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Weinreich HM, Jin V, Crowell L, Skovlund SM, Williams QL, Buhimschi IA. Surgical Instrument Designers and Inventors-Where are the Women? Am Surg 2023; 89:4835-4841. [PMID: 37148253 DOI: 10.1177/00031348231172164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Historically, surgical instruments were designed by men for male surgeons. Although instrumentation has changed with the changing paradigms of surgery, it has failed to adapt to the changing surgical workforce. Almost 30% of surgeons are female and nearly 90% of surveyed female surgeons report poor instrument design and associated musculoskeletal injuries from use. Understanding the current state of handheld surgical instrument design, published literature was reviewed, surgical instrument collections were contacted, and the U.S. Patent and Trademark databases were queried to identify public patents and pre-granted applications of female inventors of handheld surgical instruments. Twenty-five female inventors were identified from published literature and 1551 unique females hold patents. This number pales when the denominator of male inventors is considered. Hence, to address the female surgeon's lack of instrumentation and design, there is a critical need for participatory ergonomics whereby both the female surgeon and engineer collaborate on design.
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Affiliation(s)
- Heather M Weinreich
- Departments of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Vivian Jin
- Departments of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Lake Crowell
- Department of Mechanical and Industrial Engineering, College of Engineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Sandra M Skovlund
- Department of Otolaryngology-Head and Neck Surgery, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Quintin L Williams
- Department of Mechanical and Industrial Engineering, College of Engineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Irina A Buhimschi
- Departments of Obstetrics & Gynecology, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
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Ackerman WE, Buhimschi IA, Buhimschi CS. Are Early Pregnancy Blood Pressure Patterns a Crystal Ball for Predicting Preeclampsia and Gestational Hypertension? J Am Heart Assoc 2023; 12:e031068. [PMID: 37435794 PMCID: PMC10492999 DOI: 10.1161/jaha.123.031068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023]
Affiliation(s)
- William E. Ackerman
- Department of Obstetrics and GynecologyUniversity of Illinois College of Medicine at ChicagoChicagoIL
| | - Irina A. Buhimschi
- Department of Obstetrics and GynecologyUniversity of Illinois College of Medicine at ChicagoChicagoIL
| | - Catalin S. Buhimschi
- Department of Obstetrics and GynecologyUniversity of Illinois College of Medicine at ChicagoChicagoIL
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Weinreich HM, Kotini-Shah P, Man B, Pobee R, Hirshfield LE, Risman BJ, Buhimschi IA. Work-Life Balance and Academic Productivity Among College of Medicine Faculty During the Evolution of the COVID-19 Pandemic: The New Normal. Womens Health Rep (New Rochelle) 2023; 4:367-380. [PMID: 37476606 PMCID: PMC10354727 DOI: 10.1089/whr.2023.0007] [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] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/22/2023]
Abstract
Background Work and home stress, productivity, and self-care of academic medicine faculty in Spring 2021 was contrasted to faculty's experience in the Spring of 2020, both of which were relatively compared with the prepandemic period. Methods A 93-question survey was sent to academic medicine faculty at an urban public university medical center in March 2020 and again in March 2021. Demographic, family, and academic characteristics, work distribution and productivity before and during the pandemic, perceived stress related to work and home activities, and self-care data compared with the prepandemic period were collected. Differences were assessed using chi-square or Fisher exact tests. Student t-test was used for the difference in mean values, while logistic regression was used to determine predictors of work stress. Results Two hundred thirty-one faculty completed the survey in Spring 2020 and 118 faculty responded in Spring 2021. The proportion of faculty reporting increased work and home stress decreased in Spring 2021 compared with Spring 2020. A higher proportion of women compared with men reported increased work stress in both surveys. In Spring 2021, work stress decreased significantly for men but not for women. Home stress decreased significantly for women in Spring 2021 but remained stable for the men faculty. Research productivity increased for both genders in Spring 2021, but a greater percentage of women reported disturbed sleep and diet. There were no differences in home stress levels between genders when caring for young children. Conclusions Men faculty are more likely to adapt to the "new normal" by lowering work stressors and increasing productivity, whereas women's continued high work stress and increased productivity may occur at the expense of decreased self-care. The challenges associated with having young children continue to affect the productivity and well-being of all faculty.
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Affiliation(s)
- Heather M. Weinreich
- Department of Otolaryngology—Head and Neck Surgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Pavitra Kotini-Shah
- Department of Emergency Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Bernice Man
- Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Ruth Pobee
- Department of Emergency Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Laura E. Hirshfield
- Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Barbara J. Risman
- Department of Sociology, College of Liberal Arts and Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Irina A. Buhimschi
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Chicago, Illinois, USA
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Diaz-Rodriguez G, Braverman A, Elam GL, Norris-Stojak D, Harmon K, Hartwig J, Dunlap T, Nixon H, Rasamimari P, Buhimschi IA, Buhimschi CS. IS FASTER BETTER? RELATIONSHIPS OF CESAREAN ACUITY WITH RISK OF LOW APGAR SCORES AND FETAL ACIDEMIA. Am J Perinatol 2023. [PMID: 37156530 DOI: 10.1055/a-2088-5393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Timely response to obstetrical emergencies is highly desired. The recommendation for decision-to-incision (DTI) time in cesarean delivery (CD) of not more than 30 minutes was issued to prevent neonatal hypoxic-ischemic morbidities. We analyzed the efficiency with which an institutional-specific CD acuity classification system (emergent case: target DTI≤15min; urgent case: target DTI≤30min) reflected in the actual DTI time, Apgar scores and newborn acid-base status. METHODS Data on all 610 CSs performed over a 14-month period at a tertiary medical center was retrospectively extracted. Cases grouped by target DTI time categories were compared for proportions in low Agar scores and fetal acidosis. Multi-variable regression was used to identify clinical variables associated with need for neonatal resuscitation. RESULTS During the study period, 60 (10%) of CSs were emergent, 296 (49%) urgent and 254 (41%) elective. The target DTI ≤15 min. was achieved in 68% of emergent CSs with 93% having a DTI≤30 min. Among urgent surgeries, the target DTI≤30 min was reached in 48% of cases with 83% having DTI≤45 min. Compared to both urgent and scheduled procedures the incidence of newborn acidosis and Apgar scores ≤4 and ≤7 was highest amongst emergent CSs. The proportion of moderate and severe acidosis for deliveries with DTI≤15 min was significantly higher compared to procedures with DTI 16-30 min. and DTI>30 min. The need for neonatal resuscitation, including intubation were independently associated with fetal acidosis, low gestational age, surgery acuity level, general anesthesia, but not with the actual DTI time. CONCLUSIONS Adherence to tight DTI time targets is pragmatically difficult. The need for neonatal resuscitation varies with the acuity of the procedure but not with the actual DTI interval, implying that within certain time limits, the indication for surgery plays a greater role in the status of the newborn than the speed of the CS.
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Affiliation(s)
- Gian Diaz-Rodriguez
- Obstetrics & Gynecology, University of Illinois College of Medicine at Chicago, Chicago, United States
| | - Alexis Braverman
- Obstetrics & Gynecology, University of Illinois College of Medicine at Chicago, Chicago, United States
| | - Gloria L Elam
- Obstetrics & Gynecology, University of Illinois College of Medicine at Chicago, Chicago, United States
| | - Doreen Norris-Stojak
- University of Illinois Hospital and Health Sciences System, Chicago, United States
| | - Katherine Harmon
- Obstetrics & Gynecology, University of Illinois College of Medicine at Chicago, Chicago, United States
| | - Julie Hartwig
- Obstetrics & Gynecology, University of Illinois College of Medicine at Chicago, Chicago, United States
| | - Tiana Dunlap
- University of Illinois Hospital and Health Sciences System, Chicago, United States
| | - Heather Nixon
- Anesthesiology, University of Illinois College of Medicine at Chicago, Chicago, United States
| | - Phornphat Rasamimari
- Pediatrics, University of Illinois College of Medicine at Chicago, Chicago, United States
| | - Irina A Buhimschi
- Obstetrics & Gynecology, University of Illinois College of Medicine at Chicago, Chicago, United States
| | - Catalin S Buhimschi
- Obstetrics & Gynecology, University of Illinois College of Medicine at Chicago, Chicago, United States
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Ackerman Iv WE, Buhimschi CS, Brown TL, Zhao G, Summerfield TL, Buhimschi IA. Transcriptomics-Based Subphenotyping of the Human Placenta Enabled by Weighted Correlation Network Analysis in Early-Onset Preeclampsia With and Without Fetal Growth Restriction. Hypertension 2023; 80:1363-1374. [PMID: 36987911 DOI: 10.1161/hypertensionaha.122.20807] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Placental disorders contribute to pregnancy complications, including preeclampsia and fetal growth restriction (FGR), but debate regarding their specific pathobiology persists. Our objective was to apply transcriptomics with weighted gene correlation network analysis to further clarify the placental dysfunction in these conditions. METHODS We performed RNA sequencing with weighted gene correlation network analysis using human placental samples (n=30), separated into villous tissue and decidua basalis, and clinically grouped as follows: (1) early-onset preeclampsia (EOPE)+FGR (n=7); (2) normotensive, nonanomalous preterm FGR (n=5); (2) EOPE without FGR (n=8); (4) spontaneous idiopathic preterm birth (n=5) matched for gestational age (GA); and (5) uncomplicated term births (n=5). Our data was compared with RNA sequencing data sets from public databases (GSE114691, GSE148241, and PRJEB30656; n=130 samples). RESULTS We identified 14 correlated gene modules in our specimens, of which most were significantly correlated with birthweight and maternal blood pressure. Of the 3 network modules consistently predictive of EOPE±FGR across data sets, we prioritized a coexpression gene group enriched for hypoxia-response and metabolic pathways for further investigation. Cluster analysis based on transcripts from this module and the glycolysis/gluconeogenesis metabolic pathway consistently distinguished a subset of EOPE±FGR samples with an expression signature suggesting modified tissue bioenergetics. We demonstrated that the expression ratios of LDHA/LDHB and PDK1/GOT1 could be used as surrogate indices for the larger panels of genes in identifying this subgroup. CONCLUSIONS We provide novel evidence for a molecular subphenotype consistent with a glycolytic metabolic shift that occurs more frequently but not universally in placental specimens of EOPE±FGR.
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Affiliation(s)
- William E Ackerman Iv
- University of Illinois College of Medicine-Chicago, IL (W.E.A., C.S.B., G.Z., I.A.B.)
| | - Catalin S Buhimschi
- University of Illinois College of Medicine-Chicago, IL (W.E.A., C.S.B., G.Z., I.A.B.)
| | - Thomas L Brown
- Wright State University Boonshoft School of Medicine, Dayton, OH (T.L.B.)
| | - Guomao Zhao
- University of Illinois College of Medicine-Chicago, IL (W.E.A., C.S.B., G.Z., I.A.B.)
| | | | - Irina A Buhimschi
- University of Illinois College of Medicine-Chicago, IL (W.E.A., C.S.B., G.Z., I.A.B.)
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Frye LJ, Buhimschi IA, Raymond EG, Zhao G, Winikoff B. PAPP-A as a screening tool for assessment of gestational age before medication abortion in an intended-use population. Biomark Med 2023; 17:73-85. [PMID: 37038980 PMCID: PMC10183995 DOI: 10.2217/bmm-2022-0653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/15/2023] [Indexed: 04/12/2023] Open
Abstract
Introduction: Prior studies indicate that PAPP-A could serve as a marker of gestational age (GA) with the potential to determine eligibility for medication abortion. The authors validated the relationship between PAPP-A and GA in an actual-use population. Materials & methods: The authors collected blood samples, medical histories and ultrasound-determined GA from patients presenting for abortion services. They measured PAPP-A using two immunoassays and assessed diagnostic accuracy for predicting GA ≥71 days. Results: The Ansh Labs and R&D Systems immunoassays produced an area under the ROC curve of 0.982 (95% CI: 0.958-0.994) and 0.986 (95% CI: 0.963-0.996), respectively, for predicting GA ≥71 days. Conclusion: This validation study in an intended-use population confirmed that PAPP-A has a strong ability to distinguish pregnancies above and below 71 days' gestation. Clinical trial registration: NCT04232189 (ClinicalTrials.gov).
