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Vignola S, Donadono V, Cavalli C, Azzaretto V, Casagrandi D, Pandya P, Napolitano R. Use of focus point for plane acquisition to improve reproducibility in fetal biometry. Ultrasound Obstet Gynecol 2024; 63:237-242. [PMID: 37519218 DOI: 10.1002/uog.27436] [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] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/24/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To assess the reproducibility of ultrasound measurements of fetal biometry using a 'focus point' to assist the acquisition of the relevant plane. METHODS This was a study of 80 women with a singleton non-anomalous pregnancy who attended University College London Hospital, London, UK, between 18 and 37 weeks' gestation. Planes to measure head circumference (HC), abdominal circumference (AC) and femur length (FL) were obtained four times by two different sonographers with different levels of experience, who were blinded to one another; the first set of images was obtained with reference to a standard image, and the second set of images was obtained using the focus point technique. The focus point was defined as a unique fetal anatomical landmark in each plane (cavum septi pellucidi for HC, two-thirds of the umbilical vein for AC and one of the two extremities of the diaphysis for FL). Once identified, the focus point was maintained in view while the sonographer rotated the probe along three axes (x, y, z) to acquire the relevant plane. Sonographers were either in training or had > 3000 scans worth of experience. Intra- and interobserver reproducibility were assessed using Bland-Altman plots, and absolute values and percentages for mean difference and 95% limits of agreement (LoA) were reported. RESULTS Overall reproducibility was good, with all 95% LoA < 8%. Reproducibility was improved by use of the focus point compared with the standard technique for both intraobserver comparison (95% LoA, < 4% vs < 6%) and interobserver comparison (95% LoA, < 7% vs < 8%). These findings were independent of sonographer seniority and plane acquired. CONCLUSIONS Reproducibility of fetal biometry assessment is improved with use of the focus point for plane acquisition, regardless of sonographer experience. We propose that this method should be implemented in clinical practice and training programs in fetal biometry. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Vignola
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - V Donadono
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - C Cavalli
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
- ASTT Spedali Civili, Brescia, Italy
| | - V Azzaretto
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
- ASTT Spedali Civili, Brescia, Italy
| | - D Casagrandi
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - P Pandya
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - R Napolitano
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
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Peasley R, Rangel LAA, Casagrandi D, Donadono V, Willinger M, Conti G, Seminara Y, Marlow N, David AL, Attilakos G, Pandya P, Zaikin A, Peebles D, Napolitano R. Management of late-onset fetal growth restriction: pragmatic approach. Ultrasound Obstet Gynecol 2023; 62:106-114. [PMID: 36864542 DOI: 10.1002/uog.26190] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVES There is limited prospective evidence to guide the management of late-onset fetal growth restriction (FGR) and its differentiation from small-for-gestational age. The aim of this study was to assess prospectively a novel protocol in which ultrasound criteria were used to classify women with suspected late FGR into two groups: those at low risk, who were managed expectantly until the anticipated date of delivery, and those at high risk, who were delivered soon after 37 weeks of gestation. We also compared the outcome of this prospective cohort with that of a historical cohort of women presenting similarly with suspected late FGR, in order to evaluate the impact of the new protocol. METHODS This was a prospective study of women with a non-anomalous singleton pregnancy at ≥ 32 weeks' gestation attending a tertiary hospital in London, UK, between February 2018 and September 2019, with estimated fetal weight (EFW) ≤ 10th centile, or EFW > 10th centile in addition to a decrease in fetal abdominal circumference of ≥ 50 centiles compared with a previous scan, umbilical artery Doppler pulsatility index > 95th centile or cerebroplacental ratio < 5th centile. Women were classified as low or high risk based on ultrasound and Doppler criteria. Women in the low-risk group were delivered by 41 weeks of gestation, unless they subsequently met high-risk criteria, whereas women in the high-risk group (EFW < 3rd centile, umbilical artery Doppler pulsatility index > 95th centile or EFW between 3rd and 10th centiles (inclusive) with abdominal circumference drop or abnormal Dopplers) were delivered at or soon after 37 weeks. The primary outcome was adverse neonatal outcome and included hypothermia, hypoglycemia, neonatal unit admission, jaundice requiring treatment, suspected infection, feeding difficulties, 1-min Apgar score < 7, hospital readmission and any severe adverse neonatal outcome (perinatal death, resuscitation using inotropes or mechanical ventilation, 5-min Apgar score < 7, metabolic acidosis, sepsis, and cerebral, cardiac or respiratory morbidity). Secondary outcomes were adverse maternal outcome (operative delivery for abnormal fetal heart rate) and severe adverse neonatal outcome. Women managed according to the new protocol were compared with a historical cohort of 323 women delivered prior to the implementation of the new protocol, for whom management was guided by individual clinician expertise. RESULTS Over 18 months, 321 women were recruited to the prospective cohort, of whom 156 were classified as low risk and 165 were high risk. Adverse neonatal outcome was significantly less common in the low-risk compared with the high-risk group (45% vs 58%; adjusted odds ratio (aOR), 0.6 (95% CI, 0.4-0.9); P = 0.022). There was no significant difference in the rate of adverse maternal outcome (18% vs 24%; aOR, 0.7 (95% CI, 0.4-1.2); P = 0.142) or severe adverse neonatal outcome (3.8% vs 8.5%; aOR, 0.5 (95% CI, 0.2-1.3); P = 0.153) between the low- and high-risk groups. Compared with women in the historical cohort classified retrospectively as low risk, low-risk women managed under the new protocol had a lower rate of adverse neonatal outcome (45% vs 58%; aOR, 0.6 (95% CI, 0.4-0.9); P = 0.026). CONCLUSIONS Appropriate risk stratification to guide management of late FGR was associated with a reduced rate of adverse neonatal outcome in low-risk pregnancies. In clinical practice, a policy of expectantly managing women with a low-risk late-onset FGR pregnancy at term could improve neonatal and long-term development. Randomized controlled trials are needed to assess the effect of an evidence-based conservative management protocol for late FGR on perinatal morbidity and mortality and long-term neurodevelopment. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Peasley
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
| | - L A Abrego Rangel
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
- Department of Mathematics, University College London, London, UK
| | - D Casagrandi
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
| | - V Donadono
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Willinger
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
| | - G Conti
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
| | - Y Seminara
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
| | - N Marlow
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - A L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, University College London, London, UK
| | - G Attilakos
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
| | - P Pandya
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Zaikin
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
- Department of Mathematics, University College London, London, UK
| | - D Peebles
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, University College London, London, UK
| | - R Napolitano
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
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Familiari A, Napolitano R, Visser GHA, Lees C, Wolf H, Prefumo F. Antenatal corticosteroids and perinatal outcome in late fetal growth restriction: analysis of prospective cohort. Ultrasound Obstet Gynecol 2023; 61:191-197. [PMID: 36412975 PMCID: PMC10108243 DOI: 10.1002/uog.26127] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the role of antenatal administration of corticosteroids for fetal lung maturation on the short-term perinatal outcome of pregnancy complicated by late fetal growth restriction (FGR). METHODS This cohort study was a secondary analysis of a multicenter prospective observational study, the TRUFFLE-2 feasibility study, conducted between 2017 and 2018 in 33 European perinatal centers. The study included women with a singleton pregnancy from 32 + 0 to 36 + 6 weeks of gestation with a fetus considered at risk for FGR, defined as estimated fetal weight (EFW) and/or fetal abdominal circumference < 10th percentile, or umbilicocerebral ratio (UCR) ≥ 95th percentile or a drop of more than 40 percentile points in abdominal circumference measurement from the 20-week scan. For the purposes of the current study, we identified women who received a single course of steroids to improve fetal lung maturation before delivery. Each exposed pregnancy was matched with one that did not receive antenatal corticosteroids (ACS) (control), based on gestational age at delivery and birth weight. The primary adverse outcome was a composite of abnormal condition at birth, major neonatal morbidity or perinatal death. RESULTS A total of 86 pregnancies that received ACS were matched to 86 controls. The two groups were similar with respect to gestational age (33.1 vs 33.3 weeks), EFW (1673 vs 1634 g) and UCR (0.68 vs 0.62) at inclusion, and gestational age at delivery (35.5 vs 35.9 weeks) and birth weight (1925 vs 1948 g). No significant differences were observed between the exposed and non-exposed groups in the incidence of composite adverse outcome (28% vs 24%; P = 0.73) or any of its elements. CONCLUSION The present data do not show a beneficial effect of steroids on short-term outcome of fetuses with late FGR. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A. Familiari
- Department of Woman and Child Health and Public HealthFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - R. Napolitano
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonUK
- Fetal Medicine UnitUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - G. H. A. Visser
- Department of ObstetricsUniversity Medical CenterUtrechtThe Netherlands
| | - C. Lees
- Centre for Fetal Care, Department of Obstetrics and GynaecologyQueen Charlotte's and Chelsea Hospital, Imperial College LondonLondonUK
| | - H. Wolf
- Department of Obstetrics and GynecologyAmsterdam University Medical Center (Location AMC), University of AmsterdamAmsterdamThe Netherlands
| | - F. Prefumo
- Obstetrics and Gynecology UnitIRCCS Istituto Giannina GasliniGenoaItaly
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Mylrea-Foley B, Wolf H, Stampalija T, Lees C, Arabin B, Berger A, Bergman E, Bhide A, Bilardo CM, Breeze AC, Brodszki J, Calda P, Cetin I, Cesari E, Derks J, Ebbing C, Ferrazzi E, Ganzevoort W, Frusca T, Gordijn SJ, Gyselaers W, Hecher K, Klaritsch P, Krofta L, Lindgren P, Lobmaier SM, Marlow N, Maruotti GM, Mecacci F, Myklestad K, Napolitano R, Prefumo F, Raio L, Richter J, Sande RK, Thornton J, Valensise H, Visser GHA, Wee L. Longitudinal Doppler Assessments in Late Preterm Fetal Growth Restriction. Ultraschall Med 2023; 44:56-67. [PMID: 34768305 DOI: 10.1055/a-1511-8293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE To assess the longitudinal variation of the ratio of umbilical and cerebral artery pulsatility index (UCR) in late preterm fetal growth restriction (FGR). MATERIALS AND METHODS A prospective European multicenter observational study included women with a singleton pregnancy, 32+ 0-36+ 6, at risk of FGR (estimated fetal weight [EFW] or abdominal circumference [AC] < 10th percentile, abnormal arterial Doppler or fall in AC from 20-week scan of > 40 percentile points). The primary outcome was a composite of abnormal condition at birth or major neonatal morbidity. UCR was categorized as normal (< 0.9) or abnormal (≥ 0.9). UCR was assessed by gestational age at measurement interval to delivery, and by individual linear regression coefficient in women with two or more measurements. RESULTS 856 women had 2770 measurements; 696 (81 %) had more than one measurement (median 3 (IQR 2-4). At inclusion, 63 (7 %) a UCR ≥ 0.9. These delivered earlier and had a lower birth weight and higher incidence of adverse outcome (30 % vs. 9 %, relative risk 3.2; 95 %CI 2.1-5.0) than women with a normal UCR at inclusion. Repeated measurements after an abnormal UCR at inclusion were abnormal again in 67 % (95 %CI 55-80), but after a normal UCR the chance of finding an abnormal UCR was 6 % (95 %CI 5-7 %). The risk of composite adverse outcome was similar using the first or subsequent UCR values. CONCLUSION An abnormal UCR is likely to be abnormal again at a later measurement, while after a normal UCR the chance of an abnormal UCR is 5-7 % when repeated weekly. Repeated measurements do not predict outcome better than the first measurement, most likely due to the most compromised fetuses being delivered after an abnormal UCR.
