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Souza SCS, Kim K, Dingwall-Harvey ALJ, Fakhraei R, Liao Y, Gaudet LM. Evaluating the correlation between amniotic fluid volume and estimated fetal weight in healthy pregnant women. J Perinat Med 2022; 50:1096-1099. [PMID: 35589556 DOI: 10.1515/jpm-2022-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/25/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The establishment of cut-offs for normal amniotic fluid volume (AFV) is valuable to predict perinatal outcomes. However, the most common methods to measure AFV are not accurate enough. It is important to understand factors that may be able to increase the accuracy of the calculation of AFV cut-off values. The objective of this study was to verify the correlation between AFV and estimated fetal weight (EFW). METHODS Records from almost 7,000 patients between 2012 and 2017 were accessed through hospital databases. The AFV measurements included in our analysis were obtained using the maximum vertical pocket technique. RESULTS AFV was positively correlated with EFW in the overall, male and female samples; however, the magnitude of the association was small (0.1 CONCLUSIONS The incorporation of EFW together with other factors (e.g., gestational age, fetus sex) may increase the accuracy of the AFV cut-offs calculation and, ultimately, reduce morbidity.
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Affiliation(s)
- Sara C S Souza
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Katherine Kim
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Romina Fakhraei
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Yan Liao
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Laura M Gaudet
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Department of Obstetrics and Gynecology, Kingston Health Sciences Center, Kingston, Canada
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Canada
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2
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Hughes DS, Magann EF, Whittington JR, Wendel MP, Sandlin AT, Ounpraseuth ST. Accuracy of the Ultrasound Estimate of the Amniotic Fluid Volume (Amniotic Fluid Index and Single Deepest Pocket) to Identify Actual Low, Normal, and High Amniotic Fluid Volumes as Determined by Quantile Regression. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:373-378. [PMID: 31423632 DOI: 10.1002/jum.15116] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To identify abnormal amniotic fluid volumes (AFVs), normal volumes must be determined. Multiple statistical methods are used to define normal amniotic fluid curves; however, quantile regression (QR) is gaining favor. We reanalyzed ultrasound estimates in identifying oligohydramnios, normal fluid, and polyhydramnios using normal volumes calculated by QR. METHODS Data from 506 dye-determined or directly measured AFVs along with ultrasound estimates were analyzed. Each was classified as low, normal, or high for both the single deepest pocket (SDP) and amniotic fluid index (AFI). A weighted κ statistic was used to assess the level of agreement between the AFI and SDP compared to actual AFVs by QR. RESULTS The overall level of agreement for the AFI was fair (κ = 0.26), and that for the SDP was slight (κ = 0.19). Although not statistically significant (P = .792), the positive predictive value to classify a low volume using the AFI was lower compared to the SDP (35% vs 43%). The positive predictive value for a high volume was higher using the AFI compared to the SDP (55% versus 31%) but not statistically significant. The missed-call rate for high-volume identification by the SDP versus AFI was statistically significant (odds ratio, 5.5; 95% confidence interval, 2.04-14.97). The missed-call rate for low-volume identification by the AFI versus SDP was not statistically significant (odds ratio, 3.3; 95% confidence interval, 0.96-11.53). CONCLUSIONS Both the AFI and SDP identify actual normal AFVs by QR, with sensitivity higher than 90%. The SDP is superior for identification of oligohydramnios, and the AFI superior for identification of polyhydramnios.
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Affiliation(s)
- Dawn S Hughes
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Julie R Whittington
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Michael P Wendel
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Adam T Sandlin
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Songthip T Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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How Well Do the Popular Ultrasonic Techniques Estimate Amniotic Fluid Volume and Diagnose Oligohydramnios, in Fact? Ultrasound Q 2019; 35:35-38. [PMID: 30601443 DOI: 10.1097/ruq.0000000000000408] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aims of the study were to compare the different estimation methods for the diagnosis of oligohydramnios and to determine concordance between estimated amniotic fluid volume (AFV) measured by ultrasonography and actual AFV measured directly. Another purpose was to investigate the effect of oligohydramnios on neonatal outcome. This study was done at a tertiary care center. The participants were scheduled between 37 and 40 weeks for cesarean delivery. Estimated AFV was ultrasonographically assessed, and then actual AFV was directly measured during the cesarean delivery to compare the subjective method (SM), amniotic fluid index (AFI), single deepest pocket (SDP), and 2-diameter pocket. Totally, 138 patients were included in the present study. Of 35 (34%), 24 (21%), 12 (9.5%), and 10 (7.8%) were defined as oligohydramnios by the SM, AFI, SDP, and 2-diameter pocket, respectively. The number of patients with actual oligohydramnios was 35 (34%). Most authors suggest as a method use of the SDP more than the AFI, because of overmanagement through the AFI. However, this study, which was conducted using both nonprejudiced and criterion-standard methods, showed that the SM and AFI technique were more successful to estimate oligohydramnios than other methods. Also, adverse pregnancy outcome was not closely associated with isolated oligohydramnios.