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Affiliation(s)
- Laura J Frye
- Gynuity Health Projects, 220 East 42nd Street New York, NY 10017, USA
| | - Irina A Buhimschi
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60612, USA
| | | | - Guomao Zhao
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60612, USA
| | - Beverly Winikoff
- Gynuity Health Projects, 220 East 42nd Street New York, NY 10017, USA
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Valtanen RS, Buhimschi CS, Bahtiyar MO, Zhao G, Jing H, Ackerman WE, Glabe CG, Buhimschi IA. Conformation-dependent anti-Aβ monoclonal antibody signatures of disease status and severity in urine of women with preeclampsia. Pregnancy Hypertens 2022; 28:51-59. [PMID: 35183929 PMCID: PMC9133023 DOI: 10.1016/j.preghy.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/12/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
Prior research has shown that urine of women with preeclampsia (PE) contains amyloid-like aggregates that are congophilic (exhibit affinity for the amyloidophilic dye Congo red) and immunoreactive with A11, a polyclonal serum against prefibrillar β-amyloid oligomers, thereby supporting pathogenic similarity between PE and protein conformational disorders such as Alzheimer's and prion disease. The objective of this study was to interrogate PE urine using monoclonal antibodies with previously characterized A11-like epitopes. Over 100 conformation-dependent monoclonals were screened and three (mA11-09, mA11-89, and mA11-205) selected for further confirmation in 196 urine samples grouped as follows: severe features PE (sPE, n = 114), PE without severe features (mPE, n = 30), chronic hypertension (crHTN, n = 14) and normotensive pregnant control (P-CRL, n = 38). We showed that the selected conformation-specific monoclonals distinguished among patients with varying severities of PE from P-CRL and patients with crHTN. By use of latent class analysis (LCA) we identified three classes of subjects: Class 1 (n = 94) comprised patients whose urine was both congophilic and reactive with the monoclonals. These women were more likely diagnosed with early-onset sPE and had severe hypertension and proteinuria; Class 2 patients (n = 55) were negative for congophilia and against the antibodies. These were predominantly P-CRL and crHTN patients. Lastly, Class 3 patients (n = 48) were positive for urine congophilia, albeit at lower intensity, but negative for monoclonal immunoreactivities. These women were diagnosed primarily as mPE or late-onset sPE. Collectively, our study validates conformation-dependent Aβ imunoreactivity of PE urine which in conjunction to urine congophilia may represent an additional indicator of disease severity.
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Affiliation(s)
- Rosa S Valtanen
- Department of Molecular Biology & Biochemistry, University of California, Irvine, CA 92617, United States
| | - Catalin S Buhimschi
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60611, United States; Department of Obstetrics and Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Mert O Bahtiyar
- Department of Obstetrics and Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Guomao Zhao
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60611, United States; Department of Obstetrics and Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Hongwu Jing
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60611, United States
| | - William E Ackerman
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60611, United States
| | - Charles G Glabe
- Department of Molecular Biology & Biochemistry, University of California, Irvine, CA 92617, United States
| | - Irina A Buhimschi
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60611, United States; Department of Obstetrics and Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, United States.
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Cater JH, Mañucat-Tan NB, Georgiou DK, Zhao G, Buhimschi IA, Wyatt AR, Ranson M. A Novel Role for Plasminogen Activator Inhibitor Type-2 as a Hypochlorite-Resistant Serine Protease Inhibitor and Holdase Chaperone. Cells 2022; 11:cells11071152. [PMID: 35406715 PMCID: PMC8997907 DOI: 10.3390/cells11071152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 12/15/2022] Open
Abstract
Plasminogen activator inhibitor type-2 (PAI-2), a member of the serpin family, is dramatically upregulated during pregnancy and in response to inflammation. Although PAI-2 exists in glycosylated and non-glycosylated forms in vivo, the majority of in vitro studies of PAI-2 have exclusively involved the intracellular non-glycosylated form. This study shows that exposure to inflammation-associated hypochlorite induces the oligomerisation of PAI-2 via a mechanism involving dityrosine formation. Compared to plasminogen activator inhibitor type-1 (PAI-1), both forms of PAI-2 are more resistant to hypochlorite-induced inactivation of its protease inhibitory activity. Holdase-type extracellular chaperone activity plays a putative non-canonical role for PAI-2. Our data demonstrate that glycosylated PAI-2 more efficiently inhibits the aggregation of Alzheimer’s disease and preeclampsia-associated amyloid beta peptide (Aβ), compared to non-glycosylated PAI-2 in vitro. However, hypochlorite-induced modification of non-glycosylated PAI-2 dramatically enhances its holdase activity by promoting the formation of very high-molecular-mass chaperone-active PAI-2 oligomers. Both PAI-2 forms protect against Aβ-induced cytotoxicity in the SH-SY5Y neuroblastoma cell line in vitro. In the villous placenta, PAI-2 is localised primarily to syncytiotrophoblast with wide interpersonal variation in women with preeclampsia and in gestational-age-matched controls. Although intracellular PAI-2 and Aβ staining localised to different placental cell types, some PAI-2 co-localised with Aβ in the extracellular plaque-like aggregated deposits abundant in preeclamptic placenta. Thus, PAI-2 potentially contributes to controlling aberrant fibrinolysis and the accumulation of misfolded proteins in states characterised by oxidative and proteostasis stress, such as in Alzheimer’s disease and preeclampsia.
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Affiliation(s)
- Jordan H. Cater
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong 2522, Australia;
- School of Chemistry and Biomolecular Science, University of Wollongong, Wollongong 2522, Australia
| | - Noralyn B. Mañucat-Tan
- Flinders Health and Medical Research Institute and College of Medicine and Public Health, Flinders University, Bedford Park 5042, Australia; (N.B.M.-T.); (D.K.G.)
| | - Demi K. Georgiou
- Flinders Health and Medical Research Institute and College of Medicine and Public Health, Flinders University, Bedford Park 5042, Australia; (N.B.M.-T.); (D.K.G.)
| | - Guomao Zhao
- Department of Obstetrics and Gynaecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60611, USA; (G.Z.); (I.A.B.)
| | - Irina A. Buhimschi
- Department of Obstetrics and Gynaecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60611, USA; (G.Z.); (I.A.B.)
| | - Amy R. Wyatt
- Flinders Health and Medical Research Institute and College of Medicine and Public Health, Flinders University, Bedford Park 5042, Australia; (N.B.M.-T.); (D.K.G.)
- Correspondence: (A.R.W.); (M.R.)
| | - Marie Ranson
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong 2522, Australia;
- School of Chemistry and Biomolecular Science, University of Wollongong, Wollongong 2522, Australia
- Correspondence: (A.R.W.); (M.R.)
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Kotini-Shah P, Man B, Pobee R, Hirshfield LE, Risman BJ, Buhimschi IA, Weinreich HM. Work-Life Balance and Productivity Among Academic Faculty During the COVID-19 Pandemic: A Latent Class Analysis. J Womens Health (Larchmt) 2022; 31:321-330. [PMID: 34846927 PMCID: PMC8972018 DOI: 10.1089/jwh.2021.0277] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 11/12/2022] Open
Abstract
Background: For faculty in academic health sciences, the balance between research, education, and patient care has been impeded by the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to identify personal and professional characteristics of faculty to understand the impact of the pandemic on faculty and consequent policy implications. Methods: A 93-question survey was sent to faculty at a large urban public university and medical center. Demographic, family, and academic characteristics, work distribution and productivity before and during the pandemic, stress, and self-care data information were collected. Latent class analysis (LCA) was performed to identify classes of faculty sharing similar characteristics. Comparisons between latent classes were performed using analysis of variance and chi-square analyses. Results: Of 497 respondents, 60% were women. Four latent classes of faculty emerged based on six significant indicator variables. Class 1 individuals were more likely women, assistant professors, nontenured with high work and home stress; Class 2 faculty were more likely associate professors, women, tenured, who reported high home and work stress; Class 3 faculty were more likely men, professors, tenured with moderate work, but low home stress; and Class 4 faculty were more likely adjunct professors, nontenured, and had low home and work stress. Class 2 reported significantly increased administrative and clinical duties, decreased scholarly productivity, and deferred self-care. Conclusions: The pandemic has not affected faculty equally. Early and mid-career individuals were impacted negatively from increased workloads, stress, and decreased self-care. Academic leaders need to acknowledge these differences and be inclusive of faculty with different experiences when adjusting workplace or promotion policies.
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Affiliation(s)
- Pavitra Kotini-Shah
- Department of Emergency Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Bernice Man
- Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Ruth Pobee
- Department of Emergency Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Laura E. Hirshfield
- Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Barbara J. Risman
- Department of Sociology, College of Liberal Arts and Sciences, University of Illinois at Chicago, Illinois, USA
| | - Irina A. Buhimschi
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Heather M. Weinreich
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA.,Address correspondence to: Heather M. Weinreich, MD, MPH, Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago College of Medicine, 1855 West Taylor Street, Chicago, IL 60612, USA
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10
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Contag S, Nardos R, Buhimschi IA, Almanza J. Population based cohort study of fetal deaths, and neonatal and perinatal mortality at term within a Somali diaspora. BMC Pregnancy Childbirth 2021; 21:740. [PMID: 34719388 PMCID: PMC8559350 DOI: 10.1186/s12884-021-04163-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Somali women deliver at greater gestational age with limited information on the associated perinatal mortality. Our objective is to compare perinatal mortality among Somali women with the population rates. Methods This is a retrospective cohort study from all births that occurred in Minnesota between 2011 and 2017. Information was obtained from certificates of birth, and neonatal and fetal death. Data was abstracted from 470,550 non-anomalous births ≥37 and ≤ 42 weeks of gestation. The study population included U.S. born White, U.S. born Black, women born in Somalia or self-identified as Somali, and women who identified as Hispanic regardless of place of birth (377,426). We excluded births < 37 weeks and > 42 weeks, > 1 fetus, age < 18 or > 45 years, or women of other ethnicities. The exposure was documented ethnicity or place of birth, and the outcomes were live birth, fetal death, neonatal death prior to 28 days, and perinatal mortality rates. These were calculated using binomial proportions with 95% confidence intervals and compared using odds ratios adjusted (aOR) for diabetes, hypertension and maternal body mass index. Results The aOR [95%CI] for stillbirth rate in the Somali cohort was greater than for U.S. born White (2.05 [1.49–2.83]) and Hispanic women (1.90 [1.30–2.79]), but similar to U.S. born Black women (0.88 [0.57–1.34]). Neonatal death rates were greater than for U.S. born White (1.84 [1.36–2.48], U.S. born Black women (1.47 [1.04–2.06]) and Hispanic women (1.47 [1.05–2.06]). This did not change after analysis was restricted to those with spontaneous onset of labor. When analyzed by week, at 42 weeks Somali aOR for neonatal death was the same as for U.S. born White women, but compared against U.S. born Black and Hispanic women, was significantly lower. Conclusions The later mean gestational age at delivery among women of Somali ethnicity is associated with greater overall risk for stillbirth and neonatal death rates at term, except compared against U.S. born Black women with whom stillbirth rates were not different. At 42 weeks, Somali neonatal mortality decreased and was comparable to that of the U.S. born White population and was lower than that of the other minorities. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04163-z.
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Affiliation(s)
- Stephen Contag
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota School of Medicine, Medical School MMC 395, 420 Delaware St SE, Minneapolis, MN, 55455, USA.
| | - Rahel Nardos
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology and Women's Health, University of Minnesota School of Medicine, Global Women's Health, Center for Global Health and Social Responsibility, Medical School MMC 395, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Irina A Buhimschi
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL, 60612, USA
| | - Jennifer Almanza
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota School of Medicine, Medical School MMC 395, 420 Delaware St SE, Minneapolis, MN, 55455, USA
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11
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Shapiro KE, Buhimschi IA, Fleisher J. Accuracy of anemia screening by point-of-care hemoglobin testing in patients seeking abortion. Contraception 2021; 105:51-54. [PMID: 34517000 DOI: 10.1016/j.contraception.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Accurate and timely diagnosis of anemia in pregnancy is necessary for safe management of abortion care. Screening for anemia in abortion care is often accomplished using commercially-available point-of-care tests from capillary blood, but the validity of this test has not been investigated in the context of abortion care. We sought to determine the accuracy of a capillary hemoglobin (Hb) among pregnant patients seeking induced abortion. STUDY DESIGN We conducted a retrospective study of patients seeking abortion care at the University of Illinois at Chicago. We identified 108 subjects with paired capillary Hb and venous complete blood count (CBC) hemoglobin measurements within 7 days of each other and within 14 days before abortion. Agreement analysis was performed using Passing-Bablok regression and Bland-Altman plots. RESULTS More patients were deemed anemic by capillary than by venous Hb measurement (32% vs 19%, p = 0.030). Capillary Hb correlated with venous Hb (r = 0.85, p < 0.001). The average bias for capillary Hb was -1.1 ± 1.0 g/dL. Step-wise, multivariable linear regression identified venous Hb as the only determinant of capillary Hb, and failed to identify any other predictors of bias. The agreement analysis between capillary and venous Hb by Passing-Bablok regression demonstrated systematic and proportional differences. CONCLUSION Results from capillary Hb may be biased toward diagnosing anemia and should be interpreted with caution. IMPLICATIONS Misdiagnosing anemia in abortion care can have several consequences and may prevent timely medical abortion or cause delayed procedural abortion. Clinical correlation, and possibly confirmation by venous complete blood count measurement, should be considered before clinical decision-making based solely upon the capillary point-of-care assay.
