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Orsi M, Zaurino S, Cesano N, Ossola MW, Cetin I. Toward new standard assessment for suspected vasa previa. Ultrasound Obstet Gynecol 2024. [PMID: 38708446 DOI: 10.1002/uog.27677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/07/2024]
Affiliation(s)
- M Orsi
- Unit of Obstetrics, Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Zaurino
- Unit of Obstetrics, Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - N Cesano
- Unit of Obstetrics, Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M W Ossola
- Unit of Obstetrics, Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - I Cetin
- Unit of Obstetrics, Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Murina F, Torraca M, Graziottin A, Nappi RE, Villa P, Cetin I. Validation of a clinical tool for vestibular trophism in postmenopausal women. Climacteric 2023; 26:149-153. [PMID: 36722687 DOI: 10.1080/13697137.2023.2171287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to develop and validate a clinical tool to assess vestibular trophism in women with genitourinary syndrome of menopause (GSM). METHODS In this cross-sectional study, the principal investigator's center and three external reviewers assessed the vestibular images of postmenopausal women using a multi-item tool defined as vestibular trophic health (VeTH), which assessed five criteria: petechiae, pallor, thinning, dryness and redness. Dryness, dyspareunia, vulvar pain and the Vaginal Health Index (VHI) were also evaluated. RESULTS Analysis of the intraclass correlation coefficient (0.76; confidence interval 0.62-0.82) and Cronbach's alpha coefficient (0.78; confidence interval 0.64) indicated an inter-rater reliability and reproducibility of VeTH in the 70 women enrolled in the study. The observed covariance between a high VeTH score and the symptom severity demonstrated a significant correlation, which was not evident between VeTH and the total VHI score. CONCLUSIONS The vulvar vestibule is the main location of genital tenderness, primarily responsible for burning/pain and entry dyspareunia because of its capacity to develop an excess of nociceptors upon sexual hormone deprivation. Our study indicated that VeTH can be a reproducible tool for the morphological classification of vestibular trophism and bears a significant correlation with the severity of the symptoms.
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Affiliation(s)
- F Murina
- Lower Genital Tract Disease Unit, V. Buzzi Hospital-University of the Study of Milan, Milan, Italy
| | - M Torraca
- Lower Genital Tract Disease Unit, V. Buzzi Hospital-University of the Study of Milan, Milan, Italy
| | - A Graziottin
- Center of Gynecology and Medical Sexology, H. San Raffaele Resnati, Milan, Italy
| | - R E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - P Villa
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - I Cetin
- Lower Genital Tract Disease Unit, V. Buzzi Hospital-University of the Study of Milan, Milan, Italy
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Faiola S, Casati D, Nelva Stellio L, Laoreti A, Corti C, Mannarino S, Lanna M, Cetin I. Congenital heart defects in monochorionic twin pregnancy complicated by selective fetal growth restriction. Ultrasound Obstet Gynecol 2023; 61:504-510. [PMID: 36273402 DOI: 10.1002/uog.26098] [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: 05/04/2022] [Revised: 09/02/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To evaluate the prevalence, subtypes and postnatal outcomes of congenital heart defects (CHD) in a cohort of monochorionic diamniotic (MCDA) twin pregnancies complicated by selective fetal growth restriction (sFGR), and to compare this population with a cohort of uncomplicated MCDA pregnancies evaluated during the same period. METHODS This was a retrospective analysis of all consecutive MCDA pregnancies referred between 2009 and 2018, including those complicated by sFGR (Group A) and those without complications (Group B). All neonates delivered in our center were screened for CHD before discharge. Discharge letters for all those delivered elsewhere were retrieved. Pregnancies with complications other than sFGR and those without perinatal follow-up were excluded. Pregnancies in Group A were divided into three types according to the Gratacós system of sFGR classification. RESULTS A total of 870 MCDA twin pregnancies were included: 296 in Group A and 574 in Group B. In Group A, the prevalence of CHD was 3.7% (22/592 twins), with no significant difference in CHD frequency between the three types of sFGR (Type I, 3.7%; Type II, 3.2%; Type III, 4.2%; P = 