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McGee LD, Cignetti CA, Sutton A, Harper L, Dubose C, Gould S. Exercise During Pregnancy: Obstetricians' Beliefs and Recommendations Compared to American Congress of Obstetricians and Gynecologists' 2015 Guidelines. Cureus 2018; 10:e3204. [PMID: 30410829 PMCID: PMC6207175 DOI: 10.7759/cureus.3204] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose Obesity and excessive weight gain during pregnancy is a growing problem, conferring severe health risks for both mother and fetus. Exercise can help combat this epidemic. However, many pregnant women are not meeting the American Congress of Obstetricians and Gynecologists' (ACOG's) 2015 guidelines for exercise during pregnancy. The objective of this study was to evaluate obstetricians' beliefs and recommendations regarding exercise during pregnancy compared to ACOG's 2015 recommendations. Method Obstetricians were recruited via three different forums to complete a twenty-question survey: at a regional conference for Alabama and Mississippi ACOG members, at the University of Alabama at Birmingham's Obstetrics and Gynecology Department's Grand Rounds, and via telephone. Univariate statistical analysis was conducted with RedCap. Results Seventy-one surveys were completed: 33 from the ACOG conference, 27 from Grand Rounds, and 11 from those recruited by telephone. Eighty-eight percent (n=60) of respondents correctly identified ACOG's recommendation of unrestricted exercise for women with uncomplicated pregnancies. One-fourth (24%; n=16) regularly discuss exercise with most (76%-100%) pregnant patients. Most (57%; n=59) do not consistently ("never," "rarely," or "sometimes") recommend sedentary patients begin exercising during pregnancy. Nearly all (97%; n=66) advise first-trimester patients to perform aerobic exercise two to five days per week, but the recommended duration varies. One-fourth (24%; n=16) do not recommend strength-training exercise during the first trimester. Twenty-five percent (n=17) and 32% (n=22) recommend decreased aerobic or strength-training exercise, respectively, in the third trimester. More than half (54%; n=37) recommend pregnant patients limit exercise by heart rate, most commonly 121-140 bpm (25%; n=17) or 141-160 bpm (24%; n=16). Sixty-eight percent (n=46) feel "comfortable" or "very comfortable" providing advice on exercise during pregnancy. Conclusion Despite believing exercise benefits pregnant women, knowing ACOG's 2015 guidelines endorse unrestricted exercise for women with uncomplicated pregnancies, and feeling comfortable discussing this topic with patients, obstetricians are not consistently counseling their pregnant patients on exercise. Notably, physicians are not instructing their sedentary pregnant patients to exercise. While most physicians provide appropriate advice on aerobic exercise, their advice on resistance training, maximum heart rate during exercise and third-trimester exercise are often discordant with ACOG's guidelines.
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Harper L. Re: Urinary tract infection in children: Diagnosis, treatment, imaging - Comparison of current guidelines. J Pediatr Urol 2018; 14:300. [PMID: 29501379 DOI: 10.1016/j.jpurol.2018.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 11/18/2022]
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53
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Urban RR, Ramzan AA, Doo DW, Galan HL, Harper L, Omurtag K, Muffly TM, Sheeder J, Guntupalli SR. Fellow perceptions of residency training in obstetrics and gynecology. Am J Obstet Gynecol 2018; 218:461-462. [PMID: 29353035 DOI: 10.1016/j.ajog.2018.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
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54
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Gray MM, Sweeney MK, Jennings SF, Steele R, Tita A, Harper L. 396: Length of latent phase in labor induction: Maternal and neonatal outcomes. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.10.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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55
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Angelliaume A, Harper L, Lalioui A, Delgove A, Lefèvre Y. Tailor-made management of thoracic scoliosis with cervical hyperextension in muscular dystrophy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:264-269. [DOI: 10.1007/s00586-017-5113-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/25/2017] [Indexed: 11/29/2022]
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56
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Conway J, Conroy L, Harper L, Scheifele M, Smith W, Graham T, Phan T, Li H, Olivotto I. PO-0870: DIBH produces a meaningful reduction in lung dose for some women with right-sided breast cancer. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31307-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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57
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Mitchell C, Becker D, Steele R, Wang M, Biggio J, Harper L. 221: Impact of inclusion of fetal growth restriction in severe preeclampsia diagnosis. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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58
