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Hafner C, Windpassinger M, Tretter EV, Rebernig KA, Reindl SM, Hochreiter B, Dekan S, Haider P, Kiss H, Klein KU, Wohlrab P. Role of mitochondrial DNA level in epidural-related maternal fever: a single-centre, observational, pilot study. BMC Pregnancy Childbirth 2024; 24:341. [PMID: 38702618 PMCID: PMC11067090 DOI: 10.1186/s12884-024-06551-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/28/2024] [Indexed: 05/06/2024] Open
Abstract
INTRODUCTION Epidural analgesia has been associated with intrapartum maternal fever development. Epidural-related maternal fever (ERMF) is believed to be based on a non-infectious inflammatory reaction. Circulating cell-free mitochondrial deoxyribonucleic acid (mtDNA) is one of the possible triggers of sterile inflammatory processes; however, a connection has not been investigated so far. Therefore, this study aimed to investigate cell-free mtDNA alterations in women in labour with ERMF in comparison with non-febrile women. MATERIAL AND METHODS A total of 60 women in labour were assessed for maternal temperature every 4 h and blood samples were obtained at the beginning and after delivery. Depending on the analgesia and the development of fever (axillary temperature ≥ 37.5 °C), the women were allocated either to the group of no epidural analgesia (n = 17), to epidural analgesia no fever (n = 34) or to ERMF (n = 9). Circulating cell-free mtDNA was analysed in the maternal plasma for the primary outcome whereas secondary outcomes include the evaluation of inflammatory cytokine release, as well as placental inflammatory signs. RESULTS Of the women with epidural analgesia, 20% (n = 9) developed ERMF and demonstrated a decrease of circulating mtDNA levels during labour (p = 0.04), but a trend towards higher free nuclear DNA. Furthermore, women with maternal pyrexia showed a 1.5 fold increased level of Interleukin-6 during labour. A correlation was found between premature rupture of membranes and ERMF. CONCLUSIONS The pilot trial revealed an evident obstetric anaesthesia phenomenon of maternal fever due to epidural analgesia in 20% of women in labour, demonstrating counterregulated free mtDNA and nDNA. Further work is urgently required to understand the connections between the ERMF occurrence and circulating cell-free mtDNA as a potential source of sterile inflammation. TRIAL REGISTRATION NCT0405223 on clinicaltrials.gov (registered on 25/07/2019).
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Affiliation(s)
- Christina Hafner
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Marita Windpassinger
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Eva Verena Tretter
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Katharina Anna Rebernig
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Sophie Marie Reindl
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Beatrix Hochreiter
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Sabine Dekan
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Patrick Haider
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Klaus Ulrich Klein
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Wohlrab
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria.
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Deischinger C, Bastian M, Leitner K, Bancher-Todesca D, Kiss H, Baumgartner-Parzer S, Kautzky-Willer A, Harreiter J. Gremlin-1 in pregnancy and postpartum: relation to the fatty liver index, markers of bone health, glucose metabolism and gestational diabetes mellitus status. Acta Diabetol 2023; 60:1699-1707. [PMID: 37518503 PMCID: PMC10587257 DOI: 10.1007/s00592-023-02151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION Gremlin-1 is a peptide that functions as an antagonist to bone morphogenic proteins and is overexpressed in obesity and type 2 diabetes mellitus. Gremlin-1 has not yet been investigated in pregnancy, pregnancy-related insulin resistance or gestational diabetes mellitus (GDM). PATIENTS AND METHODS Gremlin-1 levels were measured throughout the pregnancy of 58 women at high risk for GDM at the Medical University of Vienna. Furthermore, an oral glucose tolerance test, fasting insulin, fasting glucose, sex hormones, blood lipids, liver and renal parameters, and markers of bone development were evaluated at two points during pregnancy (< 20 weeks of gestation (GW), GW 24-28) and 12-14 weeks postpartum. RESULTS Gremlin-1 levels decreased from < 20 GW (mean = 9.2 pg/ml, SD = 8.4 pg/ml) to GW 24-28 (mean = 6.7 pg/ml, SD = 5.7 pg/ml, p = 0.033) and increased again postpartum, albeit not significantly (mean = 10.7 pg/ml, SD = 13.1 pg/ml, p = 0.339). During pregnancy, Gremlin-1 levels correlated negatively with osteocalcin and procollagen type I aminoterminal propeptide (P1NP), markers of bone health. Concerning glucose metabolism, Gremlin-1 levels were inversely related to the Insulinogenic Index at GW < 20. However, Gremlin-1 levels were not significantly different between women with normal glucose tolerance and GDM during pregnancy. Postpartum, Gremlin-1 was associated with the fatty liver index, osteocalcin levels, diastolic blood pressure and weight. CONCLUSION Gremlin-1 levels decreased significantly during pregnancy. The biomarker is not related to GDM status, but correlates negatively with the Insulinogenic Index, an index related to beta cell function. Trial Registry Number ACTRN12616000924459.
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Affiliation(s)
- Carola Deischinger
- Gender Medicine Unit, Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Magdalena Bastian
- Gender Medicine Unit, Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Karoline Leitner
- Gender Medicine Unit, Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Dagmar Bancher-Todesca
- Division of Fetomaternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Herbert Kiss
- Division of Fetomaternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Sabina Baumgartner-Parzer
- Gender Medicine Unit, Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jürgen Harreiter
- Gender Medicine Unit, Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Schneider KH, Goldberg BJ, Hasturk O, Mu X, Dötzlhofer M, Eder G, Theodossiou S, Pichelkastner L, Riess P, Rohringer S, Kiss H, Teuschl-Woller AH, Fitzpatrick V, Enayati M, Podesser BK, Bergmeister H, Kaplan DL. Silk fibroin, gelatin, and human placenta extracellular matrix-based composite hydrogels for 3D bioprinting and soft tissue engineering. Biomater Res 2023; 27:117. [PMID: 37978399 PMCID: PMC10656895 DOI: 10.1186/s40824-023-00431-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/18/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND There is a great clinical need and it remains a challenge to develop artificial soft tissue constructs that can mimic the biomechanical properties and bioactivity of natural tissue. This is partly due to the lack of suitable biomaterials. Hydrogels made from human placenta offer high bioactivity and represent a potential solution to create animal-free 3D bioprinting systems that are both sustainable and acceptable, as placenta is widely considered medical waste. A combination with silk and gelatin polymers can bridge the biomechanical limitations of human placenta chorion extracellular matrix hydrogels (hpcECM) while maintaining their excellent bioactivity. METHOD In this study, silk fibroin (SF) and tyramine-substituted gelatin (G-TA) were enzymatically crosslinked with human placental extracellular matrix (hpcECM) to produce silk-gelatin-ECM composite hydrogels (SGE) with tunable mechanical properties, preserved elasticity, and bioactive functions. The SGE composite hydrogels were characterized in terms of gelation kinetics, protein folding, and bioactivity. The cyto- and biocompatibility of the SGE composite was determined by in vitro cell culture and subcutaneous implantation in a rat model, respectively. The most cell-supportive SGE formulation was then used for 3-dimensional (3D) bioprinting that induced chemical crosslinking during extrusion. CONCLUSION Addition of G-TA improved the mechanical properties of the SGE composite hydrogels and inhibited crystallization and subsequent stiffening of SF for up to one month. SGE hydrogels exhibit improved and tunable biomechanical properties and high bioactivity for encapsulated cells. In addition, its use as a bioink for 3D bioprinting with free reversible embedding of suspended hydrogels (FRESH) has been validated, opening the possibility to fabricate highly complex scaffolds for artificial soft tissue constructs with natural biomechanics in future.
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Affiliation(s)
- Karl Heinrich Schneider
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, 1090, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, 1090, Austria
- Department of Biomedical Engineering, Tufts University, Medford, MA, 02155, USA
| | - Benjamin J Goldberg
- Department of Biomedical Engineering, Tufts University, Medford, MA, 02155, USA
| | - Onur Hasturk
- Department of Biomedical Engineering, Tufts University, Medford, MA, 02155, USA
| | - Xuan Mu
- Department of Biomedical Engineering, Tufts University, Medford, MA, 02155, USA
- Roy J Carver Department of Biomedical Engineering, College of Engineering, the University of Iowa, Iowa City, IA, 52242, USA
| | - Marvin Dötzlhofer
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, 1090, Vienna, Austria
| | - Gabriela Eder
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, 1090, Vienna, Austria
| | - Sophia Theodossiou
- Department of Biomedical Engineering, Tufts University, Medford, MA, 02155, USA
- Department of Mechanical and Biomedical Engineering, Boise State University, Boise, ID, 83725, USA
| | - Luis Pichelkastner
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, 1090, Vienna, Austria
| | - Peter Riess
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, 1090, Vienna, Austria
| | - Sabrina Rohringer
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, 1090, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090, Vienna, Austria
| | - Andreas H Teuschl-Woller
- Department Life Science Technologies, University of Applied Sciences Technikum Wien, 1200, Vienna, Austria
| | - Vincent Fitzpatrick
- Department of Biomedical Engineering, Tufts University, Medford, MA, 02155, USA
- UMR CNRS 7338 Biomechanics & Bioengineering, Université de Technologie de Compiègne, Sorbonne Universités, 60203, Compiegne, France
| | - Marjan Enayati
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, 1090, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, 1090, Austria
| | - Bruno K Podesser
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, 1090, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, 1090, Austria
| | - Helga Bergmeister
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, 1090, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, 1090, Austria
| | - David L Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, MA, 02155, USA.
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Schirwani-Hartl N, Palmrich P, Haberl C, Perkmann-Nagele N, Kiss H, Berger A, Rittenschober-Böhm J, Kasprian G, Kienast P, Khalil A, Binder J. Biweekly Versus Monthly Hyperimmune Globulin Therapy for Primary Cytomegalovirus Infection in Pregnancy. J Clin Med 2023; 12:6776. [PMID: 37959240 PMCID: PMC10649935 DOI: 10.3390/jcm12216776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Primary cytomegalovirus (CMV) infection during pregnancy is associated with an increased risk of congenital CMV (cCMV). Hyperimmune globulin (HIG) therapy has been proposed as a potential prophylaxis to reduce maternal-fetal transmission. Data on whether the administration of HIG every 2 weeks offers benefits over HIG administration every 4 weeks are lacking. This was a retrospective analysis including pregnant women with primary CMV infection diagnosed in the first or early second trimester between 2010 and 2022 treated with HIG every 4 weeks (300 IE HIG per kg) or every 2 weeks (200 IE HIG per kg), respectively. In total, 36 women (4 weeks: n = 26; 2 weeks: n = 10) and 39 newborns (4 weeks: n = 29; 2 weeks: n = 10) were included. The median gestational age at the first HIG administration was 13.1 weeks. There was no significant difference in the cCMV rates between the women who received HIG every 4 versus every 2 weeks (n = 8/24 [33.3%] vs. 3/10 [30.0%]; p = 0.850). An abnormal fetal ultrasound was present in three fetuses and fetal magnetic resonance imaging (MRI) anomalies in four fetuses were related to cCMV infection, with no significant difference in the frequency between the two groups. A larger study will be needed to determine whether HIG administration every 2 instead of every 4 weeks improves the maternal-fetal transmission rates.
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Affiliation(s)
- Nawa Schirwani-Hartl
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (N.S.-H.); (P.P.); (C.H.); (H.K.)
| | - Pilar Palmrich
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (N.S.-H.); (P.P.); (C.H.); (H.K.)
| | - Christina Haberl
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (N.S.-H.); (P.P.); (C.H.); (H.K.)
| | | | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (N.S.-H.); (P.P.); (C.H.); (H.K.)
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (J.R.-B.)
| | - Judith Rittenschober-Böhm
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (J.R.-B.)
| | - Gregor Kasprian
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, 1090 Vienna, Austria; (G.K.); (P.K.)
| | - Patric Kienast
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, 1090 Vienna, Austria; (G.K.); (P.K.)
| | - Asma Khalil
- Fetal Medicine Unit, St George’s University Hospitals NHS Foundation Trust, University of London, London WC1E 6BT, UK;
| | - Julia Binder
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (N.S.-H.); (P.P.); (C.H.); (H.K.)
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Eigenschink M, Wessely I, Dijmarescu M, Förster-Waldl E, Farr A, Kiss H, Berger A, Wisgrill L. Transcriptomic analysis identifies lactoferrin-induced quiescent circuits in neonatal macrophages. Front Immunol 2023; 14:1276173. [PMID: 37868991 PMCID: PMC10590118 DOI: 10.3389/fimmu.2023.1276173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Upon birth, a hitherto naïve immune system is confronted with a plethora of microbial antigens due to intestinal bacterial colonization. To prevent excessive inflammation and disruption of the epithelial barrier, physiological mechanisms must promote immune-anergy within the neonatal gut. As high concentrations of human lactoferrin (hLF), a transferrin glycoprotein shown to modulate macrophage function, are frequently encountered in colostrum, its direct interaction with intestinal macrophages may satisfy this physiological need. Thus, the primary objective of this study was to investigate transcriptional changes induced by human lactoferrin in neonatal monocyte-derived macrophages. Methods Cord blood-derived monocytes were differentiated with M-CSF in presence or absence of 500 µg/mL hLF for 7 days and afterwards stimulated with 1 ng/mL LPS or left untreated. RNA was then isolated and subjected to microarray analysis. Results Differentiation of cord blood-derived monocytes in presence of hLF induced a distinct transcriptional program defined by cell cycle arrest in the G2/M phase, induction of IL-4/IL-13-like signaling, altered extracellular matrix interaction, and enhanced propensity for cell-cell interaction. Moreover, near-complete abrogation of transcriptional changes induced by TLR4 engagement with LPS was observed in hLF-treated samples. Discussion The global transition towards an M2-like homeostatic phenotype and the acquisition of quiescence elegantly demonstrate the ontogenetical relevance of hLF in attenuating pro-inflammatory signaling within the developing neonatal intestine. The marked anergy towards proinflammatory stimuli such as LPS further underlines the glycoprotein's potential therapeutic relevance.
