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Jayaram A, Collier CH, Martin JN. Preterm parturition and pre-eclampsia: The confluence of two great gestational syndromes. Int J Gynaecol Obstet 2020; 150:10-16. [PMID: 32524594 DOI: 10.1002/ijgo.13173] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/15/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Preterm birth (PTB) and pre-eclampsia independently, and frequently concurrently, adversely affect the pregnancy outcomes of millions of mothers and infants worldwide each year. OBJECTIVES To fill the gap between PTB and pre-eclampsia, which continue to constitute the two most important current global challenges to maternal and perinatal health. METHODS Pubmed, Embase, and Cochrane databases were searched from inception until December 2019 using the terms spontaneous PTB (SPTB), indicated preterm delivery (IPTD), early-onset pre-eclampsia, and pre-eclampsia. RESULTS History of PTB and pre-eclampsia were the strongest risk factors contributing to the occurrence of SPTB or IPTB. The risk of PTB and pre-eclampsia among non-Hispanic African American women was higher than the rate among all other racial/ethnic groups in the United States. Low-dose aspirin (LDA) has been reported to reduce the risk of pre-eclampsia by at least 10% and PTB by at least 14%. Lastly, women and their fetuses who develop early-onset pre-eclampsia are at higher risk for developing hypertension and cardiovascular disease later in life. CONCLUSIONS While better clarity is needed, efforts to coordinate prevention of both PTB and pre-eclampsia, even though imperfect, are critically important as part of any program to make motherhood as safe as possible.
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Affiliation(s)
- Aswathi Jayaram
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Charlene H Collier
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - James N Martin
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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Hogg JP, Szczepanski JL, Collier C, Martin JN. Immediate postpartum management of patients with severe hypertensive disorders of pregnancy: pathophysiology guiding practice. J Matern Fetal Neonatal Med 2020; 35:2009-2019. [PMID: 32519919 DOI: 10.1080/14767058.2020.1776251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Developing clinically-focused evidence and experience-based approaches to improve maternity care is a national priority. Safety and quality collaborative initiatives related to management of hypertensive disorders of pregnancy are vital in the implementation of improved care. We reviewed the obstetric literature to construct a concise summary of the core pathophysiologic issues, practice principles and clinical interventions which are foundational for physicians providing immediate postpartum care for patients with severe pregnancy-related hypertension (including those with eclampsia, HELLP syndrome, and superimposed preeclampsia inclusive of those with gestational hypertension that develop severe range blood pressures). While based largely upon the American College of Obstetrics and Gynecology (ACOG) Hypertension Task Force Guidelines released in 2013 as well as updated 2018 guidelines set forth by ACOG for hypertensive disorders of pregnancy, this summary goes beyond the basic safety bundles for hypertension management and lays a pathophysiologic foundation for the immediate postpartum care of patients with severe hypertensive disorders of pregnancy.
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Affiliation(s)
- James P Hogg
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jamie L Szczepanski
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Charlene Collier
- Department of Obstetrics and Gynecology, Division of Women's Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - James N Martin
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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Barton JR, Woelkers DA, Newman RB, Combs CA, How HY, Boggess KA, Martin JN, Kupfer K, Sibai BM. Placental growth factor predicts time to delivery in women with signs or symptoms of early preterm preeclampsia: a prospective multicenter study. Am J Obstet Gynecol 2020; 222:259.e1-259.e11. [PMID: 31518550 DOI: 10.1016/j.ajog.2019.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is a robust association between altered angiogenic factor concentrations, which includes placental growth factor and clinically recognized preeclampsia. Alterations in concentrations of angiogenic factors precede the clinical onset of preeclampsia by several weeks. The temporal relationship between the measured angiogenic factors and the time to delivery in women with suspected preeclampsia at <35 weeks gestation, however, remains to be clarified. OBJECTIVE The purposes of this study were to examine the relationship between placental growth factor and time to delivery in women at <35 weeks gestation with signs or symptoms of preeclampsia and to compare the performance of placental growth factor to other clinical markers for prediction of time to delivery in preeclampsia. STUDY DESIGN Women with signs or symptoms of preeclampsia between 20.0 and 35.0 weeks gestation were enrolled in a prospective, observational study at 24 centers. Blood was collected at presentation for placental growth factor, and subjects were evaluated and treated according to local protocols. Clinical outcomes were obtained, and all final diagnoses were adjudicated by an independent expert panel according to 2013 American College of Obstetricians and Gynecologists' Hypertension in Pregnancy criteria. Placental growth factor was measured retrospectively on the Alere, Inc, triage platform. A normal placental growth factor was defined as >100 pg/mL; the assay's limit of detection is 12 pg/mL. Two-by-2 tables were constructed for comparison of test outcomes that included negative predictive value; time-to-delivery was analyzed by survival curves and Cox regression. RESULTS Seven hundred fifty-three subjects were enrolled; 538 (71%) had a final diagnosis of preeclampsia; 542 (72%) delivered at <37 weeks gestation, and 358 (47%) delivered at <34 weeks gestation. Among the 279 women (37%) with a normal placental growth factor at presentation, the negative predictive value for preeclampsia delivered within 14 days or within 7 days was 90% and 93%, respectively. Compared with women with normal placental growth factor, women with placental growth factor ≤100 pg/mL have a hazard ratio of 7.17 (confidence interval, 5.08-10.13) in Cox regression for time to delivery after adjustment for both gestational age at enrollment and the final diagnosis of preeclampsia. The placental growth factor levels of normal (>100 pg/mL), low (12-100 pg/mL), and very low (<12 pg/mL) have well-separated distributions of time to delivery, with median values of 45, 10, and 2 days, respectively. Subjects with placental growth factor ≤100 pg/mL have a perinatal death rate of 5.7% and a small-for-gestational-age rate of 51.7%; subjects with placental growth factor >100 pg/mL have a perinatal death rate of 0% (no observations in this cohort) and an a small-for-gestational-age rate of 16.8%. CONCLUSION In women with suspected preeclampsia at <35.0 weeks gestation, a low placental growth factor was correlated strongly with preterm delivery independent of a diagnosis of preeclampsia or gestational age at presentation, whereas a normal placental growth factor was associated with pregnancy prolongation, even in patients who ultimately had a final diagnosis of preeclampsia. This suggests that placental growth factor levels are superior to clinical markers in the prediction of adverse pregnancy in women with suspected preeclampsia.
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Palomaki GE, Martin JN, Karumanchi SA, Poon LC. Updates on Screening, Prevention, Treatment, and Genetic Markers for Preeclampsia. Clin Chem 2018; 64:1684-1689. [PMID: 30201802 DOI: 10.1373/clinchem.2018.289801] [Citation(s) in RCA: 1] [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] [Received: 06/21/2018] [Accepted: 07/30/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Glenn E Palomaki
- Professor of Pathology and Laboratory Medicine, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, RI;
| | - James N Martin
- Professor Emeritus of Obstetrics, Gynecology & Maternal-Fetal Medicine, The University of Mississippi Medical Center, Jackson, MS
| | - S Ananth Karumanchi
- Professor of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA
| | - Liona C Poon
- Associate Professor of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, SAR
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Weinroth MD, Carlson CR, Martin JN, Metcalf JL, Morley PS, Belk KE. Rapid Communication: 16S ribosomal ribonucleic acid characterization of liver abscesses in feedlot cattle from three states in the United States. J Anim Sci 2018; 95:4520-4525. [PMID: 29108068 DOI: 10.2527/jas2017.1743] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Liver abscesses are a major economic burden to beef producers. Although a few causative organisms have been cultured from purulent material, the full polymicrobial diversity of liver abscesses has not been reported. The objective of this study was to characterize purulent material collected from liver abscess in beef cattle produced in different production systems in 3 cattle producing states in the United States using 16S rRNA gene sequencing. Differences between purulent material microbial communities among geographic region of feeding and application of a common antimicrobial were also investigated. Cattle included in the study were fed in California (dairy type) and Colorado and Texas (both beef type). Liver abscesses from a cross section of feedlots, geographic areas, and tylosin phosphate-administered groups were collected at harvest; DNA from 34 liver abscess samples was extracted; and the V4 region of the 16S rRNA gene was amplified and sequenced. Sequences were classified into 5 phyla, 13 classes, and 17 orders in the domain Bacteria. The phyla identified included Bacteroidetes (35.2% of reads), Proteobacteria (28.6%), Fusobacteria (18.2%), Firmicutes (12.4%), and Actinobacteria (5.5%). Sequences matching the genera and , which have previously been identified as causative agents in liver abscesses, were both present in the abscess bacterial communities at a relative abundance of 15.1 and 3.2%, respectively, of the overall relative abundance. Furthermore, 3 of the most common phyla were Gram-negative bacteria. An analysis-of-similarities test was conducted on Euclidean distances to assess differences between cattle treated and not treated with tylosin as well as to assess differences between geographic regions. Geographical region and treatment with tylosin did affect the microbiome ( = 0.002 and = 0.026 respectively); however, a more robust sample scheme is needed to explore these differences. To our knowledge, this is the first publication describing the complex community of liver purulent material using next generation sequencing in cattle. These data provide a framework for research on a more targeted approach to liver abscess prevention and treatment.
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Boykin CA, Eastwood LC, Harris MK, Hale DS, Kerth CR, Griffin DB, Arnold AN, Hasty JD, Belk KE, Woerner DR, Delmore RJ, Martin JN, VanOverbeke DL, Mafi GG, Pfeiffer MM, Lawrence TE, McEvers TJ, Schmidt TB, Maddock RJ, Johnson DD, Carr CC, Scheffler JM, Pringle TD, Stelzleni AM, Gottlieb J, Savell JW. National Beef Quality Audit - 2016: Survey of carcass characteristics through instrument grading assessments. J Anim Sci 2017; 95:3003-3011. [PMID: 28727107 DOI: 10.2527/jas.2017.1544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The instrument grading assessment portion of the National Beef Quality Audit (NBQA) - 2016 allows the unique opportunity to evaluate beef carcass traits over the course of a year. One week of instrument grading data was collected each month from 5 beef processing corporations encompassing 18 facilities from January 2016 through December 2016 ( = 4,544,635 carcasses). Mean USDA yield grade (YG) was 3.1 with 1.37 cm fat thickness (FT), 88.9 cm LM area, 393.6 kg HCW, and 2.1% KPH. Frequency distribution of USDA YG was 9.5% YG 1, 34.6% YG 2, 38.8% YG 3, 14.6% YG 4, and 2.5% YG 5. Increases in HCW and FT since the NBQA-2011 were major contributors to differences in mean YG and the (numerically) increased frequency of YG 3, 4, and 5 carcasses found in the current audit. Mean marbling score was Small, and the distribution of USDA quality grades was 4.2% Prime, 71.4% Choice, 21.7% Select, and 2.7% other. Frequency of carcasses grading Prime on Monday (6.43%) was numerically higher than the average frequency of carcasses grading Prime overall (4.2%). Monthly HCW means were 397.6 kg in January, 397.2 kg in February, 396.5 kg in March, 389.3 kg in April, 384.8 kg in May, 385.0 kg in June, 386.1 kg in July, 394.1 kg in August, 399.1 kg in September, 403.9 kg in October, 406.5 kg in November, and 401.9 kg in December. Monthly mean marbling scores were Small in January, Small in February, Small in March, Small in April, Small in May, Small in June, Small in July, Small in August, Small in September, Small in October, Small in November, and Small in December. Both mean HCW and mean marbling score declined in the months of May and June. The month with the greatest numerical frequency of dark cutters was October (0.74%). Comparison of overall data from in-plant carcass and instrument grading assessments revealed close alignment of information, especially for YG (3.1 for in-plant assessment versus 3.1 for instrument grading) and marbling (Small for in-plant assessment versus Small for instrument grading). These findings allow the beef industry access to the greatest volume of beef value-determining characteristics for the U.S. fed steer and heifer population than ever reported, resulting in potentially more precise targeting of future quality and consistency efforts.
