1
|
Miller HE, Tierney S, Stefanick ML, Mayo JA, Sedan O, Rosas LG, Melbye M, Boyd HA, Stevenson DK, Shaw GM, Winn VD, Hlatky MA. Vascular health years after a hypertensive disorder of pregnancy: The EPOCH study. Am Heart J 2024; 272:96-105. [PMID: 38484963 PMCID: PMC11070303 DOI: 10.1016/j.ahj.2024.03.004] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Preeclampsia is associated with a two-fold increase in a woman's lifetime risk of developing atherosclerotic cardiovascular disease (ASCVD), but the reasons for this association are uncertain. The objective of this study was to examine the associations between vascular health and a hypertensive disorder of pregnancy among women ≥ 2 years postpartum. METHODS Pre-menopausal women with a history of either a hypertensive disorder of pregnancy (cases: preeclampsia or gestational hypertension) or a normotensive pregnancy (controls) were enrolled. Participants were assessed for standard ASCVD risk factors and underwent vascular testing, including measurements of blood pressure, endothelial function, and carotid artery ultrasound. The primary outcomes were blood pressure, ASCVD risk, reactive hyperemia index measured by EndoPAT and carotid intima-medial thickness. The secondary outcomes were augmentation index normalized to 75 beats per minute and pulse wave amplitude measured by EndoPAT, and carotid elastic modulus and carotid beta-stiffness measured by carotid ultrasound. RESULTS Participants had a mean age of 40.7 years and were 5.7 years since their last pregnancy. In bivariate analyses, cases (N = 68) were more likely than controls (N = 71) to have hypertension (18% vs 4%, P = .034), higher calculated ASCVD risk (0.6 vs 0.4, P = .02), higher blood pressures (systolic: 118.5 vs 111.6 mm Hg, P = .0004; diastolic: 75.2 vs 69.8 mm Hg, P = .0004), and higher augmentation index values (7.7 vs 2.3, P = .03). They did not, however, differ significantly in carotid intima-media thickness (0.5 vs 0.5, P = .29) or reactive hyperemia index (2.1 vs 2.1, P = .93), nor in pulse wave amplitude (416 vs 326, P = .11), carotid elastic modulus (445 vs 426, P = .36), or carotid beta stiffness (2.8 vs 2.8, P = .86). CONCLUSION Women with a prior hypertensive disorder of pregnancy had higher ASCVD risk and blood pressures several years postpartum, but did not have more endothelial dysfunction or subclinical atherosclerosis.
Collapse
Affiliation(s)
- Hayley E Miller
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Seda Tierney
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Marcia L Stefanick
- Department of Medicine, Stanford University School of Medicine, Stanford, CA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Jonathan A Mayo
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Oshra Sedan
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Mads Melbye
- Danish Cancer Institute, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Heather A Boyd
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - David K Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Virginia D Winn
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Mark A Hlatky
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA.
| |
Collapse
|
2
|
Miller HE, Kruger SL, Panelli DM. Mental health conditions and contraception: current landscape, reproductive health and obstetric outcomes, and clinical guidance. Curr Opin Obstet Gynecol 2024; 36:81-87. [PMID: 38170628 DOI: 10.1097/gco.0000000000000936] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW This review presents the epidemiology of mental health conditions among reproductive aged people, common adverse reproductive outcomes, the hormonal profile of contraception and its relationship with psychiatric outcomes, and updated information for clinicians providing contraceptive counselling for this population. RECENT FINDINGS There is variability among contraceptive behaviours and patterns across those who have mental health conditions, impacting reproductive, psychiatric, and perinatal outcomes. The endocrinology of hormonal contraceptives is well understood, however, the impacts of steroidal hormones on mental health outcomes continue to be less understood. Overall, hormonal contraceptives are safe to use among those with mental health conditions, and among those using selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors. Additional considerations are needed when prescribing contraception among people who may be at risk of poor adherence, who use certain classes of antidepressants, antipsychotics, antiepileptics, and who are <6 weeks postpartum. SUMMARY Barriers to effective contraceptive use should be addressed and myths on negative psychiatric impacts of hormonal contraceptives should be dispelled. Healthcare clinicians should seek out opportunities to become proficient in contraception counselling to improve health outcomes among people with mental health conditions.