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Kim H, Im HJ, Koh KN, Kang SH, Yoo JW, Choi ES, Cho YU, Jang S, Park CJ, Seo JJ. Comparable Outcome with a Faster Engraftment of Optimized Haploidentical Hematopoietic Stem Cell Transplantation Compared with Transplantations from Other Donor Types in Pediatric Acquired Aplastic Anemia. Biol Blood Marrow Transplant 2019; 25:965-974. [PMID: 30639824 DOI: 10.1016/j.bbmt.2019.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 01/04/2019] [Indexed: 01/31/2023]
Abstract
Haploidentical family donors have been used as an alternative source in hematopoietic cell transplantation for patients with severe aplastic anemia. We evaluated and compared the outcomes of transplantation in pediatric acquired severe aplastic anemia based on donor type. Sixty-seven patients who underwent transplantation between 1998 and 2017 were included. Fourteen patients received grafts from matched sibling donors, 21 from suitable unrelated donors, and 32 from haploidentical family donors. Ex vivo CD3+ or αβ+ T cell-depleted grafts were used for haploidentical transplantation. Sixty-five patients (97.0%) achieved neutrophil engraftment at a median of 11 days. Haploidentical transplantation resulted in significantly faster neutrophil engraftment at a median of 10 days, compared with 14 days in cases of matched sibling donors and 12 days in cases of unrelated donor recipients. Nine patients experienced graft failure, and 5 of 7 who underwent a second transplantation are alive. There was no difference in the incidence of acute or chronic graft-versus-host disease based on donor type. The 5-year overall survival and failure-free survival rates were 93.8% ± 3.0% and 83.3% ± 4.6%, respectively, and there was no significant survival difference based on donor type. The survival outcomes of haploidentical transplantation in patients were comparable with those of matched sibling or unrelated donor transplantation. Optimized haploidentical transplantation using selective T cell depletion and conditioning regimens including low-dose total body irradiation for enhancing engraftment may be a realistic therapeutic option for pediatric patients with severe aplastic anemia.
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Affiliation(s)
- Hyery Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Ho Joon Im
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea.
| | - Kyung-Nam Koh
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Sung Han Kang
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea; Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Jae Won Yoo
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea; Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
| | - Eun Seok Choi
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Young-Uk Cho
- Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seongsoo Jang
- Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chan-Jeoung Park
- Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Jin Seo
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
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Anand-Ivell R, Cohen A, Nørgaard-Pedersen B, Jönsson BAG, Bonde JP, Hougaard DM, Lindh CH, Toft G, Lindhard MS, Ivell R. Amniotic Fluid INSL3 Measured During the Critical Time Window in Human Pregnancy Relates to Cryptorchidism, Hypospadias, and Phthalate Load: A Large Case-Control Study. Front Physiol 2018; 9:406. [PMID: 29740335 PMCID: PMC5928321 DOI: 10.3389/fphys.2018.00406] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/04/2018] [Indexed: 12/20/2022] Open
Abstract
The period of the first to second trimester transition in human pregnancy represents a sensitive window for fetal organogenesis, particularly in regard to the development of the male reproductive system. This is a time of relative analytical inaccessibility. We have used a large national biobank of amniotic fluid samples collected at routine amniocentesis to determine the impacts of exogenous endocrine disruptor load on specific fetal biomarkers at this critical time. While adrenal and testicular steroids are highly correlated, they are also mostly positively influenced by increasing phthalate load, represented by the metabolites 7cx-MMeHP and 5cx-MEPP, by perfluorooctane sulfonate (PFOS) exposure, and by smoking, suggesting an adrenal stress response. In contrast, the testis specific biomarkers insulin-like peptide 3 (INSL3) and androstenedione are negatively impacted by the phthalate endocrine disruptors. Using a case-control design, we show that cryptorchidism and hypospadias are both significantly associated with increased amniotic concentration of INSL3 during gestational weeks 13-16, and some, though not all steroid biomarkers. Cases are also linked to a specifically increased variance in the Leydig cell biomarker INSL3 compared to controls, an effect exacerbated by maternal smoking. No influence of phthalate metabolites or PFOS was evident on the distribution of cases and controls. Considering that several animal and human studies have shown a negative impact of phthalate load on fetal and cord blood INSL3, respectively, the present results suggest that such endocrine disruptors may rather be altering the relative dynamics of testicular development and consequent hormone production, leading to a desynchronization of tissue organization during fetal development. Being born small for gestational age appears not to impact on the testicular biomarker INSL3 in second trimester amniotic fluid.
