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Johnston A, Dancey SR, Tseung V, Skidmore B, Fell DB, Tanuseputro P, Smith GN, Coutinho T, Edwards JD. A systematic review of validated case-finding definitions to identify hypertensive disorders of pregnancy in administrative healthcare databases. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2504] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Administrative healthcare data are frequently used to study cardiovascular disease (CVD) risk in women with hypertensive disorders of pregnancy (HDP); however, little is known about the validity of case-finding definitions (CFDs, e.g., International Classification of Disease codes/algorithms) designed to identify these conditions in administrative databases.
Purpose
To systematically identify and summarize available evidence on the validity of administrative CFDs for HDP.
Methods
Four bibliographic databases and grey literature sources were searched for eligible studies. The titles/abstracts of all records were independently screened for eligibility by two reviewers, then assessed at full text. Study data (design and participant characteristics, validation statistics) were extracted by two independent reviewers and discrepancies resolved through consensus. Quality of reporting was assessed using checklists; risk of bias was assessed using a modified version of the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool, adapted for administrative validation studies.
Results
Twenty-five studies, published between 1998 and 2021, met the eligibility criteria. Nearly half (48%) were conducted in the United States. Ten studies validated CFDs for ≥1 HDP as a primary aim; most (60%) validated several maternal and infant morbidities, including ≥1 HDP. Preeclampsia (any, mild, moderate, serious, severe, superimposed) was the most validated HDP subtype. Only six studies reported gold standard definitions for all HDPs validated; definitions were heterogeneous with respect to blood pressure thresholds and timing of diagnosis. Seven studies (∼25%) reported all 2x2 table values (true positives/negatives, false positives/negatives) for ≥1 CFD, or they were calculable. The majority of CFDs reported in primary analyses (n=23) were highly specific (≥98%); however, sensitivity varied widely (3.2% to 100%; Figure 1). Nearly all (n=20, 87%) had a positive predictive value (PPV) of ≥70%, 13 of which had a PPV of >80% in combination with high specificity. Across studies, HDP prevalence ranged from 0.1% (eclampsia) to 37% (any maternal hypertensive disorder). Quality of reporting was generally poor to moderate, and all studies were judged to be at unclear or high risk of bias on ≥1 QUADAS-2 domain. Five studies were judged to be of “low concern” regarding study applicability (Figure 2).
Conclusions
Clinical understanding of CVD risk in women with HDP could be drastically impacted if there is low confidence that these conditions have been correctly identified from administrative data. Researchers should quantitatively explore the extent to which CVD risk estimates may be impacted by CFDs with low sensitivity and artificially inflated PPVs, influenced by greater study prevalence of HDP than would be expected in the general population. Higher quality validation studies that employ more rigorous methodology and improved reporting are needed.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Johnston
- School of Epidemiology and Public Health, University of Ottawa, & Brain and Heart Nexus Research Program, University of Ottawa Heart Institute , Ottawa , Canada
| | - S R Dancey
- University of Ottawa, School of Medicine , Ottawa , Canada
| | - V Tseung
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute , Ottawa , Canada
| | - B Skidmore
- Independent Information Specialist , Ottawa , Canada
| | - D B Fell
- School of Epidemiology and Public Health, University of Ottawa, Children's Hospital of Eastern Ontario Research Institute & ICES , Ottawa , Canada
| | - P Tanuseputro
- Ottawa Hospital Research Institute, University of Ottawa, Department of Medicine , Ottawa , Canada
| | - G N Smith
- Kingston Health Sciences Centre, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , Kingston , Canada
| | - T Coutinho
- University of Ottawa Heart Institute, Division of Cardiac Prevention and Rehabilitation, Division of Cardiology & Canadian Women's Heart Health Centre , Ottawa , Canada
| | - J D Edwards
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, School of Epidemiology and Public Health, University of Ottawa & ICES , Ottawa , Canada
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2
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Richmond E, Ray JG, Pudwell J, Djerboua M, Gaudet L, Walker M, Smith GN, Velez MP. Caesarean birth in women with infertility: population-based cohort study. BJOG 2021; 129:908-916. [PMID: 34797929 PMCID: PMC9300122 DOI: 10.1111/1471-0528.17019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
Objective Caesarean section (CS) is more common following infertility treatment (IT) but the reasons why remain unclear and confounded. The Robson 10‐Group Classification System (TGCS) may further explain variation in CS rates. We assessed the association between mode of conception and CS across Robson groups. Design Population‐based cohort study. Setting Ontario, Canada, in a public healthcare system. Population 921 023 births, 2006–2014. Methods Modified Poisson regression produced relative risks (RR) and 95% confidence intervals, comparing the risk of CS among women with (1) subfertility without IT, (2) non‐invasive IT (OI, IUI) or (3) invasive IT (IVF)—each relative to (4) spontaneous conception (SC). Main outcome measures CS rate according to one of four modes of conception, overall and stratified by each of the TGCS groups. Results Relative to SC (26.9%), the risk of CS increased in those with subfertility without IT (RR 1.17, 95% CI 1.16–1.18), non‐invasive IT (RR 1.21, 95% CI 1.18–1.24) and invasive IT (RR 1.39, 95% CI 1.36–1.42). Within each Robson group, similar patterns of RRs were seen, but with markedly differing rates. For example, in Group 1 (nulliparous, singleton, cephalic at ≥37 weeks, with spontaneous labour), the respective rates were 15.0, 19.4, 18.7 and 21.9%; in Group 2 (nulliparous, singleton, cephalic at ≥37 weeks, without spontaneous labour), the rates were 35.9, 44.4, 43.2 and 54.1%; and in Group 8 (multiple pregnancy), they were 55.9, 67.5, 65.0 and 69.3%, respectively. Conclusions CS is relatively more common in women with subfertility and those receiving IT, an effect that persists across Robson groups. Tweetable abstract Caesarean delivery is more common in women with infertility independent of demographics and prenatal conditions. Caesarean delivery is more common in women with infertility independent of demographics and prenatal conditions.
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Affiliation(s)
- E Richmond
- Department of Obstetrics & Gynaecology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - J G Ray
- ICES, Toronto, ON, Canada.,Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - J Pudwell
- Department of Obstetrics & Gynaecology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | | | - L Gaudet
- Department of Obstetrics & Gynaecology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - M Walker
- Department of Obstetrics, Gynaecology & Newborn Care, University of Ottawa, Ottawa, ON, Canada
| | - G N Smith
- Department of Obstetrics & Gynaecology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - M P Velez
- Department of Obstetrics & Gynaecology, Kingston General Hospital, Queen's University, Kingston, ON, Canada.,ICES, Toronto, ON, Canada
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3
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Woodward ML, Gicas KM, Warburton DE, White RF, Rauscher A, Leonova O, Su W, Smith GN, Thornton AE, Vertinsky AT, Phillips AA, Goghari VM, Honer WG, Lang DJ. Hippocampal volume and vasculature before and after exercise in treatment-resistant schizophrenia. Schizophr Res 2018; 202:158-165. [PMID: 30539767 DOI: 10.1016/j.schres.2018.06.054] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 02/08/2018] [Revised: 06/11/2018] [Accepted: 06/20/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Schizophrenia is associated with poor cognitive function and elevated cardiometabolic disease risk. These health concerns may exacerbate neurocognitive dysfunction associated with hippocampal abnormalities, particularly hippocampal volume reductions. Regular exercise is thought to improve symptom severity, reduce depression, and improve cognition in schizophrenia, and may trigger exercise-mediated hippocampal growth. The potential for the benefits of exercise for treatment-resistant schizophrenia patients has not been clearly assessed. This study aims to assess the effect of exercise on hippocampal plasticity and clinical outcomes in chronic schizophrenia. METHODS Seventeen DSM-IV criteria schizophrenia or schizoaffective disorder patients completed a customized moderate intensity 12-week aerobic or weight-bearing exercise program. Adherence rates were 83% ± 9.4%) with 70% of participants completing the entire exercise program. Concomitant neuroimaging, clinical and cognitive assessments were obtained at baseline and 12-weeks. RESULTS At follow-up, symptom severity scores (t(16) = -16.8, p. ≤ 0.0001) and social functioning (t(16) = 4.4, p. = 0.0004) improved. A trend for improved depression scores (t(16) = -2.0, p. = 0.06) with no change in anxiety, or extrapyramidal symptoms were seen. Hippocampal volume increased (t(16) = -2.54, p. = 0.02), specifically in the left CA-1 field (F(16) = -2.33, p. = 0.03). Hippocampal vascular volume was unchanged. Change in hippocampal volume and vascular volume was not significantly correlated with change in symptom severity or affect scores. CONCLUSIONS Adjunct exercise may accelerate symptom improvement in treatment-resistant psychosis patients. While the underlying mechanism remains unclear, these results indicate that chronic schizophrenia patients experience hippocampal plasticity in response to exercise. STUDY REGISTRATION Clinical Trials.govNCT01392885.
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Affiliation(s)
- M L Woodward
- Department of Radiology, University of British Columbia, Canada
| | - K M Gicas
- Department of Psychology, Simon Fraser University, Canada
| | - D E Warburton
- School of Kinesiology, University of British Columbia, Canada; Experimental Medicine Program, University of British Columbia, Canada
| | - R F White
- Department of Psychiatry, University of British Columbia, Canada
| | - A Rauscher
- Department of Pediatrics, University of British Columbia, Canada
| | - O Leonova
- Department of Psychiatry, University of British Columbia, Canada
| | - W Su
- Department of Psychiatry, University of British Columbia, Canada
| | - G N Smith
- Department of Psychiatry, University of British Columbia, Canada
| | - A E Thornton
- Department of Pediatrics, University of British Columbia, Canada
| | - A T Vertinsky
- Department of Radiology, University of British Columbia, Canada
| | - A A Phillips
- School of Kinesiology, University of British Columbia, Canada
| | - V M Goghari
- Department of Psychology & Graduate Department of Psychological Clinical Science, University of Toronto, Canada
| | - W G Honer
- Department of Psychiatry, University of British Columbia, Canada
| | - D J Lang
- Department of Radiology, University of British Columbia, Canada.