0.55). Of four Type-III sFGR pregnancies with CHD, one had pulmonary stenosis (PS) in the larger twin and isolated coarctation of the aorta in the smaller cotwin, and three had PS in the larger twin only. No Type-III sFGR pregnancies in which only the smaller twin was affected by CHD were observed. Of 11 CHD cases in the larger twin, 10 (91%) were right ventricular outflow tract abnormalities (RVOTA), and one (9%) was a ventricular septal defect. In the smaller twins, 11 cases of CHD were observed, covering a broad spectrum of cardiac abnormalities. In Group B, the CHD prevalence was 1.1% (13/1148 twins), which was similar to that in the general population, according to the EUROCAT registry for the same period and geographical area of the study (0.96%; P = 0.579). The CHD prevalence was significantly higher in Group A compared with Group B (3.7% vs 1.1%; P = 0.0002; odds ratio, 3.57 (95% CI, 1.78-7.22)). In all pregnancies with CHD in the study population, the anomaly was discordant. CONCLUSIONS In MCDA twin pregnancy, sFGR was associated with a three-fold higher prevalence of CHD. Women with such pregnancies should be referred to a tertiary care hospital for pre- and postnatal cardiac evaluation, treatment and long-term follow-up. In larger twins, the only major CHD observed was RVOTA, while a broad spectrum of CHD was noted in smaller twins. The higher risk of CHD in MCDA pregnancies appears to be due to the typical complications of the monochorionic pregnancy, rather than to the monochorionic nature of the pregnancy itself. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Faiola
- Fetal Therapy Unit 'Umberto Nicolini', Buzzi Children's Hospital, Milan, Italy
- Department of Women, Mother and Newborn, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - D Casati
- Fetal Therapy Unit 'Umberto Nicolini', Buzzi Children's Hospital, Milan, Italy
- Department of Women, Mother and Newborn, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - L Nelva Stellio
- Department of Women, Mother and Newborn, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - A Laoreti
- Fetal Therapy Unit 'Umberto Nicolini', Buzzi Children's Hospital, Milan, Italy
- Department of Women, Mother and Newborn, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - C Corti
- Paediatric Cardiology Unit, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - S Mannarino
- Paediatric Cardiology Unit, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - M Lanna
- Fetal Therapy Unit 'Umberto Nicolini', Buzzi Children's Hospital, Milan, Italy
- Department of Women, Mother and Newborn, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - I Cetin
- Department of Women, Mother and Newborn, Buzzi Children's Hospital, University of Milan, Milan, Italy
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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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Yeşilbağ DY, Cetin I, Cengiz SS, Cetin E, Sarpasar M. Effects of Beta Vinasse Supplementation on Performance, Meat Quality and Ilio- Caecal Microflora in Quail Rations. J HELL VET MED SOC 2023. [DOI: 10.12681/jhvms.28016] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The aim of this study was to evaluate the effects of β-vinasse supplementation on the live weight (LW), live weight gain (LWG), feed intake (FI), feed conversion ratio (FCR), carcass yield, meat quality and ilio-caecal bacteriological flora of quails. A total of 240 5-d-old Japanese (Coturnix coturnix Japonica) quails, including both males and females, were divided into 3 groups 80 quails and treated as follow: a control group with 0 g β-vinasse/kg ration; (2) 15 g/kg β-vinasse and (3) 30 g/kg β-vinasse. The study lasted for 6 weeks. At the end of the experiment, suplementation with β-vinasse did not have significant effect on FI and FCR. Dietary supplementation with 30 g/kg β-vinasse significantly (P < 0.05) increased LW (21 d) and LWG (5 to 21 d). The dietary treatment of quails with different levels of β- vinasse did not effect on hot carcass weight, cold carcass weights, hot and cold carcass yields and breast and thigh pH. The lightness (L*) and yellowness (b*) of breast values were significantly (P<0.05) increased of 30 g/kg supplementation. Different levels of β-vinasse significantly increased Lactobacillus spp. in faeces. As a result, it was concluded that β-vinasse (by-product obtained from molasses) can be used in quail diets as an alternative feed source that will meet the nutritional needs of the animal and have positive effects on the digestive system, especially on the intestinal health ( an increase in Lactobacillus spp. counts).