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Affiliation(s)
- Bronacha Mylrea-Foley
- Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London W12 0HS
| | - Hans Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Christoph Lees
- Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London W12 0HS
- Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium
| | - B Arabin
- Department of Obstetrics Charite, Humboldt University Berlin and Clara Angela Foundation, Berlin, Germany
| | - A Berger
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - E Bergman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - C M Bilardo
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, location VUMC, Amsterdam, The Netherlands
| | - A C Breeze
- Fetal Medicine Unit, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Brodszki
- Department of Pediatric Surgery and Neonatology, Lund University, Skane University Hospital, Lund, Sweden
| | - P Calda
- Department of Obstetrics and Gynaecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - I Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - E Cesari
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - J Derks
- Department of Perinatal Medicine, University of Utrecht, Utrecht, The Netherlands
| | - C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - E Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - T Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - S J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Gyselaers
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Diepenbeek, Belgium, Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk and Department Physiology, Hasselt University, Diepenbeek, Belgium
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - P Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - L Krofta
- Institute for the Care of Mother and Child, Prague, Czech Republic and Third Medical Faculty, Charles University, Prague, Czech Republic
| | - P Lindgren
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - S M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - N Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - G M Maruotti
- Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples 'Federico II', Naples, Italy
| | - F Mecacci
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | | | - R Napolitano
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - F Prefumo
- Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - L Raio
- Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland
| | - J Richter
- Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium
| | - R K Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - J Thornton
- School of Clinical Sciences, University of Nottingham, Division of Obstetrics and Gynaecology, Maternity Department, City Hospital, Nottingham, UK
| | - H Valensise
- Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata, University, Policlinico Casilino Hospital, Rome, Italy
| | - G H A Visser
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - L Wee
- The Princess Alexandra Hospital NHS Trust, Harlow, UK
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Coutinho CM, Sotiriadis A, Odibo A, Khalil A, D'Antonio F, Feltovich H, Salomon LJ, Sheehan P, Napolitano R, Berghella V, da Silva Costa F. ISUOG Practice Guidelines: role of ultrasound in the prediction of spontaneous preterm birth. Ultrasound Obstet Gynecol 2022; 60:435-456. [PMID: 35904371 DOI: 10.1002/uog.26020] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 05/15/2023]
Affiliation(s)
- C M Coutinho
- Department of Gynecology and Obstetrics, Clinics Hospital, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Odibo
- Washington University School of Medicine, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, St Louis, MO, USA
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - F D'Antonio
- Center for Fetal Care and High Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - H Feltovich
- Fetal Ultrasound, Intermountain Healthcare, Salt Lake City, UT, USA
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, France
| | - P Sheehan
- Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - R Napolitano
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - V Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - F da Silva Costa
- Maternal Fetal Medicine Unit, Gold Coast University Hospital and School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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Banerjee A, Al‐Dabbach Z, Bredaki FE, Casagrandi D, Tetteh A, Greenwold N, Ivan M, Jurkovic D, David AL, Napolitano R. Reproducibility of assessment of full-dilatation Cesarean section scar in women undergoing second-trimester screening for preterm birth. Ultrasound Obstet Gynecol 2022; 60:396-403. [PMID: 35809243 PMCID: PMC9545619 DOI: 10.1002/uog.26027] [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] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/27/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess the reproducibility of a standardized method of measuring the Cesarean section (CS) scar, CS scar niche and their position relative to the internal os of the uterine cervix by transvaginal ultrasound in pregnant women with a previous full-dilatation CS. METHODS This was a prospective, single-center reproducibility study on women with a singleton pregnancy and a previous full-dilatation CS who underwent transvaginal ultrasound assessment of cervical length and CS scar characteristics at 14-24 weeks' gestation. The CS scar was identified as a hypoechogenic linear discontinuity of the myometrium at the anterior wall of the lower uterine segment or cervix. The CS scar niche was identified as an indentation at the site of the scar with a depth of at least 2 mm. The CS scar position was evaluated by measuring the distance to the internal cervical os. CS scar niche parameters, including its length, depth, width, and residual and adjacent myometrial thickness, were assessed in the sagittal and transverse planes. Qualitative reproducibility was assessed by agreement regarding visibility of the CS scar and niche. Quantitative reproducibility of CS scar measurements was assessed using three sets of images: (1) real-time two-dimensional (2D) images (real-time acquisition and caliper placement on 2D images by two operators), (2) offline 2D still images (offline caliper placement by two operators on stored 2D images acquired by one operator) and (3) three-dimensional (3D) volume images (volume manipulation and caliper placement on 2D images extracted by two operators). Agreement on CS scar visibility and the presence of a niche was analyzed using kappa coefficients. Intraobserver and interobserver reproducibility of quantitative measurements was assessed using Bland-Altman plots. RESULTS To achieve the desired statistical power, 72 women were recruited. The CS scar was visualized in > 80% of images. Interobserver agreement for scar visualization and presence of a niche in real-time 2D images was excellent (kappa coefficients of 0.84 and 0.85, respectively). Overall, reproducibility was higher for real-time 2D and offline 2D still images than for 3D volume images. The 95% limits of agreement (LOA) for intraobserver reproducibility were between ± 1.1 and ± 3.6 mm for all sets of images; the 95% LOA for interobserver reproducibility were between ± 2.0 and ± 6.3 mm. Measurement of the distance from the CS scar to the internal cervical os was the most reproducible 2D measurement (intraobserver and interobserver 95% LOA within ± 1.6 and ± 2.7 mm, respectively). Overall, niche measurements were the least reproducible measurements (intraobserver 95% LOA between ± 1.6 and ± 3.6 mm; interobserver 95% LOA between ± 3.1 and ± 6.3 mm). There was no consistent difference between measurements obtained by reacquisition of 2D images (planes obtained twice and caliper placed), caliper placement on 2D stored images or volume manipulation (planes obtained twice and caliper placed). CONCLUSIONS The CS scar position and scar niche in pregnant women with a previous full-dilatation CS can be assessed in the second trimester of a subsequent pregnancy using either 2D or 3D volume ultrasound imaging with a high level of reproducibility. Overall, the most reproducible CS scar parameter is the distance from the CS scar to the internal cervical os. The method proposed in this study should enable clinicians to assess the CS scar reliably and may help predict pregnancy outcome. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A. Banerjee
- Fetal Medicine Unit, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
- Elizabeth Garrett Anderson Institute for Women's Health, University College LondonLondonUK
| | - Z. Al‐Dabbach
- Fetal Medicine Unit, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
| | - F. E. Bredaki
- Fetal Medicine Unit, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
| | - D. Casagrandi
- Fetal Medicine Unit, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
- Elizabeth Garrett Anderson Institute for Women's Health, University College LondonLondonUK
| | - A. Tetteh
- Fetal Medicine Unit, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
| | - N. Greenwold
- Fetal Medicine Unit, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
| | - M. Ivan
- Fetal Medicine Unit, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
- Elizabeth Garrett Anderson Institute for Women's Health, University College LondonLondonUK
| | - D. Jurkovic
- Elizabeth Garrett Anderson Institute for Women's Health, University College LondonLondonUK
- Department of GynaecologyElizabeth Garrett Anderson Wing, University College London HospitalLondonUK
| | - A. L. David
- Fetal Medicine Unit, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
- Elizabeth Garrett Anderson Institute for Women's Health, University College LondonLondonUK
- National Institute for Health Research, University College London Hospitals Biomedical Research CentreLondonUK
| | - R. Napolitano
- Fetal Medicine Unit, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
- Elizabeth Garrett Anderson Institute for Women's Health, University College LondonLondonUK
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Arrichiello G, Martinelli E, Troiani T, Incoronato P, Nacca V, Paragliola F, Napolitano R, Suarato G, Nicastro A, Perrone A. P-127 Multi-institutional analysis of real-world activity and safety of trifluridine/tipiracil plus bevacizumab in patients with refractory metastatic colorectal cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.217] [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: 11/29/2022] Open
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Napolitano R, Tonti E, Cifariello F, Sabater-Cruz N, Spadea L. Improving keratoconus management with central cor neal regularization and corneal collagen cross-linking protocol treatment. Clin Ter 2022; 173:274-279. [PMID: 35612343 DOI: 10.7417/ct.2022.2431] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE To evaluate safety and efficacy of customized central corneal regularization (CCR), together with simultaneous accelerated corneal collagen cross-linking (A-CXL) - CCR-CXL protocol, to treat keratoconus-related corneal ectasia. DESIGN Retrospective, comparative observational case series. METHODS Patients that had undergone combined CCR-CXL protocol. Main inclusion criteria were keratoconus visual acuity deterioration and contact lens intolerance. All patients underwent complete ophthalmological evaluation, corrected distance visual acuity (CDVA) and Scheimpflug-corneal tomography. Central corneal regularization was performed by ablation using flying spot laser. Subsequently, the stroma was saturated with 0.17% riboflavin-5-phosphate added every 2 minutes, followed by A-CXL 9 mW/cm2 for 10 minutes. CDVA, medium keratometry value (Kmed), and total corneal morphological irregularity index (CMI) of patients were analyzed before surgery and after 1, 3 and 12 months. A P value of .05 or less was considered statistically significant. RESULTS 46 eyes of 39 keratoconus patients were treated. At 1 month, the mean CDVA (LogMar) increased from 0.19 ± 0.02 to 0.12 ± 0.02 (P < .05), and the difference remained stable at month 12. Kmax decrease was statistically significant from 57.02 ± 5.65 to 50.21 ± 4.48 (P < .05). CMI decreased significantly from 47.8 ± 2.84 to 30.1 ± 2.4 (P < .01). CONCLUSIONS CCR-CXL protocol is safe and effective in arresting keratectasia progression and increasing corneal optic regularity in keratoconus. These findings showed a significant improvement in CDVA, keratometry values and corneal optical aberrations after being treated with the CCR-CXL protocol.
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Affiliation(s)
- R Napolitano
- Eye Clinic, Policlinico Umberto 1, "Sapienza" University of Rome, Italy
| | - E Tonti
- Eye Clinic, Policlinico Umberto 1, "Sapienza" University of Rome, Italy
| | | | | | - L Spadea
- Eye Clinic, Policlinico Umberto 1, "Sapienza" University of Rome, Italy
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Yulia A, Napolitano R, Aiman A, Desai D, Johal N, Whitten M, Ushakov F, Pandya PP, Winyard PJD. Perinatal and infant outcome of fetuses with prenatally diagnosed hyperechogenic kidneys. Ultrasound Obstet Gynecol 2021; 57:953-958. [PMID: 32530118 DOI: 10.1002/uog.22121] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/18/2020] [Accepted: 05/29/2020] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Hyperechogenic kidneys are a relatively rare antenatal finding, which can generate significant parental anxiety due to uncertain prognosis. We report on the perinatal and infant outcomes of a large cohort of fetuses with antenatally diagnosed hyperechogenic kidneys. METHODS This was a retrospective analysis of all cases diagnosed prenatally with hyperechogenic kidneys between 2002 and 2017 in a large tertiary fetal medicine unit. Hyperechogenicity was defined as kidney parenchyma with greater echogenicity than that of the liver. Pregnancy, pathological and postnatal outcomes were collected from hospital and general practitioner records up to 1 year of age. Abnormal renal outcome was defined as elevated creatinine beyond 6 months of age, hypertension requiring medication or major kidney surgery, such as nephrectomy. Severe abnormal renal outcome was defined as the need for dialysis or kidney transplant at any stage. RESULTS Three-hundred and sixteen fetuses with hyperechogenic kidneys were identified at a mean gestational age of 21 (range, 13-37) weeks. The majority of cases (97%) had bilateral hyperechogenic kidneys. In the 265 cases with available follow-up data, other associated renal tract abnormalities were identified prenatally in 36%, concomitant extrarenal structural abnormalities in 39% and abnormal karyotype in 15% of cases. Of the 316 included cases, 139 did not survive, including 105 terminations of pregnancy, five intrauterine deaths and 29 early neonatal deaths. Only 4.3% (6/139) of these fetuses had isolated hyperechogenic kidneys while 28.1% (39/139) had associated multiple renal tract abnormalities alongside hyperechogenic kidneys and over two-thirds (67.6%; 94/139) had concomitant extrarenal abnormalities. Of the 177 cases that survived beyond 1 month of age, outcome data were available in 126. Of these, based on the antenatal findings, 60 (47.6%) cases had isolated hyperechogenic kidneys, 56 (44.4%) had associated renal structural abnormalities and 10 (7.9%) had additional extrarenal abnormalities. Considering renal outcome alone, kidney function was abnormal in 13 (21.7%), 10 (17.9%) and 0 (0%) infants in these three groups, respectively, although concurrent pathology clearly affected global outcome in the more complex cases. Neonatal mortality of 1.6% was observed in the isolated renal hyperechogenicity group. The presence of oligohydramnios or abnormal renal volume was not associated significantly with abnormal renal function (odds ratio (OR), 2.32 (99% CI, 0.54-10.02) and OR, 0.74 (99% CI, 0.21-2.59), respectively) in this group. CONCLUSIONS Hyperechogenic kidneys are often complicated by associated renal tract and extrarenal abnormalities, aberrant karyotype and genetic disease, and these factors have a greater effect on overall outcome than does kidney echogenicity. The renal outcome of fetuses with isolated hyperechogenic kidneys is good generally, with over 70% of cases having normal renal function postpartum. Importantly, for prognostic counseling, all of the fetuses in this non-selected series with isolated hyperechogenic kidneys and normal amniotic fluid levels had normal renal outcome in infancy. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Yulia