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Pasko DN, Tuuli M, Tita A, Harper L. 809: Does increased cefazolin dosing decrease cesarean wound complications in class III obesity? Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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59
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Tóth F, Torrison JL, Harper L, Bussieres D, Wilson ME, Crenshaw TD, Carlson CS. Osteochondrosis prevalence and severity at 12 and 24 weeks of age in commercial pigs with and without organic-complexed trace mineral supplementation. J Anim Sci 2016; 94:3817-3825. [DOI: 10.2527/jas.2015-9950] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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60
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Bouty A, Lefevre Y, Harper L, Dobremez E. Urethral duplication in girls: Three cases associating an accessory epispadiac urethra and a main hypospadiac urethra. J Pediatr Urol 2016; 12:209.e1-5. [PMID: 27267991 DOI: 10.1016/j.jpurol.2016.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/01/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Urethral duplication is extremely rare in girls, with less than 40 cases reported so far. Most of them present as a prepubic sinus. Literature is scare regarding aetiology, classification and management in other forms. This study presents three cases of sagittal urethral duplication in girls presenting a main hypospadiac urethra and an accessory epispadiac urethra. PATIENTS AND METHODS Medical records were retrospectively reviewed of three girls with urethral duplication managed over a 30-year period at a single institution. Circumstances of diagnosis, management and outcomes were analysed. RESULTS The oldest case presented as a neonatal retrovesical mass with an accessory clitoral stream, whereas the two more recent cases presented with antenatal hydrocolpos and bilateral ureterohydronephrosis. Cases 1 and 3 had an incomplete duplication, while Case 2 had a complete form. In Case 3, the duplication was associated with a urogenital sinus and an anteriorly placed anus. Management involved resection of the epispadiac accessory urethra to achieve continence, with dilatation and/or mobilisation of the hypospadiac one. All girls are now aged >5 years old and are continent, and one is old enough to have normal menstruation. Renal function is normal in all. The summary table presents the schematic anatomical description as shown on micturating cystourethrogram and endoscopy, as well as the management for each patient. DISCUSSION Step-by-step management is necessary in urethral duplication. The neonatal emergency is to release the urinary tract compression by evacuating urinary retention or hydrocolpos. Later in infancy, decision has to be taken regarding the urethras. If the resection of the epispadiac accessory urethra seems acceptable to achieve continence, the attitude towards the hypospadiac channel is more controversial and should be individualised. Embryologic and aetiopathogenic pathways are still missing to uniformly characterise the malformation. CONCLUSION Paediatric urologists should remember that there is a wide spectrum of urethral duplication in girls, and that various presentations exist beside the more classic prepubic sinus.
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Shabir S, Smith H, Kaul B, Pachnio A, Jham S, Kuravi S, Ball S, Chand S, Moss P, Harper L, Borrows R. Cytomegalovirus-Associated CD4(+) CD28(null) Cells in NKG2D-Dependent Glomerular Endothelial Injury and Kidney Allograft Dysfunction. Am J Transplant 2016; 16:1113-28. [PMID: 26603521 DOI: 10.1111/ajt.13614] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 09/17/2015] [Accepted: 09/17/2015] [Indexed: 01/25/2023]
Abstract
Emerging data suggest that expansion of a circulating population of atypical, cytotoxic CD4(+) T cells lacking costimulatory CD28 (CD4(+) CD28(null) cells) is associated with latent cytomegalovirus (CMV) infection. The purpose of the current study was to increase the understanding of the relevance of these cells in 100 unselected kidney transplant recipients followed prospectively for a median of 54 months. Multicolor flow cytometry of peripheral blood mononuclear cells before transplantation and serially posttransplantation was undertaken. CD4(+) CD28(null) cells were found predominantly in CMV-seropositive patients and expanded in the posttransplantation period. These cells were predominantly effector-memory phenotype and expressed markers of endothelial homing (CX3CR1) and cytotoxicity (NKG2D and perforin). Isolated CD4(+) CD27(-) CD28(null) cells proliferated in response to peripheral blood mononuclear cells previously exposed to CMV-derived (but not HLA-derived) antigens and following such priming incubation with glomerular endothelium resulted in signs of endothelial damage and apoptosis (release of fractalkine and von Willebrand factor; increased caspase 3 expression). This effect was mitigated by NKG2D-blocking antibody. Increased CD4(+) CD28(null) cell frequencies were associated with delayed graft function and lower estimated glomerular filtration rate at end follow-up. This study suggests an important role for this atypical cytotoxic CD4(+) CD28(null) cell subset in kidney transplantation and points to strategies that may minimize the impact on clinical outcomes.