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Boykin CA, Eastwood LC, Harris MK, Hale DS, Kerth CR, Griffin DB, Arnold AN, Hasty JD, Belk KE, Woerner DR, Delmore RJ, Martin JN, VanOverbeke DL, Mafi GG, Pfeiffer MM, Lawrence TE, McEvers TJ, Schmidt TB, Maddock RJ, Johnson DD, Carr CC, Scheffler JM, Pringle TD, Stelzleni AM, Gottlieb J, Savell JW. National Beef Quality Audit-2016: In-plant survey of carcass characteristics related to quality, quantity, and value of fed steers and heifers. J Anim Sci 2017; 95:2993-3002. [PMID: 28727109 DOI: 10.2527/jas.2017.1543] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The National Beef Quality Audit (NBQA)-2016 used in-plant cooler assessments to benchmark the current status of the fed steer and heifer beef industry in the United States. In-plant cooler assessments ( = 9,106 carcasses) were conducted at 30 facilities, where approximately 10% of a single day's production were evaluated for USDA quality grade (QG) and yield grade (YG) factors. Frequencies of evaluated traits were 66.5% steer and 33.4% heifer sex classes and 82.9% native, 15.9% dairy-type, and 1.2% estimated breed types. Mean USDA YG factors were 1.42 cm for adjusted fat thickness, 89.5 cm for LM area, 390.3 kg for HCW, and 1.9% for KPH. Mean USDA YG was 3.1, with a frequency distribution of 9.6% YG 1, 36.7% YG 2, 39.2% YG 3, 12.0% YG 4, and 2.5% YG 5. Mean USDA QG traits were Small for marbling score, A for overall maturity, A55 for lean maturity, and A for skeletal maturity. Mean USDA QG was Select with a frequency distribution of QG of 3.8% Prime, 67.3% Choice, 23.2% Select, and 5.6% lower score. Lower score included dark cutter (1.9%), blood splash (0.1%), and hard bone, which are USDA overall maturity scores of C or older (1.8%). Marbling score distributions were 0.85% Slightly Abundant or greater, 7.63% Moderate, 23.54% Modest, 39.63% Small, 23.62% Slight, and 0.83% Traces or less. Carcasses that were Choice or Select and USDA YG 2 or 3 accounted for 70.7% of the carcasses evaluated. Compared with the previous NBQA, we found a numerical increase in mean USDA YG, USDA QG, adjusted fat thickness, HCW, LM area, and marbling score with an increase in dairy-type carcasses and percentage of carcasses grading USDA Prime and Choice as well as frequency of USDA YG 4 and 5. The findings from this study will be used by all segments of the industry to understand and improve the quality of fed steer and heifer beef that is being produced.
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Harris MK, Eastwood LC, Boykin CA, Arnold AN, Gehring KB, Hale DS, Kerth CR, Griffin DB, Savell JW, Belk KE, Woerner DR, Hasty JD, Delmore RJ, Martin JN, Lawrence TE, McEvers TJ, VanOverbeke DL, Mafi GG, Pfeiffer MM, Schmidt TB, Maddock RJ, Johnson DD, Carr CC, Scheffler JM, Pringle TD, Stelzleni AM. National Beef Quality Audit-2016: Transportation, mobility, live cattle, and carcass assessments of targeted producer-related characteristics that affect value of market cows and bulls, their carcasses, and associated by-products. Transl Anim Sci 2017; 1:570-584. [PMID: 32704679 PMCID: PMC7204971 DOI: 10.2527/tas2017.0063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/09/2017] [Indexed: 11/25/2022] Open
Abstract
The National Beef Quality Audit–2016 marks the fourth iteration in a series assessing the quality of live beef and dairy cows and bulls and their carcass counterparts. The objective was to determine the incidence of producer-related defects, and report cattle and carcass traits associated with producer management. Conducted from March through December of 2016, trailers (n = 154), live animals (n = 5,470), hide-on carcasses (n = 5,278), and hide-off hot carcasses (n = 5,510) were surveyed in 18 commercial packing facilities throughout the United States. Cattle were allowed 2.3 m2 of trailer space on average during transit indicating some haulers are adhering to industry handling guidelines for trailer space requirements. Of the mixed gender loads arriving at processing facilities, cows and bulls were not segregated on 64.4% of the trailers surveyed. When assessed for mobility, the greatest majority of cattle surveyed were sound. Since the inception of the quality audit series, beef cows have shown substantial improvements in muscle. Today over 90.0% of dairy cows are too light muscled. The mean body condition score for beef animals was 4.7 and for dairy cows and bulls was 2.6 and 3.3, respectively. Dairy cattle were lighter muscled, yet fatter than the dairy cattle surveyed in 2007. Of cattle surveyed, most did not have horns, nor any visible live animal defects. Unbranded hides were observed on 77.3% of cattle. Carcass bruising was seen on 64.1% of cow carcasses and 42.9% of bull carcasses. However, over half of all bruises were identified to only be minor in severity. Nearly all cattle (98.4%) were free of visible injection-site lesions. Current results suggest improvements have been made in cattle and meat quality in the cow and bull sector. Furthermore, the results provide guidance for continued educational and research efforts for improving market cow and bull beef quality.
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Affiliation(s)
- M K Harris
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - L C Eastwood
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - C A Boykin
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - A N Arnold
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - K B Gehring
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - D S Hale
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - C R Kerth
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - D B Griffin
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - J W Savell
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - K E Belk
- Department of Animal Sciences, Colorado State University, Fort Collins 80523
| | - D R Woerner
- Department of Animal Sciences, Colorado State University, Fort Collins 80523
| | - J D Hasty
- Department of Animal Sciences, Colorado State University, Fort Collins 80523
| | - R J Delmore
- Department of Animal Sciences, Colorado State University, Fort Collins 80523
| | - J N Martin
- Department of Animal Sciences, Colorado State University, Fort Collins 80523
| | - T E Lawrence
- Beef Carcass Research Center- Department of Agricultural Sciences, West Texas A&M University, Canyon 79016
| | - T J McEvers
- Beef Carcass Research Center- Department of Agricultural Sciences, West Texas A&M University, Canyon 79016
| | - D L VanOverbeke
- Department of Animal Science, Oklahoma State University, Stillwater 74078
| | - G G Mafi
- Department of Animal Science, Oklahoma State University, Stillwater 74078
| | - M M Pfeiffer
- Department of Animal Science, Oklahoma State University, Stillwater 74078
| | - T B Schmidt
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln 68583
| | - R J Maddock
- Department of Animal Sciences, North Dakota State University, Fargo 58108
| | - D D Johnson
- Department of Animal Sciences, University of Florida, Gainesville 32611
| | - C C Carr
- Department of Animal Sciences, University of Florida, Gainesville 32611
| | - J M Scheffler
- Department of Animal Sciences, University of Florida, Gainesville 32611
| | - T D Pringle
- Department of Animal & Dairy Science, University of Georgia, Athens 30602
| | - A M Stelzleni
- Department of Animal & Dairy Science, University of Georgia, Athens 30602
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Parikh P, Sunesara I, Singh Multani S, Patterson B, Lutz E, Martin JN. Intra-incisional liposomal bupivacaine and its impact on postcesarean analgesia: a retrospective study. J Matern Fetal Neonatal Med 2017; 32:966-970. [PMID: 29065741 DOI: 10.1080/14767058.2017.1397118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The efficacy of long-acting intraincisional bupivacaine in reducing postoperative opioid use among women who have undergone a cesarean is currently unknown. MATERIALS AND METHODS This was a retrospective case-control study with a 1:1 allocation. We identified 40 patients in each group, for a total of 80. The treatment group was administered 266 mg of liposomal bupivacaine after completion of the cesarean and was compared to historical controls. Data regarding anesthesia administered, opioid consumption, nonsteroidal anti-inflammatory use, acetaminophen use, type of cesarean, reason for cesarean, and length of postoperative stay were recorded. RESULTS The treatment group used 41.51 mg of morphine equivalents, while the control group consumed 69.90 mg (p < .001); multivariate analysis demonstrated a mean difference of 26.52 mg (95%CI 12.76-40.28). Univariate analysis demonstrated mean difference in intravenous (IV) ketorolac (40.77 mg, p < .001) and IV acetaminophen (1333.33 mg, p < .001) was different and greater in the treatment group; this was controlled for in the multivariate model. There was no difference in oral and IV ibuprofen or oral acetaminophen use between groups. There were no differences between the type of anesthesia, length of stay, reason for cesarean, and classical sections between groups. CONCLUSIONS Incisional administration of liposomal bupivacaine may be an effective adjunct in reducing opioid use postoperatively and may be a useful adjunct within an enhanced recovery program.
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Affiliation(s)
- Pavan Parikh
- a Department of Obstetrics and Gynecology , the University of Mississippi Medical Center , Jackson , MS , USA
| | - Imran Sunesara
- a Department of Obstetrics and Gynecology , the University of Mississippi Medical Center , Jackson , MS , USA
| | - Sukhpreet Singh Multani
- a Department of Obstetrics and Gynecology , the University of Mississippi Medical Center , Jackson , MS , USA
| | - Brandy Patterson
- a Department of Obstetrics and Gynecology , the University of Mississippi Medical Center , Jackson , MS , USA.,b North Mississippi Medical Center , Tupelo , MS , USA
| | - Elizabeth Lutz
- a Department of Obstetrics and Gynecology , the University of Mississippi Medical Center , Jackson , MS , USA
| | - James N Martin
- a Department of Obstetrics and Gynecology , the University of Mississippi Medical Center , Jackson , MS , USA
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Hasty JD, Pfeifer MM, Eastwood LC, Gredell DA, Gifford CL, Levey JR, Cashman CM, Woerner DR, Martin JN, Delmore RJ, Griffin WB, VanOverbeke DL, Mafi GG, Boykin CA, Hale DS, Kerth CR, Griffin DB, Arnold AN, Savell JW, Pendell DL, Belk KE. National Beef Quality Audit-2016: Phase 1, Face-to-face interviews. Transl Anim Sci 2017; 1:320-332. [PMID: 32704657 PMCID: PMC7205349 DOI: 10.2527/tas2017.0039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 04/23/2017] [Accepted: 07/15/2017] [Indexed: 11/16/2022] Open
Abstract
The National Beef Quality Audit (NBQA) is conducted every 5 yr and was most recently again conducted in 2016. Face-to-face interviews gauged progress in quality associated with live cattle production using procedures first utilized in NBQA 2011. The 2016 NBQA was the first in which interviews concerning fed steers and heifers were combined with an audit of market cow and bull beef. Face-to-face interviews were designed to illicit definitions for beef quality, estimate willingness to pay (WTP) for quality attributes, establish relative importance rankings for important quality factors, and assess images, strengths, weaknesses, potential threats, and shifting trends in the beef industry since the 2011 audit. Individuals making purchasing decisions in 5 market sectors of the steer/heifer and cow/bull beef supply chain were interviewed, including packers (n = 36), retailers (including large and small supermarket companies and warehouse food sales companies; n = 35), food service operators (including quick-serve, full-service, and institutional establishments; n = 29), further processors (n = 64), and peripherally-related government and trade organizations (GTO; n = 30). Face-to-face interviews were conducted between January and November of 2016 using a designed dynamic routing system. Definitions (as described by interviewees) for 7 pre-determined quality factors, including: (1) How and where the cattle were raised, (2) Lean, fat, and bone, (3) Weight and size, (4) Visual characteristics, (5) Food safety, (6) Eating satisfaction, and (7) Cattle genetics were recorded verbatim and categorized into similar responses for analysis. Compared to NBQA-2011, a higher percentage of companies were willing to pay premiums for guaranteed quality attributes, but overall were willing to pay lower average premiums than the companies interviewed in 2011. Food safety had the highest share of preference among all interviewees, generating a double-digit advantage over any other quality factor. The 2 beef industries have an overall positive image among interviewees, and despite lingering weaknesses, product quality continued to be at the forefront of the strengths category for both steer and heifer beef and market cow and bull beef.