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Affiliation(s)
- Michael Eigenschink
- Division of Neonatology, Pediatric Intensive Care and Neuropaediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Isabelle Wessely
- Division of Neonatology, Pediatric Intensive Care and Neuropaediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Marco Dijmarescu
- Division of Neonatology, Pediatric Intensive Care and Neuropaediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Förster-Waldl
- Division of Neonatology, Pediatric Intensive Care and Neuropaediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Alex Farr
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care and Neuropaediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Lukas Wisgrill
- Division of Neonatology, Pediatric Intensive Care and Neuropaediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Schneider KH, Oberoi G, Unger E, Janjic K, Rohringer S, Heber S, Agis H, Schedle A, Kiss H, Podesser BK, Windhager R, Toegel S, Moscato F. Medical 3D printing with polyjet technology: effect of material type and printing orientation on printability, surface structure and cytotoxicity. 3D Print Med 2023; 9:27. [PMID: 37768399 PMCID: PMC10540425 DOI: 10.1186/s41205-023-00190-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Due to its high printing resolution and ability to print multiple materials simultaneously, inkjet technology has found wide application in medicine. However, the biological safety of 3D-printed objects is not always guaranteed due to residues of uncured resins or support materials and must therefore be verified. The aim of this study was to evaluate the quality of standard assessment methods for determining the quality and properties of polyjet-printed scaffolds in terms of their dimensional accuracy, surface topography, and cytotoxic potential.Standardized 3D-printed samples were produced in two printing orientations (horizontal or vertical). Printing accuracy and surface roughness was assessed by size measurements, VR-5200 3D optical profilometer dimensional analysis, and scanning electron microscopy. Cytotoxicity tests were performed with a representative cell line (L929) in a comparative laboratory study. Individual experiments were performed with primary cells from clinically relevant tissues and with a Toxdent cytotoxicity assay.Dimensional measurements of printed discs indicated high print accuracy and reproducibility. Print accuracy was highest when specimens were printed in horizontal direction. In all cytotoxicity tests, the estimated mean cell viability was well above 70% (p < 0.0001) regardless of material and printing direction, confirming the low cytotoxicity of the final 3D-printed objects.
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Affiliation(s)
- Karl H Schneider
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Gunpreet Oberoi
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Austrian Center for Medical Innovation and Technology (ACMIT), Wiener Neustadt, Austria
| | - Ewald Unger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Klara Janjic
- University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria
| | - Sabrina Rohringer
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Stefan Heber
- Institute of Physiology, Center for Physiology and Pharmacology, Medical University of Vienna, Schwarzspanierstraße 17, 1090, Vienna, Austria
| | - Hermann Agis
- University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria
| | - Andreas Schedle
- University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Bruno K Podesser
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Karl Chiari Lab for Orthopaedic Biology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefan Toegel
- Department of Orthopedics and Trauma Surgery, Karl Chiari Lab for Orthopaedic Biology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria.
| | - Francesco Moscato
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Lackner AI, Haslinger P, Bohaumilitzky L, Höbler AL, Vondra S, Oblin VM, Knöfler M, Kiss H, Binder J, Haider S, Boehm T, Pollheimer J. Generation of extracellular fluids from first-trimester decidual tissues and their validation by detecting tissue-specific secreted proteins. Placenta 2023; 139:134-137. [PMID: 37390517 DOI: 10.1016/j.placenta.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/17/2023] [Accepted: 06/11/2023] [Indexed: 07/02/2023]
Abstract
The human placenta comes in direct contact with maternal cells and blood at two interfaces. The syncytiotrophoblast layer is surrounded by maternal blood at the intervillous space, and extravillous trophoblasts breach the vascular endothelial cells layer upon spiral artery remodeling and invasion of decidual veins. However, little knowledge exists about EVT-derived secreted factors, which may serve as predictive markers for obstetrical syndromes or shape the local environment at the maternal-fetal interface. Here, we define secreted EVT-associated genes and describe a method that yields interstitial fluids from patient-matched first-trimester decidua basalis and parietalis tissues.
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Affiliation(s)
- Andreas Ian Lackner
- Department of Obstetrics and Gynecology, Reproductive Biology Unit, Maternal-fetal Immunology Group, Medical University of Vienna, Austria; Digital Health Center, Berlin Institute of Health (BIH) at Charité, Berlin, Germany
| | - Peter Haslinger
- Department of Obstetrics and Gynecology, Reproductive Biology Unit, Maternal-fetal Immunology Group, Medical University of Vienna, Austria
| | - Lena Bohaumilitzky
- Department of Obstetrics and Gynecology, Reproductive Biology Unit, Maternal-fetal Immunology Group, Medical University of Vienna, Austria; Research Institute of Molecular Pathology, Vienna Biocenter, Austria
| | - Anna-Lena Höbler
- Department of Obstetrics and Gynecology, Reproductive Biology Unit, Maternal-fetal Immunology Group, Medical University of Vienna, Austria
| | - Sigrid Vondra
- Department of Obstetrics and Gynecology, Reproductive Biology Unit, Maternal-fetal Immunology Group, Medical University of Vienna, Austria
| | - Valentina Maria Oblin
- Department of Obstetrics and Gynecology, Reproductive Biology Unit, Maternal-fetal Immunology Group, Medical University of Vienna, Austria
| | - Martin Knöfler
- Department of Obstetrics and Gynecology, Reproductive Biology Unit, Placental Development Group, Medical University of Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Julia Binder
- Department of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Sandra Haider
- Department of Obstetrics and Gynecology, Reproductive Biology Unit, Placental Development Group, Medical University of Vienna, Austria
| | - Thomas Boehm
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | - Jürgen Pollheimer
- Department of Obstetrics and Gynecology, Reproductive Biology Unit, Maternal-fetal Immunology Group, Medical University of Vienna, Austria.
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Lietz A, Eckel F, Kiss H, Noe-Letschnig M, Farr A. Quality of life in women with chronic recurrent vulvovaginal candidosis: A sub-analysis of the prospective multicentre phase IIb/III Prof-001 study. Mycoses 2023. [PMID: 37147720 DOI: 10.1111/myc.13602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/27/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Chronic recurrent vulvovaginal candidosis (RVVC), defined as three or more episodes of vulvovaginal candidosis per year, significantly impairs quality of life (QoL) and sexual health. OBJECTIVES The primary objective of this study was to assess health-related QoL in women with RVVC using validated questionnaires before and after treatment. The secondary objective was to analyse the effect of RVVC on women's sexual health. PATIENTS/METHODS This was a sub-analysis of a randomised, controlled, double-blinded study titled 'A phase IIb/III, parallel-arm, randomized, active-controlled, double-blind, double-dummy, multicenter, non-inferiority study in patients with recurrent vulvovaginal candidosis to compare the clinical efficacy, safety and tolerability of topically administered ProF-001 (Candiplus®) to oral fluconazole, which was conducted at 35 study sites in Austria, Poland and Slovakia. QoL was assessed using the European Quality of Life (EQ) five-dimension five-level scale (EQ-5D-5L) and visual analogue scale (EQ-VAS) questionnaires, followed by specific questions regarding sexuality. RESULTS From 2019 to 2021, 360 of 432 (83.3%) women with RVVC had accomplished a 6-months maintenance treatment and were enrolled in this sub-analysis. The EQ-5D-5L and EQ-VAS scores demonstrated improved QoL in 137 (65.2%) and 159 (75.4%) women after 6 months of maintenance treatment. Each individual aspect of sexual health significantly improved (all p < .05). A reduction in pain frequency during or after sexual intercourse in the 6-month period occurred in 124 (66.3%) women. CONCLUSIONS Women with RVVC had high QoL and sexual health impairment; however, a 6-months maintenance treatment resulted in effective improvement in QoL and sexual health.
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Affiliation(s)
- Andrea Lietz
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University Vienna, Vienna, Austria
| | - Fanny Eckel
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Alex Farr
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
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Falkner F, Mayer SA, Thomas B, Zimmermann SO, Walter S, Heimel P, Thiele W, Sleeman JP, Bigdeli AK, Kiss H, Podesser BK, Kneser U, Bergmeister H, Schneider KH. Acellular Human Placenta Small-Diameter Vessels as a Favorable Source of Super-Microsurgical Vascular Replacements: A Proof of Concept. Bioengineering (Basel) 2023; 10:337. [PMID: 36978728 PMCID: PMC10045636 DOI: 10.3390/bioengineering10030337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/19/2023] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
Abstract
In this study, we aimed to evaluate the human placenta as a source of blood vessels that can be harvested for vascular graft fabrication in the submillimeter range. Our approach included graft modification to prevent thrombotic events. Submillimeter arterial grafts harvested from the human placenta were decellularized and chemically crosslinked to heparin. Graft performance was evaluated using a microsurgical arteriovenous loop (AVL) model in Lewis rats. Specimens were evaluated through hematoxylin-eosin and CD31 staining of histological sections to analyze host cell immigration and vascular remodeling. Graft patency was determined 3 weeks after implantation using a vascular patency test, histology, and micro-computed tomography. A total of 14 human placenta submillimeter vessel grafts were successfully decellularized and implanted into AVLs in rats. An appropriate inner diameter to graft length ratio of 0.81 ± 0.16 mm to 7.72 ± 3.20 mm was achieved in all animals. Grafts were left in situ for a mean of 24 ± 4 days. Decellularized human placental grafts had an overall patency rate of 71% and elicited no apparent immunological responses. Histological staining revealed host cell immigration into the graft and re-endothelialization of the vessel luminal surface. This study demonstrates that decellularized vascular grafts from the human placenta have the potential to serve as super-microsurgical vascular replacements.
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Affiliation(s)
- Florian Falkner
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, 69117 Heidelberg, Germany
| | - Simon Andreas Mayer
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, 69117 Heidelberg, Germany
| | - Benjamin Thomas
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, 69117 Heidelberg, Germany
| | - Sarah Onon Zimmermann
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Sonja Walter
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, 69117 Heidelberg, Germany
| | - Patrick Heimel
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, 1200 Vienna, Austria
- Core Facility Hard Tissue and Biomaterial Research, Karl Donath Laboratory, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Wilko Thiele
- Department of Microvascular Biology and Pathobiology, European Center for Angioscience (ECAS), Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Jonathan Paul Sleeman
- Department of Microvascular Biology and Pathobiology, European Center for Angioscience (ECAS), Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
- Institute for Biological and Chemical Systems, Karlsruhe Institute of Technology, Campus North, 76131 Karlsruhe, Germany
| | - Amir Khosrow Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, 69117 Heidelberg, Germany
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Bruno Karl Podesser
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, 69117 Heidelberg, Germany
| | - Helga Bergmeister
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, 1090 Vienna, Austria
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Karl Heinrich Schneider
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, 1090 Vienna, Austria
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
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10
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Klebanoff MA, Schuit E, Lamont RF, Larsson PG, Odendaal HJ, Ugwumadu A, Kiss H, Petricevic L, Andrews WW, Hoffman MK, Shennan A, Seed PT, Goldenberg RL, Emel LM, Bhandaru V, Weiner S, Larsen MD. Antibiotic treatment of bacterial vaginosis to prevent preterm delivery: Systematic review and individual participant data meta-analysis. Paediatr Perinat Epidemiol 2023; 37:239-251. [PMID: 36651636 PMCID: PMC10171232 DOI: 10.1111/ppe.12947] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Bacterial vaginosis (BV) increases preterm delivery (PTD) risk, but treatment trials showed mixed results in preventing PTD. OBJECTIVES Determine, using individual participant data (IPD), whether BV treatment during pregnancy reduced PTD or prolonged time-to-delivery. DATA SOURCES Cochrane Systematic Review (2013), MEDLINE, EMBASE, journal searches, and searches (January 2013-September 2022) ("bacterial vaginosis AND pregnancy") of (i) clinicaltrials.gov; (ii) Cochrane Central Register of Controlled Trials; (iii) World Health Organization International Clinical Trials Registry Platform Portal; and (iv) Web of Science ("bacterial vaginosis"). STUDY SELECTION AND DATA EXTRACTION Studies randomising asymptomatic pregnant individuals with BV to antibiotics or control, measuring delivery gestation. Extraction was from original data files. Bias risk was assessed using the Cochrane tool. Analysis used "one-step" logistic and Cox random effect models, adjusting gestation at randomisation and PTD history; heterogeneity by I2 . Subgroup analysis tested interactions with treatment. In sensitivity analyses, studies not providing IPD were incorporated by "multiple random-donor hot-deck" imputation, using IPD studies as donors. RESULTS There were 121 references (96 studies) with 23 eligible trials (11,979 participants); 13 studies (6915 participants) provided IPD; 12 (6115) were incorporated. Results from 9 (4887 participants) not providing IPD were imputed. Odds ratios for PTD for metronidazole and clindamycin versus placebo were 1.00 (95% CI 0.84, 1.17), I2 = 62%, and 0.59 (95% CI 0.42, 0.82), I2 = 0 before; and 0.95 (95% CI 0.81, 1.11), I2 = 59%, and 0.90 (95% CI: 0.72, 1.12), I2 = 0, after imputation. Time-to-delivery did not differ from null with either treatment. Including imputed IPD, there was no evidence that either drug was more effective when administered earlier, or among those with a PTD history. CONCLUSIONS Clindamycin, but not metronidazole, was beneficial in studies providing IPD, but after imputing data from missing IPD studies, treatment of BV during pregnancy did not reduce PTD, nor prolong pregnancy, in any subgroup or when started earlier in gestation.
