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Guedalia J, Lipschuetz M, Cahen-Peretz A, Cohen SM, Sompolinsky Y, Shefer G, Melul E, Ergaz-Shaltiel Z, Goldman-Wohl D, Yagel S, Calderon-Margalit R, Beharier O. Maternal hybrid immunity and risk of infant COVID-19 hospitalizations: national case-control study in Israel. Nat Commun 2024; 15:2846. [PMID: 38565530 PMCID: PMC10987618 DOI: 10.1038/s41467-024-46694-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Hybrid immunity, acquired through vaccination followed or preceded by a COVID-19 infection, elicits robust antibody augmentation. We hypothesize that maternal hybrid immunity will provide greater infant protection than other forms of COVID-19 immunity in the first 6 months of life. We conducted a case-control study in Israel, enrolling 661 infants up to 6 months of age, hospitalized with COVID-19 (cases) and 59,460 age-matched non-hospitalized infants (controls) between August 24, 2021, and March 15, 2022. Infants were grouped by maternal immunity status at delivery: Naïve (never vaccinated or tested positive, reference group), Hybrid-immunity (vaccinated and tested positive), Natural-immunity (tested positive before or during the study period), Full-vaccination (two-shot regimen plus 1 booster), and Partial-vaccination (less than full three shot regimen). Applying Cox proportional hazards models to estimate the hazard ratios, which was then converted to percent vaccine effectiveness, and using the Naïve group as the reference, maternal hybrid-immunity provided the highest protection (84% [95% CI 75-90]), followed by full-vaccination (66% [95% CI 56-74]), natural-immunity (56% [95% CI 39-68]), and partial-vaccination (29% [95% CI 15-41]). Maternal hybrid-immunity was associated with a reduced risk of infant hospitalization for Covid-19, as compared to natural-immunity, regardless of exposure timing or sequence. These findings emphasize the benefits of vaccinating previously infected individuals during pregnancy to reduce COVID-19 hospitalizations in early infancy.
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Affiliation(s)
- Joshua Guedalia
- Braun School of Public Health, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Lipschuetz
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel.
- Henrietta Szold Hadassah Hebrew University School of Nursing in the Faculty of Medicine Jerusalem, Jerusalem, Israel.
- The Jerusalem Center for Personalized Computational Medicine Jerusalem, Jerusalem, Israel.
| | - Adva Cahen-Peretz
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sarah M Cohen
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yishai Sompolinsky
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Galit Shefer
- TIMNA-Israel Ministry of Health's Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Eli Melul
- TIMNA-Israel Ministry of Health's Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Zivanit Ergaz-Shaltiel
- Neonatology Department Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Debra Goldman-Wohl
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Simcha Yagel
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofer Beharier
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel.
- The Jerusalem Center for Personalized Computational Medicine Jerusalem, Jerusalem, Israel.
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Yagel S, Cohen SM, Admati I, Skarbianskis N, Solt I, Zeisel A, Beharier O, Goldman-Wohl D. Expert review: preeclampsia Type I and Type II. Am J Obstet Gynecol MFM 2023; 5:101203. [PMID: 37871693 DOI: 10.1016/j.ajogmf.2023.101203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
Pregnancy involves an interplay between maternal and fetal factors affecting changes to maternal anatomy and physiology to support the developing fetus and ensure the well-being of both the mother and offspring. A century of research has provided evidence of the imperative role of the placenta in the development of preeclampsia. Recently, a growing body of evidence has supported the adaptations of the maternal cardiovascular system during normal pregnancy and its maladaptation in preeclampsia. Debate surrounds the roles of the placenta vs the maternal cardiovascular system in the pathophysiology of preeclampsia. We proposed an integrated model of the maternal cardiac-placental-fetal array and the development of preeclampsia, which reconciles the disease phenotypes and their proposed origins, whether placenta-dominant or maternal cardiovascular system-dominant. These phenotypes are sufficiently diverse to define 2 distinct types: preeclampsia Type I and Type II. Type I preeclampsia may present earlier, characterized by placental dysfunction or malperfusion, shallow trophoblast invasion, inadequate spiral artery conversion, profound syncytiotrophoblast stress, elevated soluble fms-like tyrosine kinase-1 levels, reduced placental growth factor levels, high peripheral vascular resistance, and low cardiac output. Type I is more often accompanied by fetal growth restriction, and low placental growth factor levels have a measurable impact on maternal cardiac remodeling and function. Type II preeclampsia typically occurs in the later stages of pregnancy and entails an evolving maternal cardiovascular intolerance to the demands of pregnancy, with a moderately dysfunctional placenta and inadequate blood supply. The soluble fms-like tyrosine kinase-1-placental growth factor ratio may be normal or slightly disturbed, peripheral vascular resistance is low, and cardiac output is high, but these adaptations still fail to meet demand. Emergent placental dysfunction, coupled with an increasing inability to meet demand, more often appears with fetal macrosomia, multiple pregnancies, or prolonged pregnancy. Support for the notion of 2 types of preeclampsia observable on the molecular level is provided by single-cell transcriptomic survey of gene expression patterns across different cell classes. This revealed widespread dysregulation of gene expression across all cell types, and significant imbalance in fms-like tyrosine kinase-1 (FLT1) and placental growth factor, particularly marked in the syncytium of early preeclampsia cases. Classification of preeclampsia into Type I and Type II can inform future research to develop targeted screening, prevention, and treatment approaches.
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Affiliation(s)
- Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel (Dr Yagel, Ms Cohen, and Drs Beharier and Goldman-Wohl).
| | - Sarah M Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel (Dr Yagel, Ms Cohen, and Drs Beharier and Goldman-Wohl)
| | - Inbal Admati
- Department of Biotechnology and Food Engineering, Technion - Israel Institute of Technology, Haifa, Israel (Ms Admati, Mr Skarbianskis, and Dr Zeisel)
| | - Niv Skarbianskis
- Department of Biotechnology and Food Engineering, Technion - Israel Institute of Technology, Haifa, Israel (Ms Admati, Mr Skarbianskis, and Dr Zeisel)
| | - Ido Solt
- Department of Obstetrics and Gynecology, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Dr Solt)
| | - Amit Zeisel
- Department of Biotechnology and Food Engineering, Technion - Israel Institute of Technology, Haifa, Israel (Ms Admati, Mr Skarbianskis, and Dr Zeisel)
| | - Ofer Beharier
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel (Dr Yagel, Ms Cohen, and Drs Beharier and Goldman-Wohl)
| | - Debra Goldman-Wohl
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel (Dr Yagel, Ms Cohen, and Drs Beharier and Goldman-Wohl)
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Yagel S, Cohen SM, Beharier O, Goldman-Wohl D. Cooperation over conflict at the maternal-fetal interface. Ultrasound Obstet Gynecol 2023; 62:911-912. [PMID: 38041630 DOI: 10.1002/uog.27525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 12/03/2023]
Abstract
Linked article: This Correspondence comments on Espinoza. Click here to view the article.
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Affiliation(s)
- S Yagel
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S M Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - O Beharier
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - D Goldman-Wohl
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Yagel S, Cohen SM. Editorial: Editors' showcase: obstetrics and gynecology. Front Med (Lausanne) 2023; 10:1308488. [PMID: 38020104 PMCID: PMC10653310 DOI: 10.3389/fmed.2023.1308488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Simcha Yagel
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sarah M. Cohen
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
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Liberty G, Shweiki F, Nica A, Anteby EY, Cohen SM, Yagel S. Fetal Inguinal Hernia: Case Report and Review of the Literature. Fetal Diagn Ther 2023; 51:39-48. [PMID: 37879314 DOI: 10.1159/000534374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023]
Abstract
Fetal inguinal hernia (FIH) is a rare event and only few cases were published in the medical literature. In the present study, we aimed to characterize the sonographic features, clinical presentation, management, outcomes, and differential diagnoses of FIH. Accordingly, we reviewed all 17 cases of FIH published in the medical literature, including one new case evaluated by our group. All 17 cases (100%) were male, and FIH is presented as a scrotal mass with a mean diameter of 38 ± 9.5 mm. The right side was dominant (62%). Peristalsis was reported in 80% of the cases, and blood flow was reported in two-thirds. Most cases were diagnosed in the third trimester (88%) at a mean gestational age (GA) of 33.1 ± 5.2 weeks. 60% of the cases had isolated FIH, and 40% had another sonographic or genetic abnormality. Three cases (18%) were syndromic with multiple malformations: trisomy 18, skeletal anomalies due to Jarcho-Levin syndrome, and undefined multiple joint contractures. Two cases (12%) had copathologies in the gastrointestinal tract: one had an echogenic bowel due to homozygosity for cystic fibrosis, and the other had low anorectal malformation. Bowel loop dilatation was observed prenatally in both cases and in another one isolated case (18%). GA at delivery was 38 ± 1.8 weeks, and the median time between diagnosis and delivery was 3 weeks. All three cases of neonatal death occurred in syndromic fetuses. All patients with nonsyndromic inguinal hernias underwent definitive surgical repair at a median of 13 days postpartum. No signs of strangulation and only one case of edematous bowel without necrosis have been reported. In conclusion, FIH should be suspected in male fetuses when an intrascrotal mass with peristalsis is diagnosed during the third trimester. Close follow-up until term in the absence of signs of bowel obstruction is reasonable, and in isolated FIH, the prognosis is favorable.
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Affiliation(s)
- Gad Liberty
- Barzilai Medical Centre Ashkelon, Obstetrics and gynecology, Ben-Gurion University of the Negev Faculty of Health Sciences, Ashkelon, Israel
| | - Firas Shweiki
- Barzilai Medical Centre Ashkelon, Obstetrics and gynecology, Ben-Gurion University of the Negev Faculty of Health Sciences, Ashkelon, Israel
| | - Adriana Nica
- Barzilai Medical Centre Ashkelon, Pediatric Surgery, Ben-Gurion University of the Negev Faculty of Health Sciences, Ashkelon, Israel
| | - Eyal Y Anteby
- Barzilai Medical Centre Ashkelon, Obstetrics and gynecology, Ben-Gurion University of the Negev Faculty of Health Sciences, Ashkelon, Israel
| | - Sarah M Cohen
- Department of Obstetrics and Gynaecology, Hadassah University Hospital Mount Scopus, Jerusalem, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynaecology, Hadassah University Hospital Mount Scopus, Jerusalem, Israel
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Lipschuetz M, Guedalia J, Cohen SM, Sompolinsky Y, Shefer G, Melul E, Ergaz-Shaltiel Z, Goldman-Wohl D, Yagel S, Calderon-Margalit R, Beharier O. Maternal third dose of BNT162b2 mRNA vaccine and risk of infant COVID-19 hospitalization. Nat Med 2023; 29:1155-1163. [PMID: 36959421 DOI: 10.1038/s41591-023-02270-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/22/2023] [Indexed: 03/25/2023]
Abstract
Infants are at a higher risk of Coronavirus Disease 2019 (COVID-19)-related hospitalizations compared to older children. In this study, we investigated the effect of the recommended third maternal dose of BNT162b2 COVID-19 vaccine during pregnancy on rates of infant COVID-19-related hospitalizations. We conducted a nationwide cohort study of all live-born infants delivered in Israel between 24 August 2021 and 15 March 2022 to estimate the effectiveness of the third booster dose versus the second dose against infant COVID-19-related hospitalizations. Data were analyzed for the overall study period, and the Delta and Omicron periods were analyzed separately. Cox proportional hazard regression models estimated hazard ratios and 95% confidence intervals (CIs) for infant hospitalizations according to maternal vaccination status at delivery. Among 48,868 live-born infants included in the analysis, rates of COVID-19 hospitalization were 0.4%, 0.6% and 0.7% in the third-dose, second-dose and unvaccinated groups, respectively. Compared to the second dose, the third dose was associated with reduced infant hospitalization with estimated effectiveness of 53% (95% CI: 36-65%). Greater protection was associated with a shorter interval between vaccination and delivery. A third maternal dose during pregnancy reduced the risk of infant hospitalization for COVID-19 during the first 4 months of life, supporting clinical and public health guidance for maternal booster vaccination to prevent infant COVID-19 hospitalization.
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Affiliation(s)
- Michal Lipschuetz
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
- Henrietta Szold Hadassah Hebrew University School of Nursing in the Faculty of Medicine, Jerusalem, Israel
| | - Joshua Guedalia
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sarah M Cohen
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yishai Sompolinsky
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Galit Shefer
- TIMNA-Israel Ministry of Health's Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Eli Melul
- TIMNA-Israel Ministry of Health's Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | | | - Debra Goldman-Wohl
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Simcha Yagel
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofer Beharier
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel.
