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Xu Z, Callahan B, Pezzullo J, Giner J. Electrophilic sterol analog inhibitors targeting autoprocessing domain of hedgehog protein. Biophys J 2022. [DOI: 10.1016/j.bpj.2021.11.2451] [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: 11/02/2022] Open
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Goehring EL, Bohn RL, Pezzullo J, Tave AK, Jones JK, Bozzi S, Tamayo RCSG, Sicignano N, Naccarelli GV. Outcomes Associated with Dronedarone Use in Patients with Atrial Fibrillation. Am J Cardiol 2020; 135:77-83. [PMID: 32861738 DOI: 10.1016/j.amjcard.2020.08.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 12/20/2022]
Abstract
The antiarrhythmic drug dronedarone was designed to reduce the extra-cardiac adverse effects associated with amiodarone use in treatment of patients with atrial fibrillation / atrial flutter (AF/AFL). This epidemiological study used a retrospective cohort design to compare risk of cardiovascular-related hospitalizations and death in AF/AFL patients treated with dronedarone versus other antiarrhythmic drugs (AADs). AF/AFL patients with incident dronedarone fills were matched by propensity score (PS) to incident users of other AADs. The primary study outcome was hospitalization for cardiovascular (CV) causes within 24 months after the first study drug fill. A secondary composite outcome comprised hospitalization for CV causes or all-cause mortality during follow-up. In the AF/AFL patient cohort meeting eligibility criteria, 6,964 incident users of dronedarone and 25 607 incident users of other AADs were identified. The PS-matched cohort comprised 6,349 Dronedarone users (91.2% of all eligible) and 12,698 other AAD users. Dronedarone patients had a significantly lower risk of hospitalization for a CV event compared to Other AAD users (hazard ratio = 0.87; 95% confidence interval = 0.79 to 0.96). This was consistent with results for the composite outcome (hazard ratio=0.86; 95% confidence interval = 0.78 to 0.95). In conclusion, AF/AFL patients initiated on dronedarone versus other AADs had significantly lower risk of CV hospitalizations as well as the composite CV hospitalization / death from any cause.
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Affiliation(s)
| | | | - John Pezzullo
- Georgetown University, Washington, District of Columbia
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Ciulla DA, Wagner AG, Xinyue L, Cooper CL, Jorgensen MT, Wang C, Goyal P, Banavali NK, Pezzullo J, Giner JL, Callahan BP. Sterol A-ring plasticity in hedgehog protein cholesterolysis supports a primitive substrate selectivity mechanism. Chem Commun (Camb) 2019; 55:1829-1832. [PMID: 30672911 PMCID: PMC6365966 DOI: 10.1039/c8cc09729a] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Indexed: 01/18/2023]
Abstract
Cholesterolysis of Hedgehog family proteins couples endoproteolysis to protein C-terminal sterylation. The transformation is self-catalyzed by HhC, a partially characterized enzymatic domain found in precursor forms of Hedgehog. Here we explore spatial ambiguity in sterol recognition by HhC, using a trio of derivatives where the sterol A-ring is contracted, fused, or distorted. Sterylation assays indicate that these geometric variants react as substrates with relative activity: cholesterol, 1.000 > A-ring contracted, 0.100 > A-ring fused, 0.020 > A-ring distorted, 0.005. Experimental results and computational sterol docking into the first HhC homology model suggest a partially unstructured binding site with substrate recognition governed in large part by hydrophobic interactions.
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Affiliation(s)
- Daniel A. Ciulla
- Chemistry Department, Binghamton University, Binghamton, New York 13902, USA
| | - Andrew G. Wagner
- Chemistry Department, Binghamton University, Binghamton, New York 13902, USA
| | - Liu Xinyue
- Biology Department, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY 12180, USA
| | - Courtney L. Cooper
- Chemistry Department, Binghamton University, Binghamton, New York 13902, USA
| | | | - Chunyu Wang
- Biology Department, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY 12180, USA
| | - Puja Goyal
- Chemistry Department, Binghamton University, Binghamton, New York 13902, USA
| | - Nilesh K. Banavali
- NYS Department of Health, ESP C419B, Biggs Laboratory, Wadsworth Center, Empire State Plaza, Albany, New York 12201-0509, USA
| | - John Pezzullo
- Department of Chemistry, SUNY-ESF, Syracuse, New York 13210, USA
| | - José-Luis Giner
- Department of Chemistry, SUNY-ESF, Syracuse, New York 13210, USA
| | - Brian P. Callahan
- Chemistry Department, Binghamton University, Binghamton, New York 13902, USA
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Evans M, Guthrie N, Pezzullo J, Sanli T, Fielding RA, Bellamine A. Efficacy of a novel formulation of L-Carnitine, creatine, and leucine on lean body mass and functional muscle strength in healthy older adults: a randomized, double-blind placebo-controlled study. Nutr Metab (Lond) 2017; 14:7. [PMID: 28115977 PMCID: PMC5244582 DOI: 10.1186/s12986-016-0158-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/26/2016] [Indexed: 01/07/2023] Open
Abstract