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Affiliation(s)
| | - Arieh Cohen
- Section of Neonatal Screening and Hormones, Department of Clinical Biochemistry and Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Bent Nørgaard-Pedersen
- Section of Neonatal Screening and Hormones, Department of Clinical Biochemistry and Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Bo A. G. Jönsson
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Jens-Peter Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - David M. Hougaard
- Section of Neonatal Screening and Hormones, Department of Clinical Biochemistry and Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Christian H. Lindh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Gunnar Toft
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten S. Lindhard
- Perinatal Epidemiology Research Unit, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Richard Ivell
- School of Biosciences, University of Nottingham, Nottingham, United Kingdom
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, United Kingdom
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Spurway J, Logan P, Pak SC, Nielsen S. Reference ranges for the intra-amniotic umbilical cord vein diameter, peak velocity and blood flow in a regional NSW population. Australas J Ultrasound Med 2017; 20:155-162. [PMID: 34760489 PMCID: PMC8409896 DOI: 10.1002/ajum.12060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AIM To construct gestational age (GA)-related reference ranges of the intra-amniotic umbilical cord vein (UCV) diameter, peak velocity (PV) and blood flow (Qucv) using a Central West New South Wales population. MATERIALS AND METHODS This was a prospective, quasi-experimental study of low risk, singleton pregnancies (n = 321) between 16 and 42 weeks of gestation. Participation was voluntary following informed consent. The UCV diameter and PV were measured using B mode and duplex Doppler respectively, and Qucv calculated. Percentile values and reference range graphs were established using quantile regression modelling in R statistical software. Intraclass correlation coefficients (ICCs) were calculated to assess the intra and intersonographer reliability. RESULTS Reference ranges for the UCV diameter, PV and Qucv were established and graphed. All three UCV measurements increased with advancing GA, with both diameter and Qucv exhibiting a decline in the late third trimester. The intrasonographer and intersonographer ICCs for the UCV diameter and PV showed almost perfect agreement within and between sonographers. CONCLUSION Gestational age-related reference ranges for the UCV diameter, PV and Qucv were developed using quantile regression from a cohort of low risk, singleton pregnancies in Central West NSW. These reference ranges have the potential to assist in the diagnosis and monitoring of fetal growth restriction.
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Affiliation(s)
- Jacqueline Spurway
- Medical Imaging DepartmentOrange Health ServicePO Box 319OrangeNew South Wales2800Australia
| | - Patricia Logan
- School of Biomedical SciencesCharles Sturt UniversityLocked Bag 49DubboNew South Wales2830Australia
| | - Sok Cheon Pak
- School of Biomedical SciencesCharles Sturt UniversityPanorama AvenueBathurstNew South Wales2795Australia
| | - Sharon Nielsen
- Quantitative Consulting UnitCharles Sturt UniversityLocked Bag 588Wagga WaggaNew South Wales2678Australia
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Ounpraseuth ST, Magann EF, Spencer HJ, Rabie NZ, Sandlin AT. Normal amniotic fluid volume across gestation: Comparison of statistical approaches in 1190 normal amniotic fluid volumes. J Obstet Gynaecol Res 2017; 43:1122-1131. [DOI: 10.1111/jog.13332] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/01/2017] [Accepted: 02/24/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Songthip T. Ounpraseuth
- Department of Biostatistics; University of Arkansas for the Medical Sciences; Little Rock Arkansas USA
| | - Everett F. Magann
- Department of Obstetrics and Gynecology; University of Arkansas for the Medical Sciences; Little Rock Arkansas USA
| | - Horace J. Spencer
- Department of Biostatistics; University of Arkansas for the Medical Sciences; Little Rock Arkansas USA
| | - Nader Z. Rabie
- Department of Obstetrics and Gynecology; University of Arkansas for the Medical Sciences; Little Rock Arkansas USA
| | - Adam T. Sandlin
- Department of Obstetrics and Gynecology; University of Arkansas for the Medical Sciences; Little Rock Arkansas USA
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Hughes DS, Magann EF. Antenatal fetal surveillance "Assessment of the AFV". Best Pract Res Clin Obstet Gynaecol 2016; 38:12-23. [PMID: 27756534 DOI: 10.1016/j.bpobgyn.2016.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/10/2016] [Accepted: 08/08/2016] [Indexed: 11/29/2022]
Abstract
The evaluation of amniotic fluid volume (AFV) is an established part of the antenatal surveillance of pregnancies at risk for an adverse pregnancy outcome. The two most commonly used ultrasound techniques to estimate AFV are the amniotic fluid index (AFI) and the single deepest pocket (SDP). Four studies have defined normal AFVs, and although their normal volumes have similarities, there are also differences primarily due to the statistical methodology used in each study. Dye-determined AFV correlates with ultrasound estimates for normal fluid volumes but correlates poorly for oligohydramnios and polyhydramnios. The addition of color Doppler in estimating AFV leads to the overdiagnosis of oligohydramnios. Neither the AFI nor the SDP is superior in identifying oligohydramnios, but the SDP is a better measurement choice as the use of AFI increases the diagnosis rate of oligohydramnios and labor inductions without an improvement in pregnancy outcomes.