- Fetal Medicine Unit, University College London Hospital, London, UK
| | - R Napolitano
- Fetal Medicine Unit, University College London Hospital, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - A Aiman
- Fetal Medicine Unit, University College London Hospital, London, UK
| | - D Desai
- Urology Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - N Johal
- Urology Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - M Whitten
- Fetal Medicine Unit, University College London Hospital, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - F Ushakov
- Fetal Medicine Unit, University College London Hospital, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - P P Pandya
- Fetal Medicine Unit, University College London Hospital, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - P J D Winyard
- Nephro-Urology Group, Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK
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Rodriguez-Sibaja MJ, Villar J, Ohuma EO, Napolitano R, Heyl S, Carvalho M, Jaffer YA, Noble JA, Oberto M, Purwar M, Pang R, Cheikh Ismail L, Lambert A, Gravett MG, Salomon LJ, Drukker L, Barros FC, Kennedy SH, Bhutta ZA, Papageorghiou AT. Fetal cerebellar growth and Sylvian fissure maturation: international standards from Fetal Growth Longitudinal Study of INTERGROWTH-21 st Project. Ultrasound Obstet Gynecol 2021; 57:614-623. [PMID: 32196791 DOI: 10.1002/uog.22017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/26/2020] [Accepted: 03/07/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To construct international ultrasound-based standards for fetal cerebellar growth and Sylvian fissure maturation. METHODS Healthy, well nourished pregnant women, enrolled at < 14 weeks' gestation in the Fetal Growth Longitudinal Study (FGLS) of INTERGROWTH-21st , an international multicenter, population-based project, underwent serial three-dimensional (3D) fetal ultrasound scans every 5 ± 1 weeks until delivery in study sites located in Brazil, India, Italy, Kenya and the UK. In the present analysis, only those fetuses that underwent developmental assessment at 2 years of age were included. We measured the transcerebellar diameter and assessed Sylvian fissure maturation using two-dimensional ultrasound images extracted from available 3D fetal head volumes. The appropriateness of pooling data from the five sites was assessed using variance component analysis and standardized site differences. For each Sylvian fissure maturation score (left or right side), mean gestational age and 95% CI were calculated. Transcerebellar diameter was modeled using fractional polynomial regression, and goodness of fit was assessed. RESULTS Of those children in the original FGLS cohort who had developmental assessment at 2 years of age, 1130 also had an available 3D ultrasound fetal head volume. The sociodemographic characteristics and pregnancy/perinatal outcomes of the study sample confirmed the health and low-risk status of the population studied. In addition, the fetuses had low morbidity and adequate growth and development at 2 years of age. In total, 3016 and 2359 individual volumes were available for transcerebellar-diameter and Sylvian-fissure analysis, respectively. Variance component analysis and standardized site differences showed that the five study populations were sufficiently similar on the basis of predefined criteria for the data to be pooled to produce international standards. A second-degree fractional polynomial provided the best fit for modeling transcerebellar diameter; we then estimated gestational-age-specific 3rd , 50th and 97th smoothed centiles. Goodness-of-fit analysis comparing empirical centiles with smoothed centile curves showed good agreement. The Sylvian fissure increased in maturation with advancing gestation, with complete overlap of the mean gestational age and 95% CIs between the sexes for each development score. No differences in Sylvian fissure maturation between the right and left hemispheres were observed. CONCLUSION We present, for the first time, international standards for fetal cerebellar growth and Sylvian fissure maturation throughout pregnancy based on a healthy fetal population that exhibited adequate growth and development at 2 years of age. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M J Rodriguez-Sibaja
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
- Maternal-Fetal Medicine Department, National Institute of Perinatology, Mexico City, Mexico
| | - J Villar
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - E O Ohuma
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, UK
| | - R Napolitano
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - S Heyl
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - M Carvalho
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Y A Jaffer
- Department of Family & Community Health, Ministry of Health, Muscat, Sultanate of Oman
| | - J A Noble
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - M Oberto
- S.C. Ostetricia 2U, Città della Salute e della Scienza di Torino, Turin, Italy
| | - M Purwar
- Nagpur INTERGROWTH-21st Research Centre, Ketkar Hospital, Nagpur, India
| | - R Pang
- School of Public Health, Peking University, Beijing, China
| | - L Cheikh Ismail
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Clinical Nutrition and Dietetics Department, University of Sharjah, Sharjah, United Arab Emirates
| | - A Lambert
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - M G Gravett
- Departments of Obstetrics & Gynecology and of Public Health, University of Washington, Seattle, WA, USA
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, Université Paris Descartes, Paris, France
| | - L Drukker
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - F C Barros
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
| | - S H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Z A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - A T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
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Napolitano R, Molloholli M, Donadono V, Ohuma EO, Wanyonyi SZ, Kemp B, Yaqub MK, Ash S, Barros FC, Carvalho M, Jaffer YA, Noble JA, Oberto M, Purwar M, Pang R, Cheikh Ismail L, Lambert A, Gravett MG, Salomon LJ, Bhutta ZA, Kennedy SH, Villar J, Papageorghiou AT. International standards for fetal brain structures based on serial ultrasound measurements from Fetal Growth Longitudinal Study of INTERGROWTH-21 st Project. Ultrasound Obstet Gynecol 2020; 56:359-370. [PMID: 32048426 DOI: 10.1002/uog.21990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To create prescriptive growth standards for five fetal brain structures, measured using ultrasound, in healthy, well-nourished women at low risk of impaired fetal growth and poor perinatal outcome, taking part in the Fetal Growth Longitudinal Study (FGLS) of the INTERGROWTH-21st Project. METHODS This was a complementary analysis of a large, population-based, multicenter, longitudinal study. The sample analyzed was selected randomly from the overall FGLS population, ensuring an equal distribution among the eight diverse participating sites and of three-dimensional (3D) ultrasound volumes across pregnancy (range: 15-36 weeks' gestation). We measured, in planes reconstructed from 3D ultrasound volumes of the fetal head at different timepoints in pregnancy, the size of the parieto-occipital fissure (POF), Sylvian fissure (SF), anterior horn of the lateral ventricle, atrium of the posterior horn of the lateral ventricle (PV) and cisterna magna (CM). Fractional polynomials were used to construct the standards. Growth and development of the infants were assessed at 1 and 2 years of age to confirm their adequacy for constructing international standards. RESULTS From the entire FGLS cohort of 4321 women, 451 (10.4%) were selected at random. After exclusions, 3D ultrasound volumes from 442 fetuses born without a congenital malformation were used to create the charts. The fetal brain structures of interest were identified in 90% of cases. All structures, except the PV, showed increasing size with gestational age, and the size of the POF, SF, PV and CM showed increasing variability. The 3rd , 5th , 50th , 95th and 97th smoothed centiles are presented. The 5th centiles for the POF and SF were 3.1 mm and 4.7 mm at 22 weeks' gestation and 4.6 mm and 9.9 mm at 32 weeks, respectively. The 95th centiles for the PV and CM were 8.5 mm and 7.5 mm at 22 weeks and 8.6 mm and 9.5 mm at 32 weeks, respectively. CONCLUSIONS We have produced prescriptive size standards for fetal brain structures based on prospectively enrolled pregnancies at low risk of abnormal outcome. We recommend these as international standards for the assessment of measurements obtained using ultrasound from fetal brain structures. © 2020 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Napolitano
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - M Molloholli
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - V Donadono
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - E O Ohuma
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, UK
| | - S Z Wanyonyi
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - B Kemp
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - M K Yaqub
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - S Ash
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - F C Barros
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
| | - M Carvalho
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Y A Jaffer
- Department of Family & Community Health, Ministry of Health, Muscat, Sultanate of Oman
| | - J A Noble
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - M Oberto
- S.C. Ostetricia 2U, Città della Salute e della Scienza di Torino, Italy
| | - M Purwar
- Nagpur INTERGROWTH-21st Research Centre, Ketkar Hospital, Nagpur, India
| | - R Pang
- School of Public Health, Peking University, Beijing, China
| | - L Cheikh Ismail
- Clinical Nutrition and Dietetics Department, University of Sharjah, Sharjah, United Arab Emirates
| | - A Lambert
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - M G Gravett
- Departments of Obstetrics and Gynecology, and of Public Health, University of Washington, Seattle, WA, USA
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, Université Paris Descartes, Paris, France
| | - Z A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - S H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - J Villar
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - A T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
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Mylrea-Foley B, Bhide A, Mullins E, Thornton J, Marlow N, Stampalija T, Napolitano R, Lees CC. Building consensus: thresholds for delivery in TRUFFLE-2 randomized intervention study. Ultrasound Obstet Gynecol 2020; 56:285-287. [PMID: 32533800 DOI: 10.1002/uog.22124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 06/11/2023]
Affiliation(s)
- B Mylrea-Foley
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
| | - E Mullins
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - J Thornton
- School of Clinical Sciences, University of Nottingham, Division of Obstetrics and Gynaecology, Maternity Department, City Hospital, Nottingham, UK
| | - N Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - R Napolitano
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - C C Lees
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK
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Stampalija T, Thornton J, Marlow N, Napolitano R, Bhide A, Pickles T, Bilardo CM, Gordijn SJ, Gyselaers W, Valensise H, Hecher K, Sande RK, Lindgren P, Bergman E, Arabin B, Breeze AC, Wee L, Ganzevoort W, Richter J, Berger A, Brodszki J, Derks J, Mecacci F, Maruotti GM, Myklestad K, Lobmaier SM, Prefumo F, Klaritsch P, Calda P, Ebbing C, Frusca T, Raio L, Visser GHA, Krofta L, Cetin I, Ferrazzi E, Cesari E, Wolf H, Lees CC. Fetal cerebral Doppler changes and outcome in late preterm fetal growth restriction: prospective cohort study. Ultrasound Obstet Gynecol 2020; 56:173-181. [PMID: 32557921 DOI: 10.1002/uog.22125] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/14/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To explore the association between fetal umbilical and middle cerebral artery (MCA) Doppler abnormalities and outcome in late preterm pregnancies at risk of fetal growth restriction. METHODS This was a prospective cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks of gestation, enrolled in 33 European centers between 2017 and 2018, in which umbilical and fetal MCA Doppler velocimetry was performed. Pregnancies were considered at risk of fetal growth restriction if they had estimated fetal weight and/or abdominal circumference (AC) < 10th percentile, abnormal arterial Doppler and/or a fall in AC growth velocity of more than 40 percentile points from the 20-week scan. Composite adverse outcome comprised both immediate adverse birth outcome and major neonatal morbidity. Using a range of cut-off values, the association of MCA pulsatility index and umbilicocerebral ratio (UCR) with composite adverse outcome was explored. RESULTS The study population comprised 856 women. There were two (0.2%) intrauterine deaths. Median gestational age at delivery was 38 (interquartile range (IQR), 37-39) weeks and birth weight was 2478 (IQR, 2140-2790) g. Compared with infants with normal outcome, those with composite adverse outcome (n = 93; 11%) were delivered at an earlier gestational age (36 vs 38 weeks) and had a lower birth weight (1900 vs 2540 g). The first Doppler observation of MCA pulsatility index < 5th percentile and UCR Z-score above gestational-age-specific thresholds (1.5 at 32-33 weeks and 1.0 at 34-36 weeks) had the highest relative risks (RR) for composite adverse outcome (RR 2.2 (95% CI, 1.5-3.2) and RR 2.0 (95% CI, 1.4-3.0), respectively). After adjustment for confounders, the association between UCR Z-score and composite adverse outcome remained significant, although gestational age at delivery and birth-weight Z-score had a stronger association. CONCLUSION In this prospective multicenter study, signs of cerebral blood flow redistribution were found to be associated with adverse outcome in late preterm singleton pregnancies at risk of fetal growth restriction. Whether cerebral redistribution is a marker describing the severity of fetal growth restriction or an independent risk factor for adverse outcome remains unclear, and whether it is useful for clinical management can be answered only in a randomized trial. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - J Thornton
- School of Clinical Sciences, University of Nottingham, Division of Obstetrics and Gynaecology, Maternity Department, City Hospital, Nottingham, UK
| | - N Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - R Napolitano
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - T Pickles
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - C M Bilardo
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Gyselaers
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Diepenbeek, Belgium
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk and Department Physiology, Hasselt University, Diepenbeek, Belgium
| | - H Valensise
- Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata University, Policlinico Casilino Hospital, Rome, Italy
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - R K Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - P Lindgren
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - E Bergman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - B Arabin
- Department of Obstetrics Charite, Humboldt University Berlin and Clara Angela Foundation, Berlin, Germany
| | - A C Breeze
- Fetal Medicine Unit, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - L Wee
- The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - J Richter
- Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium
| | - A Berger