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Chand S, McKnight AJ, Shabir S, Chan W, McCaughan JA, Maxwell AP, Harper L, Borrows R. Analysis of single nucleotide polymorphisms implicate mTOR signalling in the development of new-onset diabetes after transplantation. BBA CLINICAL 2016; 5:41-5. [PMID: 27051588 PMCID: PMC4802392 DOI: 10.1016/j.bbacli.2015.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/07/2015] [Accepted: 12/17/2015] [Indexed: 12/13/2022]
Abstract
Introduction Despite excellent first year outcomes in kidney transplantation, there remain significant long-term complications related to new-onset diabetes after transplantation (NODAT). The purpose of this study was to validate the findings of previous investigations of candidate gene variants in patients undergoing a protocolised, contemporary immunosuppression regimen, using detailed serial biochemical testing to identify NODAT development. Methods One hundred twelve live and deceased donor renal transplant recipients were prospectively followed-up for NODAT onset, biochemical testing at days 7, 90, and 365 after transplantation. Sixty-eight patients were included after exclusion for non-white ethnicity and pre-transplant diabetes. Literature review to identify candidate gene variants was undertaken as described previously. Results Over 25% of patients developed NODAT. In an adjusted model for age, sex, BMI, and BMI change over 12 months, five out of the studied 37 single nucleotide polymorphisms (SNPs) were significantly associated with NODAT: rs16936667:PRDM14 OR 10.57;95% CI 1.8–63.0;p = 0.01, rs1801282:PPARG OR 8.5; 95% CI 1.4–52.7; p = 0.02, rs8192678:PPARGC1A OR 0.26; 95% CI 0.08–0.91; p = 0.03, rs2144908:HNF4A OR 7.0; 95% CI 1.1–45.0;p = 0.04 and rs2340721:ATF6 OR 0.21; 95%CI 0.04–1.0; p = 0.05. Conclusion This study represents a replication study of candidate SNPs associated with developing NODAT and implicates mTOR as the central regulator via altered insulin sensitivity, pancreatic β cell, and mitochondrial survival and dysfunction as evidenced by the five SNPs. General significance Highlights the importance of careful biochemical phenotyping with oral glucose tolerance tests to diagnose NODAT in reducing time to diagnosis and missed cases. This alters potential genotype:phenotype association. The replication study generates the hypothesis that mTOR signalling pathway may be involved in NODAT development.