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Affiliation(s)
- Mark A. Klebanoff
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
- Departments of Pediatrics and Obstetrics and Gynecology, and Division of Epidemiology, The Ohio State University, Columbus, Ohio, USA
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, and Cochrane Netherlands, both at University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ronald F. Lamont
- Division of Surgery, University College London, Northwick Park Institute for Medical Research Campus, London, UK
- Odense University Hospital, Department of Gynecology and Obstetrics, University of Southern Denmark, Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, Odense, Denmark
| | - Per-Göran Larsson
- Department of Obstetrics and Gynaecology, Skaraborg Hospital, Skövde, Sweden
- Department of Clinical and Experimental Medicine (IKE), Linköping University, Linköping, Sweden
| | - Hein J. Odendaal
- Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - Austin Ugwumadu
- Department of Obstetrics and Gynecology, St. George’s Hospital, University of London, London, UK
| | - Herbert Kiss
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Wien, Austria
| | - Ljubomir Petricevic
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Wien, Austria
| | - William W. Andrews
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Matthew K. Hoffman
- Department of Obstetrics and Gynecology, Christiana Health Services, Newark, Delaware, USA
| | - Andrew Shennan
- Department of Women and Children’s Health, School of Life Course Sciences, FoLSM, King’s College, London, UK
| | - Paul T. Seed
- Division of Women’s Health, King’s College, London, UK
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York City, New York, USA
| | - Lynda M. Emel
- Biostatistics, Bioinformatics, and Epidemiology/VIDD, Fred Hutchinson Cancer Center Seattle, Seattle, Washington, USA
| | - Vinay Bhandaru
- The Biostatistics Center, Milken School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Steven Weiner
- The Biostatistics Center, Milken School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Michael D. Larsen
- The Biostatistics Center, Milken School of Public Health, The George Washington University, Washington, District of Columbia, USA
- Department of Mathematics and Statistics, St. Michael’s College, Colchester, Vermont, USA
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11
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Kautzky-Willer A, Winhofer Y, Kiss H, Falcone V, Berger A, Lechleitner M, Weitgasser R, Harreiter J. [Gestational diabetes mellitus (Update 2023)]. Wien Klin Wochenschr 2023; 135:115-128. [PMID: 37101032 PMCID: PMC10132924 DOI: 10.1007/s00508-023-02181-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 04/28/2023]
Abstract
Gestational diabetes (GDM) is defined as any degree of glucose intolerance with onset during pregnancy and is associated with increased feto-maternal morbidity as well as long-term complications in mothers and the offspring. Women detected to have diabetes early in pregnancy receive the diagnosis of overt, non-gestational, diabetes (glucose: fasting ≥ 126 mg/dl, spontaneous ≥ 200 mg/dl or HbA1c ≥ 6.5% before 20 weeks of gestation). GDM is diagnosed by an oral glucose tolerance test (oGTT) or increased fasting glucose (≥ 92 mg/dl). Screening for undiagnosed type 2 diabetes at the first prenatal visit is recommended in women at increased risk (history of GDM/pre-diabetes; malformation, stillbirth, successive abortions or birth weight > 4500 g previously; obesity, metabolic syndrome, age > 35 years, vascular disease; clinical symptoms of diabetes (e.g. glucosuria) or ethnic origin with increased risk for GDM/T2DM (Arab, South- and Southeast Asian, Latin American)) using standard diagnostic criteria. Performance of the oGTT (120 min; 75 g glucose) may already be indicated in the first trimester in high-risk women but is mandatory between gestational week 24-28 in all pregnant women with previous non-pathological glucose metabolism. Following WHO recommendations, which are based on the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, GDM is defined, if fasting venous plasma glucose is ≥ 92 mg/dl or 1 h ≥ 180 mg/dl or 2 h ≥ 153 mg/dl after glucose loading (international consensus criteria). In case of one pathological value a strict metabolic control is mandatory. After bariatric surgery we do not recommend to perform an oGTT due to risk of postprandial hypoglycemia. All women with GDM should receive nutritional counseling, be instructed in blood glucose self-monitoring and motivated to increase physical activity to moderate intensity levels-if not contraindicated (Evidence level A). If blood glucose levels cannot be maintained in the therapeutic range (fasting < 95 mg/dl and 1 h after meals < 140 mg/dl, Evidence level B) insulin therapy should be initiated as first choice (Evidence level A). Maternal and fetal monitoring is required in order to minimize maternal and fetal/neonatal morbidity and perinatal mortality. Regular obstetric examinations including ultrasound examinations are recommended (Evidence level A). Neonatal care of GDM offspring at high risk for hypoglycaemia includes blood glucose measurements after birth and if necessary appropriate intervention. Monitoring the development of the children and recommendation of healthy lifestyle are important issues to be tackled for the whole family. After delivery all women with GDM have to be reevaluated as to their glucose tolerance by a 75 g oGTT (WHO criteria) 4-12 weeks postpartum. Assessment of glucose parameters (fasting glucose, random glucose, HbA1c or optimally oGTT) are recommended every 2-3 years in case of normal glucose tolerance. All women have to be instructed about their increased risk of type 2 diabetes and cardiovascular disease at follow-up. Possible preventive meassures, in particular lifestyle changes as weight management and maintenance/increase of physical activity should be discussed (evidence level A).
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Affiliation(s)
- Alexandra Kautzky-Willer
- Gender Medicine Unit, Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Yvonne Winhofer
- Gender Medicine Unit, Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Herbert Kiss
- Abteilung für Geburtshilfe und feto-maternale Medizin, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Veronica Falcone
- Abteilung für Geburtshilfe und feto-maternale Medizin, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Angelika Berger
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Monika Lechleitner
- Interne Abteilung, Landeskrankenhaus Hochzirl - Natters, Hochzirl, Österreich
| | - Raimund Weitgasser
- Abteilung für Innere Medizin/Diabetologie, Privatklinik Wehrle-Diakonissen, Salzburg, Österreich
| | - Jürgen Harreiter
- Gender Medicine Unit, Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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12
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Schirwani N, Pateisky P, Koren T, Farr A, Kiss H, Bancher-Todesca D. Written Briefing and Oral Counseling Increase the Willingness to Receive the SARS-CoV-2 Vaccination among Women in Puerperium: A Qualitative Prospective Cohort Study. Vaccines (Basel) 2022; 10:vaccines10091505. [PMID: 36146582 PMCID: PMC9501465 DOI: 10.3390/vaccines10091505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/28/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Vaccination rates for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) are low in Austria. International obstetric societies recommend the SARS-CoV-2 mRNA vaccination for women in puerperium. (2) Methods: A prospective two-stage cohort study was conducted at the Medical University of Vienna between October 2022 and December 2022. Firstly, women in puerperium were assigned to the evaluation group (step 1), and secondly, another cohort of unvaccinated women were randomly assigned to study group A (written briefing) or B (written and oral briefing) (step 2). We evaluated the vaccination status among women in the evaluation group and the willingness to receive the vaccination in all three cohorts. (3) Results: We included 217 women in puerperium (evaluation: n = 69, A: n = 68; B: n = 80). In the evaluation group, 66.7% (n = 46/69) of the women were unvaccinated. A total of 45.7% (21/46) of the unvaccinated women categorically declined the SARS-CoV-2 vaccination. A total of 26.5% (n = 18/68) of women in study group A, and 43.8% (n = 35/80) of women in study group B expressed their willingness to receive the vaccination (p = 0.029). There were no differences in willingness to receive the vaccination between different age strata of women in study groups A and B. (D) Conclusion: Our qualitative data demonstrate a benefit from oral counseling in addition to written briefing in order to increase the willingness to receive the vaccination among women in puerperium.
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13
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Linder T, Eppel D, Kotzaeridi G, Rosicky I, Yerlikaya-Schatten G, Kiss H, Weißhaupt K, Henrich W, Bozkurt L, Tura A, Roden M, Göbl CS. Fatty liver indices and their association with glucose metabolism in pregnancy - An observational cohort study. Diabetes Res Clin Pract 2022; 189:109942. [PMID: 35691476 DOI: 10.1016/j.diabres.2022.109942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/20/2022] [Revised: 05/15/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022]
Abstract
AIMS Non-invasive hepatic steatosis indices can be used to assess the risk for metabolic (dysfunction) associated fatty liver disease (MAFLD). This may be helpful to detect metabolic disorders in pregnancy, specifically gestational diabetes (GDM). We aimto examine the association of these indices with parameters of glucose metabolism. METHODS 109 women underwent a metabolic characterization at 16 weeks of gestation andwere classified according to the fatty-liver index (FLI) andhepatic-steatosis index (HSI) into low (G1), intermediate (G2) and high risk (G3). At 26 weeks, participants received an oral glucose tolerance test (OGTT) to assess insulin action, β-cell function and GDM status. RESULTS Both MAFLD indices wereassociated with impaired insulin sensitivityand compensatory increase of insulin release. G3 groups showedimpaired insulin action. The higher circulating insulin concentrations were not able to compensate for insulin resistance in women with higher MAFLD scores, resulting in an increased risk of GDM(OR: 1.05, 95% CI 1.03 to 1.08, p < 0.001 for FLI). MAFLD scores were associated with fetal overgrowth. CONCLUSIONS Maternal MAFLD represents a high-risk obstetric condition. Hepatic steatosis indices are associated with impaired glucose regulation and may provide a useful tool for early risk assessment for impaired glucose metabolism.
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Affiliation(s)
- Tina Linder
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Daniel Eppel
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Grammata Kotzaeridi
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Ingo Rosicky
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | | | - Herbert Kiss
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Karen Weißhaupt
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Wolfgang Henrich
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Latife Bozkurt
- Department of Metabolic Disorders and Nephrology, Hietzing Hospital, Vienna, Austria
| | - Andrea Tura
- Metabolic Unit, CNR Institute of Neuroscience, Padova, Italy
| | - Michael Roden
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany; Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine University, Düsseldorf, Germany
| | - Christian S Göbl
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria; Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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14
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Granser S, Foessleitner P, Kiss H, Wisgrill L, Pummer L, Berger A, Berry D, Pjevac P, Hausmann B, Graf A, Farr A. Das Mikrobiom in der Schwangerschaft, bei Geburt und des Neugeborenen: Eine prospektive, longitudinale Pilotstudie. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1750240] [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: 10/17/2022] Open
Affiliation(s)
- S Granser
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, and Comprehensive Center for Pediatrics (CCP), Medical University of Vienna; Vienna, Austria
| | - P Foessleitner
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, and Comprehensive Center for Pediatrics (CCP), Medical University of Vienna; Vienna, Austria
| | - H Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, and Comprehensive Center for Pediatrics (CCP), Medical University of Vienna; Vienna, Austria
| | - L Wisgrill
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care Medicine and Neuropediatrics, and Comprehensive Center for Pediatrics (CCP), Medical University of Vienna; Vienna, Austria
| | - L Pummer
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care Medicine and Neuropediatrics, and Comprehensive Center for Pediatrics (CCP), Medical University of Vienna; Vienna, Austria
| | - A Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care Medicine and Neuropediatrics, and Comprehensive Center for Pediatrics (CCP), Medical University of Vienna; Vienna, Austria
| | - D Berry
- Joint Microbiome Facility, Medical University of Vienna and University of Vienna; Vienna, Austria
- University of Vienna, Center for Microbiology and Environmental Systems Science, Joint Microbiome Facility (JMF), Department of Microbiology and Ecosystem Science; Vienna, Austria
| | - P Pjevac
- Joint Microbiome Facility, Medical University of Vienna and University of Vienna; Vienna, Austria
- University of Vienna, Center for Microbiology and Environmental Systems Science, Joint Microbiome Facility (JMF), Department of Microbiology and Ecosystem Science; Vienna, Austria
| | - B Hausmann
- Joint Microbiome Facility, Medical University of Vienna and University of Vienna; Vienna, Austria
- Department of Laboratory Medicine, Medical University of Vienna; Vienna, Austria
| | - A Graf
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna
| | - A Farr
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, and Comprehensive Center for Pediatrics (CCP), Medical University of Vienna; Vienna, Austria
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15
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Wagner M, Falcone V, Neururer SB, Leitner H, Delmarko I, Kiss H, Berger A, Farr A. Perinatal and postpartum care during the COVID-19 pandemic: A nationwide cohort study. Birth 2022; 49:243-252. [PMID: 34617310 PMCID: PMC8653168 DOI: 10.1111/birt.12594] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/01/2021] [Accepted: 09/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to analyze perinatal outcomes and adverse events during the COVID-19 pandemic's first wave to help direct decision making in future waves. METHODS This study was an epidemiological cohort study analyzing comprehensive birth registry data among all 80 obstetric departments in Austria. Out of 469 771 records, 468 348 were considered eligible, whereof those with preterm delivery, birthweight <500 g, multiple fetuses, fetal malformations and chromosomal anomalies, intrauterine fetal death, maternal cancer, HIV infection, and/or inter-hospital transfers were excluded. Women who delivered between January and June 2020 were then classified as cases, whereas those who delivered between January and June 2015-2019 were classified as controls. Perinatal outcomes, postpartum hospitalization, and adverse events served as outcome measures. RESULTS Of 33 198 cases and 188 225 controls, data analysis showed significantly increased rates of labor induction, instrumental delivery, obstetric anesthesia, NICU transfer, and 5-min Apgar score below 7 during the COVID-19 period. There was a significantly shorter length of postpartum hospitalization during the COVID-19 period compared with the non-COVID-19 period (3.1 ± 1.4 vs 3.5 ± 1.5 days; P < .001). Significantly more women opted for short-stay delivery during the COVID-19 period (3.7% vs 2.4%; P < .001). Those who delivered during the COVID-19 period were also more likely to experience postpartum adverse events (3.0% vs 2.6%; P < .001), which was confirmed in the logistic regression model (odds ratio, 2.137; 95% confidence interval, 1.805-2.530; P < .001). CONCLUSIONS Perinatal and postpartum care during the first wave of the COVID-19 pandemic differed significantly from that provided before. Increased rates of adverse events underline the need to ensure access to high-quality obstetric care to prevent collateral damage.
