1
|
Weissmann-Brenner A, Domniz N, Meyer R, Weissbach T, Elkan T, Salem Y, Bart Y, Kassif E, Weisz B. Delivery Outcome of Fetuses with Congenital Heart Disease-Is It Influenced by Prenatal Diagnosis? J Clin Med 2022; 11:jcm11144075. [PMID: 35887840 PMCID: PMC9319522 DOI: 10.3390/jcm11144075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/12/2022] [Accepted: 07/11/2022] [Indexed: 01/27/2023] Open
Abstract
Objective: The objective of this study is to assess the delivery outcomes of neonates with congenital heart defects (CHD), and to explore the effect of prenatal diagnosis on these outcomes. Methods: A retrospective study including singleton deliveries between 2011 and 2020. All singleton neonates delivered at >24 weeks of gestation were included in this study. Fetuses with known prenatal anomalies other than CHD were excluded from this study. Pregnancy and neonatal outcomes were analyzed. A comparison was made between pregnancies with CHD and controls; and between pregnancies with prenatal diagnosis of CHD and postnatal diagnosis of CHD. Results: A total of 1598 neonates with CHD (688, 43.1% diagnosed prenatally) comprised the study group, compared to 85,576 singleton controls. Pregnancies with CHD had significantly increased BMI before pregnancy, suffered more from diabetes and chronic hypertension, had more inductions of labor, and had more cesarean deliveries (CD) including both elective CD and urgent CD due to non-reassuring fetal monitor (NRFHR) (OR = 1.75; 95%CI 1.45−2.14). Prenatal diagnosis of CHD is associated with a significant increased rate of induction of labor compared to postnatal diagnosis of CHD (OR = 1.59; 95% CI 1.15−2.22), but did not affect the mode of delivery including the rate of CD and CD due to non-reassuring fetal heart rate (NRFHR). Gestational age at birth and birthweight were significantly lower in pregnancies with CHD compared to controls, with no difference between prenatal to postnatal diagnosis of the anomaly. Neonates with CHD had a higher incidence of hypoxic ischemic encephalopathy and seizures compared to controls without any impact by prenatal diagnosis. Conclusion: Prenatal diagnosis of CHD is associated with an increased rate of induction of labor, with no increased rate of CD and CD due to NRFHR. The 5-min Apgar score is lower in pregnancies with postnatal diagnosis of CHD.
Collapse
Affiliation(s)
- Alina Weissmann-Brenner
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Correspondence: ; Tel.: +972-3-530-8116; Fax: +972-3-530-3168
| | - Noam Domniz
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Raanan Meyer
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Tal Weissbach
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Tal Elkan
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Yishai Salem
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Pediatric Cardiology Unit, Department of Pediatrics, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel
| | - Yossi Bart
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Eran Kassif
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Boaz Weisz
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| |
Collapse
|
2
|
Navon I, Wertheimer A, Hochberg A, Sapir O, Ben-Haroush A, Altman E, Domniz N, Shochat T, Shufaro Y. P-770 Is there an association between blood hCG elevation rate in very early IVF pregnancy and adverse pregnancy outcomes? Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is a slow elevation rate between the first and second hCG values following a successful fresh IVF cycle associated with long-term pregnancy outcomes?
Summary answer
A slow rate of hCG elevation in early IVF pregnancies is associated with an increased risk for low birth weight neonates.
What is known already
IVF pregnancies are associated with higher prevalence of late obstetrical complications such as preterm birth, preeclampsia and small for gestational age. Different baseline characteristics and treatment parameters are associated with obstetrical complications. Abnormal, mostly slow, hCG elevation patterns have been strongly associated with short-term adverse pregnancy outcomes such as non-viability, miscarriage, early fetal demise and ectopic pregnancies. However, the long-term impact of slow hCG elevation rate on pregnancies that do continue to term is unknown.
Study design, size, duration
Single center cohort study between 2008-2019 including 703 fresh cycles resulting in live singleton birth. Full obstetrical data for these pregnancies was available.
Participants/materials, setting, methods
The first blood hCG measurement was performed 14±1.4 days after ovum pick-up (OPU), and the second one 48-72h later. The slope between the two measurements was calculated and adjusted per day. Slow hCG elevation was defined as a slope value below the 10th percentile. Maternal and short-term neonatal outcomes were compared between cycles with a slow elevation (n = 71) and a “normal” elevation (n = 632) in hCG values. Multivariate analysis was used to control for potential confounders.