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Lanna M, Scelsa B, Cutillo G, Amendolara M, Doneda C, Balestriero M, Faiola S, Casati D, Spaccini L, Cetin I. Long-term outcome of consecutive case series of congenital isolated agenesis of corpus callosum. Ultrasound Obstet Gynecol 2022; 60:494-498. [PMID: 35274783 DOI: 10.1002/uog.24898] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 12/01/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To describe the long-term outcome of children with prenatally diagnosed isolated complete agenesis of the corpus callosum (cACC). METHODS In this single-center case series, we reviewed retrospectively the charts of fetuses referred to our fetal therapy unit from January 2004 to July 2020 for a suspected anomaly of the corpus callosum (CC). Cases with prenatally diagnosed isolated cACC were included. Fetal karyotype and comparative genomic hybridization microarray of amniotic fluid, in addition to fetal magnetic resonance imaging, were offered to all pregnant women with a diagnosis of fetal CC malformation. The surviving children were enrolled in the neurodevelopmental follow-up program at our institution, which included postnatal magnetic resonance imaging, serial neurological examinations and neurodevelopmental evaluations with standardized tests according to age. Families living in remote areas or far from our institution were offered a structured ad-hoc phone interview. RESULTS A total of 128 pregnancies with fetal CC malformation were identified (mean gestational age at diagnosis, 24.5 (range, 21-34) weeks), of which 53 cases were diagnosed prenatally with apparently isolated cACC. Of these, 12 cases underwent termination of pregnancy, one resulted in intrauterine demise at 24 weeks of gestation and 13 cases were lost to follow-up. Of the remaining 27 children, one was excluded due to an associated chromosomal anomaly (8p21.3q11.21 mosaic duplication) diagnosed after birth, which could have been detected prenatally if the parents had consented to amniocentesis. In the 26 children included in the analysis, neurodevelopmental follow-up was available for a median of 3 (range, 1-16) years. Three (11.5%) infants had severe neurodevelopmental impairment, two of which were diagnosed postnatally with a genetic syndrome (Mowat-Wilson syndrome and Vici syndrome) that would not have been diagnosed prenatally. Seven (26.9%) children had mild neurodevelopmental impairment and 16 (61.5%) had normal neurodevelopmental outcome. The Full-Scale Intelligence Quotients of the three children with severe neurodevelopmental impairment were 50, 64 and 63, respectively, while that of the remaining children was in the normal range (median, 101; range, 89-119). CONCLUSIONS In 88% of the children with cACC included in this study, neurodevelopment was not severely impaired. However, long-term follow-up is recommended in all cases of congenital isolated cACC to recognize subtle neurodevelopmental disorders as early as possible. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Lanna
- Fetal Therapy Unit 'U. Nicolini', Vittore Buzzi Children's Hospital, Milan, Italy
- Department of Women, Mother and Neonate, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - B Scelsa
- Department of Pediatric Neurology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - G Cutillo
- Department of Pediatric Neurology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - M Amendolara
- Department of Women, Mother and Neonate, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - C Doneda
- Department of Radiology and Neuroradiology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - M Balestriero
- Department of Pediatric Neurology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - S Faiola
- Fetal Therapy Unit 'U. Nicolini', Vittore Buzzi Children's Hospital, Milan, Italy
- Department of Women, Mother and Neonate, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - D Casati
- Fetal Therapy Unit 'U. Nicolini', Vittore Buzzi Children's Hospital, Milan, Italy
- Department of Women, Mother and Neonate, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - L Spaccini
- Clinical Genetic Service, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - I Cetin
- Department of Women, Mother and Neonate, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
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7