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Affiliation(s)
- Michael Wagner
- Division of Neonatology, Pediatric Intensive Care, and NeuropediatricsDepartment of PediatricsComprehensive Center for PediatricsMedical University of ViennaViennaAustria
| | - Veronica Falcone
- Division of Obstetrics and Feto‐maternal MedicineDepartment of Obstetrics and GynecologyComprehensive Center for PediatricsMedical University of ViennaViennaAustria
| | - Sabrina B. Neururer
- Department of Clinical EpidemiologyTyrolean Federal Institute for Integrated CareTirol Kliniken GmbHInnsbruckAustria
| | - Hermann Leitner
- Department of Clinical EpidemiologyTyrolean Federal Institute for Integrated CareTirol Kliniken GmbHInnsbruckAustria
| | - Irmgard Delmarko
- Department of Clinical EpidemiologyTyrolean Federal Institute for Integrated CareTirol Kliniken GmbHInnsbruckAustria
| | - Herbert Kiss
- Division of Obstetrics and Feto‐maternal MedicineDepartment of Obstetrics and GynecologyComprehensive Center for PediatricsMedical University of ViennaViennaAustria
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care, and NeuropediatricsDepartment of PediatricsComprehensive Center for PediatricsMedical University of ViennaViennaAustria
| | - Alex Farr
- Division of Obstetrics and Feto‐maternal MedicineDepartment of Obstetrics and GynecologyComprehensive Center for PediatricsMedical University of ViennaViennaAustria
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Windsperger K, Kiss H, Muin DA, Neururer SB, Delmarko I, Farr A. Einfluss der Covid-19-Pandemie auf den mütterlichen Gewichtsverlauf und Übergewichts-assoziierte Komplikationen: Eine landesweite Datenanalyse. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1750260] [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: 10/17/2022] Open
Affiliation(s)
- K Windsperger
- Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien
| | - H Kiss
- Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien
| | - D A Muin
- Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien
| | - S B Neururer
- Landesinstitut für Integrative Versorgung, Institut für Klinische Epidemiologie, Tirol Kliniken
| | - I Delmarko
- Landesinstitut für Integrative Versorgung, Institut für Klinische Epidemiologie, Tirol Kliniken
| | - A Farr
- Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien
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Schirwani N, Koren T, Farr A, Kiss H, Bancher D. Effekt von Aufklärung und Beratung auf die COVID-19 Impfbereitschaft bei Wöchnerinnen: eine prospektive Pilotstudie. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1750255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Falcone V, Catic A, Wagner M, Steinbauer P, Bibl K, Kiss H, Farr A. Schulterdystokie-Training mittels Virtual Reality: eine Pilot-Studie. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1750239] [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: 10/17/2022] Open
Affiliation(s)
- V Falcone
- Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Comprehensive Center for Pediatrics, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien
| | - A Catic
- Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Comprehensive Center for Pediatrics, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien
| | - M Wagner
- Klinische Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie, Comprehensive Center for Pediatrics, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien
| | - P Steinbauer
- Klinische Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie, Comprehensive Center for Pediatrics, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien
| | - K Bibl
- Klinische Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie, Comprehensive Center for Pediatrics, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien
| | - H Kiss
- Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Comprehensive Center for Pediatrics, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien
| | - A Farr
- Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Comprehensive Center for Pediatrics, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien
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Rohringer S, Schneider KH, Eder G, Hager P, Enayati M, Kapeller B, Kiss H, Windberger U, Podesser BK, Bergmeister H. Chorion-derived extracellular matrix hydrogel and fibronectin surface coatings show similar beneficial effects on endothelialization of expanded polytetrafluorethylene vascular grafts. Mater Today Bio 2022; 14:100262. [PMID: 35509865 PMCID: PMC9059097 DOI: 10.1016/j.mtbio.2022.100262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 11/19/2022] Open
Abstract
The endothelium plays an important regulatory role for cardiovascular homeostasis. Rapid endothelialization of small diameter vascular grafts (SDVGs) is crucial to ensure long-term patency. Here, we assessed a human placental chorionic extracellular matrix hydrogel (hpcECM-gel) as coating material and compared it to human fibronectin in-vitro. hpcECM-gels were produced from placental chorion by decellularization and enzymatic digestion. Human umbilical vein endothelial cells (HUVECs) were seeded to non-, fibronectin- or hpcECM-gel-coated expanded polytetrafluorethylene (ePTFE) SDVGs. Coating efficiency as well as endothelial cell proliferation, migration and adhesion studies on grafts were performed. hpcECM-gel depicted high collagen and glycosaminoglycan content and neglectable DNA amounts. Laminin and fibronectin were both retained in the hpcECM-gel after the decellularization process. HUVEC as well as endothelial progenitor cell attachment were both significantly enhanced on hpcECM-gel coated grafts. HUVECs seeded to hpcECM-gel depicted significantly higher platelet endothelial cell adhesion molecule-1 (PECAM-1) expression in the perinuclear region. Cell retention to flow was enhanced on fibronectin and hpcECM-gel coated grafts. Since hpcECM-gel induced a significantly higher endothelial cell adhesion to ePTFE than fibronectin, it represents a possible alternative for SDVG modification to improve endothelialization.
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Affiliation(s)
- Sabrina Rohringer
- Medical University of Vienna, Center for Biomedical Research, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Karl H. Schneider
- Medical University of Vienna, Center for Biomedical Research, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Gabriela Eder
- Medical University of Vienna, Center for Biomedical Research, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Pia Hager
- Medical University of Vienna, Center for Biomedical Research, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Marjan Enayati
- Medical University of Vienna, Center for Biomedical Research, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Barbara Kapeller
- Medical University of Vienna, Center for Biomedical Research, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Herbert Kiss
- Medical University of Vienna, Department of Obstetrics and Gynaecology, Division of Obstetrics and Feto-Maternal Medicine, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Ursula Windberger
- Medical University of Vienna, Center for Biomedical Research, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Bruno K. Podesser
- Medical University of Vienna, Center for Biomedical Research, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Helga Bergmeister
- Medical University of Vienna, Center for Biomedical Research, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
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Windsperger K, Kiss H, Oberaigner W, Leitner H, Binder F, Muin DA, Foessleitner P, Husslein PW, Farr A. Exposure to night-time light pollution and risk of prolonged duration of labor: A nationwide cohort study. Birth 2022; 49:87-96. [PMID: 34250632 PMCID: PMC9291618 DOI: 10.1111/birt.12577] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Light pollution (LP) is a ubiquitous environmental agent that affects more than 80% of the world's population. This large nationwide cohort study evaluates whether exposure to LP can influence obstetric outcomes. METHODS We analyzed Austrian birth registry data on 717 113 cases between 2008 and 2016 and excluded cases involving day-time delivery, <23 + 0 gestational weeks, and/or birthweight <500 g, induction of labor, elective cesarean, or cases with missing data. The independent variable, that is, degree of night-time LP, was categorized as low (0.174 to <0.688 mcd/m2 ), medium (0.688 to <3 mcd/m2 ), or high (3 to <10 mcd/m2 ). Duration of labor and adverse neonatal outcomes served as outcome measures. RESULTS Cases in regions with high LP (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.30-1.57) and medium LP (OR, 1.22; 95% CI, 1.14-1.31) showed increased odds of prolonged labor (P < .0001 each). Newborns born in regions with high LP (OR, 1.12; 95% CI, 1.07-1.16) and medium LP (OR, 1.07; 95% CI, 1.04-1.10) showed increased odds of experiencing adverse outcomes (P < .0001 each). Preterm delivery <28 + 0 weeks was also associated with the degree of LP (P = .04). CONCLUSIONS Night-time LP negatively interferes with obstetric outcomes. The perceived influence of LP as an environmental agent needs to be re-evaluated to minimize associated health risks.
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Affiliation(s)
- Karin Windsperger
- Department of Obstetrics and GynecologyDivision of Obstetrics and Feto‐Maternal MedicineMedical University of ViennaViennaAustria
| | - Herbert Kiss
- Department of Obstetrics and GynecologyDivision of Obstetrics and Feto‐Maternal MedicineMedical University of ViennaViennaAustria
| | - Wilhelm Oberaigner
- Department of Public Health, Health Services Research and Health Technology AssessmentInstitute of Public Health, Medical Decision Making and Health Technology AssessmentUMIT University for Health SciencesMedical Informatics and TechnologyHall in TirolAustria
| | - Hermann Leitner
- Department of Clinical EpidemiologyTyrolean Federal Institute for Integrated CareTirol Kliniken GmbHInnsbruckAustria
| | - Franz Binder
- Department of AstrophysicsUniversity of ViennaViennaAustria
| | - Dana A. Muin
- Department of Obstetrics and GynecologyDivision of Obstetrics and Feto‐Maternal MedicineMedical University of ViennaViennaAustria
| | - Philipp Foessleitner
- Department of Obstetrics and GynecologyDivision of Obstetrics and Feto‐Maternal MedicineMedical University of ViennaViennaAustria
| | - Peter W. Husslein
- Department of Obstetrics and GynecologyDivision of Obstetrics and Feto‐Maternal MedicineMedical University of ViennaViennaAustria
| | - Alex Farr
- Department of Obstetrics and GynecologyDivision of Obstetrics and Feto‐Maternal MedicineMedical University of ViennaViennaAustria
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21
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Muin DA, Pfeifer B, Helmer H, Oberaigner W, Leitner H, Kiss H, Neururer S. Universal gestational diabetes screening and antepartum stillbirth rates in Austria-A population-based study. Acta Obstet Gynecol Scand 2022; 101:396-404. [PMID: 35195277 PMCID: PMC9976563 DOI: 10.1111/aogs.14334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Occult or untreated gestational diabetes (GDM) is a well-known risk factor for adverse perinatal outcomes and may contribute to antepartum stillbirth. We assessed the impact of screening for GDM on the rate of antepartum stillbirths in non-anomalous pregnancies by conducting a population-based study in 974 889 women in Austria. MATERIAL AND METHODS Our database was derived from the Austrian Birth Registry. Inclusion criteria were singleton live births and antepartum stillbirths ≥24+0 gestational weeks, excluding fetal congenital malformations, terminations of pregnancy and women with pre-existing type 1 or 2 diabetes. Main outcome measures were (a) overall stillbirth rates and (b) stillbirth rates in women at high risk of GDM (i.e., women with a body mass index ≥30 kg/m2 , history of previous intrauterine fetal death, GDM, previous macrosomic offspring) before (2008-2010, "phase I") and after (2011-2019, "phase II") the national implementation of universal GDM screening with a 75 g oral glucose tolerance test in Austrian pregnant women by 2011. RESULTS In total, 940 373 pregnancies were included between 2008 and 2019, of which 2579 resulted in intrauterine fetal deaths at 33.51 ± 5.10 gestational weeks. After implementation of the GDM screening, a statistically significant reduction in antepartum stillbirth rates among non-anomalous singletons was observed only in women at high risk for GDM (4.10‰ [95% confidence interval (CI) 3.09-5.43] in phase I vs. 2.96‰ [95% CI 2.57-3.41] in phase II; p = 0.043) but not in the general population (2.76‰ [95% CI 2.55-2.99] in phase I vs. 2.74‰ [95% CI 2.62-2.86] in phase II; p = 0.845). The number needed to screen with the oral glucose tolerance test to subsequently prevent one case of (non-anomalous) intrauterine fetal death was 880 in the high-risk and 40 000 in the general population. CONCLUSIONS The implementation of a universal GDM screening program in Austria in 2011 has not led to any significant reduction in antenatal stillbirths among non-anomalous singletons in the general population. More international data are needed to strengthen our findings.