Collapse
Affiliation(s)
- Hayley E Miller
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology
| | - Samantha L Kruger
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Danielle M Panelli
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology
| |
Collapse
|
3
|
Panelli DM, Miller HE, Simpson SL, Hurtado J, Shu CH, Boncompagni AC, Chueh J, Carvalho B, Sultan P, Aghaeepour N, Druzin ML. Physical activity among pregnant inpatients and outpatients and associations with anxiety. Eur J Obstet Gynecol Reprod Biol 2024; 297:8-14. [PMID: 38554481 DOI: 10.1016/j.ejogrb.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/01/2024]
Abstract
OBJECTIVE Physical activity is linked to lower anxiety, but little is known about the association during pregnancy. This is especially important for antepartum inpatients, who are known to have increased anxiety yet may not be able to achieve target levels of physical activity during hospitalization. We compared physical activity metrics between pregnant inpatients and outpatients and explored correlations with anxiety. MATERIALS AND METHODS This was a prospective cohort between 2021 and 2022 of pregnant people aged 18-55 years carrying singleton gestations ≥ 16 weeks. Three exposure groups were matched for gestational age: 1) outpatients from general obstetric clinics; 2) outpatients from high-risk Maternal-Fetal Medicine obstetric clinics; and 3) antepartum inpatients. Participants wore Actigraph GT9X Link accelerometer watches for up to 7 days to measure physical activity. The primary outcome was mean daily step count. Secondary outcomes were metabolic equivalent tasks (METs), hourly kilocalories (kcals), moderate to vigorous physical activity (MVPA) bursts, and anxiety (State-Trait Anxiety Inventory [STAI]). Step counts were compared using multivariable generalized estimating equations adjusting for maternal age, body-mass index, and insurance type as a socioeconomic construct, accounting for within-group clustering by gestational age. Spearman correlations were used to correlate anxiety scores with step counts. RESULTS 58 participants were analyzed. Compared to outpatients, inpatients had significantly lower mean daily steps (primary outcome, adjusted beta -2185, 95 % confidence interval [CI] -3146, -1224, p < 0.01), METs (adjusted beta -0.18, 95 % CI -0.23, -0.13, p < 0.01), MVPAs (adjusted beta -38.2, 95 % CI -52.3, -24.1, p < 0.01), and kcals (adjusted beta -222.9, 95 % CI -438.0, -7.8, p = 0.04). Over the course of the week, steps progressively decreased for inpatients (p-interaction 0.01) but not for either of the outpatient groups. Among the entire cohort, lower step counts correlated with higher anxiety scores (r = 0.30, p = 0.02). CONCLUSION We present antenatal population norms and variance for step counts, metabolic equivalent tasks, moderate to vigorous physical activity bursts, and kcals, as well as correlations with anxiety. Antepartum inpatients had significantly lower physical activity than outpatients, and lower step counts correlated with higher anxiety levels. These results highlight the need for physical activity interventions, particularly for hospitalized pregnant people.
Collapse
Affiliation(s)
- Danielle M Panelli
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA.
| | - Hayley E Miller
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
| | - Samantha L Simpson
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
| | - Janet Hurtado
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
| | - Chi-Hung Shu
- Division of Obstetric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA
| | | | - Jane Chueh
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
| | - Brendan Carvalho
- Division of Obstetric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Pervez Sultan
- Division of Obstetric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Nima Aghaeepour
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA; Division of Obstetric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA; Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Maurice L Druzin
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
| |
Collapse
|
4
|
Miller SE, Miller HE, Waldrop AR, Karakash SD, Shaw KA. A Case of an Obstructed Delivery by a Large, Lower Uterine Segment Fibroid Interlocked with a Fetal Mentum. AJP Rep 2024; 14:e85-e87. [PMID: 38370329 PMCID: PMC10874688 DOI: 10.1055/s-0043-1778002] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/22/2023] [Indexed: 02/20/2024] Open
Abstract
Uterine leiomyomata are associated with many pregnancy complications and will likely become increasingly common as the average age of childbearing increases. We describe a case of an obstructed delivery by a large fibroid. A 37-year-old G2P1001 with a 10-cm anterior, lower uterine segment fibroid presented for labor induction. Labor was complicated by arrest of descent due to suspected obstruction of the fetal body by the fibroid after descent of the fetal head, and delivery during cesarean section was complicated by apparent interlocking of the fetal mentum with the fibroid. Large, anterior lower uterine segment fibroids have the potential to obstruct delivery of the fetal head or of the fetal body, and these patients should be counseled regarding the potential for complications via both vaginal and cesarean deliveries.
Collapse
Affiliation(s)
- Sarah E. Miller
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Hayley E. Miller
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Anne R. Waldrop
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Scarlett D. Karakash
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Kate A. Shaw
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
5
|
Miller SE, Miller HE, Waldrop AR, Karakash SD, Shaw KA. A Case of an Obstructed Delivery by a Large, Lower Uterine Segment Fibroid Interlocked with a Fetal Mentum. AJP Rep 2024; 14:e85-e87. [PMID: 38370329 PMCID: PMC10881256 DOI: 10.1055/a-2202-4234] [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] [Received: 10/18/2021] [Accepted: 10/22/2023] [Indexed: 02/24/2024] Open
Abstract
Uterine leiomyomata are associated with many pregnancy complications and will likely become increasingly common as the average age of childbearing increases. We describe a case of an obstructed delivery by a large fibroid. A 37-year-old G2P1001 with a 10-cm anterior, lower uterine segment fibroid presented for labor induction. Labor was complicated by arrest of descent due to suspected obstruction of the fetal body by the fibroid after descent of the fetal head, and delivery during cesarean section was complicated by apparent interlocking of the fetal mentum with the fibroid. Large, anterior lower uterine segment fibroids have the potential to obstruct delivery of the fetal head or of the fetal body, and these patients should be counseled regarding the potential for complications via both vaginal and cesarean deliveries.
