:552-6. [PMID: 25777333 DOI: 10.1038/sc.2015.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 01/05/2015] [Accepted: 01/08/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Patients with cervical spinal cord injury (SCI) may need prolonged mechanical ventilation (MV) and a long stay in the Intensive Care Unit. An intermediate respiratory care unit (IRCU) can shorten that stay, optimizing hospital resources. The aim of our work has been to evaluate the activity of such a unit in our hospital. METHODS This is a descriptive retrospective study based on the data of patients with SCI and respiratory failure discharged from our IRCU between 1 July 2010 and 28 February 2013. RESULTS We have analysed data from 146 patients with SCI, adding up to 228 admissions (68 first admissions and 160 readmissions due to complications or scheduled review visits). Sixty-three out of the 68 newly admitted patients survived their first admission (92.6%). Length of hospitalization was 195.6±110.4 days, 22 were admitted to monitor their respiratory status and 46 were on MV on admission. Of these, 26 (38.2%) were admitted to attempt weaning from the respirator and 20 (29.4%) to enter a programme of permanent respiratory support. Weaning was successful in 23 out of 26 patients (88.4%), the process taking 47.2±49.3 days. Forty of them (58.8%) were discharged to their home. CONCLUSIONS An IRCU can manage a substantial number of severe SCI patients who need MV, and an important number of them can be weaned from the respirator. It may also achieve a good success rate in the integration of MV-dependent patients within family and society.
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Affiliation(s)
- J Romero-Ganuza
- Intermediate Respiratory Care Unit, Internal Medicine Service, Toledo, Spain
| | - A García-Forcada
- Intermediate Respiratory Care Unit, Internal Medicine Service, Toledo, Spain
| | - E Vargas
- Rehabilitation Medicine Service, National Hospital of Paraplegics, Toledo, Spain
| | - C Gambarrutta
- Intermediate Respiratory Care Unit, Internal Medicine Service, Toledo, Spain
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Browne VA, Julian CG, Toledo-Jaldin L, Cioffi-Ragan D, Vargas E, Moore LG. Uterine artery blood flow, fetal hypoxia and fetal growth. Philos Trans R Soc Lond B Biol Sci 2015; 370:20140068. [PMID: 25602072 PMCID: PMC4305169 DOI: 10.1098/rstb.2014.0068] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Evolutionary trade-offs required for bipedalism and brain expansion influence the pregnancy rise in uterine artery (UtA) blood flow and, in turn, reproductive success. We consider the importance of UtA blood flow by reviewing its determinants and presenting data from 191 normotensive (normal, n = 125) or hypertensive (preeclampsia (PE) or gestational hypertension (GH), n = 29) Andean residents of very high (4100-4300 m) or low altitude (400 m, n = 37). Prior studies show that UtA blood flow is reduced in pregnancies with intrauterine growth restriction (IUGR) but whether the IUGR is due to resultant fetal hypoxia is unclear. We found higher UtA blood flow and Doppler indices of fetal hypoxia in normotensive women at high versus low altitude but similar fetal growth. UtA blood flow was markedly lower in early-onset PE versus normal high-altitude women, and their fetuses more hypoxic as indicated by lower fetal heart rate, Doppler indices and greater IUGR. We concluded that, despite greater fetal hypoxia, fetal growth was well defended by higher UtA blood flows in normal Andeans at high altitude but when compounded by lower UtA blood flow in early-onset PE, exaggerated fetal hypoxia caused the fetus to respond by decreasing cardiac output and redistributing blood flow to help maintain brain development at the expense of growth elsewhere. We speculate that UtA blood flow is not only an important supply line but also a trigger for stimulating the metabolic and other processes regulating feto-placental metabolism and growth. Studies using the natural laboratory of high altitude are valuable for identifying the physiological and genetic mechanisms involved in human reproductive success.