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Affiliation(s)
- Dana A. Muin
- Department of Obstetrics and Gynecology, Division of Fetomaternal MedicineMedical University of ViennaViennaAustria
| | - Bernhard Pfeifer
- Department of Clinical EpidemiologyTyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbHInnsbruckAustria
| | - Hanns Helmer
- Department of Obstetrics and Gynecology, Division of Fetomaternal MedicineMedical University of ViennaViennaAustria
| | - Wilhelm Oberaigner
- Research Unit for Diabetes Epidemiology, Institute for Public Health, Medical Decision Making and Health Technology AssessmentUMIT University for Health, Sciences, Medical Informatics and TechnologyHall in TirolAustria
| | - Hermann Leitner
- Department of Clinical EpidemiologyTyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbHInnsbruckAustria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Fetomaternal MedicineMedical University of ViennaViennaAustria
| | - Sabrina Neururer
- Department of Clinical EpidemiologyTyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbHInnsbruckAustria
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Raimann A, Farr A, Huscsava M, Krois W, Strassl R, Schellnegger J, Eibensteiner F, Göschl B, Schned H, Steinbauer P, Hetzmannseder M, Stiegner F, Greber-Platzer S, Kiss H, Plener PL, Aufricht C, Berger A, Wagner M. Saliva Sampling for Prospective SARS-CoV-2 Screening of Healthcare Professionals. Front Med (Lausanne) 2022; 9:823577. [PMID: 35155504 PMCID: PMC8825473 DOI: 10.3389/fmed.2022.823577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/04/2022] [Indexed: 12/15/2022] Open
Abstract
Objective The objective of this study was to analyze the feasibility and acceptance of a non-invasive, daily and proactive screening program for SARS-CoV-2 infection employing serial saliva testing, in combination with a digital questionnaire among healthcare providers (HCPs) in a multi-professional setting. Design This was a prospective cohort study involving HCPs from different units at a single tertiary care center, over a pilot phase of 4 weeks during the first wave of the COVID-19 pandemic from April 18th to June 6th, 2020. Setting Pediatric tertiary patient care units, Comprehensive Center for Pediatrics, Medical University of Vienna. Subjects HCPs from different units, including physicians, nurses, midwives, and administrative staff (with patient contact) were considered eligible for the study. Study participants were working in different settings in our center at varying levels of risk exposure. Interventions Saliva collection from mouth gargle and electronic symptom and exposure monitoring (eSEM) was performed by participants at the onset of each regular clinical shift (day or night shift), using an anonymous ID for matching the results. Measurements RT-PCR of all saliva samples, eSEM, as well as feasibility and acceptance thereof. Results Two hundred and seventy-five volunteers collected 1,865 saliva samples and responded 1,378 times in the eSEM during a 4-week period. 1,331 (96.7%) responses were that the testing was feasible and acceptable. The most common severe symptom during the 4-week period mentioned by HCPs was headache, reported 54 times (3.9%). Two SARS-CoV-2 positive samples—one of them being associated with symptoms—were identified. The acceptance rate among HCPs was 96.6%. Conclusion Serial saliva screening was a well-accepted and feasible method for monitoring SARS-CoV-2 infectious state in health care professionals. Combination of regular SARS-CoV-2 tests with sequential saliva collection and storage could potentially represent a highly efficient strategy to identify and trace virus positive staff for employee and patient safety.
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Affiliation(s)
- Adalbert Raimann
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Alex Farr
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Mercedes Huscsava
- Department of Child and Adolescent Psychiatry, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Wilfried Krois
- Department of Pediatric Surgery, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Robert Strassl
- Division of Clinical Virology, Institute of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Julia Schellnegger
- Division of Clinical Virology, Institute of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Fabian Eibensteiner
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Bernadette Göschl
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Hannah Schned
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Philipp Steinbauer
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Fabian Stiegner
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Susanne Greber-Platzer
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Herbert Kiss
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.,Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Christoph Aufricht
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Michael Wagner
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Muin DA, Windsperger K, Attia N, Kiss H. Predicting singleton antepartum stillbirth by the demographic Fetal Medicine Foundation Risk Calculator—A retrospective case-control study. PLoS One 2022; 17:e0260964. [PMID: 35051188 PMCID: PMC8775340 DOI: 10.1371/journal.pone.0260964] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/20/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To assess the risk of singleton intrauterine fetal death (IUFD) in women by the demographic setting of the online Fetal Medicine Foundation (FMF) Stillbirth Risk Calculator. Methods Retrospective single-centre case-control study involving 144 women having suffered IUFD and 247 women after delivery of a live-born singleton. Nonparametric receiver operating characteristics (ROC) analyses were performed to predict the prognostic power of the FMF Stillbirth risk score and to generate a cut-off value to discriminate best between the event of IUFD versus live birth. Results Women in the IUFD cohort born a significantly higher overall risk with a median FMF risk score of 0.45% (IQR 0.23–0.99) compared to controls [0.23% (IQR 0.21–0.29); p<0.001]. Demographic factors contributing to an increased risk of IUFD in our cohort were maternal obesity (p = 0.002), smoking (p<0.001), chronic hypertension (p = 0.015), antiphospholipid syndrome (p = 0.017), type 2 diabetes (p<0.001), and insulin requirement (p<0.001). ROC analyses showed an area under the curve (AUC) of 0.72 (95% CI 0.67–0.78; p<0.001) for predicting overall IUFD and an AUC of 0.72 (95% CI 0.64–0.80; p<0.001), respectively, for predicting IUFD excluding congenital malformations. The FMF risk score at a cut-off of 0.34% (OR 6.22; 95% CI 3.91–9.89; p<0.001) yielded an 82% specificity and 58% sensitivity in predicting IUFD with a positive and negative predictive value of 0.94% and 99.84%, respectively. Conclusion The FMF Stillbirth Risk Calculator based upon maternal demographic and obstetric characteristics only may help identify women at low risk of antepartum stillbirth.
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Affiliation(s)
- Dana A. Muin
- Division of Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Comprehensive Centre for Pediatrics, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Karin Windsperger
- Division of Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Comprehensive Centre for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Nadia Attia
- Division of Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Comprehensive Centre for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Herbert Kiss
- Division of Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Comprehensive Centre for Pediatrics, Medical University of Vienna, Vienna, Austria
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Muin DA, Neururer S, Falcone V, Windsperger K, Helmer H, Leitner H, Kiss H, Farr A. Antepartum stillbirth rates during the COVID-19 pandemic in Austria: A population-based study. Int J Gynaecol Obstet 2021; 156:459-465. [PMID: 34669186 PMCID: PMC9087755 DOI: 10.1002/ijgo.13989] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/19/2021] [Indexed: 12/23/2022]
Abstract
Background The coronavirus disease 2019 (COVID‐19) pandemic caused by severe acute respiratory syndrome coronavirus 2 has had dramatic effects on the pregnant population worldwide, increasing the risk of adverse perinatal outcomes. Objective To assess the incidence of antepartum stillbirth (aSB) during the COVID‐19 pandemic in Austria. Methods We collected epidemiological data from the Austrian Birth Registry and compared the rate of aSB (i.e., fetal death at or after 24+0 gestational weeks) during the pandemic period (March–December 2020) and in the respective pre‐pandemic months (2015–2019). Results In total, 65 660 pregnancies were included, of which 171 resulted in aSB at 33.7 ± 4.8 gestational weeks. During the pandemic, the aSB rate increased from 2.49‰ to 2.60‰ (P = 0.601), in contrast to the significant decline in preterm deliveries at or before 37 gestational weeks from 0.61‰ to 0.56‰ (relative risk [RR] 0.93; 95% confidence interval [CI] 0.91–0.96; P < 0.001). During the first lockdown, the aSB rate significantly increased from 2.38‰ to 3.52‰ (P = 0.021), yielding an adjusted odds ratio of 1.57 (95% CI 1.08–2.27; P = 0.018). The event of aSB during the COVID‐19 pandemic was strongly related with increased fetal weight and maternal obesity. Conclusion In Austria, there has been an overall increase in the incidence of aSB during the pandemic with a significant peak during the first lockdown.
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Affiliation(s)
- Dana A Muin
- Department of Obstetrics and Gynecology, Division of Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Sabrina Neururer
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Veronica Falcone
- Department of Obstetrics and Gynecology, Division of Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Karin Windsperger
- Department of Obstetrics and Gynecology, Division of Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Hanns Helmer
- Department of Obstetrics and Gynecology, Division of Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Hermann Leitner
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Alex Farr
- Department of Obstetrics and Gynecology, Division of Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
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Foessleitner P, Hoetzenecker K, Benazzo A, Klebermass‐Schrehof K, Scharrer A, Kiss H, Farr A. Bilateral lung transplantation during pregnancy after ECMO for influenza-A caused ARDS. Am J Transplant 2021; 21:3456-3460. [PMID: 34331831 PMCID: PMC9291052 DOI: 10.1111/ajt.16781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/11/2021] [Accepted: 07/25/2021] [Indexed: 01/25/2023]
Abstract
Pregnant women with influenza-A have an increased risk of developing acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) can be used as salvage therapy, with lung transplantation as a therapeutic option. However, successful bilateral lung transplantation during pregnancy has never been reported before. We herein report the case of a 34-year-old primipara, who was diagnosed with ARDS caused by influenza-A-induced pneumonia at early gestation. After considering all possible therapeutic options and being fully dependent on VV-ECMO support, she underwent bilateral lung transplantation. The transplantation with intraoperative central VA-ECMO support was successfully performed with good recovery after an initial primary graft dysfunction. The pregnancy was prolonged until 29+5 gestational weeks. The newborn exhibited growth retardation and was initially stabilized, but later died due to severe, hypoxic respiratory failure and pulmonary hypertension. In conclusion, lung transplantation is a possible salvage therapy for patients with severe lung failure following ARDS during pregnancy. However, it places the mother and unborn child at risk. A multi-professional approach is warranted to diagnose and treat complications at an early stage.
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Affiliation(s)
- Philipp Foessleitner
- Department of Obstetrics and GynecologyDivision of Obstetrics and Feto‐Maternal MedicineComprehensive Center for PediatricsMedical University of ViennaViennaAustria
| | | | - Alberto Benazzo
- Department of Thoracic SurgeryMedical University of ViennaViennaAustria
| | - Katrin Klebermass‐Schrehof
- Department of Pediatrics and Adolescent MedicineDivision of NeonatologyPediatric Intensive Care and NeuropediatricsComprehensive Center for PediatricsMedical University of ViennaViennaAustria
| | - Anke Scharrer
- Clinical Institute of PathologyMedical University of ViennaViennaAustria
| | - Herbert Kiss
- Department of Obstetrics and GynecologyDivision of Obstetrics and Feto‐Maternal MedicineComprehensive Center for PediatricsMedical University of ViennaViennaAustria
| | - Alex Farr
- Department of Obstetrics and GynecologyDivision of Obstetrics and Feto‐Maternal MedicineComprehensive Center for PediatricsMedical University of ViennaViennaAustria
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Schmidbauer VU, Dovjak GO, Yildirim MS, Mayr-Geisl G, Weber M, Diogo MC, Gruber GM, Prayer F, Milos RI, Stuempflen M, Ulm B, Binder J, Bettelheim D, Kiss H, Prayer D, Kasprian G. Mapping Human Fetal Brain Maturation In Vivo Using Quantitative MRI. AJNR Am J Neuroradiol 2021; 42:2086-2093. [PMID: 34503947 DOI: 10.3174/ajnr.a7286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/19/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE On the basis of a single multidynamic multiecho sequence acquisition, SyMRI generates a variety of quantitative image data that can characterize tissue-specific properties. The aim of this retrospective study was to evaluate the feasibility of SyMRI for the qualitative and quantitative assessment of fetal brain maturation. MATERIALS AND METHODS In 52 fetuses, multidynamic multiecho sequence acquisitions were available. SyMRI was used to perform multidynamic multiecho-based postprocessing. Fetal brain maturity was scored qualitatively on the basis of SyMRI-generated MR imaging data. The results were compared with conventionally acquired T1-weighted/T2-weighted contrasts as a standard of reference. Myelin-related changes in T1-/T2-relaxation time/relaxation rate, proton density, and MR imaging signal intensity of the developing fetal brain stem were measured. A Pearson correlation analysis was used to detect correlations between the following: 1) the gestational age at MR imaging and the fetal brain maturity score, and 2) the gestational age at MR imaging and the quantitative measurements. RESULTS SyMRI provided images of sufficient quality in 12/52 (23.08%) (range, 23 + 6-34 + 0) fetal multidynamic multiecho sequence acquisitions. The fetal brain maturity score positively correlated with gestational age at MR imaging (SyMRI: r = 0.915, P < .001/standard of reference: r = 0.966, P < .001). Myelination-related changes in the T2 relaxation time/T2 relaxation rate of the medulla oblongata significantly correlated with gestational age at MR imaging (T2-relaxation time: r = -0.739, P = .006/T2-relaxation rate: r = 0.790, P = .002). CONCLUSIONS Fetal motion limits the applicability of multidynamic multiecho-based postprocessing. However, SyMRI-generated image data of sufficient quality enable the qualitative assessment of maturity-related changes of the fetal brain. In addition, quantitative T2 relaxation time/T2 relaxation rate mapping characterizes myelin-related changes of the brain stem prenatally. This approach, if successful, opens novel possibilities for the evaluation of structural and biochemical aspects of fetal brain maturation.