Collapse
Affiliation(s)
- Sarah E. Miller
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Hayley E. Miller
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Anne R. Waldrop
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Scarlett D. Karakash
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Kate A. Shaw
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
6
|
Miller HE, Montemayor D, Levy S, Sharma K, Frost B, Bishop AJR. RLSuite: An Integrative R-Loop Bioinformatics Framework. J Bioinform Syst Biol 2023; 6:364-378. [PMID: 38292828 PMCID: PMC10827345 DOI: 10.26502/jbsb.5107071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
We recently described the development of a database of 810 R-loop mapping datasets and used this data to conduct a meta-analysis of R-loops. R-loops are three-stranded nucleic acid structures containing RNA:DNA hybrids and we were able to verify that 30% of expressed genes have an associated R-loop in a location conserved manner.. Moreover, intergenic R-loops map to enhancers, super enhancers and with TAD domain boundaries. This work demonstrated that R-loop mapping via high-throughput sequencing can reveal novel insight into R-loop biology, however the analysis and quality control of these data is a non-trivial task for which few bioinformatic tools exist. Herein we describe RLSuite, an integrative R-loop bioinformatics framework for pre-processing, quality control, and downstream analysis of R-loop mapping data. RLSuite enables users to compare their data to hundreds of public datasets and generate a user-friendly analysis report for sharing with non-bioinformatician colleagues. Taken together, RLSuite is a novel analysis framework that should greatly benefit the emerging R-loop bioinformatics community in a rapidly expanding aspect of epigenetic control that is still poorly understood.
Collapse
Affiliation(s)
- H E Miller
- Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, TX, USA
- Greehey Children's Cancer Research Institute, UT Health San Antonio, San Antonio, TX, USA
- Bioinformatics Research Network, Atlanta, GA, USA
| | - D Montemayor
- Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
- Center for Precision Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - S Levy
- Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, TX, USA
- Bioinformatics Research Network, Atlanta, GA, USA
- Sam & Ann Barshop Institute for Longevity & Aging Studies, UT Health San Antonio, San Antonio, TX, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
| | - K Sharma
- Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
- Center for Precision Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - B Frost
- Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, TX, USA
- Sam & Ann Barshop Institute for Longevity & Aging Studies, UT Health San Antonio, San Antonio, TX, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
| | - A J R Bishop
- Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, TX, USA
- Greehey Children's Cancer Research Institute, UT Health San Antonio, San Antonio, TX, USA
- May's Cancer Center, UT Health San Antonio, San Antonio, TX, USA
| |
Collapse
|
7
|
Henkel A, Miller HE, Zhang J, Lyell DJ, Shaw KA. Prior Cesarean Birth and Risk of Uterine Rupture in Second-Trimester Medication Abortions Using Mifepristone and Misoprostol: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 142:1357-1364. [PMID: 37884011 DOI: 10.1097/aog.0000000000005259] [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] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/11/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE To assess the risk difference of uterine rupture when using current mifepristone and misoprostol regimens for second-trimester abortion among individuals with prior cesarean birth compared with those without prior cesarean birth. DATA SOURCES We searched the terms second trimester, induction, mifepristone, and abortion in PubMed, EMBASE, POPLINE, ClinicalTrials.gov , and Cochrane Library from inception until December 2022. METHODS OF STUDY SELECTION We included randomized trials and observational studies including a mixed cohort, with and without uterine scar, of individuals at 14-28 weeks of gestation who used mifepristone and misoprostol to end a pregnancy or to manage a fetal death. We excluded case reports, narrative reviews, and studies not published in English. Two reviewers independently screened studies. TABULATION, INTEGRATION, AND RESULTS Absolute risks with binomial CIs were calculated from pooled data. Using R software, we estimated total risk difference by the Mantel-Haenszel random-effects method without continuity correction. For studies with zero events, a continuity correction of 0.5 was applied for individual risk differences and plotted graphically with forest plots. Statistical heterogeneity was assessed with Higgins I2 statistics. Funnel plot assessed for publication bias. Of 198 articles identified, 22 met the inclusion criteria: seven randomized trials (n=923) and 15 observational studies (n=6,195). Uterine rupture risk with prior cesarean birth was 1.1% (10/874) (95% CI 0.6-2.1) and without prior cesarean birth was 0.01% (2/6,244) (95% CI 0.0-0.12). The risk difference was 1.23% (95% CI 0.46-2.00, I2 =0%). Of the 12 reported uterine ruptures, three resulted in hysterectomy. CONCLUSION Uterine rupture with mifepristone and misoprostol use during second-trimester induction abortion is rare, with the risk increased to 1% in individuals with prior cesarean birth. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022302626.