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Retnakaran R, Wen SW, Tan H, Zhou S, Ye C, Shen M, Smith GN, Walker MC. Maternal pre-gravid cardiometabolic health and infant birthweight: A prospective pre-conception cohort study. Nutr Metab Cardiovasc Dis 2017; 27:723-730. [PMID: 28693965 DOI: 10.1016/j.numecd.2017.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Both low birthweight and high birthweight have been associated with the development of cardiometabolic disease in adulthood, possibly reflecting the effect of intrauterine fetal programming. As developmental programming can begin before conception, pre-gravid factors that predict birthweight may be relevant in this context. However, little is known about such factors. Thus, we established a pre-conception cohort to identify maternal pre-gravid cardiometabolic determinants of infant birthweight. METHODS AND RESULTS In this prospective observational cohort study, 1484 newly-married women in Liuyang, China, underwent baseline (pre-gravid) evaluation and then were followed across a subsequent pregnancy. Pre-gravid cardiometabolic characterization consisted of clinical (anthropometry, blood pressure) and biochemical evaluation (total/LDL/HDL cholesterol, triglycerides, glucose) at median 20 weeks before a singleton pregnancy. Mean birthweight was 3294 ± 444 g, with 173 neonates large-for-gestational-age (LGA) and 110 small-for-gestational-age (SGA). On multiple linear regression analysis, positive determinants of birthweight were maternal age, pre-gravid body mass index (BMI), weight gain in pregnancy, length of gestation, and male infant (all p ≤ 0.0003). On logistic regression analysis, independent predictors of an LGA delivery were maternal age (OR = 1.10 per year, 95%CI 1.03-1.18), pre-gravid BMI (OR = 1.21 per kg/m2, 1.07-1.37), and gestational weight gain (OR = 1.10 per kg, 1.06-1.14). The only independent predictor of SGA was gestational weight gain (OR = 0.93 per kg, 0.89-0.97). CONCLUSION Maternal weight before and during pregnancy is the predominant cardiometabolic determinant of infant birthweight, rather than pre-gravid blood pressure, glucose or lipid profile.
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Affiliation(s)
- R Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada.
| | - S W Wen
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada; School of Public Health, Central South University, Changsha, China
| | - H Tan
- School of Public Health, Central South University, Changsha, China
| | - S Zhou
- Liuyang Municipal Hospital of Maternal and Child Health, Beizheng, Liuyang, China
| | - C Ye
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - M Shen
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada; School of Public Health, Central South University, Changsha, China
| | - G N Smith
- Queen's Perinatal Research Unit, Department of Obstetrics and Gynecology, Queen's University, Kingston, Canada
| | - M C Walker
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
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North SM, Jones ER, Smith GN, Mykhaylyk OO, Annable T, Armes SP. Adsorption of Small Cationic Nanoparticles onto Large Anionic Particles from Aqueous Solution: A Model System for Understanding Pigment Dispersion and the Problem of Effective Particle Density. Langmuir 2017; 33:1275-1284. [PMID: 28075595 PMCID: PMC5299546 DOI: 10.1021/acs.langmuir.6b04541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/11/2017] [Indexed: 05/24/2023]
Abstract
The present study focuses on the use of copolymer nanoparticles as a dispersant for a model pigment (silica). Reversible addition-fragmentation chain transfer (RAFT) alcoholic dispersion polymerization was used to synthesize sterically stabilized diblock copolymer nanoparticles. The steric stabilizer block was poly(2-(dimethylamino)ethyl methacrylate) (PDMA) and the core-forming block was poly(benzyl methacrylate) (PBzMA). The mean degrees of polymerization for the PDMA and PBzMA blocks were 71 and 100, respectively. Transmission electron microscopy (TEM) studies confirmed a near-monodisperse spherical morphology, while dynamic light scattering (DLS) studies indicated an intensity-average diameter of 30 nm. Small-angle X-ray scattering (SAXS) reported a volume-average diameter of 29 ± 0.5 nm and a mean aggregation number of 154. Aqueous electrophoresis measurements confirmed that these PDMA71-PBzMA100 nanoparticles acquired cationic character when transferred from ethanol to water as a result of protonation of the weakly basic PDMA chains. Electrostatic adsorption of these nanoparticles from aqueous solution onto 470 nm silica particles led to either flocculation at submonolayer coverage or steric stabilization at or above monolayer coverage, as judged by DLS. This technique indicated that saturation coverage was achieved on addition of approximately 465 copolymer nanoparticles per silica particle, which corresponds to a fractional surface coverage of around 0.42. These adsorption data were corroborated using thermogravimetry, UV spectroscopy and X-ray photoelectron spectroscopy. TEM studies indicated that the cationic nanoparticles remained intact on the silica surface after electrostatic adsorption, while aqueous electrophoresis confirmed that surface charge reversal occurred below pH 7. The relatively thick layer of adsorbed nanoparticles led to a significant reduction in the effective particle density of the silica particles from 1.99 g cm-3 to approximately 1.74 g cm-3, as judged by disk centrifuge photosedimentometry (DCP). Combining the DCP and SAXS data suggests that essentially no deformation of the PBzMA cores occurs during nanoparticle adsorption onto the silica particles.
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Affiliation(s)
- S. M. North
- Department
of Chemistry, University of Sheffield, Dainton Building, Brook Hill, Sheffield, South Yorkshire S3 7HF, U.K.
| | - E. R. Jones
- Department
of Chemistry, University of Sheffield, Dainton Building, Brook Hill, Sheffield, South Yorkshire S3 7HF, U.K.
| | - G. N. Smith
- Department
of Chemistry, University of Sheffield, Dainton Building, Brook Hill, Sheffield, South Yorkshire S3 7HF, U.K.
| | - O. O. Mykhaylyk
- Department
of Chemistry, University of Sheffield, Dainton Building, Brook Hill, Sheffield, South Yorkshire S3 7HF, U.K.
| | - T. Annable
- Lubrizol
Limited, Hexagon Tower, P.O. Box 42, Blackley, Manchester M9
8ZS, U.K.
| | - S. P. Armes
- Department
of Chemistry, University of Sheffield, Dainton Building, Brook Hill, Sheffield, South Yorkshire S3 7HF, U.K.
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6
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Figueiró-Filho EA, Croy BA, Reynolds JN, Dang F, Piro D, Rätsep MT, Forkert ND, Paolozza A, Smith GN, Stroman PW. Diffusion Tensor Imaging of White Matter in Children Born from Preeclamptic Gestations. AJNR Am J Neuroradiol 2017; 38:801-806. [PMID: 28126749 DOI: 10.3174/ajnr.a5064] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/06/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Individuals born from pregnancies complicated by preeclampsia have an elevated risk for cognitive impairment. Deviations in maternal plasma angiokines occur for prolonged intervals before clinical signs of preeclampsia. We hypothesized that fetal brain vascular and nervous tissue development become deviated during maternal progression toward preeclampsia and that such deviations would be detectable by MR imaging. MATERIALS AND METHODS In this pilot study, 10 matched (gestational and current ages) pairs (5 boys/5 girls, 7-10 years of age) from preeclampsia or control pregnancies were examined by using diffusion tensor MR imaging. An unbiased voxel-based analysis was conducted on fractional anisotropy and mean diffusivity parametric maps. Six brain ROIs were identified for subsequent analysis by tractography (middle occipital gyrus, caudate nucleus and precuneus, cerebellum, superior longitudinal fasciculus, and cingulate gyrus). RESULTS Statistical differences were present between groups for fractional anisotropy in the caudate nucleus (offspring from preeclamptic gestation > controls), volume of the tract for the superior longitudinal fasciculus (offspring from preeclamptic gestation > controls) and the caudate nucleus (offspring from preeclamptic gestation > controls), and for parallel diffusivity of the cingulate gyrus (offspring from preeclamptic gestation > controls). CONCLUSIONS These novel preliminary results along with previous results from the same children that identified altered cerebral vessel calibers and increased regional brain volumes justify fully powered MR imaging studies to address the impact of preeclampsia on human fetal brain development.
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Affiliation(s)
- E A Figueiró-Filho
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.) .,Centre for Neuroscience Studies (E.A.F.-F., J.N.R., P.W.S.), Queen's University, Kingston, Ontario, Canada.,Faculty of Medicine (E.A.F.-F.), Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - B A Croy
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.)
| | - J N Reynolds
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.).,Centre for Neuroscience Studies (E.A.F.-F., J.N.R., P.W.S.), Queen's University, Kingston, Ontario, Canada
| | - F Dang
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.)
| | - D Piro
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.)
| | - M T Rätsep
- Obstetrics and Gynecology (M.T.R., G.N.S.)
| | - N D Forkert
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.).,Department of Radiology and Hotchkiss Brain Institute (N.D.F.), University of Calgary, Calgary, Alberta, Canada
| | - A Paolozza
- Laboratory for Infant Studies (A.P.), University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - G N Smith
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.).,Obstetrics and Gynecology (M.T.R., G.N.S.)
| | - P W Stroman
- Centre for Neuroscience Studies (E.A.F.-F., J.N.R., P.W.S.), Queen's University, Kingston, Ontario, Canada
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7
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Rätsep MT, Paolozza A, Hickman AF, Maser B, Kay VR, Mohammad S, Pudwell J, Smith GN, Brien D, Stroman PW, Adams MA, Reynolds JN, Croy BA, Forkert ND. Brain Structural and Vascular Anatomy Is Altered in Offspring of Pre-Eclamptic Pregnancies: A Pilot Study. AJNR Am J Neuroradiol 2015; 37:939-45. [PMID: 26721772 DOI: 10.3174/ajnr.a4640] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/05/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Pre-eclampsia is a serious clinical gestational disorder occurring in 3%-5% of all human pregnancies and characterized by endothelial dysfunction and vascular complications. Offspring born of pre-eclamptic pregnancies are reported to exhibit deficits in cognitive function, higher incidence of depression, and increased susceptibility to stroke. However, no brain imaging reports exist on these offspring. We aimed to assess brain structural and vascular anatomy in 7- to 10-year-old offspring of pre-eclamptic pregnancies compared with matched controls. MATERIALS AND METHODS Offspring of pre-eclamptic pregnancies and matched controls (n = 10 per group) were recruited from an established longitudinal cohort examining the effects of pre-eclampsia. Children underwent MR imaging to identify brain structural and vascular anatomic differences. Maternal plasma samples collected at birth were assayed for angiogenic factors by enzyme-linked immunosorbent assay. RESULTS Offspring of pre-eclamptic pregnancies exhibited enlarged brain regional volumes of the cerebellum, temporal lobe, brain stem, and right and left amygdalae. These offspring displayed reduced cerebral vessel radii in the occipital and parietal lobes. Enzyme-linked immunosorbent assay analysis revealed underexpression of the placental growth factor among the maternal plasma samples from women who experienced pre-eclampsia. CONCLUSIONS This study is the first to report brain structural and vascular anatomic alterations in the population of offspring of pre-eclamptic pregnancies. Brain structural alterations shared similarities with those seen in autism. Vascular alterations may have preceded these structural alterations. This pilot study requires further validation with a larger population to provide stronger estimates of brain structural and vascular outcomes among the offspring of pre-eclamptic pregnancies.