Background Progressive decline in skeletal muscle mass and function are growing concerns in an aging population. Diet and physical activity are important for muscle maintenance but these requirements are not always met. This highlights the potential for nutritional supplementation. As a primary objective, we sought to assess the effect of a novel combination of L-Carnitine, creatine and leucine on muscle mass and performance in older subjects. Method Forty-two healthy older adults aged 55–70 years were randomized to receive either a novel L-Carnitine (1500 mg), L-leucine (2000 mg), creatine (3000 mg), Vitamin D3 (10 μg) (L-Carnitine-combination) product (n = 14), L-Carnitine (1500 mg) (n = 14), or a placebo (n = 14) for eight weeks. We evaluated body mass by DXA, upper and lower strength by dynamometry, and walking distance by a 6-min walk test at baseline and after eight weeks of intervention. These measures, reflecting muscle mass, functional strength and mobility have been combined to generate a primary composite score. Quality of life, blood safety markers, and muscle biopsies for protein biomarker analysis were also conducted at baseline and the end of the study. Results The primary composite outcome improved by 63.5 percentage points in the L-Carnitine-combination group vs. placebo (P = 0.013). However, this composite score did not change significantly in the L-Carnitine group (P = 0.232), and decreased slightly in the placebo group (P = 0.534). Participants supplemented with the L-Carnitine-combination showed a 1.0 kg increase in total lean muscle mass (P = 0.013), leg lean muscle mass (0.35 kg, P = 0.005), and a 1.0 kg increase in lower leg strength (P = 0.029) at week 8. In addition, these increases were significant when compared to the placebo group (P = 0.034, P = 0.026, and P = 0.002, respectively). Total mTOR protein expression was increased in participants in the L-Carnitine-combination group at the end of the study compared to the baseline (P = 0.017). This increase was also significant when compared to the placebo (P = 0.039), suggesting that the increase in muscle mass and strength was due to new protein synthesis and mTOR pathway activation. Conclusions The trial did reach its primary objective. L-Carnitine combined with creatine and L-leucine significantly improved the composite score which reflects muscle mass and strength, at the end of the study compared to placebo. The combination showed an increase in mTOR protein level, a driver for increased muscle mass which translated to an improvement in muscle strength. This new combination may provide a potential nutritional intervention to promote muscle growth and improved physical functioning in older adults. Electronic supplementary material The online version of this article (doi:10.1186/s12986-016-0158-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - John Pezzullo
- Georgetown University Medical Center, 34744, Washington, DC USA
| | | | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 02111 Boston, MA USA
| | - Aouatef Bellamine
- Global Nutrition, Lonza Inc. 90 Boroline Rd, 07401 Allendale, NJ USA
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Ghidini A, Stewart D, Davidson N, Pezzullo J. 55: Neonatal complications in vacuum-assisted vaginal delivery: are they associated with number of pulls or cup dislodgement? Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.101] [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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Goehring E, Bohn R, Pezzullo J, Jones J. REAL-WORLD OUTCOMES FOR DRONEDARONE INITIATORS COMPARED TO OTHER ANTIARRHYTHMIC AGENTS IN THE TREATMENT OF ATRIAL FIBRILLATION IN A LARGE UNITED STATES POPULATION. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60269-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vergani P, Roncaglia N, Ghidini A, Crippa I, Cameroni I, Orsenigo F, Pezzullo J. Can adverse neonatal outcome be predicted in late preterm or term fetal growth restriction? Ultrasound Obstet Gynecol 2010; 36:166-170. [PMID: 20131337 DOI: 10.1002/uog.7583] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To identify independent predictors of adverse neonatal outcome in cases of fetal growth restriction (FGR) at > or = 34 weeks. METHODS From a cohort of 481 FGR cases delivered at > or = 34 weeks, demographic and obstetric variables, fetal biometry and Doppler indices of the uterine, umbilical and fetal middle cerebral arteries available within 2 weeks of delivery, were related to adverse neonatal outcome, defined as admission to the neonatal intensive care unit for indications other than low birth weight alone. RESULTS Logistic regression analysis showed that gestational age (GA) at delivery (odds ratio (OR) = 0.59; 95% CI, 0.50-0.70), abdominal circumference (AC) centile (OR = 0.69; 95% CI, 0.59-0.81) and umbilical artery (UA) pulsatility index (PI) centile (OR = 1.02; 95% CI, 1.01-1.04) significantly correlated with adverse neonatal outcome. From this model we calculated a score of adverse neonatal outcome expressed by the formula: (UA-PI centile/3) - (10 x AC centile) + (10 x (40 - GA at delivery in weeks)). Receiver-operating characteristics curve analysis demonstrated that a score of > or = 25 optimally predicted adverse neonatal outcome (sensitivity of 75%, false-positive rate of 18%). Beyond 37.5 weeks, gestational age no longer had an independent impact on outcome. CONCLUSIONS In late preterm or term FGR, GA at delivery is the most important predictor of adverse neonatal outcome. At > 37.5 weeks, delivery may be the best option to minimize adverse outcome in all FGR cases. At 34-37 weeks, a score based on GA at delivery, UA-PI centile and AC centile optimally predicts adverse neonatal outcome.
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Affiliation(s)
- P Vergani
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Italy.