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Fratelli N, Prefumo F, Maggi C, Cavalli C, Sciarrone A, Garofalo A, Viora E, Vergani P, Ornaghi S, Betti M, Vaglio Tessitore I, Cavaliere AF, Buongiorno S, Vidiri A, Fabbri E, Ferrazzi E, Maggi V, Cetin I, Frusca T, Ghi T, Kaihura C, Di Pasquo E, Stampalija T, Belcaro C, Quadrifoglio M, Veneziano M, Mecacci F, Simeone S, Locatelli A, Consonni S, Chianchiano N, Labate F, Cromi A, Bertucci E, Facchinetti F, Fichera A, Granata D, D'Antonio F, Foti F, Avagliano L, Bulfamante G, Calì G. Third-trimester ultrasound for antenatal diagnosis of placenta accreta spectrum in women with placenta previa: results from the ADoPAD study. Ultrasound Obstet Gynecol 2022; 60:381-389. [PMID: 35247287 PMCID: PMC9544821 DOI: 10.1002/uog.24889] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/27/2022] [Accepted: 03/05/2022] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate the performance of third-trimester ultrasound for the diagnosis of clinically significant placenta accreta spectrum disorder (PAS) in women with low-lying placenta or placenta previa. METHODS This was a prospective multicenter study of pregnant women aged ≥ 18 years who were diagnosed with low-lying placenta (< 20 mm from the internal cervical os) or placenta previa (covering the internal cervical os) on ultrasound at ≥ 26 + 0 weeks' gestation, between October 2014 and January 2019. Ultrasound suspicion of PAS was raised in the presence of at least one of these signs on grayscale ultrasound: (1) obliteration of the hypoechogenic space between the uterus and the placenta; (2) interruption of the hyperechogenic interface between the uterine serosa and the bladder wall; (3) abnormal placental lacunae. Histopathological examinations were performed according to a predefined protocol, with pathologists blinded to the ultrasound findings. To assess the ability of ultrasound to detect clinically significant PAS, a composite outcome comprising the need for active management at delivery and histopathological confirmation of PAS was considered the reference standard. PAS was considered to be clinically significant if, in addition to histological confirmation, at least one of these procedures was carried out after delivery: use of hemostatic intrauterine balloon, compressive uterine suture, peripartum hysterectomy, uterine/hypogastric artery ligation or uterine artery embolization. The diagnostic performance of each ultrasound sign for clinically significant PAS was evaluated in all women and in the subgroup who had at least one previous Cesarean section and anterior placenta. Post-test probability was assessed using Fagan nomograms. RESULTS A total of 568 women underwent transabdominal and transvaginal ultrasound examinations during the study period. Of these, 95 delivered in local hospitals, and placental pathology according to the study protocol was therefore not available. Among the 473 women for whom placental pathology was available, clinically significant PAS was diagnosed in 99 (21%), comprising 36 cases of placenta accreta, 19 of placenta increta and 44 of placenta percreta. The median gestational age at the time of ultrasound assessment was 31.4 (interquartile range, 28.6-34.4) weeks. A normal hypoechogenic space between the uterus and the placenta reduced the post-test probability of clinically significant PAS from 21% to 5% in women with low-lying placenta or placenta previa in the third trimester of pregnancy and from 62% to 9% in the subgroup with previous Cesarean section and anterior placenta. The absence of placental lacunae reduced the post-test probability of clinically significant PAS from 21% to 9% in women with low-lying placenta or placenta previa in the third trimester of pregnancy and from 62% to 36% in the subgroup with previous Cesarean section and anterior placenta. When abnormal placental lacunae were seen on ultrasound, the post-test probability of clinically significant PAS increased from 21% to 59% in the whole cohort and from 62% to 78% in the subgroup with previous Cesarean section and anterior placenta. An interrupted hyperechogenic interface between the uterine serosa and bladder wall increased the post-test probability for clinically significant PAS from 21% to 85% in women with low-lying placenta or placenta previa and from 62% to 88% in the subgroup with previous Cesarean section and anterior placenta. When all three sonographic markers were present, the post-test probability for clinically significant PAS increased from 21% to 89% in the whole cohort and from 62% to 92% in the subgroup with previous Cesarean section and anterior placenta. CONCLUSIONS Grayscale ultrasound has good diagnostic performance to identify pregnancies at low risk of PAS in a high-risk population of women with low-lying placenta or placenta previa. Ultrasound may be safely used to guide management decisions and concentrate resources on patients with higher risk of clinically significant PAS. © 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)
- N. Fratelli
- Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - F. Prefumo
- Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - C. Maggi
- Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - C. Cavalli
- Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - A. Sciarrone