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Affiliation(s)
- M T Rätsep
- From the Department of Biomedical and Molecular Sciences (M.T.R., A.F.H., B.M., V.R.K., S.M., G.N.S., J.N.R., B.A.C.)
| | - A Paolozza
- Centre for Neuroscience Studies (A.P., D.B., P.W.S., M.A.A., J.N.R.), Queen's University, Kingston, Ontario, Canada
| | - A F Hickman
- From the Department of Biomedical and Molecular Sciences (M.T.R., A.F.H., B.M., V.R.K., S.M., G.N.S., J.N.R., B.A.C.)
| | - B Maser
- From the Department of Biomedical and Molecular Sciences (M.T.R., A.F.H., B.M., V.R.K., S.M., G.N.S., J.N.R., B.A.C.)
| | - V R Kay
- From the Department of Biomedical and Molecular Sciences (M.T.R., A.F.H., B.M., V.R.K., S.M., G.N.S., J.N.R., B.A.C.)
| | - S Mohammad
- From the Department of Biomedical and Molecular Sciences (M.T.R., A.F.H., B.M., V.R.K., S.M., G.N.S., J.N.R., B.A.C.)
| | - J Pudwell
- Department of Obstetrics and Gynecology (J.P., G.N.S.), Kingston General Hospital, Kingston, Ontario, Canada
| | - G N Smith
- From the Department of Biomedical and Molecular Sciences (M.T.R., A.F.H., B.M., V.R.K., S.M., G.N.S., J.N.R., B.A.C.) Department of Obstetrics and Gynecology (J.P., G.N.S.), Kingston General Hospital, Kingston, Ontario, Canada
| | - D Brien
- Centre for Neuroscience Studies (A.P., D.B., P.W.S., M.A.A., J.N.R.), Queen's University, Kingston, Ontario, Canada
| | - P W Stroman
- Centre for Neuroscience Studies (A.P., D.B., P.W.S., M.A.A., J.N.R.), Queen's University, Kingston, Ontario, Canada
| | - M A Adams
- Centre for Neuroscience Studies (A.P., D.B., P.W.S., M.A.A., J.N.R.), Queen's University, Kingston, Ontario, Canada
| | - J N Reynolds
- From the Department of Biomedical and Molecular Sciences (M.T.R., A.F.H., B.M., V.R.K., S.M., G.N.S., J.N.R., B.A.C.) Centre for Neuroscience Studies (A.P., D.B., P.W.S., M.A.A., J.N.R.), Queen's University, Kingston, Ontario, Canada
| | - B A Croy
- From the Department of Biomedical and Molecular Sciences (M.T.R., A.F.H., B.M., V.R.K., S.M., G.N.S., J.N.R., B.A.C.)
| | - N D Forkert
- Department of Radiology and Hotchkiss Brain Institute (N.D.F.), University of Calgary, Calgary, Alberta, Canada
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8
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Abstract
BACKGROUND Reduced cortical gray-matter volume is commonly observed in patients with psychosis. Cortical volume is a composite measure that includes surface area, thickness and gyrification. These three indices show distinct maturational patterns and may be differentially affected by early adverse events. The study goal was to determine the impact of two distinct obstetrical complications (OCs) on cortical morphology. METHOD A detailed birth history and MRI scans were obtained for 36 patients with first-episode psychosis and 16 healthy volunteers. RESULTS Perinatal hypoxia and slow fetal growth were associated with cortical volume (Cohen's d = 0.76 and d = 0.89, respectively) in patients. However, the pattern of associations differed across the three components of cortical volume. Both hypoxia and fetal growth were associated with cortical surface area (d = 0.88 and d = 0.72, respectively), neither of these two OCs was related to cortical thickness, and hypoxia but not fetal growth was associated with gyrification (d = 0.85). No significant associations were found within the control sample. CONCLUSIONS Cortical dysmorphology was associated with OCs. The use of a global measure of cortical morphology or a global measure of OCs obscured important relationships between these measures. Gyrification is complete before 2 years and its strong relationship with hypoxia suggests an early disruption to brain development. Cortical thickness matures later and, consistent with previous research, we found no association between thickness and OCs. Finally, cortical surface area is largely complete by puberty and the present results suggest that events during childhood do not fully compensate for the effects of early disruptive events.
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Affiliation(s)
- G N Smith
- Department of Psychiatry,University of British Columbia,Vancouver,Canada
| | - A E Thornton
- Department of Psychology,Simon Fraser University,Burnaby,Canada
| | - D J Lang
- Department of Radiology,University of British Columbia,Vancouver,Canada
| | - G W MacEwan
- Department of Psychiatry,University of British Columbia,Vancouver,Canada
| | - L C Kopala
- Department of Psychiatry,University of British Columbia,Vancouver,Canada
| | - W Su
- Department of Psychiatry,University of British Columbia,Vancouver,Canada
| | - W G Honer
- Department of Psychiatry,University of British Columbia,Vancouver,Canada
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9
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Rodger MA, Walker MC, Smith GN, Wells PS, Ramsay T, Langlois NJ, Carson N, Carrier M, Rennicks White R, Shachkina S, Wen SW. Is thrombophilia associated with placenta-mediated pregnancy complications? A prospective cohort study. J Thromb Haemost 2014; 12:469-78. [PMID: 24447367 DOI: 10.1111/jth.12509] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [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: 09/19/2013] [Accepted: 01/08/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Case control studies suggest that genetic thrombophilias increase the risk of placenta-mediated pregnancy complications (pregnancy loss, small for gestational age (SGA), preeclampsia and/or placental abruption). Cohort studies have not supported this association but were underpowered to detect small effects. OBJECTIVE To determine if factor V Leiden (FVL) or the prothrombin gene mutation (PGM) were associated with placenta-mediated pregnancy complications. PATIENTS/METHODS A prospective cohort of unselected, consenting pregnant women at three Canadian tertiary care hospitals had blood drawn in the early second trimester and were genotyped for FVL and PGM after delivery. The main outcome measure was a composite of pregnancy loss, SGA < 10th percentile, preeclampsia or placental abruption. RESULTS Complete primary outcome and genetic data were available for 7343 women. Most were Caucasian (77.7%, n = 5707), mean age was 30.4 (± 5.1) years, and half were nulliparous. There were 507 (6.9%) women with FVL and/or PGM; 11.64% had a placenta-mediated pregnancy complication. Of the remaining 6836 women, 11.23% experienced a complication. FVL and/or PGM was associated with a relative risk of 1.04 (95% CI, 0.81-1.33) for the composite outcome, with similar results after adjustment for important covariates. CONCLUSIONS Carriers of FVL or PGM are not at significantly increased risk of these pregnancy complications.
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Affiliation(s)
- M A Rodger
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada; Department of Medicine, The University of Ottawa, Ottawa, ON, Canada
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10
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Lee DY, Smith GN, Su W, Honer WG, Macewan GW, Lapointe JS, Vertinsky AT, Vila-Rodriguez F, Kopala LC, Lang DJ. White matter tract abnormalities in first-episode psychosis. Schizophr Res 2012; 141:29-34. [PMID: 22863549 DOI: 10.1016/j.schres.2012.06.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 06/23/2012] [Accepted: 06/27/2012] [Indexed: 10/28/2022]
Abstract
Fibers connecting fronto-temporal and fronto-medial structures that pass through the anterior limb of the internal capsule (ALIC) subserve executive and psychomotor functioning. Both of these functions are adversely affected in schizophrenia, and may be abnormal at illness onset. In a study of first-episode psychosis, we used diffusion tensor imaging (DTI) and cognitive testing to examine ALIC integrity. Fourteen early psychosis patients and 29 healthy volunteers were included. Symptoms were assessed with the Positive and Negative Syndromes Scale (PANSS). All structural and diffusion scans were acquired on a GE Signa 1.5T scanner. A T1-weighted 3D FSPGR Inversion Recovery imaging series was acquired for manual seeding in structural space. Diffusion tensor imaging (DTI) was performed, and all DTI images were co-registered to structural space. Seeds were manually drawn bilaterally on the coronal plane at a specified location. Diffusion images were post-processed for subsequent Tract-based Spatial Statistics (TBSS) analysis. First-episode psychosis patients had significantly smaller fronto-medial and fronto-temporal AIC tract volumes compared to healthy volunteers on the left and the right (p-values<0.04). No differences in mean fractional anisotropy (FA) were seen within either left or right tracts (p-values>0.05), nor did TBSS reveal any other differences in FA values between groups in other regions. Relationships between tract volumes and symptom severity were not observed in this study.
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Affiliation(s)
- D Y Lee
- Department of Radiology, Royal Columbian Hospital, New Westminster, BC, Canada
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11
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Wen SW, Xie RH, Tan H, Walker MC, Smith GN, Retnakaran R. Preeclampsia and gestational diabetes mellitus: pre-conception origins? Med Hypotheses 2012; 79:120-5. [PMID: 22541860 DOI: 10.1016/j.mehy.2012.04.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 04/03/2012] [Indexed: 02/08/2023]
Abstract
Preeclampsia (PE) and gestational diabetes mellitus (GDM) are two of the most common medical complications of pregnancy, with risks for both mother and child. Like many other antepartum complications, PE and GDM occur only in pregnancy. However, it is not clear if pregnancy itself is the cause of these complications or it these conditions are caused by factors that existed prior to gestation. In this paper, we hypothesize that although the clinical findings of PE and GDM are first noted during pregnancy, the origins of both conditions may actually precede pregnancy. We further hypothesize that pathophysiologic changes underlying PE and GDM are present prior to pregnancy, but remain undetected in the non-gravid state either because pregnancy is the trigger that makes these pathologies become clinically detectable or because there has been limited prospective longitudinal data comparing the pre-gravid and antepartum status of women that go on to develop these conditions. Rigorous prospective cohort studies in which women undergo serial systematic evaluation in the pre-conception period, throughout pregnancy and into the postpartum are ideally needed to test this hypothesis of pre-conception origins of PE and GDM. In this context, we are creating a pre-conception cohort, involving about 5000 couples who plan to have a baby within six months in Liuyang county in the Chinese province of Hunan. Results from this pre-conception cohort program should be able to provide definitive answer to the question of whether the underpinnings of PE and GDM originate prior to pregnancy. Ultimately, the significance of addressing this hypothesis is underscored by its potential implications for targeted interventions that could be designed to (i) prevent the deleterious effects of PE/GDM and (ii) thereby interrupt the vicious cycle of disease that links affected women and their offspring.