Collapse
Affiliation(s)
- Andrea Henkel
- Division of Family Planning Services and Research and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | | | | | | | | |
Collapse
|
8
|
Miller HE, Fraz F, Zhang J, Henkel A, Leonard SA, Maskatia SA, El-Sayed YY, Blumenfeld YJ. Abortion Bans and Resource Utilization for Congenital Heart Disease: A Decision Analysis. Obstet Gynecol 2023; 142:652-659. [PMID: 37535962 DOI: 10.1097/aog.0000000000005291] [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] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/01/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To investigate the implications of potential national abortion ban scenarios on the incidence of neonatal single-ventricle cardiac defects. METHODS A decision tree model was developed to predict the incidence of neonatal single-ventricle cardiac defects and related outcomes in the United States under four theoretical national abortion bans: 1) abortion restrictions in existence immediately before the June 2022 Dobbs v Jackson Women's Health Organization Supreme Court decision, 2) 20 weeks of gestation, 3) 13 weeks of gestation, and 4) a complete abortion ban. The model included incidence of live births of neonates with single-ventricle cardiac defects, neonatal heart surgery (including heart transplant and extracorporeal membrane oxygenation [ECMO]), and neonatal death. Cohort size was based on national pregnancy incidence and different algorithm decision point probabilities were aggregated from the existing literature. Monte Carlo simulations were conducted with 10,000 iterations per model. RESULTS In the scenario before the Dobbs decision, an estimated 6,369,000 annual pregnancies in the United States resulted in 1,006 annual cases of single-ventricle cardiac defects. Under a complete abortion ban, the model predicted a 53.7% increase in single-ventricle cardiac defects, or an additional 9 cases per 100,000 live births. This increase would result in an additional 531 neonatal heart surgeries, 16 heart transplants, 77 ECMO utilizations, and 102 neonatal deaths annually. More restrictive gestational age-based bans are predicted to confer increases in cases of neonatal single-ventricle cardiac defects and related adverse outcomes as well. CONCLUSION Universal abortion bans are estimated to increase the incidence of neonatal single-ventricle cardiac defects, associated morbidity, and resource utilization. States considering limiting abortion should consider the implications on the resources required to care for increasing number of children that will be born with significant and complex medical needs, including those with congenital heart disease.
Collapse
Affiliation(s)
- Hayley E Miller
- Division of Maternal-Fetal Medicine and Obstetrics and the Division of Family Planning Services and Research, Department of Obstetrics and Gynecology, and the Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, and the Department of Obstetrics and Gynecology, Stanford University, Stanford, California
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Miller HE, Simpson SL, Hurtado J, Boncompagni AC, Chueh J, Druzin ML, Panelli DM. The association of anxiety and insomnia on blood pressure parameters in pregnancy: a pilot study. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.835] [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: 01/09/2023]
|
10
|
Miller HE, Henkel A, Zhang J, Leonard SA, Quirin AP, Maskatia SA, El Sayed YY, Blumenfeld YJ. Abortion restriction impact on burden of neonatal single ventricle congenital heart disease: a decision-analytic model. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.834] [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: 01/08/2023]
|
11
|
Henkel A, Miller HE, Owens SN, Lyell DJ, Shaw KA. P048Risk of uterine rupture in second-trimester medication abortions using mifepristone and misoprostol after cesarean section birth: A systematic review and meta-analysis. Contraception 2022. [DOI: 10.1016/j.contraception.2022.09.072] [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: 11/19/2022]
|
12
|
Abstract
PURPOSE OF REVIEW Postpartum hemorrhage (PPH) is the leading preventable cause of maternal morbidity and mortality worldwide. Uterine atony is identified as the underlying etiology in up to 80% of PPH. This serves as a contemporary review of the epidemiology, risk factors, pathophysiology, and treatment of uterine atony. RECENT FINDINGS Rates of postpartum hemorrhage continue to rise worldwide with the largest fraction attributed to uterine atony. A simple 0-10 numerical rating score for uterine tone was recently validated for use during cesarean delivery and may allow for more standardized assessment in clinical and research settings. The optimal prophylactic dose of oxytocin differs depending on the patient population, but less than 5 units and as low as a fraction of one unit is needed for PPH prevention, with an increased requirements within that range for cesarean birth, those on magnesium, and advanced maternal age. Carbetocin is an appropriate alternative to oxytocin. Misoprostol shows limited to no efficacy for uterine atony in recent studies. Several uncontrolled case studies demonstrate novel mechanical and surgical interventions for treating uterine atony. SUMMARY There is a critical, unmet need for contemporary, controlled studies to address the increasing threat of atonic PPH.
