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Passaponti S, Ermini L, Acconci G, Severi FM, Romagnoli R, Cutrupi S, Clerico M, Guerrera G, Ietta F. Rank-Rankl-Opg Axis in Multiple Sclerosis: The Contribution of Placenta. Cells 2022; 11:cells11081357. [PMID: 35456036 PMCID: PMC9031903 DOI: 10.3390/cells11081357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 02/01/2023] Open
Abstract
Women with multiple sclerosis (MS) can safely become pregnant and give birth, with no side effects or impediments. Pregnancy is generally accepted as a period of well-being in which relapses have a softer evolution, particularly in the third trimester. Herein, we hypothesized that the placenta, via its “secretome”, could contribute to the recognized beneficial effects of pregnancy on MS activity. We focused on a well-known receptor/ligand/decoy receptor system, such as the one composed by the receptor activator of nuclear factor-kB (RANK), its ligand (RANKL), and the decoy receptor osteoprotegerin (OPG), which have never been investigated in an integrated way in MS, pregnancy, and placenta. We reported that pregnancy at the term of gestation influences the balance between circulating RANKL and its endogenous inhibitor OPG in MS women. We demonstrated that the placenta at term is an invaluable source of homodimeric OPG. By functional studies on astrocytes, we showed that placental OPG suppresses the mRNA expression of the CCL20, a chemokine responsible for Th17 cell recruitment. We propose placental OPG as a crucial molecule for the recognized beneficial effect of late pregnancy on MS and its potential utility for the development of new and more effective therapeutic approaches.
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Affiliation(s)
- Sofia Passaponti
- Department of Life Sciences, University of Siena, 53100 Siena, Italy; (S.P.); (L.E.); (R.R.)
| | - Leonardo Ermini
- Department of Life Sciences, University of Siena, 53100 Siena, Italy; (S.P.); (L.E.); (R.R.)
| | - Giulia Acconci
- Department of Molecular and Developmental Medicine, Division of Prenatal Diagnosis and Obstetrics, University of Siena, 53100 Siena, Italy; (G.A.); (F.M.S.)
| | - Filiberto Maria Severi
- Department of Molecular and Developmental Medicine, Division of Prenatal Diagnosis and Obstetrics, University of Siena, 53100 Siena, Italy; (G.A.); (F.M.S.)
| | - Roberta Romagnoli
- Department of Life Sciences, University of Siena, 53100 Siena, Italy; (S.P.); (L.E.); (R.R.)
| | - Santina Cutrupi
- Department of Clinical and Biological Sciences, University of Turin, 10124 Turin, Italy; (S.C.); (M.C.)
| | - Marinella Clerico
- Department of Clinical and Biological Sciences, University of Turin, 10124 Turin, Italy; (S.C.); (M.C.)
| | - Gisella Guerrera
- Neuroimmunology Unit, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy;
| | - Francesca Ietta
- Department of Life Sciences, University of Siena, 53100 Siena, Italy; (S.P.); (L.E.); (R.R.)
- Correspondence: ; Tel.: +39-05-7723-2370
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Abstract
To evaluate the impact that hypothyroidism may have on the course of pregnancy and on neonatal outcome. This cross-sectional study consisting of 160 pregnant women (60 with hypothyroidism and 100 as control) who had been hospitalized at the Obstetrics and Gynecology of the University of Siena. The obstetric visit, the collection of anamnestic data and serum concentrations of TSH, FT4 and AbTPO were performed for each woman. Stratification of the population into two groups based on the BMI showed that there is an average difference of -0.88 before pregnancy BMI between healthy women and hypothyroid women. Moreover, with regard to the obstetric history, 8.7 times higher risk of abortion was found in hypothyroid women. About the current pregnancy in hypothyroid women, slight fetal growth delay, increased risk of premature rupture of membranes (PROM), and a higher risk of developing hypertension and gestational diabetes had been found. The importance of a more detailed anamnesis should be evaluated with greater attention at the beginning of pregnancy. This, in order to avoid the risks related to a hypothyroidism condition during pregnancy and to establish an early therapeutic treatment appropriate to the metabolic demands of each patient.
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Affiliation(s)
- Stefano Luisi
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Matteo Giorgi
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Silvia Riggi
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Gabriele Messina
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Filiberto Maria Severi
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
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Turchi V, Verzuri A, Nante N, Napolitani M, Bugnoli G, Severi FM, Quercioli C, Messina G. Night work and quality of life. A study on the health of nurses. Ann Ist Super Sanita 2020; 55:161-169. [PMID: 31264639 DOI: 10.4415/ann_19_02_08] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Job quality and evaluation of workers' health have both medical and social important implications. We studied health-related quality of life (HRQL) in nurses who perform their activity in night shifts. METHODS A cross-sectional study was conducted between October and November 2014. Nurses who attended night shift in the Siena Teaching Hospital (Azienda Ospedaliera Universitaria Senese - AOUS) were sampled using EpiInfo software (confidence interval 95%) and investigated using the SF-36 Questionnaire. Our results were compared with the Italian general population (Apolone, 1997). A Descriptive analysis was conducted. Wilcoxon test, Pearson coefficient, t-test, Wilcoxon signed-rank test and logistic regression were used for the statistical investigation. RESULTS 197 questionnaires were analyzed. Females were 71.7%; mean age was 39.2 years (DS 8.6); smokers were 37.8%. Males scores were higher than those of females in all dimensions of physical and mental health (p <0.05). The time taken to reach the place of work appeared to influence the dimension of General Health (coeff. -0.17); we found a worsening of 0.17 points of this dimension for every minute spent in travel. Men and nurses with more working years had a better score in Physical Pain dimension. AOUS nurses scored significantly (p <0.05) less compared with the correspondent Italian general population in General Health, Energy-fatigue, Social functioning, Physical functioning and Bodily pain. CONCLUSIONS There is a significant relationship between night work and HRQL of nurses. The health profile of AOUS nurses' ranks below the values of the Italian general population in various dimensions.
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Affiliation(s)
- Viviana Turchi
- Azienda Pubblica di Servizi alla Persona (ASP), Siena, Italy
| | - Agnese Verzuri
- Scuola di Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Siena, Siena, Italy
| | - Nicola Nante
- Dipartimento di Medicina Molecolare e dello Sviluppo, Università degli Studi di Siena, Siena, Italy
| | - Margherita Napolitani
- Scuola di Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Siena, Siena, Italy
| | - Gianluca Bugnoli
- "Le Scotte", Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Filiberto Maria Severi
- Dipartimento di Medicina Molecolare e dello Sviluppo, Università degli Studi di Siena, Siena, Italy - "Le Scotte", Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Cecilia Quercioli
- Direzione Medica di Presidio, P.O. "Alta Val d'Elsa", Azienda USL Toscana Sud-Est, Poggibonsi (Siena), Italy
| | - Gabriele Messina
- Dipartimento di Medicina Molecolare e dello Sviluppo, Università degli Studi di Siena, Siena, Italy
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Abstract
To evaluate quality of life and sexual function of childbearing-age women, affected by uterine fibromatosis undergoing medical treatment with ulipristal acetate. The data obtained by filling the questionnaires European Quality of Life Five-Dimension Scale and modified Female Sexual Function Index, were analyzed to assess UPA usefulness in improving QoL and sexual activity. A total of 139 patients affected by uterine fibromatosis undergoing conservative ulipristal acetate treatment were enrolled in this prospective observational cohort study. Seventy-one women (average age 46.5 years) answered the questionnaires: QoL and sexuality were evaluated before and after ulipristal acetate treatment. 59 patients (83.1%) had an improvement of QoL and general health state, with a reduction of VAS score after ulipristal acetate treatment. EQ-5D-5L showed a statistically significant improvement of usual act impairment, mobility, discomfort, anxiety/depression (p < .0005). There was no difference in personal care management after therapy. Modified FSFI showed a statistically significant improvement (p < .0001) of sexual satisfaction and sexual life. A not statistically significant improvement in dyspareunia was also highlighted. This study provides a clear picture about QoL impact on women and confirms the effectiveness of the ulipristal acetate in improving different aspects of daily and sexual life of patients undergoing medical treatment.
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Affiliation(s)
- Antonella Biscione
- Department of Molecular and Developmental Medicine, Obsterics and Gynecology, University of Siena, Siena, Italy
| | - Valeria Barra
- Department of Molecular and Developmental Medicine, Obsterics and Gynecology, University of Siena, Siena, Italy
| | - Emma Bellone
- Department of Molecular and Developmental Medicine, Obsterics and Gynecology, University of Siena, Siena, Italy
| | - Filiberto Maria Severi
- Department of Molecular and Developmental Medicine, Obsterics and Gynecology, University of Siena, Siena, Italy
| | - Stefano Luisi
- Department of Molecular and Developmental Medicine, Obsterics and Gynecology, University of Siena, Siena, Italy
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Abstract
Tubal pregnancy represents an entity that every gynecologist will encounter during professional life. Because of the high prevalence among the pregnant population, standardized protocols are needed in order to choose the optimal strategy for each case. Accurate ultrasound pictures are supporting a more precise diagnosis of ectopic tubal pregnancy, the evolution of which should be closely monitored in follow-up with serial β-hCG values. Laparoscopy, intramuscular methotrexate, and active expectant management are all involved, however, tailoring the best treatment to the patient's needs is the challenge to focus on. This manuscript describes how in routinary practice an evidence-based diagnostic process should be the key factor to go for the best possible management. When possible, a longsighted less invasive approach should be preferred, aiming to preserve the patient's fertility for years to come. An optimal choice of the management should involve the patient or the couple in the decision-making process to reach the ultimate goal of compliance.