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Yagel S, Cohen SM, Goldman-Wohl D, Beharier O. Redefining pre-eclampsia as Type I or II: implementing an integrated model of the maternal-cardiovascular-placental-fetal array. Ultrasound Obstet Gynecol 2023; 61:293-301. [PMID: 36378064 DOI: 10.1002/uog.26121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/04/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Affiliation(s)
- S Yagel
- Division of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S M Cohen
- Division of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - D Goldman-Wohl
- Division of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - O Beharier
- Division of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Guedalia J, Lipschuetz M, Walfisch A, Cohen SM, Sheiner E, Samson AO, Rosenbloom J, Kabiri D, Hochler H. Partogram of Grandmultiparous Parturients: A Multicenter Cohort Study. J Clin Med 2023; 12:jcm12020592. [PMID: 36675524 PMCID: PMC9860757 DOI: 10.3390/jcm12020592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/30/2022] [Accepted: 01/07/2023] [Indexed: 01/13/2023] Open
Abstract
Sparse and conflicting data exist regarding the normal partogram of grand-multiparous (GMP, defined as parity of 6+) parturients. Customized partograms may potentially lower cesarean delivery rates for protraction disorders in this population. In this study, we aim to construct a normal labor curve of GMP women and compare it to the multiparous (MP, defined as parity of 2-5) partogram. We conducted a multicenter retrospective cohort analysis of deliveries between the years 2003 and 2019. Eligible parturients were the trials of labor of singletons ≥37 + 0 weeks in cephalic presentation with ≥2 documented cervical examinations during labor. Exclusion criteria were elective cesarean delivery without a trial of labor, preterm labor, major fetal anomalies, and fetal demise. GMP comprised the study group while the MP counterparts were the control group. A total of 78,292 deliveries met the inclusion criteria, comprising 10,532 GMP and 67,760 MP parturients. Our data revealed that during the first stage of labor, cervical dilation progressed at similar rates in MPs and GMPs, while head descent was a few minutes faster in GMPs compared to MPs, regardless of epidural anesthesia. The second stage of labor was faster in GMPs compared to MPs; the 95th percentile of the second stage duration of GMPs (48 min duration) was 43 min less than that of MPs (91 min duration). These findings remained similar among deliveries with and without epidural analgesia or labor induction. We conclude that GMPs' and MPs' cervical dilation progression in the active phase of labor was similar, and the second stage of labor was shorter in GMPs, regardless of epidural use. Thus, GMPs' uterus function during labor corresponds, and possibly surpasses, that of MPs. These findings indicate that health providers can use the standard partogram of the active phase of labor when caring for GMP parturients.
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Affiliation(s)
- Joshua Guedalia
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91121, Israel
| | - Michal Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91121, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Rabin Medical Center, Petach-Tikva 49414, Israel
| | - Sarah M. Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91121, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84101, Israel
| | | | - Joshua Rosenbloom
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91121, Israel
| | - Doron Kabiri
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91121, Israel
| | - Hila Hochler
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91121, Israel
- Correspondence: ; Tel.: +972-523003722 or +972-25844400; Fax: +972-25814210
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Cahen-Peretz A, Tsaitlin-Mor L, Allouche Kam H, Frenkel R, Kabessa M, Cohen SM, Lipschuetz M, Oiknine-Djian E, Lianski S, Goldman-Wohl D, Walfisch A, Kovo M, Neeman M, Wolf DG, Yagel S, Beharier O. Boosting maternal and neonatal anti-SARS-CoV-2 humoral immunity using a third mRNA vaccine dose. JCI Insight 2023; 8:158646. [PMID: 36625348 PMCID: PMC9870074 DOI: 10.1172/jci.insight.158646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 11/16/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND To minimize COVID-19 pandemic burden and spread, 3-dose vaccination campaigns commenced worldwide. Since patients who are pregnant are at increased risk for severe disease, they were recently included in that policy, despite the lack of available evidence regarding the impact of a third boosting dose during pregnancy, underscoring the urgent need for relevant data. We aimed to characterize the effect of the third boosting dose of mRNA Pfizer BNT162b2 vaccine in pregnancy. METHODS We performed a prospective cohort study of anti-SARS-CoV-2 antibody titers (n = 213) upon delivery in maternal and cord blood of naive fully vaccinated parturients who received a third dose (n = 86) as compared with 2-dose recipients (n = 127). RESULTS We found a robust surge in maternal and cord blood levels of anti-SARS-CoV-2 titers at the time of delivery, when comparing pregnancies in which the mother received a third boosting dose with 2-dose recipients. The effect of the third boosting dose remained significant when controlling for the trimester of last exposure, suggesting additive immunity extends beyond that obtained after the second dose. Milder side effects were reported following the third dose, as compared with the second vaccine dose, among the fully vaccinated group. CONCLUSION The third boosting dose of mRNA Pfizer BNT162b2 vaccine augmented maternal and neonatal immunity with mild side effects. These data provide evidence to bolster clinical and public health guidance, reassure patients, and increase vaccine uptake among patients who are pregnant. FUNDING Israel Science Foundation KillCorona grant 3777/19; Research grant from the "Ofek" Program of the Hadassah Medical Center.
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Affiliation(s)
- Adva Cahen-Peretz
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Lilah Tsaitlin-Mor
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Hadas Allouche Kam
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Racheli Frenkel
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Maor Kabessa
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Sarah M. Cohen
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Michal Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Esther Oiknine-Djian
- Clinical Virology Unit, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sapir Lianski
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Debra Goldman-Wohl
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Michal Neeman
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot, Israel
| | - Dana G. Wolf
- Clinical Virology Unit, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.,Lautenberg Center for General and Tumor Immunology, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer Beharier
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Guedalia J, Lipschuetz M, Calderon-Margalit R, Cohen SM, Goldman-Wohl D, Kaminer T, Melul E, Shefer G, Sompolinsky Y, Walfisch A, Yagel S, Beharier O. Effectiveness of a third BNT162b2 mRNA COVID-19 vaccination during pregnancy: a national observational study in Israel. Nat Commun 2022; 13:6961. [PMID: 36379951 PMCID: PMC9664047 DOI: 10.1038/s41467-022-34605-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 07/14/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
The Centers for Disease Control (CDC) recommend a third dose of COVID-19 vaccine for pregnant women, although data regarding effectiveness during pregnancy are lacking. This national, population-based, historical cohort study of pregnant women in Israel, delivering between August 1, 2021 and March 22, 2022, aims to analyze and compare the third and second doses' vaccine effectiveness in preventing COVID-19-related hospitalizations during pregnancy during two COVID-19 waves (Delta variant in the summer of 2021 and Omicron, BA.1, variant in the winter of 2022). Time-dependent Cox proportional-hazards regression models estimate the hazard ratios (HR) and 95% confidence intervals (CI) for COVID-related outcomes according to vaccine dose, and vaccine effectiveness as 1-HR. Study includes 82,659 and 33,303 pregnant women from the Delta and Omicron waves, respectively. Compared with the second dose, the third dose effectively prevents overall hospitalizations with SARS-CoV-2 infections, with estimated effectiveness of 92% (95% CI 83-96%) during Delta, and enhances protection against significant disease during Omicron, with effectiveness of 92% (95% CI 26-99%), and 48% (95% CI 37-57%) effectiveness against hospitalization overall. A third dose of the BNT162b2 mRNA COVID-19 vaccine during pregnancy, given at least 5 months after the second vaccine dose, enhances protection against adverse COVID-19-related outcomes.
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Affiliation(s)
- Joshua Guedalia
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Lipschuetz
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel ,grid.9619.70000 0004 1937 0538Henrietta Szold Hadassah Hebrew University School of Nursing in the Faculty of Medicine, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- grid.9619.70000 0004 1937 0538Braun School of Public Health, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sarah M. Cohen
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Debra Goldman-Wohl
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tali Kaminer
- grid.414840.d0000 0004 1937 052XTIMNA-Israel Ministry of Health’s Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Eli Melul
- grid.414840.d0000 0004 1937 052XTIMNA-Israel Ministry of Health’s Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Galit Shefer
- grid.414840.d0000 0004 1937 052XTIMNA-Israel Ministry of Health’s Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Yishai Sompolinsky
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asnat Walfisch
- grid.12136.370000 0004 1937 0546Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Simcha Yagel
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofer Beharier
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
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11
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Nevo L, Cahen-Peretz A, Vorontsov O, Frenkel R, Kabessa M, Cohen SM, Hamrani A, Oiknine-Djian E, Lipschuetz M, Goldman-Wohl D, Walfisch A, Kovo M, Neeman M, Yagel S, Wolf DG, Beharier O. Boosting maternal and neonatal humoral immunity following SARS-CoV-2 infection using a single messenger RNA vaccine dose. Am J Obstet Gynecol 2022; 227:486.e1-486.e10. [PMID: 35430228 PMCID: PMC9008977 DOI: 10.1016/j.ajog.2022.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Post-COVID-19 vaccine boosting is a potent tool in the ongoing pandemic. Relevant data regarding this approach during pregnancy are lacking, which affects vaccination policy guidance, public acceptance, and vaccine uptake during pregnancy. We aimed to investigate the dynamics of anti-SARS-CoV-2 antibody levels following SARS-CoV-2 infection during pregnancy and to characterize the effect of a single postinfection vaccine booster dose on the anti-SARS-CoV-2 antibody levels in parturients in comparison with the levels in naïve vaccinated and convalescent, nonboosted parturients. STUDY DESIGN Serum samples prospectively collected from parturients and umbilical cords at delivery at our university-affiliated urban medical center in Jerusalem, Israel, from May to October 2021, were selected and analyzed in a case-control manner. Study groups comprised the following participants: a consecutive sample of parturients with a polymerase chain reaction-confirmed history of COVID-19 during any stage of pregnancy; and comparison groups selected according to time of exposure comprising (1) convalescent, nonboosted parturients with polymerase chain reaction-confirmed COVID-19; (2) convalescent parturients with polymerase chain reaction-confirmed COVID-19 who received a single booster dose of the BNT162b2 messenger RNA vaccine; and (3) infection-naïve, fully vaccinated parturients who received 2 doses of the BNT162b2 messenger RNA vaccine. Outcomes that were determined included maternal and umbilical cord blood anti-SARS-CoV-2 antibody levels detected at delivery, the reported side effects, and pregnancy outcomes. RESULTS A total of 228 parturients aged 18 to 45 years were included. Of those, samples from 64 were studied to characterize the titer dynamics following COVID-19 at all stages of pregnancy. The boosting effect was determined by comparing (1) convalescent (n=54), (2) boosted convalescent (n=60), and (3) naïve, fully vaccinated (n=114) parturients. Anti-SARS-CoV-2 antibody levels detected on delivery showed a gradual and significant decline over time from infection to delivery (r=0.4371; P=.0003). Of the gravidae infected during the first trimester, 34.6% (9/26) tested negative at delivery, compared with 9.1% (3/33) of those infected during the second trimester (P=.023). Significantly higher anti-SARS-CoV-2 antibody levels were observed among boosted convalescent than among nonboosted convalescent (17.6-fold; P<.001) and naïve vaccinated parturients (3.2-fold; P<.001). Similar patterns were observed in umbilical cord blood. Side effects in convalescent gravidae resembled those in previous reports of mild symptoms following COVID-19 vaccination during pregnancy. CONCLUSION Postinfection maternal humoral immunity wanes during pregnancy, leading to low or undetectable protective titers for a marked proportion of patients. A single boosting dose of the BNT162b2 messenger RNA vaccine induced a robust increase in protective titers for both the mother and newborn with moderate reported side effects.
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Affiliation(s)
- Lea Nevo
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adva Cahen-Peretz
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Olesya Vorontsov
- Clinical Virology Unit, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Lautenberg Center for General and Tumor Immunology, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rachelli Frenkel
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maor Kabessa
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sarah M Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adar Hamrani
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Esther Oiknine-Djian
- Clinical Virology Unit, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Debra Goldman-Wohl
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Kovo
- Department Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - Michal Neeman
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dana G Wolf
- Clinical Virology Unit, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Lautenberg Center for General and Tumor Immunology, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofer Beharier
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
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12
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Yagel S, Cohen SM. Grand Challenges in Obstetrics and Gynecology. Front Med (Lausanne) 2022; 9:939858. [PMID: 35847808 PMCID: PMC9276978 DOI: 10.3389/fmed.2022.939858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
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13
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Cohen SM, Wrobel CJJ, Prakash SJ, Schroeder FC, Sternberg PW. Formation and function of dauer ascarosides in the nematodes Caenorhabditis briggsae and Caenorhabditis elegans. G3 Genes|Genomes|Genetics 2022; 12:6517505. [PMID: 35094091 PMCID: PMC8895998 DOI: 10.1093/g3journal/jkac014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/22/2021] [Indexed: 11/12/2022]
Abstract
Abstract
The biosynthetic pathways and functions of ascaroside signaling molecules in the nematode Caenorhabditis elegans have been studied to better understand complex, integrative developmental decision-making. Although it is known that ascarosides play multiple roles in the development and behavior of nematode species other than C. elegans, these parallel pheromone systems have not been well-studied. Here, we show that ascarosides in the nematode Caenorhabditis briggsae are biosynthesized in the same manner as C. elegans and act to induce the alternative developmental pathway that generates the stress-resistant dauer lifestage. We show that ascr#2 is the primary component of crude dauer pheromone in C. briggsae; in contrast, C. elegans dauer pheromone relies on a combination of ascr#2, ascr#3, and several other components. We further demonstrate that Cbr-daf-22, like its C. elegans ortholog Cel-daf-22, is necessary to produce short-chain ascarosides. Moreover, Cbr-daf-22 and Cel-daf-22 mutants produce an ascaroside-independent metabolite that acts antagonistically to crude dauer pheromone and inhibits dauer formation.