Main results and the role of chance
There were no differences between the slow and normal hCG elevation groups in maternal age, numbers of retrieved oocytes, ICSI rates, number of transferred and usable embryos, and gestational age at delivery. Neonates from cycles with a slow hCG elevation weighed significantly less (2876±619 gr vs. 3083±553 gr, p < 0.005) and were at a higher risk (21% vs. 12%, OR = 1.96, 95% CI 1.06-3.64) of having low birth weight (LBW) (below 2500 grams). Women with slow hCG elevation rate had more hypertension-preeclampsia related complications (11% vs. 6%, p < 0.05), although barely reaching statistical significance in the multivariate analysis (OR = 1.76, 95% CI 1.0-3.6).
Limitations, reasons for caution
Retrospective design, single center, applicability to fresh cycles only.
Wider implications of the findings
Very early (5th week) initial blood hCG elevation slope, measured only in IVF gestations, might be a novel marker for identifying patients at risk for hypertensive complications during pregnancy and low birth-weight neonates. Tighter prenatal care for these patients could potentially reduce pregnancy complications and improve long-term outcome.
Trial registration number
not applicable
Collapse
Affiliation(s)
- I Navon
- Rabin Medical Center, Infertility and IVF Unit- Helen Schneider Hospital for Women , Petah Tikva, Israel
| | - A Wertheimer
- Rabin Medical Center, Infertility and IVF Unit- Helen Schneider Hospital for Women , Petah Tikva, Israel
| | - A Hochberg
- Rabin Medical Center, Infertility and IVF Unit- Helen Schneider Hospital for Women , Petah Tikva, Israel
| | - O Sapir
- Rabin Medical Center, Infertility and IVF Unit- Helen Schneider Hospital for Women , Petah Tikva, Israel
| | - A Ben-Haroush
- Rabin Medical Center, Infertility and IVF Unit- Helen Schneider Hospital for Women , Petah Tikva, Israel
| | - E Altman
- Rabin Medical Center, Infertility and IVF Unit- Helen Schneider Hospital for Women , Petah Tikva, Israel
| | - N Domniz
- Rabin Medical Center, Infertility and IVF Unit- Helen Schneider Hospital for Women , Petah Tikva, Israel
| | - T Shochat
- Rabin Medical Center, Infertility and IVF Unit- Helen Schneider Hospital for Women , Petah Tikva, Israel
| | - Y Shufaro
- Rabin Medical Center, Infertility and IVF Unit- Helen Schneider Hospital for Women , Petah Tikva, Israel
| |
Collapse
|
3
|
Weissmann-Brenner A, Domniz N, Weissbach T, Mazaki-Tovi S, Achiron R, Weisz B, Kassif E. Antenatal Detection of True Knot in the Umbilical Cord - How Accurate Can We Be? Ultraschall Med 2022; 43:298-303. [PMID: 32674187 DOI: 10.1055/a-1205-0411] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Umbilical cord knot (UCK) is associated with increased risk of fetal death, but is usually diagnosed only after delivery. Our objective was to examine the accuracy of prenatal ultrasound in the diagnosis of UCK and the outcomes of these pregnancies. METHODS A prospective study was performed on 56 patients in which UCK was suspected during a routine level-II anatomical scan (study group). Data included demographics, pregnancy outcome, and short-term neonatal follow-up. The control group included pregnant women with normal pregnancy without UCK in a 4:1 ratio matched for gestational age at delivery. RESULTS True knot was observed postnatally in 54 out of 56 fetuses (detection rate of 96.4 %). Gestational age at diagnosis of UCK was 22.1 ± 3.1 weeks. The female to male ratio was 1:1 in both groups. Maternal age and parity were significantly higher in pregnancies with UCK compared to controls. The mean gestational age at delivery was 37.1 weeks of gestation in the UCK group. There was no difference in the birthweight percentile. 47 patients (87 %) underwent induction of labor. There were no differences in the rate of cesarean section or Apgar scores. No neonate with UCK needed ventilation. None suffered from seizures and none needed brain imaging. There were no cases of fetal or neonatal death in the pregnancies with UCK. CONCLUSION There is a high detection rate of UCK during targeted scan of the umbilical cord performed during the level-II anatomical scan. Careful pregnancy follow-up and early term delivery may result in excellent obstetrical outcomes.