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Affiliation(s)
- Lorenzo Sabbioni
- Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynecology, Cesare Magati Hospital, Scandiano, Italy
| | - Emanuela Carossino
- Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynecology, Cesare Magati Hospital, Scandiano, Italy
| | - Filiberto Maria Severi
- Division of Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Stefano Luisi
- Division of Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Giustarini D, Galvagni F, Dalle Donne I, Milzani A, Severi FM, Santucci A, Rossi R. N-acetylcysteine ethyl ester as GSH enhancer in human primary endothelial cells: A comparative study with other drugs. Free Radic Biol Med 2018; 126:202-209. [PMID: 30114478 DOI: 10.1016/j.freeradbiomed.2018.08.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/10/2018] [Accepted: 08/12/2018] [Indexed: 02/08/2023]
Abstract
Several drugs are currently in use as glutathione (GSH) enhancers in clinical, pre-clinical and experimental research. Here we compare the ability of N-acetylcysteine (NAC), 2-oxothiazolidine-4-carboxylic acid (OTC), glutathione ethyl ester (GSH-EE) and N-acetylcysteine ethyl ester (NACET) to increase the intracellular concentration of GSH using primary human umbilical vein endothelial cells (HUVEC) as in vitro model. Our experiments highlighted that NACET is largely the most efficient molecule in increasing the intracellular levels of GSH, cysteine, and γ-glutamylcysteine. This is because NACET is lipophilic and can freely cross plasma membrane but, inside the cell, it is de-esterified to the more hydrophilic NAC, which, in turn, is trapped into the cell and slowly transformed into cysteine. The higher availability of cysteine is matched by an increase in GSH synthesis, cysteine availability being the rate limiting step for this reaction. Surprisingly, the increase in GSH concentration was not linear but peaked at 0.5 mM NACET and gradually decreased when cells were treated with higher concentrations of NACET. We demonstrated that this puzzling ceiling effect was due to the fact that NAC released from NACET turned out to be a competitive inhibitor of the enzyme glutamate-cysteine ligase, with a Ki value of 3.2 mM. By using a cell culture medium lacking of cysteine and methionine, we could demonstrate that the slight increase in intracellular levels of cysteine and GSH induced by NAC in HUVEC grown in standard medium was due to the reduction of the cystine present in the medium itself there rather than to the action of NAC as Cys pro-drug. This fact may explain why NAC works well as GSH enhancer at very high concentrations in pre-clinical and in vitro studies, whereas it failed in most clinical trials.
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Affiliation(s)
- Daniela Giustarini
- Department of Medicine, Surgery and Neurosciences, University of Siena, Via A. Moro 2, I-53100 Siena, Italy.
| | - Federico Galvagni
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Via A. Moro 2, I-53100 Siena, Italy
| | - Isabella Dalle Donne
- Department of Biosciences, Università degli Studi di Milano, via Celoria 26, I-20133 Milan, Italy
| | - Aldo Milzani
- Department of Biosciences, Università degli Studi di Milano, via Celoria 26, I-20133 Milan, Italy
| | - Filiberto Maria Severi
- Department of Molecular and Developmental Medicine, Via delle Scotte, University of Siena, Siena, Italy
| | - Annalisa Santucci
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Via A. Moro 2, I-53100 Siena, Italy
| | - Ranieri Rossi
- Department of Life Sciences, University of Siena, Via A. Moro 2, I-53100 Siena, Italy
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7
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Funghi L, Torricelli M, Novembri R, Vannuccini S, Cevenini G, Di Tommaso M, Severi FM, Petraglia F. Placental and maternal serum activin A in spontaneous and induced labor in late-term pregnancy. J Endocrinol Invest 2018; 41:171-177. [PMID: 28612286 DOI: 10.1007/s40618-017-0640-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 02/14/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Feto-placental unit represents an important source of activin A, a member of transforming growth factors-β involved in the mechanisms of labor. No evidences are available on activin A in pregnancies beyond 41 weeks of gestation, where induction of labor is often required. The present study aimed to evaluate activin A maternal serum levels and placental mRNA expression in term and late-term pregnancy, with spontaneous or induced labor, and its possible role to predict the response to labor induction. METHODS Maternal serum samples and placental specimens were collected from women with singleton pregnancy admitted for either term spontaneous labor (n = 23) or induction of labor for late-term pregnancy (n = 41), to evaluate activin A serum levels and placental mRNA expression. Univariate and multivariate analyses on activin A serum levels, maternal clinical parameters, and cervical length were conducted in women undergoing induction of labor. RESULTS Maternal serum activin A levels and placental activin A mRNA expression in late-term pregnancies were significantly higher than at term. Late-term pregnancies who did not respond to induction of labor showed significantly lower levels of activin A compared to responders. The combination of serum activin A and cervical length achieved a sensitivity of 100% and a specificity of 93.55% for the prediction of successful induction. CONCLUSION Late-term pregnancy is characterized by hyperexpression of placental activin A and increased maternal activin A secretion. By combining maternal serum activin A levels with cervical length, a good predictive model for the response to induction of labor was elaborated.
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Affiliation(s)
- L Funghi
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Policlinico "Santa Maria alle Scotte" Viale Bracci, 53100, Siena, Italy
| | - M Torricelli
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Policlinico "Santa Maria alle Scotte" Viale Bracci, 53100, Siena, Italy
| | - R Novembri
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Policlinico "Santa Maria alle Scotte" Viale Bracci, 53100, Siena, Italy
| | - S Vannuccini
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Policlinico "Santa Maria alle Scotte" Viale Bracci, 53100, Siena, Italy
| | - G Cevenini
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - M Di Tommaso
- Department of Health Sciences, University of Florence, Florence, Italy
| | - F M Severi
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Policlinico "Santa Maria alle Scotte" Viale Bracci, 53100, Siena, Italy
| | - F Petraglia
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Policlinico "Santa Maria alle Scotte" Viale Bracci, 53100, Siena, Italy.
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Abstract
Induction of labour (IOL) is a widely-used practice in obstetrics. Our aim was to evaluate predictors of vaginal delivery in postdate pregnancies induced with prostaglandins. We conducted a retrospective cross-sectional study with analytic component. A total of 145 women, admitted for IOL after the 41st week of gestation, were induced with a vaginal pessary releasing prostaglandins. Type of delivery, whether vaginal or caesarean, was the outcome. Several maternal and foetal variables were investigated. The Kaplan-Maier curves, monovariate and a multivariate logistic regression were carried out. In our population, 80.7% of women had vaginal delivery after the induction. Multiparity and a high Bishop score at the beginning of the IOL were protective factors for a vaginal delivery (respectively OR 0.16, p = .028 and OR 0.62, p = .034) while age >35 years, and the foetal birth weight >3500 g at the birth, resulted in being risk factors for caesarean section (respectively OR 4.20, p = .006 and OR 3.63, p = .013). IMPACT STATEMENT What is already known on this subject: Induction of labour (IOL) is a widely used practice in obstetrics. Scientific literature shows several predictors of successful induction, although there is no unanimity except for 'multiparity' and 'favourable Bishop score' which are associated with positive outcome of the induction. The main difficulty in finding other predictive factors is the heterogeneity of this field (different local protocols in each hospital, type of induction, populations and outcomes chosen in each study). In addition to that, populations are not always comparable due to the different gestation. For this reason, we decided to select a specific population of women, such as low risk postterm pregnancies induced with prostaglandins, in order to detect possible predictive factors for the success of the IOL for women with uncomplicated pregnancies. What the results of this study add: Our study agrees with existing literature that 'multiparity' and 'Bishop score' are linked with the success of IOL and adds that 'maternal age' and 'foetal birth weight' are significant risk factors for the population of uncomplicated post term pregnancies induced with prostaglandins. What the implications are of these findings for clinical practice and/or further research: Our results agreed with the existing literature regarding parity and Bishop score but not for maternal age and birth weight. This adds new precious data to the literature which could be used for systematic reviews and for implementing IOL guidelines and protocols, nationally and internationally. Our findings could be also used for guiding future research in this field. It will be interesting to investigate the existence of not just specific factors but also any combination of variables which could predict the success of the procedure. At the moment these information cannot be used in terms of decision making for healthcare professionals as no variable is 100% predictive but once further research will be added, we may be able to know when is best time to start the IOL, how to facilitate the success of the procedure and how to best support the woman throughout the whole experience.
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Affiliation(s)
- Laura Batinelli
- a Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Andrea Serafini
- b Post Graduated School in Public Health , University of Siena , Siena , Italy
| | - Nicola Nante
- a Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Felice Petraglia
- a Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Filiberto Maria Severi
- a Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Gabriele Messina
- a Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
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Orlandini C, Torricelli M, Spirito N, Alaimo L, Di Tommaso M, Severi FM, Ragusa A, Petraglia F. Maternal anemia effects during pregnancy on male and female fetuses: are there any differences? J Matern Fetal Neonatal Med 2016; 30:1704-1708. [DOI: 10.1080/14767058.2016.1222607] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Cinzia Orlandini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy,
| | - Michela Torricelli
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy,
| | - Nicoletta Spirito
- Department of Obstetric and Gynecology, Ospedale Apuane, Massa Carrara, Italy, and
| | - Lucia Alaimo
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy,
| | - Mariarosaria Di Tommaso
- Department of Health Sciences, Division of Pediatrics, Obstetrics and Gynecology and Nursing Science, University of Florence, Florence, Italy
| | | | - Antonio Ragusa
- Department of Obstetric and Gynecology, Ospedale Apuane, Massa Carrara, Italy, and
| | - Felice Petraglia
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy,
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Pierantozzi E, Vezzani B, Badin M, Curina C, Severi FM, Petraglia F, Randazzo D, Rossi D, Sorrentino V. Tissue-Specific Cultured Human Pericytes: Perivascular Cells from Smooth Muscle Tissue Have Restricted Mesodermal Differentiation Ability. Stem Cells Dev 2016; 25:674-86. [PMID: 26956507 DOI: 10.1089/scd.2015.0336] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Microvascular pericytes (PCs) are considered the adult counterpart of the embryonic mesoangioblasts, which represent a multipotent cell population that resides in the dorsal aorta of the developing embryo. Although PCs have been isolated from several adult organs and tissues, it is still controversial whether PCs from different tissues exhibit distinct differentiation potentials. To address this point, we investigated the differentiation potentials of isogenic human cultured PCs isolated from skeletal (sk-hPCs) and smooth muscle tissues (sm-hPCs). We found that both sk-hPCs and sm-hPCs expressed known pericytic markers and did not express endothelial, hematopoietic, and myogenic markers. Both sk-hPCs and sm-hPCs were able to differentiate into smooth muscle cells. In contrast, sk-hPCs, but not sm-hPCs, differentiated in skeletal muscle cells and osteocytes. Given the reported ability of the Notch pathway to regulate skeletal muscle and osteogenic differentiation, sk-hPCs and sm-hPCs were treated with N-[N-(3,5- difluorophenacetyl)-L-alanyl]-S-phenylglycine t-butyl ester (DAPT), a known inhibitor of Notch signaling. DAPT treatment, as assessed by histological and molecular analysis, enhanced myogenic differentiation and abolished osteogenic potential of sk-hPCs. In contrast, DAPT treatment did not affect either myogenic or osteogenic differentiation of sm-hPCs. In summary, these results indicate that, despite being isolated from the same anatomical niche, cultured PCs from skeletal muscle and smooth muscle tissues display distinct differentiation abilities.
