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Balducci J, Selberg K, Pool R, Radue RP. Primary ossifying fibroma of the proximal phalanx in a horse. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. Balducci
- College of Veterinary Medicine University of Georgia Athens Georgia USA
| | - K. Selberg
- Environmental and Radiological Health Sciences Colorado State University College of Veterinary Medicine and Biomedical Sciences Fort Collins Colorado USA
| | - R. Pool
- Department of Veterinary Pathobiology Texas A & M University College Station Texas USA
| | - R. P. Radue
- Damascus Equine Associates Mount Airy Maryland USA
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Vander Wyst KB, Quintana G, Balducci J, Whisner CM. Comparison and Characterization of Prenatal Nutrition Counseling among Large-for-Gestational Age Deliveries by Pre-Pregnancy BMI. Nutrients 2019; 11:nu11123018. [PMID: 31835541 PMCID: PMC6949932 DOI: 10.3390/nu11123018] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/26/2019] [Accepted: 12/06/2019] [Indexed: 11/16/2022] Open
Abstract
It is recommended that prenatal care include nutrition counseling; however, <70% of women report receipt of nutrition counseling during pregnancy. In this study, we aimed to characterize prenatal nutrition counseling (PNC) among large-for-gestational age deliveries at a low-income and minority-serving hospital by performing a retrospective chart review of infants with a birth weight > 4000 g. Of the 2380 deliveries, 165 met the inclusion criteria. Demographics, PNC receipt, and pregnancy outcomes were compared among normal-weight (NW; BMI: 18.5–24.9 kg/m2, 19%, n = 31), overweight (OW; BMI: 25–29.9 kg/m2, 29%, n = 48), and obese (OB; BMI > 30 kg/m2, 52%, n = 86) women. The majority (78%, n = 129) of women were Hispanic White with a mean age of 30.4 ± 5.7 yrs and gestational weight gain of 12.1 ± 5.8 kgs. A total of 62% (n = 103) of women received PNC. A total of 57% gained above the Institute of Medicine (IOM) recommendations (n = 94). OB women were 2.6 and 2.1 times more likely to receive PNC than OW (95% CI: 1.1–2.0) and NW (95% CI: 0.9–1.9) women, respectively. Women who gained within the IOM recommendations for their pre-pregnancy body mass index (BMI) were 50% less likely to receive PNC than women who gained above the IOM recommendations for their pre-pregnancy weight (χ = 4.45, p = 0.035; OR = 0.48, CI: 0.24 to 0.95). Infant birthweight was significantly higher among women who received PNC (4314 ± 285 vs. 4197 ± 175 g, p = 0.004). These data suggest that PNC was directed toward women who enter pregnancy in the obese weight category and/or gain excessively across gestation. Future studies should provide PNC to all women to evaluate whether it reduces the risk of delivering large-for-gestational age deliveries across all maternal weight categories. Additionally, more work is needed to identify the types of PNC that are most effective for this high-risk population.
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Affiliation(s)
| | - Guadalupe Quintana
- Maricopa Integrated Health System, Phoenix, AZ 85008, USA; (G.Q.); (J.B.)
| | - James Balducci
- Maricopa Integrated Health System, Phoenix, AZ 85008, USA; (G.Q.); (J.B.)
| | - Corrie M. Whisner
- College of Health Solutions, Arizona State University, Phoenix, AZ 85007, USA;
- Correspondence: ; Tel.: +1-(602)-496-3348
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Balducci J, Ruby J, Hall C, Williams J. Arthrotomy, curettage and medical management of septic arthritis and osteomyelitis of the temporomandibular joint in a horse. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.13156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- J. Balducci
- Department of Large Animal Medicine University of Georgia College of Veterinary MedicineAthens Georgia USA
| | - J. Ruby
- Department of Veterinary Biosciences and Diagnostic Imaging University of Georgia College of Veterinary Medicine AthensGeorgiaUSA
| | - C. Hall
- Central Georgia Equine Services Fort Valley Georgia USA
| | - J. Williams
- Department of Large Animal Medicine University of Georgia College of Veterinary MedicineAthens Georgia USA
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Lucovnik M, Chambliss L, Blumrick R, Balducci J, Antolic ZN, Garfield R. 782: Effect of obesity on preterm delivery prediction by transabdominal recording of uterine electromyography. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.815] [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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Lu J, Li C, Shi C, Balducci J, Huang H, Ji HL, Chang Y, Huang Y. Identification of novel splice variants and exons of human endothelial cell-specific chemotaxic regulator (ECSCR) by bioinformatics analysis. Comput Biol Chem 2012; 41:41-50. [PMID: 23147565 DOI: 10.1016/j.compbiolchem.2012.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 10/10/2012] [Accepted: 10/11/2012] [Indexed: 01/01/2023]
Abstract
Recent discovery of biological function of endothelial cell-specific chemotaxic regulator (ECSCR), previously known as endothelial cell-specific molecule 2 (ECSM2), in modulating endothelial cell migration, apoptosis, and angiogenesis, has made it an attractive molecule in vascular research. Thus, identification of splice variants of ECSCR could provide new strategies for better understanding its roles in health and disease. In this study, we performed a series of blast searches on the human EST database with known ECSCR cDNA sequence (Variant 1), and identified additional three splice variants (Variants 2-4). When examining the ECSCR gene in the human genome assemblies, we found a large unknown region between Exons 9 and 11. By PCR amplification and sequencing, we partially mapped Exon 10 within this previously unknown region of the ECSCR gene. Taken together, in addition to previously reported human ECSCR, we identified three novel full-length splice variants potentially encoding different protein isoforms. We further defined a total of twelve exons and nearly all exon-intron boundaries of the gene, of which only eight are annotated in current public databases. Our work provides new information on gene structure and alternative splicing of the human ECSCR, which may imply its functional complexity. This undoubtedly opens new opportunities for future investigation of the biological and pathological significance of these ECSCR splice variants.