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Affiliation(s)
- S W Wen
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
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12
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Goghari VM, Lang DJ, Khorram B, Götz J, Vandorpe RA, Smith GN, Kopala LC, Barr AM, Honer WG. Anterior internal capsule volumes increase in patients with schizophrenia switched from typical antipsychotics to olanzapine. J Psychopharmacol 2011; 25:621-9. [PMID: 20360156 DOI: 10.1177/0269881110363314] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Abnormalities in connectivity are thought to contribute to the symptoms of schizophrenia. Accumulating evidence suggests that antipsychotic medication affects both subcortical and cortical grey and white matter volumes. The goal of this study was to investigate the effects of antipsychotic medication on two white matter tracts: a subcortical-cortical tract, the anterior and posterior limbs of the internal capsule; and a cortical-cortical tract, the corpus callosum. Magnetic resonance imaging was conducted on 10 chronic schizophrenia patients treated with typical antipsychotics and 20 healthy controls at baseline. Patients were switched to olanzapine and both groups were rescanned after 1 year. At baseline, the volume of the anterior limb of the internal capsule was 24% smaller in typical-treated patients than controls (p = 0.009). Patients treated with greater amounts of chlorpromazine-equivalent daily dosage had smaller anterior internal capsule volumes at baseline (r = -0.65, p = 0.04). At follow-up, after being switched to olanzapine, there were no significant differences between patients and controls. Patients with schizophrenia had a significant 25% increase in anterior internal capsule volume from baseline to follow-up compared with controls (p = 0.04). These effects were most prominent in the anterior limb of the internal capsule, which consists of fronto-thalamic pathways, and were not statistically significant in the posterior limb of the internal capsule or corpus callosum. Olanzapine may be effective in normalizing fronto-thalamic structural connectivity in schizophrenia.
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Affiliation(s)
- V M Goghari
- Department of Psychology, University of Calgary, Calgary, AB, Canada
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13
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Seaward AVC, Burke SD, Ramshaw H, Smith GN, Croy BA. Circulating CD56+ cells of diabetic women show deviated homing potential for specific tissues during and following pregnancy. Hum Reprod 2011; 26:1675-84. [PMID: 21489978 DOI: 10.1093/humrep/der114] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Human uterine natural killer (uNK) cells, the dominant lymphocytes in early pregnancy decidua, are important for spiral arterial remodelling. uNK cells are thought to arise from circulating CD56(bright) NK cells that egress into decidualizing endometrium. Both incomplete spiral arterial modification and aberrant NK cell function have been linked with pre-eclampsia, a syndrome that is more prevalent in diabetic women. Since previous in vitro studies have shown that changes in decidual endothelium induced by type 1 diabetes (T1D) reduce its interactions with circulating leucocytes, we hypothesized that diabetes additionally has direct effects on circulating CD56(+) NK cells that impair their decidual homing potential. METHODS Serial blood samples were collected from control, T1D and T2D pregnant women throughout and after pregnancy. In vitro adhesion under shear forces was used to assay the functional capacity of circulating leucocytes and of CD56(+) cells to adhere to endothelium in cryostat sections of gestation day (gd) 7 normal mouse decidua, pancreas and lymph node. RESULTS Fewer CD56(+) cells from diabetic compared with control women adhered to normal decidual endothelium. The CD56(+) cell/total cell adhesion ratio was also lower in diabetics. More diabetic CD56(+) cells adhered to pancreatic endothelium and their proportion was greater than for controls. Neither absolute nor proportional adhesion of CD56(+) cells to lymph node endothelium differed between diabetics and controls. CONCLUSIONS The CD56(+) cell adhesion patterns of T1D and T2D women differ from those of non-diabetic women and support the hypothesis that diabetes impairs mechanisms that could be used by CD56(+) cells for egress into decidua.
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Affiliation(s)
- A V C Seaward
- Department of Anatomy and Cell Biology, Queen's University, Kingston, ON, Canada
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Smith GN, Allsop T, Kalli K, Koutsides C, Neal R, Sugden K, Culverhouse P, Bennion I. Characterisation and performance of a Terfenol-D coated femtosecond laser inscribed optical fibre Bragg sensor with a laser ablated microslot for the detection of static magnetic fields. Opt Express 2011; 19:363-370. [PMID: 21263575 DOI: 10.1364/oe.19.000363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We present a novel device for the characterisation of static magnetic fields through monitoring wavelength shifts of femtosecond inscribed fibre Bragg grating and micromachined slot, coated with Terfenol-D. The device was sensitive to static magnetic fields and can be used as a vectoral sensor for the detection of magnetic fields as low as 0.046 mT with a resolution of ± 0.3mT in transmission and ± 0.7mT in reflection. The use of a femtosecond laser to both inscribe the FBGs and micromachine the slot in a single stage prior to coating the device significantly simplifies the fabrication.
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Affiliation(s)
- G N Smith
- Aston University, Aston Triangle, Birmingham, United Kingdom.
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15
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Menzies J, Magee LA, MacNab YC, Ansermino JM, Li J, Douglas MJ, Gruslin A, Kyle P, Lee SK, Moore MP, Moutquin JM, Smith GN, Walker JJ, Walley KR, Russell JA, von Dadelszen P. Current CHS and NHBPEP Criteria for Severe Preeclampsia Do Not Uniformly Predict Adverse Maternal or Perinatal Outcomes. Hypertens Pregnancy 2009; 26:447-62. [DOI: 10.1080/10641950701521742] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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17
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Smith GN, Mickler EA, Payne KK, Lee J, Duncan M, Reynolds J, Foresman B, Wilkes DS. Lung transplant metalloproteinase levels are elevated prior to bronchiolitis obliterans syndrome. Am J Transplant 2007; 7:1856-61. [PMID: 17524078 DOI: 10.1111/j.1600-6143.2007.01850.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Parenchymal disease in the allograft lung is associated with interstitial remodeling believed to be mediated by matrix metalloproteinases (MMPs). Recent studies suggest high levels of MMP-9 are associated with bronchiolitis obliterans syndrome (BOS) in lung transplant recipients. Since BOS occurs late in the posttransplant period and may be preceded by episodes of acute rejection or infection, which are associated with interstitial remodeling, we examined MMP profiles in allograft bronchoalveolar lavage (BAL) fluid in the early posttransplant period (preceding BOS). Gelatin zymography, protein array analysis and specific ELISA on BAL fluids from transplanted lungs indicated that MMP-8, MMP-9 and TIMP-1 were strongly expressed in allograft BAL fluid from stable patients, or those with infection or rejection compared to BAL fluid from normal volunteers. Elevated expression of MMP-8, MMP-9 and TIMP-1 occurred early, and was sustained for the 3.2 years covered in this study. Elevations of MMP-8, MMP-9 and TIMP-1 in the first 2 years posttransplant appear to be associated with lung transplantation itself, and not infection or rejection. These data suggest that ongoing and clinically silent MMP activity could perpetuate progressive disease in the allograft lung.
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Affiliation(s)
- G N Smith
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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18
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Chen XK, Wen SW, Smith GN, Yang Q, Walker MC. Pregnancy-induced hypertension and infant mortality in triplets. Int J Gynaecol Obstet 2007; 98:10-4. [PMID: 17512935 DOI: 10.1016/j.ijgo.2007.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 02/15/2007] [Accepted: 02/15/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the effects of pregnancy-induced hypertension on infant mortality in triplets stratified by gestational age at birth. METHODS A retrospective cohort study was conducted using the linked 1995-2000 US birth/infant death database. Generalized estimating equations were used to evaluate the observed association. RESULTS Pregnancy-induced hypertension was associated with lesser neonatal mortality (odds ration [OR]: 0.34, 95% CI: 0.21, 0.54), postneonatal mortality (OR: 0.54, 95% CI: 0.30, 0.99) and infant mortality (OR, 0.37, 95% CI: 0.25, 0.55) in triplets. It was also associated with a decreased risk of neonatal death (OR, 0.38; 95% CI, 0.21-0.67), postneonatal death (OR, 0.45; 95% CI, 0.21-0.97), and infant death (OR, 0.39; 95% CI, 0.24-0.64) in early preterm triplets, whereas the association was not significant in late preterm or in full-term triplets. CONCLUSION Pregnancy-induced hypertension is associated with a decreased risk of infant mortality in triplets. This effect varies with gestational age at birth.
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Affiliation(s)
- X K Chen
- Clinical Epidemiology Program, Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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19
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Lang DJ, Khorram B, Goghari VM, Kopala LC, Vandorpe RA, Rui Q, Smith GN, Honer WG. Reduced anterior internal capsule and thalamic volumes in first-episode psychosis. Schizophr Res 2006; 87:89-99. [PMID: 16793239 DOI: 10.1016/j.schres.2006.05.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Revised: 04/25/2006] [Accepted: 05/01/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND The thalamus is the gateway for sensory and motor information en route to the cortex. Information is processed via thalamocortical and corticothalamic pathways coursing through the internal capsules. In this study, we investigated the relationship between the anterior limb of the internal capsule, posterior limb of the internal capsule, and thalamus in first-episode psychosis (FEP). METHODS Twenty-nine FEP subjects (26 DSM-IV schizophrenia, 2 schizoaffective disorder, 1 psychosis not otherwise specified) and 22 healthy volunteers participated in this study. Anterior limb of the internal capsule (AIC), posterior limb of the internal capsule (PIC), and the thalamus volumes were manually determined from MRI scans. RESULTS FEP subjects had reduced AIC volumes (F(1,45)=6.18, p=0.017) and thalamic volumes (F(1,45)=8.00, p=0.007) compared to healthy volunteers. PIC volumes did not differ. Significant correlations between AIC volumes and thalamic volumes were observed in subjects with FEP, but not in healthy volunteers. Negative relationships between thalamic volumes and symptom severity were also observed. CONCLUSIONS The AIC and thalamic volumes were reduced in subjects with FEP compared to healthy volunteers. Abnormalities in thalamocortical and orticothalamic pathways may contribute to functional disruption of neural circuits in psychosis.