Collapse
Affiliation(s)
- Alina Weissmann-Brenner
- Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Domniz
- Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Weissbach
- Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shalev Mazaki-Tovi
- Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reuven Achiron
- Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Weisz
- Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Kassif
- Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Weissmann-Brenner A, Meyer R, Domniz N, Levin G, Hendin N, Yoeli-Ullman R, Mazaki-Tovi S, Weissbach T, Kassif E. The perils of true knot of the umbilical cord: antepartum, intrapartum and postpartum complications and clinical implications. Arch Gynecol Obstet 2021; 305:573-579. [PMID: 34405285 DOI: 10.1007/s00404-021-06168-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND True knot of the umbilical cord (TKUC) is found in 0.3-2.1% of pregnancies and is associated with an increased risk of adverse perinatal outcomes. METHODS A retrospective cohort study including all singleton pregnancies delivered from 2011 to 2019 was performed. Diagnosis of TKUC was made postnatally, immediately after delivery of the baby. Comparison was made between pregnancies with and without TKUC regarding maternal, fetal and neonatal adverse outcome. RESULTS Overall, 867/85,541 (1%) pregnancies were diagnosed with TKUC. Maternal age, BMI, gravidity and parity were significantly higher in pregnancies with TKUC as well as higher rate of induction of labor, meconium-stained amniotic fluid, and delivery prior to 37 weeks. The rate of cesarean deliveries due to non-reassuring-fetal monitor was significantly higher in pregnancies with TKUC. Overall, there were 2.5% IUFD in pregnancies with TKUC vs. 1% in pregnancies without TKUC (p < 0.001). Importantly, the rate of IUFD prior to 37 weeks of gestation was not significantly higher in the group with TKUC, however, the rate of IUFD after 37 weeks of gestation was 10 folds higher in fetuses with TKUC, 0.9% vs. 0.08% (p < 0.001). Significantly, more neonates with TKUC needed phototherapy or suffered from hypoglycemia. There were no differences in the 5 min Apgar scores, admission to the NICU and number of days of hospitalization. CONCLUSION Pregnancies complicated with TKUC are associated with a tenfold higher risk of IUFD beyond 37 weeks of gestation. To the results of this study suggest that it would be prudent to induce labor around 37 weeks of gestation in pregnancies with prenatal diagnosis of TKUC. It may be warranted to use continuous fetal monitoring during labor and delivery in those cases were antenatal diagnosis of TKUC is made.
Collapse
Affiliation(s)
- Alina Weissmann-Brenner
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.
- The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel.
| | - Raanan Meyer
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Noam Domniz
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Levin
- The Department Gynecologic Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Natav Hendin
- The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Rakefet Yoeli-Ullman
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Shali Mazaki-Tovi
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Tal Weissbach
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Eran Kassif
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
5
|
Friedman-Gohas M, Kirshenbaum M, Michaeli A, Domniz N, Elizur S, Raanani H, Orvieto R, Cohen Y. Does the presence of AGG interruptions within the CGG repeat tract have a protective effect on the fertility phenotype of female FMR1 premutation carriers? J Assist Reprod Genet 2020; 37:849-854. [PMID: 32096109 DOI: 10.1007/s10815-020-01701-0] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/12/2019] [Indexed: 10/24/2022] Open
Abstract
PURPOSE While FMR1 premutation carriers (CGG 55-200) were shown to have reduced success with IVF treatment (lower oocyte yield), studies reporting on the association between the number of CGG repeats and patients' response to controlled ovarian hyperstimulation (COH) are inconsistent. In the present study, we aim to explore whether the number of CGG repeats in women with premutation in FMR1 gene, undergoing COH for IVF, correlates with COH variables and whether the number of AGG interruptions may function as a "protective factor" by improving the ovarian response to COH. METHODS Retrospective study, in an academic IVF-PGD unit. Fifty-seven consecutive FMR1 premutation carriers who underwent 285 IVF treatment cycles were included. The numbers of CGG repeats and AGG interruptions were retrieved and correlated to the demographics and COH variables. RESULTS There were no significant association between the numbers of CGG or the AGG interruptions and the number of oocyte retrieved or the peak estradiol levels. The lack of association was also observed when including all the IVF treatment cycles or only the first or last IVF treatment cycle. Moreover, no associations were found between the number of CGG repeats or AGG interruptions and other COH variables, i.e., duration of stimulation, the total dose of gonadotropin used, or the number of top-quality embryos. CONCLUSIONS No associations were observed between the number of CGG repeats or AGG interruptions and any of the COH variables. Further studies are required to identify early biomarkers of POI to empower FMR1 premutation carriers with risk assessment tools to consider procedures such as fertility preservation.