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Affiliation(s)
- J D Hasty
- Department of Animal Sciences, Colorado State University, Fort Collins 80523
| | - M M Pfeifer
- Department of Animal Science, Oklahoma State University, Stillwater 74078
| | - L C Eastwood
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - D A Gredell
- Department of Animal Sciences, Colorado State University, Fort Collins 80523
| | - C L Gifford
- Department of Animal Sciences, Colorado State University, Fort Collins 80523
| | - J R Levey
- Department of Animal Sciences, Colorado State University, Fort Collins 80523
| | - C M Cashman
- Department of Animal Sciences, Colorado State University, Fort Collins 80523
| | - D R Woerner
- Department of Animal Sciences, Colorado State University, Fort Collins 80523
| | - J N Martin
- Department of Animal Sciences, Colorado State University, Fort Collins 80523
| | - R J Delmore
- Department of Animal Sciences, Colorado State University, Fort Collins 80523
| | - W B Griffin
- Department of Animal Science, Oklahoma State University, Stillwater 74078
| | - D L VanOverbeke
- Department of Animal Science, Oklahoma State University, Stillwater 74078
| | - G G Mafi
- Department of Animal Science, Oklahoma State University, Stillwater 74078
| | - C A Boykin
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - D S Hale
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - C R Kerth
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - D B Griffin
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - A N Arnold
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - J W Savell
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - D L Pendell
- Department of Agricultural Economics, Kansas State University, Manhattan 66506
| | - K E Belk
- Department of Animal Sciences, Colorado State University, Fort Collins 80523
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Bernstein PS, Martin JN, Barton JR, Shields LE, Druzin ML, Scavone BM, Frost J, Morton CH, Ruhl C, Slager J, Tsigas EZ, Jaffer S, Menard MK. Consensus Bundle on Severe Hypertension During Pregnancy and the Postpartum Period. J Midwifery Womens Health 2017; 62:493-501. [PMID: 28697534 DOI: 10.1111/jmwh.12647] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 11/29/2022]
Abstract
Complications arising from hypertensive disorders of pregnancy are among the leading causes of preventable severe maternal morbidity and mortality. Timely and appropriate treatment has the potential to significantly reduce hypertension-related complications. To assist health care providers in achieving this goal, this patient safety bundle provides guidance to coordinate and standardize the care provided to women with severe hypertension during pregnancy and the postpartum period. This is one of several patient safety bundles developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. These safety bundles outline critical clinical practices that should be implemented in every maternity care setting. Similar to other bundles that have been developed and promoted by the Partnership, the hypertension safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. This commentary provides information to assist with bundle implementation.
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Bernstein PS, Martin JN, Barton JR, Shields LE, Druzin ML, Scavone BM, Frost J, Morton CH, Ruhl C, Slager J, Tsigas EZ, Jaffer S, Menard MK. Consensus Bundle on Severe Hypertension During Pregnancy and the Postpartum Period. J Obstet Gynecol Neonatal Nurs 2017; 46:776-787. [PMID: 28709727 DOI: 10.1016/j.jogn.2017.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Complications arising from hypertensive disorders of pregnancy are among the leading causes of preventable severe maternal morbidity and mortality. Timely and appropriate treatment has the potential to significantly reduce hypertension-related complications. To assist health care providers in achieving this goal, this patient safety bundle provides guidance to coordinate and standardize the care provided to women with severe hypertension during pregnancy and the postpartum period. This is one of several patient safety bundles developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. These safety bundles outline critical clinical practices that should be implemented in every maternity care setting. Similar to other bundles that have been developed and promoted by the Partnership, the hypertension safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. This commentary provides information to assist with bundle implementation.
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Eastwood LC, Boykin CA, Harris MK, Arnold AN, Hale DS, Kerth CR, Griffin DB, Savell JW, Belk KE, Woerner DR, Hasty JD, Delmore RJ, Martin JN, Lawrence TE, McEvers TJ, VanOverbeke DL, Mafi GG, Pfeiffer MM, Schmidt TB, Maddock RJ, Johnson DD, Carr CC, Scheffler JM, Pringle TD, Stelzleni AM. National Beef Quality Audit-2016: Transportation, mobility, and harvest-floor assessments of targeted characteristics that affect quality and value of cattle, carcasses, and by-products. Transl Anim Sci 2017; 1:229-238. [PMID: 32704647 PMCID: PMC7250433 DOI: 10.2527/tas2017.0029] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 04/05/2017] [Accepted: 04/17/2017] [Indexed: 11/29/2022] Open
Abstract
The National Beef Quality Audit-2016 (NBQA-2016) was conducted to assess current transportation, mobility, and quality characteristics of U.S. fed steers and heifers. Data were collected at 17 beef processing facilities between March and November 2016. About 8,000 live cattle were evaluated for transportation and mobility, and about 25,000 carcasses were evaluated on the slaughter floor. Cattle were in transit to the slaughter facility for a mean duration of 2.7 h from a mean distance of 218.5 km using trailers with dimensions ranging from 17.84 m2 to 59.09 m2. Area allotted per animal averaged 1.13 m2 and ranged from 0.85 m2 to 2.28 m2. A total of 96.8% of cattle received a mobility score of 1 (walks easily, no apparent lameness). Identification types (35.1% had multiple) were lot visual tags (61.5%), individual tags (55.0%), electronic tags (16.9%), metal-clip tags (9.2%), bar-coded tags (0.05%), wattles (0.01%), and other (2.6%). Cattle were black-hided (57.8%), Holstein (20.4%), red-hided (10.5%), yellow-hided (4.8%), gray-hided (2.9%), brown-hided (1.3%), and white-hided (1.1%). Unbranded hides were observed on 74.3% of cattle; 18.6% had brands located on the butt, 6.3% on the side, and 1.3% on the shoulder (values exceed 100% due to multiple brands). For hide-on carcasses, 37.7% displayed no mud or manure; specific locations for mud or manure were legs (40.8%), belly (33.0%), tail region (15.5%), side (6.8%), and top-line (3.9%). Cattle without horns represented 83.3% of the sample, and cattle that did have horns measured: < 2.54 cm (5.5%), 2.54 to 12.7 cm (8.3%), and > 12.7 cm (2.9%). Carcasses without bruises represented 61.1% of those sampled, whereas 28.2% had 1, 8.2% had 2, 2.1% had 3, and 0.3% had 4 bruises. Of those carcasses with a bruise, the bruise was located on the loin (29.7%), round (27.8%), chuck (16.4%), rib (14.4%), and brisket/plate/flank (11.6%). Frequencies of offal condemnations were livers (30.8%), lungs (18.2%), viscera (16.3%), hearts (11.1%), heads (2.7%), and tongues (2.0%). Compared to NBQA-2011, fewer cattle were identified for traceability, fewer were black-hided, a greater number were Holstein cattle, more with no brand and no horns, fewer without bruises, more liver, lung, and viscera condemnations, and fewer heads and tongues were condemned. The NBQA remains an influential survey for the U.S. beef industry to provide benchmarks and strategic plans for continued improvement of beef quality and consistency.
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Affiliation(s)
- L C Eastwood
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - C A Boykin
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - M K Harris
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - A N Arnold
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - D S Hale
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - C R Kerth
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - D B Griffin
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - J W Savell
- Department of Animal Science, Texas A&M AgriLife Research, Texas A&M University, College Station 77843
| | - K E Belk
- Department of Animal Sciences, Colorado State University, Fort Collins 80523
| | - D R Woerner
- Department of Animal Sciences, Colorado State University, Fort Collins 80523
| | - J D Hasty
- Department of Animal Sciences, Colorado State University, Fort Collins 80523
| | - R J Delmore
- Department of Animal Sciences, Colorado State University, Fort Collins 80523
| | - J N Martin
- Department of Animal Sciences, Colorado State University, Fort Collins 80523
| | - T E Lawrence
- Beef Carcass Research Center, Department of Agricultural Sciences, West Texas A&M University, Canyon 79016
| | - T J McEvers
- Beef Carcass Research Center, Department of Agricultural Sciences, West Texas A&M University, Canyon 79016
| | - D L VanOverbeke
- Department of Animal Science, Oklahoma State University, Stillwater 74078
| | - G G Mafi
- Department of Animal Science, Oklahoma State University, Stillwater 74078
| | - M M Pfeiffer
- Department of Animal Science, Oklahoma State University, Stillwater 74078
| | - T B Schmidt
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln 68583
| | - R J Maddock
- Department of Animal Sciences, North Dakota State University, Fargo 58108
| | - D D Johnson
- Department of Animal Sciences, University of Florida, Gainesville 32611
| | - C C Carr
- Department of Animal Sciences, University of Florida, Gainesville 32611
| | - J M Scheffler
- Department of Animal Sciences, University of Florida, Gainesville 32611
| | - T D Pringle
- Department of Animal & Dairy Science, University of Georgia, Athens 30602
| | - A M Stelzleni
- Department of Animal & Dairy Science, University of Georgia, Athens 30602
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Ferrero DM, Larson J, Jacobsson B, Di Renzo GC, Norman JE, Martin JN, D’Alton M, Castelazo E, Howson CP, Sengpiel V, Bottai M, Mayo JA, Shaw GM, Verdenik I, Tul N, Velebil P, Cairns-Smith S, Rushwan H, Arulkumaran S, Howse JL, Simpson JL. Cross-Country Individual Participant Analysis of 4.1 Million Singleton Births in 5 Countries with Very High Human Development Index Confirms Known Associations but Provides No Biologic Explanation for 2/3 of All Preterm Births. PLoS One 2016; 11:e0162506. [PMID: 27622562 PMCID: PMC5021369 DOI: 10.1371/journal.pone.0162506] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/01/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Preterm birth is the most common single cause of perinatal and infant mortality, affecting 15 million infants worldwide each year with global rates increasing. Understanding of risk factors remains poor, and preventive interventions have only limited benefit. Large differences exist in preterm birth rates across high income countries. We hypothesized that understanding the basis for these wide variations could lead to interventions that reduce preterm birth incidence in countries with high rates. We thus sought to assess the contributions of known risk factors for both spontaneous and provider-initiated preterm birth in selected high income countries, estimating also the potential impact of successful interventions due to advances in research, policy and public health, or clinical practice. METHODS We analyzed individual patient-level data on 4.1 million singleton pregnancies from four countries with very high human development index (Czech Republic, New Zealand, Slovenia, Sweden) and one comparator U.S. state (California) to determine the specific contribution (adjusting for confounding effects) of 21 factors. Both individual and population-attributable preterm birth risks were determined, as were contributors to cross-country differences. We also assessed the ability to predict preterm birth given various sets of known risk factors. FINDINGS Previous preterm birth and preeclampsia were the strongest individual risk factors of preterm birth in all datasets, with odds ratios of 4.6-6.0 and 2.8-5.7, respectively, for individual women having those characteristics. In contrast, on a population basis, nulliparity and male sex were the two risk factors with the highest impact on preterm birth rates, accounting for 25-50% and 11-16% of excess population attributable risk, respectively (p<0.001). The importance of nulliparity and male sex on population attributable risk was driven by high prevalence despite low odds ratios for individual women. More than 65% of the total aggregated risk of preterm birth within each country lacks a plausible biologic explanation, and 63% of difference between countries cannot be explained with known factors; thus, research is necessary to elucidate the underlying mechanisms of preterm birth and, hence, therapeutic intervention. Surprisingly, variation in prevalence of known risk factors accounted for less than 35% of the difference in preterm birth rates between countries. Known risk factors had an area under the curve of less than 0.7 in ROC analysis of preterm birth prediction within countries. These data suggest that other influences, as yet unidentified, are involved in preterm birth. Further research into biological mechanisms is warranted. CONCLUSIONS We have quantified the causes of variation in preterm birth rates among countries with very high human development index. The paucity of explicit and currently identified factors amenable to intervention illustrates the limited impact of changes possible through current clinical practice and policy interventions. Our research highlights the urgent need for research into underlying biological causes of preterm birth, which alone are likely to lead to innovative and efficacious interventions.
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Affiliation(s)
| | - Jim Larson
- Boston Consulting Group, Boston, MA, United States of America
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute for the Health of Women and Children, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Gian Carlo Di Renzo
- International Federation of Gynecology and Obstetrics, London, United Kingdom
- Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy
| | - Jane E. Norman
- Tommy’s Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health, Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - James N. Martin
- Division of Maternal-Fetal Medicine, University of Mississippi, Medical Center, Jackson, MS, United States of America
| | - Mary D’Alton
- Department of Obstetrics and Gynecology, Columbia University / College of Physicians and Surgeons, New York, NY, United States of America
| | - Ernesto Castelazo
- International Federation of Gynecology and Obstetrics, London, United Kingdom
| | - Chris P. Howson
- March of Dimes Foundation, White Plains, NY, United States of America
| | - Verena Sengpiel
- Department of Obstetrics and Gynecology, Institute for the Health of Women and Children, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Matteo Bottai
- Unit of Biostatistics, IMM, Karolinska Institutet, Stockholm, Sweden
| | - Jonathan A. Mayo
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Gary M. Shaw
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Ivan Verdenik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nataša Tul
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Petr Velebil
- Institute for the Care of Mother and Child, Perinatal Centre, Prague, Czech Republic
| | | | - Hamid Rushwan
- International Federation of Gynecology and Obstetrics, London, United Kingdom
| | | | - Jennifer L. Howse
- March of Dimes Foundation, White Plains, NY, United States of America
| | - Joe Leigh Simpson
- March of Dimes Foundation, White Plains, NY, United States of America
- * E-mail:
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Affiliation(s)
| | | | | | | | - John C. Morrison
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi
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Başaran B, Çelebioğlu B, Başaran A, Altınel S, Kutlucan L, Martin JN. Anesthetic practices for patients with preeclampsia or HELLP syndrome: A survey. J Turk Ger Gynecol Assoc 2016; 17:128-33. [PMID: 27651719 DOI: 10.5152/jtgga.2016.16094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/20/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Substantial controversy exists regarding anesthetic management for patients with preeclampsia or hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome. Experts, researchers, clinicians, and residents in Turkey were surveyed about their practices. MATERIAL AND METHODS Questionnaires were distributed to attendees at a national conference, and they were filled out immediately. Anonymous 10-item paper surveys were administered to both residents and non-residents. Descriptive statistics were used in the analysis. Agreement among ≥75% of the respondents was considered a majority opinion. Surveys with missing responses were used to analyze the non-response bias. The Chi-square test was used for comparisons. A historical cohort of obstetricians-gynecologists was used for comparison with anesthesiologists. RESULTS Of 339 surveys distributed, 288 were returned (84.9% response rate). Among the returned surveys, the completion rate was 96.1%. The job experience in years among clinicians and residents was 9±5 and 3±1, respectively. General anesthesia was still significantly preferred by 36.1% among patients with preeclampsia with platelet counts of ≥100,000/μL. Compared to obstetricians-gynecologists, anesthesiologists more often preferred general anesthesia. With platelet counts of <50,000/μL or eclampsia, most respondents preferred general anesthesia 94.4% for very low platelets and 89.5% for eclampsia. CONCLUSION A preferential trend toward general anesthesia for patients with preeclampsia or HELLP syndrome exists among anesthesiologists in Turkey, particularly for patients with severe thrombocytopenia and/or eclampsia. There exists a need for well-designed and well-executed prospective clinical trials to provide evidence for the best consensus practice.