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Affiliation(s)
- V U Schmidbauer
- From the Departments of Biomedical Imaging and Image-Guided Therapy (V.U.S., G.O.D., M.S.Y., M.W., M.C.D., F.P., R.-I.M., M.S., D.P. G.K)
| | - G O Dovjak
- From the Departments of Biomedical Imaging and Image-Guided Therapy (V.U.S., G.O.D., M.S.Y., M.W., M.C.D., F.P., R.-I.M., M.S., D.P. G.K)
| | - M S Yildirim
- From the Departments of Biomedical Imaging and Image-Guided Therapy (V.U.S., G.O.D., M.S.Y., M.W., M.C.D., F.P., R.-I.M., M.S., D.P. G.K)
| | | | - M Weber
- From the Departments of Biomedical Imaging and Image-Guided Therapy (V.U.S., G.O.D., M.S.Y., M.W., M.C.D., F.P., R.-I.M., M.S., D.P. G.K)
| | - M C Diogo
- From the Departments of Biomedical Imaging and Image-Guided Therapy (V.U.S., G.O.D., M.S.Y., M.W., M.C.D., F.P., R.-I.M., M.S., D.P. G.K)
| | - G M Gruber
- Department of Anatomy and Biomechanics (G.M.G.), Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - F Prayer
- From the Departments of Biomedical Imaging and Image-Guided Therapy (V.U.S., G.O.D., M.S.Y., M.W., M.C.D., F.P., R.-I.M., M.S., D.P. G.K)
| | - R-I Milos
- From the Departments of Biomedical Imaging and Image-Guided Therapy (V.U.S., G.O.D., M.S.Y., M.W., M.C.D., F.P., R.-I.M., M.S., D.P. G.K)
| | - M Stuempflen
- From the Departments of Biomedical Imaging and Image-Guided Therapy (V.U.S., G.O.D., M.S.Y., M.W., M.C.D., F.P., R.-I.M., M.S., D.P. G.K)
| | - B Ulm
- Obstetrics and Gynecology (B.U., J.B., D.B., H.K.), Medical University of Vienna, Vienna, Austria
| | - J Binder
- Obstetrics and Gynecology (B.U., J.B., D.B., H.K.), Medical University of Vienna, Vienna, Austria
| | - D Bettelheim
- Obstetrics and Gynecology (B.U., J.B., D.B., H.K.), Medical University of Vienna, Vienna, Austria
| | - H Kiss
- Obstetrics and Gynecology (B.U., J.B., D.B., H.K.), Medical University of Vienna, Vienna, Austria
| | - D Prayer
- From the Departments of Biomedical Imaging and Image-Guided Therapy (V.U.S., G.O.D., M.S.Y., M.W., M.C.D., F.P., R.-I.M., M.S., D.P. G.K)
| | - G Kasprian
- From the Departments of Biomedical Imaging and Image-Guided Therapy (V.U.S., G.O.D., M.S.Y., M.W., M.C.D., F.P., R.-I.M., M.S., D.P. G.K)
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Palmrich P, Roessler B, Wisgrill L, Kampf S, Gattinger P, Valenta R, Fleischmann E, Berger A, Kiss H, Farr A. Multiprofessional perinatal care in a pregnant patient with acute respiratory distress syndrome due to COVID-19. BMC Pregnancy Childbirth 2021; 21:587. [PMID: 34445988 PMCID: PMC8390084 DOI: 10.1186/s12884-021-04059-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/18/2021] [Indexed: 12/18/2022] Open
Abstract
Background The coronavirus disease (COVID-19) pandemic has caused ongoing challenges in health services worldwide. Despite the growing body of literature on COVID-19, reports on perinatal care in COVID-19 cases are limited. Case presentation We describe a case of severe acute respiratory distress syndrome (ARDS) in a 36-year-old G5/P2 pregnant woman with morbid obesity, confirmed severe acute respiratory syndrome coronavirus 2 infection, and fulminant respiratory failure. At 28+ 1 gestational weeks, the patient delivered an uninfected newborn. Using ImmunoCAP ISAC® technology, we found no immunoglobulin (Ig) M antibodies, suggesting that no mother-to-child viral transmission occurred during pregnancy or delivery. The maternal respiratory state improved rapidly after delivery; both maternal and neonatal outcomes were encouraging given the early gestational age and fulminant course of respiratory failure in our patient. Conclusions The management of ARDS in pregnant women with COVID-19 is complex and requires an individualized, multidisciplinary approach, while considering maternal and fetal outcomes.
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Affiliation(s)
- Pilar Palmrich
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Bernhard Roessler
- Medical Simulation and Emergency Management Research Group, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Lukas Wisgrill
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care Medicine and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Stephanie Kampf
- Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Pia Gattinger
- Department of Pathophysiology and Allergy Research, Division of Immunopathology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Rudolf Valenta
- Department of Pathophysiology and Allergy Research, Division of Immunopathology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.,NRC Institute of Immunology FMBA of Russia, Moscow, Russia.,Laboratory for Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia.,Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Edith Fleischmann
- Medical Simulation and Emergency Management Research Group, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care Medicine and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Alex Farr
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
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28
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Marschalek J, Kuessel L, Stammler-Safar M, Kiss H, Ott J, Husslein H. Comparison of a practice-based versus theory-based training program for conducting vacuum-assisted deliveries: a randomized-controlled trial. Arch Gynecol Obstet 2021; 305:365-372. [PMID: 34363518 PMCID: PMC8840931 DOI: 10.1007/s00404-021-06159-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/21/2021] [Indexed: 10/24/2022]
Abstract
PURPOSE Vacuum-assisted deliveries (VAD) are complex procedures that require training and experience to be performed proficiently. We aimed to evaluate if a more resource intensive practice-based training program for conducting VAD is more efficient compared to a purely theory-based training program, with respect to immediate training effects and persistence of skills 4-8 weeks after the initial training. METHODS In this randomized-controlled study conducted in maternity staff, participants performed a simulated low-cavity non-rotational vacuum delivery before (baseline test) and immediately after the training (first post-training test) as well as 4-8 weeks thereafter (second post-training test). The study's primary endpoint was to compare training effectiveness between the two study groups using a validated objective structured assessment of technical skills (OSATS) rating scale. RESULTS Sixty-two participants were randomized to either the theory-based group (n = 31) or the practice-based group (n = 31). Total global and specific OSATS scores, as well as distance of cup application to the flexion point improved significantly from baseline test to the first post-training test in both groups (pall < 0.007). Skill deterioration after 4-8 weeks was only found in the theory-based group, whereas skills remained stable in the practice-based group. CONCLUSION A practice-based training program for conducting VAD results in comparable immediate improvement of skills compared to a theory-based training program, but the retention of skills 4-8 weeks after training is superior in a practice-based program. Future studies need to evaluate, whether VAD simulation training improves maternal and neonatal outcome after VAD.
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Affiliation(s)
- Julian Marschalek
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Lorenz Kuessel
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Maria Stammler-Safar
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Johannes Ott
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Heinrich Husslein
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
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29
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Muin DA, Neururer S, Rotter V, Leitner H, Leutgeb S, Husslein PW, Kiss H, Kohlberger P. Institutional guidelines on maternal care and investigations following antepartum stillbirth - a national survey. BMC Pregnancy Childbirth 2021; 21:528. [PMID: 34303351 PMCID: PMC8305903 DOI: 10.1186/s12884-021-03995-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 07/09/2021] [Indexed: 02/05/2023] Open
Abstract
Background Antepartum stillbirth, i.e., intrauterine fetal death (IUFD) above 24 weeks of gestation, occurs with a prevalence of 2.4–3.1 per 1000 live births in Central Europe. In order to ensure highest standards of treatment and identify causative and associated (risk) factors for fetal death, evidence-based guidelines on clinical practice in such events are recommended. Owing to a lack of a national guideline on maternal care and investigations following stillbirth, we, hereby, sought to assess the use of institutional guidelines and clinical practice after IUFD in Austrian maternity units. Methods A national survey with a paper-based 12-item questionnaire covering demographic variables, local facilities and practice, obstetrical care and routine post-mortem work-up following IUFD was performed among all Austrian secondary and tertiary referral hospitals with maternity units (n = 75) between January and July 2019. Statistical tests were conducted using Chi2 and Fisher’s Exact test, respectively. Univariate logistic regression analyses were performed to calculate odds ratio (OR) with a 95% confidence interval (CI). Results 46 (61.3%) obstetrical departments [37 (80.4%) secondary; 9 (19.6%) tertiary referral hospitals] participated in this survey, of which 17 (37.0%) have implemented an institutional guideline. The three most common investigations always conducted following stillbirth are placental histology (20.9%), fetal autopsy (13.1%) and maternal antibody screen (11.5%). Availability of an institutional guideline was not significantly associated with type of hospital, on-site pathology department, or institutional annual live and stillbirth rates. Post-mortem consultations only in cases of abnormal investigations following stillbirth were associated with lower odds for presence of such guideline [OR 0.133 (95% CI 0.018–0.978); p = 0.047]. 26 (56.5%) departments consider a national guideline necessary. Conclusions Less than half of the surveyed maternity units have implemented an institutional guideline on maternal care and investigations following antepartum stillbirth, independent of annual live and stillbirth rate or type of referral centre. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03995-z.
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Affiliation(s)
- Dana A Muin
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Sabrina Neururer
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Anichstraße 35, 6020, Innsbruck, Austria
| | - Veronika Rotter
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Hermann Leitner
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Anichstraße 35, 6020, Innsbruck, Austria
| | - Stephanie Leutgeb
- Austrian Society of Obstetrics and Gynecology, Frankgasse 8, 1090, Vienna, Austria
| | - Peter W Husslein
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Austrian Society of Obstetrics and Gynecology, Frankgasse 8, 1090, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Austrian Society of Obstetrics and Gynecology, Frankgasse 8, 1090, Vienna, Austria
| | - Petra Kohlberger
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Austrian Society of Obstetrics and Gynecology, Frankgasse 8, 1090, Vienna, Austria
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30
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Pereira AT, Schneider KH, Henriques PC, Grasl C, Melo SF, Fernandes IP, Kiss H, Martins MCL, Bergmeister H, Gonçalves IC. Graphene Oxide Coating Improves the Mechanical and Biological Properties of Decellularized Umbilical Cord Arteries. ACS Appl Mater Interfaces 2021; 13:32662-32672. [PMID: 34240610 DOI: 10.1021/acsami.1c04028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The lack of small-diameter vascular grafts (inner diameter <5 mm) to substitute autologous grafts in arterial bypass surgeries has a massive impact on the prognosis and progression of cardiovascular diseases, the leading cause of death globally. Decellularized arteries from different sources have been proposed as an alternative, but their poor mechanical performance and high collagen exposure, which promotes platelet and bacteria adhesion, limit their successful application. In this study, these limitations were surpassed for decellularized umbilical cord arteries through the coating of their lumen with graphene oxide (GO). Placental and umbilical cord arteries were decellularized and perfused with a suspension of GO (C/O ratio 2:1) with ∼1.5 μm lateral size. A homogeneous GO coating that completely covered the collagen fibers was obtained for both arteries, with improvement of mechanical properties being achieved for umbilical cord decellularized arteries. GO coating increased the maximum force in 27%, the burst pressure in 29%, the strain in 25%, and the compliance in 10%, compared to umbilical cord decellularized arteries. The achieved theoretical burst pressure (1960 mmHg) and compliance (13.9%/100 mmHg) are similar to the human saphenous vein and mammary artery, respectively, which are used nowadays as the gold standard in coronary and peripheral artery bypass surgeries. Furthermore, and very importantly, coatings with GO did not compromise the endothelial cell adhesion but decreased platelet and bacteria adhesion to decellularized arteries, which will impact on the prevention of thrombosis and infection, until full re-endothetialization is achieved. Overall, our results reveal that GO coating has an effective role in the improvement of decellularized umbilical cord artery performance, which is a huge step toward their application as a small-diameter vascular graft.