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Brodszki
- Department of Pediatric Surgery and Neonatology, Lund University, Skane University Hospital, Lund, Sweden
| | - J Derks
- Department of Perinatal Medicine, University of Utrecht, Utrecht, The Netherlands
| | - F Mecacci
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - G M Maruotti
- Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples 'Federico II', Naples, Italy
| | | | - S M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - F Prefumo
- Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - P Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - P Calda
- Department of Obstetrics and Gynaecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - T Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - L Raio
- Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland
| | - G H A Visser
- Department of Obstetrics, Division of Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Krofta
- Institute for the Care of Mother and Child, Prague, Czech Republic and Third Medical Faculty, Charles University, Prague, Czech Republic
| | - I Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - E Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - E Cesari
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - H Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - C C Lees
- Imperial College School of Medicine, Imperial College London and Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS trust, London, UK
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14
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Yaqub M, Kelly B, Stobart H, Napolitano R, Noble JA, Papageorghiou AT. Quality-improvement program for ultrasound-based fetal anatomy screening using large-scale clinical audit. Ultrasound Obstet Gynecol 2019; 54:239-245. [PMID: 30302849 PMCID: PMC6771606 DOI: 10.1002/uog.20144] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/15/2018] [Accepted: 09/18/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE A large-scale audit and peer review of ultrasound images may improve sonographer performance, but is rarely performed consistently as it is time-consuming and expensive. The aim of this study was to perform a large-scale audit of routine fetal anatomy scans to assess if a full clinical audit cycle can improve clinical image-acquisition standards. METHODS A large-scale, clinical, retrospective audit was conducted of ultrasound images obtained during all routine anomaly scans performed from 18 + 0 to 22 + 6 weeks' gestation at a UK hospital during 2013 (Cycle 1), to build a baseline understanding of the performance of sonographers. Targeted actions were undertaken in response to the findings with the aim of improving departmental performance. A second full-year audit was then performed of fetal anatomy ultrasound images obtained during the following year (Cycle 2). An independent pool of experienced sonographers used an online tool to assess all scans in terms of two parameters: scan completeness (i.e. were all images archived?) and image quality using objective scoring (i.e. were images of high quality?). Both were assessed in each audit at the departmental level and at the individual sonographer level. A random sample of 10% of scans was used to assess interobserver reproducibility. RESULTS In Cycle 1 of the audit, 103 501 ultrasound images from 6257 anomaly examinations performed by 22 sonographers were assessed; in Cycle 2, 153 557 images from 6406 scans performed by 25 sonographers were evaluated. The analysis was performed including the images obtained by the 20 sonographers who participated in both cycles. Departmental median scan completeness improved from 72% in the first year to 78% at the second assessment (P < 0.001); median image-quality score for all fetal views improved from 0.83 to 0.86 (P < 0.001). The improvement was greatest for those sonographers who performed poorest in the first audit; with regards to scan completeness, the poorest performing 15% of sonographers in Cycle 1 improved by more than 30 percentage points, and with regards to image quality, the poorest performing 11% in Cycle 1 showed a more than 10% improvement. Interobserver repeatability of scan completeness and image-quality scores across different fetal views were similar to those in the published literature. CONCLUSIONS A clinical audit and a set of targeted actions helped improve sonographer scan-acquisition completeness and scan quality. Such adherence to recommended clinical acquisition standards may increase the likelihood of correct measurement and thereby fetal growth assessment, and should allow better detection of abnormalities. As such a large-scale audit is time consuming, further advantages would be achieved if this process could be automated. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M. Yaqub
- Institute of Biomedical Engineering, Department of Engineering ScienceUniversity of OxfordOxfordUK
| | - B. Kelly
- Nuffield Department of Women's and Reproductive HealthUniversity of OxfordOxfordUK
| | - H. Stobart
- Nuffield Department of Women's and Reproductive HealthUniversity of OxfordOxfordUK
| | - R. Napolitano
- Nuffield Department of Women's and Reproductive HealthUniversity of OxfordOxfordUK
| | - J. A. Noble
- Institute of Biomedical Engineering, Department of Engineering ScienceUniversity of OxfordOxfordUK
| | - A. T. Papageorghiou
- Nuffield Department of Women's and Reproductive HealthUniversity of OxfordOxfordUK
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15
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Salomon LJ, Alfirevic Z, Da Silva Costa F, Deter RL, Figueras F, Ghi T, Glanc P, Khalil A, Lee W, Napolitano R, Papageorghiou A, Sotiriadis A, Stirnemann J, Toi A, Yeo G. ISUOG Practice Guidelines: ultrasound assessment of fetal biometry and growth. Ultrasound Obstet Gynecol 2019; 53:715-723. [PMID: 31169958 DOI: 10.1002/uog.20272] [Citation(s) in RCA: 253] [Impact Index Per Article: 50.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 05/09/2023]
Abstract
INTRODUCTION These Guidelines aim to describe appropriate assessment of fetal biometry and diagnosis of fetal growth disorders. These disorders consist mainly of fetal growth restriction (FGR), also referred to as intrauterine growth restriction (IUGR) and often associated with small‐for‐gestational age (SGA), and large‐for‐gestational age (LGA), which may lead to fetal macrosomia; both have been associated with a variety of adverse maternal and perinatal outcomes. Screening for, and adequate management of, fetal growth abnormalities are essential components of antenatal care, and fetal ultrasound plays a key role in assessment of these conditions. The fetal biometric parameters measured most commonly are biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur diaphysis length (FL). These biometric measurements can be used to estimate fetal weight (EFW) using various different formulae1. It is important to differentiate between the concept of fetal size at a given timepoint and fetal growth, the latter being a dynamic process, the assessment of which requires at least two ultrasound scans separated in time. Maternal history and symptoms, amniotic fluid assessment and Doppler velocimetry can provide additional information that may be used to identify fetuses at risk of adverse pregnancy outcome. Accurate estimation of gestational age is a prerequisite for determining whether fetal size is appropriate‐for‐gestational age (AGA). Except for pregnancies arising from assisted reproductive technology, the date of conception cannot be determined precisely. Clinically, most pregnancies are dated by the last menstrual period, though this may sometimes be uncertain or unreliable. Therefore, dating pregnancies by early ultrasound examination at 8–14 weeks, based on measurement of the fetal crown–rump length (CRL), appears to be the most reliable method to establish gestational age. Once the CRL exceeds 84 mm, HC should be used for pregnancy dating2–4. HC, with or without FL, can be used for estimation of gestational age from the mid‐trimester if a first‐trimester scan is not available and the menstrual history is unreliable. When the expected delivery date has been established by an accurate early scan, subsequent scans should not be used to recalculate the gestational age1. Serial scans can be used to determine if interval growth has been normal. In these Guidelines, we assume that the gestational age is known and has been determined as described above, the pregnancy is singleton and the fetal anatomy is normal. Details of the grades of recommendation used in these Guidelines are given in Appendix 1. Reporting of levels of evidence is not applicable to these Guidelines.
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Affiliation(s)
- L J Salomon
- Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - F Da Silva Costa
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - R L Deter
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - F Figueras
- Hospital Clinic, Obstetrics and Gynecology, Barcelona, Spain
| | - T Ghi
- Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - P Glanc
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - W Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX, USA
| | - R Napolitano
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - A Papageorghiou
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Nuffield Department of Obstetrics and Gynecology, University of Oxford, Women's Center, John Radcliffe Hospital, Oxford, UK
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - J Stirnemann
- Obstetrics, University Paris Descartes, Hôpital Necker Enfants Malades, Paris, France
| | - A Toi
- Medical Imaging, Mount Sinai Hospital, Toronto, ON, Canada
| | - G Yeo
- Department of Maternal Fetal Medicine, Obstetric Ultrasound and Prenatal Diagnostic Unit, KK Women's and Children's Hospital, Singapore
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16
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Molloholli M, Napolitano R, Ohuma EO, Ash S, Wanyonyi SZ, Cavallaro A, Giudicepietro A, Barros F, Carvalho M, Norris S, Min AM, Zainab G, Papageorghiou AT. Image-scoring system for umbilical and uterine artery pulsed-wave Doppler ultrasound measurement. Ultrasound Obstet Gynecol 2019; 53:251-255. [PMID: 29808615 DOI: 10.1002/uog.19101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To develop an objective image-scoring system for pulsed-wave Doppler measurement of maternal uterine and fetal umbilical arteries, and evaluate how this compares with subjective assessment. METHODS As an extension to the INTERGROWTH-21st Project, we developed a scoring system based on six predefined criteria for uterine and umbilical artery pulsed-wave Doppler measurements. Objective evaluation using the scoring system was compared with subjective assessment which consisted of classifying an image as simply acceptable or unacceptable. Based on sample size estimation, a total of 120 umbilical and uterine artery Doppler images were selected randomly from the INTERGROWTH-21st image database. Two independent reviewers evaluated all images in a blinded fashion, both subjectively and using the six-point scoring system. Percentage agreement and kappa statistic were compared between the two methods. RESULTS The overall agreement between reviewers was higher for objective assessment using the scoring system (agreement, 85%; adjusted kappa, 0.70) than for subjective assessment (agreement, 70%; adjusted kappa, 0.47). For the six components of the scoring system, the level of agreement (adjusted kappa) was 0.97 for anatomical site, 0.88 for sweep speed, 0.77 for magnification, 0.68 for velocity scale, 0.68 for image clarity and 0.65 for angle of insonation. CONCLUSION In quality assessment of umbilical and uterine artery pulsed-wave Doppler measurements, our proposed objective six-point image-scoring system is associated with greater reproducibility than is subjective assessment. We recommend this as the preferred method for quality control, auditing and teaching. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Molloholli
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - R Napolitano
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - E O Ohuma
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - S Ash
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - S Z Wanyonyi
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - A Cavallaro
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - A Giudicepietro
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - F Barros
- Programa de Pos-Graduacao em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
- Programa de Pos-Graduacao em Saude e Comportamento, Universidade Catolica de Pelotas, Pelotas, Brazil
| | - M Carvalho
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - S Norris
- Developmental Pathways for Health Research Unit, Department of Pediatrics and Child Health, University of Witwatersrand, Johannesburg, South Africa
| | - A M Min
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - G Zainab
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - A T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
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17
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Cavallaro A, Ash ST, Napolitano R, Wanyonyi S, Ohuma EO, Molloholli M, Sande J, Sarris I, Ioannou C, Norris T, Donadono V, Carvalho M, Purwar M, Barros FC, Jaffer YA, Bertino E, Pang R, Gravett MG, Salomon LJ, Noble JA, Altman DG, Papageorghiou AT. Quality control of ultrasound for fetal biometry: results from the INTERGROWTH-21 st Project. Ultrasound Obstet Gynecol 2018; 52:332-339. [PMID: 28718938 DOI: 10.1002/uog.18811] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 07/01/2017] [Accepted: 07/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess a comprehensive package of ultrasound quality control in the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project, a large multicenter study of fetal growth. METHODS Quality control (QC) measures were performed for 20 313 ultrasound scan images obtained prospectively from 4321 fetuses at 14-41 weeks' gestation in eight geographical locations. At the time of each ultrasound examination, three fetal biometric variables (head circumference (HC), abdominal circumference (AC) and femur length (FL)) were measured in triplicate on separately generated images. All measurements were taken in a blinded fashion. QC had two elements: (1) qualitative QC: visual assessment by sonographers at each study site of their images based on specific criteria, with 10% of images being re-assessed at the Oxford-based Ultrasound Quality Unit (compared using an adjusted kappa statistic); and (2) quantitative QC: assessment of measurement data by comparing the first, second and third measurements (intraobserver variability), remeasurement of caliper replacement in 10% (interobserver variability), both by Bland-Altman plots and plotting frequency histograms of the SD of triplicate measurements and assessing how many were above or below 2 SD of the expected distribution. The system allowed the sonographers' performances to be monitored regularly. RESULTS A high level of agreement between self- and external scoring was demonstrated for all measurements (κ = 0.99 (95% CI, 0.98-0.99) for HC, 0.98 (95% CI, 0.97-0.99) for AC and 0.96 (95% CI, 0.95-0.98) for FL). Intraobserver 95% limits of agreement (LoA) of ultrasound measures for HC, AC and FL were ± 3.3%, ± 5.6% and ± 6.2%, respectively; the corresponding values for interobserver LoA were ± 4.4%, ± 6.0% and ± 5.6%. The SD distribution of triplicate measurements for all biometric variables showed excessive variability for three of 31 sonographers, allowing prompt identification and retraining. CONCLUSIONS Qualitative and quantitative QC monitoring was feasible and highly reproducible in a large multicenter research study, which facilitated the production of high-quality ultrasound images. We recommend that the QC system we developed is implemented in future research studies and clinical practice. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Cavallaro
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - S T Ash
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - R Napolitano