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Affiliation(s)
- Jia Lu
- Department of Obstetrics and Gynecology, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
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Hibner M, Castellanos ME, Drachman D, Balducci J. Repeat Operation for Treatment of Persistent Pudendal Nerve Entrapment After Pudendal Neurolysis. J Minim Invasive Gynecol 2012; 19:325-30. [DOI: 10.1016/j.jmig.2011.12.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 12/15/2011] [Accepted: 12/21/2011] [Indexed: 11/26/2022]
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Baumbach J, Shi SQ, Shi L, Balducci J, Coonrod DV, Garfield RE. Inhibition of uterine contractility with various tocolytics with and without progesterone: in vitro studies. Am J Obstet Gynecol 2012; 206:254.e1-5. [PMID: 22244470 DOI: 10.1016/j.ajog.2011.12.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 11/14/2011] [Accepted: 12/12/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Various tocolytics are used to suppress uterine contractility in patients in preterm labor. Progesterone (P4) is used in patients at high risk for preterm delivery. In this study, we evaluated the effects of various tocolytics with and without P4 to examine effects on uterine contractility. STUDY DESIGN Uterine tissues (n = 280) from women undergoing cesarean at term were exposed in vitro to various agents (vehicle, magnesium sulfate [MgSO(4)], nifedipine, indomethacin, or pinacidil-all with and without P4). Contractility was measured before and after addition of the various agents. RESULTS P4 alone at 10(-5) mol/L concentration has little effect to inhibit contractility (P ≥ .05). MgSO(4) (2-8 × 10(-3) mol/L) inhibits uterine contractility (P < .05) but there is no change when combined with P4 (P > .05). Nifedipine (10(-8) mol/L) and indomethacin (10(-5) mol/L) inhibit contractions alone (P < .05) and to a greater extent when combined with P4 (P < .05). P4 significantly (P < .05) reduced the effects of pinacidil (10(-6.5) mol/L). CONCLUSION Combinations of P4 with nifedipine or indomethacin, but not MgSO(4), might be used to effectively suppress preterm labor.
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Affiliation(s)
- Jennifer Baumbach
- Department of Obstetrics and Gynecology, and Women's Health, Maricopa Integrated Health System, Phoenix, AZ 85008, USA.
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Hibner M, Castellanos M, Desai N, Cookingham L, Balducci J. Pelvic Vein Ligation for the Treatment of Pelvic Congestion Syndrome in Women Who Desire Preservation of Fertility. J Minim Invasive Gynecol 2011. [DOI: 10.1016/j.jmig.2011.08.039] [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: 10/17/2022]
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Castellanos M, Desai N, Foss C, Balducci J, Hibner M. Removal of the Retained Cervical Stump for the Treatment of Chronic Pelvic Pain. J Minim Invasive Gynecol 2011. [DOI: 10.1016/j.jmig.2011.08.038] [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: 10/17/2022]
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Ma F, Wei Z, Shi C, Gan Y, Lu J, Frank SJ, Balducci J, Huang Y. Signaling cross talk between growth hormone (GH) and insulin-like growth factor-I (IGF-I) in pancreatic islet β-cells. Mol Endocrinol 2011; 25:2119-33. [PMID: 22034225 DOI: 10.1210/me.2011-1052] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Dysfunction and destruction of pancreatic islet β-cells is a hallmark of diabetes. Better understanding of cell signals regulating β-cell growth and antiapoptosis will allow development of therapeutic strategies for diabetes by preservation and expansion of β-cell mass. GH and IGF-I share a complicated physiological relationship and have both been implicated in β-cell function. GH and IGF-I exert their biological effects through binding to respective receptors (GHR and IGF-IR) and subsequently engaging downstream signaling pathways. However, their collaborative roles in modulation of β-cell mass and the underlying molecular mechanisms remain poorly understood. In this study, we demonstrate that cultured β-cells are appealing systems for investigating potential GH-IGF-I signaling cross talk. We uncover that GH specifically promotes formation of a protein complex containing GHR, Janus kinase 2 (a nonreceptor kinase coupled to GH/GHR signaling), and IGF-IR. More importantly, GH and IGF-I synergistically activate both signal transducer and activator of transcription 5 and Akt pathways. Concomitantly, β-cells proliferate more robustly and are better protected from serum deprivation-induced apoptosis when exposed to GH and IGF-I in combination vs. GH or IGF-I alone. The augmented proliferative effects by GH and IGF-I are confirmed in isolated islets. Taken together, our findings strongly suggest that there exists a novel signaling relationship between GH/GHR and IGF-I/IGF-IR systems in β-cells, i.e. IGF-IR may serve as a proximal component of GH/GHR signaling, contributing to enhancement of β-cell mass and function. In support of this, IGF-IR knockdown in β-cells resulted in the desensitization of acute GH-induced signal transducer and activator of transcription 5 activation.
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Affiliation(s)
- Fanxin Ma
- Laboratory of Signal Transduction, Department of Obstetrics and Gynecology, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona 85004, USA
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Kuon RJ, Shi SQ, Maul H, Sohn C, Balducci J, Shi L, Garfield RE. A novel optical method to assess cervical changes during pregnancy and use to evaluate the effects of progestins on term and preterm labor. Am J Obstet Gynecol 2011; 205:82.e15-20. [PMID: 21497789 DOI: 10.1016/j.ajog.2011.02.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Revised: 02/08/2011] [Accepted: 02/14/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether optical methods can estimate cervix function during pregnancy and whether progestins modify this process. STUDY DESIGN Photos of the external cervix of timed-pregnant rats were taken every other day from day 13 until postpartum day 5 after daily treatments with vehicle (controls) or progestin treatments (progesterone, subcutaneously or vaginally; 17-alpha-hydroxyprogesterone caproate [17P] and RU-486 subcutaneously, once on day 16). The surface area of the cervix was estimated from photos. RESULTS The surface area of cervix increases throughout pregnancy and reverses after delivery in controls. In the progesterone subcutaneously or 17P subcutaneously groups, increases in surface area are lower (17P group until day 19 only; P < .05). Vaginal progesterone does not prevent surface area increases. Only the progesterone subcutaneously blocked delivery. RU-486 increases the surface area of the cervix (P < .05) during preterm delivery. CONCLUSION An optical method is useful for quantitative assessment of the cervix and evaluation of agents that modify cervical function.