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Affiliation(s)
- Betül Başaran
- Department of Anesthesiology, Konya Training and Research Hospital, Konya, Turkey
| | - Bilge Çelebioğlu
- Department of Anesthesiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ahmet Başaran
- Department of Obstetrics and Gynecology, Konya Training and Research Hospital, Konya, Turkey
| | - Seher Altınel
- Department of Anesthesiology, Ankara Gazi Mustafa Kemal State Hospital, Ankara, Turkey
| | - Leyla Kutlucan
- Department of Anesthesiology, Konya Training and Research Hospital, Konya, Turkey
| | - James N Martin
- Department of Obstetrics and Gynecology, The University of Mississippi Medical Center, Jackson, USA
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Abstract
Timely and appropriate response to severe hypertension during gestation is an important component of quality, safe care for pregnant or puerperal mothers regardless of causation. The reduction of severe maternal morbidity and maternal mortality in the hypertensive mother is clearly enhanced by the addition of standard protocols for provider response to severe hypertension, particularly severe systolic hypertension. The program developed in New York State via the Safe Motherhood Initiative promotes the implementation of unit-specific safety bundles, especially one that is focused upon a standardized approach to handling the obstetric emergency of severe hypertension usually associated with preeclampsia/eclampsia. The comprehensive preeclampsia/eclampsia safety bundle as summarized by Drs. Moroz and colleagues is reviewed especially from the perspective of its focus on the timely and specific responses for health care providers to make when severe hypertension is detected in the pregnant patient. Evidence-based guidance to practice considerations and clinical care of patients with preeclampsia/eclampsia is embedded within the program outlined for New York State by Moroz and her District II ACOG colleagues. There is a central focus on timely and appropriate antepartum/postpartum management of severe hypertension, a core concept to lessen maternal risk for cerebral hemorrhage. Ten considerations for further integration into the New York program are suggested. Beyond blood pressure control, there is a need for systematic review of interventions and outcomes over time, attention to possible future variations of the protocol for racial/ethnic patient groups at highest risk for maternal morbidity and mortality, and the identification of biomarker(s) that further specify and quantify risk to the maternal brain and other organ systems when severe hypertension develops. Safer motherhood will happen when evidence for best practice is integrated into systems of care for all patients.
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Affiliation(s)
- James N Martin
- Department of Obstetrics and Gynecology, The University of Mississippi Medical Center, Jackson, MS.
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Pokharel S, Brooks JC, Martin JN, Echeverry A, Parks AR, Corliss B, Brashears MM. Internalization and thermal susceptibility of Shiga toxin-producing Escherichia coli (STEC) in marinated beef products. Meat Sci 2016; 116:213-20. [PMID: 26900979 DOI: 10.1016/j.meatsci.2016.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 01/22/2016] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Abstract
This study evaluated the internalization and cooking susceptibility of seven individual Escherichia coli (STEC) serogroups in surface-inoculated (10(5)log CFU/cm(2)) and vacuum tumbled marinated (30 or 60 min) bottom sirloin steaks. After storage for 14 days (0 to 2°C), flaps were cooked to various endpoint temperatures (55, 60, 65, and 71°C) for evaluation of pathogen survival by direct plating or rapid PCR based detection (BAX®). Direct plating of cooked samples yielded no enumerable plates. The data indicate varied internalization, translocation, and heat susceptibility patterns among serogroups. Using the rapid PCR based detection method O26, O103, and O111 were detected in flaps after cooking to 55 and 60°C, while O157:H7 survived in flaps cooked to 60 and 65°C. However, STEC O145 was the only serogroup that survived in all cooking temperatures. Serogroup O121 was not detected by plating or PCR in any cooked products. Intriguingly, STEC serogroups can be internalized during marination and the internalized pathogens vary in thermal susceptibility.
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Affiliation(s)
- S Pokharel
- Texas Tech University, Department of Animal and Food Sciences, Box 42141, Lubbock, TX 79409, United States
| | - J C Brooks
- Texas Tech University, Department of Animal and Food Sciences, Box 42141, Lubbock, TX 79409, United States
| | - J N Martin
- Texas Tech University, Department of Animal and Food Sciences, Box 42141, Lubbock, TX 79409, United States
| | - A Echeverry
- Texas Tech University, Department of Animal and Food Sciences, Box 42141, Lubbock, TX 79409, United States
| | - A R Parks
- Texas Tech University, Department of Animal and Food Sciences, Box 42141, Lubbock, TX 79409, United States
| | - B Corliss
- Texas Tech University, Department of Animal and Food Sciences, Box 42141, Lubbock, TX 79409, United States
| | - M M Brashears
- Texas Tech University, Department of Animal and Food Sciences, Box 42141, Lubbock, TX 79409, United States.
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Başaran A, Başaran M, Topatan B, Martin JN. Effect of chorionic villus sampling on the occurrence of preeclampsia and gestational hypertension: An updated systematic review and meta-analysis. J Turk Ger Gynecol Assoc 2016; 17:65-72. [PMID: 27403071 DOI: 10.5152/jtgga.2016.16026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/22/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To perform a meta-analysis for an assessment of the risk of preeclampsia or gestational hypertension following chorionic villus sampling (CVS). DATA SOURCE PubMed was systematically searched from its inception through January 2016. MATERIAL AND METHODS Nine reports were identified. A pre-specified scale was used to assess their quality. TABULATION INTEGRATION AND RESULTS We performed pooling into three subgroups with respect to the control group: A) Patients with no invasive prenatal diagnostic procedure served as a control group for comparison. The odds ratios for gestational hypertension (0.76, 95% CI 0.46-1.26), preeclampsia (0.83, 95% CI 0.42-1.67), and severe preeclampsia (0.49, 95% CI 0.04-5.78) or when hypertension categories were pooled (0.80, 95% CI 0.46-1.41) were not significantly different. B) Patients with midtrimester diagnostic amniocentesis and patients with no invasive prenatal diagnostic procedure were combined as a control group for comparison. The odds ratios for preeclampsia (1, 95% CI 0.46-2.18), severe preeclampsia (0.83, 95% CI 0.14-4.85), and pooled hypertension categories (1.07, 95% CI 0.63-1.84) were not significantly different. C) Patients with midtrimester diagnostic amniocentesis served as a control group. There was a significant difference in the odds ratio for preeclampsia between the CVS and amniocentesis groups (2.47, 95% CI 1.14-5.33). There was a marginal difference in the odds ratio for combined pregnancy-induced hypertension categories between the CVS and amniocentesis groups (1.61, 95% CI 1.02-2.53). CONCLUSION The available data do not indicate an increased risk of preeclampsia or gestational hypertension following first trimester CVS. The heterogeneity and retrospective design of existing studies are limiting factors for our analysis and findings.
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Affiliation(s)
- Ahmet Başaran
- Department of Obstetrics and Gynecology, Konya Training and Research Hospital, Konya, Turkey
| | - Mustafa Başaran
- Department of Obstetrics and Gynecology, Konya Training and Research Hospital, Konya, Turkey
| | - Betül Topatan
- Department of Anesthesiology, Konya Training and Research Hospital, Konya, Turkey
| | - James N Martin
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Di Renzo GC, Conry JA, Blake J, DeFrancesco MS, DeNicola N, Martin JN, McCue KA, Richmond D, Shah A, Sutton P, Woodruff TJ, van der Poel SZ, Giudice LC. International Federation of Gynecology and Obstetrics opinion on reproductive health impacts of exposure to toxic environmental chemicals. Int J Gynaecol Obstet 2015; 131:219-25. [PMID: 26433469 DOI: 10.1016/j.ijgo.2015.09.002] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Exposure to toxic environmental chemicals during pregnancy and breastfeeding is ubiquitous and is a threat to healthy human reproduction. There are tens of thousands of chemicals in global commerce, and even small exposures to toxic chemicals during pregnancy can trigger adverse health consequences. Exposure to toxic environmental chemicals and related health outcomes are inequitably distributed within and between countries; universally, the consequences of exposure are disproportionately borne by people with low incomes. Discrimination, other social factors, economic factors, and occupation impact risk of exposure and harm. Documented links between prenatal exposure to environmental chemicals and adverse health outcomes span the life course and include impacts on fertility and pregnancy, neurodevelopment, and cancer. The global health and economic burden related to toxic environmental chemicals is in excess of millions of deaths and billions of dollars every year. On the basis of accumulating robust evidence of exposures and adverse health impacts related to toxic environmental chemicals, the International Federation of Gynecology and Obstetrics (FIGO) joins other leading reproductive health professional societies in calling for timely action to prevent harm. FIGO recommends that reproductive and other health professionals advocate for policies to prevent exposure to toxic environmental chemicals, work to ensure a healthy food system for all, make environmental health part of health care, and champion environmental justice.
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Affiliation(s)
| | - Jeanne A Conry
- American College of Obstetricians and Gynecologists, Washington, DC, USA
| | - Jennifer Blake
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
| | - Mark S DeFrancesco
- American College of Obstetricians and Gynecologists, Washington, DC, USA
| | - Nathaniel DeNicola
- American College of Obstetricians and Gynecologists, Washington, DC, USA
| | - James N Martin
- American College of Obstetricians and Gynecologists, Washington, DC, USA
| | - Kelly A McCue
- American College of Obstetricians and Gynecologists, Washington, DC, USA
| | - David Richmond
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Abid Shah
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Patrice Sutton
- Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, CA, USA
| | - Tracey J Woodruff
- Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, CA, USA.
| | | | - Linda C Giudice
- American Society for Reproductive Medicine, Birmingham, AL, USA
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Chua SL, Amerson EH, Leslie KS, McCalmont TH, Leboit PE, Martin JN, Bangsberg D, Maurer TA. Factors associated with pruritic papular eruption of human immunodeficiency virus infection in the antiretroviral therapy era. Br J Dermatol 2015; 170:832-9. [PMID: 24641299 DOI: 10.1111/bjd.12721] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pruritic papular eruption (PPE) of HIV is common in HIV-infected populations living in the tropics. Its aetiology has been attributed to insect bite reactions and it is reported to improve with antiretroviral therapy (ART). Its presence after at least 6 months of ART has been proposed as one of several markers of treatment failure. OBJECTIVES To determine factors associated with PPE in HIV-infected persons receiving ART. METHODS A case-control study nested within a 500-person cohort from a teaching hospital in Mbarara, Uganda. Forty-five cases and 90 controls were enrolled. Cases had received ART for ≥ 15 months and had an itchy papular rash for at least 1 month with microscopic correlation by skin biopsy. Each case was individually matched with two controls for age, sex and ART duration. RESULTS Twenty-five of 45 cases (56%) had microscopic findings consistent with PPE. At skin examination and biopsy (study enrolment), a similar proportion of PPE cases and matched controls had plasma HIV RNA < 400 copies mL(-1) (96% vs. 85%, P = 0·31). The odds of having PPE increased fourfold with every log increase in viral load at ART initiation (P = 0·02) but not at study enrolment. CD4 counts at ART initiation and study enrolment, and CD4 gains and CD8(+) T-cell activation measured 6 and 12 months after ART commencement were not associated with PPE. Study participants who reported daily insect bites had greater odds of being cases [odds ratio (OR) 8·3, P < 0·001] or PPE cases (OR 8·6, P = 0·01). CONCLUSIONS Pruritic papular eruption in HIV-infected persons receiving ART for ≥ 15 months was associated with greater HIV viraemia at ART commencement, independent of CD4 count. Skin biopsies are important to distinguish between PPE and other itchy papular eruptions.