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - S Wanyonyi
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - E O Ohuma
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - M Molloholli
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - J Sande
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - I Sarris
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - C Ioannou
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - T Norris
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - V Donadono
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - M Carvalho
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - M Purwar
- Nagpur INTERGROWTH-21st Research Centre, Ketkar Hospital, Nagpur, India
| | - F C Barros
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, RS, Brazil
| | - Y A Jaffer
- Department of Family & Community Health, Ministry of Health, Muscat, Sultanate of Oman
| | - E Bertino
- Dipartimento di Scienze Pediatriche e dell'Adolescenza, Cattedra di Neonatologia, Università degli Studi di Torino, Torino, Italy
| | - R Pang
- School of Public Health, Peking University, Beijing, China
| | - M G Gravett
- Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), Seattle, WA, USA
| | - L J Salomon
- Maternité Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
| | - J A Noble
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - D G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - A T Papageorghiou
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
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Visser GHA, Bilardo CM, Derks JB, Ferrazzi E, Fratelli N, Frusca T, Ganzevoort W, Lees CC, Napolitano R, Todros T, Wolf H, Hecher K. Fetal monitoring indications for delivery and 2-year outcome in 310 infants with fetal growth restriction delivered before 32 weeks' gestation in the TRUFFLE study. Ultrasound Obstet Gynecol 2017; 50:347-352. [PMID: 27854382 DOI: 10.1002/uog.17361] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 10/17/2016] [Accepted: 11/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE In the TRUFFLE (Trial of Randomized Umbilical and Fetal Flow in Europe) study on the outcome of early fetal growth restriction, women were allocated to one of three groups of indication for delivery according to the following monitoring strategies: (1) reduced fetal heart rate (FHR) short-term variation (STV) on cardiotocography (CTG); (2) early changes in fetal ductus venosus (DV) waveform (DV-p95); and (3) late changes in fetal DV waveform (DV-no-A). However, many infants per monitoring protocol were delivered because of safety-net criteria, for maternal or other fetal indications, or after 32 weeks of gestation when the protocol was no longer applied. The objective of the present posthoc subanalysis was to investigate the indications for delivery in relation to 2-year outcome in infants delivered before 32 weeks to further refine management proposals. METHODS We included all 310 cases of the TRUFFLE study with known outcome at 2 years' corrected age and seven fetal deaths, excluding seven cases with inevitable perinatal death. Data were analyzed according to the allocated fetal monitoring strategy in combination with the indication for delivery. RESULTS Overall, only 32% of liveborn infants were delivered according to the specified monitoring parameter for indication for delivery; 38% were delivered because of safety-net criteria, 15% for other fetal reasons and 15% for maternal reasons. In the CTG-STV group, 51% of infants were delivered because of reduced STV. In the DV-p95 group, 34% of infants were delivered because of abnormal DV and, in the DV-no-A group, only 10% of infants were delivered accordingly. The majority of infants in the DV groups were delivered for the safety-net criterion of spontaneous decelerations in FHR. Two-year intact survival was highest in the DV groups combined compared with the CTG-STV group (P = 0.05 for live births only, P = 0.21 including fetal death), with no difference between DV groups. A poorer outcome in the CTG-STV group was restricted to infants delivered because of FHR decelerations in the safety-net subgroup. Infants delivered because of maternal reasons had the highest birth weight and a non-significantly higher intact survival. CONCLUSIONS In this subanalysis of infants delivered before 32 weeks, the majority were delivered for reasons other than the allocated monitoring strategy indication. Since, in the DV group, CTG-STV criteria were used as a safety net but in the CTG-STV group, no DV safety-net criteria were applied, we speculate that the slightly poorer outcome in the CTG-STV group might be explained by the absence of DV data. The optimal timing of delivery of fetuses with early intrauterine growth restriction may therefore be best determined by monitoring them longitudinally, with both DV and CTG monitoring. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- G H A Visser
- Department of Perinatology, University Medical Center, Utrecht, The Netherlands
| | - C M Bilardo
- Department of Obstetrics and Gynaecology, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - J B Derks
- Department of Perinatology, University Medical Center, Utrecht, The Netherlands
| | - E Ferrazzi
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - N Fratelli
- Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - T Frusca
- Department of Obstetrics and Gynecology, University Hospital, Parma, Italy
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - C C Lees
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - R Napolitano
- Department of Gynecology and Obstetrics, University Federico II of Naples, Naples, Italy
| | - T Todros
- Department of Obstetrics and Gynecology, Sant' Anna Hospital, Turin, Italy
| | - H Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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19
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Stampalija T, Arabin B, Wolf H, Bilardo CM, Lees C, Brezinka C, Derks J, Diemert A, Duvekot J, Ferrazzi E, Frusca T, Ganzevoort W, Hecher K, Kingdom J, Marlow N, Marsal K, Martinelli P, Ostermayer E, Papageorghiou A, Schlembach D, Schneider K, Thilaganathan B, Thornton J, Todros T, Valcamonico A, Valensise H, van Wassenaer-Leemhuis A, Visser G, Aktas A, Borgione S, Chaoui R, Cornette J, Diehl T, van Eyck J, Fratelli N, van Haastert I, Lobmaier S, Lopriore E, Missfelder-Lobos H, Mansi G, Martelli P, Maso G, Maurer-Fellbaum U, Mensing van Charante N, Mulder-de Tollenaer S, Napolitano R, Oberto M, Oepkes D, Ogge G, van der Post J, Prefumo F, Preston L, Raimondi F, Reiss I, Scheepers L, Skabar A, Spaanderman M, Weisglas-Kuperus N, Zimmermann A. Is middle cerebral artery Doppler related to neonatal and 2-year infant outcome in early fetal growth restriction? Am J Obstet Gynecol 2017; 216:521.e1-521.e13. [PMID: 28087423 DOI: 10.1016/j.ajog.2017.01.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Reduced fetal middle cerebral artery Doppler impedance is associated with hypoxemia in fetal growth restriction. It remains unclear as to whether this finding could be useful in timing delivery, especially in the third trimester. In this regard there is a paucity of evidence from prospective studies. OBJECTIVES The aim of this study was to determine whether there is an association between middle cerebral artery Doppler impedance and its ratio with the umbilical artery in relation to neonatal and 2 year infant outcome in early fetal growth restriction (26+0-31+6 weeks of gestation). Additionally we sought to explore which ratio is more informative for clinical use. STUDY DESIGN This is a secondary analysis from the Trial of Randomized Umbilical and Fetal Flow in Europe, a prospective, multicenter, randomized management study on different antenatal monitoring strategies (ductus venosus Doppler changes and computerized cardiotocography short-term variation) in fetal growth restriction diagnosed between 26+0 and 31+6 weeks. We analyzed women with middle cerebral artery Doppler measurement at study entry and within 1 week before delivery and with complete postnatal follow-up (374 of 503). The primary outcome was survival without neurodevelopmental impairment at 2 years corrected for prematurity. Neonatal outcome was defined as survival until first discharge home without severe neonatal morbidity. Z-scores were calculated for middle cerebral artery pulsatility index and both umbilicocerebral and cerebroplacental ratios. Odds ratios of Doppler parameter Z-scores for neonatal and 2 year infant outcome were calculated by multivariable logistic regression analysis adjusted for gestational age and birthweight p50 ratio. RESULTS Higher middle cerebral artery pulsatility index at inclusion but not within 1 week before delivery was associated with neonatal survival without severe morbidity (odds ratio, 1.24; 95% confidence interval, 1.02-1.52). Middle cerebral artery pulsatility index Z-score and umbilicocerebral ratio Z-score at inclusion were associated with 2 year survival with normal neurodevelopmental outcome (odds ratio, 1.33; 95% confidence interval, 1.03-1.72, and odds ratio, 0.88; 95% confidence interval, 0.78-0.99, respectively) as were gestation at delivery and birthweight p50 ratio (odds ratio, 1.41; 95% confidence interval, 1.20-1.66, and odds ratio, 1.86; 95% confidence interval, 1.33-2.60, respectively). When comparing cerebroplacental ratio against umbilicocerebral ratio, the incremental range of the cerebroplacental ratio tended toward zero, whereas the umbilicocerebral ratio tended toward infinity as the values became more abnormal. CONCLUSION In a monitoring protocol based on ductus venosus and cardiotocography in early fetal growth restriction (26+0-31+6 weeks of gestation), the impact of middle cerebral artery Doppler and its ratios on outcome is modest and less marked than birthweight and delivery gestation. It is unlikely that middle cerebral artery Doppler and its ratios are informative in optimizing the timing of delivery in fetal growth restriction before 32 weeks of gestation. The umbilicocerebral ratio allows for a better differentiation in the abnormal range than the cerebroplacental ratio.
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Perito M, Calia R, Carpentieri G, De Guglielmo S, Del Buono G, Fasano V, Fiorentino N, Napolitano R, Forgione M, Scotti D, Solomita B, Franza F. Migrants and Psychosomatic Symptoms: An Evaluation in an Emergency Centre. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IntroductionIn recent years, there has been an increase in migration in Europe. Particularly, Italy has been one of the most important landing place. Currently, migrants in the province of Avellino, South Italy city, amount to about 1400, housed in 40 facilities in 23 municipalities. Psychological interest on migration and its impact on lifestyle patterns has increased in recent years.ObjectivesThere are few studies that evaluated the frequent psychosomatic symptoms in these populations. Despite the trauma experienced, they are not able to give a name to the suffered and somatized pain.AimAssessment of somatic symptoms reported by the immigrant cohort after a three-month observation period.MethodsWe included 50 migrants (21.3 mean years) hosted in emergency centre in Avellino, Italy. All guests have conducted psychological clinical interviews. At baseline, were administered following scales: the patient health questionnaire (PHQ-9); Illness Behaviour Inventory (IBI); Symptoms checklist-90-Revised (SCL-90-R) scale. Same data was collected after three months.ResultsThe migrant group was a heterogeneous group. Overall data on IBI and PHQ-9 scale indicate a statistically significant variation baseline vs deadline Data of IBI scale is statistically significant [T-Score: 3,921; P: 003]; also with PHQ-9 [T0 vs. T1: T-Score: 3,986; P: .003]. Similar results have been found with SCL-90-R.ConclusionsIn their vocabulary, terms such as anxiety, sadness, fear exist hardly. They tend to minimize the psychological pain, not because I do not feel, but because move it on the body. They have difficulty to talk about emotions, not just a matter of culture and language, but also because they are ashamed.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Maraci M, Bridge C, Napolitano R, Papageorghiou A, Noble J. A framework for analysis of linear ultrasound videos to detect fetal presentation and heartbeat. Med Image Anal 2017; 37:22-36. [DOI: 10.1016/j.media.2017.01.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 12/22/2016] [Accepted: 01/05/2017] [Indexed: 12/22/2022]
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Vergara D, Simeone P, De Matteis S, Carloni S, Lanuti P, Marchisio M, Miscia S, Rizzello A, Napolitano R, Agostinelli C, Maffia M. Comparative proteomic profiling of Hodgkin lymphoma cell lines. Mol Biosyst 2016; 12:219-32. [PMID: 26588820 DOI: 10.1039/c5mb00654f] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Classical Hodgkin lymphoma (cHL) is a malignancy with complex pathogenesis. The hallmark of the disease is the presence of large mononucleated Hodgkin and bi- or multinucleated Reed/Sternberg (H/RS) cells. The origin of HRS cells in cHL is controversial as these cells show the coexpression of markers of several lineages. Using a proteomic approach, we compared the protein expression profile of cHL models of T- and B-cell derivation to find proteins differentially expressed in these cell lines. A total of 67 proteins were found differentially expressed between the two cell lines including metabolic proteins and proteins involved in the regulation of the cytoskeleton and/or cell migration, which were further validated by western blotting. Additionally, the expression of selected B- and T-cell antigens was also assessed by flow cytometry to reveal significant differences in the expression of different surface markers. Bioinformatics analysis was then applied to our dataset to find enriched pathways and networks, and to identify possible key regulators. In the present study, a proteomic approach was used to compare the protein expression profiles of two cHL cell lines. The identified proteins and/or networks, many of which not previously related to cHL, may be important to better define the pathogenesis of the disease, to identify novel diagnostic markers, and to design new therapeutic strategies.
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Affiliation(s)
- D Vergara
- Department of Biological and Environmental Sciences and Technologies, University of Salento, via Monteroni, 73100 Lecce, Italy. and Laboratory of Clinical Proteomic, "Giovanni Paolo II" Hospital, ASL-Lecce, Italy.
| | - P Simeone
- Department of Medicine and Aging Science, School of Medicine and Health Science and Unit of Cytomorphology, Research Centre on Aging (Ce.S.I), University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - S De Matteis
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy
| | - S Carloni
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy
| | - P Lanuti
- Department of Medicine and Aging Science, School of Medicine and Health Science and Unit of Cytomorphology, Research Centre on Aging (Ce.S.I), University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - M Marchisio
- Department of Medicine and Aging Science, School of Medicine and Health Science and Unit of Cytomorphology, Research Centre on Aging (Ce.S.I), University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - S Miscia
- Department of Medicine and Aging Science, School of Medicine and Health Science and Unit of Cytomorphology, Research Centre on Aging (Ce.S.I), University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - A Rizzello
- Department of Biological and Environmental Sciences and Technologies, University of Salento, via Monteroni, 73100 Lecce, Italy. and Laboratory of Clinical Proteomic, "Giovanni Paolo II" Hospital, ASL-Lecce, Italy.
| | - R Napolitano
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy
| | - C Agostinelli
- Department of Experimental, Hematopathology and Hematology Sections, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - M Maffia
- Department of Biological and Environmental Sciences and Technologies, University of Salento, via Monteroni, 73100 Lecce, Italy. and Laboratory of Clinical Proteomic, "Giovanni Paolo II" Hospital, ASL-Lecce, Italy.