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Affiliation(s)
- Ruben J Kuon
- Department of Obstetrics and Gynecology of the St. Joseph's Hospital and Medical Center, Phoenix, AZ 85004, USA
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Lucovnik M, Kuon RJ, Chambliss LR, Maner WL, Shi SQ, Shi L, Balducci J, Garfield RE. Progestin treatment for the prevention of preterm birth. Acta Obstet Gynecol Scand 2011; 90:1057-69. [PMID: 21564026 DOI: 10.1111/j.1600-0412.2011.01178.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Progestin supplementation appears to be a promising approach to both preventing initiation of preterm labor and treating it once it is already established, given the role of progesterone in maintaining pregnancy, as well as support from basic and clinical research. Progesterone and 17α-hydroxyprogesterone acetate slow the process of cervical ripening, and this is the rationale for prophylactic long-term progestin supplementation mostly studied so far. However, progesterone (but not 17α-hydroxyprogesterone acetate) also inhibits myometrial activity even after the cervix has already ripened. Moreover, these effects depend greatly on the vehicle used and the route of administration. Understanding different mechanisms of action, as well as the importance of progestin formulation, vehicle and route of administration, is the key to finding the optimal progestin treatment for prevention of preterm birth.
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Affiliation(s)
- Miha Lucovnik
- Department of Obstetrics and Gynecology, St Joseph's Hospital and Medical Center, 445 North 5th Street, Phoenix, AZ 85004, USA
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Shi C, Lu J, Wu W, Ma F, Georges J, Huang H, Balducci J, Chang Y, Huang Y. Endothelial cell-specific molecule 2 (ECSM2) localizes to cell-cell junctions and modulates bFGF-directed cell migration via the ERK-FAK pathway. PLoS One 2011; 6:e21482. [PMID: 21720547 PMCID: PMC3123356 DOI: 10.1371/journal.pone.0021482] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [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: 03/03/2011] [Accepted: 05/30/2011] [Indexed: 12/27/2022] Open
Abstract
Background Despite its first discovery by in silico cloning of novel endothelial cell-specific genes a decade ago, the biological functions of endothelial cell-specific molecule 2 (ECSM2) have only recently begun to be understood. Limited data suggest its involvement in cell migration and apoptosis. However, the underlying signaling mechanisms and novel functions of ECSM2 remain to be explored. Methodology/Principal Findings A rabbit anti-ECSM2 monoclonal antibody (RabMAb) was generated and used to characterize the endogenous ECSM2 protein. Immunoblotting, immunoprecipitation, deglycosylation, immunostaining and confocal microscopy validated that endogenous ECSM2 is a plasma membrane glycoprotein preferentially expressed in vascular endothelial cells (ECs). Expression patterns of heterologously expressed and endogenous ECSM2 identified that ECSM2 was particularly concentrated at cell-cell contacts. Cell aggregation and transwell assays showed that ECSM2 promoted cell-cell adhesion and attenuated basic fibroblast growth factor (bFGF)-driven EC migration. Gain or loss of function assays by overexpression or knockdown of ECSM2 in ECs demonstrated that ECSM2 modulated bFGF-directed EC motility via the FGF receptor (FGFR)-extracellular regulated kinase (ERK)-focal adhesion kinase (FAK) pathway. The counterbalance between FAK tyrosine phosphorylation (activation) and ERK-dependent serine phosphorylation of FAK was critically involved. A model of how ECSM2 signals to impact bFGF/FGFR-driven EC migration was proposed. Conclusions/Significance ECSM2 is likely a novel EC junctional protein. It can promote cell-cell adhesion and inhibit bFGF-mediated cell migration. Mechanistically, ECSM2 attenuates EC motility through the FGFR-ERK-FAK pathway. The findings suggest that ECSM2 could be a key player in coordinating receptor tyrosine kinase (RTK)-, integrin-, and EC junctional component-mediated signaling and may have important implications in disorders related to endothelial dysfunction and impaired EC junction signaling.
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Affiliation(s)
- Chunwei Shi
- Department of Obstetrics and Gynecology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America
- Department of Pathogen Biology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Lu
- Department of Obstetrics and Gynecology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America
- Department of Pathogen Biology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen Wu
- Department of Obstetrics and Gynecology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America
- Department of Pathogen Biology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fanxin Ma
- Department of Obstetrics and Gynecology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America
- State Key Laboratory of Biotherapy, West China Hospital, College of Life Science, Sichuan University, Chengdu, China
| | - Joseph Georges
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America
| | - Hanju Huang
- Department of Pathogen Biology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - James Balducci
- Department of Obstetrics and Gynecology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America
| | - Yongchang Chang
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America
| | - Yao Huang
- Department of Obstetrics and Gynecology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America
- * E-mail:
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Orth TA, Shi SQ, Williamson K, Shi L, Chambliss L, Coonrod DV, Balducci J, Garfield RE. Additive Inhibitory Effects of Progesterone and Sodium Nitroprusside on Uterine Contractility During Pregnancy. Reprod Sci 2011; 18:868-75. [DOI: 10.1177/1933719111398141] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Teresa A. Orth
- Obstetrics and Gynecology Department, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
- Obstetrics and Gynecology Department, Maricopa Medical Center, Phoenix, AZ, USA
| | - Shao-Qing Shi
- Obstetrics and Gynecology Department, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Kelli Williamson
- Obstetrics and Gynecology Department, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Leili Shi
- Obstetrics and Gynecology Department, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Linda Chambliss
- Obstetrics and Gynecology Department, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Dean V. Coonrod
- Obstetrics and Gynecology Department, Maricopa Medical Center, Phoenix, AZ, USA
| | - James Balducci
- Obstetrics and Gynecology Department, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Robert E. Garfield
- Obstetrics and Gynecology Department, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
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Lucovnik M, Kuon RJ, Chambliss LR, Maner WL, Shi SQ, Shi L, Balducci J, Garfield RE. Use of uterine electromyography to diagnose term and preterm labor. Acta Obstet Gynecol Scand 2010; 90:150-7. [PMID: 21241260 DOI: 10.1111/j.1600-0412.2010.01031.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Current methodologies to assess the process of labor, such as tocodynamometry or intrauterine pressure catheters, fetal fibronectin, cervical length measurement and digital cervical examination, have several major drawbacks. They only measure the onset of labor indirectly and do not detect cellular changes characteristic of true labor. Consequently, their predictive values for term or preterm delivery are poor. Uterine contractions are a result of the electrical activity within the myometrium. Measurement of uterine electromyography (EMG) has been shown to detect contractions as accurately as the currently used methods. In addition, changes in cell excitability and coupling required for effective contractions that lead to delivery are reflected in changes of several EMG parameters. Use of uterine EMG can help to identify patients in true labor better than any other method presently employed in the clinic.