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Affiliation(s)
- Vaughn A Browne
- Department of Emergency Medicine, University of Colorado Denver, Aurora, CO 80045, USA
| | - Colleen G Julian
- Department of Medicine, University of Colorado Denver, Aurora, CO 80045, USA
| | | | - Darleen Cioffi-Ragan
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO 80045, USA
| | - Enrique Vargas
- Instituto Boliviano de Biología de Altura, La Paz, Bolivia
| | - Lorna G Moore
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO 80045, USA
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Niermeyer S, Andrade-M MP, Vargas E, Moore LG. Neonatal oxygenation, pulmonary hypertension, and evolutionary adaptation to high altitude (2013 Grover Conference series). Pulm Circ 2015; 5:48-62. [PMID: 25992270 PMCID: PMC4405714 DOI: 10.1086/679719] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 11/21/2014] [Indexed: 01/30/2023] Open
Abstract
Andeans and Tibetans have less altitude reduction in birth weight than do shorter-resident groups, but only Tibetans are protected from pulmonary hypertension and chronic mountain sickness (CMS). We hypothesized that differences in neonatal oxygenation were involved, with arterial O2 saturation (SaO2) being highest in Tibetans, intermediate in Andeans, and lowest in Han or Europeans, and that improved oxygenation in Andeans relative to Europeans was accompanied by a greater postnatal decline in systolic pulmonary arterial pressures (Ppasys ). We studied 41 healthy (36 Andeans, 5 Europeans) and 9 sick infants at 3,600 m in Bolivia. The SaO2 in healthy babies was highest at 6-24 hours of postnatal age and then declined, whereas sick babies showed the opposite pattern. Compared to that of 30 Tibetan or Han infants studied previously at 3,600 m, SaO2 was higher in Tibetans than in Han or Andeans during wakefulness and active or quiet sleep. Tibetans, as well as Andeans, had higher values than Han while feeding. The SaO2's of healthy Andeans and Europeans were similar and, like those of Tibetans, remained at 85% or above, whereas Han values dipped below 70%. Andean and European Ppasys values were above sea-level norms and higher in sick than in healthy babies, but right heart pressure decreased across 4-6 months in all groups. We concluded that Tibetans had better neonatal oxygenation than Andeans at 3,600 m but that, counter to our hypothesis, neither was SaO2 higher nor Ppa lower in Andean than in European infants. Further, longitudinal studies in these 4 groups are warranted to determine whether neonatal oxygenation influences susceptibility to high-altitude pulmonary hypertension and CMS later in life.
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Affiliation(s)
- Susan Niermeyer
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
| | - Mario Patricio Andrade-M
- Division of Cardiology (Pediatrics), Caja Nacional de Salud and Clínica del Sur, La Paz, Bolivia
| | - Enrique Vargas
- Department of Respiratory Medicine, Cardiology, and Physiology, Instituto Boliviano de Biología de Altura, La Paz, Bolivia
| | - Lorna G. Moore
- Department of Obstetrics and Gynecology and Center for Women’s Health Research, University of Colorado Denver, Aurora, Colorado, USA
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Herrero A, Garzón G, Gil A, García I, Vargas E, Torres N. [Control of cardiovascular risk factors among patients with diabetes with and without cardiovascular disease]. Semergen 2014; 41:354-61. [PMID: 25163908 DOI: 10.1016/j.semerg.2014.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 06/13/2014] [Accepted: 07/09/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION There is evidence that cardiovascular goals are beneficial in diabetes. OBJECTIVE To determine the distribution of cardiovascular risk levels in patients with diabetes and the clinical interventions they have received. DESIGN Descriptive cross-sectional study. SETTING SERMAS (Madrid) 2010. SUBJECTS All patients with diabetes. (n=41,096). MAIN MEASUREMENTS Patients in primary or secondary prevention, metabolic and cardiovascular risk factors control, pharmacological and non-pharmacological interventions. Patient and professional variables. RESULTS Around one-fifth (21.5%) (95%CI: 21.1% -21.9%) in secondary prevention (very high cardiovascular risk). HbA1c was under control in 31% (95%CI: 30.1%-32%), with 49.9% (95%CI: 48.8%-50.9%) with BP under control, and 39.4% (95% CI: 38.4%-40.4%) with LDL controlled. Only 8.9% (95%CI: 8.3%-9.5%) had a well-controlled HdA1c, BP and LDL, and in 19.8% (95%CI: 19%-20.6%) none of these were under control. Of those with an uncontrolled BP, 23.6% (95% CI: 23.2%-24%) had antihypertensive drugs. There was better control in patients older than 70 years, and those who lived in an urban center, or a lower number of patients per day. CONCLUSION In diabetic patients with very high cardiovascular risk (secondary prevention), just half of them had good control of cardiovascular risk factors (BP and LDL). An association was found between better control and older than 70, urban center or lower number of patients per day. This suggests developing strategies to promote a comprehensive control of cardiovascular risk factors in diabetic patients in secondary prevention.