Collapse
Affiliation(s)
- Hayley E Miller
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine
| | - Jessica R Ansari
- Division of Obstetric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford and Department of Anesthesiology, Stanford, Palo Alto, California, USA
| |
Collapse
|
13
|
Miller HE, Sie L, Minor KC, Bianco K, Druzin ML, Lee HC, Leonard SA. Preterm twin gestation: The association between severity of small for gestational age and neonatal outcomes. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.655] [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: 11/01/2022]
|
14
|
Panelli DM, Sherwin EB, Lee CJ, Leonard SA, Miller SE, Miller HE, Tolani AT, Hoover V, Ansari JR, Khandelwal A, Bianco K. Clinical factors associated with a positive postpartum depression screen in people with cardiac disease during pregnancy. Curr Res Psychiatry 2022; 2:25-29. [PMID: 36570491 PMCID: PMC9788649 DOI: 10.46439/psychiatry.2.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background While people with cardiac disease are known to be at increased lifetime risk of depression, little is known about postpartum depression rates in this population. Describing rates of positive postpartum depression screens and identifying risk factors that are unique to cardiac patients may help inform risk reduction strategies. Methods This retrospective cohort study included pregnant patients with congenital and/or acquired cardiac disease who delivered at a single institution between 2014 and 2020. The primary outcome was a positive postpartum depression screen, defined as Edinburgh Postpartum Depression Score (EPDS) ≥10. Potential exposures were selected a priori and compared between patients with and without a positive postpartum depression screen using Wilcoxon rank-sum and Fisher's exact tests. Secondary outcomes were responses to a longitudinal follow-up survey sent to English-speaking patients evaluating cardiac status, mental health, and infant development. Results Of 126 eligible cardiac patients, 23 (18.3%) had a positive postpartum depression screen. Patients with a positive postpartum depression screen were more likely to have had antepartum anticoagulation with heparin or enoxaparin (56.5% versus 26.2%, p=0.007), blood transfusion during delivery (8.7% versus 0%, p=0.032), and maternal-infant separation postpartum (52.2% versus 28.2%, p=0.047) compared to patients with a negative screen. Among 29 patients with a positive screen who responded to the follow up survey, 50% reported being formally diagnosed with anxiety or depression and 33.3% reported child development problems. Conclusions Our results highlight the importance of screening for postpartum depression in patients with cardiac disease, especially those requiring antepartum anticoagulation or maternal-infant separation postpartum.
Collapse
Affiliation(s)
- Danielle M. Panelli
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA,Author for correspondence:
| | - Elizabeth B. Sherwin
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Christine J. Lee
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephanie A. Leonard
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Sarah E. Miller
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Hayley E. Miller
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Alisha T. Tolani
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Valerie Hoover
- Department of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Jessica R. Ansari
- Division of Obstetric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Abha Khandelwal
- Department of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Katherine Bianco
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
15
|
Miller HE, Henkel A, Leonard SA, Miller SE, Tran L, Bianco K, Shaw KA. The impact of the COVID-19 pandemic on postpartum contraception planning. Am J Obstet Gynecol MFM 2021; 3:100412. [PMID: 34058421 PMCID: PMC8161810 DOI: 10.1016/j.ajogmf.2021.100412] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/10/2021] [Accepted: 05/26/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVE The COVID-19 pandemic necessitated rapid adjustment of obstetrical delivery models including fewer antenatal appointments and increased use of telehealth. We hypothesized that an increase in telemedicine and a decrease in antepartum visits owing to the COVID-19 pandemic led to a decreased proportion of people with a postpartum contraception plan at the time of the birth-hospitalization admission and a reduced uptake of top-tier forms of contraception at birth-hospitalization admission and discharge, and the routine postpartum visit, which has otherwise been increasing in recent years.1,2 STUDY DESIGN A retrospective cohort study comparing a randomly selected sample of people giving birth at a large, tertiary referral center during a regional “shelter in place” order, March 16, 2020, to July 31, 2020, with a previously abstracted random sample of people delivering between November 1, 2017, and April 30, 2018, was conducted. This study was reviewed and approved by the Stanford University Institutional Review Board before its initiation. The study was powered to detect a 10% difference in the proportion of those arriving at birth-hospitalization with a contraceptive plan (power 80%, alpha 0.05). The final sample size included 586 people (318 in the pre-COVID cohort and 268 in the COVID cohort). Multivariable modified Poisson regression model was used to estimate the relative risk of arriving at birth-hospitalization with a contraceptive plan in pre-COVID vs COVID cohorts, adjusting for age, parity, insurance status, and delivery mode. Secondary outcomes included tier of contraception plan at admission, discharge, and 6 weeks postpartum (classified by World Health Organization Tiered-Effectiveness3), attendance at postpartum visit, and whether the postpartum