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Affiliation(s)
- Katherine E Shapiro
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60612, United States
| | - Irina A Buhimschi
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60612, United States
| | - Jonah Fleisher
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60612, United States.
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12
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Buhimschi IA, Zhao G, El Helou Y, Frye LJ, Winikoff B, Raymond EG. Analytical Comparison of Pregnancy-Associated Plasma Protein-A (PAPP-A) Immunoassays for Biochemical Determination of Gestational Age. J Appl Lab Med 2021; 6:1517-1532. [PMID: 34329446 DOI: 10.1093/jalm/jfab057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Accurate pregnancy dating is critical for maternal and child health and for counseling on safe and effective abortion methods. While last menstrual period and first trimester ultrasound are often used together to determine gestational age (GA), they have limited accuracy and availability, respectively. Prior studies have shown that pregnancy-associated plasma protein-A (PAPP-A) increases exponentially during pregnancy and has the potential to serve as a biochemical marker of GA. We aimed to analyze the relationship between sonographically determined GA and serum PAPP-A concentration measured by different immunoassays and to derive cutoff levels informative for the 70 days GA commonly recommended limit for medical abortion in outpatient settings. METHODS We compared technical characteristics of 4 commercially available PAPP-A immunoassays and tested 120 maternal serum samples (GA range: 34-231 days) along with contrived pool samples and traceable quality controls. These characteristics included area under the receiver operator characteristic (AUROC) plot, sensitivity and specificity based on cutoffs defined by the Youden Index, and likelihood ratios. RESULTS All 4 immunoassays had sensitivities and specificities ≥80%, and AUROC values ranging from 0.948 to 0.968. Marked differences among absolute PAPP-A values were noted depending on immunoassay. PAPP-A cutoff values at 70 days GA for each individual immunoassay were established along with procedural recommendations that increase equivalence among immunoassays. CONCLUSIONS Maternal serum PAPP-A levels correlated strongly with GA despite differences in immunoassay formats and absolute data output. Serum PAPP-A has biomarker potential for future development of a point-of-care test aimed at increasing access to medical abortion.
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Affiliation(s)
- Irina A Buhimschi
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60612
| | - Guomao Zhao
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60612
| | - Yara El Helou
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60612
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13
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Jayaram A, Buhimschi IA, Aldasoqi H, Hartwig J, Owens T, Elam GL, Buhimschi CS. Who said differentiating preeclampsia from COVID-19 infection was easy? Pregnancy Hypertens 2021; 26:8-10. [PMID: 34392167 PMCID: PMC8302825 DOI: 10.1016/j.preghy.2021.07.248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Aswathi Jayaram
- Department of Obstetrics, Gynecology, University of Illinois College of Medicine, Chicago, IL, United States.
| | - Irina A Buhimschi
- Department of Obstetrics, Gynecology, University of Illinois College of Medicine, Chicago, IL, United States
| | - Hayfaa Aldasoqi
- Patient Care Nursing Administration, University of Illinois Hospital and Health Sciences System, Chicago, IL, United States
| | - Julie Hartwig
- Department of Obstetrics, Gynecology, University of Illinois College of Medicine, Chicago, IL, United States
| | - Thomas Owens
- Department of Obstetrics, Gynecology, University of Illinois College of Medicine, Chicago, IL, United States
| | - Gloria L Elam
- Department of Obstetrics, Gynecology, University of Illinois College of Medicine, Chicago, IL, United States
| | - Catalin S Buhimschi
- Department of Obstetrics, Gynecology, University of Illinois College of Medicine, Chicago, IL, United States
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14
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Ackerman WE, Buhimschi CS, Snedden A, Summerfield TL, Zhao G, Buhimschi IA. Molecular signatures of labor and nonlabor myometrium with parsimonious classification from 2 calcium transporter genes. JCI Insight 2021; 6:148425. [PMID: 33945511 PMCID: PMC8262336 DOI: 10.1172/jci.insight.148425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/29/2021] [Indexed: 11/26/2022] Open
Abstract
Clinical phenotyping of term and preterm labor is imprecise, and disagreement persists on categorization relative to underlying pathobiology, which remains poorly understood. We performed RNA sequencing (RNA-seq) of 31 specimens of human uterine myometrium from 10 term and 21 preterm cesarean deliveries with rich clinical context information. A molecular signature of 4814 transcripts stratified myometrial samples into quiescent (Q) and nonquiescent (NQ) phenotypes, independent of gestational age and incision site. Similar stratifications were achieved using expressed genes in Ca2+ signaling and TGF-β pathways. For maximal parsimony, we evaluated the expression of just 2 Ca2+ transporter genes, ATP2B4 (encoding PMCA4) and ATP2A2 (coding for SERCA2), and we found that their ratio reliably distinguished NQ and Q specimens in the current study, and also in 2 publicly available RNA-seq data sets (GSE50599 and GSE80172), with an overall AUC of 0.94. Cross-validation of the ATP2B4/ATP2A2 ratio by quantitative PCR in an expanded cohort (by 11 additional specimens) achieved complete separation (AUC of 1.00) of NQ versus Q specimens. While providing additional insight into the associations between clinical features of term and preterm labor and myometrial gene expression, our study also offers a practical algorithm for unbiased classification of myometrial biopsies by their overall contractile program.
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Affiliation(s)
- William E Ackerman
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Catalin S Buhimschi
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Ali Snedden
- The High Performance Computing Facility, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Taryn L Summerfield
- The Ohio State University College of Medicine, Department of Obstetrics & Gynecology, Columbus, Ohio, USA
| | - Guomao Zhao
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Irina A Buhimschi
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
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15
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Ware CA, Buhimschi CS, Zhao G, El Helou Y, Buhimschi IA. Amniotic Fluid Proteasome and Immunoproteasome in the Setting of Intra-Amniotic Infection, Inflammation, and Preterm Birth. Reprod Sci 2021; 28:2562-2573. [PMID: 33665784 DOI: 10.1007/s43032-021-00512-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/21/2021] [Indexed: 11/30/2022]
Abstract
Preterm birth is an important determinant of neonatal morbidity and mortality and intra-amniotic infection (IAI) and inflammation play a causative role. The constitutive proteasome and immunoproteasome are key players in maintenance of proteostasis and their alteration outside pregnancy has been linked to pathogenesis of numerous inflammatory diseases. Our goal was to evaluate the levels, activities, and potential origin of amniotic fluid (AF) proteasome in women with preterm birth induced by infection and/or inflammation. Total proteasome and immunoproteasome concentrations were measured in AF retrieved by trans-abdominal amniocentesis from 155 pregnant women. Proteasome activities were measured with fluorogenic substrates targeting caspase-like (CAS-L), trypsin-like (TRY-L), or chymotrypsin-like (CHE-L) lytic activities. We found that IAI significantly upregulated AF concentrations of total proteasome and of the immunoproteasome (P<0.001 for both) with no differences based on gestational age. Based on substrate preference and profile of pharmacologic inhibition, we identified the CHE-L activity of the immunoproteasome as the primary lytic activity upregulated in AF of pregnancies complicated by IAI. When compared with matched maternal blood and cord blood, proteasome activity was by far the highest in AF and this was further elevated in IAI. Western blot confirmed β5 (PSMB5) and β5i (PSMB8) subunits of the constitutive proteasome and immunoproteasome are present in AF and IHC staining of fetal membranes pointed to chorio-decidua as a potential source. In conclusion, IAI is associated with increased AF immunoproteasome activity that by analogy with other inflammatory diseases may generate antigenic oligopeptides and may play a role in triggering preterm birth.
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Affiliation(s)
- Courtney A Ware
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, 43210, USA
| | - Catalin S Buhimschi
- Department of Obstetrics and Gynecology, University of Illinois College of Medicine, Chicago, IL, 60612, USA
| | - Guomao Zhao
- Department of Obstetrics and Gynecology, University of Illinois College of Medicine, Chicago, IL, 60612, USA.,Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, 43215, USA
| | - Yara El Helou
- Department of Obstetrics and Gynecology, University of Illinois College of Medicine, Chicago, IL, 60612, USA
| | - Irina A Buhimschi
- Department of Obstetrics and Gynecology, University of Illinois College of Medicine, Chicago, IL, 60612, USA. .,Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, 43215, USA.
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16
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Jing H, Ackerman WE, Zhao G, El Helou Y, Buhimschi CS, Buhimschi IA. Connecting the dots on vertical transmission of SARS-CoV-2 using protein-protein interaction network analysis - Potential roles of placental ACE2 and ENDOU. Placenta 2021; 104:16-19. [PMID: 33197855 PMCID: PMC7649632 DOI: 10.1016/j.placenta.2020.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 12/30/2022]
Abstract
We conducted a protein-protein interaction (PPI) network study searching for proteins relevant to pregnancy-associated COVID-19 in pregnancy complicated with severe preeclampsia (sPE) and intra-amniotic infection and/or inflammation (Triple-I). PPI networks from sPE and Triple-I were intersected with the PPI network from coronavirus infection. Common proteins included the SARS-CoV-2 entry receptor ACE2 and ENDOU, a placental endoribonuclease homologous to Nsp15, a protein produced by the virus to escape host immunity. Remarkably, placental ENDOU mRNA expression far exceeded that of ACE2. Immunohistochemistry confirmed ENDOU localization at the hemochorial maternal-fetal interface. Investigation of ENDOU's relevance to vertical transmission of SARS-CoV-2 is further warranted.
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Affiliation(s)
- Hongwu Jing
- Department of Obstetrics and Gynecology, College of Medicine, University of Illinois at Chicago, IL, 60612, USA.
| | - William E Ackerman
- Department of Obstetrics and Gynecology, College of Medicine, University of Illinois at Chicago, IL, 60612, USA
| | - Guomao Zhao
- Department of Obstetrics and Gynecology, College of Medicine, University of Illinois at Chicago, IL, 60612, USA
| | - Yara El Helou
- Department of Obstetrics and Gynecology, College of Medicine, University of Illinois at Chicago, IL, 60612, USA
| | - Catalin S Buhimschi
- Department of Obstetrics and Gynecology, College of Medicine, University of Illinois at Chicago, IL, 60612, USA
| | - Irina A Buhimschi
- Department of Obstetrics and Gynecology, College of Medicine, University of Illinois at Chicago, IL, 60612, USA
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17
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Bracken H, Buhimschi IA, Rahman A, Smith PRS, Pervin J, Rouf S, Bousieguez M, López LG, Buhimschi CS, Easterling T, Winikoff B. Congo red test for identification of preeclampsia: Results of a prospective diagnostic case-control study in Bangladesh and Mexico. EClinicalMedicine 2021; 31:100678. [PMID: 33385127 PMCID: PMC7770484 DOI: 10.1016/j.eclinm.2020.100678] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Misfolded proteins in the urine of women with preeclampsia bind to Congo Red dye (urine congophilia). We evaluated a beta prototype of a point-of-care test for the identification of urine congophilia in preeclamptic women. METHODS Prospective diagnostic case-control study conducted in 409 pregnant women (n = 204 preeclampsia; n = 205 uncomplicated pregnancies) presenting for delivery in two tertiary level hospitals located in Bangladesh and Mexico. The GV-005, a beta prototype of a point-of-care test for detecting congophilia, was performed on fresh and refrigerated urine samples. The primary outcome was the prevalence of urine congophilia in each of the two groups. Secondary outcome was the likelihood of the GV-005 (index test) to confirm and rule-out preeclampsia based on an adjudicated diagnosis (reference standard). FINDINGS The GV-005 was positive in 85% of clinical cases (83/98) and negative in 81% of clinical controls (79/98) in the Bangladesh cohort. In the Mexico cohort, the GV-005 test was positive in 48% of clinical cases (51/106) and negative in 77% of clinical controls (82/107). Adjudication confirmed preeclampsia in 92% of Bangladesh clinical cases (90/98) and 61% of Mexico clinical cases (65/106). The odds ratio of a urine congophilia in adjudicated cases versus controls in the Bangladesh cohort was 34.5 (14.7 - 81.1) (p<0.001) compared to 4.2 (2.1 - 8.4; p<0.001) in the Mexico cohort. INTERPRETATION The GV-005, a beta prototype of a point-of-care test for detection of urine congophilia, is a promising tool for rapid identification of preeclampsia. FUNDING Saving Lives at Birth.