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Affiliation(s)
- S L Chua
- Department of Dermatology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2WB, U.K
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Amaral LM, Cornelius DC, Moseley J, Martin JN, LaMarca B. [55-OR]. Pregnancy Hypertens 2015. [DOI: 10.1016/j.preghy.2014.10.059] [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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Basaran A, Basaran M, Basaran B, Sen C, Martin JN. Controversial clinical practices for patients with preeclampsia or HELLP syndrome: a survey. J Perinat Med 2015; 43:61-6. [PMID: 24810554 DOI: 10.1515/jpm-2014-0109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/11/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Considerable controversy continues to surround the management of severe preeclampsia and HELLP syndrome. Experts, researchers, and those published in the field were surveyed about their specific practices. MATERIALS AND METHODS An extensive literature search was undertaken to identify the cohort of authors with recent publications on the subjects of preeclampsia (2009-2012) and HELLP syndrome (2005-2012). Online surveys were sent to all authors using the email addresses found in their publications. RESULTS Surveys were delivered by email to 363 authors of preeclampsia publications and 91 authors of HELLP syndrome publications. Completed surveys were received from 61 (13.4%) of the group. Except for consensus about the indication of corticosteroids for the enhancement of fetal lung maturation, there was considerable variation in corticosteroid practice and anesthesia techniques. CONCLUSIONS A marked diversity in practice characterized the clinical care rendered by experts in the field of preeclampsia and HELLP syndrome. Thus, there is an urgent need for well-designed and executed prospective clinical trials to improve the evidence for best consensus practice in this area of obstetrical medicine.
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Morris R, Sunesara I, Darby M, Novotny S, Kiprono L, Bautista L, Sawardecker S, Bofill J, Anderson B, Martin JN. Impedance cardiography assessed treatment of acute severe pregnancy hypertension: a randomized trial. J Matern Fetal Neonatal Med 2014; 29:171-6. [DOI: 10.3109/14767058.2014.995081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Rachael Morris
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Imran Sunesara
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Marie Darby
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Sarah Novotny
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Luissa Kiprono
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Leody Bautista
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Sandip Sawardecker
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - James Bofill
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Belinda Anderson
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - James N. Martin
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
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Affiliation(s)
- James N Martin
- The Aerospace Corporation; M/S CH1-410, 15049 Conference Center Drive Chantilly VA 20151
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Amaral LM, Cornelius DC, Harmon A, Moseley J, Martin JN, LaMarca B. 17-hydroxyprogesterone caproate significantly improves clinical characteristics of preeclampsia in the reduced uterine perfusion pressure rat model. Hypertension 2014; 65:225-31. [PMID: 25368030 DOI: 10.1161/hypertensionaha.114.04484] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Preeclampsia is characterized by increased uterine artery resistance index, chronic immune activation, and decreased circulating nitric oxide levels. 17-α-Hydroxyprogesterone caproate (17-OHPC) is a synthetic metabolite of progesterone used for the prevention of recurrent preterm birth. We hypothesized that 17-OHPC could reduce mean arterial pressure by decreasing inflammation, whereas improving vasodilation by increasing nitric oxide bioavailability and uterine artery resistance index during late gestation in the reduced uterine perfusion pressure (RUPP) rat model of preeclampsia. 17-OHPC (3.32 mg/kg) was intraperitoneally administered on gestation day 18 into RUPP rats, carotid catheters inserted, and mean arterial pressure, blood, and tissues were collected on day 19. Mean arterial pressure in normal pregnant (NP; n=13) was 92±2.0 and increased to123±2.0 in RUPP (n=18; P<0.0001), which was improved to 116±1.5 mm Hg in RUPP+17-OHPC (n=10; P<0.05). Circulating CD4+ T cells were 1.19%±1.0% of gated cells in NP (n=7), which increased to 8.52%±2.4% in RUPP rats (n=10; P<0.05) but was reduced to 2.72%±0.87% (n=14; P<0.05) in RUPP+17-OHPC. Circulating nitrate/nitrite was 26.34±3.5 µmol/L in NP (n=12) but was reduced to14.58±3.1 in RUPP rats (n=8; P=0.03) and increased to 22.69±1.62 in RUPP+17-OHPC (n=7; P=0.05). Endothelial nitric oxide synthase expression was 0.65±0.11 AU in NP (n=4), which decreased to 0.33±0.01 in RUPP rats (n=4; P=0.05) but increased to 0.57±0.01 in RUPP+17-OHPC (n=5; P=0.03). Uterine artery resistance index was 0.54±0.02 in NP (n=3), 0.78±0.03 in RUPP (n=4), and 0.63±0.038 in RUPP+17-OHPC (n=8; both P<0.05). Our findings demonstrate that even though modest, lowering blood pressure with 17-OHPC could be a viable treatment option for suppressing inflammation, uterine artery vasoconstriction while improving litter size.
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Affiliation(s)
- Lorena M Amaral
- From the Departments of Pharmacology (L.M.A., D.C.C., A.H., J.N.M., B.L.) and Obstetrics and Gynecology (J.N.M.), University of Mississippi Medical Center, Jackson
| | - Denise C Cornelius
- From the Departments of Pharmacology (L.M.A., D.C.C., A.H., J.N.M., B.L.) and Obstetrics and Gynecology (J.N.M.), University of Mississippi Medical Center, Jackson
| | - Ashlyn Harmon
- From the Departments of Pharmacology (L.M.A., D.C.C., A.H., J.N.M., B.L.) and Obstetrics and Gynecology (J.N.M.), University of Mississippi Medical Center, Jackson
| | - Janae Moseley
- From the Departments of Pharmacology (L.M.A., D.C.C., A.H., J.N.M., B.L.) and Obstetrics and Gynecology (J.N.M.), University of Mississippi Medical Center, Jackson
| | - James N Martin
- From the Departments of Pharmacology (L.M.A., D.C.C., A.H., J.N.M., B.L.) and Obstetrics and Gynecology (J.N.M.), University of Mississippi Medical Center, Jackson
| | - Babbette LaMarca
- From the Departments of Pharmacology (L.M.A., D.C.C., A.H., J.N.M., B.L.) and Obstetrics and Gynecology (J.N.M.), University of Mississippi Medical Center, Jackson.
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Amaral LM, Moseley J, Cornelius DC, Martin JN, LaMarca B. Abstract 093: Progesterone Supplementation Improves Blood Pressure And Uterine Artery Resistance In Response To Placental Ischemia During Pregnancy. Hypertension 2014. [DOI: 10.1161/hyp.64.suppl_1.093] [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: 11/16/2022]
Abstract
Preeclampsia (PE), new onset hypertension at 20 weeks of gestation, is characterized by increased uterine artery resistance index (UARI), chronic immune activation and decreased of vasodilators such as nitric oxide (NO). Despite being one of the leading causes of death in pregnant women, currently there is no effective treatment for PE except for early delivery of the fetus. We have demonstrated that PE women have significantly lower circulating progesterone than normal pregnant (NP). 17-alpha-hydroxyprogesterone caproate (17-OHPC) is a synthetic metabolite of progesterone used for the prevention of recurrent preterm birth and although the mechanism is not understood, is suspected to have vasodilatory and anti-inflammatory effects. Therefore, we hypothesized that progesterone (17-OHPC) supplementation could reduce blood pressure (MAP), pro-inflammatory cytokines, CD4+ T cells, UARI, as well as increase NO bioavailability in a hypertensive rat model of PE. To address this question 17-OHPC (3.32mg/kg) was intraperitoneally administered on day 18 of gestation into Reduced Uterine Perfusion Pressure (RUPP) rats and carotid catheters were inserted. MAP, blood and tissues were collected on day 19. MAP in NP rats (n=13) was 92±2; 123±2 in RUPP (n=18), and 116 ±1 mmHg in RUPP+17-OHPC (n=10), p <0.05. UARI was 0.78±0.03 in RUPP (n=4) and 0.63±0.038 in RUPP+17-OHPC (n=8), p<0.05. Circulating CD4+ T cells were 1.19±1.0% of gated cells in NP (n=7), which increased to 8.52±2.4% in RUPP rats (n=10) but was significantly reduced to 2.72±0.87% (n=14) in RUPP + 17 O-HPC, p <0.05. Total circulating nitrate/nitrite was 26.34 ±3.5 μM in NP (n=12); 14.58±3.1 in RUPP rats (n=8) and increased to 26.69±1.62 in RUPP+17-OHPC (n=7), p <0.05. Aortic eNOS expression was 0.65±0.11 A.U in NP (n=4), which decreased to 0.33±0.01 in RUPP rats (n=4) but increased to 0.57±0.01 in RUPP+17-OHPC (n=5), p <0.05. Levels of TNF-alpha were 65.84±17.7 pg/ml in RUPP rats (n=5) but were blunted to 17.24±3.9 in RUPP+17-OHPC (n=8), p <0.05. In conclusion, 17-OHPC supplementation improves inflammation, UARI, hypertension, and nitric oxide bioavailability in response to placental ischemia during pregnancy and should therefore be considered further for addition to the clinical management of PE
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Amaral LM, Kiprono L, Cornelius DC, Shoemaker C, Wallace K, Moseley J, Wallukat G, Martin JN, Dechend R, LaMarca B. Progesterone supplementation attenuates hypertension and the autoantibody to the angiotensin II type I receptor in response to elevated interleukin-6 during pregnancy. Am J Obstet Gynecol 2014; 211:158.e1-6. [PMID: 24548847 DOI: 10.1016/j.ajog.2014.02.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/08/2014] [Accepted: 02/14/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Preeclampsia is a multisystem disorder recognized as hypertension with proteinuria developing >20 weeks' gestation. Preeclampsia is associated with chronic immune activation characterized by increased T and B lymphocytes, cytokines, and antibodies activating the angiotensin II type I receptor (AT1-AA). Hypertension in response to elevated interleukin (IL)-6 during pregnancy occurs with increased renin activity and AT1-AA, and reduced kidney function. STUDY DESIGN We aim to determine whether 17-alpha-hydroxyprogesterone caproate (17-OHPC), progesterone, improved inflammatory pathways during elevated IL-6 in pregnant rats. IL-6 (5 ng/d) was infused via miniosmotic pumps into normal pregnant (NP) rats beginning on day 14 of gestation and 17-OHPC (3.32 mg/kg) was diluted in normal saline and injected on day 18. Blood pressure (mean arterial pressure [MAP]) determination and serum collection were performed on day 19 of gestation. RESULTS MAP in NP was 100 ± 3 mm Hg, which increased with IL-6 to 112 ± 4 mm Hg (P < .05). Pregnant rats given 17-OHPC alone had a MAP of 99 ± 3 mm Hg and MAP increased to 103 ± 2 mm Hg in IL-6+17-OHPC. AT1-AA was 1.2 ± 0.5 bpm in NP rats, increased to 17 ± 9 bpm with IL-6 infusion but administration of 17-OHPC significantly blunted AT1-AA to 4 ± 0.8 bpm in NP+IL-6+17-OHPC. Total circulating nitrate/nitrite was significantly decreased and placental Ser(1177)-phosporylated-eNOS/eNOS was lowered with IL-6 infusion. Supplementation of 17-OHPC significantly improved placental Ser(1177)-phosporylated-eNOS/eNOS however, circulating nitrate/nitrite was unchanged with 17-OHPC supplementation. CONCLUSION This study illustrates that 17-OHPC attenuated hypertension, decreased AT1-AA activity, and improved placental nitric oxide in response to elevated IL-6 during pregnancy and could lend hope to a new potential therapeutic for preeclampsia.