Collapse
Affiliation(s)
- M Friedman-Gohas
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - M Kirshenbaum
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - A Michaeli
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - N Domniz
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel
| | - S Elizur
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - H Raanani
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - R Orvieto
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Y Cohen
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| |
Collapse
|
6
|
Abstract
Premature ovarian insufficiency (POI) is a clinical syndrome defined by loss of ovarian activity before the age of 40 years and has a potentially devastating effect upon women's health, both physically and psychologically. An underlying autoimmune disease has been identified in approximately 20% of patients with POI, the most common of which are disorders of the thyroid and adrenal glands. Nevertheless, in the majority of cases, the etiology is unknown. The damage mechanism to the ovary is usually caused by antibodies, and autoimmune POI is usually characterized by cellular infiltration of the theca cells of growing follicles by various inflammatory cells. Yet, other various factors and proteins of unknown clinical significance are present. The major diagnostic tool for otherwise idiopathic POI is the presence of autoantibodies against various ovarian components that strongly support the option of autoimmune etiology of POI. Treatment of the underlying cause of POI is the main strategy, although immunosuppressive therapy should be considered in a selected population of well-defined autoimmune POI and, as in idiopathic POI, in whom the resumption of ovarian activity is possible.
Collapse
Affiliation(s)
- Noam Domniz
- Dept. Obstetrics and Gynecology, Sheba Medical Center, Tel Aviv University, Tel Hashomer, 52651, Israel.
| | - Dror Meirow
- Dept. Obstetrics and Gynecology, Sheba Medical Center, Tel Aviv University, Tel Hashomer, 52651, Israel
| |
Collapse
|
7
|
Domniz N, Ries-Levavi L, Cohen Y, Marom-Haham L, Berkenstadt M, Pras E, Glicksman A, Tortora N, Latham GJ, Hadd AG, Nolin SL, Elizur SE. Absence of AGG Interruptions Is a Risk Factor for Full Mutation Expansion Among Israeli FMR1 Premutation Carriers. Front Genet 2018; 9:606. [PMID: 30619448 PMCID: PMC6300753 DOI: 10.3389/fgene.2018.00606] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 11/19/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Fragile X syndrome (FXS) is a common form of X-linked intellectual and developmental disability with a prevalence of 1/4000-5000 in males and 1/6000-8000 in females. Most cases of the syndrome result from expansion of a premutation (55-200 CGGs) to a full mutation (>200 CGGs) repeat located in the 5' untranslated region of the fragile X mental retardation (FMR1) gene. The risk for full mutation expansions increases dramatically with increasing numbers of CGG repeats. Recent studies, however, revealed AGG interruptions within the repeat area function as a "protective factor" decreasing the risk of intergenerational expansion. Materials and Methods: This study was conducted to validate the relevance of AGG analysis for the ethnically diverse Israeli population. To increase the accuracy of our results, we combined results from Israel with those from the New York State Institute for Basic Research in Developmental Disabilities (IBR). To the best of our knowledge this is the largest cohort of different ethnicities to examine risks of unstable transmissions and full mutation expansions among FMR1 premutation carriers. Results: The combined data included 1471 transmissions of maternal premutation alleles: 369 (25.1%) stable and 1,102 (74.9%) unstable transmissions. Full mutation expansions were identified in 20.6% (303/1471) of transmissions. A total of 97.4% (388/397) of transmissions from alleles with no AGGs were unstable, 79.6% (513/644) in alleles with 1 AGG and 46.7% (201/430) in alleles with 2 or more AGGs. The same trend was seen with full mutation expansions where 40% (159/397) of alleles with no AGGs expanded to a full mutation, 20.2% (130/644) for alleles with 1 AGG and only 3.2% (14/430) in alleles with 2 AGGs or more. None of the alleles with 3 or more AGGs expanded to full mutations. Conclusion: We recommend that risk estimates for FMR1 premutation carriers be based on AGG interruptions as well as repeat size in Israel and worldwide.