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Affiliation(s)
- Hillary Bracken
- Gynuity Health Projects, 220 East 42nd Street, Suite #710, New York, NY 10017, USA
- Corresponding author.
| | - Irina A. Buhimschi
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, College of Medicine, Chicago, IL 60612, USA
| | - Anisur Rahman
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | | | - Jesmin Pervin
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Salma Rouf
- Department of Obstetrics and Gynecology, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Manuel Bousieguez
- Gynuity Health Projects, 220 East 42nd Street, Suite #710, New York, NY 10017, USA
| | | | - Catalin S. Buhimschi
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, College of Medicine, Chicago, IL 60612, USA
| | | | - Beverly Winikoff
- Gynuity Health Projects, 220 East 42nd Street, Suite #710, New York, NY 10017, USA
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18
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Buhimschi CS, Elam GL, Locher SR, Norris-Stojak D, Aldasoqi H, Stephenson MD, Buhimschi IA. Prevalence and Neighborhood Geomapping of COVID-19 in an Underserved Chicago Pregnant Population. AJP Rep 2020; 10:e413-e416. [PMID: 33294287 PMCID: PMC7714615 DOI: 10.1055/s-0040-1721416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/17/2020] [Accepted: 09/16/2020] [Indexed: 11/21/2022] Open
Abstract
Objective The Chicago area is known to harbor some of the deepest racial and ethnic socioeconomic inequalities in the United States. We studied the prevalence and neighborhood distribution of patients who tested positive for COVID-19 after implementation of universal screening at an academic hospital providing obstetrical services to an underserved Chicago population. Study Design From April 16 to June 16, 2020, a total of 369 patients were screened for COVID-19 at University of Illinois at Chicago with either the Abbott Point-of-Care (POC, n = 266) or reverse transcription polymerase chain reaction test (RT-PCR, n = 101). Patient residential data mapped using ESRI ArcGIS Pro was integrated in ESRI's Living Atlas with the Neighborhood Socioeconomic Status Index (NSEI). Results Precisely, 7.9% (29/369) of screened patients tested positive; 69% (17/29) with the POC test and 31% (12/29) by RT-PCR. The prevalence of an outpatient RT-PCR positive result was 8.9% (9/101). All but one of the 29 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive patients were either Hispanic or Black, and the majority resided in disadvantaged neighborhoods. Conclusion The disproportionate hit of COVID-19 pandemic on the Hispanic and Black communities reflects in SARS-CoV-2 positivity rates in the obstetrical population. Our report provides data that may be useful to policy makers when prioritizing resources to communities in need.
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Affiliation(s)
- Catalin S Buhimschi
- Department of Obstetrics, Gynecology, University of Illinois College of Medicine, Chicago, Illinois
| | - Gloria L Elam
- Department of Obstetrics, Gynecology, University of Illinois College of Medicine, Chicago, Illinois
| | - Stephen R Locher
- Department of Obstetrics, Gynecology, University of Illinois College of Medicine, Chicago, Illinois
| | - Doreen Norris-Stojak
- Patient Care Nursing Administration, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Hayfaa Aldasoqi
- Patient Care Nursing Administration, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Mary D Stephenson
- Department of Obstetrics, Gynecology, University of Illinois College of Medicine, Chicago, Illinois
| | - Irina A Buhimschi
- Department of Obstetrics, Gynecology, University of Illinois College of Medicine, Chicago, Illinois
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19
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Fair SR, Julian D, Hartlaub AM, Pusuluri ST, Malik G, Summerfied TL, Zhao G, Hester AB, Ackerman WE, Hollingsworth EW, Ali M, McElroy CA, Buhimschi IA, Imitola J, Maitre NL, Bedrosian TA, Hester ME. Electrophysiological Maturation of Cerebral Organoids Correlates with Dynamic Morphological and Cellular Development. Stem Cell Reports 2020; 15:855-868. [PMID: 32976764 PMCID: PMC7562943 DOI: 10.1016/j.stemcr.2020.08.017] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 12/22/2022] Open
Abstract
Cerebral organoids (COs) are rapidly accelerating the rate of translational neuroscience based on their potential to model complex features of the developing human brain. Several studies have examined the electrophysiological and neural network features of COs; however, no study has comprehensively investigated the developmental trajectory of electrophysiological properties in whole-brain COs and correlated these properties with developmentally linked morphological and cellular features. Here, we profiled the neuroelectrical activities of COs over the span of 5 months with a multi-electrode array platform and observed the emergence and maturation of several electrophysiologic properties, including rapid firing rates and network bursting events. To complement these analyses, we characterized the complex molecular and cellular development that gives rise to these mature neuroelectrical properties with immunohistochemical and single-cell transcriptomic analyses. This integrated approach highlights the value of COs as an emerging model system of human brain development and neurological disease. CO electrophysiology can be quantified with a multi-electrode array method CO electrophysiological trajectories correlate with molecular and cellular development The neurotrophin/TRK signaling pathway is active in COs by 5 months in culture
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Affiliation(s)
- Summer R Fair
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, Columbus, OH 43205-2716, USA
| | - Dominic Julian
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, Columbus, OH 43205-2716, USA
| | - Annalisa M Hartlaub
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Sai Teja Pusuluri
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Girik Malik
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Khoury College of Computer Sciences, Northeastern University, Boston, MA 02115, USA
| | - Taryn L Summerfied
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Guomao Zhao
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60612, USA
| | - Arelis B Hester
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, Columbus, OH 43205-2716, USA
| | - William E Ackerman
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60612, USA
| | - Ethan W Hollingsworth
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, Columbus, OH 43205-2716, USA
| | - Mehboob Ali
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Craig A McElroy
- College of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Irina A Buhimschi
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60612, USA
| | - Jaime Imitola
- Department of Neurology, Laboratory for Neural Stem Cells and Functional Neurogenetics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Nathalie L Maitre
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Tracy A Bedrosian
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, Columbus, OH 43205-2716, USA
| | - Mark E Hester
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, Columbus, OH 43205-2716, USA; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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20
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Finneran MM, Ware CA, Russo J, Webster S, Mathew S, Buhimschi IA, Buhimschi CS. Use of birth weight- vs. ultrasound-derived fetal weight classification methods: implications for detection of abnormal umbilical artery Doppler. J Perinat Med 2020; 48:615-624. [PMID: 32484452 DOI: 10.1515/jpm-2020-0068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/19/2020] [Accepted: 04/24/2020] [Indexed: 11/15/2022]
Abstract
Objectives To compare a birth weight-derived (Brenner) and multiple ultrasound-derived [Hadlock, National Institute of Child Health and Human Development (NICHD), International Fetal and Newborn Growth Consortium (INTERGROWTH)] classification systems' frequency of assigning an antenatal estimated fetal weight (EFW) <10% and subsequent detection rate for abnormal umbilical artery Doppler (UAD). Methods We analyzed 569 consecutive non-anomalous singleton gestations identified by ultrasound with either an abdominal circumference (AC) <3% or EFW <10% at a tertiary medical center between 1/2012 and 12/2016. The biometric measurements were exported for all serial ultrasounds and the sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC) were calculated for the diagnosis of any abnormal UAD, absent or reversed end-diastolic flow (AREDF), and small for gestational age (SGA) for each classification method. Results Brenner classified less patients with EFW <10% (49.7%) vs. the comparison methods (range: 84.2-85.0%; P < 0.001). The sensitivity was highest using Hadlock for detection of any abnormal UAD [96.6%; confidence interval (CI) 92.8-98.8%], AREDF (100%; CI 95.1-100%), and SGA (89.0%; CI 85.4-91.6%). However, there was minimal variation between the Hadlock, NICHD, and INTERGROWTH methods for detection of the studied outcomes. The AUCs for any abnormal UAD, AREDF, and SGA were highest for the Brenner method, but there were a substantial number of false-negative results with lower overall detection rates. Conclusions Use of a birth weight-derived method to assign a fetal weight <10% as the threshold to initiate UAD surveillance has a lower detection rate for abnormal UAD when compared to ultrasound-derived methods. Despite substantial methodological differences in the creation of the Hadlock, NICHD, and INTERGROWTH methods, there were no differences in the detection rates of abnormal UAD.
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Affiliation(s)
- Matthew M Finneran
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA.,Division of Maternal-Fetal Medicine, Medical University of South Carolina, 96 Jonathan Lucas St., MSC 643, Charleston, SC 29425-1600, USA
| | - Courtney A Ware
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jessica Russo
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Shaylyn Webster
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Susanne Mathew
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
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21
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Irani RA, Buhimschi CS, Cross SN, Zhao G, Copel JA, Bhandari V, Buhimschi IA, Bahtiyar MO. Fetal Myocardial Function as Assessed by N-Terminal Fragment Brain Natriuretic Protein in Premature Fetuses Exposed to Intra-amniotic Inflammation. Am J Perinatol 2020; 37:745-753. [PMID: 31121635 DOI: 10.1055/s-0039-1688909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to determine the relationship between fetal exposure to intra-amniotic infection/inflammation (IAI) and fetal heart ventricular function as assessed by circulatory levels of N-terminal fragment brain natriuretic protein (NT-proBNP) and the Tei index. STUDY DESIGN We analyzed 70 samples of paired amniotic fluid (AF) and cord blood retrieved from mothers who delivered preterm at <34 weeks as follows: Yes-IAI (n = 36) and No-IAI (n = 34). IAI was diagnosed by amniocentesis and AF mass spectrometry. Fetal exposure to inflammation was determined through the evaluation of cord blood haptoglobin (Hp) switch-on status and level, and interleukin (IL)-6 levels by Western blotting and enzyme-linked immunosorbent assay, respectively. Fetal heart function was assessed by cord blood NT-proBNP immunoassay and fetal echocardiogram (Tei index). RESULTS IAI was characterized by significantly higher levels of AF (p < 0.001) and umbilical cord IL-6 (p = 0.004). Cord blood Hp levels and frequency of switch-on status were higher in fetuses exposed to IAI (p < 0.001, both). Fetuses exposed to IAI did not have higher levels of NT-proBNP. Following correction for gestational age and race, neither cord blood NT-proBNP nor the Tei index was significantly different in fetuses with Hp switched-on status (p > 0.05, both). CONCLUSION Fetal myocardial left ventricular function does not seem to be significantly impaired in fetuses born alive due to IAI if delivery of the fetus occurs immediately following the diagnosis of IAI.