Oral glucose tolerance tests reduce time to NODAT diagnosis and missed cases Biochemical testing changes genotype:phenotype association mTOR signalling pathway may be involved in NODAT development
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Key Words
- ATF6, Activated transcription factor
- BMI, Body mass index
- GWAS, Genome-wide association study
- HLA, Human leucocyte antigen
- HNF4, Hepatocyte nuclear factor 4
- NODAT, New-onset diabetes after transplantation
- New-onset diabetes after transplantation
- PI3, Phospho-inositide 3-kinase
- PPARGC1α, Peroxisome proliferator-activated receptor gamma co-activator 1 alpha
- PPARy, Peroxisome proliferator-activated receptor gamma
- PRDM14, PR domain zinc protein 14
- SNP, Single nucleotide polymorphism
- mTOR
- mTOR, Mammalian target of rapamycin
- single nucleotide polymorphisms
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Pasko DN, Tita A, Tang Y, Steele R, Biggio J, Harper L. 791: Effect of 2nd and 3rd trimester blood pressure control in gravidas with chronic hypertension. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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64
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Anderson S, Tita A, Youngstrom M, Allen S, Tang Y, Harper L. 719: Pregnancy outcomes with first line blood pressure agents in chronic hypertension. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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65
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Harper L, Choleris E, Ervin K, Fureix C, Reynolds K, Walker M, Mason G. Stereotypic mice are aggressed by their cage-mates, and tend to be poor demonstrators in social learning tasks. Anim Welf 2015. [DOI: 10.7120/09627286.24.4.463] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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66
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Farrer K, Lal S, Teubner A, Harper L, Abraham A, Myers A, Carlson G. Fistuloclysis and distal enteral feeding in acute intestinal failure. Clin Nutr ESPEN 2015; 10:e189. [DOI: 10.1016/j.clnesp.2015.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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67
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Shabir S, Girdlestone J, Briggs D, Kaul B, Smith H, Daga S, Chand S, Jham S, Navarrete C, Harper L, Ball S, Borrows R. Transitional B lymphocytes are associated with protection from kidney allograft rejection: a prospective study. Am J Transplant 2015; 15:1384-91. [PMID: 25808898 DOI: 10.1111/ajt.13122] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/27/2014] [Accepted: 10/28/2014] [Indexed: 01/25/2023]
Abstract
Recent cross-sectional studies suggest an important role for transitional B lymphocytes (CD19 + CD24hiCD38hi) in promoting transplant tolerance, and protecting from late antibody-mediated rejection (ABMR). However, prospective studies are lacking. This study enrolled 73 de novo transplant recipients, and collected serial clinical, immunological and biochemical information over 48 ± 6 months. Cell phenotyping was conducted immediately prior to transplantation, and then on five occasions during the first year posttransplantation. When modeled as a time-dependent covariate, transitional B cell frequencies (but not total B cells or "regulatory" T cells) were associated with protection from acute rejection (any Banff grade; HR: 0.60; 95% CI: 0.37-0.95; p = 0.03). No association between transitional B cell proportions and either de novo donor-specific or nondonor-specific antibody (dnDSA; dnNDSA) formation was evident, although preserved transitional B cell proportions were associated with reduced rejection rates in those patients developing dnDSA. Three episodes of ABMR occurred, all in the context of nonadherence, and all associated with in vitro anti-HLA T cell responses in an ELISPOT assay (p = 0.008 versus antibody-positive patients not experiencing ABMR). This prospective study supports the potential relevance of transitional ("regulatory") B cells as a biomarker and therapeutic intervention in transplantation, and highlights relationships between humoral immunity, cellular immunity and nonadherence.
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Wong L, Harper L, Little MA. Getting the balance right: adverse events of therapy in anti-neutrophil cytoplasm antibody vasculitis. Nephrol Dial Transplant 2015; 30 Suppl 1:i164-70. [DOI: 10.1093/ndt/gfu406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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69
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Harper L, Biggio J, Tita A. 834: Use of oral hypoglycemics in pregestational type 2 diabetes. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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70
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Harper L. 587: Carpenter-coustan versus national diabetes data group criteria for diagnosing gestational diabetes. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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71
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Durst J, Subramaniam A, Tang Y, Szychowski J, Campbell S, Biggio J, Harper L. 652: Induction of labor for gestational hypertension at term: a look at outcomes. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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72
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Anderson S, Jauk V, Harper L, Biggio J, Tita A. 708: Mid-trimester blood pressures below 140/90 and risk of small-for-gestational age (SGA) in pregnancies complicated by chronic hypertension. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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73
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Harper L, Tita A, Biggio J. 470: Predicting failure of glyburide treatment in gestational diabetes. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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74
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Shanks A, Mehra S, Gross G, Harper L, Colvin R, Tuuli M. 71: Treatment utility of postpartum antibiotics in chorioamniotis (TUPAC) study. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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75
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Pasko D, Jenkins S, Owen J, Harper L. 784: Effect of maternal morbid obesity on completion and sensitivity of the fetal anatomic survey. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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