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Affiliation(s)
- Sarah M Cohen
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Chester J J Wrobel
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, NY 14853, USA
| | - Sharan J Prakash
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Frank C Schroeder
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, NY 14853, USA
| | - Paul W Sternberg
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
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14
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Yagel S, Cohen SM, Goldman-Wohl D. An integrated model of preeclampsia: a multifaceted syndrome of the maternal cardiovascular-placental-fetal array. Am J Obstet Gynecol 2022; 226:S963-S972. [PMID: 33712272 DOI: 10.1016/j.ajog.2020.10.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/13/2020] [Accepted: 10/19/2020] [Indexed: 12/16/2022]
Abstract
Maternal tolerance of the semiallogenic fetus necessitates conciliation of competing interests. Viviparity evolved with a placenta to mediate the needs of the fetus and maternal adaptation to the demands of pregnancy and to ensure optimal survival for both entities. The maternal-fetal interface is imagined as a 2-dimensional porous barrier between the mother and fetus, when in fact it is an intricate multidimensional array of tissues and resident and circulating factors at play, encompassing the developing fetus, the growing placenta, the changing decidua, and the dynamic maternal cardiovascular system. Pregnancy triggers dramatic changes to maternal hemodynamics to meet the growing demands of the developing fetus. Nearly a century of extensive research into the development and function of the placenta has revealed the role of placental dysfunction in the great obstetrical syndromes, among them preeclampsia. Recently, a debate has arisen questioning the primacy of the placenta in the etiology of preeclampsia, asserting that the maternal cardiovascular system is the instigator of the disorder. It was the clinical observation of the high rate of preeclampsia in hydatidiform mole that initiated the focus on the placenta in the etiology of the disease. Over many years of research, shallow trophoblast invasion with deficient remodeling of the maternal spiral arteries into vessels of higher capacitance and lower resistance has been recognized as hallmarks of the preeclamptic milieu. The lack of the normal decrease in uterine artery resistance is likewise predictive of preeclampsia. In abdominal pregnancies, however, an extrauterine pregnancy develops without remodeling of the spiral arteries, yet there is reduced resistance in the uterine arteries and distant vessels, such as the maternal ophthalmic arteries. Proponents of the maternal cardiovascular model of preeclampsia point to the observed maternal hemodynamic adaptations to pregnancy and maladaptation in gestational hypertension and preeclampsia and how the latter resembles the changes associated with cardiac disease states. Recognition of the importance of the angiogenic-antiangiogenic balance between placental-derived growth factor and its receptor soluble fms-like tyrosine kinase-1 and disturbance in this balance by an excess of a circulating isoform, soluble fms-like tyrosine kinase-1, which competes for and disrupts the proangiogenic receptor binding of the vascular endothelial growth factor and placental-derived growth factor, opened new avenues of research into the pathways to normal adaptation of the maternal cardiovascular and other systems to pregnancy and maladaptation in preeclampsia. The significance of the "placenta vs heart" debate goes beyond the academic: understanding the mutuality of placental and maternal cardiac etiologies of preeclampsia has far-reaching clinical implications for designing prevention strategies, such as aspirin therapy, prediction and surveillance through maternal hemodynamic studies or serum placental-derived growth factor and soluble fms-like tyrosine kinase-1 testing, and possible treatments to attenuate the effects of insipient preeclampsia on women and their fetuses, such as RNAi therapy to counteract excess soluble fms-like tyrosine kinase-1 produced by the placenta. In this review, we will present an integrated model of the maternal-placental-fetal array that delineates the commensality among the constituent parts, showing how a disruption in any component or nexus may lead to the multifaceted syndrome of preeclampsia.
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Affiliation(s)
- Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Sarah M Cohen
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Debra Goldman-Wohl
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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15
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Chai CM, Chen W, Wong WR, Park H, Cohen SM, Wan X, Sternberg PW. A conserved behavioral role for a nematode interneuron neuropeptide receptor. Genetics 2022; 220:iyab198. [PMID: 34741504 PMCID: PMC8733633 DOI: 10.1093/genetics/iyab198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/28/2021] [Indexed: 01/14/2023] Open
Abstract
Neuropeptides are evolutionarily conserved modulators of many aspects of animal behavior and physiology, and expand the repertoire of processes that can be controlled by a limited number of neurons. Deciphering the neuropeptidergic codes that govern distinct processes requires systematic functional analyses of neuropeptides and their cognate receptors. Even in well-studied model organisms like Caenorhabditis elegans, however, such efforts have been precluded by a lack of mutant reagents. Here, we generated and screened 21 C. elegans neuropeptide G-protein coupled receptor mutants with no pre-existing reagents for the touch-evoked escape response, and implicated six receptors expressed in diverse neuron classes representing multiple circuit levels in this behavior. We further characterized the mutant with the most severe phenotype, frpr-14, which was defective in multiple behavioral paradigms. We leveraged this range of phenotypes to reveal that FRPR-14 modulation of different precommand interneuron classes, AVH and AIB, can drive distinct behavioral subsets, demonstrating cellular context-dependent roles for FRPR-14 signaling. We then show that Caenorhabditis briggsae CBR-FRPR-14 modulates an AVH-like interneuron pair to regulate the same behaviors as C. elegans but to a smaller extent. Our results also suggest that differences in touch-evoked escape circuit architecture between closely related species results from changes in neuropeptide receptor expression pattern, as opposed to ligand-receptor pairing. This study provides insights into the principles utilized by a compact, multiplexed nervous system to generate intraspecific behavioral complexity and interspecific variation.
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Affiliation(s)
- Cynthia M Chai
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Wen Chen
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Wan-Rong Wong
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Heenam Park
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Sarah M Cohen
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Xuan Wan
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Paul W Sternberg
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
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16
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Guedalia J, Lipschuetz M, Cohen SM, Sompolinsky Y, Walfisch A, Sheiner E, Sergienko R, Rosenbloom J, Unger R, Yagel S, Hochler H. Transporting an Artificial Intelligence Model to Predict Emergency Cesarean Delivery: Overcoming Challenges Posed by Interfacility Variation. J Med Internet Res 2021; 23:e28120. [PMID: 34890352 PMCID: PMC8709908 DOI: 10.2196/28120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/25/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Research using artificial intelligence (AI) in medicine is expected to significantly influence the practice of medicine and the delivery of health care in the near future. However, for successful deployment, the results must be transported across health care facilities. We present a cross-facilities application of an AI model that predicts the need for an emergency caesarean during birth. The transported model showed benefit; however, there can be challenges associated with interfacility variation in reporting practices.
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Affiliation(s)
- Joshua Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Michal Lipschuetz
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel.,Division of Obstetrics & Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sarah M Cohen
- Division of Obstetrics & Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yishai Sompolinsky
- Division of Obstetrics & Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asnat Walfisch
- Division of Obstetrics & Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruslan Sergienko
- Department of Public Health, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Joshua Rosenbloom
- Division of Obstetrics & Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ron Unger
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Simcha Yagel
- Division of Obstetrics & Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hila Hochler
- Division of Obstetrics & Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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17
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Liberty G, Gemer O, Siyanov I, Anteby EY, Apter A, Cohen SM, Bord I, Yagel S. The relation between head circumference and mid pelvic circumference: A simple index for cephalo-pelvic disproportion evaluation. Fetal Diagn Ther 2021; 48:840-848. [PMID: 34879366 DOI: 10.1159/000521115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/22/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cephalo-pelvic-disproportion (CPD) is one of the most common obstetric complications. Since CPD is the disproportion between the fetal head and maternal bony pelvis, evaluation of the head-circumference (HC) relative to maternal bony pelvis may be a useful adjunct to pre-labor CPD evaluation. The aim of the present study was a proof-of-concept evaluation of the ratio between HC to pelvic circumference (PC) as a predictor of CPD. METHODS Of 11,822 deliveries, 104 cases that underwent an abdomino-pelvic CT for any medical indication and who underwent normal vaginal deliveries (NVD) (n=84) or cesarean deliveries (CD) due to CPD (n=20) were included retrospectively. Maternal pelvis dimensions were reconstructed and neonatal HC, as a proxy for fetal HC, were measured. The correlation between cases of CPD and Cephalo-Pelvic Circumference Index (CPCI), which represents the ratio between the HC and PC in percent (HC/PC *100) was evaluated. RESULTS The mid-pelvis cephalo-pelvic circumference index (MP-CPCI) was larger in CD groups as compared to the NVD group: 103±11 vs. 97±8% respectively (p=0.0003). In logistic regression analysis, the MP-CPCI was found to be independently associated with CD due to CPD: each 1% increase in MP-CPCI increased the likelihood of CD for CPD by 11% (aOR 1.11, CI 95% 1.03-1.19, p=0.004). The adjusted odds ratio for CD due to CPD increased incrementally as the MP-CPCI increased, from 3.56 (95%CI, 1.01-12.6) at MP-CPCI of 100, to 5.6 (95%CI, 1.63-19.45) at 105, 21.44 (95%CI, 3.05-150.84) at 110, and 28.88 (95%CI, 2.3-362.27) at MP-CPCI of 115 Conclusions: The MP-CPCI, representing the relative dimensions of the fetal HC and maternal PC, is a simple tool that can potentially distinguish between parturients at lower and higher risk of CPD. Prospective randomized studies are required to evaluate the feasibility of prenatal pelvimetry and MP-CPCI to predict the risk of CPD during labor.
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Affiliation(s)
- Gad Liberty
- Department of Obstetrics and Gynecology, Barzilai Medical Center, Ashkelon, Affiliated with Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ofer Gemer
- Department of Obstetrics and Gynecology, Barzilai Medical Center, Ashkelon, Affiliated with Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Irena Siyanov
- Department of Obstetrics and Gynecology, Barzilai Medical Center, Ashkelon, Affiliated with Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Y Anteby
- Department of Obstetrics and Gynecology, Barzilai Medical Center, Ashkelon, Affiliated with Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alona Apter
- Department of Radiology, Barzilai Medical Center, Ashkelon, Affiliated with Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sarah M Cohen
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ilia Bord
- Department of Fertility and IVF Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Simcha Yagel
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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18
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Hochler H, Guedalia J, Lipschuetz M, Walfisch A, Yagel S, Guedalia Friedman E, Unger R, Sergienko R, Yoles I, Kabiri D, Cohen SM, Sheiner E. Normal labor curve in twin gestation. Am J Obstet Gynecol 2021; 225:546.e1-546.e11. [PMID: 34363782 DOI: 10.1016/j.ajog.2021.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/12/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Failure to progress is one of the leading indications for cesarean delivery in trials of labor in twin gestations. However, assessment of labor progression in twin labors is managed according to singleton labor curves. OBJECTIVE This study aimed to establish a partogram for twin deliveries that reflects normal and abnormal labor progression and customized labor curves for different subgroups of twin labors. STUDY DESIGN This was a multicenter, retrospective cohort analysis of twin deliveries that were recorded in 3 tertiary medical centers between 2003 and 2017. Eligible parturients were those with twin gestations at ≥34 weeks' gestation with cephalic presentation of the presenting twin and ≥2 cervical examinations during labor. Exclusion criteria were elective cesarean delivery without a trial of labor, major fetal anomalies, and fetal demise. The study group comprised twin gestations, whereas singleton gestations comprised the control group. Statistical analysis was performed using Python 3.7.3 and SPSS, version 27. Categorical variables were analyzed using chi-square tests. Student t test and Mann-Whitney U test were applied to analyze the differences in continuous variables, as appropriate. RESULTS A total of 1375 twin deliveries and 142,659 singleton deliveries met the inclusion criteria. Duration of the active phase of labor was significantly longer in twin labors than in singleton labors in both nulliparous and multiparous parturients; the 95th percentile duration was 2 hours longer in nulliparous twin labors and >3.5 hours longer in multiparous twin labors than in singleton labors. The cervical dilation progression rate was significantly slower in twin deliveries than in singleton deliveries with a mean rate in twin deliveries of 1.89 cm/h (95th percentile, 0.51 cm/h) and a mean rate of 2.48 cm/h (95th percentile, 0.73 cm/h) in singleton deliveries (P<.001). In addition, epidural use further slowed labor progression in twin deliveries. The second stage of labor was also markedly longer in twin deliveries, both in nulliparous and multiparous women (95th percentile, 3.04 vs 2.83 hours, P=.002). CONCLUSION Twin labors are characterized by a slower progression of the active phase and second stage of labor compared with singleton labors in nulliparous and multiparous parturients. Epidural analgesia further slows labor progression in twin labors. Implementation of these findings in clinical management might lower cesarean delivery rates among cases with protracted labor in twin gestations.
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Affiliation(s)
- Hila Hochler
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
| | - Joshua Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Michal Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel; The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
| | - Efrat Guedalia Friedman
- Ben-Gurion University of the Negev, Be'er Sheva, Israel; Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Ron Unger
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Ruslan Sergienko
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Israel Yoles
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Doron Kabiri
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel
| | - Sarah M Cohen
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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19
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Wrobel CJJ, Yu J, Rodrigues PR, Ludewig AH, Curtis BJ, Cohen SM, Fox BW, O'Donnell MP, Sternberg PW, Schroeder FC. Combinatorial Assembly of Modular Glucosides via Carboxylesterases Regulates C. elegans Starvation Survival. J Am Chem Soc 2021; 143:14676-14683. [PMID: 34460264 DOI: 10.1021/jacs.1c05908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The recently discovered modular glucosides (MOGLs) form a large metabolite library derived from combinatorial assembly of moieties from amino acid, neurotransmitter, and lipid metabolism in the model organism C. elegans. Combining CRISPR-Cas9 genome editing, comparative metabolomics, and synthesis, we show that the carboxylesterase homologue Cel-CEST-1.2 is responsible for specific 2-O-acylation of diverse glucose scaffolds with a wide variety of building blocks, resulting in more than 150 different MOGLs. We further show that this biosynthetic role is conserved for the closest homologue of Cel-CEST-1.2 in the related nematode species C. briggsae, Cbr-CEST-2. Expression of Cel-cest-1.2 and MOGL biosynthesis are strongly induced by starvation conditions in C. elegans, one of the premier model systems for mechanisms connecting nutrition and physiology. Cel-cest-1.2-deletion results in early death of adult animals under starvation conditions, providing first insights into the biological functions of MOGLs.