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Affiliation(s)
- A Herrero
- Centro de Salud Federica Montseny, Servicio Madrileño de Salud, Madrid, España.
| | - G Garzón
- Centro de Salud Federica Montseny, Servicio Madrileño de Salud, Madrid, España
| | - A Gil
- Departamento de Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, España
| | - I García
- Centro de Salud Federica Montseny, Servicio Madrileño de Salud, Madrid, España
| | - E Vargas
- Centro de Salud Federica Montseny, Servicio Madrileño de Salud, Madrid, España
| | - N Torres
- Centro de Salud Federica Montseny, Servicio Madrileño de Salud, Madrid, España
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Charles SM, Julian CG, Vargas E, Moore LG. Higher estrogen levels during pregnancy in Andean than European residents of high altitude suggest differences in aromatase activity. J Clin Endocrinol Metab 2014; 99:2908-16. [PMID: 24684460 PMCID: PMC4121036 DOI: 10.1210/jc.2013-4102] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Uteroplacental hypoxia has been reported to lower estrogen levels in preeclampsia as the result of reduced aromatase activity. OBJECTIVE We asked whether the chronic hypoxia of residence at high altitude in the absence of preeclampsia lowered estrogen, whether such effects differed in Andean vs European high-altitude residents, and whether such effects were related to uterine artery diameter or blood flow. DESIGN, SETTING, AND PARTICIPANTS Studies at weeks 20 and 36 of pregnancy were conducted in 108 healthy Bolivian low- (400 m, n = 53) or high-altitude (3600 m, n = 55) residents of European (n = 28 low and 26 high altitude) or Andean (n = 25 low and 29 high altitude) ancestry. All groups were similar in age, nonpregnant body mass index, and pregnancy weight gain. RESULTS High-altitude residence increased circulating progesterone, cortisol, estrone, 17β-estradiol, and estriol levels (all P < .01). High-altitude Andeans vs Europeans at week 36 had higher progesterone, estrone, 17β-estradiol, and estriol levels as well as product to substrate ratios for the reactions catalyzed by aromatase, whereas week 36 cortisol levels were greater in the European than Andean women (all P < .05). Lower cortisol, higher estriol (both P < .01), and trends for higher progesterone and 17β-estradiol levels were associated with greater uterine artery diameters and blood flow at high altitude. CONCLUSIONS Chronic hypoxia does not lower but rather raises estrogen levels in multigenerational Andeans vs shorter-term Europeans, possibly as the result of greater aromatase activity. Because hypoxia alone does not lower estrogen, other attributes of the disease may be responsible for the lower estrogen levels seen previously in preeclamptic women.