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Deering S, Stagg A, Spong C, Abubakar K, Pezzullo J, Ghidini A. Antenatal magnesium treatment and neonatal illness severity as measured by the Score for Neonatal Acute Physiology (SNAP). J Matern Fetal Neonatal Med 2009. [DOI: 10.1080/jmf.17.2.151.155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Shad Deering
- Departments of Obstetrics and Gynecology, Georgetown University Hospital, Washington, DC, USA
| | - Amy Stagg
- Departments of Obstetrics and Gynecology, Georgetown University Hospital, Washington, DC, USA
| | - Catherine Spong
- Departments of Obstetrics and Gynecology, Georgetown University Hospital, Washington, DC, USA
| | - Kabir Abubakar
- Pediatrics, Georgetown University Hospital, Washington, DC, USA
| | - John Pezzullo
- Pharmacology and Biostatistics, Georgetown University Hospital, Washington, DC, USA
| | - Alessandro Ghidini
- Departments of Obstetrics and Gynecology, Georgetown University Hospital, Washington, DC, USA
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Gilo N, Pezzullo J, Ghidini A, Poggi S. 776: Patients undergoing physical exam-indicated cerclage: What factors predict cerclage-to-delivery interval and preterm delivery? Am J Obstet Gynecol 2008. [DOI: 10.1016/j.ajog.2008.09.807] [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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Hickey K, Pezzullo J, Poggi S, Ghidini A. 139: Role of middle cerebral artery (MCA) doppler for prediction of adverse neonatal outcome in fetal growth restriction (FGR). Am J Obstet Gynecol 2008. [DOI: 10.1016/j.ajog.2008.09.166] [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: 10/21/2022]
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Crippa I, Roncaglia N, Cameroni I, Vergani P, Orsenigo F, Pezzullo J, Ghidini A. 363: Fetal growth restriction near term: Which gestational age is optimal for delivery? Am J Obstet Gynecol 2008. [DOI: 10.1016/j.ajog.2008.09.391] [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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Incerti M, Locatelli A, Ghidini A, Ciriello E, Nespoli A, Greco M, Pezzullo J. 586: Progression of cervical dilation in nulliparous women at term. Am J Obstet Gynecol 2008. [DOI: 10.1016/j.ajog.2008.09.616] [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: 10/21/2022]
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Gilo N, Amini D, Pezzullo J, Ghidini A, Poggi S. 488: Predictors of chorioamnionitis in patients who have undergone physical exam-indicated cerclage. Am J Obstet Gynecol 2008. [DOI: 10.1016/j.ajog.2008.09.517] [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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Gilo N, Pezzullo J, Ghidini A, Poggi S. 271: Patients undergoing physical exam-indicated cerclage: What are the predictors of microbial invasion of the amniotic cavity? Am J Obstet Gynecol 2008. [DOI: 10.1016/j.ajog.2008.09.299] [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: 10/21/2022]
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Hickey K, Ghidini A, Wahdan Y, Pezzullo J, Gilo N, Amini D, Poggi S. 731: Maternal pulse as a predictor of abnormal uterine artery Doppler indices. Am J Obstet Gynecol 2007. [DOI: 10.1016/j.ajog.2007.10.760] [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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Vyas N, Ghidini A, Anderson S, Pezzullo J, Landy H, Poggi S. Does increasing BMI affect cerclage efficacy? Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.372] [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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Vergani P, Pezzullo J, Roncaglia N, Crippa I, Andreotti C, Cameroni I, Ghidini A. Fetal growth restriction near term: What predicts cesarean delivery during labor among women eligible for vaginal delivery? Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.379] [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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Locatelli A, Ghidini A, Verderio M, Andreani M, Strobelt N, Pezzullo J, Vergani P. Predictors of perinatal survival in a cohort of pregnancies with severe oligohydramnios due to premature rupture of membranes at <26 weeks managed with serial amnioinfusions. Eur J Obstet Gynecol Reprod Biol 2006; 128:97-102. [PMID: 16530921 DOI: 10.1016/j.ejogrb.2006.02.003] [Citation(s) in RCA: 29] [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] [Received: 10/18/2004] [Revised: 01/03/2006] [Accepted: 02/03/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate whether successful amnioinfusion is an independent predictor of perinatal survival in a cohort of cases with extreme and persistent oligohydramnios due to preterm premature rupture of membranes (pPROM) who reached viability and were managed with serial amnioinfusions. STUDY DESIGN We included all consecutive singleton pregnancies with pPROM at <26 weeks and oligohydramnios lasting >4 days between 1/1991 and 12/2001 and who consented to undergo amnioinfusion (n=77). Women received serial transabdominal amnioinfusions in an attempt to maintain a pocket of fluid >2 cm. The procedure was deemed successful if the median deepest pocket of fluid during the latency period was >2 cm. Excluded were miscarriages (n=10), fetal deaths before viability (24 weeks) (n=15), and cases that did not develop oligohydramnios (n=17). Prenatal predictors of outcome were compared between cases who survived the perinatal period and those who did not using Wilcoxon rank-sum test, Fisher's exact test and stepwise logistic regression analysis, with a two-tailed P<0.05 considered significant. RESULTS Of the 35 patients fulfilling the study criteria, 20 (57%) survived the perinatal period. Perinatal survivors had similar gestational age at pPROM (P=0.68) and at first amnioinfusion (P=0.53) as those who died in the perinatal period, but longer latency (P=0.013). Consequently, median gestational age at delivery [29.2 (25.4-35.3) weeks versus 26.1 (24.0-34.0) weeks, P<0.001] and median birth weight [1220 (650-2240) g versus 863 (520-2200) g, P=0.001] were significantly greater among survivors than among those who died. Significant predictors of survival at univariate analysis were entered into a stepwise logistic regression analysis in the chronological order in which they normally occur. The analysis demonstrated that successful amnioinfusion (OR=6.9, 95% CI 1.2-40.4) and administration of steroids (OR=14.6, 95% CI 1.5-144.1) were independent and significant predictors of perinatal survival. CONCLUSION In a cohort of women with pPROM at <26 weeks and severe oligohydramnios managed with serial amnioinfusions, successful procedures and prenatal administration of corticosteroids are the only independent predictors of perinatal survival.
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Affiliation(s)
- Anna Locatelli
- Department of Obstetrics and Gynaecology, University of Milano-Bicocca, Ospedale San Gerardo, Via Solferino 16, 20052 Monza, Italy.