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Napolitano R, Donadono V, Ohuma EO, Knight CL, Wanyonyi SZ, Kemp B, Norris T, Papageorghiou AT. Scientific basis for standardization of fetal head measurements by ultrasound: a reproducibility study. Ultrasound Obstet Gynecol 2016; 48:80-5. [PMID: 27158767 PMCID: PMC5113683 DOI: 10.1002/uog.15956] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/27/2016] [Accepted: 04/29/2016] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To compare the standard methods for ultrasound measurement of fetal head circumference (HC) and biparietal diameter (BPD) (outer-to-outer (BPDoo) vs outer-to-inner (BPDoi) caliper placement), and compare acquisition of these measurements in transthalamic (TT) vs transventricular (TV) planes. METHODS This study utilized ultrasound images acquired from women participating in the Oxford arm of the INTERGROWTH-21(st) Project. In the first phase of the study, BPDoo and BPDoi were measured on stored images. In the second phase, real-time measurements of BPD, occipitofrontal diameter (OFD) and HC in TT and TV planes were obtained by pairs of sonographers. Reproducibility of measurements made by the same (intraobserver) and by different (interobserver) sonographers, as well as the reproducibility of caliper placement and measurements obtained in different planes, was assessed using Bland-Altman plots. RESULTS In Phase I, we analyzed ultrasound images of 108 singleton fetuses. The mean intraobserver and interobserver differences were < 2% (1.34 mm) and the 95% limits of agreement were < 5% (3 mm) for both BPDoo and BPDoi. Neither method for measuring BPD showed consistently better reproducibility. In Phase II, we analyzed ultrasound images of 100 different singleton fetuses. The mean intraobserver and interobserver differences were < 1% (2.26 mm) and the 95% limits of agreement were < 8% (14.45 mm) for all fetal head measurements obtained in TV and TT planes. Neither plane for measuring fetal head showed consistently better reproducibility. Measurement of HC using the ellipse facility was as reproducible as HC calculated from BPD and OFD. OFD by itself was the least reproducible of all fetal head measurements. CONCLUSIONS Measurements of BPDoi and BPDoo are equally reproducible; however, we believe BPDoo should be used in clinical practice as it allows fetal HC to be measured and compared with neonatal HC. For all head measurements, TV and TT planes provide equally reproducible values at any gestational age, and HC values are similar in both planes. Fetal head measurement in the TT plane is preferable as international standards in this plane are available; however, measurements in the TV plane can be plotted on the same standards. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R. Napolitano
- Nuffield Department of Obstetrics & GynaecologyUniversity of OxfordOxfordUK
| | - V. Donadono
- Nuffield Department of Obstetrics & GynaecologyUniversity of OxfordOxfordUK
| | - E. O. Ohuma
- Nuffield Department of Obstetrics & GynaecologyUniversity of OxfordOxfordUK
- Oxford Maternal & Perinatal Health Institute, Green Templeton CollegeUniversity of OxfordOxfordUK
- Centre for Statistics in Medicine, Botnar Research CentreUniversity of OxfordOxfordUK
| | - C. L. Knight
- Nuffield Department of Obstetrics & GynaecologyUniversity of OxfordOxfordUK
| | - S. Z. Wanyonyi
- Nuffield Department of Obstetrics & GynaecologyUniversity of OxfordOxfordUK
| | - B. Kemp
- Nuffield Department of Obstetrics & GynaecologyUniversity of OxfordOxfordUK
| | - T. Norris
- Nuffield Department of Obstetrics & GynaecologyUniversity of OxfordOxfordUK
| | - A. T. Papageorghiou
- Nuffield Department of Obstetrics & GynaecologyUniversity of OxfordOxfordUK
- Oxford Maternal & Perinatal Health Institute, Green Templeton CollegeUniversity of OxfordOxfordUK
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Wanyonyi SZ, Napolitano R, Ohuma EO, Salomon LJ, Papageorghiou AT. Image-scoring system for crown-rump length measurement. Ultrasound Obstet Gynecol 2014; 44:649-654. [PMID: 24677327 DOI: 10.1002/uog.13376] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 03/14/2014] [Accepted: 03/18/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To develop and evaluate an objective image-scoring system for crown-rump length (CRL) measurements and to determine how this compares with subjective assessment. METHODS A total of 125 CRL ultrasound images were selected from the database of the International Fetal and Newborn Growth Consortium for the 21(st) Century study group. Two reviewers, who were blinded to the operators' and to each others' results, evaluated all images both subjectively and objectively. Subjective evaluation consisted of rating an image as acceptable or unacceptable, while objective evaluation was based on six criteria. Reviewer differences for both the subjective and objective evaluations were compared using percentage of agreement and adjusted kappa values. RESULTS The distribution of individual scores and differences between subjective and objective evaluation for the two reviewers was similar. Overall agreement between the reviewers was higher for objective evaluation (95.2%; adjusted κ, 0.904), than for subjective evaluation (77.6%; adjusted κ, 0.552). There was a high level of agreement for horizontal position (κ = 0.951), magnification (κ = 0.919), visualization of crown and rump (κ = 0.806) and caliper placement (κ = 0.756), while agreement for mid-sagittal section (κ = 0.629) and neutral position (κ = 0.565) were moderate and poor, respectively. CONCLUSION The proposed six-point scoring system for CRL image rating is more reproducible than is subjective evaluation and should be considered as a method of quality assessment and audit.
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Affiliation(s)
- S Z Wanyonyi
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Napolitano R, Dhami J, Ohuma EO, Ioannou C, Conde-Agudelo A, Kennedy SH, Villar J, Papageorghiou AT. Pregnancy dating by fetal crown-rump length: a systematic review of charts. BJOG 2014; 121:556-65. [DOI: 10.1111/1471-0528.12478] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2013] [Indexed: 11/29/2022]
Affiliation(s)
- R Napolitano
- Nuffield Department of Obstetrics & Gynaecology; University of Oxford; Oxford UK
| | - J Dhami
- Nuffield Department of Obstetrics & Gynaecology; University of Oxford; Oxford UK
| | - EO Ohuma
- Nuffield Department of Obstetrics & Gynaecology; University of Oxford; Oxford UK
| | - C Ioannou
- Nuffield Department of Obstetrics & Gynaecology; University of Oxford; Oxford UK
| | - A Conde-Agudelo
- Perinatology Research Branch; Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Institutes of Health; Department of Health and Human Services; Bethesda Maryland and Detroit Michigan USA
| | - SH Kennedy
- Nuffield Department of Obstetrics & Gynaecology; University of Oxford; Oxford UK
- Oxford Maternal & Perinatal Health Institute; Green Templeton College; University of Oxford; Oxford UK
| | - J Villar
- Nuffield Department of Obstetrics & Gynaecology; University of Oxford; Oxford UK
- Oxford Maternal & Perinatal Health Institute; Green Templeton College; University of Oxford; Oxford UK
| | - AT Papageorghiou
- Nuffield Department of Obstetrics & Gynaecology; University of Oxford; Oxford UK
- Oxford Maternal & Perinatal Health Institute; Green Templeton College; University of Oxford; Oxford UK
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Gianolio E, Porto S, Napolitano R, Baroni S, Giovenzana GB, Aime S. Relaxometric investigations and MRI evaluation of a liposome-loaded pH-responsive gadolinium(III) complex. Inorg Chem 2012; 51:7210-7. [PMID: 22716284 DOI: 10.1021/ic300447n] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Accurate measurement of the tissue pH in vivo by MRI may be of clinical value for both diagnosis and selection/monitoring of therapy. To act as pH reporters, MRI contrast agents have to provide responsiveness to pH that does not require prior knowledge of the actual concentration of the contrast agent. This work deals with the use of a paramagnetic gadolinium(III) complex, loaded into liposomes, whose relaxometric properties are affected by the pH of the medium. In this system, the amphiphilic metal complex, which contains a moiety whose protonation changes the coordination properties of the metal chelate, experiences a different intraliposomial distribution depending on the pH conditions. The pH of the solution can be unambiguously identified by exploiting the peculiar characteristics of the resulting NMRD profiles, and a ratiometric pH-responsive method has been set up by comparing the relaxation enhancement at different magnetic field strengths.
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Affiliation(s)
- E Gianolio
- Department of Chemistry & Molecular Imaging Center, University of Torino, Via Nizza 52, Torino, Italy
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Migliucci A, Di Fraja D, Sarno L, Acampora E, Mazzarelli LL, Quaglia F, Mallia Milanes G, Buffolano W, Napolitano R, Simioli S, Maruotti GM, Martinelli P. Prenatal diagnosis of congenital rubella infection and ultrasonography: a preliminary study. Minerva Ginecol 2011; 63:485-489. [PMID: 22036752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM The aim of this study was to analyze the role of ultrasonography in the prenatal diagnosis of women with confirmed rubella infection in pregnancy. METHODS We performed a retrospective, population-based study on 175 women referred to our Centre of Infectious Disease in Pregnancy of AOU Federico II for rubella infection, in the period between January 1999 and December 2009. In confirmed cases of infection we performed periodic ultrasonographic assessment of fetal anatomy looking for prenatal findings of rubeovirus infection. Neonatal outcomes were collected. RESULTS Among 175 women, 48 (27.4%) were confirmed cases, in 83 (47.4%) cases rubella infection remain suspected. The remaining 44 (25.1%) women were excluded to having rubella infection in pregnancy. No defined probable cases were found. Among children born to mother with confirmed rubella infection, 9 (18.7%) resulted infected by rubella virus. In particular 6 newborns (66% of the affected) were asymptomatic, two babies showed incomplete congenital rubella syndrome (CRS), due to the presence of deafness in the absence of other congenital abnormalities without showing any USG findings. Only one baby showed a complete CRS: USG prenatal rubella infection findings were IUGR, polydramnios, cardiomegaly, defects of atrial septum, hepatosplenomegaly, ascites, echogenic bowel, placentomegaly. USG specificity and sensitivity was 100% and 11% respectively. CONCLUSION USG has an important role in the detection rubella intrauterine infection in case of severe abnormalities. The obstetricians should understand the limitations of ultrasound in detection of deafness and minor abnormalities.
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Affiliation(s)
- A Migliucci
- Department of Obstetrics and Gynecology, University Hospital Federico II, Naples, Italy.
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Di Fraja D, Sarno L, Migliucci A, Acampora E, Napolitano R, Maruotti GM, Martinelli P. Prenatal diagnosis of β-thalassemia: nuchal translucency in affected fetuses. Minerva Ginecol 2011; 63:491-494. [PMID: 22036753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM Thalassemia syndromes are a group of blood disorders inherited in autosomal recessive manner. Prenatal diagnosis of disease is based on invasive procedures. Fetuses affected by homozygous thalassemia are not reported to be anemic. We studied their nuchal translucency (NT) measurements to identify as an ultrasonographic marker of disease and highlight any correlations. METHODS Between April 2006 and July 2010 NT test was offered to women referred to our center for prenatal diagnosis of thalassemia. All the NT tests were performed in the time of chorionic villus sampling (CVS), according to the standards of the Fetal Medicine Foundation. Measurements of fetuses affected by homozygous thalassemia were compared with normal fetuses. RESULTS A total of 55 fetuses were recruited. Of these, 15 were confirmed to be affected by homozygous thalassemia and 40 resulted to be carriers of thalassemia trait. Neither abnormal karyotype or structural abnormalities were detected and all the NT measurement were normal. NT was not different between the affected and normal fetuses. CONCLUSION NT is not a marker of homozygous thalassemia in fetuses at risk. Invasive procedures remain the only available methods for diagnosis.
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Affiliation(s)
- D Di Fraja
- Department of Gynecology and Obstetrics, University AOU Federico II, Naples, Italy.
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Dias T, Arcangeli T, Bhide A, Napolitano R, Mahsud-Dornan S, Thilaganathan B. First-trimester ultrasound determination of chorionicity in twin pregnancy. Ultrasound Obstet Gynecol 2011; 38:530-532. [PMID: 21308842 DOI: 10.1002/uog.8956] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To determine the accuracy of ultrasound at 11-14 weeks' gestation in the diagnosis of chorionicity in twin pregnancy. METHODS This was a retrospective observational study of data obtained between 1999 and 2010. At the first-trimester routine ultrasound scan, chorionicity was assigned according to the number of placental masses and T or λ-signs for a single placental mass. Chorionicity was confirmed by histology or discordant sex at birth. RESULTS A total of 648 pregnancies were assigned chorionicity by first-trimester ultrasound during the study period. Chorionicity was ascertained in 613 cases, either by histology (n = 340) or discordant sex (n = 273). Chorionicity was correctly assigned by ultrasound at 11-14 weeks in 612 of 613 pregnancies (accuracy 99.8%). Sensitivity and specificity for determining monochorionicity were 100% and 99.8%, respectively. CONCLUSIONS First-trimester ultrasound can be used to determine chorionicity reliably by noting the number of placental masses and T or λ-signs. Determination of twin chorionicity is important and should be completed in the first trimester.
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Affiliation(s)
- T Dias
- Fetal Medicine Unit, St George's University of London, London, UK
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Napolitano R, Rajakulasingam R, Memmo A, Bhide A, Thilaganathan B. Uterine artery Doppler screening for pre-eclampsia: comparison of the lower, mean and higher first-trimester pulsatility indices. Ultrasound Obstet Gynecol 2011; 37:534-537. [PMID: 20878683 DOI: 10.1002/uog.8848] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/21/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES A previous study suggested that the lower uterine artery pulsatility index (PI) is a better predictor of pre-eclampsia than is either the mean or higher indices. The aim of this study was to assess the relative value of these three indices for the prediction of pre-eclampsia in the first trimester of pregnancy. METHODS This was a prospective study of 6221 singleton pregnancies. Uterine artery PI was obtained at the time of the 11-14-week nuchal translucency scan and receiver-operating characteristics curves for the lower, mean and higher PI value of the two uterine arteries in the prediction of pre-eclampsia were calculated. RESULTS There were 178 cases of pre-eclampsia. The associations between uterine artery PI and pre-eclampsia were stronger for early (requiring delivery < 34 weeks' gestation) and preterm (requiring delivery < 37 weeks) pre-eclampsia compared to pre-eclampsia at any gestation. There was no significant difference in the strength of the association between lower, mean and higher PI for pre-eclampsia at any gestation. CONCLUSIONS First-trimester uterine artery PI is strongly associated with the development of early and preterm pre-eclampsia. Lower, mean and higher uterine artery PIs are comparable in screening for pre-eclampsia. Any differences that exist between the lower, mean and higher uterine artery indices are unlikely to have a significant impact on screening sensitivities.