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Affiliation(s)
- Miha Lucovnik
- Department of Obstetrics and Gynecology, St Joseph's Hospital and Medical Center, Phoenix, AZ 85004, USA
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Wu W, Shi SQ, Huang HJ, Balducci J, Garfield RE. Changes in PGRMC1, a potential progesterone receptor, in human myometrium during pregnancy and labour at term and preterm. Mol Hum Reprod 2010; 17:233-42. [DOI: 10.1093/molehr/gaq096] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kuon RJ, Shi SQ, Maul H, Sohn C, Balducci J, Maner WL, Garfield RE. Pharmacologic actions of progestins to inhibit cervical ripening and prevent delivery depend on their properties, the route of administration, and the vehicle. Am J Obstet Gynecol 2010; 202:455.e1-9. [PMID: 20452487 PMCID: PMC3048062 DOI: 10.1016/j.ajog.2010.03.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 03/01/2010] [Accepted: 03/11/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate cervical changes and delivery at term during pregnancy in rats after various progestin treatments. STUDY DESIGN Pregnant rats were treated by various routes and vehicles with progesterone, 17-alpha-hydroxyprogesterone caproate (17P), R5020, and RU-486. Delivery time was determined and cervical ripening was assessed in vivo by collagen light-induced fluorescence. RESULTS The cervix is rigid in the progesterone injection, 17P, and vaginal R5020 groups vs controls. Vaginal progesterone had no effect. RU-486 treatment softened the cervix during preterm delivery. Only subcutaneous injected progesterone, R5020 (subcutaneous and vaginal), and topical progesterone in sesame and fish oil inhibits delivery. Delivery is not changed by subcutaneous injection of 17P, vaginal progesterone, oral progesterone, and topical progesterone in Replens (Crinone; Columbia Labs, Livingston, NJ). CONCLUSION Inhibition of cervical ripening and delivery by progestins depends on many factors that include their properties, the route of administration, and the vehicle. This study suggests reasons that the present treatments for preterm labor are not efficacious.
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Affiliation(s)
- Ruben J Kuon
- Department of Obstetrics and Gynecology, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85004, USA
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Kuon RJ, Maul H, Sohn C, Balducci J, Garfield RE. 12: Pharmacological actions of progesterone (P4) or 17-alpha-hydroxyprogesterone caproate (17P) to inhibit cervical ripening or prevent term delivery depend upon the route of administration and effects on the myometrium. Am J Obstet Gynecol 2009. [DOI: 10.1016/j.ajog.2009.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dong YL, Siller RB, Shi SQ, Shi L, Balducci J, Chambliss L, Romero R, Garfield R. 300: A role for myometrial membrane progesterone receptors in pregnancy maintenance and the control of human parturition: evidence derived from studies of expression (mRNA and protein), immunolocalization, binding and contractility. Am J Obstet Gynecol 2009. [DOI: 10.1016/j.ajog.2009.10.315] [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: 10/20/2022]
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Lucovnik M, Maner W, Chambliss L, Blumrick R, Balducci J, Garfield R. 458: Propagation velocity of electrical signals of the uterus is significantly higher in patients during labor at term and preterm compared to non-labor states. Am J Obstet Gynecol 2009. [DOI: 10.1016/j.ajog.2009.10.624] [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: 10/20/2022]
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Orth T, Shi SQ, Williamson K, Shi L, Coonrod DV, Balducci J, Garfield RE. 462: Additive inhibitory effects of progesterone and sodium nitroprusside on uterine contractility during pregnancy. Am J Obstet Gynecol 2009. [DOI: 10.1016/j.ajog.2009.10.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Orth T, Shi SQ, Williamson K, Shi L, Coonrod D, Balducci J, Garfield RE. 461: Inhibition of oxytocin-induced uterine contractions with progesterone, sodium nitroprusside or their combination. Am J Obstet Gynecol 2009. [DOI: 10.1016/j.ajog.2009.10.627] [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: 10/20/2022]
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Ma F, Zhang D, Yang H, Sun H, Wu W, Gan Y, Balducci J, Wei YQ, Zhao X, Huang Y. Endothelial cell-specific molecule 2 (ECSM2) modulates actin remodeling and epidermal growth factor receptor signaling. Genes Cells 2009; 14:281-93. [PMID: 19267780 DOI: 10.1111/j.1365-2443.2008.01267.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Endothelial cell-specific molecules (ECSMs) play a pivotal role in the pathogenesis of many angiogenesis-related diseases. Since its initial discovery, the exact function of human ECSM2 has not been defined. In this study, by database mining, we identified a number of hypothetical proteins across species exhibiting substantial sequence homology to the human ECSM2. We showed that ECSM2 is preferentially expressed in endothelial cells and blood vessels. Their characteristic structures and unique expression patterns suggest that ECSM2 is an evolutionarily conserved gene and may have important functions. We further explored the potential roles of human ECSM2 at the molecular and cellular level. Using a reconstitution mammalian cell system, we demonstrated that ECSM2 mainly resides at the cell membrane, is critically involved in cell-shape changes and actin cytoskeletal rearrangement, and suppresses tyrosine phosphorylation signaling. More importantly, we uncovered that ECSM2 can cross-talk with epidermal growth factor receptor (EGFR) to attenuate the EGF-induced cell migration, possibly via inhibiting the Shc-Ras-ERK (MAP kinase) pathway. Given the importance of growth factor and receptor tyrosine kinase-mediated signaling and cell migration in angiogenesis-related diseases, our findings regarding the inhibitory effects of ECSM2 on EGF-mediated signaling and cell motility may have important therapeutic implications.