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Affiliation(s)
- Shelton M Charles
- Department of Obstetrics and Gynecology (S.M.C.), Wake Forest University, Winston-Salem, North Carolina 27157; Division of Biomedical Informatics and Personalized Medicine (C.G.J.), Departments of Medicine and Obstetrics and Gynecology (L.G.M.), University of Colorado Denver, Aurora, Colorado 80045; and Instituto de Biología de Altura (E.V.), La Paz, Bolivia
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Bigham AW, Julian CG, Wilson MJ, Vargas E, Browne VA, Shriver MD, Moore LG. Maternal PRKAA1 and EDNRA genotypes are associated with birth weight, and PRKAA1 with uterine artery diameter and metabolic homeostasis at high altitude. Physiol Genomics 2014; 46:687-97. [PMID: 25225183 DOI: 10.1152/physiolgenomics.00063.2014] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Low birth weight and intrauterine growth restriction (IUGR) increase the risk of mortality and morbidity during the perinatal period as well as in adulthood. Environmental and genetic factors contribute to IUGR, but the influence of maternal genetic variation on birth weight is largely unknown. We implemented a gene-by-environment study wherein we utilized the growth restrictive effects of high altitude. Multigenerational high-altitude residents (Andeans) are protected from altitude-associated IUGR compared with recent migrants (Europeans). Using a combined cohort of low- and high-altitude European and Andean women, we tested 63 single nucleotide polymorphisms (SNPs) from 16 natural selection-nominated candidate gene regions for associations with infant birth weight. We identified significant SNP associations with birth weight near coding regions for two genes involved in oxygen sensing and vascular control, PRKAA1 and EDNRA, respectively. Next, we identified a significant association for the PRKAA1 SNP with an intermediate phenotype, uterine artery diameter, which has been shown to be related to Andean protection from altitude-associated reductions in fetal growth. To explore potential functional relationships for the effect of maternal SNP genotype on birth weight, we evaluated the relationship between maternal PRKAA1 SNP genotype and gene expression patterns in general and, in particular, of key pathways involved in metabolic homeostasis that have been proposed to play a role in the pathophysiology of IUGR. Our observations suggest that maternal genetic variation within genes that regulate oxygen sensing, metabolic homeostasis, and vascular control influence fetal growth and birth weight outcomes and hence Andean adaptation to high altitude.
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Affiliation(s)
- Abigail W Bigham
- Department of Anthropology, University of Michigan, Ann Arbor, Michigan;
| | - Colleen G Julian
- Departments of Anthropology and Health/Behavioral Sciences, University of Colorado Denver, Denver, Colorado; Department of Medicine, University of Colorado Denver, Aurora, Colorado
| | - Megan J Wilson
- Departments of Anthropology and Health/Behavioral Sciences, University of Colorado Denver, Denver, Colorado; Department of Biology, Western State Colorado University, Gunnison, Colorado
| | - Enrique Vargas
- Instituto Boliviano de Biología de Altura, La Paz, Bolivia
| | - Vaughn A Browne
- Altitude Research Center, Department of Emergency Medicine, University of Colorado Denver, Aurora, Colorado
| | - Mark D Shriver
- Department of Anthropology, Pennsylvania State University, University Park, Pennsylvania; and
| | - Lorna G Moore
- Departments of Anthropology and Health/Behavioral Sciences, University of Colorado Denver, Denver, Colorado; Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, Colorado
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Carrascosa R, Solano-López G, Vargas E, Fraga J. Squamous cell carcinoma in an immunosuppressed patient on voriconazole. Actas Dermo-Sifiliográficas (English Edition) 2014. [DOI: 10.1016/j.adengl.2013.06.004] [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: 11/16/2022] Open
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Julian CG, Yang IV, Browne VA, Vargas E, Rodriguez C, Pedersen BS, Moore LG, Schwartz DA. Inhibition of peroxisome proliferator-activated receptor γ: a potential link between chronic maternal hypoxia and impaired fetal growth. FASEB J 2014; 28:1268-79. [PMID: 24307415 PMCID: PMC3929669 DOI: 10.1096/fj.13-239749] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 11/18/2013] [Indexed: 12/13/2022]
Abstract