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Affiliation(s)
| | - Bianca Vezzani
- 1 Molecular Medicine Section, University of Siena , Siena, Italy
| | - Margherita Badin
- 1 Molecular Medicine Section, University of Siena , Siena, Italy
| | - Carlo Curina
- 1 Molecular Medicine Section, University of Siena , Siena, Italy
| | - Filiberto Maria Severi
- 2 Division of Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena , Siena, Italy
| | - Felice Petraglia
- 2 Division of Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena , Siena, Italy
| | - Davide Randazzo
- 1 Molecular Medicine Section, University of Siena , Siena, Italy
| | - Daniela Rossi
- 1 Molecular Medicine Section, University of Siena , Siena, Italy
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Prefumo F, Ferrazzi E, Di Tommaso M, Severi FM, Locatelli A, Chirico G, Dani C, Lista G, Orabona R, Zambolo C, Frusca T. Neonatal morbidity after cesarean section before labor at 34(+0) to 38(+6) weeks: a cohort study. J Matern Fetal Neonatal Med 2015; 29:1334-8. [PMID: 26037729 DOI: 10.3109/14767058.2015.1047758] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 11/13/2022]
Abstract
OBJECTIVE To describe morbidity in neonates born by cesarean section (CS) before labor between 34(+0) and 38(+6) weeks, stratified by gestational age. METHODS Cohort study from five Italian tertiary care hospitals. Consecutive singleton pregnancies delivered by CS before labor between 34(+0) and 38(+6) weeks of gestation from January 2010 to August 2011 were included. Women in labor, with premature rupture of membranes, or with previous administration of steroids were excluded. The incidence of neonatal complication by gestational week was calculated. RESULTS A total of 1135 cases were analyzed. Composite adverse neonatal outcomes, respiratory distress syndrome, transient tachypnea and use of continuous airway positive pressure decreased from 50%, 28%, 5% and 22% at 34 weeks of gestation, to 4.7%, 1.0%, 0.9% and 0.3% at 38 weeks of gestation. Multivariate analysis showed that the only variable independently associated with composite adverse neonatal outcome was gestational age at delivery (adjusted odds ratio 0.49; 95% confidence interval 0.39-0.61). CONCLUSIONS The prevalence of neonatal complications in newborns delivered by CS before labor halves at each week of gestation from 34 to 38 weeks. Nonetheless complications, and mainly respiratory problems, are still present at early term gestation.
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Affiliation(s)
- Federico Prefumo
- a Departments of Obstetrics, Gynecology and Neonatology, Spedali Civili di Brescia , University of Brescia , Brescia , Italy
| | - Enrico Ferrazzi
- b Department of Woman Mother and Neonate, Buzzi Hospital , Biomedical and Clinical Sciences School of Medicine, University of Milan , Milan , Italy
| | - Mariarosaria Di Tommaso
- c Departments of Obstetrics, Gynecology and Neonatology , Careggi Hospital, University of Florence , Florence , Italy
| | | | - Anna Locatelli
- e Department of Obstetrics and Gynecology , San Gerardo Hospital, University of Milan-Bicocca , Monza , Italy
| | - Gaetano Chirico
- a Departments of Obstetrics, Gynecology and Neonatology, Spedali Civili di Brescia , University of Brescia , Brescia , Italy
| | - Carlo Dani
- c Departments of Obstetrics, Gynecology and Neonatology , Careggi Hospital, University of Florence , Florence , Italy
| | - Gianluca Lista
- b Department of Woman Mother and Neonate, Buzzi Hospital , Biomedical and Clinical Sciences School of Medicine, University of Milan , Milan , Italy
| | - Rossana Orabona
- a Departments of Obstetrics, Gynecology and Neonatology, Spedali Civili di Brescia , University of Brescia , Brescia , Italy
| | - Chiara Zambolo
- a Departments of Obstetrics, Gynecology and Neonatology, Spedali Civili di Brescia , University of Brescia , Brescia , Italy
| | - Tiziana Frusca
- a Departments of Obstetrics, Gynecology and Neonatology, Spedali Civili di Brescia , University of Brescia , Brescia , Italy
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Andrissi L, Petraglia F, Giuliani A, Severi FM, Angioni S, Valensise H, Vannuccini S, Comoretto N, Tambone V. The influence of doctor-patient and midwife-patient relationship in quality care perception of italian pregnant women: an exploratory study. PLoS One 2015; 10:e0124353. [PMID: 25905494 PMCID: PMC4408047 DOI: 10.1371/journal.pone.0124353] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/02/2015] [Indexed: 11/18/2022] Open
Abstract
Background The study focuses on the perceived nature / technique opposition in pregnancy and delivery emerging from gynaecologist/ midwife/ pregnant woman relationships. We developed a cross-sectional survey to identify, by means of a multidimensional data-driven approach, the main latent concepts structuring the between items correlation correspondent to the different general opinions present in the data set. The obtained results can set the basis to improve patient satisfaction while decreasing healthcare costs. Methods The sample is made of 90 pregnant women within 24-48 hours after natural or operative birth, from three maternity units in Italy. Women filled in a questionnaire about their relationship with gynaecologist and midwife during pregnancy and hospital stay for delivery. Results Participation rate approached 100%. The emerging factorial structure gave a proof-of-concept of the hypothesis of ‘nature vs. technique’ as the main dimension shaping women opinions. The results highlighted the role of midwife as the ‘link’ between the natural and technical dimension of birth. The quality of welcome and the establishing of an empathic relation between mother and healthcare professional was shown to decrease further request of care in the post-partum period. Conclusions The “fault plane” between nature and technique is a very critical zone for litigation. Women are particularly sensitive to the consideration and attention they receive at their admission in the hospital, as well as to the quality of human relationship with midwife. The perceived quality of welcome scaled with a decreased need of additional care and, more in general, with a more faithful attitude towards health professionals. We hypothesize that increasing the quality of welcome can exert an effect on both welfare costs and litigation. This opens the way (through an extension of this pilot study to wider populations) to relevant ameliorative actions on quality of care at practically null cost.
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Affiliation(s)
- Laura Andrissi
- Institute of Philosophy of Scientific and Technological Activity, University Campus Bio-Medico, Rome, Italy
| | - Felice Petraglia
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Alessandro Giuliani
- Environment and Health Dept. Istituto Superiore di Sanità, Rome, Italy
- * E-mail:
| | - Filiberto Maria Severi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Stefano Angioni
- Division of Gynaecology, Obstetrics and Pathophysiology of Human Reproduction, Department of Surgery, Maternal-Fetal Medicine and Imaging, University of Cagliari, Cagliari, Italy
| | - Herbert Valensise
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
| | - Silvia Vannuccini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Nunziata Comoretto
- Institute of Philosophy of Scientific and Technological Activity, University Campus Bio-Medico, Rome, Italy
| | - Vittoradolfo Tambone
- Institute of Philosophy of Scientific and Technological Activity, University Campus Bio-Medico, Rome, Italy
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Torricelli M, Vannuccini S, Moncini I, Cannoni A, Voltolini C, Conti N, Di Tommaso M, Severi FM, Petraglia F. Anterior placental location influences onset and progress of labor and postpartum outcome. Placenta 2014; 36:463-6. [PMID: 25573094 DOI: 10.1016/j.placenta.2014.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/15/2014] [Accepted: 12/18/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of the study is to evaluate whether placental location at term is associated with delivery outcome. METHODS A prospective study including 2354 patients with singleton pregnancy at term admitted for vaginal delivery was conducted. Placental position was determined before delivery by ultrasonographic examination performed transabdominally with women in the supine position. Maternal characteristics and delivery outcome such as premature rupture of membranes, induction of labor, mode and gestational age at delivery, indication for cesarean section, duration of the third stage, postpartum hemorrhage (PPH) and manual removal of placenta were correlated with anterior, posterior or fundal placental locations. RESULTS Among women enrolled: i) 1164 had an anterior placenta, ii) 1087 a posterior placenta, iii) 103 a fundal placenta. Women with anterior placenta showed: i) a higher incidence of induction of labor (p = 0.0001), especially for postdate pregnancies and prolonged prelabor rupture of membranes (p < 0.0001), ii) a higher rate of cesarean section rate for failure to progress in labor (p = 0.02), iii) a prolonged third stage (p = 0.01), iv) a higher incidence of manual removal of placenta (p = 0.003) and a higher rate of PPH in vaginal deliveries (p = 0.02). DISCUSSION The present study showed the influence of anterior placental location on the course of labor, with a later onset of labor, a higher rate of induction and cesarean section and postpartum complications. The reason for this influence on labor and delivery complications remains to be elucidated.