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Affiliation(s)
- D J Lang
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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20
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Smith GN, Boydell J, Murray RM, Flynn S, McKay K, Sherwood M, Honer WG. The incidence of schizophrenia in European immigrants to Canada. Schizophr Res 2006; 87:205-11. [PMID: 16905294 DOI: 10.1016/j.schres.2006.06.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 06/08/2006] [Accepted: 06/14/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The risk for schizophrenia in immigrants to Europe is approximately three times that of native-born populations. Discrimination and marginalization may influence the risk for schizophrenia within migrant populations. The primary objective of the present study was to determine whether the risk associated with migration was also evident 100 years ago. A second objective was to determine whether changing social stresses are associated with changes to the incidence of schizophrenia. METHOD During the first two decades of the twentieth century, the Provincial Mental Hospital was the sole provider of psychiatric services in British Columbia, Canada. Detailed clinical records have been preserved for 99.5% of 2477 patients who had a psychiatric admission between 1902 and 1913. Diagnoses were made after a detailed file review and 807 patients met DSM-IV criteria for first-episode schizophrenia, schizophreniform disorder, schizoaffective disorder, or psychosis not otherwise specified. Diagnoses had high inter-rater reliability. The incidence of schizophrenia in migrants from Britain or Continental Europe was compared with that in the Canadian-born population using indirect standardization and Poisson models. RESULTS Migration from Britain or Continental Europe to Canada in the early twentieth century was associated with an increased rate of schizophrenia; IRR=1.54, (95% CI=1.33-1.78). Incidence increased over time in immigrants but not in the native-born population and this increase occurred during a period of economic recession. CONCLUSIONS Migration was a risk factor for schizophrenia a century ago as it is today. This risk occurred in white migrants from Europe and increased during a period of increased social stress.
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Affiliation(s)
- G N Smith
- Department of Psychiatry, University of British Columbia, 828 West 10th Ave, Vancouver, BC, Canada V5Z 1L8.
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21
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Luo ZC, Fraser WD, Julien P, Deal CL, Audibert F, Smith GN, Xiong X, Walker M. Tracing the origins of “fetal origins” of adult diseases: Programming by oxidative stress? Med Hypotheses 2006; 66:38-44. [PMID: 16198060 DOI: 10.1016/j.mehy.2005.08.020] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.6] [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: 08/01/2005] [Revised: 08/04/2005] [Accepted: 08/15/2005] [Indexed: 12/13/2022]
Abstract
Too small size at birth (due to poor fetal growth and/or preterm delivery) has been associated with substantially elevated risks of the metabolic syndrome (dislipidemia, insulin resistance, hypertension), type 2 diabetes and cardiovascular disease in adulthood. The mechanisms of such "fetal origins" or "programming" of disease phenomenon remain unresolved. Too large size at birth seems also associated with an increased risk. Many known or suspected causes of or conditions associated with adverse (poor or excessive) fetal growth or preterm birth have been associated with oxidative stress. Plausibly, oxidative stress may be a common link underlying the superficial "programming" associations between adverse fetal growth or preterm birth and elevated risks of certain chronic diseases. The mechanisms of oxidative stress programming may be through directly modulating gene expression or indirectly through the effects of certain oxidized molecules. Experimental investigations have well demonstrated the role of redox balance in modulating gene expression, and recent studies indicate that both the insulin functional axis and blood pressure could be sensitive targets to oxidative stress programming. Adverse programming may occur without affecting fetal growth, but more frequently among low birth weight infants merely because they more frequently experienced known or unknown conditions with oxidative insults. As oxidative stress levels are easily modifiable during pregnancy and early postnatal periods (which are plausible critical windows), the hypothesis, if proved valid, will suggest new measures that could be very helpful on fighting the increasing epidemic of the metabolic syndrome, type 2 diabetes and cardiovascular disease. Currently, there are several ongoing large randomized trials of antioxidant supplementation to counter oxidative stress during pregnancy for the prevention of preeclampsia. It would be invaluable if long-term follow-ups of infants born to women in such trials could be realized to test the oxidative stress programming hypothesis in such experimental trial settings.
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Affiliation(s)
- Z C Luo
- Department of Obstetrics and Gyneocology, Sainte Justine Hospital, University of Montreal, Room-4981, 3175 Cote-Sainte-Catherine, Montreal, Que. Canada H3T 1C5.
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22
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Yang Q, Wen SW, Smith GN, Chen Y, Krewski D, Chen XK, Walker MC. 455-S: Maternal Cigarette Smoking Decreases the Risk of Pregnancy-Induced Hypertension and Eclampsia in an Exposure-Response Relationship. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s114b] [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: 11/12/2022] Open
Affiliation(s)
- Q Yang
- OMNI Research Group, Dept of Ob/Gyn, Univ of Ottawa, Ottawa, Ontario, K1H 8L6
| | - S W Wen
- OMNI Research Group, Dept of Ob/Gyn, Univ of Ottawa, Ottawa, Ontario, K1H 8L6
| | - G N Smith
- OMNI Research Group, Dept of Ob/Gyn, Univ of Ottawa, Ottawa, Ontario, K1H 8L6
| | - Y Chen
- OMNI Research Group, Dept of Ob/Gyn, Univ of Ottawa, Ottawa, Ontario, K1H 8L6
| | - D Krewski
- OMNI Research Group, Dept of Ob/Gyn, Univ of Ottawa, Ottawa, Ontario, K1H 8L6
| | - X K Chen
- OMNI Research Group, Dept of Ob/Gyn, Univ of Ottawa, Ottawa, Ontario, K1H 8L6
| | - M C Walker
- OMNI Research Group, Dept of Ob/Gyn, Univ of Ottawa, Ottawa, Ontario, K1H 8L6
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Swansburg ML, Brown CA, Hains SMJ, Smith GN, Kisilevsky BS. Maternal cardiac autonomic function and fetal heart rate in preeclamptic compared to normotensive pregnancies. Can J Cardiovasc Nurs 2005; 15:42-52. [PMID: 16295797] [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: 05/05/2023]
Abstract
BACKGROUND Preeclampsia during pregnancy increases a woman's risk of cardiovascular disease in two ways. Women who develop preeclampsia are at increased risk for the development of hypertension and cardiovascular disease later in life. As well, fetal adaptations (e.g., growth restriction) may lead to the development of cardiovascular risk factors (e.g., obesity, increased cholesterol) in the offspring. Although atypical maternal cardiac autonomic function has been reported in preeclampsia, to date, its effects on fetal cardiac function have not been determined. PURPOSE To characterize the pattern of short-term maternal cardiac autonomic modulation and spontaneous fetal heart rate changes in preeclamptic compared to normotensive women and to determine the relationship between them. METHOD Twenty-seven mother-fetal pairs (n = 9 preeclamptic, n = 18 normotensive) at 32 to 40 weeks gestation were tested on one occasion. Maternal autonomic modulation of heart rate was measured for 20 minutes using electrocardiographic and beat-by-beat arterial systolic blood pressure recordings. Simultaneously, spontaneous fetal heart rate was obtained using a cardiotachograph. Women's cardiac autonomic responses to orthostatic stress were obtained for five minutes in a standing position. RESULTS Comparisons of maternal cardiac measures in the preeclamptic versus the normotensive group showed that the preeclamptic group had a decreased parasympathetic nervous system indicator and an increased sympathetic nervous system indicator with increasing gestation. In response to orthostatic stress, women in both groups showed a similar increase in arterial systolic blood pressure and a decrease in parasympathetic nervous system indicator and R-R interval when standing compared to lying. Fetuses in the normotensive compared to the preeclamptic group had more spontaneous fetal heart rate accelerations; the greater the decrease in the parasympathetic nervous system indicator from lying to standing, the greater the number of fetal heart rate accelerations. CONCLUSIONS These findings serve to further our understanding of the cardiovascular pathophysiology of preeclampsia in both the mother and the fetus. Women who develop preeclampsia during pregnancy show atypical autonomic nervous system modulation of heart rate that is associated with a decrease in spontaneous fetal heart rate accelerations in late gestation. Implications for cardiovascular nursing practice include the monitoring of maternal cardiac autonomic function during pregnancy, especially during standing, as well as a need for continued surveillance of maternal cardiovascular function following pregnancy. The negative effect on fetal heart rate accelerations has implications for the interpretation of standardized obstetrical tests of fetal well-being.
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MESH Headings
- Adult
- Analysis of Variance
- Autonomic Nervous System Diseases/diagnosis
- Autonomic Nervous System Diseases/etiology
- Autonomic Nervous System Diseases/physiopathology
- Cardiotocography
- Case-Control Studies
- Female
- Fetal Monitoring/methods
- Fetal Monitoring/nursing
- Gestational Age
- Heart Rate
- Heart Rate, Fetal
- Hospitals, Community
- Hospitals, Teaching
- Humans
- Hypotension, Orthostatic/etiology
- Linear Models
- Monitoring, Physiologic/methods
- Monitoring, Physiologic/nursing
- Nurse's Role
- Ontario
- Pre-Eclampsia/physiopathology
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/etiology
- Pregnancy Complications, Cardiovascular/physiopathology
- Pregnancy Trimester, Third
- Supine Position
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Affiliation(s)
- M L Swansburg
- School of Nursing, Department of Obstetrics and Gynecology, Queen's University and Kingston General Hospital, ON
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Ehmann TS, Khanbhai I, Macewan GW, Smith GN, Honer WG, Flynn S, Altman S. Neuropsychological correlates of the PANSS Cognitive Factor. Psychopathology 2004; 37:253-8. [PMID: 15452413 DOI: 10.1159/000081022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2002] [Accepted: 06/21/2004] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Factor analytic studies of the Positive and Negative Syndrome Scale (PANSS) have consistently isolated a factor that is frequently labeled as 'cognitive'. The present study sought to further explore the factor by examining the relationships between 4 versions of the cognitive factor and a set of neuropsychological tests. METHOD Thirty-seven inpatients diagnosed with schizophrenia or schizoaffective disorder were assessed with the PANSS and neuropsychological measures. RESULTS Verbal intelligence and verbal memory were found to be most closely associated with cognitive factor scores. A global rating of illness severity showed greater relationships to cognitive variables than any cognitive factor. CONCLUSIONS The PANSS cognitive factor may reflect verbal ability and memory, but is not sufficiently comprehensive to be considered as a replacement for direct assessment of cognitive functioning.