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Turpin A, Sheldon E, Schwartz H, Kalman D, Pezzullo J, Beer C, Bucci L. Comparison of glucosamine‐containing dietary supplements on knee osteoarthritis symptoms. FASEB J 2006. [DOI: 10.1096/fasebj.20.5.lb90] [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: 11/11/2022]
Affiliation(s)
- Amy Turpin
- ResearchSchiff Nutrition International2002 South 5070 WestSalt Lake CityUT84104
| | - Eric Sheldon
- Miami Research Associates6280 Sunset Drive #600MiamiFL33143
| | | | - Douglas Kalman
- Miami Research Associates6280 Sunset Drive #600MiamiFL33143
| | - John Pezzullo
- Miami Research Associates6280 Sunset Drive #600MiamiFL33143
| | - Christina Beer
- ResearchSchiff Nutrition International2002 South 5070 WestSalt Lake CityUT84104
| | - Luke Bucci
- ResearchSchiff Nutrition International2002 South 5070 WestSalt Lake CityUT84104
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Gurewitsch E, Pezzullo J, Silva A, Agarwal S, Hamzehzadeh S, Allen R. Are brachial plexus injuries more common on days with high volumes of deliveries? Am J Obstet Gynecol 2005. [DOI: 10.1016/j.ajog.2005.10.720] [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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Vergani P, Locatelli A, Ratti M, Scian A, Zangheri G, Pezzullo J, Ghidini A. Predictors of adverse perinatal outcome in twins delivered at < 37 weeks. J Matern Fetal Neonatal Med 2005; 16:343-7. [PMID: 15621553 DOI: 10.1080/14767050400018254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Multiple gestations are at increased risk for prematurity as well as perinatal mortality and morbidity. The aim of this study was to identify the independent risk factors for adverse perinatal outcome in a large uniform population of twins delivered preterm. METHODS We accessed a cohort of twin gestations for the period 1990-2000 delivered at < 37.0 weeks gestation. Chorionicity was established by ultrasound assessment of the dividing membrane, neonatal gender and histologic examination of the placenta at birth. Adverse perinatal outcome was defined as stillbirth, neonatal death, or major neonatal complications. Statistical analysis used contingency tables, Student's t test, one-way ANOVA and logistic regression, with a two-tailed p < 0.05 considered significant. RESULTS A total of 356 twin gestations (712 twins) were included in the database, and 183 twins (25.7%) had adverse perinatal outcome. Logistic regression analysis demonstrated that gestational age at delivery (p < 0.001), premature rupture of membranes (PROM) (p = 0.004), birth weight discordance (p = 0.009), and 5-min Apgar scores (p = 0.001) were significant and independent predictors of adverse perinatal outcome, whereas monochorionicity and twin-twin transfusion syndrome were not. CONCLUSIONS Gestational age at delivery and birth weight discordance are the most important independent predictors of perinatal mortality or morbidity among preterm twins.
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Affiliation(s)
- Patrizia Vergani
- Department of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
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Vergani P, Locatelli A, Ratti M, Scian A, Zangheri G, Pezzullo J, Ghidini A. Predictors of adverse perinatal outcome in twins delivered at <?37 weeks. J Matern Fetal Neonatal Med 2004. [DOI: 10.1080/jmf.16.6.343.347] [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: 10/20/2022]
Affiliation(s)
- Patrizia Vergani
- Department of Obstetrics and Gynaecology, San Gerardo Hospital University of Milano-Bicocca Monza Italy
| | - Anna Locatelli
- Department of Obstetrics and Gynaecology, San Gerardo Hospital University of Milano-Bicocca Monza Italy
| | - Marta Ratti
- Department of Obstetrics and Gynaecology, San Gerardo Hospital University of Milano-Bicocca Monza Italy
| | - Antonietta Scian
- Department of Obstetrics and Gynaecology, San Gerardo Hospital University of Milano-Bicocca Monza Italy
| | - Giulia Zangheri
- Department of Obstetrics and Gynaecology, San Gerardo Hospital University of Milano-Bicocca Monza Italy
| | - John Pezzullo
- Department of Obstetrics and Gynaecology, San Gerardo Hospital University of Milano-Bicocca Monza Italy
| | - Alessandro Ghidini
- Department of Obstetrics and Gynaecology, San Gerardo Hospital University of Milano-Bicocca Monza Italy
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Poggi S, Spong C, Patel C, Ghidini A, Pezzullo J, Allen R. Randomized trial of prophylactic mcroberts versus lithotomy to decrease force applied to fetus during delivery. Am J Obstet Gynecol 2003. [DOI: 10.1016/j.ajog.2003.10.486] [Citation(s) in RCA: 4] [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: 11/26/2022]
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Locatelli A, Roncaglia N, Andreotti C, Toso L, Doria V, Pezzullo J, Ghidini A. Factors affecting survival and severe morbidity in infants weighing 750 g or less. Am J Obstet Gynecol 2003. [DOI: 10.1016/j.ajog.2003.10.373] [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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Zimmer J, Pezzullo J, Choucair W, Southard J, Kokkinos P, Karasik P, Greenberg MD, Singh SN. Meta-analysis of antiarrhythmic therapy in the prevention of postoperative atrial fibrillation and the effect on hospital length of stay, costs, cerebrovascular accidents, and mortality in patients undergoing cardiac surgery. Am J Cardiol 2003; 91:1137-40. [PMID: 12714166 DOI: 10.1016/s0002-9149(03)00168-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Jennifer Zimmer
- Department of Cardiology, Veterans Affairs Medical Center, Washington, DC 20422, USA