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MESH Headings
- Adult
- Cesarean Section/adverse effects
- Female
- Fetal Membranes, Premature Rupture/epidemiology
- Fetal Membranes, Premature Rupture/etiology
- Fetal Membranes, Premature Rupture/therapy
- Gestational Age
- Hospitals, University
- Humans
- Incidence
- Italy/epidemiology
- Labor, Induced/adverse effects
- Obstetric Labor Complications/epidemiology
- Obstetric Labor Complications/etiology
- Obstetric Labor Complications/therapy
- Placenta/diagnostic imaging
- Postpartum Hemorrhage/epidemiology
- Postpartum Hemorrhage/etiology
- Postpartum Hemorrhage/therapy
- Pregnancy
- Pregnancy Outcome
- Pregnancy, Angular/diagnostic imaging
- Pregnancy, Angular/physiopathology
- Pregnancy, Angular/therapy
- Pregnancy, Prolonged/epidemiology
- Pregnancy, Prolonged/etiology
- Pregnancy, Prolonged/therapy
- Prospective Studies
- Ultrasonography, Prenatal
- Young Adult
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Affiliation(s)
- M Torricelli
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - S Vannuccini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - I Moncini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - A Cannoni
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - C Voltolini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - N Conti
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - M Di Tommaso
- Department of Health Sciences, University of Florence, Florence, Italy
| | - F M Severi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - F Petraglia
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
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Conti N, Cevenini G, Vannuccini S, Orlandini C, Valensise H, Gervasi MT, Ghezzi F, Di Tommaso M, Severi FM, Petraglia F. Women with endometriosis at first pregnancy have an increased risk of adverse obstetric outcome. J Matern Fetal Neonatal Med 2014; 28:1795-8. [DOI: 10.3109/14767058.2014.968843] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Batinelli L, Serafini A, Nante N, Petraglia F, Severi FM, Messina G. Predictive factors of induction delivery failure. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku163.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Torricelli M, Voltolini C, Toti P, Vellucci FL, Conti N, Cannoni A, Moncini I, Occhini R, Severi FM, Petraglia F. Histologic chorioamnionitis: different histologic features at different gestational ages. J Matern Fetal Neonatal Med 2013; 27:910-3. [DOI: 10.3109/14767058.2013.846313] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Severi FM, De Bonis M, Vellucci FL, Voltolini C, Bocchi C, Di Tommaso M, Torricelli M, Petraglia F. The obstetric syndromes: clinical relevance of placental hormones. Expert Rev Endocrinol Metab 2013; 8:127-138. [PMID: 30736173 DOI: 10.1586/eem.12.79] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Preterm delivery, preeclampsia and intrauterine growth restriction are the major diseases of pregnancy. A key role in their pathogenesis is played by the placenta, which is the source of hormones and other important regulatory molecules providing the metabolic and endocrine homeostasis of the fetal-placental unit. Since obstetric syndromes are characterized by important maternal and neonatal morbidity and mortality worldwide, numerous efforts have been made over the years to prevent and treat them. Due to their complex pathogenesis, however, the therapy is poor and not very effective. Therefore, great emphasis is currently given to the prevention of these diseases through the identification of biochemical and biophysical markers, among which placental factors play a crucial role. The increasing knowledge of the role of placental molecules can indeed lead to the development of new therapeutic and diagnostic tools.
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Affiliation(s)
- Filiberto Maria Severi
- a Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Viale Bracci, 53100 Siena, Italy
| | - Maria De Bonis
- a Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Viale Bracci, 53100 Siena, Italy
| | - Francesca Letizia Vellucci
- a Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Viale Bracci, 53100 Siena, Italy
| | - Chiara Voltolini
- a Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Viale Bracci, 53100 Siena, Italy
| | - Caterina Bocchi
- a Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Viale Bracci, 53100 Siena, Italy
| | | | - Michela Torricelli
- a Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Viale Bracci, 53100 Siena, Italy
| | - Felice Petraglia
- a Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Viale Bracci, 53100 Siena, Italy
- c Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Viale Bracci, 53100 Siena, Italy.
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Torricelli M, Voltolini C, Conti N, Vellucci FL, Orlandini C, Bocchi C, Severi FM, Toti P, Buonocore G, Petraglia F. Histologic chorioamnionitis at term: implications for the progress of labor and neonatal wellbeing. J Matern Fetal Neonatal Med 2012; 26:188-92. [PMID: 22928534 DOI: 10.3109/14767058.2012.722724] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate: i) the rate of histologic chorioamnionitis in relation to the onset of labor and mode of delivery; ii) influence of clinical parameters on the risk of histologic chorioamnionitis in laboring women; iii) neonatal outcome in relation to histologic chorioamnionitis. METHODS A cohort study was conducted on 395 healthy women at term, with singleton uneventful pregnancy, of which 195 with spontaneous onset of labor and 200 with elective cesarean section. All placentas, collected after delivery, were examined for the diagnosis of histologic chorioamnionitis. Mode of delivery, presence of bacterial infection of placenta and membranes, maternal clinical parameters and neonatal outcome were recorded. RESULTS The rate of histologic chorioamnionitis in women with spontaneous onset of labor was significantly higher than in those experiencing elective cesarean section (28.7% vs. 11.5%). Nulliparity and the duration of labor were independent variables associated with acute histologic chorioamnionitis. The presence of histologic chorioamnionitis did not affect neonatal outcome. CONCLUSIONS The present study showed a highest rate of histological chorionamniositis in women delivering after spontaneous onset of term labor, although the mode of delivery either vaginally or by emergency cesarean section was not influenced by the presence of this pathological condition.
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Affiliation(s)
- Michela Torricelli
- Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Italy
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Torricelli M, Voltolini C, De Bonis M, Vellucci FL, Conti N, Severi FM, Petraglia F. The identification of high risk pregnancy: a new challenge in obstetrics. J Matern Fetal Neonatal Med 2012; 25 Suppl 1:2-5. [DOI: 10.3109/14767058.2012.664355] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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De Bonis M, Torricelli M, Leoni L, Berti P, Ciani V, Puzzutiello R, Severi FM, Petraglia F. Carbetocin versus oxytocin after caesarean section: similar efficacy but reduced pain perception in women with high risk of postpartum haemorrhage. J Matern Fetal Neonatal Med 2011; 25:732-5. [PMID: 21761999 DOI: 10.3109/14767058.2011.587920] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [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]
Abstract
OBJECTIVE To compare the effectiveness of carbetocin with oxytocin with respect to maintain adequate uterine tone and to reduce the incidence and severity of postpartum haemorrhage. Moreover safety, adverse effects and the need of additional medications were evaluated. METHODS Prospective controlled clinical trial. We compared the effect of a single dose of carbetocin (n = 55) with oxytocin infusion (n = 55) in a women population undergoing to elective caesarean section with regional subarachnoid anaesthesia with at least one risk factor for postpartum haemorrhage. RESULTS The mean ± SD of postoperative pain in the day of surgery in carbetocin group was significantly lower than in oxytocin group and remained significant till the third day after caesarean section. In the day of surgery and the first day after surgery, women of carbetocin group who needed analgesic drugs were significantly lower than women of oxytocin group. The differences of diuresis and of diuretic drugs need were not statistically significant between the two groups. CONCLUSIONS A single carbetocin injection is efficacious and safe on the maintenance of uterine tone and on the limitation of blood losses, in peri- and in postoperative period. In addition, carbetocin was able to reduce pain perception during postoperative days improving quality life of women.
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Affiliation(s)
- Maria De Bonis
- Section of Obstetrics and Gynecology, Department of Pediatrics, Obstetrics, and Reproductive Medicine, University of Siena, Siena, Italy
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21
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Ciarmela P, Bloise E, Gray PC, Carrarelli P, Islam MS, De Pascalis F, Severi FM, Vale W, Castellucci M, Petraglia F. Activin-A and myostatin response and steroid regulation in human myometrium: disruption of their signalling in uterine fibroid. J Clin Endocrinol Metab 2011; 96:755-65. [PMID: 21177794 PMCID: PMC3047220 DOI: 10.1210/jc.2010-0501] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [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 Investigation of activin-A (A) and myostatin (M) in human myometrium (HM) and leiomyoma (HL) will explain their involvement in human myometrial pathophysiology. OBJECTIVE We aimed to investigate A and M response and steroid regulation in HM. We also evaluated A and M expression and response in HL. DESIGN Tissues were analyzed and cultured. PATIENTS Patients included fertile (in proliferative phase) and menopausal women undergoing hysterectomy. INTERVENTIONS HM explant cultures were treated with A and M (for Smad-7 mRNA quantification) or estrogen and progesterone (for A and M mRNA quantification). A and M expression levels were also evaluated in menopausal (physiological absence of steroids) HM specimens. A and M and their receptors were evaluated in HL (n = 8, diameter 5-8 cm) compared with their matched HM. HL explants cultures were treated with A and M (for Smad7 mRNA quantification), and, to explain the absence of response, the levels of follistatin, follistatin-related gene (FLRG), and Cripto were evaluated. RESULTS A and M increased Smad7 expression in HM explants. A and M mRNAs were both reduced after estradiol treatment, unchanged after progesterone treatment, but were higher in menopausal than fertile (in proliferative phase) specimens. A, M, and FLRG were expressed at higher levels in HL compared with adjacent HM, whereas the receptors, follistatin, and Smad7 mRNAs resulted unchanged. Cripto mRNA was expressed only in HL. CONCLUSIONS A and M act on human HM and are regulated by steroids. In HL there is an increase of A, M, FLRG, and Cripto expression.
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Affiliation(s)
- Pasquapina Ciarmela
- Department of Molecular Pathology and Innovative Therapies, Faculty of Medicine, Polytechnic University of Marche, via Tronto 10/a, 60020 Ancona, Italy.
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22
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D'Aniello G, Bocchi C, Florio P, Ignacchiti E, Guidoni CG, Centini G, Cito G, Picciolini E, Severi FM, Petraglia F. Cervical ripening and induction of labor by prostaglandin E2: a comparison between intracervical gel and vaginal pessary. J Matern Fetal Neonatal Med 2009; 14:158-62. [PMID: 14694970 DOI: 10.1080/jmf.14.3.158.162] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare the effectiveness and safety of two formulations of prostaglandin (PG) E2 (gel and pessary) for induction of labor. Primary outcomes were cervical ripening, initiation/duration of labor, and type of delivery. STUDY DESIGN A total of 115 women with singleton gestations were consecutively enrolled and assigned to receive intracervical PGE2 (dinoprostone 0.5 mg) by gel (n = 66) or PGE2 (dinoprostone 10 mg) by intravaginal pessary (n = 49). RESULTS Independently from parity, the vaginal pessary induced successful cervical ripening with a slightly higher but not statistically significant occurrence of vaginal delivery with respect to gel induction. The mean time interval from induction to vaginal delivery did not differ between groups, despite being shorter for the pessary group in inducation-delivery intervals > 12 h. No significant differences were found between the groups with respect to patients who required a second course of PGE2 (9% vs. 2%), as well as oxytocin (11% vs. 13%) induction. No significant difference was found in the incidence of uterine hyperstimulation and other adverse reactions in nulliparas, or in fetal and neonatal outcome. CONCLUSION Independently from parity, both PGE2 administration routes appeared to be effective in achieving cervical ripening, initiation of labor and optimal type of delivery, and showed the same incidence of side-effects.
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Affiliation(s)
- G D'Aniello
- Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy
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Messina M, Severi FM, Bocchi C, Ferrucci E, Di Maggio G, Petraglia F. Voluminous perinatal pelvic mass: a case of congenital hydrometrocolpos. J Matern Fetal Neonatal Med 2009; 15:135-7. [PMID: 15209124 DOI: 10.1080/14767050410001659888] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Imperforate hymen is the most frequent congenital malformation of the female genital tract; it usually does not show symptoms until puberty. Only rarely, imperforate hymen manifests itself as an abdominal mass detectable in the prenatal period. We describe a rare case of voluminous hydrometrocolpos, antenatally diagnosed and successfully treated immediately after birth.