visit was conducted via telehealth. Tiered effectiveness was used for this study's purposes because it was hypothesized that telehealth would mostly affect the provision of top-tier forms of contraception that require in-person initiation. Fisher exact test was used to compare the secondary outcomes. RESULTS For the 2 cohorts, the median age was 32 years (range, 17–48 years) and median parity was 1 (range, 0–6). The majority (78%) had private insurance and most commonly identified as non-Hispanic White (38%) and Asian (36%). Baseline demographics did not differ between the cohorts. At birth-hospitalization admission, a smaller proportion of people had a postpartum contraceptive plan in the COVID cohort than in the pre-COVID cohort (73.9% vs 99.4%, adjusted risk ratio, 0.87; 95% confidence interval, 0.84–0.91, P<.001). A smaller proportion of people had a plan for top-tier contraception among the COVID cohort compared with the pre-COVID cohort at both admission and discharge (46.0% vs 71.0%, P<.01 and 31.0% vs 37.9%, P=.05) (Figure). More than 80% of the people attended a routine postpartum visit in both cohorts (P=.30) with 17.7% being telehealth visits in the COVID cohort compared with telehealth not being offered pre-COVID. Among those who attended their postpartum visit, the proportion discharged with a plan for interval top-tier contraception that was fulfilled was high in both groups (76.3% pre-COVID vs 71.2% post-COVID, P=.56). CONCLUSION The study found a significant decrease in people arriving at birth-hospitalization with a contraception plan in the months following a COVID-19 “shelter in place” order when compared with the pre-COVID cohort. It is suspected that changes in the obstetrical service models indirectly deprioritized the most effective forms of postpartum contraception because sterilization requires a signed consent before birth-hospitalization and postplacental intrauterine devices require consent before delivery.4,5 Current state legislation requiring in-person signature to consent for federally funded sterilization remains a barrier. We found that fewer individuals left with top-tier contraception than with plan on admission, especially within the COVID cohort. In addition to clinical contraindications that arise during labor, which preclude placement of an intrauterine device in the postpartum setting, many patients requested an expedited discharge during the peak of the COVID-19 pandemic. As the prenatal care model continues, this transition to adopt virtual visits, reduce visit schedules, and expedite postpartum discharge, actualizing patients’ contraceptive plans is increasingly more dependent on early inpatient provision. Maternity care providers should consider initiating postpartum contraception counseling and completing mandatory consents earlier in the antenatal period. This study is inherently limited by its retrospective nature of review and additional qualitative studies may better characterize this trend in contraceptive uptake. In the meantime, obstetrical care providers should carefully evaluate institutional barriers to postpartum contraception during this movement to telehealth.
Collapse
Affiliation(s)
- Hayley E Miller
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Dr. HH333, Stanford, CA 94305.
| | - Andrea Henkel
- Division of Family Planning Services and Research, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Stephanie A Leonard
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Sarah E Miller
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Linh Tran
- Department of Obstetrics and Gynecology Stanford University School of Medicine San Mateo County Medical Center Stanford, CA
| | | | - Kate A Shaw
- Division of Family Planning Services and Research, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
16
|
Miller HE, Seckel E, Sanchez D, White C, Mueller C, Bianco K. 553: Impact of gender, rank and research productivity on salary in obstetrics and gynecology. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.569] [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: 11/29/2022]
|
17
|
Miller HE, Suharwardy S, Leonard SA, Girsen A, Lyell DJ. 865: Cervical insufficiency, cerclage, and early preterm birth: differences among racial/ethnic subgroups. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
18
|
|
19
|
Abstract
BACKGROUND Considerable scientific evidence suggests that whole grains, as commonly consumed in the United States and Europe, reduce risk for chronic disease including cancer and heart disease. Whole grains provide a wide range of nutrients and phytochemicals that may work synergistically to optimize human health. Fruits and vegetables provide protection against age related diseases. It is believed their high content of antioxidant compounds is key to such protection. OBJECTIVE This research compares the antioxidant activity of whole grain, ready-to-eat (RTE) breakfast cereals to that of fruits and vegetables. METHOD Antioxidant activity was determined by dispersing finely ground samples in a 50% aqueous methanol solution of the stable free radical 2,2-diphenyl-1-picrylhydrazyl (DPPH). DPPH, which forms a deep purple solution, reacts with antioxidants and color loss at 515 nm correlates to antioxidant content, which is expressed as Trolox equivalents/100 grams (TE). RESULTS Whole grain breakfast cereals analyzed in this study contained from 2,200-3,500 TE. By comparison, fruits generally ranged from 600-1,700 TE, with a high of 2,200 TE for red plums. Berries averaged 3,700 TE and. vegetables averaged 450 TE with a high of 1,400 TE for red cabbage. A 41 gram average serving of RTE breakfast cereal provides 1,120 TE, while an average 85 gram serving of vegetables or fruits provides 380 and 1,020 TE, respectively. CONCLUSION Whole grain breakfast cereals, fruits and vegetables are all important dietary sources of antioxidants.