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Jenkins CB, Pezzullo J, Baschat AA, Eglinton GS. Fetal Growth Patterns in Triplet Gestation. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200304001-00282] [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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Khan N, Pezzullo J. Images in medicine. Type I Gaucher's disease. Med Health R I 2002; 85:286. [PMID: 12371214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Abernethy DR, Pezzullo J, Mascelli MA, Frederick B, Kleiman NS, Freedman J. Pharmacodynamics of abciximab during angioplasty: comparison to healthy subjects. Clin Pharmacol Ther 2002; 71:186-95. [PMID: 11907493 DOI: 10.1067/mcp.2002.121775] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [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] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Our objectives were to compare and contrast abciximab concentration-effect relationships in healthy volunteer participants with those in patients with coronary atherosclerosis undergoing elective coronary angioplasty. We also aimed to establish abciximab plasma concentrations associated with 80% inhibition of platelet aggregation. METHODS Abciximab clearance and concentration-effect relationships were determined from two separate clinical studies, one in 30 healthy subjects aged 21 to 66 years and the other in 32 patients aged 44 to 74 years before they underwent elective coronary angioplasty. After abciximab administration, abciximab plasma concentrations, platelet glycoprotein IIb/IIIa (GP IIb/IIIa) receptor occupancy, and degree of inhibition of platelet aggregation in the presence of 5-micromol/L and 20-micromol/L adenosine diphosphate was determined. With an E(max) (receptor occupancy) or inhibitory E(max) (inhibition of platelet aggregation) model, abciximab concentrations required for 80% receptor occupancy and 80% inhibition of platelet aggregation were determined. RESULTS Abciximab steady-state clearance in healthy participants was 183 +/- 72 ml/min (mean +/- SD), and single-dose clearance in patients undergoing angioplasty was 405 +/- 240 ml/min (mean +/- SD). Abciximab concentration required for 80% GP IIb/IIIa receptor occupancy was 35.2 +/- 2.4 versus 72.8 +/- 6.4 ng/ml in healthy participants versus patients (P <.01). Concentrations required for 80% inhibition of platelet aggregation stimulated by 5-micromol/L adenosine diphosphate were 25.6 +/- 1.6 versus 68.9 +/- 9.2 ng/ml (P <.01). Similarly, the concentrations required for 80% inhibition of platelet aggregation stimulated by 20-micromol/L adenosine diphosphate were 56.0 +/- 3.2 versus 141 +/- 16.8 ng/ml (P <.01). CONCLUSION Approximately 2-fold greater abciximab exposure is required to achieve the same degree of GP IIb/IIIa occupancy and inhibition of platelet aggregation in patients undergoing angioplasty as compared with healthy participants. The difference between groups may be related either to different states of basal platelet activation or to the effect of heparin that patients received as part of the angioplasty procedure. A therapeutic concentration range for patients is 100 to 175 ng/ml, because this is the concentration consistent with >80% inhibition of platelet aggregation when 20-micromol/L adenosine diphosphate is used as the aggregating stimulus.
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Affiliation(s)
- Darrell R Abernethy
- Division of Clinical Pharmacology, Georgetown University School of Medicine, Washington, DC, USA.
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30
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Espinosa B, Crane M, Gross S, Castillo W, Pezzullo J, Salafia C. 397 Maternal serum HCG in HIV+ women—implications for prenatal screening and trophoblast function? Am J Obstet Gynecol 2001. [DOI: 10.1016/s0002-9378(01)80429-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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31
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Moretti M, Abouzeid A, Pullano J, Katz S, Ghidini A, Pezzullo J, Salafia C. 399 Maternal vascular/endothelial function in uncomplicated diabetic pregnancy. Am J Obstet Gynecol 2001. [DOI: 10.1016/s0002-9378(01)80431-2] [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: 11/26/2022]
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32
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Moretti M, Abouzeid A, Pullano J, Katz S, Pezzullo J, Ghidini A, Salafia C. 398 Maternal vascular and endothelial function in untreated preeclamptic pregnancy. Am J Obstet Gynecol 2001. [DOI: 10.1016/s0002-9378(01)80430-0] [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: 10/24/2022]
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33
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Abstract
STUDY DESIGN The administrative database maintained by the National Council on Compensation Insurance (United States) was used to compare health care use and indemnity costs within the natural history of work-related low back pain disability. OBJECTIVES To determine the relative costs of health care services and indemnity at different phases of work disability. SUMMARY OF BACKGROUND DATA Existing studies have compared total costs along the work disability continuum. This study replicates and extends these earlier studies by providing detailed evaluations of costs by service categories along this continuum. METHODS Total health care and indemnity costs accrued along the disability curve were examined. Based on the number of days workers were absent from work and receiving indemnity payments (disability days), detailed mean health care costs by type of medial service were computed and compared across four time intervals for the sample. RESULTS Health care costs were disproportionately distributed along the disability curve, with 20% of claimants disabled 4 months or more, accounting for 60% of health care costs. The most costly service category was diagnostic procedures (25% of total medical costs), with surgical costs (21%) and physical therapy (20%) representing the next two most costly categories. Mental health and chiropractic care represented a small percentage of overall costs (0.4% and 2.9%, respectively). CONCLUSIONS These data provide policy-makers, program development, and health care industry groups with cost information from which to establish benchmarks for future decisions that facilitate the allocation of resources for more cost-effective management and prevention of work disability.