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Martin JN, Garmyn AJ, Miller MF, Hodgen JM, Pfeiffer KD, Thomas CL, Rathmann RJ, Yates DA, Hutcheson JP, Brooks JC. Comparative effects of beta-adrenergic agonist supplementation on the yield and quality attributes of selected subprimals from calf-fed Holstein steers. J Anim Sci 2014; 92:4204-16. [PMID: 25006060 DOI: 10.2527/jas.2014-7881] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mechanical portioning tests were performed on beef rib, strip loin, tenderloin, and top sirloin subprimals obtained from calf-fed Holstein steers to characterize the influence of zilpaterol hydrochloride (ZH), ractopamine hydrochloride (RH), or no β-adrenergic agonist (βAA; CON) on subprimal and steak yield. In addition, βAA effects on tenderness, composition, and raw and cooked color of steaks from the aforementioned strip loin subprimals were characterized. At 14 to 15 d (ribs, tenderloins, and top sirloin) or 16 d (strip loin) postmortem, subprimals were portioned into steaks using a mechanical portioning machine. The appropriate variables were measured before and after portioning to determine βAA influence on trimmed and untrimmed subprimal weight, subprimal length (rib only), steak weight and yield, and steak thickness (rib only). Steaks obtained from the strip loin subprimals were subjected to analysis of raw instrument color (L*, a*, b*), proximate composition, and pH. In addition, strip steaks were aged (16 or 23 d) before analysis of cooked internal color, Warner-Bratzler shear force (WBSF), and slice shear force (SSF). Briefly, ZH supplementation increased (P < 0.01) the weight of all subprimals when compared to CON. Furthermore, subprimals from CON animals consistently had fewer and lighter steaks (P ≤ 0.04) than subprimals from ZH-fed steers. Additionally, raw steaks from ZH cattle were a less vivid red (lower a* and saturation index values; P < 0.01) when compared to CON and RH steaks, which did not differ (P > 0.05). There was no interaction between βAA treatment and postmortem aging length for WBSF or SSF (P > 0.10). However, CON steaks (3.25 kg) had lower WBSF values (P < 0.05) than ZH or RH steaks (3.68 and 3.67 kg, respectively). Regardless, aging for 23 d vs. 16 d resulted in decreased WBSF and SSF (P < 0.01) for all βAA treatments. Although differences were numerically small, evaluations indicated the internal cooked surfaces of ZH and RH steaks were less red (P < 0.05) than CON steaks. Overall, these data reemphasize increased subprimal weights due to βAA supplementation, particularly ZH. However, the data are not indicative of increased steak yield due to βAA supplementation. Furthermore, the data demonstrate βAA supplementation increases the shear force of calf-fed Holstein strip steaks regardless of postmortem aging period. However, no differences in shear force between the βAA treatments (ZH or RH) were noted.
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Affiliation(s)
- J N Martin
- Department of Animal and Food Sciences, Texas Tech University, Lubbock 79409
| | - A J Garmyn
- Department of Animal and Food Sciences, Texas Tech University, Lubbock 79409
| | - M F Miller
- Department of Animal and Food Sciences, Texas Tech University, Lubbock 79409
| | | | | | | | - R J Rathmann
- Department of Animal and Food Sciences, Texas Tech University, Lubbock 79409
| | - D A Yates
- Merck Animal Health, DeSoto, KS 66018
| | | | - J C Brooks
- Department of Animal and Food Sciences, Texas Tech University, Lubbock 79409
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Owens MY, Thigpen B, Parrish MR, Keiser SD, Sawardecker S, Wallace K, Martin JN. Management of preeclampsia when diagnosed between 34-37 weeks gestation: deliver now or deliberate until 37 weeks? J Miss State Med Assoc 2014; 55:208-211. [PMID: 25252423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate maternal-newborn outcomes with immediate or expectantly managed preeclampsia first diagnosed at 34-37 weeks. METHODS Late preterm patients with preeclampsia without severe features were randomly assigned to immediate delivery (n=94) or expectant management (n = 75) until 37 weeks gestation or earlier if severe features developed. Data were analyzed by appropriate tests for continuous or categorical outcomes with differences considered significant if p < 0.05. RESULTS The two groups were similar at presentation. 41% of those expectantly managed developed severe features of preeclampsia within 72 hours versus 3% in the immediately delivered group (p < 0.001). Immediate delivery did not significantly increase cesarean delivery or neonatal morbidity. CONCLUSION Immediate delivery of the late preterm patient with preeclampsia significantly lessens her development of severe features without significantly increasing newborn risks. For the expectantly managed late preterm patient with preeclampsia, close surveillance for the first 72 hours following diagnosis and twice weekly thereafter appears prudent.
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Forrestel AK, Naujokas A, Martin JN, Maurer TA, McCalmont TH, Laker-Opwonya MO, Mulyowa G, Busakhala N, Amerson EH. Bacillary angiomatosis masquerading as Kaposi's sarcoma in East Africa. J Int Assoc Provid AIDS Care 2014; 14:21-5. [PMID: 24718378 DOI: 10.1177/2325957414521497] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Bacillary angiomatosis (BA) is a rare manifestation of infection caused by Bartonella species, which leads to vasoproliferative lesions of skin and other organs. Bacillary angiomatosis affects individuals with advanced HIV disease or other immunocompromised individuals. In sub-Saharan Africa, despite the high prevalence of HIV infection and documentation of the causative Bartonella species in humans, mammalian hosts, and arthropod vectors, BA has only rarely been described. METHODS Three adult patients from Uganda and Kenya with deep purple dome-shaped papules or nodules of the skin underwent punch biopsies for histopathologic diagnosis. The biopsies of all 3 patients were sent to a local pathologist as well as to a dermatopathologist at the University of California, San Francisco. RESULTS All 3 patients were clinically suspected to have Kaposi's sarcoma (KS), and local pathologists had interpreted the lesions as KS in 2 of the cases and nonspecific inflammation in the third. Histologic examination by dermatopathologists in the United States revealed nodular dermal proliferations of irregular capillaries lined by spindled to epithelioid endothelial cells. The surrounding stroma contained a mixed inflammatory infiltrate with lymphocytes, eosinophils, and neutrophils. Extracellular deposits of pale amphophilic granular material were noted in the surrounding stroma. A Warthin-Starry stain highlighted clumps of bacilli, confirming the diagnosis of BA. CONCLUSIONS These 3 cases, to our knowledge, are the first reports of BA in East Africa in the biomedical literature. Each had been originally incorrectly diagnosed as KS. We speculate BA is underdiagnosed and underreported in resource-poor regions, such as sub-Saharan Africa, that have high endemic rates of HIV infection.
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Affiliation(s)
- A K Forrestel
- Yale University School of Medicine, New Haven, CT, USA
| | - A Naujokas
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - J N Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - T A Maurer
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - T H McCalmont
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - M O Laker-Opwonya
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA Infectious Diseases Institute, Kampala, Uganda
| | - G Mulyowa
- Skin Clinic, Mbarara University of Science and Technology, Mbarara, Uganda
| | - N Busakhala
- Moi University School of Medicine, Eldoret, Kenya
| | - Erin H Amerson
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
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Spratling PM, Pryor ER, Moneyham LD, Hodges AL, White-Williams CL, Martin JN. Effect of an Educational Intervention on Cardiovascular Disease Risk Perception among Women with Preeclampsia. J Obstet Gynecol Neonatal Nurs 2014; 43:179-89. [DOI: 10.1111/1552-6909.12296] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Rogers HB, Brooks JC, Martin JN, Tittor A, Miller MF, Brashears MM. The impact of packaging system and temperature abuse on the shelf life characteristics of ground beef. Meat Sci 2014; 97:1-10. [PMID: 24468705 DOI: 10.1016/j.meatsci.2013.11.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 11/11/2013] [Accepted: 11/22/2013] [Indexed: 11/26/2022]
Abstract
New ground beef packaging systems have warranted investigation of their spoilage and quality characteristics. Furthermore, analysis of ground beef spoilage in modified atmosphere packaging (MAP) and stored at abusive temperature is lacking. This research aimed to determine the effect of packaging systems and temperature abuse on the sensory and shelf-life characteristics of ground beef. Ground beef patties were packaged using polyvinyl chloride overwrap (OW), HI-OX MAP (80% O2, 20% CO2), LO-OX MAP (30% CO2, 70% N2), CO-MAP (0.4% CO, 30% CO2, 69.6% N2), or vacuum (VAC) prior to color, odor, biochemical, and microbial analyses over display. CO-MAP exhibited more desirable color and consumer acceptability throughout display. Lean discoloration and odor scores were lower for anaerobic packaging than aerobic packaging. Microbial results mirrored sensory preferences for anaerobic packaging. These results indicate anaerobic packaging extends shelf-life properties and desirable sensory attributes throughout display and temperature abuse.
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Affiliation(s)
- H B Rogers
- Department of Animal & Food Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - J C Brooks
- Department of Animal & Food Sciences, Texas Tech University, Lubbock, TX 79409, USA.
| | - J N Martin
- Department of Animal & Food Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - A Tittor
- Department of Animal & Food Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - M F Miller
- Department of Animal & Food Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - M M Brashears
- Department of Animal & Food Sciences, Texas Tech University, Lubbock, TX 79409, USA
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Chancey CC, Brooks JC, Martin JN, Echeverry A, Jackson SP, Thompson LD, Brashears MM. Survivability of Escherichia coli O157:H7 in mechanically tenderized beef steaks subjected to lactic acid application and cooking under simulated industry conditions. J Food Prot 2013; 76:1778-83. [PMID: 24112580 DOI: 10.4315/0362-028x.jfp-12-566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mechanical tenderization improves the palatability of beef; however, it increases the risk of translocating pathogenic bacteria to the interior of beef cuts. This study investigated the efficacies of lactic acid spray (LA; 5 % ), storage, and cooking on the survivability of Escherichia coli O157:H7 in mechanically tenderized beef steaks managed under simulated industry conditions. Beef subprimals inoculated with either high (10(5) CFU/ml) or low (10(3) CFU/ml) levels of E. coli O157:H7 were treated (LA or control) and stored for 21 days prior to mechanical tenderization, steak portioning (2.54 cm), and additional storage for 7 days. Steaks were then cooked to an internal temperature of 55, 60, 65, 70, or 75°C. Samples were enumerated and analyzed using DNA-based methods. Treatment with LA immediately reduced E. coli O157:H7 on the lean and fat surfaces of high- and low-inoculum-treated subprimals by more than 1.0 log CFU/cm(2) (P < 0.05). Storage for 21 days reduced surface populations of E. coli O157:H7 regardless of the inoculation level; however, the populations on LA- and control-treated lean surfaces of high- and low-inoculum-treated subprimals were not different after 21 days (P > 0.05). E. coli O157:H7 was detected in core samples from high-inoculum-treated steaks cooked to 55, 60, or 70°C. Conversely, E. coli O157:H7 was not detected in core samples from low-inoculum-treated steaks, regardless of the internal cooking temperature. These data suggest that LA- and storage-mediated reduction of pathogens on subprimals exposed to typical industry contamination levels (10(1) CFU/cm(2)) reduces the risk of pathogen translocation and subsequent survival after cooking.
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Affiliation(s)
- C C Chancey
- Department of Animal and Food Sciences, Texas Tech University, Box 42141, Lubbock, Texas 79409, USA
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Darby MM, Wallace K, Cornelius D, Chatman KT, Mosely JN, Martin JN, Purser CA, Baker RC, Owens MT, Lamarca BB. Vitamin D Supplementation Suppresses Hypoxia-Stimulated Placental Cytokine Secretion, Hypertension and CD4 + T Cell Stimulation in Response to Placental Ischemia. Med J Obstet Gynecol 2013; 1:1012. [PMID: 25414911 PMCID: PMC4235666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate a role of Vitamin D in the pathogenesis of preeclampsia (PE), and to discern any potential benefits of Vitamin D supplementation on hypertension in the RUPP rat model of PE. STUDY DESIGN Blood and placentas from normal pregnancies (NP) and PE were collected following elective cesarean delivery without evidence of infection. Circulating Vitamin D was extracted by HPLC and measured via mass spectrometry. Media for placenta explants was supplemented with Vitamin D and exposed to hypoxic (1% O2) or normoxic (6% O2) conditions for 24 hours. ELISAs were performed on media and normalized to total protein to determine cytokine secretion. RUPP rats were supplemented with vitamin D by oral gavage, and blood pressure (MAP) and pup weights were measured in NP and RUPP rats with or without Vitamin D supplementation. Flow cytometry was used to evaluate CD4+ Tcells in control RUPP rats and RUPP rats treated with Vitamin D. RESULTS Inflammatory cytokine secretion was higher (p<0.05) while the anti-inflammatory cytokine, IL-10, was significantly lower in the media of PE placentas compared to NP (p=0.005). Vitamin D supplementation decreased hypoxia stimulated pro-inflammatory cytokine secretion (p=0.003) in the media of PE placentas. Vitamin D decreased MAP and circulating CD4+ T cells in the RUPP rat model of PE (p<0.05). CONCLUSION Vitamin D supplementation may be useful in the treatment or prevention of hypertensive disorders in pregnancy.