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Affiliation(s)
- M Messina
- Department of Pediatrics, Obstetrics and Reproductive Medicine, Section of Pediatric Surgery, University of Siena, Siena, Italy
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Severi FM, Bocchi C, Voltolini C, Borges LE, Florio P, Petraglia F. Thickness of fetal membranes: a possible ultrasound marker for preterm delivery. Ultrasound Obstet Gynecol 2008; 32:205-209. [PMID: 18663768 DOI: 10.1002/uog.5406] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To evaluate whether measurement of the thickness of the fetal membranes by high-resolution ultrasound is a useful marker to predict preterm delivery. METHODS One hundred and fifty-eight women with singleton pregnancies at 18-35 gestational weeks were enrolled consecutively at our referral center for obstetric care and the thickness of their fetal membranes was measured using high-resolution ultrasound equipment. Data were analyzed to determine whether there were significant differences between those delivering at term and those delivering preterm. Receiver-operating characteristics (ROC) curves were used to determine the best cut-off point of membrane thickness for predicting preterm birth. RESULTS Women who delivered preterm had greater fetal membrane thickness than did those who delivered at term (1.67 +/- 0.27 mm vs. 1.14 +/- 0.30 mm, P < 0.0001). For the best cut-off indicated by ROC curve analysis (1.2 mm), the sensitivity and specificity for predicting preterm birth were 100% (95% CI, 80.3-100) and 69.5% (95% CI, 61.2-77.0), respectively, and positive and negative likelihood ratios were 3.3 and 0.0, respectively. CONCLUSION Sonographic measurement of fetal membrane thickness could be helpful in the prediction of preterm delivery.
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Affiliation(s)
- F M Severi
- Division of Obstetrics and Gynecology, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy
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Cevenini G, Severi FM, Bocchi C, Petraglia F, Barbini P. An informative probability model enhancing real time echobiometry to improve fetal weight estimation accuracy. Med Biol Eng Comput 2008; 46:109-20. [PMID: 18196306 DOI: 10.1007/s11517-007-0299-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Accepted: 11/28/2007] [Indexed: 11/29/2022]
Abstract
A multinormal probability model is proposed to correct human errors in fetal echobiometry and improve the estimation of fetal weight (EFW). Model parameters were designed to depend on major pregnancy data and were estimated through feed-forward artificial neural networks (ANNs). Data from 4075 women in labour were used for training and testing ANNs. The model was implemented numerically to provide EFW together with probabilities of congruence among measured echobiometric parameters. It enabled ultrasound measurement errors to be real-time checked and corrected interactively. The software was useful for training medical staff and standardizing measurement procedures. It provided multiple statistical data on fetal morphometry and aid for clinical decisions. A clinical protocol for testing the system ability to detect measurement errors was conducted with 61 women in the last week of pregnancy. It led to decisive improvements in EFW accuracy.
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Affiliation(s)
- G Cevenini
- Department of Surgery and Bioengineering, University of Siena, Viale Mario Bracci 16, Siena, Italy.
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Prattichizzo D, la Torre B, Barbagli F, Vicino A, Severi FM, Petraglia F. The FeTouch project: an application of haptic technologies to obstetrics and gynaecology. Int J Med Robot 2007; 1:83-7. [PMID: 17520599 DOI: 10.1002/rcs.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ultrasound technologies have been widely used in gynecology and obstetrics. Modern ultrasound systems allow the reconstruction of a 3D model of the subject being scanned, but even though visual interfaces have reached very high standards, the problem of representing a 3D image on a 2D computer screen still exists. Moreover no physical interaction is possible with such a model. The FeTouch system, developed at Siena University in the last two years, partially solves such issues by using stereo visual feedback and haptic devices. While the system can be used with any 3D model obtained from ultrasound scans, its current prime use is to allow mothers to interact with a model of the fetus they are carrying. The system is freely available on the project web page.
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Affiliation(s)
- D Prattichizzo
- Dipartimento di Ingegneria dell'Informazione, Università di Siena, Italy.
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27
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Rubegni P, Sbano P, Burroni M, Cevenini G, Bocchi C, Severi FM, Risulo M, Petraglia F, Dell'Eva G, Fimiani M, Andreassi L. Melanocytic skin lesions and pregnancy: digital dermoscopy analysis. Skin Res Technol 2007; 13:143-7. [PMID: 17374054 DOI: 10.1111/j.1600-0846.2007.00180.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Very few studies have tried to clarify how pregnancy influences the morphology of pigmented skin lesions (PSL). Our purpose was to objectively determine, by digital dermoscopy analysis (DDA), any dermoscopic changes of acquired melanocitic nevi during pregnancy and after 1 year from delivery. METHODS Thirty-five healthy pregnant women and 35 age-matched female controls were enrolled in the study. Nevi of pregnant women were analysed by DDA between 5 and 8 weeks of pregnancy, between 39 and 41 weeks of pregnancy and 12 months after delivery. Nevi of control women were analysed by DDA in a month of the year matching the period of recruitment of pregnant women and 21 months later. RESULTS Multivariate analysis of variance (manova) for repeated measures revealed that dermoscopic variables SKIN-GREEN-AVERAGE, SKIN-BLUE-AVERAGE and CONTRAST changed during pregnancy but returned to non-significant values after a year from delivery. The variable ENTROPY showed significant differences between initial evaluation and 1 year after delivery. Finally, the variable VARIANCE OF BORDER GRADIENT showed a significant difference between the first and the last evaluations, in both pregnant and control subjects. CONCLUSIONS The study showed that pregnancy leads to significant modifications in PSL, especially with regard to pigment network, globules and architectural order or disorder.
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Affiliation(s)
- Pietro Rubegni
- Department of Clinical Medicine and Immunological Sciences, Section of Dermatology, University of Siena, Siena, Italy.
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Florio P, Severi FM, Bocchi C, Luisi S, Mazzini M, Danero S, Torricelli M, Petraglia F. Single serum activin a testing to predict ectopic pregnancy. J Clin Endocrinol Metab 2007; 92:1748-53. [PMID: 17341564 DOI: 10.1210/jc.2006-2188] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Ectopic pregnancy (EP) is an important cause of maternal deaths in early pregnancy because most fatal cases result from delayed diagnosis and inappropriate investigation. OBJECTIVE We evaluated whether the measurement of activin A may be useful in the diagnosis of EP in women with unknown pregnancy location. DESIGN The study was designed as an open observational study. SETTING The study was set in a tertiary referral center for obstetric care. PATIENTS Patients were women with unknown pregnancy location (n = 536) who had complaints of bleeding, pain, or cramping. INTERVENTIONS Interventions included clinical examination; transvaginal ultrasound scan; human chorionic gonadotropin (hCG), progesterone, and activin A measurements; laparoscopy; uterine curettage; and histological examination. MAIN OUTCOME MEASURES Main outcome measures were pregnancy outcomes and evaluation of sensitivity, specificity, and predictive values of hCG, progesterone, and activin A as diagnostic tests for the detection of EP. RESULTS Pregnancy outcomes included 155 (28.9%) viable intrauterine pregnancies (IUP), 305 (56.9%) first-trimester spontaneous abortion (SAB), and 76 (14.2%) EP. SAB had the lowest (P < 0.0001) hCG and progesterone concentrations, significantly lower than EP (P < 0.001) and IUP (P < 0.001). In EP, levels were significantly (P < 0.001) lower than in IUP. On the contrary, activin A levels were lowest (P < 0.0001) in EP, significantly lower than in SAB (P < 0.001) and IUP (P < 0.001). IUP had significantly (P < 0.001) lower activin A levels than SAB. When evaluated by the receiver operating curve analysis, activin A at the cutoff of 0.37 ng/ml combined a sensitivity and a specificity of 100 and 99.6%, respectively, for prediction of EP. When activin A concentrations were below the cutoff, the positive predictive value for EP was 97.43%, and 0% for concentrations higher than 0.37 ng/ml. CONCLUSIONS Activin A measurement may identify patients at risk of EP with a high sensibility and specificity.
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Affiliation(s)
- Pasquale Florio
- Chair of Obstetrics and Gynecology, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico Le Scotte, viale Bracci, 53100 Siena, Italy
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Luisi S, Borges LE, Lazzeri L, Dell'Anna A, Severi FM, Petraglia F. Vaginally administered estroprogestinic decreases serum inhibin A and inhibin B levels and reduces endometrial thickness. Fertil Steril 2006; 86:1483-7. [PMID: 16989826 DOI: 10.1016/j.fertnstert.2006.04.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Revised: 04/03/2006] [Accepted: 04/03/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Serum levels of inhibin A, inhibin B, FSH, and LH were measured in healthy volunteers before and during oral or vaginal estroprogestinic administration. In addition, the effect on endometrial thickness and on follicular growth pattern were also assessed by vaginal ultrasound. DESIGN Prospective study. SETTING University of Siena. PATIENT(S) Seventeen healthy fertile women. INTERVENTION(S) This open-label study was performed in 10 healthy volunteers, who were assigned to vaginal ethinylestradiol (15 microg) and etonogestrel (120 microg), one ring to be used for one cycle, after stratification for the ovulation day in a pretreatment cycle. A similar study on seven women assigned to oral ethinylestradiol (20 microg) and levonorgestrel (100 microg) was considered, to compare the effects of the two different routes of administration. Blood samples were collected the cycle before (days 8-10) and during (days 8-10) vaginal ring insertion and serum inhibin B, inhibin A, FSH, and LH levels were measured by ELISA. Concomitantly, transvaginal ultrasound was performed in all subjects for endometrial and follicular growth assessment. MAIN OUTCOME MEASURE(S) Inhibin A, inhibin B, FSH, and LH levels. RESULT(S) Vaginal administration induced a significant decrease of serum inhibin A, inhibin B, FSH, and LH. No significant changes in inhibin B and FSH secretion were observed during oral contraceptive (OC) administration, whereas LH and inhibin A levels significantly decreased. Endometrial thickness and ovarian volume decreased significantly during vaginal ring insertion, but not after OC administration. CONCLUSION(S) The present findings showed that treatment with vaginal estroprogestinic decreases serum inhibin A and inhibin B levels, the follicular diameter, and endometrial thickness, showing a rapid and significant effect with the vaginal route.