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Affiliation(s)
- D A Williams
- Department of Psychiatry, Georgetown University Medical Center, Washington, D.C
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34
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Osorio M, Torres J, Moya F, Pezzullo J, Salafia C, Baxter R, Schwander J, Fant M. Insulin-like growth factors (IGFs) and IGF binding proteins-1, -2, and -3 in newborn serum: relationships to fetoplacental growth at term. Early Hum Dev 1996; 46:15-26. [PMID: 8899351 DOI: 10.1016/0378-3782(96)01737-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cord sera were obtained from term, Chilean newborns exhibiting various patterns of intrauterine growth and assayed for IGF-1, IGF-2, IGFBP-1, IGFBP-2, and IGFBP-3 by specific radioimmunoassays (RIA). Serum levels of each peptide were correlated with birth weight (BW), ponderal index (PI), and placental weight (PW). Total IGF-1 levels correlated with BW (r = 0.665, P = 0.0001). PI (r = 0.527, P = 0.004), and PW (r = 0.596, P = 0.0017). In contrast, IGF-2 failed to correlate with any growth parameter. Of the three binding proteins, IGFBP-3 exhibited the strongest relationship to each growth parameter. IGFBP-3 correlated significantly with BW (r = 0.71, P < 0.0001), PI (r = 0.782, P < 0.0001), and PW (r = 0.57, P = 0.0029). In addition IGFBP-3 levels positively correlated to IGF-1 levels (r = 0.614, P = 0.0005). By contrast, circulating IGFBP-1 and IGFBP-2 were inversely related to IGF-1 levels. All five peptides were subjected to multiple regression analysis and related to BW. Significant relationships between the predicted BW and the actual BW were observed in these infants (r = 0.802, P = 0.0006). The BWs of a cohort of unrelated North American infants were also predicted using the Chilean-derived equation and found to be significantly related to their actual BWs (r = 0.453, P = 0.0033). These relationships were strengthened by the inclusion of estimated gestational age (EGA) as an independent variable. These data point to particularly important roles for IGF-1 and IGFBP-3 in regulating fetal growth at term, and suggest that they are regulated in a coordinated manner during the latter stage of gestation. Furthermore, they suggest that IGFBPs play multiple, and potentially opposing, regulatory roles in modulating IGF action. Lastly, an integrated expression of IGF activity derived from one population significantly correlated with newborn BW in a geographically and culturally distinct population.
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Affiliation(s)
- M Osorio
- Department of Pediatrics, Facultad de Medicina, University of Chile, Santiago
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35
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Abstract
Neonatal and follow-up data of infants from the special care nursery whose birth weights were < 750 g, born between 1980 and 1990, were reviewed. There was a 20% relative improvement in the odds of surviving the neonatal period, a 16% improvement in the odds of being discharged and a 19% improvement in the odds of surviving until 2 years of age with each consecutive year. Home oxygen use increased significantly over the study period. The neurodevelopmental outcomes of infants were similar over the 11-year period, with 53% being classified as neurologically normal, with a mean developmental index of 83 at 1 to 2 years of age. We conclude that there has been an improved survival of infants with birth weights < 750 g in our institution, and that the overall incidence of serious neurodevelopmental deficits among survivors has remained stable.
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MESH Headings
- Birth Weight
- Brain Damage, Chronic/etiology
- Brain Damage, Chronic/mortality
- Cause of Death
- Child, Preschool
- Female
- Follow-Up Studies
- Humans
- Infant
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/mortality
- Infant, Small for Gestational Age
- Length of Stay/statistics & numerical data
- Male
- Neurologic Examination
- Rhode Island/epidemiology
- Risk Factors
- Survival Rate
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Affiliation(s)
- J Blaymore-Bier
- Department of Pediatrics, Rhode Island Hospital, Providence, USA
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36
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Fant M, Salafia C, Baxter RC, Schwander J, Vogel C, Pezzullo J, Moya F. Circulating levels of IGFs and IGF binding proteins in human cord serum: relationships to intrauterine growth. Regul Pept 1993; 48:29-39. [PMID: 7505470 DOI: 10.1016/0167-0115(93)90333-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cord sera were obtained from 44 term, human infants exhibiting various patterns of intrauterine growth and were assayed for IGF-1, IGF-2, and IGFBP-1, 2, and 3 by specific RIAs. Serum levels were correlated with birth weight (BW), ponderal index (PI), and placental weight (PW). Total IGF-1 levels correlated significantly with BW (r = 0.392), PW (r = 0.351), and PI (r = 0.481). By contrast, the correlation of IGF-2 with birth weight was not statistically significant (r = 0.264, P = 0.091). The association of IGF-2 with PI, however, was significant (r = 3.348, P = 0.024). IGFBP-3 exhibited significant correlations with BW, PI, and PW, similar to those seen with IGF-1. IGFBP-1 and IGFBP-2, however, were not significantly related to growth parameters. IGF-1 levels correlated strongly with IGFBP-3 levels (r = 0.646, P = 0.001). By contrast, IGF-1 correlated with the reciprocal of both IGFBP-1 and IGFBP-2. Based upon in vitro affinity constants, theoretical concentrations for each [IGF/IGFBP] complex, free IGFs, and free IGFBPs were calculated for each infant. Multiple regression analysis was performed including all 11 calculated variables and correlated with each growth parameter. This analysis revealed that an integrated expression of IGF activity exhibited stronger correlations with growth than each individual peptide species (BW, r = 0.681; PI, r = 0.660; PW, r = 0.658). These data further support roles for IGF related peptides (IGFRPs) in human fetal and placental growth and suggest regulatory/counterregulatory roles for the IGFBPs. It also supports the hypothesis that individual IGFRPs interact in a complex manner to define 'net IGF activity' in relation to fetal growth and/or metabolic status.