Collapse
Affiliation(s)
- H E Miller
- General Mills, Inc., Minneapolis, Minnesota 55427, USA
| | | | | | | | | |
Collapse
|
20
|
Abstract
BACKGROUND Uncertainties remain about the role of serotonin in the aetiology and treatment of panic disorder. AIMS To investigate the effect of reducing brain serotonin function on anxiety at rest, and following 5% CO2 provocation in normal controls and patients with panic disorder. METHOD Twenty drug-free patients with DSM-III-R panic disorder and 19 controls received a tryptophan-free amino acid drink on one occasion and a control drink on the other in a double-blind, balanced protocol. 5% CO2 was given as a panic challenge after 270 minutes. RESULTS Plasma tryptophan fell by more than 80% both patients and controls after the tryptophan-free drink. Tryptophan depletion did not alter resting anxiety. In patients alone, tryptophan depletion caused a greater anxiogenic response and an increased rate of panic attacks (9 v. 2, P < 0.05) after 5% CO2 challenge. No normal volunteers panicked. CONCLUSIONS Serotonin may directly modulate panic anxiety in patients with panic disorder. This may underlie the efficacy of serotonergic antidepressants in treating panic disorder.
Collapse
Affiliation(s)
- H E Miller
- Department of Psychiatry, Manchester Royal Infirmary
| | | | | |
Collapse
|
21
|
Abstract
We studied the effect of 3 weeks treatment with the selective serotonin reuptake inhibitor (SSRI), fluvoxamine, on hormonal and psychological responses to buspirone, a 5-HT1A receptor partial agonist which also binds to dopamine receptors, in normal male volunteers. Eleven subjects received buspirone, 30 mg, and placebo before, and in week 3 of fluvoxamine treatment (mean dose 127 mg/day). Placebo and buspirone were given in a balanced order, double-blind. Buspirone significantly elevated plasma prolactin (PRL) and growth hormone (GH) concentrations but had no significant effect on cortisol (CORT) or temperature. Significant psychological effects of lightheadedness, tiredness and difficulty thinking occurred. Fluvoxamine treatment resulted in a nearly 3-fold increase in plasma buspirone with a similar enhancement of the PRL response. In contrast the GH and psychological responses were blunted. The increased buspirone concentrations are likely to be due to inhibition of first pass liver metabolism by fluvoxamine acting on the cytochrome P-450 system. The PRL response is probably mediated by antagonism of pituitary dopamine-D2 receptors and its enhancement by fluvoxamine treatment may be a pharmacokinetic effect. The blunting of GH and psychological responses suggest that 5-HT1A receptor function is reduced by chronic fluvoxamine treatment.
Collapse
Affiliation(s)
- I M Anderson
- University of Manchester, Department of Psychiatry, Manchester Royal Infirmary, UK
| | | | | |
Collapse
|
22
|
Fredrickson BE, Yuan HA, Miller HE. Treatment of painful long-standing displaced fracture-dislocations of the sacrum. A case report. Clin Orthop Relat Res 1982:93-5. [PMID: 7083691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A 19-year-old white man sustained multiple injuries, including a severely displaced Malgaigne fracture. Secondary uncontrollable hemorrhage was treated successfully by arterial embolization. The patient retained a painfully displaced right sacroiliac joint. His multiple injuries resolved symptom free with the exception of the right sacroiliac region. An attempt to reduce the dislocation by an extensive soft tissue release and skeletal traction was unsuccessful. Solid fusion of the L4 and L5 vertebrae to the ilium significantly reduced the patient's pain. Painful, long-standing severely displaced Malgaigne fracture can be successfully treated by sacroiliac arthrodesis without reduction.
Collapse
|
23
|
Nuessle WF, Miller HE, Norman FC, Vagneur DA. Sedimentation rate in polymyalgia rheumatica: report of 24 cases. Minn Med 1976; 59:297-300. [PMID: 1272217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
24
|
Spruill JH, Toole JF, Kitto W, Miller HE. A comparison of betahistine hydrochloride with placebo for vertebral-basilar insufficiency: a double-blind study. Stroke 1975; 6:116-20. [PMID: 1092033 DOI: 10.1161/01.str.6.2.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
To test the effectiveness of betahistine HC1 in reducing the frequency of transient ischemic attacks (TIAs) caused by vertebral-basilar artery insufficiency, we randomly assigned 26 patients with a typical history of the condition to a placebo-drug or a drug-placebo sequence, each sequence lasting two months. During the study, the frequency of TIAs did not differ significantly between the placebo and the drug groups. Subjective responses indicated some value for betahistine as a palliative agent.