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Affiliation(s)
- Stefano Luisi
- Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy
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Morgante G, Delia A, Musacchio MC, Severi FM, Petraglia F, De Leo V. Effects of raloxifene therapy on plasma renin and aldosterone levels and blood pressure in postmenopausal women. Gynecol Endocrinol 2006; 22:376-80. [PMID: 16864147 DOI: 10.1080/09513590600850300] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Blood pressure, which generally increases after menopause, is one of the best tools to characterize cardiovascular disease. The renin-aldosterone system plays a role in determining cardiovascular risk and the role of estrogen in the regulation of angiotensinogen gene expression and serum levels is well known. Raloxifene can induce endothelium-dependent vasodilation without affecting endothelium-independent vasorelaxation. The aim of the study was to investigate the effects of raloxifene on the renin-aldosterone system and blood pressure in postmenopausal women. DESIGNS Forty women, 54-59 years of age, in physiological menopause for 6 months to 4 years, were enrolled in the study and treated with raloxifene 60 mg/day for 6 months. All had blood pressure less than 130/85 mm Hg at the start of the study. The women were divided into two groups: the first (group A; 20 women) with normal blood pressure and the second (group B; 20 women) with previous high blood pressure treated with antihypertensive drugs, not angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. RESULTS No significant changes in plasma renin activity (PRA) or plasma concentrations of aldosterone were observed between the two groups after 6 months of raloxifene use. There was a slight reduction in PRA (11+/-4% for group A and 13+/-5% for group B) and in plasma levels of aldosterone (3.6+/-0.5% and 4.6+/-0.5%, respectively) with respect to basal values, but neither change was statistically significant. CONCLUSIONS The results of the present study show that raloxifene at 60 mg/day dose is well tolerated and has no clinical impact on blood pressure, PRA or aldosterone in postmenopausal women.
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Affiliation(s)
- Giuseppe Morgante
- Department of Pediatrics, Obstetrics and Reproductive Medicine, Section of Obstetrics and Gynecology, University of Siena, Siena, Italy
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Florio P, Reis FM, Severi FM, Luisi S, Imperatore A, Palumbo MA, Bagnoli F, Gioffre W, Petraglia F. Umbilical Cord Serum Activin A Levels are Increased in Pre-eclampsia with Impaired Blood Flow in the Uteroplacental and Fetal Circulation. Placenta 2006; 27:432-7. [PMID: 16051348 DOI: 10.1016/j.placenta.2005.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2004] [Revised: 04/21/2005] [Accepted: 04/23/2005] [Indexed: 10/25/2022]
Abstract
The aims of the present study were to evaluate the umbilical cord serum activin A concentrations in complicated pregnancies and also to explore the relationship between activin A levels and blood flow velocity in fetal arteries. Umbilical cord blood samples were obtained postpartum after a full term uneventful gestation (control group, n=40), and from pregnancies complicated by gestational diabetes (n=13), preterm labour (n=18), or pre-eclampsia (n=19). Cord serum activin A levels were three-fold higher in pregnancies complicated by pre-eclampsia (1.17+/-0.14 ng/ml, p<0.01) than in the control group (0.43+/-0.03 ng/ml), but were unaltered in the diabetes and preterm labour groups. The pre-eclampsia group had a marked increase of umbilical artery pulsatility index (PI) and also a decrease of middle cerebral artery PI (p<0.01). Furthermore, activin A concentration correlated directly with the umbilical artery PI (r=0.540, p=0.021), with the length of stay in the Neonatal Intensive Care Unit (r=0.857, p<0.001) and also with cord blood pH (r=-0.886, p<0.001). In conclusion, umbilical cord serum activin A levels are increased in the presence of pre-eclampsia and provide an indirect marker of impaired blood flow in the uteroplacental and fetal circulation.
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Affiliation(s)
- P Florio
- Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy
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Severi FM, Prattichizzo D, Casarosa E, Barbagli F, Ferretti C, Altomare A, Vicino A, Petraglia F. Virtual fetal touch through a haptic interface decreases maternal anxiety and salivary cortisol. ACTA ACUST UNITED AC 2005; 12:37-40. [PMID: 15629669 DOI: 10.1016/j.jsgi.2004.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate whether a virtual reality workstation (Fetouch system) offering three-dimensional (3D) fetal visual and kinesthetic interaction may affect maternal stress. METHODS Maternal-fetal visual and kinesthetic interaction was obtained through a haptic interface based on 3D reconstruction of sequencial bi-dimensional ultrasound images of the fetus. Maternal stress was assessed before and after visual/kinesthetic interaction with the fetus: 1) by using the State Trait Anxiety Inventory-Form Y (STAI) test, and 2) by measuring salivary cortisol levels. Statistical analysis was performed by paired t test and analysis of variance for repeated measures. RESULTS After the fetal visual and kinesthetic experiences, a significant reduction was observed in anxiety (low state anxiety group, P < .0034; high state anxiety group, P < .0108), as well as in salivary cortisol concentration (P < .0004). CONCLUSION Physical interaction with the fetus through a 3D model may reduce maternal stress.
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Affiliation(s)
- F M Severi
- Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy
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Florio P, Lambert-Messerlian G, Severi FM, Buonocore G, Canick JA, Petraglia F. Fetal neural tube defects: maternal serum and amniotic fluid activin A levels. Prenat Diagn 2005; 24:574-5. [PMID: 15300753 DOI: 10.1002/pd.829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Human placenta, decidua, and fetal membranes are the major sites of production and secretion of inhibin A and activin A in maternal serum, amniotic fluid, and umbilical cord blood. These tissues also express follistatin-related gene and betaglycan, the binding proteins of activin A and inhibin A, respectively, recently identified. They show a different expression throughout pregnancy, suggesting new functional roles into gestational tissues. The availability of suitable assays for measuring inhibin A and activin A lead us the possibility to investigate their secretion in healthy pregnancy. In addition, several evidences underline the potential role and the clinical usefulness of their measurement in the diagnosis, prevention, prognosis and follow-up of different gestational pathologies such as: threatened abortion, placental tumors, hypertensive disorders of pregnancy, intrauterine growth restriction, fetal hypoxia. The measurement of inhibin A and activin A into the biological fluids of pregnancy will offer in the future further possibilities in early diagnosis, prediction, and monitoring pregnancy diseases.
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Affiliation(s)
- P Florio
- Chair of Obstetrics and Gynecology, Deaprtment of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy
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Prattichizzo D, la Torre B, Barbagli F, Vicino A, Severi FM, Petraglia F. The FeTouch Project: an application of haptic technologies to obstetrics and gynaecology. Int J Med Robot 2004. [DOI: 10.1581/mrcas.2004.010110] [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: 11/15/2022]
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Florio P, Severi FM, Luisi S, Ignacchiti E, Calonaci G, Bocchi C, Petraglia F. Abnormal Umbilical Artery Doppler Waveforms and Cord Blood Inhibin A and Inhibin B Levels. Neonatology 2003; 84:281-6. [PMID: 14593237 DOI: 10.1159/000073635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Inhibin A and inhibin B are glycoprotein hormones produced by human placenta and by several fetal organs during pregnancy. They are secreted in maternal circulation in increasing amounts from early until term pregnancy, and in umbilical cord blood levels are significantly lower than in maternal serum and do not differ from mid-pregnancy to term gestation. In the present study, we aimed to determine whether secretion of inhibin A and inhibin B into the fetal circulation is increased in pregnancies complicated by umbilical-placental vascular insufficiency. A group of women (n = 13) with abnormal Doppler umbilical artery flow velocimetry and a group of control women (n = 11) with uncomplicated term pregnancies and normal umbilical artery flow velocity waveforms were studied. In each woman, inhibin A and inhibin B concentrations were estimated in umbilical cord artery and vein. In the two groups of women, mean inhibin A levels did not differ between umbilical cord artery and vein. In addition, no difference was retrieved both in umbilical cord artery and vein values between healthy controls and patients with abnormal Doppler umbilical artery flow velocimetry. On the contrary, inhibin B levels were significantly higher in samples from umbilical cord vein than artery, in both groups of pregnant women (both p < 0.001). However, women with abnormal Doppler umbilical artery flow velocimetry had inhibin B levels significantly higher than healthy controls (p = 0.005) only in the umbilical cord artery, but not in the vein. In the presence of abnormal Doppler umbilical artery flow velocity, the concentrations of inhibin B are increased in the arterial umbilical circulation, suggesting that inhibin B is released from multiple fetal sources as a response to hypoxemic stress. As inhibins may affect the hypothalamus-pituitary-adrenal axis which plays an important role in the mechanisms of adaptations to the post-natal life, inhibin B in fetal circulation might then be beneficial to a fetus whose intrauterine survival is threatened by impaired umbilical-placental blood flow.
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Affiliation(s)
- P Florio
- Chair of Obstetrics and Gynecology, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy
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Reis FM, Gervasi MT, Florio P, Bracalente G, Fadalti M, Severi FM, Petraglia F. Prediction of successful induction of labor at term: role of clinical history, digital examination, ultrasound assessment of the cervix, and fetal fibronectin assay. Am J Obstet Gynecol 2003; 189:1361-7. [PMID: 14634569 DOI: 10.1067/s0002-9378(03)00725-7] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate whether biochemical (fetal fibronectin assay) or biophysical (cervical assessment by transvaginal ultrasound) tests may have more value than digital examination in predicting successful induction of labor at term. STUDY DESIGN The study enrolled prospectively 134 women undergoing labor induction at term caused by several obstetric conditions. All participants submitted to digital examination, fetal fibronectin assay, and transvaginal ultrasound for measurement of the cervical length and detection of funneling. The performance of each test in predicting delivery within 24 hours of labor induction was evaluated. Cox multiple regression analysis was performed to identify, among clinical and laboratory tests, which variables were independently associated with the duration of the latent phase and with the total duration of induced labor. RESULTS The likelihood ratios for positive results (predicting that delivery would occur within 24 hours) were 6.61 (95% CI, 1.7-25.8) for a positive obstetric history (previous vaginal delivery), 2.61 (95% CI, 1.6-4.3) for a "favorable" digital examination, 1.41 (95% CI, 0.9-2.2) for a positive fetal fibronectin test, 1.61 (95% CI, 0.9-3.0) for cervical length, and 2.20 (95% CI, 1.1-4.4) for the presence of funneling at transvaginal ultrasound. The likelihood ratios for negative results were 1.81 (1.3-2.5) for obstetric history, 4.34 (2.5-7.7) for digital examination, 1.41 (0.9-2.1) for fetal fibronectin, 1.29 (1.0-1.7) for cervical length, and 1.48 (1.1-2.0) for funneling. On multiple regression, the only variables independently associated with the duration of the latent phase and with the total duration of induced labor were obstetric history and digital examination. CONCLUSION Only obstetric history and digital examination predicted accurately vaginal delivery within 24 hours and were independently associated with labor duration. Fetal fibronectin and ultrasound measurements failed to predict accurately the outcome of induced labor.