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Affiliation(s)
- Chester J J Wrobel
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, New York 14853, United States
| | - Jingfang Yu
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, New York 14853, United States
| | - Pedro R Rodrigues
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, New York 14853, United States
| | - Andreas H Ludewig
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, New York 14853, United States
| | - Brian J Curtis
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, New York 14853, United States
| | - Sarah M Cohen
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, California 91125, United States
| | - Bennett W Fox
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, New York 14853, United States
| | - Michael P O'Donnell
- Department of Molecular, Cellular and Developmental Biology, New Haven, Connecticut 06511, United States
| | - Paul W Sternberg
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, California 91125, United States
| | - Frank C Schroeder
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, New York 14853, United States
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20
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Cohen SM, Le HH, Sternberg PW. A Mutation of lips-6 in C. elegans. MicroPubl Biol 2021; 2021:10.17912/micropub.biology.000419. [PMID: 34258545 PMCID: PMC8271349 DOI: 10.17912/micropub.biology.000419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 11/09/2022]
Abstract
The lips-6 gene encodes a putative lipase that plays a role in adult starvation response through a pathway that is parallel to the dauer pathway in larval Caenorhabditis elegans worms. We created a mutation of lips-6 to study its effects on lifespan and the ascaroside profile. We found that lips-6 had a wild-type lifespan and a wild-type ascaroside profile. These results suggest that the lips-6 gene plays a minimal role in C. elegans lifespan biology and does not affect the ascaroside profile until it is specifically activated by starvation in adult worms.
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Affiliation(s)
- Sarah M Cohen
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Henry H Le
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, New York 14853, United States
| | - Paul W Sternberg
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA,
Correspondence to: Paul W Sternberg ()
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21
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Charach R, Cohen SM, Yagel S, Valsky DV. It takes two great vessels to tango: fetal nutcracker phenomenon. Ultrasound Obstet Gynecol 2021; 57:1017-1019. [PMID: 33524214 DOI: 10.1002/uog.23602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/22/2021] [Indexed: 06/12/2023]
Affiliation(s)
- R Charach
- Fetal Medicine & Ultrasound Unit, Division of Obstetrics and Gynecology, Mt. Scopus campus, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - S M Cohen
- Division of Obstetrics and Gynecology, Mt. Scopus campus, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - S Yagel
- Division of Obstetrics and Gynecology, Mt. Scopus campus, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - D V Valsky
- Fetal Medicine & Ultrasound Unit, Division of Obstetrics and Gynecology, Mt. Scopus campus, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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22
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Hochler H, Lipschuetz M, Guedalia J, Karavani G, Cohen SM, Yagel S, Kabiri D, Walfisch A. The impact of peak and duration of maternal intrapartum fever on perinatal outcomes. Am J Obstet Gynecol MFM 2021; 3:100390. [PMID: 33984531 DOI: 10.1016/j.ajogmf.2021.100390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/27/2021] [Accepted: 05/03/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Intrapartum fever is a common perinatal complication, associated with short- and long-term adverse outcomes. Limited data exist regarding the association between the peak and duration of maternal fever and the extent and severity of maternal and neonatal complications. OBJECTIVE This study aimed to examine the association between maternal intrapartum fever peak and duration and perinatal outcomes. STUDY DESIGN A retrospective cohort analysis of term singleton live births in 2 medical centers between the years 2003 and 2015 was conducted. The study group included parturients who experienced intrapartum fever, defined as a temperature of ≥38.0°C (100.4°F). Fever duration was defined as the time elapsed between the first documented fever and subsequent first documented normal body temperature (<38°C or <100.4°F) or if the temperature did not return to normal until delivery. Adjusted risks for adverse perinatal outcomes were calculated using multiple logistic regression models to control for confounders. RESULTS A cohort study of 85,713 deliveries was analyzed, of which 1517 (1.8%) parturients experienced fever during delivery. Adverse composite neonatal outcome gradually worsens, in a dose-response manner, with higher maximal maternal temperature. Similar dose-response deterioration was found when maximal parturient temperature was combined with fever duration (P=.015). Higher or longer maternal fever was not independently associated with cesarean or instrumental deliveries (P=.648). Duration alone was not significantly associated with worsening neonatal outcomes (P=.711). CONCLUSION Maximal intrapartum maternal fever, solely and when combined with fever duration, is correlated with neonatal complications in a dose-dependent manner. Further prospective studies are needed to examine the potential benefit of rigorous maternal body temperature control on perinatal outcomes.
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Affiliation(s)
- Hila Hochler
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel (Dr Hochler, Mss Lipschuetz and Cohen, and Drs Yagel and Walfisch).
| | - Michal Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel (Dr Hochler, Mss Lipschuetz and Cohen, and Drs Yagel and Walfisch); The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel (Ms Lipschuetz and Mr Guedalia)
| | - Joshua Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel (Ms Lipschuetz and Mr Guedalia)
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel (Drs Karavani and Kabiri)
| | - Sarah M Cohen
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel (Dr Hochler, Mss Lipschuetz and Cohen, and Drs Yagel and Walfisch)
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel (Dr Hochler, Mss Lipschuetz and Cohen, and Drs Yagel and Walfisch)
| | - Doron Kabiri
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel (Drs Karavani and Kabiri)
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel (Dr Hochler, Mss Lipschuetz and Cohen, and Drs Yagel and Walfisch)
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23
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Cohen SM, Sun JJ, Schroeder FC, Sternberg PW. Transcriptional Response to a Dauer-Inducing Ascaroside Cocktail in Late L1 in C. elegans. MicroPubl Biol 2021; 2021. [PMID: 33997661 PMCID: PMC8116936 DOI: 10.17912/micropub.biology.000397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The dauer diapause stage in C. elegans is a non-feeding alternative to the L3 larval stage that is highly resistant to harsh environmental conditions. The decision to enter dauer is a two-step process. First, L1 larvae encounter adverse conditions such as lack of food or overcrowding and decide to enter the L2d rather than the L2 stage. Second, L2d worms that continue to experience disadvantageous conditions decide to enter dauer instead of L3. Here, we have used RNA-seq to characterize the transcriptional response to a cocktail of dauer-inducing ascaroside pheromones at the late L1 stage as worms enter the L2d phase. We find that, in response to ascarosides, C. elegans L1 larvae preparing to enter the L2d stage begin upregulating genes involved in stress response and downregulating genes associated with growth and metabolism.
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Affiliation(s)
- Sarah M Cohen
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Jessica J Sun
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Frank C Schroeder
- Boyce Thompson Institute, Ithaca, NY 14853, USA.,Department of Chemistry and Chemical Biology, Cornell University, Ithaca NY 14853, USA
| | - Paul W Sternberg
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
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24
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Guedalia J, Sompolinsky Y, Novoselsky Persky M, Cohen SM, Kabiri D, Yagel S, Unger R, Lipschuetz M. Prediction of severe adverse neonatal outcomes at the second stage of labour using machine learning: a retrospective cohort study. BJOG 2021; 128:1824-1832. [PMID: 33713380 DOI: 10.1111/1471-0528.16700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/19/2021] [Accepted: 03/03/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To create a personalised machine learning model for prediction of severe adverse neonatal outcomes (SANO) during the second stage of labour. DESIGN Retrospective Electronic-Medical-Record (EMR) -based study. POPULATION A cohort of 73 868 singleton, term deliveries that reached the second stage of labour, including 1346 (1.8%) deliveries with SANO. METHODS A gradient boosting model was created, analysing 21 million data points from antepartum features (e.g. gravidity and parity) gathered at admission to the delivery unit, and intrapartum data (e.g. cervical dilatation and effacement) gathered during the first stage of labour. Deliveries were allocated to high-risk and low-risk groups based on the Youden index to maximise sensitivity and specificity. MAIN OUTCOME MEASURES SANO was defined as either umbilical cord pH levels ≤7.1 or 1-minute or 5-minute Apgar score ≤7. RESULTS The model for prediction of SANO yielded an area under the receiver operating curve (AUC) of 0.761 (95% CI 0.748-0.774). A third of the cohort (33.5%, n = 24 721) were allocated to a high-risk group for SANO, which captured up to 72.1% of these cases (odds ratio 5.3, 95% CI 4.7-6.0; high-risk versus low-risk groups). CONCLUSIONS Data acquired throughout the first stage of labour can be used to predict SANO during the second stage of labour using a machine learning model. Stratifying parturients at the beginning of the second stage of labour in a 'time out' session, can direct a personalised approach to management of this challenging aspect of labour, as well as improve allocation of staff and resources. TWEETABLE ABSTRACT Personalised prediction score for severe adverse neonatal outcomes in labour using machine learning model.
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Affiliation(s)
- J Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Y Sompolinsky
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - M Novoselsky Persky
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S M Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - D Kabiri
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S Yagel
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - R Unger
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - M Lipschuetz
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel.,Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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25
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Lewkowicz AA, Lipschuetz M, Cohen SM, Guedalia J, Shwartz T, Levin G, Rottenstreich A, Yagel S. Successful vaginal birth after cesarean in the second delivery is not associated with the stage of labor of the primary unplanned cesarean delivery. Eur J Obstet Gynecol Reprod Biol 2020; 256:109-113. [PMID: 33202319 DOI: 10.1016/j.ejogrb.2020.10.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Candidates for trial of labor after cesarean must be carefully screened to maximize success and minimize morbidity. Demographic and obstetric characteristics affecting success rates must be delineated. OBJECTIVE We examined whether the labor stage of the primary delivery in which a woman underwent an unplanned cesarean delivery would affect the likelihood that she could achieve a subsequent vaginal birth. STUDY DESIGN Electronic medical records-based study of 676 parturients. Trial of labor rates and outcomes were compared between women whose primary cesarean delivery was performed in the first vs. the second stage of labor. SETTING Hadassah Medical Center, Israel POPULATION: Women in their second pregnancies, with singleton fetuses, who underwent unplanned cesarean delivery in their first pregnancy and elected trial of labor in the second delivery. The main outcome measures were maternal and neonatal complications and vaginal birth rates in first vs. second stage of labor groups. RESULTS In our population, 76 % of women attempt trial of labor after cesarean. Rates of successful vaginal delivery did not differ significantly between those who underwent primary cesarean in the first vs. second stage of labor: 67.4 % vs. 70.2 %, p = 0.483, respectively. Among women whose primary UCD was in the second stage, only 18.2 % (35/192) required a UCD in the second stage in the subsequent delivery, while 58.9 % (113/192) underwent UCD in the first stage in both deliveries. CONCLUSION Labor stage of the primary unplanned cesarean delivery, should not dissuade women from a trial of labor after cesarean in their second delivery.
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Affiliation(s)
- Aya A Lewkowicz
- Division of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Michal Lipschuetz
- Division of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Sarah M Cohen
- Division of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Joshua Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Tomer Shwartz
- Division of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Gabriel Levin
- Division of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amihai Rottenstreich
- Division of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simcha Yagel
- Division of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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26
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Le HH, Wrobel CJ, Cohen SM, Yu J, Park H, Helf MJ, Curtis BJ, Kruempel JC, Rodrigues PR, Hu PJ, Sternberg PW, Schroeder FC. Modular metabolite assembly in Caenorhabditis elegans depends on carboxylesterases and formation of lysosome-related organelles. eLife 2020; 9:61886. [PMID: 33063667 PMCID: PMC7641594 DOI: 10.7554/elife.61886] [Citation(s) in RCA: 8] [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: 08/07/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023] Open
Abstract
Signaling molecules derived from attachment of diverse metabolic building blocks to ascarosides play a central role in the life history of C. elegans and other nematodes; however, many aspects of their biogenesis remain unclear. Using comparative metabolomics, we show that a pathway mediating formation of intestinal lysosome-related organelles (LROs) is required for biosynthesis of most modular ascarosides as well as previously undescribed modular glucosides. Similar to modular ascarosides, the modular glucosides are derived from highly selective assembly of moieties from nucleoside, amino acid, neurotransmitter, and lipid metabolism, suggesting that modular glucosides, like the ascarosides, may serve signaling functions. We further show that carboxylesterases that localize to intestinal organelles are required for the assembly of both modular ascarosides and glucosides via ester and amide linkages. Further exploration of LRO function and carboxylesterase homologs in C. elegans and other animals may reveal additional new compound families and signaling paradigms.