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Affiliation(s)
- T S Ehmann
- Department of Psychiatry, St. Paul's Hospital, Vancouver, Canada
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Appleton SD, Lash GE, Marks GS, Nakatsu K, Brien JF, Smith GN, Graham CH. Effect of glucose and oxygen deprivation on heme oxygenase expression in human chorionic villi explants and immortalized trophoblast cells. Am J Physiol Regul Integr Comp Physiol 2004; 285:R1453-60. [PMID: 14615405 DOI: 10.1152/ajpregu.00234.2003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although hypoxia induces heme oxygenase (HO)-1 mRNA and protein expression in many cell types, recent studies in our laboratory using human placental tissue have shown that a preexposure to hypoxia does not affect subsequent HO enzymatic activity for optimized assay conditions (20% O2; 0.5 mM NADPH; 25 microM methemalbumin) or HO-1 protein content. One of the consequences of impaired blood flow is glucose deprivation, which has been shown to be an inducer of HO-1 expression in HepG2 hepatoma cells. The objective of the present study was to test the effects of a 24-h preexposure to glucose-deprived medium, in 0.5 or 20% O2, on HO protein content and enzymatic activity in isolated chorionic villi and immortalized HTR-8/SVneo first-trimester trophoblast cells. HO protein content was determined by Western blot analysis, and microsomal HO enzymatic activity was measured by assessment of the rate of CO formation. HO enzymatic activity was increased (P < 0.05) in both placental models after 24-h preexposure to glucose-deficient medium in 0.5 or 20% O2. Preexposure (24 h) in a combination of low O2 and low glucose concentrations decreased the protein content of the HO-1 isoform by 59.6% (P < 0.05), whereas preexposure (24 h) to low glucose concentration alone increased HO-2 content by 28.2% in chorionic villi explants (P < 0.05). In this preparation, HO enzymatic activity correlated with HO-2 protein content (r = 0.825). However, there was no correlation between HO-2 protein content and HO enzymatic activity in HTR-8/SVneo trophoblast cells preexposed to 0.5% O2 and low glucose concentration for 24 h. These findings indicate that the regulation of HO expression in the human placenta is a complex process that depends, at least in part, on local glucose and oxygen concentrations.
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Affiliation(s)
- S D Appleton
- Department of Pharmacology and Toxicology, Queen's University, Kingston, Ontario, Canada
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Ehmann TS, Kragelj T, Smith GN, Higgs E, Flynn SW, Altman S, MacEwan GW, Honer WG. Outcome measurement in pharmacological trials: validity of the Routine Assessment of Patient Progress (RAPP). J Psychopharmacol 2003; 17:425-9. [PMID: 14870955 DOI: 10.1177/0269881103174006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The assessment of outcomes after treatment with antipsychotic medication is fundamental to clinical care and research. The Routine Assessment of Patient Progress (RAPP) is a reliable multidimensional scale that employs nurses' ratings of symptoms and functioning in psychiatric inpatients. The present study sought to extend validity evidence for the RAPP by examining its ability to reflect changes associated with treatment by antipsychotic medications. The use of a different sample in this study also provided the opportunity to replicate earlier validity data collected on the original set of patients. Ninety-seven separate trials were conducted, involving 65 consecutive admissions to a unit that specializes in the assessment and treatment of patients with long standing severe psychiatric disorders. The RAPP, along with the Positive and Negative Syndrome Scale and global measures of severity, were administered at baseline and at the end of each trial. Both factor scores and clinically-derived subscales were analysed for sensitivity to change. Patients were globally rated as improved, unchanged or worsened at the end of the medication trial. Results indicated that the RAPP factor, clinical scale and total scores compared favourably to other outcome measures in patients rated as improved or worse. In patients rated as unchanged, RAPP scores displayed significantly less change than did the PANSS scores. These findings support the validity of the RAPP as an outcome measure in treatment trials.
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Affiliation(s)
- T S Ehmann
- Department of Psychiatry, St Vincent's Hospital, Vancouver, BC, Canada.
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Flynn SW, Lang DJ, Mackay AL, Goghari V, Vavasour IM, Whittall KP, Smith GN, Arango V, Mann JJ, Dwork AJ, Falkai P, Honer WG. Abnormalities of myelination in schizophrenia detected in vivo with MRI, and post-mortem with analysis of oligodendrocyte proteins. Mol Psychiatry 2003; 8:811-20. [PMID: 12931208 DOI: 10.1038/sj.mp.4001337] [Citation(s) in RCA: 328] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Schizophrenia unfolds during the late period of brain maturation, while myelination is still continuing. In the present study, we used MRI and T2 relaxation analysis to measure the myelin water fraction in schizophrenia. In schizophrenia (n=30) compared with healthy subjects (n=27), overall white matter showed 12% lower myelin water fraction (P=0.031), with the most prominent effects on the left genu of the corpus callosum (36% lower, P=0.002). The left anterior genu was affected in both first-episode (P=0.035) and chronic patients (P=0.011). In healthy subjects, myelin water fraction in total white matter and in frontal white matter increased with age, and with years of education, indicating ongoing maturation. In patients with schizophrenia, neither relation was statistically significant. Post-mortem studies of anterior frontal cortex demonstrated less immunoreactivity of two oligodendrocyte-associated proteins in schizophrenia (2',3'-cyclic nucleotide 3'-phosphodiesterase by 33%, P=0.05; myelin-associated glycoprotein by 27%, P=0.14). Impaired myelination in schizophrenia could contribute to abnormalities of neural connectivity and persistent functional impairment in the illness.
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Affiliation(s)
- S W Flynn
- Centre for Complex Disorders, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Appleton SD, Marks GS, Nakatsu K, Brien JF, Smith GN, Graham CH, Lash GE. Effects of hypoxia on heme oxygenase expression in human chorionic villi explants and immortalized trophoblast cells. Am J Physiol Heart Circ Physiol 2003; 284:H853-8. [PMID: 12578814 DOI: 10.1152/ajpheart.00655.2002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although hypoxia induces heme oxygenase (HO)-1 protein and mRNA expression in many cell types, hypoxia has also been shown to decrease HO-1 mRNA and protein expression. We tested the hypothesis that 24-h preexposure to hypoxia in human placental preparations suppresses HO protein expression and enzymatic function. Immortalized HTR-8/SVneo first-trimester trophoblast cells and explants of normal human chorionic villi (CV) from term placentas were cultured for 24 h in 1%, 5%, or 20% O(2). HO protein levels were determined by Western blot analysis, and microsomal HO activity was measured. HO-2 protein content was decreased by 17% and 5% in human trophoblast cells after 24-h exposure to 1% and 5% O(2), respectively, versus 20% O(2). In contrast, HO-2 protein content in CV explants was unaffected by changes in oxygenation. HO-1 protein content, which was barely detectable in both biological systems, was not affected by changes in oxygenation. Similarly, HO enzymatic activity was unchanged in both preparations after 24-h exposure to 1%, 5%, or 20% O(2). The above data do not support the hypothesis that hypoxia in the human placenta suppresses both HO protein content and HO protein function. The present observations reinforce the necessity to determine both HO protein expression and function.
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Affiliation(s)
- S D Appleton
- Department of Pharmacology and Toxicology, Queen's University, Kingston, Ontario, Canada K7L 3N6
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Lash GE, McLaughlin BE, MacDonald-Goodfellow SK, Smith GN, Brien JF, Marks GS, Nakatsu K, Graham CH. Relationship between tissue damage and heme oxygenase expression in chorionic villi of term human placenta. Am J Physiol Heart Circ Physiol 2003; 284:H160-7. [PMID: 12388278 DOI: 10.1152/ajpheart.00738.2002] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Heme oxygenase (HO) catalyzes the oxidation of heme to carbon monoxide (CO), biliverdin, and iron and is thought to play a role in protecting tissues from oxidative damage. There are three isoforms of HO: HO-1 (inducible), HO-2 (constitutive), and HO-3 (unknown function). Preeclampsia is characterized by an inadequately perfused placenta and areas of tissue damage. We hypothesized that damaged areas of placentas from women with PE and uncomplicated pregnancies are associated with an alteration in HO expression. Compared with microsomes isolated from morphologically normal and peri-infarct chorionic villi of pathological placentas, microsomes from infarcted chorionic villi from the same placentas had decreased HO activity measured under optimized assay conditions. There was no correlation between microsomal HO levels and activity and tissue damage in uncomplicated pregnancies. Whereas there was no significant difference in HO-1 protein levels across all regions of uncomplicated and mildly preeclamptic pregnancies, HO-2 protein levels were decreased (P < 0.05) in peri-infarct regions and infarcted chorionic villi of mildly preeclamptic pregnancies. Immunohistochemical analysis revealed an apparent decrease in both HO-1 and HO-2 protein expression in damaged tissues. HO-1 and HO-2 were immunolocalized in the syncytiotrophoblast layer of the chorionic villi, the underlying cytotrophoblast, and in the vascular endothelium. This study suggests that the ability of the chorionic villi to oxidize heme to CO, biliverdin, and iron may be compromised in areas of tissue damage in the placenta of women with preeclampsia.
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Affiliation(s)
- G E Lash
- Department of Anatomy and Cell Biology, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada K7L 3N6
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Abstract
Carbon monoxide (CO) is one of the metabolites formed via heme oxidation catalysed by the enzyme heme oxygenase (HO). Endogenous formation of CO, mediated by HO, has been noted in both placental and umbilical vessels. In blood vessels from different mammalian sources, it has been proposed that the vasodilator effect of CO is mediated via stimulation of soluble guanylyl cyclase (sGC) and consequent increased cGMP formation. The purpose of the present study was to determine the effect of exogenous CO on placental cotyledon perfusion pressure and to determine the role of sGC in the CO-induced decrease of perfusion pressure using the in vitro human placental perfusion preparation. A thromboxane A2 mimetic (U46619) was added to the foetal perfusion medium to constrict the placental blood vessels. Carbon monoxide was added to the foetal perfusion medium in increasing concentrations to determine its effect on placental perfusion pressure. Carbon monoxide produced a concentration-dependent decrease in placental perfusion pressure. The addition of ODQ, a sGC inhibitor, attenuated the CO-induced decrease in placental perfusion pressure, while addition of YC-1, an activator of sGC, augmented the CO-induced decrease in placental perfusion pressure. The data indicate that CO causes vasorelaxation of placental resistance blood vessels, in large part, via activation of sGC.