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Affiliation(s)
- Fanxin Ma
- State Key Laboratory of Biotherapy, West China Hospital, College of Life Science, Sichuan University, Chengdu, Sichuan, China
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Williamson K, Good M, Taber E, Balducci J, Kim M. The methamphetamine epidemic: Neonatal implications. Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Good M, Williamson K, Blumrick R, Balducci J, Kim M. The methamphetamine epidemic: Maternal implications. Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Brady M, Veres S, Balducci J. Labor induction at term without identified indication: Maternal and neonatal outcomes. Am J Obstet Gynecol 2005. [DOI: 10.1016/j.ajog.2005.10.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rust OA, Atlas O, Reed J, van Gaalen J, Balducci J. Reply. Am J Obstet Gynecol 2002. [DOI: 10.1067/mob.2002.12496] [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: 11/22/2022]
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Benham BN, Balducci J, Atlas RO, Rust OA. Risk factors for preterm delivery in patients demonstrating sonographic evidence of premature dilation of the internal os, prolapse of the membranes in the endocervical canal and shortening of the distal cervical segment by second trimester ultrasound. Aust N Z J Obstet Gynaecol 2002; 42:46-50. [PMID: 11926640 DOI: 10.1111/j.0004-8666.2002.00052.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the outcomes and risk factors associated with the second trimester sonographic findings of premature dilation of the internal cervical os, prolapse of the membranes into the endocervical canal and shortening of the distal segment. STUDY DESIGN Retrospective chart review to identify patients who met the following criteria: (i) gestational age between 16 and 24 weeks; (ii) a vaginal probe ultrasound documenting dilatation of the internal os, prolapsed membranes into the endocervical canal but not extending beyond the external os, and a shortened distal cervix; and (iii) no evidence of increased uterine activity METHODS Sonographic measurements obtained included: (i) the width of the internal os dilation; (ii) the depth of membranes prolapsed into endocervix (funneling); (iii) the distal cervical length; and (iv) the total cervical length. Patients were stratified into two groups according to gestational age at delivery: the preterm group (< 34 weeks) and the near-term group (> or = 34 weeks). RESULTS Thirty-seven patients had complete records for analysis and their pregnancies resulted in 47 live births. Eighteen patients were stratified to the near term group and 19 were stratified to the preterm group. There were no stillborn infants and 10 neonatal deaths. Ten patients received cerclage and seven patients delivered at < 34 weeks gestational age. Risk factors found to be significant for preterm delivery included a gestational age at diagnosis of < or = 20 weeks gestation (p = 0.03), dilatation of the internal os > 1.3 cm (p = 0.04), and a composite Benham score > or = 1.0 (p = 0.02). CONCLUSIONS The sonographic findings of premature dilatation of the internal os, prolapse of the membranes into the endocervical canal and shortening of the distal cervix are associated with a high rate of delivery < 34 weeks (51%) and neonatal death (27%).
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Affiliation(s)
- Brady N Benham
- Lehigh Valley Hospital, Department of Obstetrics and Gynecology, Allentown, Pennsylvania 18105, United States of America
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Rust OA, Atlas RO, Reed J, van Gaalen J, Balducci J. Revisiting the short cervix detected by transvaginal ultrasound in the second trimester: why cerclage therapy may not help. Am J Obstet Gynecol 2001; 185:1098-105. [PMID: 11717641 DOI: 10.1067/mob.2001.118163] [Citation(s) in RCA: 190] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to identify the risk factors that are associated with increased neonatal morbidity in patients who were treated for sonographic evidence of internal os dilation and distal cervical shortening during the second trimester. STUDY DESIGN From May 1998 to June 2000 patients between 16 and 24 weeks of gestation with the following sonographic criteria were randomly assigned to McDonald cerclage or no cerclage: internal os dilation and either membrane prolapse into the endocervical canal at least 25% of the total cervical length but not beyond the external os or a shortened distal cervix <2.5 cm. Before randomization, all patients were treated identically with an amniocentesis, multiple urogenital cultures, and therapy with indomethacin and clindamycin for 48 to 72 hours. Except for the cerclage, all patients were treated identically after randomization. Multiple variables of perinatal outcome were analyzed. A regression model with gestational age at delivery as the dependent variable was constructed and repeated with neonatal morbidity as the dependent variable. This model was applied to 3 populations: the cerclage group, the no cerclage group, and both groups combined. RESULTS Of the 135 patients, 20 patients declined randomization, and 2 patients were diagnosed with acute chorioamnionitis. Of the 113 patients remaining, 55 patients were randomly assigned to the cerclage group, and 58 patients were randomly assigned to the no cerclage group. There were 8 rescue cerclage procedures (4 in each group). Regression analysis showed that readmission for preterm labor, chorioamnionitis, and abruption were consistently associated with early gestational age at delivery and increased morbidity. Cerclage did not affect perinatal outcome. CONCLUSION The sonographic findings of second trimester internal os dilation, membrane prolapse, and distal cervical shortening likely represent a common pathway of several pathophysiologic processes. Use of cerclage does not alter any perinatal outcome variables. Increased neonatal morbidity in these patients appears to be associated with subclinical infection, preterm labor, and abruption.