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Affiliation(s)
- Marie M Darby
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, USA
| | - Kedra Wallace
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, USA
| | - Denise Cornelius
- Department of Pharmacology, University of Mississippi Medical Center, USA
| | - Krystal T Chatman
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, USA
| | - Janae N Mosely
- Department of Pharmacology/Toxicology, University of Mississippi Medical Center, USA
| | - James N Martin
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, USA
| | - Christine A Purser
- Department of Pharmacology/Toxicology, University of Mississippi Medical Center, USA
| | - Rodney C Baker
- Department of Pharmacology/Toxicology, University of Mississippi Medical Center, USA
| | - Michelle T Owens
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, USA
| | - B Babbette Lamarca
- Department of Pharmacology/Toxicology, University of Mississippi Medical Center, USA
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Brewer J, Liu R, Lu Y, Scott J, Wallace K, Wallukat G, Moseley J, Herse F, Dechend R, Martin JN, Lamarca B. Endothelin-1, oxidative stress, and endogenous angiotensin II: mechanisms of angiotensin II type I receptor autoantibody-enhanced renal and blood pressure response during pregnancy. Hypertension 2013; 62:886-92. [PMID: 24041954 DOI: 10.1161/hypertensionaha.113.01648] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Hypertension during preeclampsia is associated with increased maternal vascular sensitivity to angiotensin II (ANGII). This study was designed to determine mechanisms whereby agonistic autoantibodies to the ANGII type I receptor (AT1-AA) enhance blood pressure (mean arterial pressure [MAP]) and renal vascular sensitivity to ANGII during pregnancy. First, we examined MAP and renal artery resistance index in response to chronic administration of ANGII or AT1-AA or AT1-AA+ANGII in pregnant rats compared with control pregnant rats. To examine mechanisms of heightened sensitivity in response to AT1-AA during pregnancy, we examined the role of endogenous ANGII in AT1-AA-infused pregnant rats, and that of endothelin-1 and oxidative stress in AT1-AA+ANGII-treated rats. Chronic ANGII increased MAP from 95±2 in normal pregnant rats to 115±2 mm Hg; chronic AT1-AA increased MAP to 118±1 mm Hg in normal pregnant rats, which further increased to 123±2 mm Hg with AT1-AA+ANGII. Increasing ANGII from 10(-11) to 10(-8) decreased afferent arteriole diameter from 15% to 20% but sharply decreased afferent arteriole diameter to 60% in AT1-AA-pretreated vessels. Renal artery resistance index increased from 0.67 in normal pregnant rats to 0.70 with AT1-AA infusion, which was exacerbated to 0.74 in AT1-AA+ANGII-infused rats. AT1-AA-induced hypertension decreased with enalapril but was not attenuated. Both tissue endothelin-1 and reactive oxygen species increased with AT1-AA+ANGII compared with AT1-AA alone, and blockade of either of these pathways had significant effects on MAP or renal artery resistance index. These data support the hypothesis that AT1-AA, via activation of endothelin-1 and oxidative stress and interaction with endogenous ANGII, is an important mechanism whereby MAP and renal vascular responses are enhanced during preeclampsia.
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Affiliation(s)
- Justin Brewer
- Department of Pharmacology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216.
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Amaral LM, Cornelius D, Wallace K, Kipprono L, Moseley J, Herse F, Wallukat G, Martin JN, Dechend R, LaMarca B. Abstract 542: Progesterone Supplementation Attenuates Hypertension And AT1-AA in Response Tt Elevated IL-6 During Pregnancy. Hypertension 2013. [DOI: 10.1161/hyp.62.suppl_1.a542] [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: 11/16/2022]
Abstract
Preeclampsia is a multi-system disorder defined as new-onset hypertension with proteinuria developing after 20 weeks gestation. Preeclampsia remains a significant contributor to maternal morbidity and mortality, with great impact in perinatal morbidity. Research efforts throughout the world have focused on alternative therapies for the treatment of preeclampsia to the mainstay treatment of delivery of the fetus and placenta. 17-alpha-hydroxyprogesterone caproate (17-OHP) is a synthetic metabolite of progesterone used effectively for the prevention of recurrent preterm birth in singleton pregnancies. Previously we identified potential role for 17-OHP as an anti-inflammatory that suppressed inflammatory cytokines, hypertension and endothelin-1 in response to placental ischemia in the RUPP rat model of preeclampsia. In the current study we examined a role 17-OHP to blunt the pathophysiological effects to elevated IL-6 during pregnancy. IL-6 induced hypertension during pregnancy occurs with increased renin activity, autoantibodies to the angiotensin II type I receptor (AT1-AA) and reduced kidney function. This experiment was performed in the following groups of normal pregnant rats: NP (n=5); NP+17-OHP (n=6); NP+IL-6 (n=10); NP+IL-6+17-OHP (n=10). To test our hypothesis IL-6 (5ng/day) was infused via miniosmotic pump into normal pregnant rats beginning on day 14 of gestation and 17-OHP (3.32mg/kg) was diluted in normal saline and injected on day 18. Blood pressure (MAP) determination and serum collection was performed on day 19 of gestation. MAP in NP was 100+3mmHg which increased with IL-6 to 112+4mmHg, p <0.05. Pregnant rats given 17-OHP alone had a MAP of 99+3mmHg and MAP only increased to 103+2mmHg in IL-6+17-OHP. AT1-AA was 1.2+0.5 bpm in NP rats and increased to 17+9 bpm with IL-6 infusion. Administration of 17-OHP significantly blunted AT1-AA to 4+0.8bpm in NP+IL-6+17-OHP. Importantly, this study illustrates that 17-OHP attenuates hypertension and AT1-AA in response to elevated IL-6 during pregnancy and could lend hope to a new potential therapeutic for preeclampsia.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ralf Dechend
- Campus-Buch & Max-Delbrueck Cntr, Berlin, Germany
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Darby M, Martin JN, LaMarca B. A complicated role for the renin-angiotensin system during pregnancy: highlighting the importance of drug discovery. Expert Opin Drug Saf 2013; 12:857-64. [PMID: 23915333 DOI: 10.1517/14740338.2013.823945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Blood pressure management is recommended to avoid maternal cerebrovascular or cardiovascular compromise during pregnancy. Current antihypertensive treatment during pregnancy with positive safety profiles includes labetalol, hydralazine, methyldopa and nifedipine. AREAS COVERED Many earlier animal and human studies indicate that angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) are associated with fetopathy; therefore, these drugs are contraindicated during pregnancy, especially if these medications were taken during the second and third trimesters. The role of the RAS is quite complex, with fetal development heavily dependent on its appropriate expression and function. New findings indicate that the placental unit expresses its own RAS in order to regulate angiogenesis. Multiple studies have shown that women with abnormal uterine doppler sonography produce an agonistic autoantibody to the angiotensin I receptor, implicating a role for RAS function and regulation in abnormal pregnancies. Importantly, interruption of a normal RAS compromises fetal development. EXPERT OPINION Traditional medications that inhibit components of RAS for long-term hypertension control are not appropriate for use before or during pregnancy. Further study and drug discovery are needed to find alternative pathways for treatment of hypertensive disorders when pregnancy is present or a possibility.
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Affiliation(s)
- Marie Darby
- University of Mississippi Medical Center, Departments of Obstetrics & Gynecology , 2500 North State Street, Jackson MS 39216 , USA +1 601 984 5358 ;
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Parrish MR, Martin JN, Lamarca BB, Ellis B, Parrish SA, Owens MY, May WL. Randomized, placebo controlled, double blind trial evaluating early pregnancy phytonutrient supplementation in the prevention of preeclampsia. J Perinatol 2013; 33:593-9. [PMID: 23448939 DOI: 10.1038/jp.2013.18] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 01/11/2013] [Accepted: 01/24/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Daily provision of pregnant patients with dietary supplements containing antioxidants and phytonutrients, if initiated in the first trimester of pregnancy and continued throughout the gestation, may significantly decrease the incidence of preeclampsia. STUDY DESIGN We conducted a single center, randomized, placebo-controlled investigation in which women were randomized by their risk status and assigned to daily ingestion of a supplement consisting primarily of a blended fruit and vegetable juice powder concentrate or placebo. RESULT Of the 684 patients randomized to the trial, 267 (39.0%) completed it. The final analysis is based on those participants who completed the study. For the primary outcome of preeclampsia, there was no difference observed between the phytonutrient supplement group and the placebo group: 15.9% vs 16.3%, respectively, (R.R. 0.97 (0.56-1.69)). Non-significant trends toward lower placenta-related obstetrical complications were observed in the supplement group compared with the placebo cohort (8.3% vs 15.5%, respectively, (R.R. 0.57 (0.29-1.14). Those infants born to mothers taking the supplement in the high-risk stratified group demonstrated non-significant trends toward lower rates of respiratory distress syndrome (RDS); 5.3% in the supplement group vs 15.4% in the placebo group: R.R. 0.34 (0.12-1.01). CONCLUSION Initiation of antioxidant/phytonutrient supplementation in the first trimester did not decrease rates of preeclampsia. Non-significant trends toward lower incidences of placental derived morbidity in those mothers taking the supplement in addition to decreased rates of RDS in infants born to supplemented mothers considered to be high-risk for preeclampsia, warrant further investigation.
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Affiliation(s)
- M R Parrish
- Departments of Obstetrics and Gynecology and Biostatistics, Winfred L. Wiser Hospital for Women and Infants, University of Mississippi Medical Center, Jackson, MS, USA.
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Darby M, Martin JN, Mitchell SQ, Owens MY, Wallace K. Using case reports to determine when liver bleeding occurs during disease progression in HELLP syndrome. Int J Gynaecol Obstet 2013; 123:7-9. [DOI: 10.1016/j.ijgo.2013.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 03/26/2013] [Accepted: 06/21/2013] [Indexed: 11/28/2022]
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Novotny S, Wallace K, Herse F, Moseley J, Darby M, Heath J, Gill J, Wallukat G, Martin JN, Dechend R, LaMarca B. CD4 + T Cells Play a Critical Role in Mediating Hypertension in Response to Placental Ischemia. J Hypertens (Los Angel) 2013; 2:14873. [PMID: 25401050 PMCID: PMC4231445 DOI: 10.4172/2167-1095.1000116] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Similar to preeclamptic women, hypertension in the chronic Reduced Uterine Perfusion Pressure Rat Model Of Preeclampsia (RUPP) is associated with increased CD4+ T cells, cytokines, sFlt-1 and agonistic autoantibodies to the AngII receptor (AT1-AA). We examined the effect inhibition of T cell co-stimulation in RUPP rats treated with (A) (abatacept, 250 mg/kg, infused i.v. at gestation day 13), on hypertension and sFlt-1, TNF-α and AT1-AA. RUPP surgical procedure was performed on day 14. On day 19 MAP increased from 94+2 mmHg in Normal Pregnant (NP) to 123 ± 3 mmHg in RUPP control rats. This response was attenuated by Abatacept, MAP was 104 ± 2 mmHg in RUPP ± A, and 96 ± 2 mmHg NP ± A. Percent circulating CD4+ T cells were 66 ± 3% in RUPPs compared to 55 ± 3% NP rats (p<0.04) but were normalized in RUPP ± A rats (54 ± 3%). The twofold increase in TNF alpha seen in RUPPs (277 ± 47 pg/ml) was decreased to 80 ± 18 pg/ml in RUPP+A. Placental sFlt-1 was reduced 70 % to 151 ± 28 in RUPP ± A compared 488 ± 61 pg/ml in RUPP (p<0.001). AT1-AA decreased from 20 ± 0.8 bpm in control RUPP to 6 ± 0.7 bpm in RUPP ± A. We next determined the effect of RUPP in causing hypertension in pregnant T cell deficient rats by examining MAP in NP (123 ± 5 mmHg) and RUPP athymic nude rats (123 ± 7 mmHg). In the absence of T cells, hypertension in response to placental ischemia was completely abolished. Collectively these data indicate that CD4+ Tcells in response to placental ischemia play an important role in the pathophysiology of hypertension associated with preeclampsia.