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Affiliation(s)
- F M Reis
- Department of Pediatrics, Obstetrics, and Reproductive Medicine, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy
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Severi FM, Bocchi C, Florio P, Picciolini E, D'Aniello G, Petraglia F. Comparison of two-dimensional and three-dimensional ultrasound in the assessment of the cervix to predict preterm delivery. Ultrasound Med Biol 2003; 29:1261-1265. [PMID: 14553802 DOI: 10.1016/s0301-5629(03)01011-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This study sought to determine whether 3-D transvaginal ultrasound (3D-TVS), compared with the 2-D transvaginal approach (2D-TVS), offers a better identification of some specific features of the uterine cervix that could be useful in the prediction of spontaneous preterm delivery (PTD). A total of 103 women with singleton pregnancies were prospectively evaluated with 2D-TVS and 3D-TVS in the second or third trimester of pregnancy. Statistical analysis was performed with Wilcoxon matched-pairs test, chi2 and Pearson test (p<0.05 was considered significant) and receiver operating characteristic (ROC) curve analysis. Significant differences between these approaches were found for cervical length (p<0.001). A significant correlation was identified between 3D-TVS cervical length and the interval between ultrasound examination and delivery as well as the gestational age at delivery (both p<0.001). ROC curve identified a threshold for 3D-TVS cervical length of 35 mm as an optimal predictor of PTD in the second trimester (sensitivity 100%, specificity 88%). 3D-TVS evaluation of the cervix in pregnancy seems to be an effective, noninvasive method for predicting PTD risk.
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Affiliation(s)
- Filiberto Maria Severi
- Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy.
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Florio P, Calonaci G, Luisi S, Severi FM, Ignacchiti E, Palumbo M, Bocchi C, Petraglia F. Inhibin A, inhibin B and activin A concentrations in umbilical cord artery and vein. Gynecol Endocrinol 2003; 17:181-5. [PMID: 12857425 DOI: 10.1080/gye.17.3.181.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Activin A and inhibins (A and B) are growth factors expressed during pregnancy by the human placenta, decidua and fetal membranes, and by several fetal organs. They are secreted in both the maternal and the fetal circulations, but the net contribution of the fetus to inhibins/activin A production is still unclear. In the present study we determined whether there was a difference in the serum concentration of activin A, inhibin A and inhibin B between the artery and vein of the umbilical cord. Arterial and venous umbilical cord blood was obtained immediately before elective Cesarean section of 16 term infants from uncomplicated pregnancies. Inhibins and activin A levels were assayed by specific enzyme-linked immunosorbent assays. The paired t-test and linear regression analysis were used to calculate statistical significance. Inhibin A levels did not differ between the artery and vein of the umbilical cord. In contrast, arterial inhibin B levels were significantly (p < 0.001) lower, and activin A concentrations significantly (p < 0.05) higher than the respective venous concentrations. A significant correlation between arterial and venous levels of inhibin A (r = 0.591; p < 0.05), inhibin B (r = 0.749; p < 0.0001) and activin A (r = 0.571; p < 0.05) was found. The present findings suggest that the human placenta is the main source of inhibin B, and the fetus of activin A, in the umbilical cord. In light of the possible roles played by inhibin and activin in erythroid differentiation, protection of neurons against brain injury and modulation of adrenal and pancreatic hormone release, the present data may be of help in evaluating their changes in the umbilical cord when gestational diseases occur.
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Affiliation(s)
- P Florio
- Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy
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Severi FM, Bocchi C, Sanseverino F, Petraglia F. Prenatal ultrasonographic diagnosis of diastrophic dysplasia at 13 weeks of gestation. J Matern Fetal Neonatal Med 2003; 13:282-4. [PMID: 12854932 DOI: 10.1080/jmf.13.4.282.284] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Diastrophic dwarfism is a skeletal dysplasia that can be identified by ultrasound usually during the second trimester of pregnancy. This severe but non-lethal disorder of the cartilage can be diagnosed earlier using transvaginal sonography (TVS). We present a case of diastrophic dysplasia diagnosed at 13 weeks of gestation by TVS. The early TVS evaluation of the fetal biometric parameters and the accurate study of the morphological features of the fetal long bones and extremities allowed an early diagnosis of this rare pathology that leads to a progressive physical handicap, due mainly to severe kyphoscoliosis and arthropathies. Recently, the routine use of TVS at 11-14 weeks of gestation has permitted an earlier diagnosis to be reached of a great number of congenital anomalies. Patients at risk for skeletal dysplasia could benefit from the enhancements of ultrasound techniques. An early diagnosis of diastrophic dysplasia can be reached at the and of the first trimester of pregnancy, using TVS.
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Affiliation(s)
- F M Severi
- Department of Obstetrics and Gynecology, University of Siena, Policlinico Le Scotte, Siena, Italy
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Affiliation(s)
- P Florio
- University of Siena, Policlinico Le Scotte Dept of OB/GYN, Viale Bracci, Italy
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Luisi S, Florio P, D'Antona D, Severi FM, Sanseverino F, Danero S, Petraglia F. Maternal serum inhibin A levels are a marker of a viable trophoblast in incomplete and complete miscarriage. Eur J Endocrinol 2003; 148:233-6. [PMID: 12590643 DOI: 10.1530/eje.0.1480233] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE From early gestation the human trophoblast secretes large amounts of inhibin A and activin A, and their measurement provides a value for predicting the outcome in women who become pregnant after assisted reproductive techniques. The aim of the study was to investigate the putative role of maternal serum inhibin A and activin A levels as markers of a viable trophoblast in women who miscarry. DESIGN Controlled cross-sectional study. METHODS One group consisted of 65 healthy pregnant women (controls), progressing to deliver a healthy singleton baby and another group consisted of 54 miscarriages (38 incomplete (27 non-viable, 11 anembryonic pregnancies) and 16 complete). Maternal blood samples were collected between 5 and 12 weeks of gestation. RESULTS Serum human chorionic gonadotrophin concentrations in women with incomplete or complete miscarriages were significantly (both P<0.001) lower than in controls; activin A levels being lowest only in women with a complete miscarriage (P<0.001). On the other hand, inhibin A levels were significantly lower in incomplete or complete miscarriage than in controls (both P<0.0001). CONCLUSIONS Maternal serum inhibin A, but not activin A, determination reflects the lack of a viable trophoblast in complete miscarriage.
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Affiliation(s)
- S Luisi
- Chair of Obstetrics and Gynecology, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy
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Florio P, Reis FM, Pezzani I, Luisi S, Severi FM, Petraglia F. The addition of activin A and inhibin A measurement to uterine artery Doppler velocimetry to improve the early prediction of pre-eclampsia. Ultrasound Obstet Gynecol 2003; 21:165-169. [PMID: 12601840 DOI: 10.1002/uog.29] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate whether the measurement of maternal serum activin A and inhibin A adds any clinically relevant information for the prediction of pre-eclampsia in women with altered uterine artery Doppler velocimetry at 24 weeks of gestation. METHODS This was a prospective, controlled, hospital-based study involving 58 asymptomatic pregnant women at 24 weeks' gestation in whom a diastolic notch of the uterine artery waveform was noted at routine Doppler examination. Doppler assessment of the uterine artery waveform and measurement of maternal activin A and inhibin A serum levels by specific two-site enzyme immunoassays were performed. The cut-off points for defining 'high' serum activin A and inhibin A levels for prediction of pre-eclampsia were chosen by receiver-operating characteristics (ROC) curve analysis. The probability of developing pre-eclampsia was calculated for several combinations of results of hormone testing. RESULTS Activin A and inhibin A levels were higher in patients who developed pre-eclampsia (n = 18; mean +/- standard error: 2.69 +/- 0.35 ng/mL and 131.2 +/- 22.7 pg/mL, respectively) than in those who did not present with pre-eclampsia at follow-up (n = 40; activin A: 1.79 +/- 0.18 ng/mL and inhibin A: 91.9 +/- 6.2 pg/mL; P < 0.05). Activin A at the cut-off value of 1.7 multiples of the median (MoM) achieved a sensitivity of 61% and a specificity of 89%, whereas inhibin A at the cut-off value of 1.8 MoM combined a sensitivity of 39% with a specificity of 92% for prediction of pre-eclampsia. The probability of pre-eclampsia was 31% in the whole study population, 86% if both activin A and inhibin A were elevated and 17% if both hormone markers were unaltered. CONCLUSION The measurement of serum activin A and inhibin A levels may add significant prognostic information for predicting pre-eclampsia in pregnant women showing specific Doppler alterations in the late second trimester.
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Affiliation(s)
- P Florio
- Chair of Obstetrics and Gynecology, University of Siena, Siena, Italy
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Florio P, Ciarmela P, Luisi S, Palumbo MA, Lambert-Messerlian G, Severi FM, Petraglia F. Pre-eclampsia with fetal growth restriction: placental and serum activin A and inhibin A levels. Gynecol Endocrinol 2002; 16:365-72. [PMID: 12587530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
Activin A (beta A beta A) and inhibin A (alpha beta A) are dimeric glycoproteins secreted from early to term pregnancy in the maternal circulation. They circulate in higher amounts in women with gestational hypertension and/or pre-eclampsia, the most important gestational diseases also causing fetal growth restriction (FGR). Since no data are available in patients with pre-eclampsia and superimposed FGR, by using two-site immunoassays we evaluated serum activin A and inhibin A levels in serum samples collected from: healthy normotensive pregnant controls (n = 42); and women with pre-eclampsia with (n = 19) or without superimposed FGR (n = 21). In addition, by quantitative reverse transcriptase-polymerase chain reaction the changes of alpha- and beta A-subunit mRNA expression in placentas collected from healthy controls (n = 7) and pre-eclamptic pregnancies with (n = 6) or without (n = 6) superimposed FGR was also investigated. Activin A and inhibin A serum levels were significantly higher in pre-eclampsia, and the presence of FGR did not significantly modify these concentrations. Similarly, inhibin-subunit mRNA levels in placentas from pre-eclampsia were significantly higher than in controls, and FGR did not significantly affect this expression. The present data suggest that the increased placental expression of inhibin subunit mRNAs is part of the mechanism leading to increased serum activin A and inhibin A levels.