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Affiliation(s)
- Roxanna A Irani
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California San Francisco, San Francisco, California
| | - Catalin S Buhimschi
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Sarah N Cross
- Department of Obstetrics, Gynecology, and Women's Health, Division of Maternal-Fetal Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Guomao Zhao
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Joshua A Copel
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut.,Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Vineet Bhandari
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Irina A Buhimschi
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Mert Ozan Bahtiyar
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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22
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Rood KM, Buhimschi CS, Zhao G, Oliver EA, Summerfield T, Bahtiyar MO, Buhimschi IA. Tenascin-X in amniotic fluid and reproductive tissues of pregnancies complicated by infection and preterm prelabor rupture of membranes†. Biol Reprod 2020; 100:773-782. [PMID: 30277495 DOI: 10.1093/biolre/ioy216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/05/2018] [Accepted: 09/30/2018] [Indexed: 11/12/2022] Open
Abstract
Preterm prelabor rupture of membranes (PPROM), which can precede or follow intra-amniotic infection/inflammation (IAI), is a poorly understood pregnancy complication. Tenascin-X (TNX) is a connective tissue extracellular matrix protein that regulates fibrillogenesis of collagens I, III, and V. Our goal was to investigate the presence and level of soluble TNX (sTNX) in amniotic fluid (AF) and TNX expression in reproductive tissues of pregnancies complicated by PPROM and IAI. We prospectively recruited 334 women pregnant with singletons who had a clinically indicated amniocentesis for genetic karyotyping, lung maturity testing, or rule-out IAI in the presence or absence of PPROM. We quantified TNX expression in fetal membranes, myometrium, cervix, and placenta using immunological methods and qRT-PCR. In pregnancies with normal outcomes, AF sTNX levels were GA-regulated with lower levels toward term. IAI significantly upregulated AF sTNX levels independent of membrane status. AF sTNX levels inversely correlated with fetal membranes tenascin XB (TNXB) mRNA level, which was significantly downregulated by IAI. Western blotting identified characteristic ∼75 and ∼140 kDa sTNX forms in both AF and fetal membranes. Fetal membranes, placenta, and cervix constitutively express TNX with the highest abundance in the amnion. Amnion TNX richness is significantly lost in the setting of IAI. Our results suggest that fetal membranes may be a source of AF sTNX whereby protein and mRNA expression seem to be significantly impacted by inflammation independent of fetal membrane status. A more thorough understanding of TNX changes may be valuable for understanding spontaneous PPROM and to potentially develop therapeutic targets.
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Affiliation(s)
- Kara M Rood
- Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Catalin S Buhimschi
- Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Guomao Zhao
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Emily A Oliver
- Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Taryn Summerfield
- Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Mert Ozan Bahtiyar
- Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Maternal-Fetal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Irina A Buhimschi
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
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23
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Fisher AL, Sangkhae V, Presicce P, Chougnet CA, Jobe AH, Kallapur SG, Tabbah S, Buhimschi CS, Buhimschi IA, Ganz T, Nemeth E. Fetal and amniotic fluid iron homeostasis in healthy and complicated murine, macaque, and human pregnancy. JCI Insight 2020; 5:135321. [PMID: 31990688 DOI: 10.1172/jci.insight.135321] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/22/2020] [Indexed: 12/21/2022] Open
Abstract
Adequate iron supply during pregnancy is essential for fetal development. However, how fetal or amniotic fluid iron levels are regulated during healthy pregnancy, or pregnancies complicated by intraamniotic infection or inflammation (IAI), is unknown. We evaluated amniotic fluid and fetal iron homeostasis in normal and complicated murine, macaque, and human pregnancy. In mice, fetal iron endowment was affected by maternal iron status, but amniotic fluid iron concentrations changed little during maternal iron deficiency or excess. In murine and macaque models of inflamed pregnancy, the fetus responded to maternal systemic inflammation or IAI by rapidly upregulating hepcidin and lowering iron in fetal blood, without altering amniotic fluid iron. In humans, elevated cord blood hepcidin with accompanying hypoferremia was observed in pregnancies with antenatal exposure to IAI compared with those that were nonexposed. Hepcidin was also elevated in human amniotic fluid from pregnancies with IAI compared with those without IAI, but amniotic fluid iron levels did not differ between the groups. Our studies in mice, macaques, and humans demonstrate that amniotic fluid iron is largely unregulated but that the rapid induction of fetal hepcidin by inflammation and consequent fetal hypoferremia are conserved mechanisms that may be important in fetal host defense.
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Affiliation(s)
- Allison L Fisher
- Molecular, Cellular and Integrative Physiology Graduate Program, Graduate Programs in Bioscience.,Center for Iron Disorders, and
| | | | - Pietro Presicce
- Neonatal-Perinatal Medicine, Department of Pediatrics, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Claire A Chougnet
- Division of Immunobiology, Cincinnati Children's Hospital Research Foundation.,University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alan H Jobe
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Neonatology/Pulmonary Biology, Cincinnati Children's Hospital Research Foundation, Cincinnati, Ohio, USA
| | - Suhas G Kallapur
- Neonatal-Perinatal Medicine, Department of Pediatrics, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Sammy Tabbah
- Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center and Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Catalin S Buhimschi
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Irina A Buhimschi
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
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24
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Buhimschi IA, Buhimschi CS, Ahmad L, Solden L, Zhao G, Keim S, Bailey M. 555: Lessons learned from investigating the microbiome structure of Somali-Americans, a low risk preterm birth population. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.571] [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: 11/25/2022]
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25
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Ackerman WE, Buhimschi IA, Zhao G, Buhimschi CS. 478: Inflammatory gene expression in placentas of pregnancies with Intra-Amniotic Infection (IAI) and Severe Preeclampsia (sPE). Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.494] [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]
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26
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Jing H, Teng T, Zhao G, Lee J, Buhimschi CS, Buhimschi IA. 693: Probing amyloid-like protein aggregates in urine of women with preeclampsia (PE) using atomic force microscopy. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.707] [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]
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27
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Buhimschi CS, Zhao G, Solden L, Rood KM, Jing H, Vickers S, Buhimschi IA. 1109: The circulating maternal bacterial microbiome in preterm prelabor rupture of membranes (PPROM). Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.1121] [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]
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28
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Berryman K, Buhimschi CS, Zhao G, Axe M, Locke M, Buhimschi IA. Proteasome Levels and Activity in Pregnancies Complicated by Severe Preeclampsia and Hemolysis, Elevated Liver Enzymes, and Thrombocytopenia (HELLP) Syndrome. Hypertension 2019; 73:1308-1318. [PMID: 31067191 DOI: 10.1161/hypertensionaha.118.12437] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Excessive accumulation of misfolded proteins was recently demonstrated in preeclampsia. We examined levels and activity of circulatory proteasome and immunoproteasome (inflammatory subtype) in preeclampsia and hemolysis, elevated liver enzymes, and thrombocytopenia (HELLP) syndrome. We analyzed samples from women with hypertensive pregnancy disorders (n=115), including preeclampsia with severe features (sPE) and HELLP syndrome, and normotensive controls (n=45). Plasma proteasome and immunoproteasome immunoreactivity were determined by quantifying the α-subunit of the 20S core and β5i (proteasome subunit beta 8 [PSMB8]), respectively. Plasma proteasome activity was analyzed with fluorogenic substrates. MG132, lactacystin, and ONX0914 were used to inhibit the circulating proteasome and immunoproteasome, respectively. Plasma cytokine profiles were evaluated by multiplex immunoassay. Placental expression of β5 (constitutive proteasome) and β5i (immunoproteasome) was interrogated by immunohistochemistry. Women with sPE had increased plasma 20S levels ( P<0.001) and elevated lytic activities (chymotrypsin-like 7-fold, caspase-like 4.2-fold, trypsin-like 2.2-fold; P <0.001 for all) compared with pregnant controls. Women with features of HELLP displayed the highest plasma proteasome levels and activity, which correlated with decreased IFN-γ (interferon-γ), and increased IL (interleukin)-8 and IL-10. In sPE and HELLP, chymotrypsin-like activity was suppressed by proteasome inhibitors including ONX0914. Compared with gestational age-matched controls, sPE placentas harbored increased β5 and β5i immunostaining in trophoblasts. β5i signal was elevated in HELLP with predominant staining in villous core, extravillous trophoblasts in placental islands, and extracellular vesicles in intervillous spaces. Pregnancy represents a state of increased proteostatic stress. sPE and HELLP were characterized by significant upregulation in circulating levels and lytic activity of the proteasome that was partially explained by placental immunoproteasome upregulation.
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Affiliation(s)
- Kathryn Berryman
- From the Department of Obstetrics and Gynecology (K.B., C.S.B.), The Ohio State University College of Medicine, Columbus
| | - Catalin S Buhimschi
- From the Department of Obstetrics and Gynecology (K.B., C.S.B.), The Ohio State University College of Medicine, Columbus.,Department of Pediatrics (C.S.B., I.A.B.), The Ohio State University College of Medicine, Columbus
| | - Guomao Zhao
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH (G.Z., M.A., M.L., I.A.B.)
| | - Michelle Axe
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH (G.Z., M.A., M.L., I.A.B.)
| | - Megan Locke
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH (G.Z., M.A., M.L., I.A.B.)
| | - Irina A Buhimschi
- Department of Pediatrics (C.S.B., I.A.B.), The Ohio State University College of Medicine, Columbus.,Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH (G.Z., M.A., M.L., I.A.B.)
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29
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Ackerman WE, Buhimschi IA, Brubaker D, Maxwell S, Rood KM, Chance MR, Jing H, Mesiano S, Buhimschi CS. Integrated microRNA and mRNA network analysis of the human myometrial transcriptome in the transition from quiescence to labor. Biol Reprod 2019; 98:834-845. [PMID: 29447339 DOI: 10.1093/biolre/ioy040] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 02/12/2018] [Indexed: 12/31/2022] Open
Abstract
We conducted integrated transcriptomics network analyses of miRNA and mRNA interactions in human myometrium to identify novel molecular candidates potentially involved in human parturition. Myometrial biopsies were collected from women undergoing primary Cesarean deliveries in well-characterized clinical scenarios: (1) spontaneous term labor (TL, n = 5); (2) term nonlabor (TNL, n = 5); (3) spontaneous preterm birth (PTB) with histologic chorioamnionitis (PTB-HCA, n = 5); and (4) indicated PTB nonlabor (PTB-NL, n = 5). RNAs were profiled using RNA sequencing, and miRNA-target interaction networks were mined for key discriminatory subnetworks. Forty miRNAs differed between TL and TNL myometrium, while seven miRNAs differed between PTB-HCA vs. PTB-NL specimens; six of these were cross-validated using quantitative PCR. Based on the combined sequencing data, unsupervised clustering revealed two nonoverlapping cohorts that differed primarily by absence or presence of uterine quiescence, rather than gestational age or original clinical cohort. The intersection of differentially expressed miRNAs and their targets predicted 22 subnetworks with enriched representation of miR-146b-5p, miR-223-3p, and miR-150-5p among miRNAs, and of myocyte enhancer factor-2C (MEF2C) among mRNAs. Of four known MEF2 transcription factors, decreased MEF2A and MEF2C expression in women with uterine nonquiescence was observed in the sequencing data, and validated in a second cohort by quantitative PCR. Immunohistochemistry localized MEF2A and MEF2C to myometrial smooth muscle cells and confirmed decreased abundance with labor. Collectively, these results suggest altered MEF2 expression may represent a previously unrecognized process through which miRNAs contribute to the phenotypic switch from quiescence to labor in human myometrium.
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Affiliation(s)
- William E Ackerman
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Irina A Buhimschi
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Douglas Brubaker
- Center for Proteomics and Bioinformatics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sean Maxwell
- Center for Proteomics and Bioinformatics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kara M Rood
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Mark R Chance
- Center for Proteomics and Bioinformatics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Hongwu Jing
- Department of Chemistry, The Ohio State University, Columbus, Ohio, USA
| | - Sam Mesiano
- Department of Reproductive Biology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Catalin S Buhimschi
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
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30
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Beck S, Buhimschi IA, Summerfield TL, Ackerman WE, Guzeloglu-Kayisli O, Kayisli UA, Zhao G, Schatz F, Lockwood CJ, Buhimschi CS. Toll-like receptor 9, maternal cell-free DNA and myometrial cell response to CpG oligodeoxynucleotide stimulation. Am J Reprod Immunol 2019; 81:e13100. [PMID: 30758898 DOI: 10.1111/aji.13100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/01/2019] [Accepted: 02/08/2019] [Indexed: 01/05/2023] Open
Abstract
PROBLEM Among mechanisms triggering onset of parturition, it has been recently postulated that Toll-Like Receptor (TLR)9 engagement by cell-free DNA (cfDNA) triggers inflammation, myometrial contractions, and labor in absence of infection. The current study evaluated whether direct (myometrial) or indirect (decidual) TLR9 engagement enhances human myometrial contractility. METHOD OF STUDY Toll-like receptor 9 expression and cellular localization were surveyed by immunohistochemistry of placenta, fetal membranes, and myometrium in term (gestational age [GA]: >37 weeks) labor (TL, n = 7) or term non-labor (TNL, n = 7) tissues. Non-pregnant myometrium (n = 4) served as reference. TLR9 mRNA expression relative to other TLRs was evaluated through the mining of an RNA-seq dataset and confirmed by RT-PCR. Immortalized human myometrial cells (hTERT-HM) were treated with incremental concentrations of TLR9 agonist ODN2395, TNF-α, or LPS. Secreted cytokines were quantified by multiplex immunoassay, and contractility was assessed by an in-gel cell contraction assay (n = 9). Induction of hTERT-HM contractility was also evaluated indirectly following exposure to conditioned media from primary term decidual cells (n = 4) previously stimulated with ODN2395. RESULTS Toll-like receptor 9 immunostaining in placenta and amniochorion was strongest in decidual cells, but unrelated to labor. TLR9 staining intensity was significantly decreased in TL compared with TNL myometrium (P = 0.002). Although total cfDNA in maternal circulation increased in TL (P = 0.025 vs TNL), difference in cffDNA was non-significant. Myometrial TLR9 mRNA levels were unaffected by contractile status and far less abundant than other pro-inflammatory TLRs. hTERT-HM contractility was enhanced by LPS (P = 0.002) and TNF-α (P = 0.003), but not by ODN2395 (P = 0.345) or supernatant of TLR9-stimulated decidual cells. CONCLUSION Myometrial and decidual TLR9 are unlikely to directly regulate human parturition.