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Affiliation(s)
- Sarah Novotny
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - Kedra Wallace
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - Florian Herse
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - Janae Moseley
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - Marie Darby
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - Judith Heath
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - James Gill
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - Gerd Wallukat
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - James N Martin
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - Ralf Dechend
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - Babbette LaMarca
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
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Brewer J, Owens MY, Wallace K, Reeves AA, Morris R, Khan M, LaMarca B, Martin JN. Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia. Am J Obstet Gynecol 2013; 208:468.e1-6. [PMID: 23395926 DOI: 10.1016/j.ajog.2013.02.015] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/04/2013] [Accepted: 02/05/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We sought to investigate the concurrence of posterior reversible encephalopathy syndrome (PRES) with eclampsia and to describe the obstetric, radiological, and critical care correlates. STUDY DESIGN This was a single-center, 2001-2010 retrospective cohort study of all patients with eclampsia who underwent neuroimaging via magnetic resonance imaging (MRI) or computerized tomography (CT) with or without contrast. RESULTS Forty-six of 47 of eclamptic patients (97.9%) revealed PRES on neuroimaging using 1 or more modalities: MRI without contrast, 41 (87.2%); MRI with contrast, 27 (57.4%); CT without contrast, 16 (34%); CT with contrast, 7 (14.8%); and/or magnetic resonance angiography/magnetic resonance venography, 2 (4.3%). PRES was identified within the parietal, occipital, frontal, temporal, and basal ganglia/brainstem/cerebellum areas of the brain. Eclampsia occurred antepartum in 23 patients and postpartum in 24 patients. Headache was the most common presenting symptom (87.2%) followed by altered mental status (51.1%), visual disturbances (34%), and nausea/vomiting (19.1%). Severe systolic hypertension was present in 22 patients (47%). CONCLUSION The common finding of PRES in patients with eclampsia suggests that PRES is a core component of the pathogenesis of eclampsia. Therapy targeted at prevention or reversal of PRES pathogenesis may prevent or facilitate recovery from eclampsia.
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D'Alton ME, Bonanno CA, Berkowitz RL, Brown HL, Copel JA, Cunningham FG, Garite TJ, Gilstrap LC, Grobman WA, Hankins GDV, Hauth JC, Iriye BK, Macones GA, Martin JN, Martin SR, Menard MK, O'Keefe DF, Pacheco LD, Riley LE, Saade GR, Spong CY. Putting the "M" back in maternal-fetal medicine. Am J Obstet Gynecol 2013; 208:442-8. [PMID: 23211544 DOI: 10.1016/j.ajog.2012.11.041] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/16/2012] [Accepted: 11/28/2012] [Indexed: 11/16/2022]
Abstract
Although maternal death remains rare in the United States, the rate has not decreased for 3 decades. The rate of severe maternal morbidity, a more prevalent problem, is also rising. Rise in maternal age, in rates of obesity, and in cesarean deliveries as well as more pregnant women with chronic medical conditions all contribute to maternal mortality and morbidity in the United States. We believe it is the responsibility of maternal-fetal medicine (MFM) subspecialists to lead a national effort to decrease maternal mortality and morbidity. In doing so, we hope to reestablish the vital role of MFM subspecialists to take the lead in the performance and coordination of care in complicated obstetrical cases. This article will summarize our initial recommendations to enhance MFM education and training, to establish national standards to improve maternal care and management, and to address critical research gaps in maternal medicine.
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Affiliation(s)
- Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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Martin JN, Brooks JC, Thompson LD, Savell JW, Harris KB, May LL, Haneklaus AN, Schutz JL, Belk KE, Engle T, Woerner DR, Legako JF, Luna AM, Douglass LW, Douglass SE, Howe J, Duvall M, Patterson KY, Leheska JL. Nutrient database improvement project: the influence of U.S.D.A. Quality and Yield Grade on the separable components and proximate composition of raw and cooked retail cuts from the beef rib and plate. Meat Sci 2013; 95:486-94. [PMID: 23793084 DOI: 10.1016/j.meatsci.2013.05.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 05/17/2013] [Accepted: 05/20/2013] [Indexed: 11/16/2022]
Abstract
Beef nutrition is important to the worldwide beef industry. The objective of this study was to analyze proximate composition of eight beef rib and plate cuts to update the USDA National Nutrient Database for Standard Reference (SR). Furthermore, this study aimed to determine the influence of USDA Quality Grade on the separable components and proximate composition of the examined retail cuts. Carcasses (n=72) representing a composite of Yield Grade, Quality Grade, gender and genetic type were identified from six regions across the U.S. Beef plates and ribs (IMPS #109 and 121C and D) were collected from the selected carcasses and shipped to three university meat laboratories for storage, retail fabrication, cooking, and dissection and analysis of proximate composition. These data provide updated information regarding the nutrient content of beef and emphasize the influence of common classification systems (Yield Grade and Quality Grade) on the separable components, cooking yield, and proximate composition of retail beef cuts.
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Affiliation(s)
- J N Martin
- Texas Tech University, Department of Animal and Food Sciences, Lubbock, TX 79409, United States
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Wallace K, Martin JN, Tam Tam K, Wallukat G, Dechend R, Lamarca B, Owens MY. Seeking the mechanism(s) of action for corticosteroids in HELLP syndrome: SMASH study. Am J Obstet Gynecol 2013; 208:380.e1-8. [PMID: 23380266 DOI: 10.1016/j.ajog.2013.01.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 01/07/2013] [Accepted: 01/29/2013] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Administration of dexamethasone to the hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome patients (10 mg intravenously [IV] every 12 hours) shortens the disease course and reduces maternal morbidity in patients treated at the University of Mississippi Medical Center (UMMC), associated with this severe form of preeclampsia. However, the pathophysiological mechanisms involved with this intervention remain unclear. OBJECTIVE We sought to investigate the potential role of IV dexamethasone to restore the imbalance among antiangiogenic and inflammatory factors known to be significantly elevated in women with HELLP syndrome. STUDY DESIGN This was a single-center prospective study of women diagnosed with HELLP syndrome who were treated for IV dexamethasone at UMMC. Blood was drawn prior to dexamethasone administration and again 12 and 24 hours after the initial dexamethasone administration. Enzyme-linked immune assays were used to measure circulating inflammatory cytokines and antiangiogenic factors. A repeated-measures analysis of variance was used to analyze the data collected before, after, and during dexamethasone administration. RESULTS Seventeen women with HELLP syndrome were enrolled in this study. Dexamethasone significantly decreased evidence of hemolysis (P = .002) and liver enzymes (P = .003), and significantly increased platelets (P = .0001) within 24 hours of administration. Circulating interleukin-6 levels after 24 hours were decreased (P < .001); soluble fms-like tyrosine kinase-1 and soluble endoglin were also significantly decreased by 24 hours after dexamethasone administration (P < .002 and P < .004, respectively). There were no significant differences in circulating levels of placental growth factor (P = .886) due to dexamethasone administration. Angiotensin II receptor autoantibody levels were unchanged by dexamethasone administration. CONCLUSION We conclude that 1 important mechanism of dexamethasone administration is to blunt the release of both antiangiogenic and inflammatory factors suggested to play role in the pathophysiology of HELLP syndrome.
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Affiliation(s)
- Kedra Wallace
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS, USA
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Martin JN, Brewer JM, Wallace K, Sunesara I, Canizaro A, Blake PG, LaMarca B, Owens MY. Hellp syndrome and composite major maternal morbidity: importance of Mississippi classification system. J Matern Fetal Neonatal Med 2013; 26:1201-6. [DOI: 10.3109/14767058.2013.773308] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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LaMarca B, Novotny S, Wallace K, Moseley J, Darby M, Heath J, Martin JN. Abstract 26: CD4+T Cells Play a Critical Role in Mediating Hypertension in Response to Placental Ischemia. Hypertension 2012. [DOI: 10.1161/hyp.60.suppl_1.a26] [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: 11/16/2022]
Abstract
Similar to preeclamptic women, hypertension in the chronic reduced uterine perfusion pressure rat model of preeclampsia (RUPP) is associated with increased CD4+ T cell activation, cytokines, sFlt-1 and agonistic autoantibodies to the AngII receptor (AT1-AA). Although we have shown that adoptive transfer of RUPP CD4+ Tcells into normal pregnant (NP) recipients rats causes hypertension and the release of above mentioned factors, the role of endogenous CD4+T cells in mediating the pathophysiology of preeclampsia was unknown. Therefore, we tested the hypothesis that activation of CD4+ T cells causes hypertension and increased sFlt-1, TNF-alpha and AT1-AA. We first examined the effect CD4+ T cell blockade in NP and RUPP rats treated with Orencia, (abatecept, 250mg/kg, infused iv at gestation day 13), clinically used to inhibit T cell activation. RUPP surgical procedure was performed on day 14. On day 19 MAP increased from 94+/-2 mmHg in NP to 123+/-3 mmHg in RUPP control rats. This response was attenuated by CD4+ Tcell blockade, MAP was 104+/-2 mmHg in Orencia treated RUPPs, and 96 +/-2 mmHg Orencia treated NPs. Circulating CD4+ T cells were 66+/-3 in RUPPs compared to 55+/-3 NP rats (p<0.04) but were normalized in Orencia treated RUPP rats (54+/-3). The twofold increase in TNF alpha seen in RUPPs (277+/-47 pg/ml) was decreased to 80 +/-18 pg/ml in Orencia treated RUPPs. Placental sFlt-1 was reduced 70 % to 151+/-28 in Orencia treated RUPP compared 488+/-61 pg/ml in RUPP (P<0.001). AT1-AA decreased from 20+/-0.8 bpm in control RUPP to 6+/-0.7 bpm in Orencia treated RUPPs. We next determined the effect of RUPP in causing hypertension in pregnant T cell deficient rats by examining MAP in NP (121 mmHg) and RUPP athymic nude rats (126 mmHg). In the absence of T cells, hypertension in response to placental ischemia was completely abolished. Collectively these data indicate that activation of CD4+ Tcells in response to placental ischemia plays an important role in the pathophysiology of hypertension associated with preeclampsia.
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Rodas-González A, Pflanzer SB, Garmyn AJ, Martin JN, Brooks JC, Knobel SM, Johnson BJ, Starkey JD, Rathmann RJ, de Felicio PE, Streeter MN, Yates DA, Hodgen JM, Hutcheson JP, Miller MF. Effects of postmortem calcium chloride injection on meat palatability traits of strip loin steaks from cattle supplemented with or without zilpaterol hydrochloride. J Anim Sci 2012; 90:3584-95. [PMID: 22851240 DOI: 10.2527/jas.2012-5159] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An experiment was conducted to determine the effects of zilpaterol hydrochloride mM supplementation (ZH; 8.3 mg/kg on a DM basis for 20 d) and calcium chloride injection [CaCl(2), 200 at 5% (wt/wt) at 72 h postmortem] on palatability traits of beef (Bos taurus) strip loin steaks. Select (USDA) strip loins were obtained from control (no ZH = 19) and ZH-supplemented carcasses (n = 20). Right and left sides were selected alternatively to serve as a control (no INJ) or CaCl(2)-injected (INJ) and stored at 4°C. Before injecting the subprimals (72 h postmortem), 2 steaks were cut for proximate, sarcomere length, and myofibrillar fragmentation index (MFI) analyses. At 7 d postmortem each strip loin was portioned into steaks, vacuum packaged, and aged for the appropriate period for Warner-Bratzler shear force (WBSF; 7, 14, 21, and 28 d postmortem), trained sensory analysis (14 and 21 d postmortem), purge loss (7 d), and MFI (3, 7, 14, 21, and 28 d postmortem). Results indicated steaks from both ZH supplementation and INJ had reduced WBSF values as days of postmortem aging increased. The WBSF values of ZH steaks were greater (P < 0.05) than no ZH steaks at each postmortem aging period. The INJ steaks had lower WBSF values (P < 0.05) than non-injected steaks. A greater percentage (91 vs. 71%) of steaks had WBSF values < 4.6 kg from steers with no ZH supplementation at 7 d postmortem, but the percentage did not differ (P > 0.05) due to ZH at 14, 21, or 28 d or due to INJ at any aging period. Trained panelists rated tenderness less in ZH steaks than steaks with no ZH at 14 d and 21 d. However, INJ improved (P < 0.05) the tenderness ratings and flavor intensity of the trained panelists, compared with their non-injected cohorts at 21 d. Zilpaterol hydrochloride supplementation reduced (P < 0.05) MFI values, but INJ resulted in greater (P < 0.05) MFI values compared with no INJ. Subprimals from ZH and INJ showed greater purge loss (P < 0.05). Although no interactions were found with ZH and CaCl(2), injecting USDA Select strip loins from ZH-fed cattle can help reduce the normal WBSF variation as it does in steaks from non-ZH-fed cattle.
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Affiliation(s)
- A Rodas-González
- Department of Animal and Food Sciences, Texas Tech University, Lubbock 79409, USA
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