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Affiliation(s)
- P Florio
- Department of Pediatric, Obstetric and Reproductive Medicine, University of Siena, Siena, Italy
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Severi FM, Bocchi C, Visentin A, Falco P, Cobellis L, Florio P, Zagonari S, Pilu G. Uterine and fetal cerebral Doppler predict the outcome of third-trimester small-for-gestational age fetuses with normal umbilical artery Doppler. Ultrasound Obstet Gynecol 2002; 19:225-228. [PMID: 11896941 DOI: 10.1046/j.1469-0705.2002.00652.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To assess the value of different admission tests in predicting the outcome of small-for-gestational age (SGA) fetuses with normal Doppler waveforms in the umbilical artery. METHODS Criteria for admission into this retrospective study included: singleton pregnancy with a birth weight < 10th centile; absence of severe maternal complications; no evidence of fetal anomalies on the sonogram; normal umbilical artery Doppler; and availability of complete follow-up. At the first antenatal sonogram classifying the fetus as SGA, Doppler analysis of the uterine and middle cerebral arteries was performed and amniotic fluid volume was assessed. Outcome variables included adverse perinatal outcome (perinatal death, severe morbidity) and emergency Cesarean section for fetal distress. RESULTS Two hundred and thirty-one pregnancies were included in the study. The mean +/- standard deviation birth weight and gestational age at delivery were 2222 +/- 502 g and 37.3 +/- 2.9 weeks, respectively. In 37 cases (16%), an emergency Cesarean section was performed. There was one intrauterine death and three fetuses delivered by emergency Cesarean section developed severe morbidity. Logistic regression demonstrated that abnormal velocimetry of the uterine arteries and fetal middle cerebral artery were independently correlated with the occurrence of Cesarean section. CONCLUSIONS SGA fetuses with normal umbilical artery Doppler waveforms and abnormal uterine arteries and fetal middle cerebral artery waveforms have an increased risk of developing distress and being delivered by emergency Cesarean section. Particularly when both uterine and fetal cerebral waveforms are altered at the same time, the risk is exceedingly high (86%) and delivery as soon as fetal maturity is achieved seems advisable. On the other hand, when both vessels have normal waveforms, the chances of fetal distress are small (4%) and expectant management is the most reasonable choice.
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Affiliation(s)
- F M Severi
- Department of Obstetrics and Gynaecology, University of Siena, Italy
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Florio P, Mezzesimi A, Turchetti V, Severi FM, Ticconi C, Forconi S, Petraglia F. High levels of human chromogranin A in umbilical cord plasma and amniotic fluid at parturition. J Soc Gynecol Investig 2002; 9:32-6. [PMID: 11839506 DOI: 10.1016/s1071-5576(01)00149-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The human placenta is a neuroendocrine organ that produces several hypothalamic and pituitary hormones that are secreted during pregnancy and parturition into maternal and fetal circulation and amniotic fluid. Human chromogranin A (CgA) is a glycoprotein mainly localized to the adrenal medulla and released in response to several stressful events. During pregnancy, intrauterine tissues express and synthesize CgA mRNA and peptide and secret it into the biologic fluids of pregnancy, so we investigated whether maternal, umbilical, and amniotic human CgA levels are affected by the stress of parturition. METHODS We measured pregnancy CgA levels in maternal and umbilical cord plasma and in amniotic fluid at term (39-40 weeks), by enzyme-linked immunosorbent assay at elective cesarean (n = 16), after spontaneous vaginal delivery (n = 12), and longitudinally throughout labor and 2 hours postpartum. RESULTS CgA levels were highest in umbilical cord blood (P <.001). Umbilical cord plasma and amniotic fluid CgA levels were significantly higher at spontaneous vaginal delivery than at cesarean (P <.001), and the levels were not changed in maternal plasma according to cervical dilatation and postpartum. CONCLUSIONS The present findings showed that the stress of parturition increased CgA levels in umbilical cord plasma and amniotic fluid and was probably of fetal origin. Whatever the mode of delivery, CgA levels in infants were much more elevated than in mothers, providing evidence for an unusual and sustained high level of sympathoadrenal stimulation in full-term neonates.
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Affiliation(s)
- Pasquale Florio
- Department of Obstetrics and Gynecology, Institute of Internal Medicine, University of Siena, Italy
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Reis FM, Florio P, Cobellis L, Luisi S, Severi FM, Bocchi C, Picciolini E, Centini G, Petraglia F. Human placenta as a source of neuroendocrine factors. Biol Neonate 2001; 79:150-6. [PMID: 11275643 DOI: 10.1159/000047083] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Progress in the understanding of the physiological and pathological functions of the placenta introduced the concept that the placenta is a neuroendocrine organ, since it shows local production and release of substances analog to neurohormones. These products act as endocrine, paracrine and autocrine factors to control the secretion of other regulatory molecules, including the pituitary hormones of both mother and fetus and their placental counterparts. Furthermore, they may play a role in the regulation of maternal and fetal physiology during pregnancy, ranging from the control of placental anchoring to fetal growth and maturation, fine regulation of uterine blood flow and/or initiation of labor. All this evidence underlines the decisive contribution of the placenta to all phases of gestation, through a range of substances largely exceeding the classically known sex steroids and chorionic gonadotropin, throughout normal pregnancy as well as in the presence of gestational diseases.
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Affiliation(s)
- F M Reis
- Obstetrics and Gynecology, University of Siena, Italy
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Abstract
Inhibin-related proteins are involved in the control of the feto-maternal communication required to maintain pregnancy. Human placenta, decidua, and fetal membranes are the major sites of production and secretion of activin A, inhibin A and inhibin B in maternal serum, amniotic fluid, and cord blood. The availability of suitable assays developed in the last years has enabled the measurement of inhibins and activin A in their dimeric forms, in order to investigate their role in physiological conditions of pregnancy. The studies conducted on inhibin-related proteins and human pregnancy suggested the possibility of an involvement of inhibin A and activin A in the pathogenesis of gestational diseases. In fact, several lines of evidence underline the potential role and the clinical usefulness of inhibin-related proteins measurement in the diagnosis, prevention, prognosis and follow-up of different gestational pathologies such as early pregnancy viability, Down's syndrome, fetal demise, pre-eclampsia, pregnancy-induced hypertension, preterm delivery and intrauterine growth restriction. The measurement of inhibin A and activin A into the biological fluids of pregnancy will offer in the future, further possibilities in the early diagnosis, prediction, and monitoring diseases of pregnancy.
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Affiliation(s)
- P Florio
- Department of Obstetrics and Gynecology, University of Siena, Policlinico "Le Scotte", Viale Bracci, 53100, Siena, Italy
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Cobellis L, Pecori E, De Lucia E, Pierno G, Stradella L, Severi FM, Petraglia F. Regression of ovarian enlargement in pharmacological ovulation induction. Gynecol Endocrinol 2001; 15:239-42. [PMID: 11447737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
The aim of the present study was to determine a possible relationship between ovarian functionality and regression of ovarian enlargement according to the different categories and degree of severity of ovarian hyperstimulation syndrome (OHSS). Among a group of sterile woman (n = 111), two subgroups were studied: group A (n = 15), patients affected by severe syndrome; and group B (n = 96), patients with massive ovarian enlargement only. The protocol of ovarian stimulation was conducted in various in vitro fertilization (IVF) centers; ultrasonographic examination and hematological checks were carried out daily; patients with severe OHSS were hospitalized. In women of group A, severe symptoms disappeared in 7-11 days; in nine patients with regular cycles ovary size returned to normal in about 30-40 days, whereas in six subjects with anovulatory cycles, the resolution was recorded in about 50-60 days; serum estradiol returned to physiological levels within 20-30 days. Women of group B showed a spontaneous regression at different times: in 43 subjects that presented regular ovulatory cycles, the resolution was recorded in about 30-40 days, whereas in 36 women with anovulatory cycles before pharmacological induction, resolution occurred in 50-60 days, and in 17 cases with polycystic ovary syndrome before pharmacological ovulation, an incomplete resolution was obtained; serum estradiol levels returned to a physiological range within 20-30 days. Our results show that in patients with regular ovulatory cycles, resolution of symptoms is obtained in a shorter time than in patients with anovulatory cycles before pharmacological induction.
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Affiliation(s)
- L Cobellis
- Chair of Obstetrics and Gynecology, Second University of Naples, Naples, Italy
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Cobellis L, Di Pietto F, Di Pietto L, Stradella L, Reis FM, Severi FM, Petraglia F. Ultrasound diagnosis and Doppler monitoring of a pelvic spleen in pregnancy. Ultrasound Obstet Gynecol 2001; 17:453-454. [PMID: 11380975 DOI: 10.1046/j.1469-0705.2001.00403.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We describe a patient with a pelvic spleen diagnosed during pregnancy and monitored through gestation which we believe to be the first reported case. A 40-year-old woman was referred at 8 weeks of gestation because of a chronic intense pain in the left iliac cavity which had spread to her lower back. Clinical examination revealed a poorly defined pelvic mass. Pelvic ultrasound demonstrated a gestational sac containing a viable embryo whose size was consistent with the period of amenorrhea. While the splenic area in the left hypocondrium was found to be empty, a homogeneous and elongate mass measuring 152 x 123 mm with a maximum thickness of 53.4 mm was observed in the left iliac cavity above the uterus. This mass, the ectopic spleen, was monitored by Doppler velocimetry at monthly intervals until delivery and no variation throughout gestation was observed; therefore, despite the occasional occurrence of heavy pain, it was possible to exclude circulatory complications such as thrombosis or torsion. Doppler ultrasound proved to be a useful tool for the differential diagnosis of this rare anatomical variation.
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Affiliation(s)
- L Cobellis
- Department of Obstetrics and Gynecology, University of Siena, Siena, Italy.
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