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Affiliation(s)
- Stacy Beck
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Irina A Buhimschi
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.,Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Taryn L Summerfield
- Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - William E Ackerman
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Ozlem Guzeloglu-Kayisli
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Umit A Kayisli
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Guomao Zhao
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Frederick Schatz
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Charles J Lockwood
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Catalin S Buhimschi
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
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Buhimschi CS, Jablonski KA, Rouse DJ, Varner MW, Reddy UM, Mercer BM, Leveno KJ, Wapner RJ, Sorokin Y, Thorp JM, Ramin SM, Malone FD, Carpenter MW, O'Sullivan MJ, Peaceman AM, Saade GR, Dudley D, Caritis SN, Buhimschi IA. Cord Blood Haptoglobin, Cerebral Palsy and Death in Infants of Women at Risk for Preterm Birth: A Secondary Analysis of a Randomised Controlled Trial. EClinicalMedicine 2019; 9:11-18. [PMID: 31143877 PMCID: PMC6510719 DOI: 10.1016/j.eclinm.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Antenatal exposure to intra-uterine inflammation results in precocious Haptoglobin (Hp) expression (switch-on status). We investigated the relationships between foetal Hp expression at birth with newborn and childhood outcomes. METHODS We evaluated cord blood samples from 921 newborns of women at imminent risk for preterm delivery randomised to either placebo (n = 471, birth gestational age (GA) median [min-max]: 31 [24-41] weeks) or magnesium sulphate (n = 450, GA 31 [24-42] weeks]). Primary outcome was infant death by 1 year and/or cerebral palsy (CP) ≥ 2 years of corrected age. Adjusted odd ratios (aOR) for neonatal and childhood outcomes were calculated controlling for GA, birth weight, sex, and magnesium exposure. FINDINGS Primary outcome occurred in 2.8% of offspring. Newborns were classified in three pre-defined categorisation groups by cord blood Hp switch status and IL-6 levels: inflammation-nonexposed (Category 1, n = 432, 47%), inflammation-exposed haptoglobinemic (Category 2, n = 449, 49%), and inflammation-exposed anhaptoglobinemic or hypohaptoglobinemic (Category 3, n = 40, 4%). Newborns, found anhaptoglobinemic or hypohaptoglobinemic (Category 3) had increased OR for intraventricular haemorrhage (IVH) and/or death (aOR: 7.0; 95% CI: 1.4-34.6, p = 0.02) and for CP and/or death (aOR: 6.27; 95% CI: 1.7-23.5, p = 0.006) compared with Category 2. Foetal ability to respond to inflammation by haptoglobinemia resulted in aOR similar to inflammation-nonexposed newborns. Hp1-2 or Hp2-2 phenotypes protected against retinopathy of prematurity (aOR = 0.66; 95% CI 0.48-0.91, p = 0.01). INTERPRETATION Foetal ability to switch-on Hp expression in response to inflammation was associated with reduction of IVH and/or death, and CP and/or death. Foetuses unable to mount such a response had an increased risk of adverse outcomes.Trial Registration: clinicaltrials.gov Identifier: NCT00014989.
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Affiliation(s)
- Catalin S. Buhimschi
- Department of Obstetrics and Gynaecology, The Ohio State University, Columbus, OH, United States of America
- Corresponding author at: Department of Obstetrics & Gynecology, University of Illinois at Chicago, Chicago, IL 60612, United States of America.
| | - Kathleen A. Jablonski
- The George Washington University Biostatistics Center, Washington, DC, United States of America
| | - Dwight J. Rouse
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | | | - Uma M. Reddy
- the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
| | - Brian M. Mercer
- Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH, United States of America
- University of Tennessee, Memphis, TN, United States of America
| | | | - Ronald J. Wapner
- Thomas Jefferson University, Philadelphia, PA, United States of America
- Drexel University, Philadelphia, PA, United States of America
| | - Yoram Sorokin
- Wayne State University, Detroit, MI, United States of America
| | - John M. Thorp
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Susan M. Ramin
- University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | | | | | | | | | - George R. Saade
- University of Texas Medical Branch, Galveston, TX, United States of America
| | - Donald Dudley
- University of Texas at San Antonio, San Antonio, TX, United States of America
| | - Steve N. Caritis
- University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Irina A. Buhimschi
- Centre for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America
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Jones ML, Buhimschi IA, Zhao G, Bartholomew A, Smith-Timms J, Rood KM, Buhimschi CS. Acute Glucose Load, Inflammation, Oxidative Stress, Nonenzymatic Glycation, and Screening for Gestational Diabetes. Reprod Sci 2019:1933719119831772. [PMID: 30813845 DOI: 10.1177/1933719119831772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS: To investigate if oral glucose tolerance test (OGTT) associates with changes in maternal symptoms (ie, flushing, sweating), blood nonenzymatic advanced glycation end products (AGE), acute-phase reactive inflammatory markers, and oxidative stress. METHODS: Prospective case-control study of patients screened for gestational diabetes mellitus (GDM). One hundred nonfasting, second-trimester consecutive pregnant women allocated to either 50 g OGTT or water. Five women who had a 3-hour fasting 100 g OGTT also enrolled. Maternal serum glucose, AGE, soluble receptor for AGE (sRAGE), interleukin (IL)-6, and C-reactive protein (CRP) were immunoassayed. Total radical-trapping antioxidant parameter (TRAP) estimated with antioxidant capacity-peroxyl assay. Data corrected for gestational age and maternal body mass index. RESULTS: During 50 g OGTT there was a decrease in systolic blood pressure not accompanied by the onset of adverse clinical symptoms. There was a decrease in serum glucose levels 1 hour after water ( P = .019) but not glucose ingestion. Serum CRP ( P = .001) but not IL-6 was increased. The AGE, sRAGE, and TRAP levels remained unchanged. Similar results were seen during 100 g OGTT, except serum glucose was significantly elevated after 1 hour. CONCLUSION: Results suggest screening tools for gestational diabetes are safe and clinically well tolerated during pregnancy. Clinical Trial Registration: ClinicalTrials.gov NCT03029546.
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Affiliation(s)
- Megan L Jones
- 1 Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Irina A Buhimschi
- 2 Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- 3 Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Guomao Zhao
- 2 Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Anna Bartholomew
- 1 Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jordan Smith-Timms
- 1 Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kara M Rood
- 1 Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Catalin S Buhimschi
- 1 Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
- 2 Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
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He L, Lee GT, Zhou H, Buhimschi IA, Buhimschi CS, Weiner CP, Mason CW. Expression, Regulation, and Function of the Calmodulin Accessory Protein PCP4/PEP-19 in Myometrium. Reprod Sci 2019; 26:1650-1660. [PMID: 30744532 DOI: 10.1177/1933719119828072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Calmodulin (CaM) plays a key role in the orchestration of Ca2+ signaling events, and its regulation is considered an important component of cellular homeostasis. The control of uterine smooth muscle function is largely dependent on the regulation of Ca2+ and CaM signaling. The objective of this study was to investigate the expression, function, and regulation of CaM regulatory proteins in myometrium during pregnancy. STUDY DESIGN Myometrium was obtained from nonpregnant women and 4 groups of pregnant women at the time their primary cesarean delivery: (i) preterm not in labor, (ii) preterm in labor with clinical and/or histological diagnosis of chorioamnionitis, (3) term not in labor; and (4) term in labor. The effect of perinatal inflammation on pcp4/pep-19 expression was evaluated in a mouse model of Ureaplasma parvum-induced chorioamnionitis. Human myometrial cells stably expressing wild-type and mutant forms of PCP4/PEP-19 were used in the evaluation of agonist-induced intracellular Ca2+ mobilization. RESULTS Compared to other CaM regulatory proteins, PCP4/PEP-19 transcripts were more abundant in human myometrium. The expression of PCP4/PEP-19 was lowest in myometrium of women with preterm pregnancy and chorioamnionitis. In the mouse uterus, pcp4/pep-19 expression was lower in late compared to mid-gestation and decreased in mice injected intra-amniotic with Ureaplasma parvum. In myometrial smooth muscle cells, tumor necrosis factor alpha and progesterone decreased and PCP4/PEP-19 promoter activity increased. Finally, the overexpression of PCP4/PEP-19 reduced agonist-induced intracellular Ca2+ levels in myometrial cells. CONCLUSION The decreased expression of PCP4/PEP-19 in myometrium contributes to a loss of quiescence in response to infection-induced inflammation at preterm pregnancy.
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Affiliation(s)
- Lily He
- Department of Obstetrics and Gynecology, Division of Research, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Gene T Lee
- Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Kansas School of Medicine, Kansas City, KS, USA.,The Center for Perinatal Research, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Helen Zhou
- Department of Obstetrics and Gynecology, Division of Research, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Irina A Buhimschi
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA.,Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Catalin S Buhimschi
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA.,Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Carl P Weiner
- Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Clifford W Mason
- Department of Obstetrics and Gynecology, Division of Research, University of Kansas School of Medicine, Kansas City, KS, USA.,The Center for Perinatal Research, University of Kansas School of Medicine, Kansas City, KS, USA
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Rood KM, Buhimschi CS, Dible T, Webster S, Zhao G, Samuels P, Buhimschi IA. Congo Red Dot Paper Test for Antenatal Triage and Rapid Identification of Preeclampsia. EClinicalMedicine 2019; 8:47-56. [PMID: 31193633 PMCID: PMC6537515 DOI: 10.1016/j.eclinm.2019.02.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 08/10/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Proteins in the urine of women with preeclampsia (PE) bind Congo Red dye (urine congophilia). We sought to determine the diagnostic performance of a paper-based point-of-care test detecting urine congophilia for rapid triage and diagnosis of PE. METHODS Prospective cohort study conducted in 346 consecutive pregnant women evaluated for PE in the Labour and Delivery triage unit at our institution. The Congo Red Dot (CRD) Paper Test (index test) was performed on fresh urine samples. The CRD Paper Test results were compared to an expert adjudicated diagnosis in each case. The accuracy of the CRD Paper Test was also compared to urine and serum analytes (placental growth factor and soluble fms-like tyrosine kinase-1) previously proposed as diagnostic aids for PE. FINDINGS During the first triage visit, 32% (112/346) of women received a clinical diagnosis of PE. Yet, 63% (217/346) were admitted for in-patient diagnostic work-up or delivery. The CRD Paper Test was positive in 25% (86/346) of the cases. Adjudication confirmed PE in 28% (96/346) of all cases. The CRD Paper Test outperformed measured serum and urine markers (80·2% sensitivity, 89·2% specificity, 92·1% negative predictive value, 86·7% accuracy). The pre-test, positive and negative post-test probabilities were 27·7%, 74·0%, and 8·0%, respectively. Of women who were discharged undelivered, 38% (133/346) had at least one additional triage visit and the interval between the last negative and first positive CRD Paper Test was 12 (interquartile range, [5-34]) days. INTERPRETATION The CRD Paper Test is a simple, non-invasive, "sample-in/answer-out" point-of-care clinical tool for rapid identification of PE. FUNDING Saving Lives at Birth Program and NICHD.
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Affiliation(s)
- Kara M. Rood
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH 43210, USA
- Corresponding author at: The Ohio State University, Department of Obstetrics and Gynecology, Columbus, OH 43215, USA.
| | - Catalin S. Buhimschi
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH 43210, USA
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, 60612, USA
| | - Theresa Dible
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Shaylyn Webster
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Guomao Zhao
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43215, USA
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, 60612, USA
| | - Philip Samuels
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Irina A. Buhimschi
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43215, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43215, USA
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, 60612, USA
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Abstract
This before-and-after cohort analysis assesses whether implementing a recommendation of antenatal magnesium use at an institutional level in 2009 resulted in fewer subsequent cases of moderate or severe cerebral palsy.