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Affiliation(s)
- Henry H Le
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, United States
| | - Chester Jj Wrobel
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, United States
| | - Sarah M Cohen
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, United States
| | - Jingfang Yu
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, United States
| | - Heenam Park
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, United States
| | - Maximilian J Helf
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, United States
| | - Brian J Curtis
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, United States
| | - Joseph C Kruempel
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, United States
| | - Pedro Reis Rodrigues
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, United States
| | - Patrick J Hu
- Departments of Medicine and Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, United States
| | - Paul W Sternberg
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, United States
| | - Frank C Schroeder
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, United States
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27
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Lipschuetz M, Guedalia J, Rottenstreich A, Novoselsky Persky M, Cohen SM, Kabiri D, Levin G, Yagel S, Unger R, Sompolinsky Y. Prediction of vaginal birth after cesarean deliveries using machine learning. Am J Obstet Gynecol 2020; 222:613.e1-613.e12. [PMID: 32007491 DOI: 10.1016/j.ajog.2019.12.267] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/30/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Efforts to reduce cesarean delivery rates to 12-15% have been undertaken worldwide. Special focus has been directed towards parturients who undergo a trial of labor after cesarean delivery to reduce the burden of repeated cesarean deliveries. Complication rates are lowest when a vaginal birth is achieved and highest when an unplanned cesarean delivery is performed, which emphasizes the need to assess, in advance, the likelihood of a successful vaginal birth after cesarean delivery. Vaginal birth after cesarean delivery calculators have been developed in different populations; however, some limitations to their implementation into clinical practice have been described. Machine-learning methods enable investigation of large-scale datasets with input combinations that traditional statistical analysis tools have difficulty processing. OBJECTIVE The aim of this study was to evaluate the feasibility of using machine-learning methods to predict a successful vaginal birth after cesarean delivery. STUDY DESIGN The electronic medical records of singleton, term labors during a 12-year period in a tertiary referral center were analyzed. With the use of gradient boosting, models that incorporated multiple maternal and fetal features were created to predict successful vaginal birth in parturients who undergo a trial of labor after cesarean delivery. One model was created to provide a personalized risk score for vaginal birth after cesarean delivery with the use of features that are available as early as the first antenatal visit; a second model was created that reassesses this score after features are added that are available only in proximity to delivery. RESULTS A cohort of 9888 parturients with 1 previous cesarean delivery was identified, of which 75.6% of parturients (n=7473) attempted a trial of labor, with a success rate of 88%. A machine-learning-based model to predict when vaginal delivery would be successful was developed. When features that are available at the first antenatal visit are used, the model showed a receiver operating characteristic curve with area under the curve of 0.745 (95% confidence interval, 0.728-0.762) that increased to 0.793 (95% confidence interval, 0.778-0.808) when features that are available in proximity to the delivery process were added. Additionally, for the later model, a risk stratification tool was built to allocate parturients into low-, medium-, and high-risk groups for failed trial of labor after cesarean delivery. The low- and medium-risk groups (42.4% and 25.6% of parturients, respectively) showed a success rate of 97.3% and 90.9%, respectively. The high-risk group (32.1%) had a vaginal delivery success rate of 73.3%. Application of the model to a cohort of parturients who elected a repeat cesarean delivery (n=2145) demonstrated that 31% of these parturients would have been allocated to the low- and medium-risk groups had a trial of labor been attempted. CONCLUSION Trial of labor after cesarean delivery is safe for most parturients. Success rates are high, even in a population with high rates of trial of labor after cesarean delivery. Application of a machine-learning algorithm to assign a personalized risk score for a successful vaginal birth after cesarean delivery may help in decision-making and contribute to a reduction in cesarean delivery rates. Parturient allocation to risk groups may help delivery process management.
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Affiliation(s)
- Michal Lipschuetz
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel; Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Joshua Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Amihai Rottenstreich
- Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Sarah M Cohen
- Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Doron Kabiri
- Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Gabriel Levin
- Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simcha Yagel
- Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Ron Unger
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Yishai Sompolinsky
- Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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28
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Lipschuetz M, Nir EA, Cohen SM, Guedalia J, Hochler H, Amsalem H, Karavani G, Hochner-Celnikier D, Unger R, Yagel S. Cervical dilation at the time of epidural catheter insertion is not associated with the degree of prolongation of the first or second stages of labor, or the rate of instrumental vaginal delivery. Acta Obstet Gynecol Scand 2020; 99:1039-1049. [PMID: 32031682 DOI: 10.1111/aogs.13822] [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] [Received: 09/02/2019] [Revised: 01/23/2020] [Accepted: 02/02/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Epidural analgesia (EA) is an established option for efficient intrapartum analgesia. Meta-analyses have shown that EA differentially affects the first stage of labor but prolongs the second. The question of EA timing remains open. We aimed to investigate whether EA prolongs delivery in total and whether the EA administration timing vis-à-vis cervical dilation at catheter insertion is associated with a modulation of its effects on the duration of the first and second stages, as well as the rate of instrumental vaginal delivery in primiparas and multiparas. MATERIAL AND METHODS A retrospective electronic medical records-based study of 18 870 singleton term deliveries occurring in our institution from 2003 to 2015. Cervical dilation was determined within a half-hour of EA administration. We examined whether cervical dilation at EA administration correlated with the duration of the first and/or second stage, with the rate of prolonged second stage, and with the rate of interventional delivery. The study group was stratified to 10 subgroups defined by 1-cm intervals of cervical dilation at EA administration. Logistic regression modeling was applied to analyze the association between EA timing and rate of instrumental delivery while controlling for possible confounders. RESULTS In primiparas, receiving EA correlated with longer medians of active first stage (+51 minutes; P < .001) and second stage (+55 minutes; P < .001). In multiparas, median increases in active first stage (+43 minutes; P < .001) and second stage (+8 minutes; P < .001) were noted. The timing of EA, vis-à-vis cervical dilation (1-10 cm) was not associated with a substantial modulation of these effects. Logistic regression showed that cervical dilation at EA was not associated with a higher instrumental vaginal delivery rate. CONCLUSIONS Epidural analgesia prolonged the first and second stages of labor vs no epidural. Having EA was associated with a higher instrumental delivery rate but not with higher rates of maternal or neonatal complications, in primi- and multiparas. Importantly, the timing of EA, vis-à-vis cervical dilation, was not associated with substantial changes in the duration of labor stages or the instrumental delivery rate. Thus, EA may be offered early in the first stage of labor.
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Affiliation(s)
- Michal Lipschuetz
- Division of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Eshel A Nir
- Division of Anesthesiology & Critical Care, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Department of Anesthesiology, Perioperative Medicine, and Pain Treatment, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sarah M Cohen
- Division of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Joshua Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Hila Hochler
- Division of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Hagai Amsalem
- Division of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Gilad Karavani
- Division of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Ron Unger
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Simcha Yagel
- Division of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Lipschuetz M, Guedalia J, Cohen SM, Lewkowicz AA, Amsalem H, Karavani G, Yagel S, Unger R. Unplanned Cesarean Delivery in the Second Stage of Labor Holds Higher Odds of Complications than in the First Stage, while Similar in Primiparas and Multiparas. Fetal Diagn Ther 2020; 47:565-571. [PMID: 31982884 DOI: 10.1159/000504573] [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] [Received: 08/08/2019] [Accepted: 11/04/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND While endeavors to reduce cesarean delivery (CD) rates are given priority worldwide, it is important to evaluate if these efforts place parturients and neonates at risk. CD performed in the second stage of labor carries higher risks of maternal and fetal complications and is a more challenging surgical procedure than that performed in the first stage or before labor. In a population with a low CD rate, we sought to evaluate the rate of maternal and fetal complications associated with unplanned CD (UCD) performed in the second vs. the first stage of labor, in primiparas and multiparas, as well as the risk factors leading to and the complications associated with UCD in the second stage of labor in this low-CD rate setting. METHODS This was a retrospective, electronic medical record-based study of 7,635 term and preterm singletons born via UCD in the period 2003-2015. Maternal and neonatal background and outcome parameters were compared between groups. Logistic regression modeling was applied to adjust for clinically and statistically significant risk factors. RESULTS UCD was more likely to be performed in the second stage of labor in mothers delivering larger fetuses (head circumference and body weight ≥90 centile) and those with persistent occiput posterior (POP) presentation. UCD in the second stage was strongly associated with serious maternal complications (excessive hemorrhage and fever) compared to UCD performed in the first stage, in both primiparas and multiparas. CONCLUSIONS UCD performed in the second stage of labor, while less frequent than first-stage UCD, is more likely with larger neonates and POP presentation, and is associated with a higher rate of maternal complications in primiparas and multiparas. Complication rates in our low-CD-rate population did not exceed those reported in the literature from high-CD-rate areas.
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Affiliation(s)
- Michal Lipschuetz
- Obstetrics and Gynecology Division, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel.,The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Joshua Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Sarah M Cohen
- Obstetrics and Gynecology Division, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - Aya A Lewkowicz
- Obstetrics and Gynecology Division, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - Hagai Amsalem
- Obstetrics and Gynecology Division, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - Gilad Karavani
- Obstetrics and Gynecology Division, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - Simcha Yagel
- Obstetrics and Gynecology Division, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel,
| | - Ron Unger
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
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Yagel S, Cohen SM, Valsky DV. Simplifying imaging of the abdominal fetal precordial venous system. Ultrasound Obstet Gynecol 2019; 53:571-575. [PMID: 29573303 DOI: 10.1002/uog.19053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/10/2018] [Accepted: 03/16/2018] [Indexed: 06/08/2023]
Affiliation(s)
- S Yagel
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel
| | - S M Cohen
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel
| | - D V Valsky
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel
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de Souza NP, Cardoso AF, Gomide L, Lima T, Miot HA, Martino-Andrade AJ, Arnold LL, Pennington KL, Cohen SM, de Camargo J, Nascimento E Pontes MG. Experimental cryptorchidism enhances testicular susceptibility to dibutyl phthalate or acrylamide in Sprague-Dawley rats. Hum Exp Toxicol 2019; 38:899-913. [PMID: 30995857 DOI: 10.1177/0960327119845040] [Citation(s) in RCA: 4] [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: 01/04/2023]
Abstract
Cryptorchidism (CPT), the most common male congenital abnormality, is variably associated with other male reproductive tract problems. We evaluated if cryptorchid rats develop enhanced testicular susceptibility to dibutyl phthalate (DBP) or acrylamide (AA) after extended exposure. Three studies with rats were performed: (1) in utero and postnatal exposure to DBP or AA; (2) establishment of CPT and orchiopexy; and (3) in utero and postnatal exposures to DBP or AA associated with CPT/orchiopexy. Seminiferous tubules were histologically scored according to the severity of lesions: (1) Rats exposed to DBP (score 1.5) or AA (score 1.1) presented mostly preserved spermatogenesis. Some seminiferous tubules showed vacuolated germinative epithelium, germ cell apoptosis, and a Sertoli cell-only (SCO) pattern. (2) CPT (score 3.3) resulted in decreased absolute testes weights, degenerated and SCO tubules, and spermatogenesis arrest that were reversed by orchiopexy (score 1.1). (3) Exposure to DBP or AA with CPT/orchiopexy led to atrophic testes, spermatogenesis arrest, germ cell exfoliation/multinucleation, and SCO tubules (both chemicals score 2.5). Exposure to chemicals such as DBP or AA prevented the recovery of cryptorchid testes by orchiopexy. The possible role of environmental contaminants should be considered when looking for factors that modulate human testicular disorders associated with CPT.
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Affiliation(s)
- N P de Souza
- 1 Department of Pathology, Center for Evaluation of the Impact of the Environmental on Human Health (TOXICAM), Botucatu Medical School, Botucatu Campus, Sao Paulo State University (UNESP), São Paulo, Brazil
| | - Ap Ferragut Cardoso
- 1 Department of Pathology, Center for Evaluation of the Impact of the Environmental on Human Health (TOXICAM), Botucatu Medical School, Botucatu Campus, Sao Paulo State University (UNESP), São Paulo, Brazil
| | - Lmm Gomide
- 1 Department of Pathology, Center for Evaluation of the Impact of the Environmental on Human Health (TOXICAM), Botucatu Medical School, Botucatu Campus, Sao Paulo State University (UNESP), São Paulo, Brazil
| | - Trr Lima
- 1 Department of Pathology, Center for Evaluation of the Impact of the Environmental on Human Health (TOXICAM), Botucatu Medical School, Botucatu Campus, Sao Paulo State University (UNESP), São Paulo, Brazil
| | - H A Miot
- 1 Department of Pathology, Center for Evaluation of the Impact of the Environmental on Human Health (TOXICAM), Botucatu Medical School, Botucatu Campus, Sao Paulo State University (UNESP), São Paulo, Brazil
| | - A J Martino-Andrade
- 2 Department of Physiology, Polytechnic Centre, Federal University of Paraná, Curitiba, Brazil
| | - L L Arnold
- 3 Department of Pathology and Microbiology and the Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - K L Pennington
- 3 Department of Pathology and Microbiology and the Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - S M Cohen
- 3 Department of Pathology and Microbiology and the Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA.,4 Havlik-Wall Professor of Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jlv de Camargo
- 1 Department of Pathology, Center for Evaluation of the Impact of the Environmental on Human Health (TOXICAM), Botucatu Medical School, Botucatu Campus, Sao Paulo State University (UNESP), São Paulo, Brazil
| | - M G Nascimento E Pontes
- 1 Department of Pathology, Center for Evaluation of the Impact of the Environmental on Human Health (TOXICAM), Botucatu Medical School, Botucatu Campus, Sao Paulo State University (UNESP), São Paulo, Brazil
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Hosokawa H, Ungerbäck J, Wang X, Matsumoto M, Nakayama KI, Cohen SM, Tanaka T, Rothenberg EV. Transcription Factor PU.1 Represses and Activates Gene Expression in Early T Cells by Redirecting Partner Transcription Factor Binding. Immunity 2019; 48:1119-1134.e7. [PMID: 29924977 DOI: 10.1016/j.immuni.2018.04.024] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [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: 10/19/2017] [Revised: 02/21/2018] [Accepted: 04/19/2018] [Indexed: 01/09/2023]
Abstract
Transcription factors normally regulate gene expression through their action at sites where they bind to DNA. However, the balance of activating and repressive functions that a transcription factor can mediate is not completely understood. Here, we showed that the transcription factor PU.1 regulated gene expression in early T cell development both by recruiting partner transcription factors to its own binding sites and by depleting them from the binding sites that they preferred when PU.1 was absent. The removal of partner factors Satb1 and Runx1 occurred primarily from sites where PU.1 itself did not bind. Genes linked to sites of partner factor "theft" were enriched for genes that PU.1 represses despite lack of binding, both in a model cell line system and in normal T cell development. Thus, system-level competitive recruitment dynamics permit PU.1 to affect gene expression both through its own target sites and through action at a distance.