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Affiliation(s)
- Dawn S Hughes
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Olson CK, Iwamoto M, Perkins KM, Polen KND, Hageman J, Meaney-Delman D, Igbinosa II, Khan S, Honein MA, Bell M, Rasmussen SA, Jamieson DJ. Preventing Transmission of Zika Virus in Labor and Delivery Settings Through Implementation of Standard Precautions - United States, 2016. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2016; 65:290-2. [PMID: 27010422 DOI: 10.15585/mmwr.mm6511e3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Zika virus transmission was detected in the Region of the Americas (Americas) in Brazil in May 2015, and as of March 21, 2016, local mosquito-borne transmission of Zika virus had been reported in 32 countries and territories in the Americas, including Puerto Rico and the U.S. Virgin Islands.* Most persons infected with Zika virus have a mild illness or are asymptomatic. However, increasing evidence supports a link between Zika virus infection during pregnancy and adverse pregnancy and birth outcomes (1), and a possible association between recent Zika virus infection and Guillain-Barré syndrome has been reported (2). Although Zika virus is primarily transmitted through the bite of Aedes species of mosquitoes, sexual transmission also has been documented (3). Zika virus RNA has been detected in a number of body fluids, including blood, urine, saliva, and amniotic fluid (3-5), and whereas transmission associated with occupational exposure to these body fluids is theoretically possible, it has not been documented. Although there are no reports of transmission of Zika virus from infected patients to health care personnel or other patients, minimizing exposures to body fluids is important to reduce the possibility of such transmission. CDC recommends Standard Precautions in all health care settings to protect both health care personnel and patients from infection with Zika virus as well as from blood-borne pathogens (e.g., human immunodeficiency virus [HIV] and hepatitis C virus [HCV]) (6). Because of the potential for exposure to large volumes of body fluids during the labor and delivery process and the sometimes unpredictable and fast-paced nature of obstetrical care, the use of Standard Precautions in these settings is essential to prevent possible transmission of Zika virus from patients to health care personnel.
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Amniotic fluid volume: Rapid MR-based assessment at 28-32 weeks gestation. Eur Radiol 2016; 26:3752-9. [DOI: 10.1007/s00330-015-4179-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/02/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022]
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Ireland DJ, Kemp MW, Miura Y, Saito M, Newnham JP, Keelan JA. Intra-amniotic pharmacological blockade of inflammatory signalling pathways in an ovine chorioamnionitis model. Mol Hum Reprod 2015; 21:479-89. [DOI: 10.1093/molehr/gav005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/27/2015] [Indexed: 01/09/2023] Open
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Liu L, Zhang M, Min X, Cai L. Low Serum Levels of ABCA1, an ATP-Binding Cassette Transporter, Are Predictive of Preeclampsia. TOHOKU J EXP MED 2015; 236:89-95. [DOI: 10.1620/tjem.236.89] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Lixing Liu
- Department of Anatomy, Basic medical department of Putian College
| | - Min Zhang
- Department of Physiological, Basic medical department of Putian College
| | - Xianhui Min
- Department of Obstetrics and Gynecology, First Hospital Affiliated to Fuzhou General Hospital
| | - Lixi Cai
- Department of Biochemical, Basic medical department of Putian College
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