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Affiliation(s)
- Bethany T. Stetson
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Catalin S. Buhimschi
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Brian A. Kellert
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Krystal Hay
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Irina A. Buhimschi
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Nathalie L. Maitre
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
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Buhimschi IA, Makin J, Rood KM, Bracken H, Buhimschi CS, Pattinson R. 441: The burden of preeclampsia and potentially life threatening complications (PLTC) in high versus low- income countries. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.462] [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: 10/27/2022]
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Buhimschi CS, Bahtiyar MO, Abdelghany O, Schneider L, Abdel-Raqez S, Dulay AT, Lipkind H, Lopez E, Zhao G, Rogers L, Bhandari V, Buhimschi IA. 9: Randomized controlled trial of n-acetylcysteine to prevent adverse neonatal outcome in pregnancies with intra-amniotic infection/inflammation. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ackerman WE, Buhimschi IA, Zhao G, Rood KM, Buhimschi CS. 516: Global transcriptomic analysis of sibling placentas in twin gestations complicated by preeclampsia. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.538] [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]
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Ware CA, Buhimschi CS, Zhao G, Buhimschi IA. 626: Fetus has minimal circulatory enzymatic proteasome activity. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.648] [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: 11/25/2022]
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Buhimschi CS, Zhao G, Rood KM, Webster S, Guessas M, Hearne S, Moussa A, Guessas S, Berryman K, Buhimschi IA. 529: Bacteria are rapidly cleared from maternal bloodstream after delivery in pregnancies complicated by PPROM. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nayeri UA, Buhimschi CS, Zhao G, Buhimschi IA, Bhandari V. Components of the antepartum, intrapartum, and postpartum exposome impact on distinct short-term adverse neonatal outcomes of premature infants: A prospective cohort study. PLoS One 2018; 13:e0207298. [PMID: 30517142 PMCID: PMC6281222 DOI: 10.1371/journal.pone.0207298] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/29/2018] [Indexed: 12/15/2022] Open
Abstract
We aimed to test the hypothesis that determinants of the perinatal clinical exposome related to the underlying etiology of premature birth (PTB) impact differently on select neonatal outcomes. We conducted a prospective longitudinal study of 377 singleton preterm neonates [gestational age (GA) at birth: 23-34 weeks] separated into three distinct contemporaneous newborn cohorts: i) spontaneous PTB in the setting of intra-amniotic infection/inflammation (yes-IAI, n = 116); ii) spontaneous PTB in the absence of IAI (no-IAI, n = 130), and iii) iatrogenic PTB for preeclampsia (iPTB-PE, n = 131). Newborns (n = 372) were followed until death or discharge. Amniotic fluid defensins 1&2 and calgranulins A&C were used as biomarkers of IAI. An algorithm considering cord blood interleukin-6 (IL-6) and haptoglobin (Hp switch-on) was used to assess fetal exposure to IAI. Intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), early-onset neonatal (EONS) and late-onset (LOS) sepsis, death. Independent risk factors for adverse outcomes were: i) IVH (n = 53): histologic chorioamnionitis, GA, fetal growth restriction, male sex, Hp switch-on; ii) PVL (n = 11): cord blood IL-6; iii) NEC (n = 25), GA; iv) BPD (n = 53): ventilator support, need for surfactant, GA; v) ROP (n = 79): ventilator support, Hp switch-on, GA; vi) fetal and neonatal death (n = 31): GA, amniotic fluid IL-6; vii) suspect EONS (n = 92): GA, Hp switch-on; viii) LOS (n = 81): GA. Our findings are applicable to pregnancies delivered between 23 and 34 weeks' gestation in the setting of IAI and PE, and suggest that GA and inflammatory intrauterine environment play key roles in occurrence of IVH, PVL, ROP, death, EONS and LOS. Postnatal determinants seem to play major role in NEC and BPD.
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Affiliation(s)
- Unzila Ali Nayeri
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, School of Medicine, New Haven, Connecticut, United states of America
| | - Catalin S. Buhimschi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, School of Medicine, New Haven, Connecticut, United states of America
| | - Guomao Zhao
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, School of Medicine, New Haven, Connecticut, United states of America
| | - Irina A. Buhimschi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, School of Medicine, New Haven, Connecticut, United states of America
| | - Vineet Bhandari
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, School of Medicine, New Haven, Connecticut, United states of America
- Department of Pediatrics, Yale University, School of Medicine, New Haven, Connecticut, United states of America
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Allen TK, Nazzal MN, Feng L, Buhimschi IA, Murtha AP. Progestins Inhibit Tumor Necrosis Factor α-Induced Matrix Metalloproteinase 9 Activity via the Glucocorticoid Receptor in Primary Amnion Epithelial Cells. Reprod Sci 2018; 26:1193-1202. [PMID: 30453830 DOI: 10.1177/1933719118811646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Progestins have been recommended for preterm birth prevention in high-risk women; however, their mechanism of action still remains an area of debate. Medroxyprogesterone acetate (MPA) has previously been shown to significantly inhibit tumor necrosis factor α (TNFα)-induced matrix metalloproteinase 9 (MMP9) messenger RNA (mRNA) expression and activity in primary amnion epithelial cells, a process that may lead to preterm premature rupture of membranes. A mechanism that explains MPA's inhibition of TNFα-induced MMP9 mRNA expression and activity in primary amnion epithelial cells is unclear since these cells lack the classic nuclear progesterone receptor but express a membrane-associated progesterone receptor-progesterone receptor membrane component 1 (PGRMC1) along with the glucocorticoid receptor (GR). Primary amnion epithelial cells harvested from healthy term pregnant women at cesarean section were treated with PGRMC1 (to knockdown PGRMC1 expression), GR (to knockdown GR expression), or control small interfering RNA (siRNA; 10 nm) for 72 hours, pretreated with ethanol or MPA (10-6 M) for 6 hours, and then stimulated with or without TNFα 10 ng/mL for 24 hours. Real-time quantitative polymerase chain reaction and gelatin zymography were used to quantify MMP9 mRNA expression and activity, respectively. Experimental groups were compared using 1-way analysis of variance. Both TNFα-induced MMP9 mRNA expression and activity were significantly inhibited by pretreatment with MPA; however, only the inhibition of TNFα-induced MMP9 activity was partially reversed with PGRMC1 siRNA. However, GR siRNA reversed both the inhibition of TNFα-induced MMP9 mRNA expression and activity by MPA. This study demonstrates that MPA mediates its anti-inflammatory effects primarily through GR and partially through PGRMC1 in primary amnion epithelial cells.
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Affiliation(s)
- Terrence K Allen
- 1 Department of Anesthesiology, Duke University Hospital, Durham, NC, USA
| | - Matthew N Nazzal
- 2 Department of Obstetrics and Gynecology, Duke University Hospital, Durham, NC, USA
| | - Liping Feng
- 2 Department of Obstetrics and Gynecology, Duke University Hospital, Durham, NC, USA
| | - Irina A Buhimschi
- 3 Perinatal Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amy P Murtha
- 2 Department of Obstetrics and Gynecology, Duke University Hospital, Durham, NC, USA
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Oliver EA, Klebanoff M, Yossef-Salameh L, Oza-Frank R, Moosavinasab S, Reagan P, Muglia L, Buhimschi CS, Buhimschi IA. Preterm Birth and Gestational Length in Four Race-Nativity Groups, Including Somali Americans. Obstet Gynecol 2018; 131:281-289. [PMID: 29324604 DOI: 10.1097/aog.0000000000002427] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare preterm birth rates and gestational length in four race-nativity groups including Somali Americans. METHODS Using a retrospective cohort study design of Ohio birth certificates, we analyzed all singleton births between 2000 and 2015 from four groups of women categorized as U.S.-born, non-Hispanic white (USBW), U.S.-born, non-Hispanic black (USBB), African-born black (ABB, primarily of West African birth country), and Somalia-born (SB). An algorithm trained on maternal names was used to confirm Somali ethnicity. Gestational length was analyzed as completed weeks or aggregated by clinically relevant periods. Risk of spontaneous and health care provider-initiated preterm birth was calculated in a competing risk model. RESULTS Births to women in the designated groups accounted for 1,960,693 births (USBW n=1,638,219; USBB n=303,028; ABB n=10,966, and SB n=8,480). Women in the SB group had a lower preterm birth rate (5.9%) compared with women in the USBB (13.0%), ABB (8.4%), and USBW (7.9%) groups (P<.001). Women in the SB group had a higher frequency of postterm pregnancy (5.8% vs less than 1%, P<.001 for all groups). The lower rate of preterm birth in the SB group was unrelated to differences in parity or smoking or whether preterm birth was spontaneous or health care provider-initiated. The lower rate of preterm birth and tendency for prolonged gestation was attenuated in ethnic Somali women born outside Somalia. CONCLUSION We report a positive disparity in preterm birth and a tendency for prolonged gestation for ethnic Somali women in Ohio. Etiologic studies in multiethnic cohorts aimed to uncover the sociobiological determinants of gestational length may lead to practical approaches to reduce prematurity in the general population.
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Affiliation(s)
- Emily A Oliver
- Center for Perinatal Research, the Research Institute at Nationwide Children's Hospital, the Departments of Obstetrics and Gynecology and Pediatrics and the College of Public Health, The Ohio State University, and Research Information Solutions and Innovation (RISI), the Research Institute at Nationwide Children's Hospital, Columbus, and Cincinnati Children's Hospital Medical Center, Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati, Ohio
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Ali M, Rogers LK, Heyob KM, Buhimschi CS, Buhimschi IA. Changes in Vasodilator-Stimulated Phosphoprotein Phosphorylation, Profilin-1, and Cofilin-1 in Accreta and Protection by DHA. Reprod Sci 2018; 26:757-765. [PMID: 30092744 DOI: 10.1177/1933719118792095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Accreta and gestational trophoblastic disease (ie, choriocarcinoma) are placental pathologies characterized by hyperproliferative and invasive trophoblasts. Cellular proliferation, migration, and invasion are heavily controlled by actin-binding protein (ABP)-mediated actin dynamics. The ABP vasodilator-stimulated phosphoprotein (VASP) carries key regulatory role. Profilin-1, cofilin-1, and VASP phosphorylated at Ser157 (pVASP-S157) and Ser239 (pVASP-S239) are ABPs that regulate actin polymerization and stabilization and facilitate cell metastases. Docosahexaenoic acid (DHA) inhibits cancer cell migration and proliferation. We hypothesized that analogous to malignant cells, ABPs regulate these processes in extravillous trophoblasts (EVTs), which exhibit aberrant expression in placenta accreta. Placental-myometrial junction biopsies of histologically confirmed placenta accreta had significantly increased immunostaining levels of cofilin-1, VASP, pVASP-S239, and F-actin. Treatment of choriocarcinoma-derived trophoblast (BeWo) cells with DHA (30 µM) for 24 hours significantly suppressed proliferation, migration, and pVASP-S239 levels and altered protein profiles consistent with increased apoptosis. We concluded that in accreta changes in the ABP expression profile were a response to restore homeostasis by counteracting the hyperproliferative and invasive phenotype of the EVT. The observed association between VASP phosphorylation, apoptosis, and trophoblast proliferation and migration suggest that DHA may offer a therapeutic solution for conditions where EVT is hyperinvasive.