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Affiliation(s)
- Andreia T Pereira
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- INEB-Instituto de Engenharia Biomédica, Universidade do Porto, 4200-135 Porto, Portugal
- Center for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Karl H Schneider
- Center for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
- Ludwig Boltzmann Institute of Cardiovascular Research, 1090 Vienna, Austria
| | - Patrícia C Henriques
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- INEB-Instituto de Engenharia Biomédica, Universidade do Porto, 4200-135 Porto, Portugal
| | - Christian Grasl
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
| | - Sofia F Melo
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- INEB-Instituto de Engenharia Biomédica, Universidade do Porto, 4200-135 Porto, Portugal
| | - Inês P Fernandes
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- INEB-Instituto de Engenharia Biomédica, Universidade do Porto, 4200-135 Porto, Portugal
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - M Cristina L Martins
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- INEB-Instituto de Engenharia Biomédica, Universidade do Porto, 4200-135 Porto, Portugal
| | - Helga Bergmeister
- Center for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
- Ludwig Boltzmann Institute of Cardiovascular Research, 1090 Vienna, Austria
| | - Inês C Gonçalves
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- INEB-Instituto de Engenharia Biomédica, Universidade do Porto, 4200-135 Porto, Portugal
- ICBAS-Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
- FEUP-Faculdade de Engenharia da Universidade do Porto, 4200-465 Porto, Portugal
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Khalaveh F, Seidl R, Czech T, Reinprecht A, Gruber GM, Berger A, Kiss H, Prayer D, Kasprian G. Myelomeningocele-Chiari II malformation-Neurological predictability based on fetal and postnatal magnetic resonance imaging. Prenat Diagn 2021; 41:922-932. [PMID: 34124788 PMCID: PMC8361919 DOI: 10.1002/pd.5987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/18/2021] [Accepted: 05/30/2021] [Indexed: 12/13/2022]
Abstract
Objective This systematic comparison between pre‐ and postnatal imaging findings and postnatal motor outcome assesses the reliability of MRI accuracy in the prognostication of the future long‐term (mean, 11.4 years) ambulatory status in a historic group of postnatally repaired myelomeningocele (MMC) cases. Methods A retrospective, single‐center study of 34 postnatally repaired MMC patients was performed. We used fetal and postnatal magnetic resonance imaging (MRI) to compare the fetal and postnatal radiological lesion level to each other and to the postnatal ambulatory level as a standard of reference and analyzed Chiari II malformation characteristics. Results In 13/15 (87%) and 29/31 (94%) cases, the functional level was equal to or better than the prenatal and postnatal radiological lesion level. A radiological lesion level agreement within two segments could be achieved in 13/15 (87%) patients. A worse than expected functional level occurred in cases with Myelocele (2/3 patients), coexistent crowding of the posterior fossa (2/3 patients) and/or abnormal white matter architecture, represented by callosal dysgenesis (1/3 patients). In all patients (2/2) with a radiological disagreement of more than two segments, segmentation disorders and scoliosis were observed. Conclusion Fetal and postnatal MRI are predictive of the long‐term ambulatory status in postnatally repaired MMC patients.
What's already known about this topic?
Fetal and postnatal magnetic resonance imaging (MRI) show a good correlation in identifying the level of the myelomeningocele (MMC) lesion. Prenatal ultrasound (US) and fetal MRI show a comparable agreement, within two segments, in predicting the short‐term ambulatory status.
What does this study add?
Fetal and postnatal MRI have a good predictive value for the long‐term ambulatory status in patients with postnatal MMC closure. MMC patients with worse than expected ambulatory status showed signs of vermian displacement and corpus callosum dysgenesis. In MMC patients with spinal segmentation disorders and scoliosis, there was a major disagreement between fetal and postnatal MRI, specifically with regard to the MMC lesion level.
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Affiliation(s)
- Farjad Khalaveh
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Rainer Seidl
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Andrea Reinprecht
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Gerlinde Maria Gruber
- Division of Anatomy and Developmental Biology, Department of Anatomy und Biomechanics, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria.,Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Division of Neonatology, Pediatric Intensive Care & Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Daniela Prayer
- Department of Radiology, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Department of Radiology, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
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Rosta K, Mazzucato-Puchner A, Kiss H, Malik V, Mandl P, Petricevic L, Foessleitner P, Shafran I, Temsch W, Farr A. Vaginal microbiota in pregnant women with inflammatory rheumatic and inflammatory bowel disease: A matched case-control study. Mycoses 2021; 64:909-917. [PMID: 33884668 PMCID: PMC8360144 DOI: 10.1111/myc.13288] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Rheumatic diseases and vaginal infections both increase the risk of preterm birth. It is unclear whether pregnant women with rheumatic disease are more likely to experience vaginal infections, which might potentially accumulate modifiable risk factors. OBJECTIVE In this study, we sought to evaluate the vaginal microbiota of pregnant women with inflammatory rheumatic and inflammatory bowel disease. METHODS A total of 539 asymptomatic women with singleton pregnancy were routinely screened for an abnormal vaginal microbiota between 10 + 0 and 16 + 0 gestational weeks. Vaginal smears were Gram-stained and microscopically analysed. Those with inflammatory diseases (with or without immunomodulatory therapy) were assigned to the case group and matched in a 1:3 ratio to healthy pregnant controls. RESULTS Overall, an abnormal vaginal microbiota occurred more frequently among women of the case group, compared with those of the control group (33.8% vs 15.6%; 95% CI: 1.78-4.27, p < .001). In particular, Candida colonisation (22.3% vs 9.2%; 95% CI: 1.69-4.75, p < .001), but also bacterial vaginosis (14.9% vs 7.2%; 95% CI: 1.25-4.1, p = .006), occurred more often in the case than in the control group. No significant difference was found with regard to the occurrence of an abnormal vaginal microbiota between subgroups with and without immunomodulatory treatment (37.0% vs 27.1%; 95% CI: 0.29-1.35, p = .232). CONCLUSION Pregnant women with inflammatory rheumatic and inflammatory bowel disease are at risk for bacterial vaginosis and Candida colonisation, which might pose a risk for preterm birth. Prospective studies are needed to further evaluate the influence of autoimmune conditions and immunosuppressive therapy on the vaginal microbiota.
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Affiliation(s)
- Klara Rosta
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Veronika Malik
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Mandl
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Ljubomir Petricevic
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Philipp Foessleitner
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Inbal Shafran
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Wilhelm Temsch
- Section for Medical Statistics, Center of Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Alex Farr
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
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Schwartz E, Diogo MC, Glatter S, Seidl R, Brugger PC, Gruber GM, Kiss H, Nenning KH, Langs G, Prayer D, Kasprian G. The Prenatal Morphomechanic Impact of Agenesis of the Corpus Callosum on Human Brain Structure and Asymmetry. Cereb Cortex 2021; 31:4024-4037. [PMID: 33872347 DOI: 10.1093/cercor/bhab066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 11/14/2022] Open
Abstract
Genetic, molecular, and physical forces together impact brain morphogenesis. The early impact of deficient midline crossing in agenesis of the Corpus Callosum (ACC) on prenatal human brain development and architecture is widely unknown. Here we analyze the changes of brain structure in 46 fetuses with ACC in vivo to identify their deviations from normal development. Cases of complete ACC show an increase in the thickness of the cerebral wall in the frontomedial regions and a reduction in the temporal, insular, medial occipital and lateral parietal regions, already present at midgestation. ACC is associated with a more symmetric configuration of the temporal lobes and increased frequency of atypical asymmetry patterns, indicating an early morphomechanic effect of callosal growth on human brain development affecting the thickness of the pallium along a ventro-dorsal gradient. Altered prenatal brain architecture in ACC emphasizes the importance of conformational forces introduced by emerging interhemispheric connectivity on the establishment of polygenically determined brain asymmetries.
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Affiliation(s)
- Ernst Schwartz
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Sarah Glatter
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Rainer Seidl
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Peter C Brugger
- Center for Anatomy and Cell Biology, Medical University of Vienna, 1090 Vienna, Austria
| | - Gerlinde M Gruber
- Department of Anatomy and Biomechanics, Karl Landsteiner University of Health Sciences, 3500 Krems an der Donau, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
| | - Karl-Heinz Nenning
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Georg Langs
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Daniela Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
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Kienast P, Schwartz E, Diogo MC, Gruber GM, Brugger PC, Kiss H, Ulm B, Bartha-Doering L, Seidl R, Weber M, Langs G, Prayer D, Kasprian G. The Prenatal Origins of Human Brain Asymmetry: Lessons Learned from a Cohort of Fetuses with Body Lateralization Defects. Cereb Cortex 2021; 31:3713-3722. [PMID: 33772541 DOI: 10.1093/cercor/bhab042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/13/2021] [Accepted: 02/01/2021] [Indexed: 11/14/2022] Open
Abstract
Knowledge about structural brain asymmetries of human fetuses with body lateralization defects-congenital diseases in which visceral organs are partially or completely incorrectly positioned-can improve our understanding of the developmental origins of hemispheric brain asymmetry. This study investigated structural brain asymmetry in 21 fetuses, which were diagnosed with different types of lateralization defects; 5 fetuses with ciliopathies and 26 age-matched healthy control cases, between 22 and 34 gestational weeks of age. For this purpose, a database of 4007 fetal magnetic resonance imagings (MRIs) was accessed and searched for the corresponding diagnoses. Specific temporal lobe brain asymmetry indices were quantified using in vivo, super-resolution-processed MR brain imaging data. Results revealed that the perisylvian fetal structural brain lateralization patterns and asymmetry indices did not differ between cases with lateralization defects, ciliopathies, and normal controls. Molecular mechanisms involved in the definition of the right/left body axis-including cilium-dependent lateralization processes-appear to occur independently from those involved in the early establishment of structural human brain asymmetries. Atypically inverted early structural brain asymmetries are similarly rare in individuals with lateralization defects and may have a complex, multifactorial, and neurodevelopmental background with currently unknown postnatal functional consequences.
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Affiliation(s)
- Patric Kienast
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna 1090, Austria
| | - Ernst Schwartz
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna 1090, Austria
| | - Mariana C Diogo
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna 1090, Austria
| | - Gerlinde M Gruber
- Department of Anatomy and Biomechanics, Karl Landsteiner University of Health Sciences, Krems, Lower Austria 3500, Austria
| | - Peter C Brugger
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna 1090, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna 1090, Austria
| | - Barbara Ulm
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna 1090, Austria
| | - Lisa Bartha-Doering
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna 1090, Austria
| | - Rainer Seidl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna 1090, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna 1090, Austria
| | - Georg Langs
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna 1090, Austria
| | - Daniela Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna 1090, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna 1090, Austria
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Foessleitner P, Petricevic L, Boerger I, Steiner I, Kiss H, Rieger A, Touzeau‐Roemer V, Farr A. HIV infection as a risk factor for vaginal dysbiosis, bacterial vaginosis, and candidosis in pregnancy: A matched case-control study. Birth 2021; 48:139-146. [PMID: 33462893 PMCID: PMC8247846 DOI: 10.1111/birt.12526] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/26/2020] [Accepted: 12/28/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study aimed to evaluate the vaginal microbiota of HIV-positive pregnant women relative to HIV-negative controls, and to compare their risk of vaginal dysbiosis, bacterial vaginosis, and vulvovaginal candidosis (VVC). METHODS This is a nested matched case-control study that analyzed data from women who received pregnancy care at our center from 2003 to 2014. Women routinely underwent screening for asymptomatic vaginal infections using phase microscopy on Gram-stained smears. HIV-positive women were assigned to the case group, and HIV-negative women were assigned to the control group. Cases and controls were matched in a 1:4 ratio. Logistic regression was used to test whether HIV infection was associated with vaginal dysbiosis (Nugent score 4-6), BV (Nugent score 7-10), or VVC. RESULTS One hundred and twenty-seven women were assigned to the case group, and 4290 were assigned to the control group (including 508 matched controls). Dysbiosis or BV was found in 29.9% of the cases and 17.6% of the controls. Women in the case group had increased risk of vaginal dysbiosis or BV (odds ratio [OR] 2.09, 95% confidence interval [CI], 1.30-3.32, P = .002). The risk of VVC was also higher in the case group (OR 2.14, 95% CI, 1.22-3.77, P = .008). The incidence of preterm birth did not differ significantly between the groups (cases: 8.7%; controls: 10%, P = .887). CONCLUSIONS HIV-positive women are at risk of vaginal dysbiosis, BV, and VVC during pregnancy. As imbalances of the vaginal microbiota can lead to preterm birth, screening and treatment of HIV-positive pregnant women are warranted.