- Obstetrics–Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and GynecologyCittà della Salute e della ScienzaTurinItaly
| | - A. Garofalo
- Obstetrics–Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and GynecologyCittà della Salute e della ScienzaTurinItaly
| | - E. Viora
- Obstetrics–Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and GynecologyCittà della Salute e della ScienzaTurinItaly
| | - P. Vergani
- University of Milan‐Bicocca, School of Medicine and Surgery, Department of Obstetrics and GynecologyFondazione MBBM Onlus, San Gerardo HospitalMonzaItaly
| | - S. Ornaghi
- University of Milan‐Bicocca, School of Medicine and Surgery, Department of Obstetrics and GynecologyFondazione MBBM Onlus, San Gerardo HospitalMonzaItaly
| | - M. Betti
- Obstetrics and Gynaecology Unit, A. Manzoni Hospital, ASST LeccoLeccoItaly
| | - I. Vaglio Tessitore
- University of Milan‐Bicocca, School of Medicine and Surgery, Department of Obstetrics and GynecologyFondazione MBBM Onlus, San Gerardo HospitalMonzaItaly
| | - A. F. Cavaliere
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità PubblicaFondazione Policlinico Universitario ‘A. Gemelli’ IRCCS‐Università Cattolica del Sacro CuoreRomeItaly
| | - S. Buongiorno
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità PubblicaFondazione Policlinico Universitario ‘A. Gemelli’ IRCCS‐Università Cattolica del Sacro CuoreRomeItaly
| | - A. Vidiri
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità PubblicaFondazione Policlinico Universitario ‘A. Gemelli’ IRCCS‐Università Cattolica del Sacro CuoreRomeItaly
| | - E. Fabbri
- Obstetrics and Gynecology UnitBuzzi Children's Hospital, University of MilanMilanItaly
| | - E. Ferrazzi
- Fondazione IRCCS Ca Granda Ospedale Maggiore PoliclinicoMilano, Unit of ObstetricsMilanItaly
- Department of Clinical and Community SciencesUniversity of MilanMilanItaly
| | - V. Maggi
- Fondazione IRCCS Ca Granda Ospedale Maggiore PoliclinicoMilano, Unit of ObstetricsMilanItaly
| | - I. Cetin
- Obstetrics and Gynecology UnitBuzzi Children's Hospital, University of MilanMilanItaly
| | - T. Frusca
- Department of Medicine and Surgery, Obstetrics and Gynaecology UnitUniversity of ParmaParmaItaly
| | - T. Ghi
- Department of Medicine and SurgeryUniversity of ParmaParmaItaly
| | - C. Kaihura
- Department of Medicine and Surgery, Obstetrics and Gynaecology UnitUniversity of ParmaParmaItaly
| | - E. Di Pasquo
- Department of Medicine and Surgery, Obstetrics and Gynaecology UnitUniversity of ParmaParmaItaly
| | - T. Stampalija
- Unit of Fetal Medicine and Prenatal DiagnosisInstitute for Maternal and Child Health, IRCCS Burlo GarofoloTriesteItaly
- Department of Medical, Surgical and Health ScienceUniversity of TriesteTriesteItaly
| | - C. Belcaro
- Unit of Fetal Medicine and Prenatal DiagnosisInstitute for Maternal and Child Health, IRCCS Burlo GarofoloTriesteItaly
| | - M. Quadrifoglio
- Unit of Fetal Medicine and Prenatal DiagnosisInstitute for Maternal and Child Health, IRCCS Burlo GarofoloTriesteItaly
| | - M. Veneziano
- Obstetrics and Gynecology UnitBolzano HospitalBolzanoItaly
| | - F. Mecacci
- Department of Woman and Child's HealthCareggi University HospitalFlorenceItaly
| | - S. Simeone
- Department of Woman and Child's HealthCareggi University HospitalFlorenceItaly
| | - A. Locatelli
- University of Milan‐Bicocca, School of Medicine and Surgery, Obstetrics and Gynecology Unit, Carate Brianza Hospital, ASST BrianzaCarate BrianzaItaly
| | - S. Consonni
- Obstetrics and Gynecology Unit, Carate Brianza Hospital, ASST BrianzaCarate BrianzaItaly
| | - N. Chianchiano
- Fetal Medicine Unit, Bucchieri La Ferla–Fatebenefratelli HospitalPalermoItaly
| | - F. Labate
- Department of Obstetrics and GynaecologyAzienda Ospedaliera Villa Sofia CervelloPalermoItaly
| | - A. Cromi
- Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
| | - E. Bertucci
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Children and AdultsUniversity of Modena and Reggio Emilia School of MedicineModenaItaly
| | - F. Facchinetti
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Children and AdultsUniversity of Modena and Reggio Emilia School of MedicineModenaItaly
| | - A. Fichera
- Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - D. Granata
- Obstetrics and Gynecology UnitBolognini HospitalSeriateItaly
| | - F. D'Antonio
- Center for Fetal Care and High‐Risk Pregnancy, Department of Obstetrics and GynecologyUniversity of ChietiChietiItaly
| | - F. Foti
- Obstetrics and Gynecology Unit, Civico Hospital of PartinicoPalermoItaly
| | - L. Avagliano
- Department of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - G. P. Bulfamante
- Department of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - G. Calì
- Department of Obstetrics and GynaecologyArnas Civico HospitalPalermoItaly