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Affiliation(s)
- Mehboob Ali
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, Columbus, OH, 43215, USA.
| | - Lynette K Rogers
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, Columbus, OH, 43215, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kathryn M Heyob
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, Columbus, OH, 43215, USA
| | - Catalin S Buhimschi
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Irina A Buhimschi
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, Columbus, OH, 43215, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
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Tabbah SM, Buhimschi CS, Rodewald-Millen K, Pierson CR, Bhandari V, Samuels P, Buhimschi IA. Hepcidin, an Iron Regulatory Hormone of Innate Immunity, is Differentially Expressed in Premature Fetuses with Early-Onset Neonatal Sepsis. Am J Perinatol 2018; 35. [PMID: 29532452 PMCID: PMC7412256 DOI: 10.1055/s-0038-1626711] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 12/17/2022]
Abstract
OBJECTIVE Hepcidin, a mediator of innate immunity, binds the iron exporter ferroportin, leading to functional hypoferremia through intracellular iron sequestration. We explored hepcidin-ferroportin interactions in neonates clinically diagnosed with early-onset neonatal sepsis (EONS). STUDY DESIGN Hepcidin and interleukin (IL)-6 were quantified by enzyme-linked immunosorbent assay (ELISA) in 92 paired cord blood-maternal blood samples in the following groups: "Yes" EONS (n = 41, gestational age [GA] 29 ± 1 weeks) and "No" EONS (n = 51, GA 26 ± 1 weeks). Placental hepcidin and ferroportin expression were evaluated by immunohistochemistry and real-time-polymerase chain reaction (RT-PCR). Liver hepcidin and ferroportin expression patterns were ascertained in autopsy specimens of neonates (n = 8) who died secondary to culture-proven sepsis. RESULTS Cord blood hepcidin was significantly elevated (GA corrected, p = 0.018) and was positively correlated with IL-6 (r = 0.379, p = 0.001) in EONS. Hepcidin localized at syncytiotrophoblast and fetal vascular endothelium. Placental ferroportin, but not hepcidin mRNA correlated with cord blood hepcidin levels (r = 0.46, p = 0.039) and funisitis severity (r = 0.50, p = 0.018). Newborns who died from sepsis (n = 4) had higher hepatic hepcidin and iron sequestration, but lower ferroportin staining than those who died of nonsepsis causes (n = 4). CONCLUSION Premature fetuses with EONS have elevated circulating hepcidin, likely related to lower placenta and liver ferroportin expression. Fetal hepcidin-ferroportin interaction appears to play a role in EONS pathophysiology independent of maternal response to intrauterine inflammation.
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Affiliation(s)
- Sammy M. Tabbah
- Department of Obstetrics & Gynecology, The Ohio State
University College of Medicine, Columbus, OH 43210
| | - Catalin S. Buhimschi
- Department of Obstetrics & Gynecology, The Ohio State
University College of Medicine, Columbus, OH 43210
| | - Katherine Rodewald-Millen
- Department of Obstetrics & Gynecology, The Ohio State
University College of Medicine, Columbus, OH 43210
| | - Christopher R. Pierson
- Department of Pathology and Laboratory Medicine, Nationwide
Children’s Hospital, Columbus, OH 43205, Departments of Pathology and
Biomedical Education & Anatomy, The Ohio State University College of Medicine
Columbus, OH 43210
| | - Vineet Bhandari
- Department of Pediatrics, Drexel University College of
Medicine, Philadelphia, PA 19134
| | - Philip Samuels
- Department of Obstetrics & Gynecology, The Ohio State
University College of Medicine, Columbus, OH 43210
| | - Irina A. Buhimschi
- Center for Perinatal Research, The Research Institute at
Nationwide Children’s Hospital, Columbus, OH 43215,Department of Pediatrics, The Ohio State University College
of Medicine, Columbus, OH 43210
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46
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Rood KM, Buhimschi IA, Jurcisek JA, Summerfield TL, Zhao G, Ackerman WE, Wang W, Rumpf RW, Thung SF, Bakaletz LO, Buhimschi CS. Skin Microbiota in Obese Women at Risk for Surgical Site Infection After Cesarean Delivery. Sci Rep 2018; 8:8756. [PMID: 29884793 PMCID: PMC5993816 DOI: 10.1038/s41598-018-27134-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/24/2018] [Indexed: 01/01/2023] Open
Abstract
The obesity pandemic in the obstetrical population plus increased frequency of Cesarean delivery (CD) has increased vulnerability to surgical site infection (SSI). Here we characterized the microbiome at the site of skin incision before and after CD. Skin and relevant surgical sites were sampled before and after surgical antisepsis from obese (n = 31) and non-obese (n = 27) pregnant women. We quantified bacterial biomass by qPCR, microbial community composition by 16sRNA sequencing, assigned operational taxonomic units, and stained skin biopsies from incision for bacteria and biofilms. In obese women, incision site harbors significantly higher bacterial biomass of lower diversity. Phylum Firmicutes predominated over Actinobacteria, with phylotypes Clostridales and Bacteroidales over commensal Staphylococcus and Propionbacterium spp. Skin dysbiosis increased post-surgical prep and at end of surgery. Biofilms were identified post-prep in the majority (73%) of skin biopsies. At end of surgery, incision had significant gains in bacterial DNA and diversity, and obese women shared more genera with vagina and surgeon's glove in CD. Our findings suggest microbiota at incision differs between obese and non-obese pregnant women, and changes throughout CD. An interaction between vaginal and cutaneous dysbiosis at the incision site may explain the a priori increased risk for SSI among obese pregnant women.
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Affiliation(s)
- Kara M Rood
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, 43210, USA.
| | - Irina A Buhimschi
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, 43215, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, 43210, USA
| | - Joseph A Jurcisek
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, 43215, USA
| | - Taryn L Summerfield
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, 43210, USA
| | - Guomao Zhao
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, 43215, USA
| | - William E Ackerman
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, 43210, USA
| | - Weiwei Wang
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, 43215, USA
| | - R Wolfgang Rumpf
- Battelle Center for Mathematical Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, 43215, USA
| | - Stephen F Thung
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, 43210, USA
| | - Lauren O Bakaletz
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, 43215, USA
| | - Catalin S Buhimschi
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, 43210, USA
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47
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Millen KR, Buhimschi CS, Zhao G, Rood KM, Tabbah S, Buhimschi IA. Serum and Urine Thioflavin-T-Enhanced Fluorescence in Severe Preeclampsia. Hypertension 2018; 71:1185-1192. [PMID: 29686018 DOI: 10.1161/hypertensionaha.118.11034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 03/07/2018] [Accepted: 03/23/2018] [Indexed: 01/23/2023]
Abstract
Common features of amyloid-like proteotoxic aggregates are the ability to bind Congo red (congophilia) and to induce fluorescence of thioflavin-T (ThT). Based on the prior discovery that women with preeclampsia exhibit urine congophilia, we proposed that amyloid-like protein aggregates present in urine also circulate in the bloodstream and this feature is linked to disease severity and clinical phenotype. ThT fluorescence was investigated in 217 paired serum and urine samples from women with severe features of preeclampsia (n=101; median [interquartile range] gestational age [GA], 32 [29-35] weeks), mild features of preeclampsia (n=22; GA, 36 [36-37] weeks), chronic hypertension (n=15; GA, 38 [37-39] weeks), healthy pregnant controls (n=57; GA, 39 [38-39] weeks), and nonpregnant controls (n=22). Serum and urine fluorescence attributable to advanced glycation end products was measured in the same samples with correction for autofluorescence. There were no GA-related changes in ThT fluorescence, although near-term serum ThT fluorescence increased compared with nonpregnant state. Compared with healthy pregnant controls, serum and urine ThT fluorescence was increased in severe features of preeclampsia (P<0.001 for both) but not in mild features of preeclampsia or chronic hypertension. Except for chronic hypertension, advanced glycation end products-related fluorescence of serum or urine did not differ from controls. Urine congophilia had a stronger relationship with preeclampsia severity compared with either urine or serum ThT fluorescence. However, serum ThT fluorescence was independently associated with clinical features of hemolysis, elevated liver enzyme levels, and low platelet levels syndrome (P=0.003). We demonstrate that ThT fluorescence, a marker of amyloid-like aggregates, is increased in serum of women with preeclampsia and likely because of their cytotoxicity associated with hemolysis, elevated liver enzyme levels, and low platelet levels syndrome.
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Affiliation(s)
- Katherine R Millen
- From the Department of Obstetrics and Gynecology (K.R.M., C.S.B., K.M.R., S.T., I.A.B.)
| | - Catalin S Buhimschi
- From the Department of Obstetrics and Gynecology (K.R.M., C.S.B., K.M.R., S.T., I.A.B.).,and Department of Pediatrics (C.S.B., I.A.B.)
| | - Guomao Zhao
- The Ohio State University College of Medicine, Columbus; and Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH (G.Z., I.A.B.)
| | - Kara M Rood
- From the Department of Obstetrics and Gynecology (K.R.M., C.S.B., K.M.R., S.T., I.A.B.)
| | - Sammy Tabbah
- From the Department of Obstetrics and Gynecology (K.R.M., C.S.B., K.M.R., S.T., I.A.B.)
| | - Irina A Buhimschi
- From the Department of Obstetrics and Gynecology (K.R.M., C.S.B., K.M.R., S.T., I.A.B.) .,and Department of Pediatrics (C.S.B., I.A.B.).,The Ohio State University College of Medicine, Columbus; and Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH (G.Z., I.A.B.)
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48
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Duzyj CM, Buhimschi IA, Laky CA, Cozzini G, Zhao G, Wehrum M, Buhimschi CS. Extravillous trophoblast invasion in placenta accreta is associated with differential local expression of angiogenic and growth factors: a cross-sectional study. BJOG 2018; 125:1441-1448. [DOI: 10.1111/1471-0528.15176] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2018] [Indexed: 11/30/2022]
Affiliation(s)
- CM Duzyj
- Department of Obstetrics, Gynecology and Reproductive Sciences; Rutgers University Robert Wood Johnson School of Medicine; New Brunswick NJ USA
| | - IA Buhimschi
- Center for Perinatal Research; Department of Pediatrics; The Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine; Columbus OH USA
| | - CA Laky
- Maternal Fetal Medicine; Mary Washington Hospital; Fredericksburg VA USA
| | - G Cozzini
- Americorps Communities in Schools Central Texas; Austin TX USA
| | - G Zhao
- Center for Perinatal Research; Department of Pediatrics; The Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine; Columbus OH USA
| | - M Wehrum
- Maternal-Fetal Care Center; Florida Hospital Medical Group; Orlando FL USA
| | - CS Buhimschi
- Department of Obstetrics & Gynecology; The Ohio State University College of Medicine; Columbus OH USA
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49
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Zuckerwise L, Li J, Lu L, Men Y, Geng T, Buhimschi CS, Buhimschi IA, Bukowski R, Guller S, Paidas M, Huang Y. H19 long noncoding RNA alters trophoblast cell migration and invasion by regulating TβR3 in placentae with fetal growth restriction. Oncotarget 2018; 7:38398-38407. [PMID: 27223264 PMCID: PMC5122399 DOI: 10.18632/oncotarget.9534] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/08/2016] [Indexed: 02/05/2023] Open
Abstract
Fetal growth restriction (FGR) is a well-recognized risk factor for perinatal mortality and morbidity, as well as neurodevelopmental impairment and adulthood onset disorders. Here we report that the H19 long noncoding RNA (lncRNA) is significantly decreased in placentae from pregnancies with FGR. Downregulation of H19 leads to reduced migration and invasion of extravillous trophoblast (EVT) cells in vitro. This is consistent with reduced trophoblast invasion that has been observed in FGR. Genome-scale transcriptome profiling of EVT cells reveals significantly decreased expression of the type III TGF-β receptor (TβR3) following H19 knockdown. Decreased TβR3 expression is also seen in FGR placentae. TβR3 repression decreases EVT cell migration and invasion, owing to impaired TGF-β signaling through a non-canonical TGF-β signaling pathway. Further, we identify TβR3 as a novel regulatory target of microRNA let-7. We propose that dysregulation of this newly identified H19/TβR3-mediated regulatory pathway may contribute to the molecular mechanism of FGR. Our findings are the first to show a lncRNA-based mechanism of FGR, holding promise for the development of novel predictive, diagnostic, and therapeutic modalities for FGR.
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Affiliation(s)
- Lisa Zuckerwise
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Jing Li
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.,Deparment of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Lingeng Lu
- Department of Chronic Diseases Epidemiology, Yale School of Public Health, Yale University School of Medicine, New Haven, CT, USA
| | - Yi Men
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.,Department of Head and Neck Surgery, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Tingting Geng
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.,Department of Endocrinology, School of Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China
| | - Catalin S Buhimschi
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Irina A Buhimschi
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Radek Bukowski
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Seth Guller
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Michael Paidas
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.,Yale Women and Children's Center for Blood Disorders and Preeclampsia Advancement, Yale School of Medicine, New Haven, CT, USA
| | - Yingqun Huang
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
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50
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Oliver EA, Kellert BA, Stetson BT, Klebanoff MA, Buhimschi IA. 736: Birth weight disparities between three race nativity groups in the United States. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.11.267] [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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