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Affiliation(s)
- O A Rust
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Lehigh Valley Hospital and Health Network, Allentown, Pa 18105-1556, USA
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Rust OA, Greybush M, Atlas RO, Jones KJ, Balducci J. Preinduction cervical ripening. A randomized trial of intravaginal misoprostol alone vs. a combination of transcervical Foley balloon and intravaginal misoprostol. J Reprod Med 2001; 46:899-904. [PMID: 11725734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To determine if the addition of a mechanical ripening agent (transcervical Foley balloon) to a pharmacologic agent (intravaginal misoprostol) improves the efficiency of preinduction cervical ripening. STUDY DESIGN Singleton patients with an indication for delivery, unfavorable cervix (Bishop score < or = 5) and no contraindication to labor were randomly assigned to two groups: misoprostol alone (25 micrograms intravaginally every 3 hours for no more than 12 hr) or combination therapy (25-French transcervical Foley balloon inflated to 50 mL of sterile water with identical intravaginal misoprostol dosing). All patients received a history and physical examination (including Bishop score), preripening ultrasound, electronic fetal heart rate and contraction monitoring (to rule out spontaneous labor and document fetal well-being). Multiple variables of perinatal outcome were analyzed, including the main outcome variables of ripening-to-delivery time and cesarean section rate. RESULTS During August 1998 to August 1999, 81 patients were randomized, 40 to misoprostol alone and 41 to combination therapy. There were no differences between the groups with respect to maternal demographics, preripening Bishop score, maternal complications, intrapartum intervention or neonatal outcome. The misoprostol group spent longer periods of time in active labor, and there was a trend for the combination group to require oxytocin for longer intervals. These findings did not significantly affect the total ripening-to-delivery time or cesarean section rate which were similar for both groups. CONCLUSION The addition of mechanical ripening with a transcervical Foley balloon to intravaginal misoprostol did not improve the efficiency of preinduction cervical ripening. Mechanical and pharmacologic cervical ripening agents appear to act independently rather than synergistically.
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Affiliation(s)
- O A Rust
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lehigh Valley Hospital, Allentown, Pennsylvania 18105-1556, USA
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Greybush M, Singleton C, Atlas RO, Balducci J, Rust OA. Preinduction cervical ripening techniques compared. J Reprod Med 2001; 46:11-7. [PMID: 11209625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To assess the clinical efficacy of pharmacologic, mechanical and combination techniques of cervical ripening. STUDY DESIGN From March 1997 to August 1998, all cervical-ripening patients at Lehigh Valley Hospital were randomly assigned to three groups: intravaginal misoprostol, intracervical Foley catheter, or combination prostaglandin E2 (PGE2) gel and Foley catheter. Inclusion criteria included Bishop score < or = 5 and no contraindication to labor. The remaining delivery process was actively managed according to established guidelines. Multiple variables in perinatal outcome were analyzed, with the cesarean section rate and time from ripening to delivery as the main outcome variables. RESULTS Of the 205 patients, 65 were randomized to the misoprostol group, 71 to the Foley group and 69 to the catheter-and-gel group. There were no differences between groups in delivery indications, maternal demographics, ultrasound findings, labor interventions, intrapartum times, mode of delivery, postpartum complications or neonatal outcomes. The misoprostol group demonstrated a higher rate of uterine tachysystole and required oxytocin less when compared to the two catheter groups. CONCLUSION The higher rate of uterine tachysystole with misoprostol did not increase the cesarean section rate. The higher rate of oxytocin required by the two catheter groups did not increase the delivery time intervals. There appears to be no benefit to adding intracervical or intravaginal PGE2 gel to the intracervical Foley balloon. The misoprostol and catheter ripening techniques have similar safety and efficacy.
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Affiliation(s)
- M Greybush
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lehigh Valley Hospital, 17th and Chew Streets, P.O. Box 7017, Allentown, PA 18105-7017, USA
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Rust OA, Atlas RO, Jones KJ, Benham BN, Balducci J. A randomized trial of cerclage versus no cerclage among patients with ultrasonographically detected second-trimester preterm dilatation of the internal os. Am J Obstet Gynecol 2000; 183:830-5. [PMID: 11035321 DOI: 10.1067/mob.2000.109040] [Citation(s) in RCA: 149] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to compare perinatal outcomes of patients with second-trimester ultrasonographic evidence of preterm dilatation of the internal os treated with cerclage versus those of patients not treated with cerclage. STUDY DESIGN From May 1998 through June 1999 patients with ultrasonographic evidence of preterm dilatation of the internal os between 16 and 24 weeks' gestation were randomly assigned to receive a McDonald cerclage or no cerclage. Before random assignment all patients underwent amniocentesis and urogenital cultures and then received 48 hours of therapy with indomethacin and antibiotics. After treatment each patient was followed up as an outpatient with bed rest and weekly ultrasonographic evaluation. RESULTS Of the 61 patients 31 were randomly assigned to cerclage and 30 were randomly assigned to no cerclage. There were no differences between groups with respect to maternal demographic characteristics, risk factors for preterm birth, cervical measurements, rescue procedures, readmission, chorioamnionitis, and abruptio placentae. The mean gestational age at delivery (33.5 +/- 6.3 weeks) and the perinatal death rate (12. 9%) in the cerclage group were similar to the mean gestational age at delivery (34.7 +/- 4.7 weeks; P =.4) and the perinatal death rate (10.0%; P =.9) in the no-cerclage group. CONCLUSION Treatment with McDonald cerclage of preterm dilatation of the cervix detected ultrasonographically during the second trimester did not improve perinatal outcomes.