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Affiliation(s)
- S A Bainbridge
- Department of Anatomy & Cell Biology, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
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Affiliation(s)
- G N Smith
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Queen's University, Kingston, Ontario, Canada
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Smith GN, Mickler EA, Albrecht ME, Myers SL, Brandt KD. Severity of medial meniscus damage in the canine knee after anterior cruciate ligament transection. Osteoarthritis Cartilage 2002; 10:321-6. [PMID: 11950255 DOI: 10.1053/joca.2002.0520] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the relationship between the severity of cartilage damage and the severity of meniscus damage after transection of the anterior cruciate ligament (ACLT) in adult dogs. DESIGN Data were obtained from 40 dogs which underwent ACLT and from three additional sham-operated dogs that were subjected to arthrotomy but not ligament transection. Joint pathology was analysed 12, 24 or 32 weeks after surgery. The severity of damage to the articular cartilage on the femoral condyle and tibial plateau was graded with a scoring system based on that of the Sociètè Française d'Arthroscopie and meniscus damage was graded on a 0-4 scale. RESULTS No damage to the meniscus or articular cartilage was observed 12 weeks after surgery in the dogs subjected only to arthrotomy. In contrast, tears of the medial meniscus were observed in two of 10 (20%) dogs examined 12 weeks after ACLT. The incidence of severe tears increased to 86% and 84% after 24 weeks and 32 weeks, respectively. Damage to the lateral meniscus was mild, with only 7.5% of all dogs with a cruciate-deficient knee having a bucket handle or complete tear. Most of the unstable knees exhibited ulceration of the articular cartilage of the femoral condyles and tibial plateaus 12 weeks (mean chondropathy score+/-standard deviation 11.9+/-8.5, N=10), 24 weeks (7.9+/-5.0, N=7), and 32 weeks (7.1+/-5.5, N=23) after ACLT. The mean chondropathy scores for the tibial plateaus were similar to those for the femoral condyles. No correlation was apparent between the severity of cartilage damage and of meniscus damage for either joint surface. CONCLUSION Damage to the medial meniscus is a consistent feature of the pathology which develops in the canine knee after ACLT, but the severity of cartilage damage is not correlated with the severity of meniscal damage.
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Affiliation(s)
- G N Smith
- Rheumatology Division, Department of Medicine, and Department of Anatomy, Indiana University School of Medicine, Indianapolis, IN 46202-5103, USA
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McLaughlin BE, Lash GE, Graham CH, Smith GN, Vreman HJ, Stevenson DK, Marks GS, Nakatsu K, Brien JF. Endogenous carbon monoxide formation by chorionic villi of term human placenta. Placenta 2001; 22:886-8. [PMID: 11718578 DOI: 10.1053/plac.2001.0729] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Carbon monoxide (CO) is a novel messenger that is proposed to play a complementary role with nitric oxide in the regulation of placental haemodynamics. In a previous study, CO formation from exogenous haem has been measured in the microsomal fraction of chorionic villi as an index of haem oxygenase activity. The objective of the present study was to determine whether endogenous CO is formed by dissected chorionic villi of term human placenta, to which no exogenous substrate or co-factor had been added. Each sample of freshly isolated chorionic villi (approximately 0.4 g) of term human placenta from caesarean delivery was incubated in a sealed vial containing 1 ml of Krebs' solution (pH 7.4) at 37 degrees C. CO formation was determined by quantitating, using a gas-chromatographic method, the amount of CO released into the headspace gas of the incubation vial. There was time-dependent formation of endogenous CO in chorionic villi incubated at 37 degrees C during a 60-min time course. CO formation was found to be minimal in chorionic villi samples incubated at 4 degrees C and was increased relative to tissue weight. The data demonstrate that there is endogenous CO formation by chorionic villi of term human placenta.
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Affiliation(s)
- B E McLaughlin
- Department of Pharmacology and Toxicology, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
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Abstract
PURPOSE The purpose of this study was to determine the prevalence of exercise-induced bronchospasm (EIB) in collegiate cross-country runners using a protocol involving an intense exercise challenge conducted in the same environment in which the athletes train and compete. METHODS One-hundred eighteen collegiate cross-country runners from the Los Angeles, California, metropolitan area participated in the study. All testing took place on a track at the time and location of a normal practice session. The baseline peak expiratory flow rate (PEFR) measurements (best of three) and preexercise heart rate were recorded, after which the athletes ran 2000 m on a track at 85% of maximum heart rate. The postexercise heart rate was recorded and then PEFR measurements at 2, 5, 10, and 30 min after exercise were recorded. The athletes completed a 16-item questionnaire regarding asthma symptoms and health history. Those athletes with a history of asthma and currently taking medications for the asthma were then excluded from statistical analysis of the questionnaire responses. A decrease in PEFR of 15% was considered positive for EIB. RESULTS Of the 114 athletes not currently taking medications for asthma, at least 14% (16 athletes) were EIB positive. There was a poor correlation between reported symptoms of asthma and testing positive for EIB. CONCLUSION This study demonstrates a high prevalence of EIB in collegiate cross-country runners (at least 14%) and that reported symptoms are a poor predictor of actual EIB.
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Affiliation(s)
- R T Thole
- Kaiser Permanente Sports Medicine Fellowship, USA
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Abstract
This study sought to: a) ascertain the effect on rates of violence by varying its operational definition and b) compare characteristics of violent and nonviolent patients. Aggressive behavior was recorded daily for every patient (N = 78) during a 2-year period. Standardized rating scales were used to rate psychopathology and functioning. Almost two thirds of patients were aggressive to others, and 26% violently assaulted another person. Official incident reports underestimated rates of violence to others, self- harm, and property damage. Multivariate predictive models that greatly improved accuracy over base rates showed that violent patients tended to be female, schizophrenic (nonparanoid type), and abusive of alcohol before admission. Violence is more common in treatment resistant psychotic inpatients than suggested by incident reports. Standardized definitions of violence are urged in order to accurately study its prevalence and correlates. Models combining both historical/demographic and clinical data may enhance prediction of violence.
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Affiliation(s)
- T S Ehmann
- Department of Psychiatry, St Vincent's Hospital, Vancouver, British Columbia, Canada
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Yasufuku K, Heidler KM, O'Donnell PW, Smith GN, Cummings OW, Foresman BH, Fujisawa T, Wilkes DS. Oral tolerance induction by type V collagen downregulates lung allograft rejection. Am J Respir Cell Mol Biol 2001; 25:26-34. [PMID: 11472972 DOI: 10.1165/ajrcmb.25.1.4431] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Immunization with specific proteins or peptides has been used to induce immunologic tolerance to allografts other than the lung. Recently, we have reported that the immune response to lung alloantigen also involves an immune response to type V collagen [col(V)]. The purpose of the current study was to determine if oral administration of col(V) to lung allograft recipients before transplantation downregulates acute rejection episodes. The data show that, compared with controls, col(V)-fed recipients had fewer polymorphonuclear cells and lymphocytes in allograft bronchoalveolar lavage fluid, and reduced rejection pathology. Data showing that col(V)- fed allograft recipients had diminished delayed-type hypersensitivity (DTH) responses to donor alloantigens suggest that feeding col(V) prevented allograft rejection by inducing tolerance to donor antigens. Systemic production of transforming growth factor (TGF)-beta, interleukin (IL)-4, or IL-10 has been reported to be a mechanism for oral tolerance-induced suppression of immune responses. Feeding col(V) induced upregulated production of TGF-beta, but not IL-4 or IL-10 in serum. Neutralizing TGF-beta recovered the DTH response to donor antigen in tolerant allograft recipients. Collectively, these data show that oral administration of col(V) is a novel approach to induce immunologic tolerance to lung allografts, and that TGF-beta contributed to suppression of the rejection response.
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Affiliation(s)
- K Yasufuku
- Department of Surgery, Institute of Pulmonary Cancer Research, Chiba University School of Medicine, Chiba, Japan
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Abstract
Cerebral palsy remains a significant cause of perinatal morbidity in medically developed countries. Human epidemiologic data suggest a relationship between cerebral palsy and chorioamnionitis mediated by proinflammatory cytokines. This association has been confirmed by experimental data from human and animal research that demonstrate an increase in cytokine levels in the amniotic fluid of cases of white matter damage. Recent evidence suggests this damage is the result of a fetal inflammatory response initiated in response to placental inflammation. The strong association between cerebral palsy and chorioamnionitis warrants additional investigation into the mechanisms by which white matter damage is initiated and into possible neuroprotective treatments to prevent the development of cerebral palsy.
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Affiliation(s)
- L M Gaudet
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
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Smith GN, Mickler EA, Myers SL, Brandt KD. Effect of intraarticular hyaluronan injection on synovial fluid hyaluronan in the early stage of canine post-traumatic osteoarthritis. J Rheumatol 2001; 28:1341-6. [PMID: 11409129] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
OBJECTIVE To determine how the quantity and molecular weight of synovial fluid hyaluronan (HA) within the synovial fluid (SF) of osteoarthritis (OA) joints is affected by intraarticular injection of HA. METHODS Dogs in which OA was induced by transection of the anterior cruciate ligament received 5 weekly injections of HA (1.5 x 10(6) Da) in saline (10 mg/0.67 ml) or an equal volume of saline into the operated knee, beginning the day after surgery. Immediately before each injection, SF was aspirated and the volume of SF and the concentration of HA was measured (uronic acid), and the molecular weight of the HA in each sample was estimated by electrophoresis in agarose. RESULTS The volume of SF in the unstable knee increased after surgery, and the molecular weight decreased from approximately 2.5 x 10(6) Da to approximately 2 x 10(6) Da. Injection of HA did not affect the volume of SF or average molecular weight of HA in samples obtained immediately before each injection or at the end of the experiment, 12 weeks after surgery. The SF HA concentration fell from a baseline value of 2.3 +/- 0.1 mg/ml to 1.1 +/- 0.2 mg/ml the day after surgery and remained low throughout the course of injections. The HA concentration 12 weeks after surgery in the HA injected knees was approximately 40% lower than the preoperative value, although it increased slightly relative to saline injected knees (1.4 +/- 0.3 vs 1.1 +/- 0.01 mg/ml, respectively; p = 0.04). CONCLUSION Intraarticular injection of HA did not alter the volume of SF or molecular weight of HA in SF of OA canine knees, nor did it restore the HA concentration to that of normal canine SF.