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Affiliation(s)
- R Napolitano
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's Hospital Medical School, London, UK
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Napolitano R, Santo S, D'Souza R, Bhide A, Thilaganathan B. Sensitivity of higher, lower and mean second-trimester uterine artery Doppler resistance indices in screening for pre-eclampsia. Ultrasound Obstet Gynecol 2010; 36:573-576. [PMID: 20503226 DOI: 10.1002/uog.7645] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES First-trimester Doppler studies have reported that the lower uterine artery (UtA) resistance index (RI) is better for the prediction of pre-eclampsia (PE) than is either the mean or higher indices. The aim of this study was to determine if this relationship is true in the second trimester. METHODS This was a retrospective study of 24 859 singleton pregnancies. During the study period second-trimester UtA Doppler assessment was routinely available to all nulliparous women and to parous women at increased risk of PE. UtA-RI was obtained at the time of the anomaly scan. Receiver-operating characteristics curves for the lower, mean and higher UtA-RI for the prediction of PE were calculated. RESULTS There were 1037 cases of PE. There were significant associations between UtA-RI and PE, the association being stronger for early and preterm than late or term PE. There was no significant difference in the strength of the association between lower, mean and higher RI with PE at any gestation. CONCLUSION Performance of UtA-RI in predicting PE is no different for the lower, higher or mean RI of the two UtAs. The most likely explanation for the discrepancy with first-trimester studies is that the placental-side effect on Doppler indices may change with advancing gestational age and progressive trophoblast development and invasion.
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Affiliation(s)
- R Napolitano
- Academic Department of Obstetrics and Gynaecology, St George's Hospital Medical School, London, UK
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Witney TH, Kettunen MI, Hu DE, Gallagher FA, Bohndiek SE, Napolitano R, Brindle KM. Detecting treatment response in a model of human breast adenocarcinoma using hyperpolarised [1-13C]pyruvate and [1,4-13C2]fumarate. Br J Cancer 2010; 103:1400-6. [PMID: 20924379 PMCID: PMC2990617 DOI: 10.1038/sj.bjc.6605945] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [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] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The recent introduction of a dynamic nuclear polarisation technique has permitted noninvasive imaging of tumour cell metabolism in vivo following intravenous administration of (13)C-labelled cell substrates. METHODS Changes in hyperpolarised [1-(13)C]pyruvate and [1,4-(13)C(2)]fumarate metabolism were evaluated in both MDA-MB-231 cells and in implanted MDA-MB-231 tumours following doxorubicin treatment. RESULTS Treatment of MDA-MB-231 cells resulted in the induction of apoptosis, which was accompanied by a decrease in hyperpolarised (13)C label flux between [1-(13)C]pyruvate and lactate, which was correlated with a decrease in the cellular NAD(H) coenzyme pool. There was also an increase in the rate of fumarate conversion to malate, which accompanied the onset of cellular necrosis. In vivo, the decrease in (13)C label exchange between pyruvate and lactate and the increased flux between fumarate and malate, following drug treatment, were shown to occur in the absence of any detectable change in tumour size. CONCLUSION We show here that the early responses of a human breast adenocarcinoma tumour model to drug treatment can be followed by administration of both hyperpolarised [1-(13)C]pyruvate and [1,4-(13)C(2)]fumarate. These techniques could be used, therefore, in the clinic to detect the early responses of breast tumours to treatment.
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Affiliation(s)
- T H Witney
- Department of Biochemistry, University of Cambridge, Tennis Court Road, Cambridge CB2 1GA, UK
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Napolitano R, Sansone M, Floridia M, Cappelli C, Maruotti GM, Agangi A, Capone A, Mazzarelli LL, Martinelli P. Prevalence and characteristics of symptomatic and asymptomatic tuboovarian masses in women with HIV: an ultrasonographic study. Int J STD AIDS 2010; 21:472-6. [PMID: 20852196 DOI: 10.1258/ijsa.2009.009223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
HIV-positive women with pelvic inflammatory disease have been reported to have an increased prevalence of tuboovarian masses (TOMs). The aim of this study was to assess the prevalence of asymptomatic ultrasonographic TOMs in women with HIV and to identify associated factors in order to formulate a selective ultrasonographic screening strategy. Two-hundred and four HIV outpatients underwent transvaginal ultrasonography. Eight (3.9%) had a diagnosis of TOM (5 were asymptomatic). Two profiles of patients at risk for TOM were identified who could be considered for selective screening strategies: the 'long-term infected' (age>35 years, diagnosis of HIV infection more than 5 years ago, HIV clinical category C, CD4 counts below 200/mm(3), >5 lifetime partners and on antiretroviral therapy) and the 'recently diagnosed with HIV' (African ethnicity, age 25-35, HIV diagnosis in the previous year, >5 lifetime partners, HIV clinical category C and not on antiretroviral therapy).
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Affiliation(s)
- R Napolitano
- Department of Obstetrics and Gynecology, Centre for STD and HIV/AIDS in Obstetrics and Gynecology, University of Naples, Federico II, Italy
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Simioli S, Napolitano R, Quaglia F, Mazzarelli LL, Agangi A, Milanes GM, Tessitore G, Iannaccone A, Maruotti GM, Martinelli P. Fetal borderline cerebral ventriculomegaly: clinical significance and management. Minerva Ginecol 2009; 61:109-112. [PMID: 19255558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM The aim of this study was to evaluate the clinical significance and the management of fetal borderline lateral cerebral ventriculomegaly. METHODS Fetuses with a sonographic diagnosis of lateral cerebral ventriculomegaly isolated or associated to other fetal malformations were followed monthly and a review of the English-language literature was made. RESULTS Of 86 fetuses analyzed, 30 suffered from hydrocephaly (monolateral, bilateral), 56 showed also several other malformations . Chromosomal aberrations is possible also in case of isolated hydrocephaly. Neurological sequelae, mostly a mild to moderate delay in cognitive and/or motor development, is present in 10% of the cases. CONCLUSIONS In most cases, isolated borderline lateral cerebral ventriculomegaly has no consequence. However, the risk of cerebral maldevelopment, delayed neurological development and, possibly, chromosomal aberrations is increased. The optimum management of these cases remains uncertain.
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Affiliation(s)
- S Simioli
- Ostetrics and Ginecology Emergency Unit, Department of Ostetrics, Ginecology and Reproduction Physiopathology, University Federico II, Naples, Italy.
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Mallia Milanes G, Napolitano R, Quaglia F, Mazzarelli LL, Agangi A, Tessitore G, Sansone M, Simioli S, Maruotti GM, Martinelli P. Prenatal diagnosis of arthrogryposis. Minerva Ginecol 2007; 59:203-4. [PMID: 17505463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Napolitano R, Maruotti GM, Mazzarelli LL, Quaglia F, Tessitore G, Pecoraro M, Agangi A, Mallia Milanes G, Martinelli P. Prenatal diagnosis of placental chorioangioma: our experience. Minerva Ginecol 2005; 57:649-54. [PMID: 16306870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Placental chorioangioma is the most common benign tumor of placenta. The relationship of vascularized chorioangiomas to adverse pregnancy outcome is well recognized. We report 3 cases of placental chorioangioma. Hypervascularization of the lesions in all patients and the immune hydrops with adverse fetal outcome in 2 cases are the complications of our mini-series. Ultrasonography and Doppler ultrasonography findings were useful in establishing the prenatal diagnosis and the prognosis.
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Affiliation(s)
- R Napolitano
- Obstetrics and Gynecology Emergencies Unit, Department Obstetrics, Gynecology and Human Reproduction Physiopathology, University Federico II, Via Sergio Pansini 5, 81000 Naples, Italy
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Littger R, Alke A, Tewes B, Gropp F, Asai T, Watanabe K, Kuromi K, Kurohane K, Ogino K, Taki T, Tsukada H, Nakayama J, Oku N, Babai I, Matyas G, Baranji L, Milosevits J, Alving CR, Bendas G, Rothe U, Scherphof GL, Kamps JAAM, Kessner S, Rothe U, Bendas G, Carafa M, Di Stefano A, Sozio P, Cacciatore I, Mosciatti B, Santucci E, Choice E, Harvie P, Galbraith T, Zunder E, Dutzar B, Anklesaria P, Paul R, Cocquyt J, De Cuyper M, Van der Meeren P, Cruz MEM, Gaspar MM, Silva MT, Dathe M, Nikolenko H, Wessolowski A, Schmieder P, Beyermann M, Bienert M, Santos ND, Cox KA, Allen C, Gallagher RC, Ickenstein L, Mayer LD, Bally MB, Fischer S, Margalit R, Freisleben HJ, Garidel P, Chen HC, Moore D, Mendelsohn R, Garidel P, Keller M, Hildebrand A, Blume A, Girão da Cruz MT, Simões S, Pedroso de Lima MC, Graser A, Nahde T, Fahr A, Müller R, Müller-Brüsselbach S, Harvie P, Dutzar B, Choice E, Cudmore S, O'Mahony D, Anklesaria P, Paul R, Hoving S, van Tiel ST, Seynhaeve ALB, Ambagtsheer G, Eggermont AMM, ten Hagen TLM, Høyrup P, Jensen SS, Jørgensen K, Iden D, Kuang H, Mullen P, Jacobs C, Roben P, Stevens T, Lollo C, Ishida T, Maeda R, Masuda K, Ichihara M, Kiwada H, Jung K, Reszka R, Kaiser N, Ohloff I, Linser-Haar S, Massing U, Schubert R, Kan P, Tsao CW, Chen WK, Wang AJ, Kimpfler A, Gerber C, Wieschollek A, Bruchelt G, Schubert R, Kobayashi T, Okada Y, Ishida T, Sone S, Harashima H, Maruyama K, Kiwada H, Kondo M, Lee CM, Tanaka T, Su W, Kitagawa T, Ito T, Matsuda H, Murai T, Miyasaka M, Junji K, Kondo M, Asai T, Ogino K, Taki T, Tsukada H, Baba K, Oku N, Koning GA, Wauben MHM, ten Hagen TLM, Vestweber D, Everts M, Kok RJ, Schraa AJ, Molema G, Schiffelers RM, Storm G, Kristl J, Šentjurc M, Abramović Z, Landry S, Perron S, Bestman-Smith J, Désormeaux A, Tremblay MJ, Bergeron MG, Madeira C, Loura LMS, Fedorov A, Prieto M, Aires-Barros MR, Marques CM, Simões SI, Cruz ME, Cevc G, Martins MB, Moreira JN, Gaspar R, Allen TM, Esposito C, Ortaggi G, Bianco A, Bonadies F, Malizia D, Napolitano R, Cametti C, Mossa G, Endert G, Essler F, Lutz S, Panzner S, Pastorino F, Brignole C, Pagnan G, Moase EH, Allen TM, Ponzoni M, Pavelic Z, Škalko-Basnet N, Jalšenjak I, Penacho N, Simões S, Pedroso de Lima MC, Pisano C, Bucci F, Serafini S, Martinelli R, Cupelli A, Marconi A, Ferrara FF, Santaniello M, Critelli L, Tinti O, Luisi P, Carminati P, Santaniello M, Bucci F, Tinti O, Pisano C, Critelli L, Galletti B, Luisi P, Carminati P, Sauer I, Nikolenko H, Dathe M, Schleef M, Voß C, Schmidt T, Flaschel E, König S, Wenger T, Dumond J, Bogetto N, Reboud-Ravaux M, Schramm HJ, Schramm W, Sheynis T, Rozner S, Kolusheva S, Satchell D, Jelnik R, Shigeta Y, Imanaka H, Ando H, Makino T, Kurohane K, Oku N, Baba N, Shimizu K, Asai T, Takada M, Baba K, Namba Y, Oku N, Simberg D, Danino D, Talmon Y, Minsky A, Ferrari ME, Wheeler CJ, Barenholz Y, Takada M, Shimizu K, Kuromi K, Asai T, Baba K, Oku N, Takeuchi Y, Kurohane K, North JR, Namba Y, Nango M, Oku N, Tewes B, Köchling T, Deissler M, Kühl C, Marx U, Strote G, Gropp F, Qualls MM, Kim JM, Thompson DH, Zhang ZY, Shum P, Collier JH, Hu BH, Ruberti JW, Messersmith PB, Thompson DH, Tsuruda T, Nakade A, Sadzuka Y, Hirota S, Sonobe T, Vorauer-Uhl K, Wagner A, Katinger H, Wagner A, Vorauer-Uhl K, Katinger H, Weeke-Klimp AH, Bartsch M, Meijer DKF, Scherphof GL, Kamps JAAM, Zeisig R, Walther W, Reß A, Fichtner I, Zschörnig O, Schiller J, Süß M, Bergmeier C, Arnold K, Nchinda G, Überla K, Zschörnig O. Poster Abstracts. J Liposome Res 2003. [DOI: 10.1081/lpr-120017490] [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: 11/03/2022]
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Alosilla Fonttis A, Napolitano R, Tomás MA. Successful ICSI in a case of severe asthenozoospermia due to 93% non-specific axonemal alterations and 90% abnormal or absent mitochondrial sheaths. Reprod Biomed Online 2002; 5:270-2. [PMID: 12470525 DOI: 10.1016/s1472-6483(10)61831-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The use of IVF and intracytoplasmic sperm injection (ICSI) to treat male infertility due to severe asthenozoospermia in cases of electron microscopically confirmed axonemal abnormalities has been reported. However, even with these sophisticated technologies, very few pregnancies and births have been achieved with ejaculated spermatozoa in infertility due to this condition. The existence of sperm-derived defects preclude normal embryo development, and another reason for low success rates may be that the most commonly used method for selecting viable spermatozoa for ICSI is sperm motility, which is absent in affected men. Consequently, the likelihood of selecting non-viable spermatozoa for ICSI is higher in these cases. This report describes a case of a pregnancy achieved by ICSI with ejaculated spermatozoa containing 93% non-specific axonemal alterations and 90% abnormal or absent mitochondrial sheaths. A total of 14 oocytes was obtained from the 31-year-old patient in her first IVF treatment cycle. Three of the 13 matured (metaphase II) oocytes were inseminated conventionally, and the other 10 metaphase II oocytes were submitted to ICSI. None of the oocytes inseminated conventionally were fertilized. Of the 10 oocytes submitted to ICSI, four zygotes and cleavage embryos resulted. Three embryos were transferred on day 3, and a successful pregnancy was achieved. One gestational sac, together with regular heart activity, was recorded by ultrasonography at 8 weeks of gestation. A pregnancy is currently ongoing.