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Affiliation(s)
- O A Rust
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lehigh Valley Hospital, Allentown, PA 18105-1556, USA
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Balducci J, Weiss PM, Atlas RO, Pajarillo MF, Dupree WB, Klasko SK. Preeclampsia: immunologic alteration of Nitabuch's membrane? Clinical sequelae. J Matern Fetal Med 1997; 6:324-8. [PMID: 9438214 DOI: 10.1002/(sici)1520-6661(199711/12)6:6<324::aid-mfm5>3.0.co;2-q] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine if preeclampsia is an immunologic disease process consistent with a host-vs.-graft reaction by examining differences in immunoglobulin deposition at the maternal fetal interface (Nitabuch's layer) in preeclamptic patients. STUDY DESIGN A prospective study of patients at Lehigh Valley Hospital was conducted between July 1993 and April 1994. Group 1 (study) consisted of 11 primigravid women meeting the criteria for the diagnosis of preeclampsia. Group 2 (control) consisted of 11 primigravid women who had an uncomplicated pregnancy. At delivery, basal plate placental specimens were obtained, fixed, and processed for study by a blinded observer utilizing IgG, IgA, IgM, IgE immunofluorescence techniques. The placenta was then sent to a gynecologic pathologist for blinded evaluation and measurement of Nitabuch's membrane by light microscopy. RESULTS Taking the average width of 3 measurements of Nitabuch's membrane by light microscopy revealed no significant difference (group 1, .1839 mm vs. group 2, .1555 mm). Immunofluorescence techniques revealed that the thickness of immunofluorescence of Nitabuch's membrane was significantly greater in the study group vs. the control group (157.48 pixels vs. 63.80 pixels, P = .006, respectively). CONCLUSION Evaluation of the maternal-fetal interface reveals the deposition of increased immunoglobulins, the physiology of which may be similar to nephropathies as seen in systemic disease processes. The deposition of immunoglobulins may be associated with a common antigen which may point to an immunologic etiology for preeclampsia in some women.
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Affiliation(s)
- J Balducci
- Department of Obstetrics and Gynecology, Lehigh University, Allentown, Pennsylvania, USA
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Abstract
A retrospective study was performed comparing centralized monitoring to noncentralized monitoring in regard to perinatal outcome. The study was conducted at Lehigh Valley Hospital (Allentown, PA) between August 1994 and February 1995. All deliveries during a 28-week-period were studied retrospectively. The study was designed such that for 14 weeks all patients were centrally monitored (Group A). During the following 14 weeks, no patients were centrally monitored (Group B). Patients not requiring monitoring, such as elective cesarean sections, were excluded from the study. The variables that were studied were the 5-minute Apgar, cord blood pH, perinatal mortality, admissions to the neonatal intensive care unit (NICU), spontaneous vaginal deliveries, cesarean sections, and operative vaginal deliveries. A total of 1,622 deliveries occurred during the 28 weeks of antenatal care. Group A consisted of 805 centralized monitored patients and Group B had 817 noncentralized monitored patients. There was no statistical difference in the 5-minute Apgar, umbilical artery pH, perinatal mortality, or the NICU admissions between the two groups. However, there was a significant statistical difference in the percent of cesarean sections performed for nonreassuring fetal heart rate tracings (Group A, 17.89% vs. Group B, 12.16%; P = 0.02). The overall cesarean section rate was increased in the centrally monitored group (Group A, 23.6% vs. Group B, 18.1%; P = 0.01). There were also statistically significant differences in operative vaginal deliveries (forceps and vacuum) for fetal heart rate abnormalities between Group A, 0.52% vs. Group B, .39% (P = 0.05). Centralized monitoring may be associated with an increase in the overall cesarean section rate. In addition, the rate of operative vaginal and abdominal deliveries appears to be increased for the indication of nonreassuring fetal heart rate tracings with the use of centralized monitoring.
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Affiliation(s)
- P M Weiss
- Department of Obstetrics and Gynecology, Lehigh Valley Hospital, Allentown, Pennsylvania 18105-7017, USA
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Balducci J, Linnander J, Reed J, Pajarillo M, Sussman E, Klasko S. Do incentive programs influence perinatal outcomes? Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80487-5] [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: 11/27/2022]
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Balducci J, Weiss PM, Atlas RO, Pajarillo MF, Dupree WB, Klasko SK. Preeclampsia. J Matern Fetal Neonatal Med 1997. [DOI: 10.3109/14767059709162015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lemus J, Balducci J, Atlas R, Klasko S. Lowering the incidence of cesarean section with active management of labor. Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80549-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND A review of the literature and an extensive Medline search revealed that this is the first case report of fetal seizures diagnosed by ultrasound. CASE A 23-year-old woman was found to have a fetus with bilateral choroid plexus cysts during a second-trimester ultrasound examination. Karyotype and alpha-fetoprotein level were normal. The cysts resolved, but idiopathic polyhydramnios was noted. Fetal testing beginning at 32 weeks revealed abnormal fetal behavior patterns on ultrasound and documented fetal seizures with rapid, repetitive limb movements noted on several occasions and lasting 30-60 seconds. Similar movements continued after birth as tonic-clonic seizure activity. CONCLUSION Qualitative changes in movement patterns are common in neurologically impaired fetuses. Ultrasound may be used to diagnose these neurologic abnormalities that can be connected with clinical outcomes. This will better prepare the parents and hospital staff members for delivery and may also decrease medicolegal risk for the obstetrician because the abnormal behavior predates the birth process.