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Affiliation(s)
- Hiroyuki Hosokawa
- Division of Biology & Biological Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Jonas Ungerbäck
- Division of Biology & Biological Engineering, California Institute of Technology, Pasadena, CA, USA; Division of Molecular Hematology, Lund University, Sweden
| | - Xun Wang
- Division of Biology & Biological Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Masaki Matsumoto
- Department of Molecular and Cellular Biology, Medical Institute of Bioregulation, Kyushu University, Japan
| | - Keiichi I Nakayama
- Department of Molecular and Cellular Biology, Medical Institute of Bioregulation, Kyushu University, Japan
| | - Sarah M Cohen
- Division of Biology & Biological Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Tomoaki Tanaka
- Department of Molecular Diagnosis, Graduate School of Medicine, Chiba University, Japan; AMED-CREST, AMED, Japan Agency for Medical Research and Development, Tokyo, Japan
| | - Ellen V Rothenberg
- Division of Biology & Biological Engineering, California Institute of Technology, Pasadena, CA, USA.
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Lipschuetz M, Cohen SM, Lewkowicz AA, Amsalem H, Haj Yahya R, Levitt L, Yagel S. [PROLONGED SECOND STAGE OF LABOR: CAUSES AND OUTCOMES]. Harefuah 2018; 157:685-690. [PMID: 30457229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Professional bodies have published guidelines defining the length of the second stage of labor and when it is "prolonged", according to parity and epidural anesthesia administration. Recently these guidelines have been extended, aiming to reduce rates of unplanned cesarean deliveries. AIMS To examine the risk factors and outcomes of a prolonged second stage of labor, in order to understand its causes and implications for mothers and neonates, including the delivery mode. METHODS A retrospective study based on 26,476 electronic medical records of deliveries to primiparous mothers of a term singleton fetus, at Hadassah Medical Center, between 2003 and 2015. RESULTS A prolonged second stage of labor was recorded in 3,225 (12.2%) of mothers (i.e. exceeding 2 hours without epidural anesthesia and 3 hours with it). Epidural anesthesia, persistent occiput posterior, and head circumference or birth weight above the 90th percentile, increased the risk of the prolonged second stage. The risk of unplanned cesarean delivery rose significantly before the 2- or 3-hour cut-off defining a prolonged second stage. Risks of maternal and neonatal complications included: grade III-IV perineal tear, maternal hemorrhage, 5-minute Apgar≤7, umbilical artery pH<7.1, neonatal intensive care admission were also increased. CONCLUSIONS Epidural anesthesia and fetal parameters increased the risk of prolonged second stage; risks of maternal and fetal complications were also increased. The risk of interventional delivery increased significantly well before the defined cut-off. DISCUSSION Prolongation of the second stage of labor is a common pathway of many obstetric outcomes. Obstetric management should be based on considerations of individual maternal and neonatal well-being, rather than administrative goals. While reducing cesarean rates is an important goal, attempts to achieve this by prolonging the second stage of labor exposes mothers and neonates to excess risk of cesarean and vacuum delivery as well as obstetric and neonatal complications.
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Affiliation(s)
- Michal Lipschuetz
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Sarah M Cohen
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Aya A Lewkowicz
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Hagai Amsalem
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Rani Haj Yahya
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Lorinne Levitt
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simcha Yagel
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Hosokawa H, Ungerbäck J, Wang X, Matsumoto M, Nakayama KI, Cohen SM, Tanaka T, Rothenberg EV. Transcription Factor PU.1 Represses and Activates Gene Expression in Early T Cells by Redirecting Partner Transcription Factor Binding. Immunity 2018; 49:782. [PMID: 30332634 DOI: 10.1016/j.immuni.2018.09.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kabiri D, Lipschuetz M, Cohen SM, Yagel O, Levitt L, Herzberg S, Ezra Y, Yagel S, Amsalem H. Vacuum extraction failure is associated with a large head circumference. J Matern Fetal Neonatal Med 2018; 32:3325-3330. [PMID: 29631472 DOI: 10.1080/14767058.2018.1463364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 10/17/2022]
Abstract
Objective: To determine whether large head circumference increases the risk of vacuum extraction failure. Study design: This EMR-based study included all attempted vacuum extractions performed in a tertiary center between January 2010 and June 2015. All term singleton live births were eligible. Cases were divided into four groups: head circumference ≥90th percentile both with birth weight ≥90th percentile and <90th percentile and fetal head circumference <90th percentile with birth weight ≥90th and <90th percentile. Risk of failed vacuum extraction was compared among these groups. Other neonatal and maternal parameters were also evaluated as potential risk factors. Multinomial multivariable regression provided adjusted odds ratio for vacuum extraction failure while controlling for potential confounders. Results: During the study period, 48,007 deliveries met inclusion criteria, of which 3835 had an attempt at vacuum extraction. We identified 215 (5.6%) cases of vacuum extraction failure. The adjusted odds ratios (aOR) for vacuum extraction failure in cases of large fetal head circumference was 2.31 (95%CI, 1.7-3.15, p < .001). Primiparity, prolonged second stage and occipito-posterior presentation were also found to be significant risk factors for failed vacuum extraction. Comments: In this study, we found that large head circumference was associated with vacuum extraction failure rather than high birth weight.
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Affiliation(s)
- Doron Kabiri
- a Department of Obstetrics and Gynecology , Hadassah Hebrew University Medical Center , Jerusalem , Israel
| | - Michal Lipschuetz
- a Department of Obstetrics and Gynecology , Hadassah Hebrew University Medical Center , Jerusalem , Israel.,b Mina and Everard Goodman Faculty of Life Sciences , Bar-Ilan University , Ramat Gan , Israel
| | - Sarah M Cohen
- a Department of Obstetrics and Gynecology , Hadassah Hebrew University Medical Center , Jerusalem , Israel
| | - Oren Yagel
- a Department of Obstetrics and Gynecology , Hadassah Hebrew University Medical Center , Jerusalem , Israel
| | - Lorinne Levitt
- a Department of Obstetrics and Gynecology , Hadassah Hebrew University Medical Center , Jerusalem , Israel
| | - Shmuel Herzberg
- a Department of Obstetrics and Gynecology , Hadassah Hebrew University Medical Center , Jerusalem , Israel
| | - Yossef Ezra
- a Department of Obstetrics and Gynecology , Hadassah Hebrew University Medical Center , Jerusalem , Israel
| | - Simcha Yagel
- a Department of Obstetrics and Gynecology , Hadassah Hebrew University Medical Center , Jerusalem , Israel
| | - Hagai Amsalem
- a Department of Obstetrics and Gynecology , Hadassah Hebrew University Medical Center , Jerusalem , Israel
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Lipschuetz M, Cohen SM, Israel A, Baron J, Porat S, Valsky DV, Yagel O, Amsalem H, Kabiri D, Gilboa Y, Sivan E, Unger R, Schiff E, Hershkovitz R, Yagel S. Sonographic large fetal head circumference and risk of cesarean delivery. Am J Obstet Gynecol 2018; 218:339.e1-339.e7. [PMID: 29305249 DOI: 10.1016/j.ajog.2017.12.230] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/27/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Persistently high rates of cesarean deliveries are cause for concern for physicians, patients, and health systems. Prelabor assessment might be refined by identifying factors that help predict an individual patient's risk of cesarean delivery. Such factors may contribute to patient safety and satisfaction as well as health system planning and resource allocation. In an earlier study, neonatal head circumference was shown to be more strongly associated with delivery mode and other outcome measures than neonatal birthweight. OBJECTIVE In the present study we aimed to evaluate the association of sonographically measured fetal head circumference measured within 1 week of delivery with delivery mode. STUDY DESIGN This was a multicenter electronic medical record-based study of birth outcomes of primiparous women with term (37-42 weeks) singleton fetuses presenting for ultrasound with fetal biometry within 1 week of delivery. Fetal head circumference and estimated fetal weight were correlated with maternal background, obstetric, and neonatal outcome parameters. Elective cesarean deliveries were excluded. Multinomial regression analysis provided adjusted odds ratios for instrumental delivery and unplanned cesarean delivery when the fetal head circumference was ≥35 cm or estimated fetal weight ≥3900 g, while controlling for possible confounders. RESULTS In all, 11,500 cases were collected; 906 elective cesarean deliveries were excluded. A fetal head circumference ≥35 cm increased the risk for unplanned cesarean delivery: 174 fetuses with fetal head circumference ≥35 cm (32%) were delivered by cesarean, vs 1712 (17%) when fetal head circumference <35 cm (odds ratio, 2.49; 95% confidence interval, 2.04-3.03). A fetal head circumference ≥35 cm increased the risk of instrumental delivery (odds ratio, 1.48; 95% confidence interval, 1.16-1.88), while estimated fetal weight ≥3900 g tended to reduce it (nonsignificant). Multinomial regression analysis showed that fetal head circumference ≥35 cm increased the risk of unplanned cesarean delivery by an adjusted odds ratio of 1.75 (95% confidence interval, 1.4-2.18) controlling for gestational age, fetal gender, and epidural anesthesia. The rate of prolonged second stage of labor was significantly increased when either the fetal head circumference was ≥35 cm or the estimated fetal weight ≥3900 g, from 22.7% in the total cohort to 31.0%. A fetal head circumference ≥35 cm was associated with a higher rate of 5-minute Apgar score ≤7: 9 (1.7%) vs 63 (0.6%) of infants with fetal head circumference <35 cm (P = .01). The rate among fetuses with an estimated fetal weight ≥3900 g was not significantly increased. The rate of admission to the neonatal intensive care unit did not differ among the groups. CONCLUSION Sonographic fetal head circumference ≥35 cm, measured within 1 week of delivery, is an independent risk factor for unplanned cesarean delivery but not instrumental delivery. Both fetal head circumference ≥35 cm and estimated fetal weight ≥3900 g significantly increased the risk of a prolonged second stage of labor. Fetal head circumference measurement in the last days before delivery may be an important adjunct to estimated fetal weight in labor management.
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Semino R, Moreton JC, Ramsahye NA, Cohen SM, Maurin G. Understanding the origins of metal-organic framework/polymer compatibility. Chem Sci 2018; 9:315-324. [PMID: 29629100 PMCID: PMC5868319 DOI: 10.1039/c7sc04152g] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/26/2017] [Indexed: 12/23/2022] Open
Abstract
The microscopic interfacial structures for a series of metal-organic framework/polymer composites consisting of the Zr-based UiO-66 coupled with different polymers are systematically explored by applying a computational methodology that integrates density functional theory calculations and force field-based molecular dynamics simulations. These predictions are correlated with experimental findings to unravel the structure-compatibility relationship of the MOF/polymer pairs. The relative contributions of the intermolecular MOF/polymer interactions and the flexibility/rigidity of the polymer with respect to the microscopic structure of the interface are rationalized, and their impact on the compatibility of the two components in the resulting composite is discussed. The most compatible pairs among those investigated involve more flexible polymers, i.e. polyvinylidene fluoride (PVDF) and polyethylene glycol (PEG). These polymers exhibit an enhanced contact surface, due to a better adaptation of their configuration to the MOF surface. In these cases, the irregularities at the MOF surface are filled by the polymer, and even some penetration of the terminal groups of the polymer into the pores of the MOF can be observed. As a result, the affinity between the MOF and the polymer is very high; however, the pores of the MOF may be sterically blocked due to the strong MOF/polymer interactions, as evidenced by UiO-66/PEG composites. In contrast, composites involving polymers that exhibit higher rigidity, such as the polymer of intrinsic microporosity-1 (PIM-1) or polystyrene (PS), present interfacial microvoids that contribute to a decrease in the contact surface between the two components, thus reducing the MOF/polymer affinity.
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Affiliation(s)
- R Semino
- Institut Charles Gerhardt Montpellier UMR 5253 CNRS , Université de Montpellier , Place E. Bataillon , 34095 Montpellier Cedex 05 , France .
| | - J C Moreton
- Department of Chemistry and Biochemistry , University of California , La Jolla , San Diego , California 92093-0358 , USA .
| | - N A Ramsahye
- Institut Charles Gerhardt Montpellier UMR 5253 CNRS , Université de Montpellier , Place E. Bataillon , 34095 Montpellier Cedex 05 , France .