Collapse
Affiliation(s)
- Noam Domniz
- IVF Unit, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Ries-Levavi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Danek Genetic Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Yoram Cohen
- IVF Unit, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lilach Marom-Haham
- IVF Unit, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Berkenstadt
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Danek Genetic Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Elon Pras
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Danek Genetic Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Anne Glicksman
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY, United States
| | - Nicole Tortora
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY, United States
| | | | | | - Sarah L Nolin
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY, United States
| | - Shai E Elizur
- IVF Unit, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
8
|
Domniz N, Ries-Levavi L, Marom Haham L, Berkenstadt M, Orvieto R, Elizur S, Cohen Y. Absence of AGG interruptions is a risk factor for a full mutation expansion among Israeli FMR1 premutation carriers. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.184] [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]
|
9
|
Haham LM, Avrahami I, Domniz N, Ries-Levavi L, Berkenstadt M, Orvieto R, Cohen Y, Elizur SE. Preimplantation genetic diagnosis versus prenatal diagnosis-decision-making among pregnant FMR1 premutation carriers. J Assist Reprod Genet 2018; 35:2071-2075. [PMID: 30136016 DOI: 10.1007/s10815-018-1293-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/16/2018] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To detect which factors influence decision-making among pregnant FMR1 premutation carriers regarding the preferred mode of genetic diagnosis: IVF-PGT-M (in vitro fertilization with preimplantation genetic testing for monogenic gene diseases), or CVS (chorionic villus sampling), or AC (amniocentesis) after spontaneous conception. METHODS In Israel FMR1 premutation preconception genetic screening is offered, free of charge, to every woman in her reproductive years. FMR1 premutation carriers with ≥ 70 CGG repeats, or a history of FXS offspring, are offered IVF-PGT-M. This is a historical cohort study including all pregnant FMR1 premutation carriers who underwent prenatal diagnosis between the years 2011 and 2016 at a tertiary medical center. Data were collected from electronic charts and through phone interviews. RESULTS One hundred seventy-five women with high-risk pregnancies who were offered IVF-PGT-M were evaluated. In 37 pregnancies (21%), the women decided to undergo IVF-PGT-M. Using the generalized estimating equations (GEE) statistical method including seven parameters, we found that previous termination of pregnancy due to FXS and advanced woman's age were significantly associated with making the decision to undergo IVF-PGT-M. Previously failed IVF was the most significant parameter in a woman's decision not to undergo IVF-PGT-M. CONCLUSION The most dominant factor affecting the decision of FMR1 premutation carriers to choose spontaneous conception with prenatal diagnosis versus IVF-PGT-M is a previous experience of failed IVF treatments. Women whose IVF treatments failed in the past tended to try to conceive naturally and later, during the course of the pregnancy, perform CVS or AC. Conversely, women who previously experienced a termination of pregnancy (TOP) due to an affected fetus, and older women, preferred to undergo IVF-PGT-M procedures.
Collapse
Affiliation(s)
| | | | - Noam Domniz
- IVF Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Liat Ries-Levavi
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Berkenstadt
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raoul Orvieto
- IVF Unit, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoram Cohen
- IVF Unit, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai E Elizur
- IVF Unit, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
10
|
Shmuely H, Domniz N, Yahav J. Non-pharmacological treatment of Helicobacter pylori. World J Gastrointest Pharmacol Ther 2016; 7:171-178. [PMID: 27158532 PMCID: PMC4848239 DOI: 10.4292/wjgpt.v7.i2.171] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/12/2015] [Accepted: 02/16/2016] [Indexed: 02/06/2023] Open
Abstract
Many food and plant extracts have shown in vitro anti-Helicobacter pylori (H. pylori) activity, but are less effective in vivo. The anti-H. pylori effects of these extracts are mainly permeabilitization of the membrane, anti-adhesion, inhibition of bacterial enzymes and bacterial grown. We, herein, review treatment effects of cranberry, garlic, curcumin, ginger and pistacia gum against H. pylori in both in vitro, animal studies and in vivo studies.
Collapse
|
11
|
Weissman O, Domniz N, Petashnick YR, Gilboa D, Raviv T, Barzilai L, Farber N, Harats M, Winkler E, Haik J. Corrigendum: Examining the Correlation between Objective Injury Parameters, Personality Traits and Adjustment Measures among Burn Victims. Front Public Health 2016; 4:1. [PMID: 26870721 PMCID: PMC4735396 DOI: 10.3389/fpubh.2016.00001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 01/04/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Oren Weissman
- The Burn Unit, Department of Plastic and Reconstructive Surgery, Sheba Medical Center , Ramat Gan , Israel
| | - Noam Domniz
- The Burn Unit, Department of Plastic and Reconstructive Surgery, Sheba Medical Center , Ramat Gan , Israel
| | | | - Dalia Gilboa
- Psychology Service, Sheba Medical Center (Affiliated to Sackler School of Medicine, Tel-Aviv University) , Ramat Gan , Israel
| | - Tal Raviv
- Department of Plastic and Reconstructive Surgery, Assaf Harofeh Medical Center (Affiliated to Sackler School of Medicine, Tel-Aviv University) , Tzrifin , Israel
| | - Liran Barzilai
- The Burn Unit, Department of Plastic and Reconstructive Surgery, Sheba Medical Center , Ramat Gan , Israel