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Affiliation(s)
- Philipp Foessleitner
- Department of Obstetrics and GynecologyDivision of Obstetrics and Feto‐maternal MedicineMedical University of ViennaViennaAustria
| | - Ljubomir Petricevic
- Department of Obstetrics and GynecologyDivision of Obstetrics and Feto‐maternal MedicineMedical University of ViennaViennaAustria
| | - Isabell Boerger
- Department of Obstetrics and GynecologyDivision of Obstetrics and Feto‐maternal MedicineMedical University of ViennaViennaAustria
| | - Irene Steiner
- Center for Medical StatisticsInformatics and Intelligent Systems (IMS)Medical University of ViennaViennaAustria
| | - Herbert Kiss
- Department of Obstetrics and GynecologyDivision of Obstetrics and Feto‐maternal MedicineMedical University of ViennaViennaAustria
| | - Armin Rieger
- Department of DermatologyMedical University of ViennaViennaAustria
| | | | - Alex Farr
- Department of Obstetrics and GynecologyDivision of Obstetrics and Feto‐maternal MedicineMedical University of ViennaViennaAustria
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37
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Schneider KH, Rohringer S, Kapeller B, Grasl C, Kiss H, Heber S, Walter I, Teuschl AH, Podesser BK, Bergmeister H. Riboflavin-mediated photooxidation to improve the characteristics of decellularized human arterial small diameter vascular grafts. Acta Biomater 2020; 116:246-258. [PMID: 32871281 DOI: 10.1016/j.actbio.2020.08.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/27/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023]
Abstract
Vascular grafts with a diameter of less than 6 mm are made from a variety of materials and techniques to provide alternatives to autologous vascular grafts. Decellularized materials have been proposed as a possible approach to create extracellular matrix (ECM) vascular prostheses as they are naturally derived and inherently support various cell functions. However, these desirable graft characteristics may be limited by alterations of the ECM during the decellularization process leading to decreased biomechanical properties and hemocompatibility. In this study, arteries from the human placenta chorion were decellularized using two distinct detergents (Triton X-100 or SDS), which differently affect ECM ultrastructure. To overcome biomechanical strength loss and collagen fiber exposure after decellularization, riboflavin-mediated UV (RUV) crosslinking was used to uniformly crosslink the collagenous ECM of the grafts. Graft characteristics and biocompatibility with and without RUV crosslinking were studied in vitro and in vivo. RUV-crosslinked ECM grafts showed significantly improved mechanical strength and smoothening of the luminal graft surfaces. Cell seeding using human endothelial cells revealed no cytotoxic effects of the RUV treatment. Short-term aortic implants in rats showed cell migration and differentiation of host cells. Functional graft remodeling was evident in all grafts. Thus, RUV crosslinking is a preferable tool to improve graft characteristics of decellularized matrix conduits.
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Janjic N, Petricevic L, Foessleitner P, Rosicky I, Kiss H, Farr A. Behandlung von Frauen mit intermediärer vaginaler Mikrobiota mit vaginalen Probiotika und Lactobacillus casei rhamnosus (Lcr regenerans) zur Verbesserung des Schwangerschaftsoutcomes. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717184] [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: 10/23/2022] Open
Affiliation(s)
- N. Janjic
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
| | - L. Petricevic
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
| | - P. Foessleitner
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
| | - I. Rosicky
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
| | - H. Kiss
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
| | - A. Farr
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
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Foessleitner P, Farr A, Boerger I, Kiss H, Rieger A, Touzeau-Roemer V, Petricevic L. HIV als Risikofaktor für vaginale Infektionen während der Schwangerschaft. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717916] [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: 10/23/2022] Open
Affiliation(s)
- P Foessleitner
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
| | - A Farr
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
| | - I Boerger
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
| | - H Kiss
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
| | - A Rieger
- Medizinische Universität Wien, Universitätsklinik für Dermatologie
| | - V Touzeau-Roemer
- Medizinische Universität Wien, Universitätsklinik für Dermatologie
| | - L Petricevic
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
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Windsperger K, Kiss H, Oberaigner W, Leitner H, Binder F, Muin D, Fößleitner P, Husslein P, Farr A. Die vorherrschende Lichtverschmutzung erhöht das Risiko für ein schlechtes neonatales Outcome – eine retrospektive Kohortenstudie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717991] [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: 10/23/2022] Open
Affiliation(s)
- K Windsperger
- Medizinische Universität Wien, Frauenheilkunde, Geburtshilfe und feto-maternale Medizin
| | - H Kiss
- Medizinische Universität Wien, Frauenheilkunde, Geburtshilfe und feto-maternale Medizin
| | - W Oberaigner
- Institut für Public Health, Medical Decision Making und HTA
| | - H Leitner
- Institut für klinische Epidemiologie
| | | | - D Muin
- Medizinische Universität Wien, Frauenheilkunde, Geburtshilfe und feto-maternale Medizin
| | - P Fößleitner
- Medizinische Universität Wien, Frauenheilkunde, Geburtshilfe und feto-maternale Medizin
| | - P Husslein
- Medizinische Universität Wien, Frauenheilkunde, Geburtshilfe und feto-maternale Medizin
| | - A Farr
- Medizinische Universität Wien, Frauenheilkunde, Geburtshilfe und feto-maternale Medizin
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Sustr V, Petricevic L, Foessleitner P, Rosicky I, Kiss H, Farr A. Orale Probiotika bei Kolonisation mit vaginalen Gruppe B Streptokokken (GBS) in der Schwangerschaft: eine randomisierte placebo-kontrollierte Doppelblindstudie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717977] [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: 10/23/2022] Open
Affiliation(s)
- V Sustr
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
| | - L Petricevic
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
| | - P Foessleitner
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
| | - I Rosicky
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
| | - H Kiss
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
| | - A Farr
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
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Foessleitner P, Farr A, Boerger I, Kiss H, Rieger A, Touzeau-Roemer V, Petricevic L. HIV als Risikofaktor für vaginale Infektionen während der Schwangerschaft. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1713214] [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: 10/24/2022] Open
Affiliation(s)
- P Foessleitner
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien, Österreich
| | - A Farr
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien, Österreich
| | - I Boerger
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien, Österreich
| | - H Kiss
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien, Österreich
| | - A Rieger
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Österreich
| | - V Touzeau-Roemer
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Österreich
| | - L Petricevic
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien, Österreich
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Windsperger K, Kiss H, Oberaigner W, Leitner H, Binder F, Muin D, Fößleitner P, Husslein P, Farr A. Die vorherrschende Lichtverschmutzung in Österreich erhöht das Risiko für ein schlechtes neonatales Outcome – eine retrospektive Kohortenstudie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1713228] [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: 10/24/2022] Open
Affiliation(s)
- K Windsperger
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien, Österreich
| | - H Kiss
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien, Österreich
| | - W Oberaigner
- Department für Public Health, Versorgungsforschung und HTA, Institut für Public Health, Medical Decision Making und HTA, UMIT, Hall i. T., Österreich
| | - H Leitner
- Institut für Klinische Epidemiologie, Tirol Kliniken, Innsbruck, Österreich
| | - F Binder
- Institut für Klinische Epidemiologie, Tirol Kliniken, Innsbruck, Österreich
| | - D Muin
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien, Österreich
| | - P Fößleitner
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien, Österreich
| | - P Husslein
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien, Österreich
| | - A Farr
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien, Österreich
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Sustr V, Petricevic L, Foessleitner P, Rosicky I, Kiss H, Farr A. Orale Probiotika bei Kolonisation mit vaginalen Gruppe B Streptokokken (GBS) in der Schwangerschaft: eine randomisierte placebo-kontrollierte Doppelblindstudie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1713203] [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: 10/24/2022] Open
Affiliation(s)
- V Sustr
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien
| | - L Petricevic
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien
| | - P Foessleitner
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien
| | - I Rosicky
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien
| | - H Kiss
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien
| | - A Farr
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien
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Janjic N, Petricevic L, Foessleitner P, Rosicky I, Kiss H, Farr A. Behandlung von Frauen mit intermediärer vaginaler Mikrobiota mit vaginalen Probiotika und Lactobacillus casei rhamnosus (Lcr regenerans) zur Verbesserung des Schwangerschaftsoutcomes. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1713202] [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: 10/24/2022] Open
Affiliation(s)
- N Janjic
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien
| | - L Petricevic
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien
| | - P Foessleitner
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien
| | - I Rosicky
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien
| | - H Kiss
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien
| | - A Farr
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien
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Foessleitner P, Gasser J, Kiss H, Flunt A, Presterl E, Petricevic L, Farr A. Vaginal colonization of extended-spectrum beta-lactamase-producing bacteria during pregnancy: An observational study. Eur J Obstet Gynecol Reprod Biol 2020; 246:86-89. [DOI: 10.1016/j.ejogrb.2020.01.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 02/04/2023]
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Diogo MC, Glatter S, Binder J, Kiss H, Prayer D. The MRI spectrum of congenital cytomegalovirus infection. Prenat Diagn 2020; 40:110-124. [PMID: 31802515 PMCID: PMC7027449 DOI: 10.1002/pd.5591] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/16/2019] [Accepted: 10/07/2019] [Indexed: 01/01/2023]
Abstract
Human cytomegalovirus (CMV) is an ubiquitous pathogen, with a high worldwide seroprevalence. When acquired in the prenatal period, congenital CMV (cCMV) is a major cause of neurodevelopmental sequelae and hearing loss. cCMV remains an underdiagnosed condition, with no systematic screening implemented in pregnancy or in the postnatal period. Therefore, imaging takes a prominent role in prenatal diagnosis of cCMV. With the prospect of new viable therapies, accurate and timely diagnosis becomes paramount, as well as identification of fetuses at risk for neurodevelopmental sequelae. Fetal magnetic resonance imaging (MRI) provides a complementary method to ultrasound (US) in fetal brain and body imaging. Anterior temporal lobe lesions are the most specific finding, and MRI is superior to US in their detection. Other findings such as ventriculomegaly, cortical malformations and calcifications, as well as hepatosplenomegaly, liver signal changes and abnormal effusions are unspecific. However, when seen in combination these should raise the suspicion of fetal infection, highlighting the need for a full fetal assessment. Still, some fetuses deemed normal on prenatal imaging are symptomatic at birth or develop delayed cCMV-associated symptoms, leaving room for improvement of diagnostic tools. Advanced MR sequences may help in this field and in determining prognosis, but further studies are needed.
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Affiliation(s)
- Mariana C. Diogo
- Department of Image Guided TherapyUniversity Clinic for Neuroradiology and Musculoskeletal Radiology, Medical University of ViennaViennaAustria
| | - Sarah Glatter
- Department of Image Guided TherapyUniversity Clinic for Neuroradiology and Musculoskeletal Radiology, Medical University of ViennaViennaAustria
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Julia Binder
- Department of Obstetrics and GynecologyMedical University of ViennaViennaAustria
| | - Herbert Kiss
- Department of Obstetrics and GynecologyMedical University of ViennaViennaAustria
| | - Daniela Prayer
- Department of Image Guided TherapyUniversity Clinic for Neuroradiology and Musculoskeletal Radiology, Medical University of ViennaViennaAustria
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Foessleitner P, Just U, Kiss H, Farr A. Pyoderma gangraenosum nach Sectio: ein Fallbericht. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1693872] [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: 10/26/2022] Open
Affiliation(s)
- P Foessleitner
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien, Österreich
| | - U Just
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Österreich
| | - H Kiss
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien, Österreich
| | - A Farr
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien, Österreich
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Abstract
Pyoderma gangrenosum is a neutrophilic skin disease that leads to extensive, painful, necrotic ulcerations, particularly at surgical sites. As obstetric cases with pyoderma gangrenosum are rare and, therefore, often misdiagnosed initially, it is important to raise awareness about this rare complication. Here, we describe a patient who presented with pyoderma gangrenosum at the surgical site 4 days after undergoing a caesarean section. The erythema was initially misdiagnosed as wound infection, and the patient, who was experiencing pain, underwent antibiotic treatment and surgical wound debridement. When the wound was unresponsive to these treatments, a dermatologist was consulted who suspected pyoderma gangrenosum and began a high-dose corticosteroids therapy, which led to a fulminant improvement of the local wound. In conclusion, the rare diagnosis of pyoderma gangrenosum should be considered in the differential diagnosis of a suspected surgical wound infection. Early interdisciplinary treatment is essential to avoid further complications.
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Affiliation(s)
- Philipp Foessleitner
- Department of Obstetrics and Gynecology, Medizinische Universität Wien, Vienna, Austria
| | - Ulrike Just
- Department of Dermatology, Medizinische Universitat Wien, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Medizinische Universität Wien, Vienna, Austria
| | - Alex Farr
- Department of Obstetrics and Gynecology, Medizinische Universität Wien, Vienna, Austria
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Holzer I, Husslein PW, Bettelheim D, Scheidl J, Kiss H, Farr A. Value of increased nuchal translucency in the era of noninvasive prenatal testing with cell-free DNA. Int J Gynaecol Obstet 2019; 145:319-323. [PMID: 30901484 DOI: 10.1002/ijgo.12808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/12/2018] [Accepted: 03/20/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the value of increased nuchal translucency (NT) at first-trimester screening (FTS) despite the superiority of noninvasive prenatal testing with cell-free DNA (cfDNA) for the detection of fetal aneuploidies. METHODS Retrospective analysis of all FTS data from 2005 to 2015 in our department. Only cases with increased NT and euploid karyotype were considered eligible for inclusion. Abnormal findings, diagnostic work-up, and perinatal outcomes were assessed. RESULTS Of 18 084 FTS results, 460 (2.5%) showed increased fetal NT, of which 242 (52.6%) underwent invasive karyotyping and 179 (74.0%) had an aneuploidy. Of the remaining 63 cases, 61 (96.8%) showed an additional sonographic finding at FTS and25 (78.1%) had a major anomaly at the second trimester organ scan. The outcome was termination of pregnancy in 28 (44.4%) cases, fetal demise in 5 (7.9%), delivery of an infant with malformation in 21 (33.3%), and delivery of a healthy infant in 7 (11.1%) cases. CONCLUSION All cases with increased NT would have been detected by cfDNA or by a major sonographic anomaly not later than the second trimester. Routine use of cfDNA, a basic sonogram, and an organ scan could reduce unnecessary work-up and anxiety.
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Affiliation(s)
- Iris Holzer
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Peter W Husslein
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Dieter Bettelheim
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Julia Scheidl
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Herbert Kiss
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Alex Farr
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
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