Chronic exposure to hypoxia raises the risk of pregnancy disorders characterized by maternal vascular dysfunction and diminished fetal growth. In an effort to identify novel pathways for these hypoxia-related effects, we assessed gene expression profiles of peripheral blood mononuclear cells (PBMCs) obtained from 43 female, high-altitude or sea-level residents in the nonpregnant state or during pregnancy (20 or 36 wk). Hypoxia-related fetal growth restriction becomes apparent between 25 and 29 wk of gestation and continues until delivery. Our sampling strategy was designed to capture changes occurring before (20 wk) and during (36 wk) the time frame of slowed fetal growth. PBMC gene expression profiles were generated using human gene expression microarrays and compared between altitudes. Biological pathways were identified using pathway analysis. Modest transcriptional differences were observed between altitudes in the nonpregnant state. Of the genes that were differentially expressed at high altitude vs. sea level during pregnancy (20 wk: 59 probes mapped to 41 genes; 36 wk: 985 probes mapped to 700 genes), several are of pathological relevance for fetal growth restriction. In particular, transcriptional changes were consistent with the negative regulation of peroxisome proliferator-activated receptor γ (PPARγ) at high altitude; such effects were accompanied by reduced birth weight (P <0.05) and head circumference (P <0.01) at high altitude vs. sea level. Our findings indicate that chronic exposure to hypoxia during pregnancy alters maternal gene expression patterns in general and, in particular, expression of key genes involved in metabolic homeostasis that have been proposed to play a role in the pathophysiology of fetal growth restriction.
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Affiliation(s)
- Colleen G Julian
- 1Department of Medicine, University of Colorado-Denver, 12700 E 19th Ave., Mailstop 8611, 3rd Floor Research Complex 2, Aurora, CO 80045, USA.
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Zamudio S, Borges M, Echalar L, Kovalenko O, Vargas E, Torricos T, Khan AA, Alvarez M, Illsley NP. Maternal and fetoplacental hypoxia do not alter circulating angiogenic growth effectors during human pregnancy. Biol Reprod 2014; 90:42. [PMID: 24352559 DOI: 10.1095/biolreprod.113.115592] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
One causal model of preeclampsia (PE) postulates that placental hypoxia alters the production of angiogenic growth effectors (AGEs), causing an imbalance leading to maternal endothelial cell dysfunction. We tested this model using the natural experiment of high-altitude (HA) residence. We hypothesized that in HA pregnancies 1) circulating soluble fms-like tyrosine kinase 1 (sFlt-1) is increased and placental growth factor (PlGF) decreased, and 2) AGE concentrations correlate with measures of hypoxia. A cross-sectional study of healthy pregnancies at low altitude (LA) (400 m) versus HA (3600 m) compared normal (n = 80 at HA, n = 90 at LA) and PE pregnancies (n = 20 PE at HA, n = 19 PE at LA). Blood was collected using standard serum separation and, in parallel, by a method designed to inhibit platelet activation. AGEs were measured by enzyme-linked immunosorbent assays. AGEs did not differ between altitudes in normal or PE pregnancies. AGE concentrations were unrelated to measures of maternal or fetal hypoxia. PlGF was lower and sFlt-1 higher in PE, but overlapped considerably with the range observed in normal samples. PlGF correlated with placental mass in both normal and PE pregnancies. The contribution of peripheral cells to the values measured for AGEs was similar at LA and HA, but was greater in PE than in normotensive women. Hypoxia, across a wide physiological range in pregnancy, does not alter levels of circulating AGEs in otherwise normal pregnancies. Peripheral cell release of AGEs with the hemostasis characteristic of standard blood collection is highly variable and contributes to a doubling of the amount of sFlt-1 measured in PE as compared to normal pregnancies.
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Affiliation(s)
- Stacy Zamudio
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine and Surgery, Hackensack University Medical Center, Hackensack, New Jersey
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Llamas-Velasco M, Vargas E, Delgado Y, García-Diez A. Extensive Bowenoid Papulosis of the Vulva Treated by Carbon Dioxide Laser in a Patient With AIDS. Actas Dermo-Sifiliográficas (English Edition) 2013. [DOI: 10.1016/j.adengl.2012.11.024] [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] Open
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