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Affiliation(s)
- G N Smith
- Rheumatology Division, Department of Medicine, and Department of Anatomy, Indiana University School of Medicine, Room 545, 1110 W. Michigan Street, Indianapolis, IN 46202-5103, USA
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Lang DJ, Kopala LC, Vandorpe RA, Rui Q, Smith GN, Goghari VM, Honer WG. An MRI study of basal ganglia volumes in first-episode schizophrenia patients treated with risperidone. Am J Psychiatry 2001; 158:625-31. [PMID: 11282699 DOI: 10.1176/appi.ajp.158.4.625] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The basal ganglia may contribute to extrapyramidal movement disorders, affective disturbances, and cognitive deficits in schizophrenia. Basal ganglia volumes are putatively affected by antipsychotic medications. The purpose of this study was to determine the long-term effects of risperidone treatment in a cohort of first-episode patients with schizophrenia. METHOD The subjects were 30 patients with first-episode schizophrenia, 12 patients chronically treated with typical antipsychotics, and 23 healthy comparison subjects. They were scanned by magnetic resonance imaging at baseline. The first-episode patients received 1 year of continuous risperidone treatment, after which they and the comparison subjects were rescanned. Caudate, putamen, and globus pallidus volumes were determined from coronal images. RESULTS The baseline caudate, putamen, and globus pallidus volumes were significantly larger in the chronically treated patients than in the untreated first-episode subjects and comparison subjects. These volumes did not differ between the first-episode patients and healthy comparison subjects. Basal ganglia volumes were unchanged after 1 year of exposure to risperidone in the first-episode subjects. Extrapyramidal movement disorders were present in the majority of chronically treated patients and more than one-third of the never-medicated first-episode patients at baseline. CONCLUSIONS This group of first-episode patients did not exhibit abnormalities of basal ganglia volumes, nor were basal ganglia volumes affected by exposure to risperidone. Movement disorders were observed in both first-episode and chronically treated patients, suggesting effects of both illness and medications.
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Affiliation(s)
- D J Lang
- Molecular Psychiatry and Therapeutics Laboratory, Department of Psychiatry, Dalhousie University, Queen Elizabeth-II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Abstract
In the general population, low birthweight (LBW) is associated with neurological and psychological problems during childhood and adolescence. LBW may result from premature birth or poor fetal growth, and the independent effects of these two events on childhood development are not fully understood. The rate of low weight births is increased in schizophrenia and is associated with social withdrawal during childhood and an early onset of illness. However, it is unclear whether this LBW reflects poor fetal growth or premature birth, or whether these two risk factors have distinct implications for childhood functioning and age at onset of schizophrenia. Subjects included 270 patients with schizophrenia for whom a detailed history of obstetric events could be obtained. The rate of low weight births was high and was associated with poorer premorbid functioning and an earlier age at illness onset. The rate of both premature births and poor fetal growth was high relative to the normal population. Prematurity, but not poor fetal growth, was associated with premorbid social withdrawal and an early age at illness onset. Poor fetal growth, but not prematurity, was associated with low educational achievement. These results suggest that poor fetal growth and prematurity are associated with distinct patterns of childhood maladjustment in individuals who develop schizophrenia.
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Affiliation(s)
- G N Smith
- Department of Psychiatry, University of British Columbia, Vancouver Hospital Research Pavilion, 828 West 10th Avenue, BC V5Z 1L8, Vancouver, BC, V5Z 1L8, Canada.
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Abstract
Homocysteine is a sulfur-containing amino acid produced by the breakdown of methionine. Plasma homocysteine levels can be elevated due to a variety of genetic and nutritional factors. Poor nutrition from diets low in folate and vitamin B12 can lead to hyperhomocysteinemia. Mildly elevated levels of homocysteine have been implicated in a number of disease processes such as atherosclerotic vascular disease and adverse obstetrical outcomes. High levels of plasma homocysteine are also associated with abnormal collagen cross-linking. Due to homocysteine's effects on connective tissue integrity, it is hypothesized that hyperhomocysteinemia in pregnancy is associated with preterm premature rupture of membranes (PPROM). Hyperhomocysteinemia, therefore, could be a treatable cause of this important public health concern.
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Affiliation(s)
- S E Ferguson
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
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Ehmann TS, Holliday SG, MacEwan GW, Smith GN. Multidimensional assessment of psychosis: a factor-analytic validation study of the Routine Assessment of Patient Progress. Compr Psychiatry 2001; 42:32-8. [PMID: 11154713 DOI: 10.1053/comp.2001.16557] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The areas of function affected by major mental disorders are more diverse than the list of core symptoms assessed by many psychiatric rating scales, and the cross-sectional picture obtained in mental status interviews often fails to capture important data. Information on patient function can be obtained from measures that are based on extended observation and complement symptom-focused assessments. The Routine Assessment of Patient Progress (RAPP) is a 21-item rating scale that assesses both functional and psychiatric symptoms. It is usually completed by nursing staff who have observed patients over a 1-week period. Previous research has shown it to be reliable, valid, simple to complete, and of substantial value for patient care and diagnosis. The present study sought to examine the psychometric structure of the RAPP to define what domains of symptoms and behavior it measures. RAPP scores obtained from 165 psychotic inpatients were submitted to a factor analysis. A five-factor solution was derived in which 18 of 21 RAPP items were assigned to factors. The factors were labeled aggression, positive symptoms, negative symptoms, somatization/anxiety, and organic/ disorganization. The RAPP factors were moderately correlated with conceptually similar factor scores derived from the Positive and Negative Syndrome Scale (PANSS). RAPP aggression scores were validated with an independent clinical measure of aggression. Patients who were independently rated as improved over their hospital stay showed significant improvement on all RAPP factors, and unimproved patients showed stability or deterioration on RAPP measures. The data indicate that RAPP factors assess domains of psychopathology that are moderately correlated with both global ratings and symptom-focused scales. The RAPP's sensitivity to change suggests it is a valid measure of treatment outcome that could be used in controlled trials, as well as standard care outcome evaluation.
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Affiliation(s)
- T S Ehmann
- Department of Psychology, Riverview Hospital, Port Coquitlam, British Columbia, Canada
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Abstract
Carbon monoxide (CO) is a novel gaseous chemical messenger, formed during heme oxygenase (HO)-catalysed oxidation of heme. CO is proposed to play a key role(s) in cell function in many organ systems, including vasodilator action in the cardiovascular system. Recently, it has been demonstrated that there is expression of HO protein in the human placenta and this appears to have a regulatory role in placental perfusion. The objective of the present study was to determine HO enzymatic activity in vitro in five different regions of term human placenta. HO activity was determined in the microsomal fraction of tissue homogenate by measuring the rate of formation of CO from heme, using a gas-chromatographic method. HO activity, expressed as nmol CO formed/g tissue wet weight/h, was higher (P< 0.05) in the chorionic plate, chorionic villi, basal plate and chorio-decidua compared with the amnion. The finding that HO enzymatic activity is present in different regions of term human placenta supports the concept that the heme-CO (HO) pathway plays a complementary role with the L -arginine-nitric oxide (nitric oxide synthase) pathway in the regulation of placental haemodynamics.
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Affiliation(s)
- B E McLaughlin
- Department of Pharmacology and Toxicology, Queen's University, Kingston, Ontario, Canada
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Sun HB, Smith GN, Hasty KA, Yokota H. Atomic force microscopy-based detection of binding and cleavage site of matrix metalloproteinase on individual type II collagen helices. Anal Biochem 2000; 283:153-8. [PMID: 10906235 DOI: 10.1006/abio.2000.4629] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Type II tropocollagen molecules were reacted with matrix metalloproteinase 8 (MMP-8) and the binding sites as well as the cleavage site of MMP-8 were detected on individual molecules using atomic force microscopy (AFM). Approximately 300-nm-long coiled-coil tropocollagen molecules were straightened and immobilized on an atomically flat surface for detection by AFM. The direct visualization of individual collagen molecules revealed heterogeneous characteristics of MMP-8:collagen complexes. We observed that there existed multiple MMP-8 nonspecific binding sites on the collagen molecules, but cleavage always took place at a unique site. When collagen molecules, straightened and immobilized on the surface, were reacted with MMP-8, a site of cleavage appeared as a gap in stretched molecules. This is the first report to visually show direct collagenase:collagen interactions using AFM. The described AFM-based analysis has potential as a protein analysis tool for understanding a complex mechanism of enzyme:substrate interactions.
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Affiliation(s)
- H B Sun
- Biomedical Engineering Program, Department of Anatomy and Cell Biology, Rheumatology Division, Indiana University-Purdue University at Indianapolis, Indiana University School of Medicine, Indiana, Indianapolis 46202, USA
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Mares DC, Heidler KM, Smith GN, Cummings OW, Harris ER, Foresman B, Wilkes DS. Type V collagen modulates alloantigen-induced pathology and immunology in the lung. Am J Respir Cell Mol Biol 2000; 23:62-70. [PMID: 10873154 DOI: 10.1165/ajrcmb.23.1.3924] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Perivascular and peribronchiolar tissues are targets of the immune response during lung allograft rejection. Collagen type V (col[V]) is located within these tissues. Col(V) may be major histocompatibility complex (MHC)-like, and MHC-derived peptides have been used to induce immunologic tolerance and prevent rejection in allografts other than the lung. The current study tests the hypothesis that col(V) could be used to downregulate immune responses to lung alloantigen in vivo. We developed a murine model in which instillations of allogeneic bronchoalveolar lavage (BAL) cells (C57BL/6, I-a(b), H-2(b)) into lungs of BALB/c mice (I-a(d), H-2(d)) induce histology similar to grades 1 and 2 acute lung allograft rejection, apoptosis of airway epithelium and vascular endothelium, and upregulate tumor necrosis factor (TNF)-alpha production locally. The current study reports that instillations of col(V) into lungs before allogeneic BAL cells prevent development of rejection pathology and apoptosis, downregulate alloantigen-induced T-lymphocyte proliferation, and abrogate local TNF-alpha production. In addition, instillation of col(V)-pulsed autologous BAL cells into lungs of mice primed with allogeneic BAL cells perpetuates rejection pathology. Collectively, these data show that col(V) is a novel antigen involved in the rejection process, and suggest that col(V) could be used to modulate the rejection response to lung allografts.
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Affiliation(s)
- D C Mares
- Departments of Medicine, Pathology, and Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Affiliation(s)
- K D Brandt
- Indiana University School of Medicine, and Indiana University Multipurpose Arthritis and Musculoskeletal Diseases Center, Indianapolis 46202, USA
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Affiliation(s)
- G N Smith
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada
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