- Institut Charles Gerhardt Montpellier , UMR 5253 CNRS, UM, ENSCM , 8 rue de l'Ecole Normale , 34296 Montpellier Cedex 05 , France
| | - S M Cohen
- Department of Chemistry and Biochemistry , University of California , La Jolla , San Diego , California 92093-0358 , USA .
| | - G Maurin
- Institut Charles Gerhardt Montpellier UMR 5253 CNRS , Université de Montpellier , Place E. Bataillon , 34095 Montpellier Cedex 05 , France .
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Yagel S, Lipschuetz M, Cohen SM. Pelvic floor trauma and maternal age. Am J Obstet Gynecol 2017; 217:384-385. [PMID: 28549977 DOI: 10.1016/j.ajog.2017.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/15/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Simcha Yagel
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | | | - Sarah M Cohen
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Yagel O, Cohen SM, Lipschuetz M, Bdolah-Abram T, Amsalem H, Kabiri D, Yagel S. Higher Rates of Operative Delivery and Maternal and Neonatal Complications in Persistent Occiput Posterior Position with a Large Head Circumference: A Retrospective Cohort Study. Fetal Diagn Ther 2017; 44:51-58. [DOI: 10.1159/000478010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/30/2017] [Indexed: 11/19/2022]
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Panda O, Akagi AE, Artyukhin AB, Judkins JC, Le HH, Mahanti P, Cohen SM, Sternberg PW, Schroeder FC. Biosynthesis of Modular Ascarosides in
C. elegans. Angew Chem Int Ed Engl 2017. [DOI: 10.1002/ange.201700103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Oishika Panda
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology Cornell University Ithaca NY USA
| | - Allison E. Akagi
- Howard Hughes Medical Institute and Division of Biology and Biological Engineering California Institute of Technology Pasadena CA USA
| | - Alexander B. Artyukhin
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology Cornell University Ithaca NY USA
| | - Joshua C. Judkins
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology Cornell University Ithaca NY USA
| | - Henry H. Le
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology Cornell University Ithaca NY USA
| | - Parag Mahanti
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology Cornell University Ithaca NY USA
| | - Sarah M. Cohen
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology Cornell University Ithaca NY USA
- Howard Hughes Medical Institute and Division of Biology and Biological Engineering California Institute of Technology Pasadena CA USA
| | - Paul W. Sternberg
- Howard Hughes Medical Institute and Division of Biology and Biological Engineering California Institute of Technology Pasadena CA USA
| | - Frank C. Schroeder
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology Cornell University Ithaca NY USA
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Panda O, Akagi AE, Artyukhin AB, Judkins JC, Le HH, Mahanti P, Cohen SM, Sternberg PW, Schroeder FC. Biosynthesis of Modular Ascarosides in C. elegans. Angew Chem Int Ed Engl 2017; 56:4729-4733. [PMID: 28371259 DOI: 10.1002/anie.201700103] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/20/2017] [Indexed: 11/11/2022]
Abstract
The nematode Caenorhabditis elegans uses simple building blocks from primary metabolism and a strategy of modular assembly to build a great diversity of signaling molecules, the ascarosides, which function as a chemical language in this model organism. In the ascarosides, the dideoxysugar ascarylose serves as a scaffold to which diverse moieties from lipid, amino acid, neurotransmitter, and nucleoside metabolism are attached. However, the mechanisms that underlie the highly specific assembly of ascarosides are not understood. We show that the acyl-CoA synthetase ACS-7, which localizes to lysosome-related organelles, is specifically required for the attachment of different building blocks to the 4'-position of ascr#9. We further show that mutants lacking lysosome-related organelles are defective in the production of all 4'-modified ascarosides, thus identifying the waste disposal system of the cell as a hotspot for ascaroside biosynthesis.
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Affiliation(s)
- Oishika Panda
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, NY, USA
| | - Allison E Akagi
- Howard Hughes Medical Institute and Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Alexander B Artyukhin
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, NY, USA
| | - Joshua C Judkins
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, NY, USA
| | - Henry H Le
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, NY, USA
| | - Parag Mahanti
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, NY, USA
| | - Sarah M Cohen
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, NY, USA.,Howard Hughes Medical Institute and Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Paul W Sternberg
- Howard Hughes Medical Institute and Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Frank C Schroeder
- Boyce Thompson Institute and Department of Chemistry and Chemical Biology, Cornell University, Ithaca, NY, USA
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Troester MA, Sun X, Allott EH, Kit CK, Thorne L, Mathews M, Cohen SM, Geradts J, Kirk E, Li Y, Hu Z, Robinson W, Hoadley KA, Reeder-Hayes K, Earp S, Olshan AF, Carey LA, Perou CM. Abstract PD8-01: Race and age differences in PAM50 biomarker status in the Carolina breast cancer study. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-pd8-01] [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
Abstract
Background: African American breast cancer patients have lower relative frequency of hormone receptor (HR)-positive/HER2-negative disease and higher subtype-specific mortality. However, few population-based studies have RNA-based subtyping data, and racial differences in the biology of HR-positive/HER2-negative tumors are not well understood.
Methods: Using data and biospecimens from the Carolina Breast Cancer Study (CBCS) Phase 3 (2008-2013), we classified approximately 1,000 invasive breast cancers according to PAM50 subtype and two risk of recurrence scores (ROR-P and ROR-PT). Relative frequency of Luminal A, Luminal B, Her2-enriched, and Basal-like subtypes and ROR scores (low/medium/high) were compared by race (blacks vs. whites) and age (≤50 years vs. >50 years), overall and among HR-positive/HER2-negative cases.
Results: Black women of all ages had significantly higher relative frequency of Basal-like breast cancer (36 and 31% in blacks vs. 18 and 15% in whites; younger and older, respectively) and lower frequency of Luminal A breast cancer (26 and 34% in blacks vs. 43 and 52% in whites; younger and older, respectively). Frequency of Luminal B and HER2-enriched breast cancer did not vary by race or age. Among clinically HR-positive, HER2-negative cases, Luminal A subtype comprised only half of the cases among black women, and was significantly less common than among white women (51% vs 60% in whites, p<0.05). Black women with HR-positive/HER2-negative disease also had significantly higher ROR scores (ROR-P medium or high 82% vs. 66% in whites, p=0.01; ROR-PT medium or high 85% vs. 69% in whites, p<0.01).
Conclusions: Multi-gene assays highlight disparities in frequency of aggressive, poorer prognosis tumor subtypes and implicate differences in tumor biology as an important contributor to mortality disparities among HR-positive/HER2-negative patients.
Citation Format: Troester MA, Sun X, Allott EH, Kit C-K, Thorne L, Mathews M, Cohen SM, Geradts J, Kirk E, Li Y, Hu Z, Robinson W, Hoadley KA, Reeder-Hayes K, Earp S, Olshan AF, Carey LA, Perou CM. Race and age differences in PAM50 biomarker status in the Carolina breast cancer study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr PD8-01.
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Affiliation(s)
- MA Troester
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - X Sun
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - EH Allott
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - C-K Kit
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - L Thorne
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - M Mathews
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - SM Cohen
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - J Geradts
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - E Kirk
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - Y Li
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - Z Hu
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - W Robinson
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - KA Hoadley
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - K Reeder-Hayes
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - S Earp
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - AF Olshan
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - LA Carey
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - CM Perou
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
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Valsky DV, Cohen SM, Lipschuetz M, Hochner-Celnikier D, Daum H, Yagel I, Yagel S. Third- or Fourth-Degree Intrapartum Anal Sphincter Tears Are Associated With Levator Ani Avulsion in Primiparas. J Ultrasound Med 2016; 35:709-715. [PMID: 26960799 DOI: 10.7863/ultra.15.04032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES We evaluated primiparous women with clinically diagnosed third- and fourth-degree and anal sphincter tears, to evaluate the rate of levator ani muscle injury compared to primiparous women without sphincter tears. METHODS Primiparous women delivering in our maternity ward with intrapartum diagnoses of third- or fourth-degree anal sphincter tears, repaired by the overlapping technique, were recruited to undergo 3-dimensional transperineal sonography of the pelvic floor anatomy, including the anterior and posterior compartments. Primiparas with uncomplicated vaginal deliveries were recruited as a comparison group. Patient files were examined, and maternal backgrounds and delivery and neonatal details were extracted for all patients. RESULTS Ninety-four women with tears were recruited to the study group, and 464 women with normal vaginal deliveries constituted the comparison group. The groups differed significantly in the rates of levator ani defects: 38 of 94 women (40.4%) in the study group versus 75 of 464 (16.2%) in the comparison group (P < .001; odds ratio, 3.53; 95% confidence interval, 2.18–5.7). Neonatal head circumference differed significantly between the study and comparison groups: (mean ・} SD, 34.5 ・} 1.3 cm in the study group versus 33.9 ・} 1.3 cm in the comparison group; P= .005), as did birth weight (3322 ・} 430 g in the study group versus 3169 ・} 458 g in the comparison group; P= .007). The groups did not differ in maternal age, gestational age at delivery, length of second stage of labor, and rates of epidural anesthesia, episiotomy, and vacuum extraction. CONCLUSIONS Third- and fourth-degree intrapartum sphincter tears are associated with levator ani avulsion. Knowledge of complex pelvic floor damage may allow for prompt referral to secondary preventive measures for pelvic floor disorders.
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Lipschuetz M, Cohen SM, Ein-Mor E, Sapir H, Hochner-Celnikier D, Porat S, Amsalem H, Valsky DV, Ezra Y, Elami-Suzin M, Paltiel O, Yagel S. A large head circumference is more strongly associated with unplanned cesarean or instrumental delivery and neonatal complications than high birthweight. Am J Obstet Gynecol 2015; 213:833.e1-833.e12. [PMID: 26254515 DOI: 10.1016/j.ajog.2015.07.045] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 06/18/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Fetal size impacts on perinatal outcomes. We queried whether the fetal head, as the fetal part interfacing with the birth canal, might impact on obstetric outcomes more than birthweight (BW). We examined associations between neonatal head circumference (HC) and delivery mode and risk of perinatal complications as compared to high BW. STUDY DESIGN This was an electronic medical records-based study of term singleton births (37-42 weeks' gestation) from January 2010 through December 2012 (N = 24,780, 6343 primiparae). We assessed risks of unplanned cesarean or instrumental delivery and maternal and fetal complications in cases with HC or BW ≥95th centile (large HC, high BW) vs those with parameters <95th centile (normal). Newborns were stratified into 4 subgroups: normal HC/normal BW (reference, n = 22,548, primiparae 5862); normal HC/high BW (n = 817, P = 213); large HC/normal BW (n = 878, P = 265); and large HC/high BW (n = 537, P = 103). Multinomial multivariable regression provided adjusted odds ratio (aOR) while controlling for potential confounders. RESULTS Infants with HC ≥95th centile (n = 1415) were delivered vaginally in 62% of cases, unplanned cesarean delivery 16%, and instrumental delivery 11.2%; 78.4% of infants with HC <95th centile were delivered vaginally, 7.8% unplanned cesarean, and 6.7% instrumental delivery. Odds ratio (OR) for unplanned cesarean was 2.58 (95% confidence interval [CI], 2.22-3.01) and for instrumental delivery OR was 2.13 (95% CI, 1.78-2.54). In contrast, in those with BW ≥95th centile (n = 1354) 80.3% delivered vaginally, 10.2% by unplanned cesarean (OR, 1.2; 95% CI, 1.01-1.44), and 3.4% instrumental delivery (OR, 0.46; 95% CI, 0.34-0.62) compared to infants with BW <95th centile: spontaneous vaginal delivery, 77.3%, unplanned cesarean 8.2%, instrumental 7.1%. Multinomial regression with normal HC/normal BW as reference group showed large HC/normal BW infants were more likely to be delivered by unplanned cesarean (aOR, 3.08; 95% CI, 2.52-3.75) and instrumental delivery (aOR, 3.03; 95% CI, 2.46-3.75). Associations were strengthened in primiparae. Normal HC/high BW was not associated with unplanned cesarean (aOR, 1.18; 95% CI, 0.91-1.54), while large HC/high BW was (aOR, 1.93; 95% CI, 1.47-2.52). Analysis of unplanned cesarean indications showed large HC infants had more failure to progress (27.7% vs 14.1%, P < .001), while smaller HC infants had more fetal distress (23.4% vs 16.9%, P < .05). CONCLUSION A large HC is more strongly associated with unplanned cesarean and instrumental delivery than high BW. Prospective studies are needed to test fetal HC as a predictive parameter for prelabor counseling of women with "big babies."
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Valsky DV, Lipschuetz M, Cohen SM, Daum H, Messing B, Yagel I, Yagel S. Persistence of levator ani sonographic defect detected by three-dimensional transperineal sonography in primiparous women. Ultrasound Obstet Gynecol 2015; 46:724-729. [PMID: 25760927 DOI: 10.1002/uog.14840] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/02/2015] [Accepted: 03/04/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Correlation of the sonographic appearance of levator ani muscle (LAM) injury soon after delivery with that at long-term follow-up has not been described fully. We aimed to compare results of three-dimensional (3D) transperineal sonographic (TPS) evaluation of the LAM from the period immediately postpartum with long-term follow-up, to determine whether sonographic findings persist over time. METHODS Primiparous women (n = 210) who had been examined by 3D-TPS in a previous study to determine LAM trauma 24-72 hours after delivery were invited to participate in a follow-up examination 3-21 months postpartum. We included in this study only women who were not pregnant when approached and who had not given birth in the interim. LAM trauma was diagnosed with 3D-TPS when we observed discontinuity and distortion of the most anteromedial part of the pubovisceral muscle in the coronal C-plane or rendered image. Initial and follow-up 3D-TPS results were compared using Cohen's kappa test for inter-rater agreement. RESULTS Among the 87 women included in this study we found strong correlation between earlier and later sonographic appearance of LAM: 17/21 women with a sonographic finding of LAM injury in the period immediately postpartum were positive in the follow-up examination, and only 2/66 women negative for LAM damage at the first examination were found to have sonographic evidence of LAM defect at follow-up (Cohen's kappa, 0.805 (95% CI, 0.656-0.954), P < 0.001). CONCLUSIONS Our findings suggest that 3D-TPS of the LAM is a reliable examination. A sonographic finding of LAM defect identified in the period immediately postpartum persists months or years after delivery; therefore, this test may be performed following delivery, or may be delayed without impacting the result. It is likely that this sonographic defect represents real anatomical disruption and is not an imaging artifact.