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Affiliation(s)
- M Fant
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110
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37
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Salafia C, Maier D, Vogel C, Pezzullo J, Burns J, Silberman L. Placental and decidual histology in spontaneous abortion: detailed description and correlations with chromosome number. Obstet Gynecol 1993; 82:295-303. [PMID: 8336881] [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: 01/30/2023]
Abstract
OBJECTIVES To determine the histopathology of failed pregnancy in clinically symptomatic women with no more than one prior pregnancy loss in order to provide baseline data, and to determine whether the histology of the conceptus in spontaneous abortions could predict a normal or abnormal chromosome number. METHODS A review of all spontaneous abortions from which karyotypes were obtained between 1984-1991 yielded 224 cases in which maternal history indicated no more than one prior spontaneous abortion, a reliable date of last menstrual period (LMP), and available villous (221) and/or decidual/implantation site (175) pathology. Molar pregnancies were excluded. RESULTS Multivariate logistic regression analysis showed a significant relationship between chromosome number and gestational age at loss as calculated from the LMP. Considering this confounder, a villous circulation indicating fetal life to 11 or more weeks, chronic intervillositis and villous infarcts (each P < .01), and decidual vasculitis (P < .05) were more frequent in chromosomally normal conceptions. Substituting possible variables into the logistic regression equation yielded predictions ranging from 88% likelihood of chromosomal abnormality to 97% likelihood of normal chromosome number. CONCLUSIONS Histology can assist in assessing whether a spontaneous abortion is chromosomally normal or abnormal. There are many pathologic findings seen in spontaneous abortions regardless of karyotype; however, certain findings are more common in chromosomally normal abortions. These data provide a baseline for study of the histopathology of habitual abortion.
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Affiliation(s)
- C Salafia
- Department of Laboratory Medicine, Danbury Hospital, Connecticut
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38
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Abstract
The present study of 466 consecutive liveborn preterm singleton deliveries included 238 cases of spontaneous preterm labor and delivery, 175 cases with premature rupture of membranes, 13 cases of nonhypertensive abruption, 18 cases of preeclampsia, and 22 cases of placenta previa. Placental infarction, chronic villitis, and decidual pathologic processes showed different associations with fetal growth, depending on the clinical circumstances. Placental infarction was associated with decreased growth in all groups except placenta previa; in cases of placenta previa, placental infarction was associated with heavier infants. Chronic villitis was related to decreased growth in spontaneous rupture of membranes and preterm labor cases but was related to increased growth in cases of preeclampsia.
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Affiliation(s)
- C M Salafia
- Department of Laboratory Medicine, Danbury Hospital, Connecticut 06810
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39
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Abstract
Microscopic features of placentas from 539 consecutive preterm deliveries and 214 term deliveries were compared. The presence of either umbilical or chorionic vasculitis was identified in 38% of the cases at 22 to 28 weeks' gestation, in 32% of the cases at 29 to 32 weeks' gestation, in 13% of the cases at 33 to 36 weeks' gestation, and in 10% of the cases at term (p less than 0.0001). Decidual vascular abnormality was present in 70% of the cases at 22 to 28 weeks' gestation, in 35% of the cases at 29 to 32 weeks, in 29% of the cases at 33 to 36 weeks, and in 15% of the cases at term (p less than 0.0001). Chronic villitis was significantly more frequent in preterm deliveries without umbilical vasculitis than in those cases with umbilical vasculitis (17% vs 8%, p less than 0.05). Our data indicate that the placental lesions of umbilical-chorionic vasculitis, decidual vascular abnormality, and chronic villitis are related to preterm birth. Umbilical-chorionic vasculitis reflects acute ascending bacterial infection. Decidual vascular abnormality has been associated with maternal autoimmune or alloimmune disorders. Chronic villitis may indicate either congenital viral infection or maternal-fetal immunopathologic conditions. Both decidual vascular abnormality and chronic villitis may reflect the activation of inflammatory mechanisms capable of leading to preterm delivery.
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Affiliation(s)
- C M Salafia
- Department of Laboratory Medicine, Danbury Hospital, CT 06810
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40
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Schwartz RM, Michelman T, Pezzullo J, Phibbs CS. Explaining resource consumption among non-normal neonates. Health Care Financ Rev 1991; 13:19-28. [PMID: 10122360 PMCID: PMC4193221] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The adoption by Medicare in 1983 of prospective payment using diagnosis-related groups (DRGs) has stimulated research to develop case-mix grouping schemes that more accurately predict resource consumption by patients. In this article, the authors explore a new method designed to improve case-mix classification for newborns through the use of birth weight in combination with DRGs to adjust the unexplained case-mix severity. Although the findings are developmental in nature, they reveal that the model significantly improves our ability to explain resource use.