| | - Nimrod Farber
- The Burn Unit, Department of Plastic and Reconstructive Surgery, Sheba Medical Center , Ramat Gan , Israel
| | - Moti Harats
- The Burn Unit, Department of Plastic and Reconstructive Surgery, Sheba Medical Center , Ramat Gan , Israel
| | - Eyal Winkler
- The Burn Unit, Department of Plastic and Reconstructive Surgery, Sheba Medical Center , Ramat Gan , Israel
| | - Josef Haik
- The Burn Unit, Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Ramat Gan, Israel; The Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel
| |
Collapse
|
12
|
Barzilai L, Harats M, Wiser I, Weissman O, Domniz N, Glassberg E, Stavrou D, Zilinsky I, Winkler E, Hiak J. Characteristics of Improvised Explosive Device Trauma Casualties in the Gaza Strip and Other Combat Regions: The Israeli Experience. Wounds 2015; 27:209-214. [PMID: 26284374] [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: 06/04/2023]
Abstract
OBJECTIVE Low-intensity conflict is characterized in asymmetrical conventional and nonconventional warfare. The use of improvised explosive devices (IEDs) in the Israeli-Palestinian conflict has evolved over the past few decades to include the addition of diesel, biological agents, shrapnel, and nitroglycerin to the explosive content. Due to its nature and mechanism, an IED injury might present as a multidimensional injury, impairing numerous systems and organs. MATERIALS AND METHODS The authors present a case series of 5 Israeli Defense Forces (IDF) soldiers wounded by an IED presenting a typical and similar pattern of burns to their faces, trunks, and limbs, in addition to ocular, ear/nose/throat, and orthopedic injuries. An analysis of the experience in treating the aforementioned injuries is included. RESULTS Improvement in casualties' burns and traumatic tattoos was observed following debridement, aggressive scrubbing with or without dermabrasion, and conservative local dressing treatment protocol. The authors found a positive correlation between improvement degree and treatment timing. Injury pattern was correlative to the protective gear worn by the soldiers. Wearing protective eye gear and wearing ceramic vests can diminish the extent of IED injuries, while creating typical patterns of injuries to be treated. CONCLUSION Based on these experiences, such injuries should be brought to a trauma center as soon as possible. Treating multidimensional trauma should be done in a facility with abilities to treat head injuries, eye injuries, penetrating injuries, blast injuries, and burns. Such specialized disciplines and facilities that have past experience with IEDs and war injuries are able to assess and treat these injuries in a more dedicated manner, resulting in better long-term rehabilitation.
Collapse
Affiliation(s)
- Liranr Barzilai
- Department of Plastic and Reconstructive Surgery and the Burn Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Moti Harats
- Department of Plastic and Reconstructive Surgery and the Burn Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Itay Wiser
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel; and 3Department of Surgery, A. Meir Medical Center, Kfar Saba, Israel
| | - Oren Weissman
- Department of Plastic and Reconstructive Surgery and the Burn Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Noam Domniz
- Department of Plastic and Reconstructive Surgery and the Burn Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Elon Glassberg
- Department of Surgery, A. Meir Medical Center, Kfar Saba, Israel
| | - Demetris Stavrou
- Department of Plastic and Reconstructive Surgery and the Burn Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Issac Zilinsky
- Department of Plastic and Reconstructive Surgery and the Burn Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Eyal Winkler
- Department of Plastic and Reconstructive Surgery and the Burn Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Josef Hiak
- Department of Plastic and Reconstructive Surgery and the Burn Unit, Sheba Medical Center, Tel Hashomer, Israel
| |
Collapse
|
13
|
Weissman O, Domniz N, Petashnick YR, Gilboa D, Raviv T, Barzilai L, Farber N, Harats M, Winkler E, Haik J. Examining the Correlation between Objective Injury Parameters, Personality Traits, and Adjustment Measures among Burn Victims. Front Public Health 2015; 3:49. [PMID: 25874193 PMCID: PMC4379611 DOI: 10.3389/fpubh.2015.00049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 03/05/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Burn victims experience immense physical and mental hardship during their process of rehabilitation and regaining functionality. We examined different objective burn-related factors as well as psychological ones, in the form of personality traits that may affect the rehabilitation process and its outcome. OBJECTIVE To assess the influence and correlation of specific personality traits and objective injury-related parameters on the adjustment of burn victims post-injury. METHODS Sixty-two male patients admitted to our burn unit due to burn injuries were compared with 36 healthy male individuals by use of questionnaires to assess each group's psychological adjustment parameters. Multivariate and hierarchical regression analysis was conducted to identify differences between the groups. RESULTS A significant negative correlation was found between the objective burn injury severity (e.g., total body surface area and burn depth) and the adjustment of burn victims (p < 0.05, p < 0.001, Table 3). Moreover, patients more severely injured tend to be more neurotic (p < 0.001), and less extroverted and agreeable (p < 0.01, Table 4). CONCLUSION Extroverted burn victims tend to adjust better to their post-injury life while the neurotic patients tend to have difficulties adjusting. This finding may suggest new tools for early identification of maladjustment-prone patients and therefore provide them with better psychological support in a more dedicated manner.