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Affiliation(s)
- D V Valsky
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - M Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - S M Cohen
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - H Daum
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - B Messing
- Department of Obstetrics and Gynecology, Mayanei HaYeshua Medical Center, Bnei Brak, Israel
| | - I Yagel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - S Yagel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
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Lipschuetz M, Cohen SM, Liebergall-Wischnitzer M, Zbedat K, Hochner-Celnikier D, Lavy Y, Yagel S. Degree of bother from pelvic floor dysfunction in women one year after first delivery. Eur J Obstet Gynecol Reprod Biol 2015; 191:90-4. [PMID: 26103101 DOI: 10.1016/j.ejogrb.2015.05.015] [Citation(s) in RCA: 41] [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] [Received: 02/17/2015] [Revised: 05/12/2015] [Accepted: 05/19/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate rates and range of pelvic floor dysfunction complaints, including anterior and posterior compartments and sexual function, in an unselected population of primiparous women one year from delivery, and examine the degree of bother they cause. STUDY DESIGN Cross sectional study. Primiparous women who delivered their first child in our delivery wards 10-14 months previously, were approached by phone and asked to complete the Pelvic Floor Symptom Bother Questionnaire (PFBQ) and provide general demographic information. Details regarding participants' labor and delivery were extracted from electronic medical records. PFBQ score was correlated to demographic and labor and delivery parameters. RESULTS 198 women completed the questionnaire. Response rate was 94%. Scores ranged from 0 to 44.4 (out of a possible 100). At least one symptom of PFD was reported by 64% of respondents. Various degrees of urinary incontinence were reported by 9.1-12.1% of women. Some degree of fecal or flatus incontinence was reported by 10.1% of women; 11.1% reported some degree of obstructed defecation. Severe degree of bother from one or more PFD symptoms was reported by 40.1-90.9%. Some level of dyspareunia was reported by 37.3%. A "dose response" trend between mode of delivery and rate of dyspareunia was observed. CONCLUSIONS Two-thirds of primiparous women one year after delivery suffer PFD symptoms that cause some degree of bother. When asked, women are willing to discuss pelvic floor function; caregivers should initiate discussion and refer women promptly to interventions where necessary.
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Affiliation(s)
- Michal Lipschuetz
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sarah M Cohen
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Kifah Zbedat
- Henrietta Szold Hadassah/Hebrew University School of Nursing, Jerusalem, Israel
| | | | - Yuval Lavy
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simcha Yagel
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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D'Hoore A, Albert MR, Cohen SM, Herbst F, Matter I, Van Der Speeten K, Dominguez J, Rutten H, Muldoon JP, Bardakcioglu O, Senagore AJ, Ruppert R, Mills S, Stamos MJ, Påhlman L, Choman E, Wexner SD. COMPRES: a prospective postmarketing evaluation of the compression anastomosis ring CAR 27(™) /ColonRing(™). Colorectal Dis 2015; 17:522-9. [PMID: 25537083 DOI: 10.1111/codi.12884] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 11/11/2014] [Indexed: 02/08/2023]
Abstract
AIM Preclinical studies have suggested that nitinol-based compression anastomosis might be a viable solution to anastomotic leak following low anterior resection. A prospective multicentre open label study was therefore designed to evaluate the performance of the ColonRing(™) in (low) colorectal anastomosis. METHOD The primary outcome measure was anastomotic leakage. Patients were recruited at 13 different colorectal surgical units in Europe, the United States and Israel. Institutional review board approval was obtained. RESULTS Between 21 March 2010 and 3 August 2011, 266 patients completed the study protocol. The overall anastomotic leakage rate was 5.3% for all anastomoses, including a rate of 3.1% for low anastomoses. Septic anastomotic complications occurred in 8.3% of all anastomoses and 8.2% of low anastomoses. CONCLUSION Nitinol compression anastomosis is safe, effective and easy to use and may offer an advantage for low colorectal anastomosis. A prospective randomized trial comparing ColonRing(™) with conventional stapling is needed.
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Affiliation(s)
- A D'Hoore
- Department of Abdominal Surgery, University Hospital Gasthuisberg Leuven, Leuven, Belgium
| | - M R Albert
- Center for Colon and Rectal Surgery, Altamonte Springs and Florida Hospital, Orlando, Florida, USA
| | - S M Cohen
- Southern Regional Medical Center, Spivey Station Surgery Center, Emory Healthcare, Atlanta, Georgia, USA
| | - F Herbst
- Abteilung für Chirurgie, Barmherzige Brueder, Krankenhaus Wien, Vienna, Austria
| | - I Matter
- Bnai Zion Medical Center, Haifa, Israel
| | | | - J Dominguez
- Department of Colorectal Surgery, Ferrell-Duncan Clinic, Springfield, Missouri, USA
| | - H Rutten
- Catharina Ziekenhuis, Eindhoven, Netherlands
| | - J P Muldoon
- Section of Colon and Rectal Surgery, NorthShore University Healthsystem and University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA
| | - O Bardakcioglu
- Department of Surgery, University of Nevada School of Medicine, Las Vegas, Nevada, USA
| | - A J Senagore
- Department of General Surgery, CMU College of Medicine, Saginaw, Missouri, USA
| | - R Ruppert
- Klinikum Neuperlach, Department of Coloproctology, Munich, Germany
| | - S Mills
- Department of Surgery, Division of Colon and Rectal Surgery, University of California, Irvine, Orange, California, USA
| | - M J Stamos
- Department of Surgery, University of California, Irvine, Orange, California, USA
| | - L Påhlman
- Deparment of Surgical Science, Uppsala University, Uppsala, Sweden
| | | | - S D Wexner
- Digestive Disease Center, Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
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Yagel S, Cohen SM, Valsky DV, Shen O, Lipschuetz M, Messing B. Systematic examination of the fetal abdominal precordial veins: a cohort study. Ultrasound Obstet Gynecol 2015; 45:578-583. [PMID: 24919785 DOI: 10.1002/uog.13444] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 05/21/2014] [Accepted: 06/05/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Examination of the fetal venous system is a necessary part of complete fetal organ scanning to confirm landmark anatomy, such as the ductus venosus and course of the umbilical veins, and, whenever cardiovascular anomalies are identified, to exclude associated anomalous development of the fetal veins. We aimed to develop a protocol for systematic examination of the fetal venous system during midtrimester targeted organ scanning. METHODS We included low-risk women with a singleton fetus presenting between January 2011 and June 2013 to our center for routine midtrimester (20-24 weeks) targeted organ scanning. Imaging of the venous system was added to the booked scan and comprised two-dimensional color Doppler scanning of the fetal abdomen in three discrete planes, two transverse and one longitudinal. The more caudal plane was obtained in a ventral or lateral transverse abdominal plane to image the umbilical vein, left portal vein, portal sinus, anterior right portal vein, posterior right portal vein, main portal vein and splenic vein and artery. Moving cephalad, a ventral or lateral transverse plane was obtained to image the right, middle and left hepatic veins and inferior vena cava (IVC). Finally, a longitudinal anteroposterior plane showed the umbilical vein, ductus venosus, IVC and left hepatic vein. In some cases the pulsed Doppler waveform of a given target vessel was also examined. Three-dimensional/4D ultrasound was applied as necessary, when anomalous cases were encountered. RESULTS We examined 1810 women. Their body mass index ranged from 19 to 40 (mean, 24.7). In 38 (2.1%) women, the target anatomy was not visualized satisfactorily owing to maternal body habitus. A T-shaped configuration of the portal system vessels was observed in 63% of cases, an X-shaped configuration in 25% and an H-shaped configuration in 12%. During the study period, 24 congenital anomalies of the precordial venous system were diagnosed: nine cases of persistent right umbilical vein, seven of agenesis of the ductus venosus, five of anomalous portal venous drainage and three of interrupted IVC with azygos continuation. CONCLUSIONS Examination of the fetal venous system is feasible with the application of three abdominal planes. While a venous system scan is not practicable as part of a screening-level examination, mastery of the normal anatomy is an essential part of the professional knowledge base, in order to provide ready and complete scanning of the system in cases of suspected anomalies or disordered cardiac function.
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Affiliation(s)
- S Yagel
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
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Affiliation(s)
- S M Cohen
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha
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50
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Yagel S, Cohen SM, Benacerraf BR, Cuckle H, Kagan KO, Van den Veyver I, Wapner R, Lee W. Noninvasive prenatal testing and fetal sonographic screening: roundtable discussion. J Ultrasound Med 2015; 34:363-369. [PMID: 25715356 DOI: 10.7863/ultra.34.3.363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Simcha Yagel
- From the Baylor College of Medicine/Texas Children's Hospital, Houston, Texas USA (W.L.); Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel (S.Y., S.M.C.); Departments of Radiology and Obstetrics and Gynecology, Brigham and Women's Hospital, and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts USA (B.R.B.); Department of Reproductive Epidemiology, University of Leeds, Leeds, England (H.C.); Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany (K.O.K.); Departments of Obstetrics and Gynecology and Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas USA (I.V.d.V.); and Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York USA (R.W.).
| | - Sarah M Cohen
- From the Baylor College of Medicine/Texas Children's Hospital, Houston, Texas USA (W.L.); Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel (S.Y., S.M.C.); Departments of Radiology and Obstetrics and Gynecology, Brigham and Women's Hospital, and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts USA (B.R.B.); Department of Reproductive Epidemiology, University of Leeds, Leeds, England (H.C.); Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany (K.O.K.); Departments of Obstetrics and Gynecology and Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas USA (I.V.d.V.); and Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York USA (R.W.)
| | - Beryl R Benacerraf
- From the Baylor College of Medicine/Texas Children's Hospital, Houston, Texas USA (W.L.); Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel (S.Y., S.M.C.); Departments of Radiology and Obstetrics and Gynecology, Brigham and Women's Hospital, and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts USA (B.R.B.); Department of Reproductive Epidemiology, University of Leeds, Leeds, England (H.C.); Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany (K.O.K.); Departments of Obstetrics and Gynecology and Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas USA (I.V.d.V.); and Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York USA (R.W.)
| | - Howard Cuckle
- From the Baylor College of Medicine/Texas Children's Hospital, Houston, Texas USA (W.L.); Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel (S.Y., S.M.C.); Departments of Radiology and Obstetrics and Gynecology, Brigham and Women's Hospital, and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts USA (B.R.B.); Department of Reproductive Epidemiology, University of Leeds, Leeds, England (H.C.); Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany (K.O.K.); Departments of Obstetrics and Gynecology and Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas USA (I.V.d.V.); and Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York USA (R.W.)
| | - Karl O Kagan
- From the Baylor College of Medicine/Texas Children's Hospital, Houston, Texas USA (W.L.); Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel (S.Y., S.M.C.); Departments of Radiology and Obstetrics and Gynecology, Brigham and Women's Hospital, and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts USA (B.R.B.); Department of Reproductive Epidemiology, University of Leeds, Leeds, England (H.C.); Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany (K.O.K.); Departments of Obstetrics and Gynecology and Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas USA (I.V.d.V.); and Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York USA (R.W.)
| | - Ignatia Van den Veyver
- From the Baylor College of Medicine/Texas Children's Hospital, Houston, Texas USA (W.L.); Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel (S.Y., S.M.C.); Departments of Radiology and Obstetrics and Gynecology, Brigham and Women's Hospital, and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts USA (B.R.B.); Department of Reproductive Epidemiology, University of Leeds, Leeds, England (H.C.); Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany (K.O.K.); Departments of Obstetrics and Gynecology and Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas USA (I.V.d.V.); and Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York USA (R.W.)
| | - Ron Wapner
- From the Baylor College of Medicine/Texas Children's Hospital, Houston, Texas USA (W.L.); Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel (S.Y., S.M.C.); Departments of Radiology and Obstetrics and Gynecology, Brigham and Women's Hospital, and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts USA (B.R.B.); Department of Reproductive Epidemiology, University of Leeds, Leeds, England (H.C.); Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany (K.O.K.); Departments of Obstetrics and Gynecology and Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas USA (I.V.d.V.); and Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York USA (R.W.)
| | - Wesley Lee
- From the Baylor College of Medicine/Texas Children's Hospital, Houston, Texas USA (W.L.); Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel (S.Y., S.M.C.); Departments of Radiology and Obstetrics and Gynecology, Brigham and Women's Hospital, and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts USA (B.R.B.); Department of Reproductive Epidemiology, University of Leeds, Leeds, England (H.C.); Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany (K.O.K.); Departments of Obstetrics and Gynecology and Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas USA (I.V.d.V.); and Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York USA (R.W.)
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