Collapse
|
25
|
Dunkelblum E, Miller HE, Dreiding AS. On the mechanism of decarboxylation of betanidine. A contribution to the interpretation of the biosynthesis of betalaines. Helv Chim Acta 1972; 55:642-8. [PMID: 5023155 DOI: 10.1002/hlca.19720550239] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
26
|
Miller HE. Polymyalgia rheumatica. Minn Med 1972; 55:48. [PMID: 5009224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
27
|
|
28
|
Nuessle WF, Miller HE, Norman FC. Urinary rentention from Ornade. Geriatrics (Basel) 1968; 23:166-9. [PMID: 4386397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
|
29
|
Miller HE, Rösler H, Wohlpart A, Wyler H, Wilcox ME, Frohofer H, Mabry TJ, Dreiding AS. [Biogenesis of betalaine. Biotransformation of dopa and tyrosine in betalaminic acid part of the betanins]. Helv Chim Acta 1968; 51:1470-4. [PMID: 5680746 DOI: 10.1002/hlca.19680510634] [Citation(s) in RCA: 49] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
30
|
Nuessle WF, Miller HE, Norman FC. Polymyalgia rheumatica. Report of seven cases. Minn Med 1967; 50:1483-7. [PMID: 6056093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
31
|
Abstract
SUMMARY
Total exchangeable sodium, potassium and bromide space were measured by a triple isotope technique, and antipyrine space, body weight, plasma electrolyte concentrations and urine electrolyte excretion were determined before and after intramuscular injection of 0·5 mg. aldosterone 6-hourly for 6–8 days in nine convalescent men.
After the treatment with aldosterone there were mean increases in body weight of 2·5 kg., 2·5 1. in total body water, and of 3·0 1. in extracellular fluid volume; a slight decrease in intracellular fluid volume was not significant. The mean total exchangeable sodium increased by 463 m-equiv. and the mean cumulative urinary excretion of sodium decreased by 444 m-equiv. The sodium was retained in the extracellular fluid without significant change in exchangeable intracellular sodium. Mean total exchangeable potassium was reduced by 207 m-equiv. while mean cumulative urinary potassium excretion increased by 88 m-equiv. The potassium loss was entirely intracellular.
The main source of error arose from isotope counting. The coefficient of variation of the sample count minus the background exceeded ±3% in 18 out of 150 samples: these results were discarded. Sixteen of the inaccurate counts were due to low concentrations of sodium or potassium in the specimens.
Collapse
|
32
|
|
33
|
Miller HE, Epstein NN, Simpson RG. Mapharsen: Its Use in the Treatment of Syphilis. Cal West Med 1936; 45:321-324. [PMID: 18743825 PMCID: PMC1761405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
34
|
Miller HE. Tularemia in California. Cal West Med 1935; 42:236-240. [PMID: 18743215 PMCID: PMC1752149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
35
|
Miller HE. The Local Treatment of Eczema in Infancy and Childhood. Cal West Med 1934; 40:33-35. [PMID: 18742738 PMCID: PMC1658928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
36
|
Miller HE. MONILIA INFECTIONS OF THE SKIN. Cal West Med 1931; 35:92-94. [PMID: 18741855 PMCID: PMC1657899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
37
|
Miller HE. CAROTINEMIA: REPORT OF CASES. Cal West Med 1930; 33:662-663. [PMID: 18741504 PMCID: PMC1657505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
38
|
Miller HE. GOLD AND SODIUM THIOSULPHATE IN THE TREATMENT OF LUPUS ERYTHEMATOSUS. Cal West Med 1928; 29:243-246. [PMID: 18740833 PMCID: PMC1656032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
39
|
Miller HE, Epstein NN. NON-SPECIFIC PROTEIN THERAPY IN DERMATOLOGY. Cal West Med 1927; 27:500-503. [PMID: 18740487 PMCID: PMC1655684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
40
|
Miller HE, Epstein N. VINCENT'S ANGINA: THE SIGNIFICANCE OF FUSIFORM BACILLI AND SPIRILLA IN MUCOUS MEMBRANE LESIONS. Cal West Med 1926; 24:633-637. [PMID: 18739974 PMCID: PMC1655133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
41
|
Miller HE. RINGWORM OF THE SCALP. Cal West Med 1925; 23:313-316. [PMID: 18739586 PMCID: PMC1654738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
42
|
Miller HE. POST-ARSPHENAMINE ERUPTIONS: WITH SPECIAL REFERENCE TO ETIOLOGY AND TREATMENT. Cal State J Med 1923; 21:473-477. [PMID: 18739142 PMCID: PMC1517844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|