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MESH Headings
- Birth Weight
- Diagnosis-Related Groups/classification
- Diagnosis-Related Groups/economics
- Health Care Costs/statistics & numerical data
- Health Resources/statistics & numerical data
- Health Services Research/methods
- Hospitals, Urban/economics
- Hospitals, Urban/statistics & numerical data
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/classification
- Infant, Newborn, Diseases/economics
- Intensive Care Units, Neonatal/economics
- Intensive Care Units, Neonatal/statistics & numerical data
- Length of Stay/statistics & numerical data
- Models, Statistical
- Prospective Payment System
- Regression Analysis
- Severity of Illness Index
- United States
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Affiliation(s)
- R M Schwartz
- National Perinatal Information Center, Providence, RI 02908
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Abstract
We have conducted a double-blind controlled trial of colchicine in patients with primary biliary cirrhosis. Fifty-seven patients with biopsy-proven primary biliary cirrhosis were randomized to receive either 0.6 mg of colchicine twice daily or an identically appearing placebo. Patients underwent clinical and laboratory evaluation every 3 mo and liver biopsy annually. Differences in mean alkaline phosphatase and alanine aminotransferase values between the colchicine and placebo recipients were statistically significant at 4 yr. Differences in mean bilirubin and immunoglobulin M values, although lower in the colchicine group, did not reach statistical significance. In colchicine-treated patients, mean alkaline phosphatase values fell significantly compared with controls, from 281 to 112 IU/L (p less than 0.01). Similarly, mean alanine aminotransferase values fell significantly compared with controls, from 129 to 86 IU/L (p less than 0.05). Bilirubin values remained stable in drug-treated patients, even in those patients with initially elevated bilirubin values, whereas they nearly doubled in subjects receiving placebo. Although biochemical parameters of disease activity improved or stabilized in colchicine-treated subjects, no difference in histologic progression was detected between the two treatment groups. We conclude that colchicine is of clinical benefit to patients with primary biliary cirrhosis as judged by improvement in alkaline phosphatase and alanine aminotransferase activities as well as a tendency for stabilization of bilirubin values.
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Affiliation(s)
- H Bodenheimer
- Department of Medicine, Rhode Island Hospital, Providence
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42
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Abstract
The effects of a systematic reduction of whole blood (WB) availability on transfusion practice were studied at a large university-affiliated community hospital from 1978 through 1985. The reduction in WB availability was part of a planned statewide shift in blood procurement and processing from hospitals' individual blood banks to a new statewide blood center. Hospital WB use declined 96 percent, from 3400 to 109 units annually, with a net addition of more than 3000 units of plasma to the statewide stocks. A large increase in the use of other blood components occurred when WB was withdrawn, but this use fell sharply in 1984 and 1985, despite the continued relative unavailability of WB. Analysis of individual hospitals' services showed that increases in the use of packed red cells were distributed across all the services that frequently use red cell transfusions. However, a disproportionate rise and then fall in the use of fresh-frozen plasma and platelets for cardiovascular operations were observed. The data suggest that education and more conservative transfusion practices are reducing the use of blood components despite continued restricted availability of WB.
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Affiliation(s)
- J P Crowley
- Department of Medicine, Rhode Island Hospital, Providence
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43
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Abuelo D, Barsel-Bowers G, Busch W, Pueschel S, Pezzullo J. Risk for trisomy 21 in offspring of individuals who have relatives with trisomy 21. Am J Med Genet 1986; 25:365-7. [PMID: 2946226 DOI: 10.1002/ajmg.1320250223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This study was performed to determine if sibs and other relatives of individuals with trisomy 21 are themselves at increased risk for having offspring with trisomy 21. The results suggest that the reproductive risk to these relatives is not increased beyond the risk to the general population.
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Abstract
A group of 12 internists, members of a university-affiliated hospital, designed and implemented protocols for the general inpatient management of four medical problems (chest pain, stroke, pneumonia, and upper gastrointestinal hemorrhage). Hospital charges for the 63 cases were compared with charges generated by 64 controls who had been patients admitted to the same physicians with the same diagnoses during the same period of the preceding year, before the project was begun. A group of nonparticipating internists was similarly evaluated during the two time periods to control for changes in practice patterns extraneous to the intervention. Adjustment was made for inflation (6%) and differences in case mix. The program resulted in a 15% reduction in total average charge generated by the cases. Sizeable reductions were achieved in utilization of EKGs (34.8%), x-rays (15.4%), laboratory testing (20.4%), and drugs (11.4%). Given the prevailing attitude that health care costs are too high and that many services are unnecessary, the benefit of altering physician behavior by using standards established by them for themselves could be substantial, especially with the threat of more restrictive and less sympathetic modes of controlling costs.
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45
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Bodenheimer HC, Schaffner F, Sternlieb I, Klion FM, Vernace S, Pezzullo J. A prospective clinical trial of D-penicillamine in the treatment of primary biliary cirrhosis. Hepatology 1985; 5:1139-42. [PMID: 3905561 DOI: 10.1002/hep.1840050613] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We conducted a prospective clinical trial to assess the relative efficacy and safety of high- vs. low-dose D-penicillamine in patients with primary biliary cirrhosis. Following clinical tests and liver biopsy diagnostic of primary biliary cirrhosis, 56 patients were randomized to receive either 250 or 750 mg D-penicillamine daily. Patients were monitored with clinical tests and annual liver biopsy. Randomization produced two groups without differences in demographic, clinical or histologic characteristics. During the trial, no differences were seen between the mean change in liver test results in patients in either treatment group. The 11% per year rise of bilirubin in the 750 mg dose group during the first 3 years was not significantly different from the 18% per year rise in the 250 mg dose group. No patient showed improvement on liver biopsy although patients on 750 mg D-penicillamine deteriorated more slowly. Side effects, particularly rash and dysgeusia, were more common in the 750 mg dose group. The frequency and severity of side effects were responsible for the early conclusion of our trial. Twenty-six patients experienced side effects necessitating discontinuation of D-penicillamine. No evidence of increased efficacy was demonstrated by high-dose D-penicillamine therapy, and side effects were observed in patients on 250 mg D-penicillamine daily. With the severity of adverse effects and continued progression of disease, D-penicillamine is not a clinically useful therapy in primary biliary cirrhosis.
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46
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Martin HF, Fanger H, Pezzullo J. When to automate the clinical laboratory. Automation not justified unless work load reaches 25-30 tests per day. R I Med J 1968; 51:555-7 passim. [PMID: 5245549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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