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Affiliation(s)
- A Alosilla Fonttis
- Centro de Reproducción, 41 N masculine 485, La Plata (1900), Buenos Aires, Argentina.
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Abstract
Traumatic embryo transfers impact negatively on pregnancy rates. This study reports a clinical pregnancy obtained by transferring a blastocyst developed from a 72-h embryo, which had been retained on the catheter in a difficult transfer. A total of five oocytes was obtained from the 32-year-old patient in her first IVF treatment. Only one zygote and cleavage embryo resulted. A traumatic and bloody transfer was performed on day 3. The unique embryo was retained on the catheter. The embryo was left in culture medium until the blastocyst stage was achieved. A second transfer was performed and a successful pregnancy was achieved after transferring this blastocyst. A healthy baby was born. The results of the present report suggest that in cases of difficult transfers, waiting for the blastocyst stage might allow a second, non-traumatic transfer to be performed without embryos and cervix under the effects of stress.
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Affiliation(s)
- R Napolitano
- Centro de Reproducción, 41 N masculine 485, La Plata (1900), Buenos Aires, Argentina.
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Corradini P, Napolitano R, Petraccone V, Pirozzi B, Tuzi A. Conformational analysis of syndiotactic polymer chains in the crystalline state: polypropylene and 1,2-poly(1,3-butadiene). Macromolecules 2002. [DOI: 10.1021/ma00232a053] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fuchs RP, Koffel-Schwartz N, Pelet S, Janel-Bintz R, Napolitano R, Becherel OJ, Broschard TH, Burnouf DY, Wagner J. DNA polymerases II and V mediate respectively mutagenic (-2 frameshift) and error-free bypass of a single N-2-acetylaminofluorene adduct. Biochem Soc Trans 2001; 29:191-5. [PMID: 11356152 DOI: 10.1042/0300-5127:0290191] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NarI sequence represents a strong mutation hot spot for -2 frameshift mutations induced by N-2-acetylaminofluorene (AAF), a strong chemical carcinogen. Only when bound to the third (underlined) guanine (5'-GGCGCC-->GGCC) can AAF trigger frameshift mutations, suggesting the involvement of a slipped replication intermediate with a two-nucleotide bulge. While base substitutions induced by UV light or abasic sites require DNA polymerase V (Pol V; umuDC), the AAF-induced -2 frameshift pathway requires DNA polymerase II, the polB gene product. Interestingly, error-free bypass of the G-AAF adduct requires Pol V. The genes encoding both Pol II and Pol V are induced by the SOS regulon, a co-ordinated cellular response to environmental stress. A given lesion, G-AAF, can thus be bypassed by two SOS-controlled DNA polymerases (II and V), generating mutagenic (-2 frameshifts) and error-free replication products respectively. Therefore both Pol II and Pol V can compete for the blocked replication intermediate in the vicinity of the lesion and engage in replication by transiently replacing the replicative DNA Pol III. Our data suggest that, in order to cope with the large diversity of existing DNA lesions, cells use a single or a combination of translesional DNA polymerases to achieve translesion synthesis.
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Affiliation(s)
- R P Fuchs
- UPR 9003, CNRS Cancerogenese et Mutagenese Moleculaire et Structurale, ESBS and IRCAD, Strasbourg 67400, France.
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Napolitano R, Janel-Bintz R, Wagner J, Fuchs RP. All three SOS-inducible DNA polymerases (Pol II, Pol IV and Pol V) are involved in induced mutagenesis. EMBO J 2000; 19:6259-65. [PMID: 11080171 PMCID: PMC305832 DOI: 10.1093/emboj/19.22.6259] [Citation(s) in RCA: 320] [Impact Index Per Article: 13.3] [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: 08/08/2000] [Revised: 09/22/2000] [Accepted: 09/26/2000] [Indexed: 11/14/2022] Open
Abstract
Most organisms contain several members of a recently discovered class of DNA polymerases (umuC/dinB superfamily) potentially involved in replication of damaged DNA. In Escherichia coli, only Pol V (umuDC) was known to be essential for base substitution mutagenesis induced by UV light or abasic sites. Here we show that, depending upon the nature of the DNA damage and its sequence context, the two additional SOS-inducible DNA polymerases, Pol II (polB) and Pol IV (dinB), are also involved in error-free and mutagenic translesion synthesis (TLS). For example, bypass of N:-2-acetylaminofluorene (AAF) guanine adducts located within the NAR:I mutation hot spot requires Pol II for -2 frameshifts but Pol V for error-free TLS. On the other hand, error-free and -1 frameshift TLS at a benzo(a)pyrene adduct requires both Pol IV and Pol V. Therefore, in response to the vast diversity of existing DNA damage, the cell uses a pool of 'translesional' DNA polymerases in order to bypass the various DNA lesions.
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Affiliation(s)
- R Napolitano
- UPR 9003, CNRS Cancérogenèse et Mutagenèse Moléculaire et Structurale, ESBS and IRCAD, Strasbourg, France
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Santulli B, Kazmierczak B, Napolitano R, Caliendo I, Chiappetta G, Rippe V, Bullerdiek J, Fusco A. A 12q13 translocation involving the HMGI-C gene in richter transformation of a chronic lymphocytic leukemia. Cancer Genet Cytogenet 2000; 119:70-3. [PMID: 10812175 DOI: 10.1016/s0165-4608(99)00205-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We report a case of Richter transformation of a chronic lymphocytic leukemia with a 12q13 translocation involving the HMGI-C gene. Fluorescence in situ hybridization analysis with the use of two different cosmid pools spanning the entire HMGI-C region showed that the breakpoint on chromosome 12 was located in the HMGI-C gene, presumably within intron 3. In fact, the 3' region of HMGI-C had been translocated to a derivative chromosome 6. This translocation was not visible at the cytogenetic level. Immunohistochemical analysis performed on the bone marrow smear demonstrated the expression of the HMGI-C protein specifically in the blasts, suggesting that the aberrant expression of the HMGI-C gene might have an important role in the process of leukemogenesis.
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MESH Headings
- Chromosomes, Human, Pair 12
- Chromosomes, Human, Pair 14
- Female
- HMGA2 Protein
- High Mobility Group Proteins/genetics
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Middle Aged
- Neoplasm Proteins/genetics
- Translocation, Genetic
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Affiliation(s)
- B Santulli
- A. O. San Giuseppe Moscati, Avellino, Italy
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Abstract
Medium chain fatty acids are known inhibitors of the activity of lipogenic enzymes at the transcriptional level. Mature Triatoma infestans eggs incorporate [14C]-acetate into phospholipid (PL), triacylglycerol (TG), and free fatty acid (FFA) fractions. In the presence of sodium octanoate (SO) or sodium phenylethylpropionate (PHEP), lipid synthesis is inhibited in a dose-dependent manner. When eggs are incubated in vivo with [14C]-acetate, the usual fatty acid products are largely palmitic and oleic acids. However, in the presence of SO (5-10 mM), the elongation of [14C]-acetate units is interrupted at [14C] eight total carbons. Eggs incubated in vivo with [14C]-SO, accumulate most of the label in the FFA fraction. SO (> 0.1 mM) but not sodium hexanoate (SH), inhibits the activity of microsomal and cytosolic fatty acid synthetases (FAS's), measured as [14C]-malonyl-CoA incorporation. PHEP (1 mM) and SO (10 mM) also produce major alterations in egg hatching and survival of the emerged insects, after a 1 h immersion bioassay.
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Affiliation(s)
- M P Juárez
- Instituto de Investigaciones Bioquímicas de la Plata, Facultad de Ciencias Médicas, UNLP, La Plata, Argentina.
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Abstract
Studies were undertaken to analyze the ability of entomopathogenous fungi to degrade insect hydrocarbons. Strains of Beauveria bassiana and Metarhizium anisopliae pathogenic to the blood-sucking bug Triatoma infestans were grown on hydrocarbon and non-hydrocarbon insect lipid extracts and on synthetic hydrocarbon-enriched media as the sole carbon source. Entomopathogenous fungi were shown to utilize hydrocarbons as the only carbon source for their growth. Insect-derived hydrocarbons served more efficiently as metabolic fuel rather than synthetic compounds of similar structure. [3H]n-Pentacosane, [11,12-3H]3,11-dimethylnonacosane, and [14C]n-hexadecane were catabolized into different amounts of polar lipids, free fatty acids, and acylglycerols. In experiments using the branched alkane, labeled hydrocarbons of different chain length than the precursor were also synthesized. Evidence of complete catabolism was obtained by a significant release of 14CO2 from [1-14C]n-hexadecane. 14CO2 production might be used as a simple method to compare hydrocarbon utilization by fungal strains. These data demonstrate that entomopathogenous fungi are able to transform a variety of hydrocarbon structures into different lipid products, part of which may be subsequently utilized for energy production and for the biosynthesis of cellular components. These data are the first evidence of hydrocarbon catabolism and synthesis in entomopathogenous fungi.
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Affiliation(s)
- R Napolitano
- Facultad de Ciencias Médicas, Instituto de Investigaciones Bioquímicas de La Plata, Argentina
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Zilio SC, Marcassa L, Muniz S, Horowicz R, Bagnato V, Napolitano R, Weiner J, Julienne PS. Polarization dependence of optical suppression in photoassociative ionization collisions in a sodium magneto-optic trap. Phys Rev Lett 1996; 76:2033-2036. [PMID: 10060589 DOI: 10.1103/physrevlett.76.2033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Tsao C, Napolitano R, Wang Y, Weiner J. Ultracold photoassociative ionization collisions in an atomic beam: Optical field intensity and polarization dependence of the rate constant. Phys Rev A 1995; 51:R18-R21. [PMID: 9911660 DOI: 10.1103/physreva.51.r18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Napolitano R, Weiner J, Williams CJ, Julienne PS. Line shapes of high resolution photoassociation spectra of optically cooled atoms. Phys Rev Lett 1994; 73:1352-1355. [PMID: 10056771 DOI: 10.1103/physrevlett.73.1352] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Vittone L, Mundiña C, Napolitano R, Chiappe de Cingolani G, Mattiazzi A. Characteristics of ryanodine-induced tetani in the perfused rat heart. Tetanic tension is not the highest force that cardiac muscle can generate. Arch Int Physiol Biochim Biophys 1992; 100:349-54. [PMID: 1282388 DOI: 10.3109/13813459209000725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The aim of the present study was to elucidate the conditions required to obtain tetanic contractions in rat intact heart and to investigate whether tetanic tension was actually the maximal tension that isolated rat heart is able to generate. Experiments were performed on isolated rat hearts (Langendorff technique) perfused at constant coronary flow (8-9 ml/min). Rapid repetitive stimulation (400 to 3000 pulses/min) failed to elicit a fused tetanus. The first twitch that occurred at the end of the rapid stimulation period was a potentiated beat (PSP) of significantly greater magnitude than that of the regular twitch. This potentiation declined in successive beats. When rapid electrical stimulation (600 to 3000 pulses/min) was applied to hearts treated with 5 x 10(-6) M ryanodine, the result was a fused and steady tetanic tension. Ryanodine suppressed PSP. Tetanic tension could be graded by stepwise increase of [Ca2+]o from 0.25 to 5 mM. Maximal tetanic tension occurred at a [Ca2+]o between 3.85 and 5 mM. At any of the [Ca2+]o, tetanic tension was significantly greater than the tension of the twitch obtained at approximately the natural frequency of rat heart in the intact animal (250 beats/min) but it did not differ significantly from the twitch obtained at 100 beats/min. Moreover, the tension of PSP at 0.25 and 1.35 mM [Ca2+]o was significantly greater than the maximal tetanic tension that could be obtained. Similar results to that obtained with ryanodine, were obtained in additional experiments in which caffeine was used to evoke tetanic contraction.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L Vittone
- Centro de Investigaciones Cardiovasculares, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, Argentina
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