Collapse
Affiliation(s)
- Oren Weissman
- The Burn Unit, Department of Plastic and Reconstructive Surgery, Sheba Medical Center (Affiliated to Sackler School of Medicine, Tel-Aviv University), Ramat Gan, Israel
| | - Noam Domniz
- The Burn Unit, Department of Plastic and Reconstructive Surgery, Sheba Medical Center (Affiliated to Sackler School of Medicine, Tel-Aviv University), Ramat Gan, Israel
| | | | | | - Tal Raviv
- Department of Plastic and Reconstructive Surgery, Assaf Harofeh Medical Center (Affiliated to Sackler School of Medicine, Tel-Aviv University), Tzrifin, Israel
| | - Liran Barzilai
- The Burn Unit, Department of Plastic and Reconstructive Surgery, Sheba Medical Center (Affiliated to Sackler School of Medicine, Tel-Aviv University), Ramat Gan, Israel
| | - Nimrod Farber
- The Burn Unit, Department of Plastic and Reconstructive Surgery, Sheba Medical Center (Affiliated to Sackler School of Medicine, Tel-Aviv University), Ramat Gan, Israel
| | - Moti Harats
- The Burn Unit, Department of Plastic and Reconstructive Surgery, Sheba Medical Center (Affiliated to Sackler School of Medicine, Tel-Aviv University), Ramat Gan, Israel
| | - Eyal Winkler
- The Burn Unit, Department of Plastic and Reconstructive Surgery, Sheba Medical Center (Affiliated to Sackler School of Medicine, Tel-Aviv University), Ramat Gan, Israel
| | - Josef Haik
- The Burn Unit, Department of Plastic and Reconstructive Surgery, Sheba Medical Center (Affiliated to Sackler School of Medicine, Tel-Aviv University), Ramat Gan, Israel
- The Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel
| |
Collapse
|
14
|
Hiersch L, Yogev Y, Domniz N, Meizner I, Bardin R, Melamed N. The role of cervical length in women with threatened preterm labor: is it a valid predictor at any gestational age? Am J Obstet Gynecol 2014; 211:532.e1-9. [PMID: 24907701 DOI: 10.1016/j.ajog.2014.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 04/14/2014] [Accepted: 06/06/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether the predictive accuracy of sonographic cervical length (CL) for preterm delivery (PTD) in women with threatened preterm labor (PTL) is related to gestational age (GA) at presentation. STUDY DESIGN A retrospective cohort study of all women with singleton pregnancies who presented with PTL at less than 34 + 0 weeks and underwent sonographic measurement of CL in a tertiary medical center between 2007 and 2012. The predictive accuracy of CL for PTD was stratified by GA at presentation. RESULTS Overall, 1077 women who presented with PTL have had sonographic measurement of CL and met the study inclusion criteria. Of those, 223 (20.7%) presented at 24 + 0-26 + 6 weeks (group 1), 274 (25.4%) at 27 + 0-29 + 6 weeks (group 2), 283 (26.3%) at 30 + 0-31 + 6 weeks (group 3), and 297 (27.6%) at 32 + 0-33 + 6 weeks (group 4). The overall performance CL as a predictive test for PTD was similar in the 4 GA groups, as reflected by the similar degree of correlation between CL with the examination to delivery interval (r = 0.27, r = 0.26, r = 0.28, and r = 0.29, respectively, P = .8), the similar area under the receiver-operator characteristic curve (0.641-0.690, 0.631-0.698, 0.643-0.654, and 0.678-0.698, respectively, P = .7), and a similar decrease in the risk of PTD of 5-10% for each additional millimeter of CL. The optimal cutoff of CL, however, was affected by GA at presentation, so that a higher cutoff of CL was needed to achieve a target negative predictive value for delivery within 14 days from presentation for women who presented later in pregnancy. The optimal thresholds to maximize the negative predictive value for delivery within 14 days were 36 mm, 32.5 mm, 24 mm and 20.5 mm for women who presented at 32 + 0 to 33 + 6 weeks, 30 + 0 to 31 + 6 weeks, 27 + 0 to 29 + 6 weeks and 24 + 0 to 26 + 6, respectively. CONCLUSION CL has modest predictive accuracy in women with threatened PTL, regardless of GA at presentation. However, the optimal cutoff of CL for the purpose of clinical decision making in women with PTL needs to be adjusted based on GA at presentation.