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Affiliation(s)
- L A Abrams
- Department of Obstetrics and Gynecology Lehigh Valley Hospital, Allentown, PA 18105-7017, USA
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Klasko SK, Cummings RV, Balducci J, DeFulvio JD, Reed JF. The impact of mandated in-hospital coverage on primary cesarean delivery rates in a large nonuniversity teaching hospital. Am J Obstet Gynecol 1995; 172:637-42. [PMID: 7856698 DOI: 10.1016/0002-9378(95)90585-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Our purpose was to determine whether attending physician call status affected the primary cesarean delivery rates of the resident or private services after institution of in-hospital coverage. STUDY DESIGN Data for the study year, during which in-hospital attending coverage was in place, were compared with those of the previous year, during which in-hospital attending coverage of residents was not in place. Birth records were analyzed retrospectively for physician and patient factors. RESULTS For the year before in-hospital coverage the institutional total cesarean rate was 24.9%, with a primary cesarean section rate of 17.6%. In the first year of coverage the total cesarean delivery was 21.7%, with a decrease in the primary rate to 15.3%. The resident service primary cesarean delivery rate was 10.6% during the study year, which was unchanged from 10.9% the prior year and did not contribute to the overall decrease. Conversely, the private service primary cesarean rate decreased from 18.0% in the prestudy year to 13.4% when the attending physician was on call in the hospital but remained higher at 17.5% when the attending physician was on call not in the hospital. CONCLUSIONS In-hospital attending physician coverage lowered individual attending physicians' private service primary cesarean rates. Resident service primary cesarean rates were lower than private service and were unaffected by the initiation of in-hospital coverage.
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Affiliation(s)
- S K Klasko
- Department of Obstetrics and Gynecology, Lehigh Valley Hospital, Allentown, PA 18105-7017
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Egan JFX, Vintzileos AM, Turner G, Fleming A, Scorza W, Wolf E, Balducci J. Correlation of Uterine Fundal Height with Ultrasonic Measurements in Twin Gestations. J Matern Fetal Neonatal Med 1994. [DOI: 10.3109/14767059409017258] [Citation(s) in RCA: 5] [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: 11/13/2022]
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Abstract
OBJECTIVE The purpose of this study was to determine if gap junctions are a necessary component of the human laboring uterus and if their presence in myometrium is a prerequisite for both term and preterm labor. STUDY DESIGN We obtained 27 human myometrial samples at cesarean section or nongravid hysterectomy. Gap junction formation was analyzed in a blind fashion by freeze fracture and indirect immunofluorescence. Six samples were obtained from term patients with no labor, six from term patients in labor, six from preterm patients with no labor, six from patients in preterm labor, and three from nongravid hysterectomy specimens. RESULTS Gap junction structures were identified in the human myometrium of patients in term and in preterm labor but not in the other patient samples. In addition, evidence was obtained for the expression of (alpha 1) gap junction ribonucleic acid and (alpha 1) gap junction protein in term samples of human myometrium. CONCLUSION Gap junctions are a necessary component of the human myometrium during term and preterm labor. The formation of gap junctions may be a final common event for the development of labor, and inhibition of gap junction activity could be a novel approach for the treatment of preterm labor.
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Affiliation(s)
- J Balducci
- Department Obstetrus and Gynecology, University of Connecticut Health Center, Farmington
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Vintzileos AM, Egan JF, Rodis JF, Campbell WA, Wolf EJ, Balducci J. Obstetrical Factors Associated with Nuchal Cord in a High-Risk Population. J Matern Fetal Neonatal Med 1992. [DOI: 10.3109/14767059209161918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Balducci J, Rodis JF, Rosengren S, Vintzileos AM, Spivey G, Vosseller C. Pregnancy outcome following first-trimester varicella infection. Obstet Gynecol 1992; 79:5-6. [PMID: 1727585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Varicella infection in the first trimester has been associated with a constellation of congenital abnormalities. The incidence of the congenital varicella syndrome is unknown, although it has been reported to be as high as 9%. In a prospective study performed between 1986-1990, 40 patients were identified who had first-trimester varicella infection. Pregnant patients were referred from physicians in the perinatal regional network after developing the classical picture of varicella infection. Targeted fetal ultrasound examinations were performed between 16-20 weeks' gestation in all cases and neonatal outcome was determined. Of the 40 patients, three had first-trimester losses and another underwent an elective termination of pregnancy after counseling. Of the remaining 36 women, one had fetal omphalocele. Thirty-five pregnancies continued until term, and no infant had features of the congenital varicella syndrome at birth. Other than the case of omphalocele, no major congenital anomalies were identified. This study, the largest series of patients with first-trimester varicella infection, showed an incidence of congenital varicella syndrome of 0% and an incidence of congenital anomalies of 3% (range 0-8% at 95% confidence level).
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Affiliation(s)
- J Balducci
- Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington
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Vintzileos AM, Fleming AD, Scorza WE, Wolf EJ, Balducci J, Campbell WA, Rodis JF. Relationship between fetal biophysical activities and umbilical cord blood gas values. Am J Obstet Gynecol 1991; 165:707-13. [PMID: 1822963 DOI: 10.1016/0002-9378(91)90314-h] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In a prospective study of 62 patients undergoing cesarean section before the onset of labor a fetal biophysical profile assessment was performed within 3 hours before the cesarean section. The presence or absence of the individual fetal biophysical activities (fetal heart rate reactivity, fetal breathing movements, fetal body movements, and fetal tone) were correlated with umbilical cord blood gas and acid-base measurements (artery and vein). Fetuses with nonreactive nonstress test results or the absence of breathing had significantly lower cord artery pH, PO2 bicarbonate, and base excess measurements but not a significantly different PCO2 level as compared with fetuses that had these activities present. Fetuses with the absence of movements or tone had lower pH, PO2 bicarbonate, and base excess levels and higher PCO2 levels as compared with fetuses with the presence of movements or tone, respectively. These blood gas and acid-base differences were observed in both umbilical cord artery and vein. Subsequent analysis of the blood gas and acid-base measurements of the fetuses with compromised biophysical activities revealed that there are different levels of acidemia, hypoxemia, and hypercapnia at which the individual biophysical activities are compromised. These data suggest that the first manifestations of fetal hypoxemia and acidemia are nonreactive nonstress test results and loss of fetal breathing; in advanced acidemia, hypoxemia, and hypercapnia fetal movements and fetal tone are compromised.
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Affiliation(s)
- A M Vintzileos
- Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington 06030
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