Collapse
Affiliation(s)
- Liran Hiersch
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Domniz
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Meizner
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Bardin
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Melamed
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
15
|
Abstract
OBJECTIVE The aim of this article was to evaluate the prevalence of Helicobacter pylori infection in patients diagnosed with advanced colorectal neoplasia undergoing a colonoscopy compared to patients without neoplasia. MATERIAL AND METHODS This cross-sectional study investigated the association of neoplastic lesions diagnosed on colonoscopy with H. pylori infection in a consecutive series of subjects who had undergone a pancolonoscopy in a single academic medical center. All patients were tested by ELISA and the immunoblot technique for serum anti-H. pylori and CagA protein IgG antibodies. Multivariate analyses were adjusted for potential-relevant confounders, including age, sex, smoking, childhood socioeconomic status, and family history of colorectal cancer. RESULTS Two hundred and seventy-three patients were included in the study: 75% (84/112), diagnosed with neoplastic colorectal lesions and 48% (77/161) without neoplastic lesions, were found to be seropositive for H. pylori infection (p < 0.001). H. pylori infection was found in 66/77 (86 %) patients with advanced neoplasia, 18/35 (51%) patients with nonadvanced neoplasia, and 48% (77/161) patients without neoplasia (p < 0.001). In the adjusted analysis, H. pylori infection was found to be associated with advanced colorectal neoplasia (odds ratio, OR 9.57; 95% CI 4.31-21.2; p < 0.001) and CRC (OR 7.98;95% CI 3.16-20.16; p < 0.001). There was no association in patients who were CagA positive. CONCLUSION H. pylori infection is associated with the development of advanced colorectal neoplasia. More studies are needed to confirm our findings.
Collapse
Affiliation(s)
- Haim Shmuely
- Department of Internal Medicine D, Kaplan Medical Center, Rehovot and the Faculty of Medicine, Hebrew University , Jerusalem , Israel
| | | | | | | | | |
Collapse
|
16
|
Domniz N, Perry ZH, Lantsberg L, Avinoach E, Mizrahi S, Kirshtein B. Slit versus non-slit mesh placement in total extraperitoneal inguinal hernia repair. World J Surg 2012; 35:2382-6. [PMID: 21935723 DOI: 10.1007/s00268-011-1251-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The goal of the present research was to study patients who underwent laparoscopic total extraperitoneal repair using slit and non-slit mesh placement. METHODS Patients who underwent laparoscopic inguinal hernia repair in our hospital between 2005 and 2009 were interviewed and examined. Surgery outcome, hernia recurrence, postoperative pain and time to return to normal physical activities, and surgery satisfaction were compared. RESULTS During the study period 389 consecutive patients underwent laparoscopic groin hernia repair: 387 by the total extraperitoneal (TEP) approach and 2 by the TAPP approach. Six of the TEP patients were converted to TAPP. Eighty-seven patients in the TEP group had slit mesh placement and 300 had non-slit mesh placement. Mean follow-up was 36 months (range: 6-66 months). At follow-up, 387 patients responded to a request for interview and 277 were examined. The overall recurrence rate was 4.7%, the incidence of constant postoperative pain was 1.3%, the presence of permanent testicular pain was 2.8%, and patient satisfaction with the surgery was 94.5%. A significantly lower recurrence rate was found in the slit mesh group than in the non-slit group (0.6% versus 5.9%; p < 0.003). There was no difference in the length of time until return to normal activities, patient satisfaction, and postoperative pain between the groups. Surgery time and the occurrence of testicular pain were significantly greater in the anatomic group. CONCLUSIONS Total extraperitoneal inguinal hernia repair with slit mesh placement is a safe technique with a very low recurrence rate and is superior to non-slit mesh positioning.
Collapse
Affiliation(s)
- Noam Domniz
- Department of Surgery "A", Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, POB 151, 84101, Beer-Sheva, Israel
| | | | | | | | | | | |
Collapse
|
17
|
Zilinsky I, Farber N, Weissman O, Israeli H, Haik J, Domniz N, Winkler E. Defying consensus: correct sizing of full-thickness skin grafts. J Drugs Dermatol 2012; 11:520-523. [PMID: 22453591] [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: 05/31/2023]
Abstract
BACKGROUND Full-Thickness skin grafts are routinely used to reconstruct defects throughout the body. When planning the size of the graft, the surgeon usually copies a template from the defect and measures the graft to fit its full dimensions. This may lead to an oversized graft, resulting an unaesthetic outcome. OBJECTIVE To evaluate discrepancy in size between the excised full-thickness skin and the excision (donor) site. METHODS Data from 20 cases of full-thickness excisions was reviewed and analyzed. RESULTS There was a considerable difference in length of both the short and long axes between the excised full-thickness skin and the excision site. CONCLUSIONS The initial size of a full-thickness skin graft should be smaller than the defect it is planned to cover.
Collapse
|