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Ornaghi S, Colciago E, Vaglio Tessitore I, Abbamondi A, Antolini L, Locatelli A, Inversetti A, Pintucci A, Cetin I, Bracco B, Fabbri E, Sala V, Meroni M, Volpe G, Benedetti S, Bulfoni C, Marconi A, Lagrasta F, Paolini CL, Mazza E, Candiani M, Valsecchi L, Smid M, Pasi F, Pozzoni M, Castoldi M, Vignali M, Dal Molin G, Guarano A, Pellegrino A, Callegari C, Betti M, Lazzarin S, Prefumo F, Zanardini C, Parolin V, Catalano A, Barbolini E, Antonazzo P, Pignatti L, Tintoni M, Spelzini F, Martinelli A, Facchinetti F, Chiossi G, Vergani P. Mode of birth in women with low-lying placenta: protocol for a prospective multicentre 1:3 matched case-control study in Italy (the MODEL-PLACENTA study). BMJ Open 2021; 11:e052510. [PMID: 34873004 PMCID: PMC8650481 DOI: 10.1136/bmjopen-2021-052510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The term placenta praevia defines a placenta that lies over the internal os, whereas the term low-lying placenta identifies a placenta that is partially implanted in the lower uterine segment with the inferior placental edge located at 1-20 mm from the internal cervical os (internal-os-distance). The most appropriate mode of birth in women with low-lying placenta is still controversial, with the majority of them undergoing caesarean section. The current project aims to evaluate the rate of vaginal birth and caesarean section in labour due to bleeding by offering a trial of labour to all women with an internal-os-distance >5 mm as assessed by transvaginal sonography in the late third trimester. METHODS AND ANALYSIS The MODEL-PLACENTA is a prospective, multicentre, 1:3 matched case-control study involving 17 Maternity Units across Lombardy and Emilia-Romagna regions, Italy. The study includes women with a placenta located in the lower uterine segment at the second trimester scan. Women with a normally located placenta will be enrolled as controls. A sample size of 30 women with an internal-os-distance >5 mm at the late third trimester scan is needed at each participating Unit. Since the incidence of low-lying placenta decreases from 2% in the second trimester to 0.4% at the end of pregnancy, 150 women should be recruited at each centre at the second trimester scan. A vaginal birth rate ≥60% in women with an internal-os-distance >5 mm will be considered appropriate to start routinely admitting to labour these women. ETHICS AND DISSEMINATION Ethical approval for the study was given by the Brianza Ethics Committee (No 3157, 2019). Written informed consent will be obtained from study participants. Results will be disseminated by publication in peer-reviewed journals and presentation in international conferences. TRIAL REGISTRATION NUMBER NCT04827433 (pre-results stage).
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Affiliation(s)
- Sara Ornaghi
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Obstetrics and Gynaecology, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Monza, Italy
| | | | | | | | - Laura Antolini
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Anna Locatelli
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Obstetrics and Gynaecology, ASST di Vimercate, Carate Brianza, Italy
| | - Annalisa Inversetti
- Department of Obstetrics and Gynaecology, ASST di Vimercate, Carate Brianza, Italy
| | - Armando Pintucci
- Department of Obstetrics and Gynaecology, ASST di Monza, Desio, Italy
| | - I Cetin
- Department of BioMedical and Clinical Sciences, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Benedetta Bracco
- Department of BioMedical and Clinical Sciences, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Elisa Fabbri
- Department of BioMedical and Clinical Sciences, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Valentina Sala
- Department of BioMedical and Clinical Sciences, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Mario Meroni
- Department of Obstetrics and Gynaecology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Grazia Volpe
- Department of Obstetrics and Gynaecology, Ca' Grande Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Sara Benedetti
- Department of Obstetrics and Gynaecology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Camilla Bulfoni
- Department of Obstetrics and Gynaecology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Annamaria Marconi
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynaecology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | - Federica Lagrasta
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynaecology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | - Cinzia Lucia Paolini
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynaecology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | - Elisabetta Mazza
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynaecology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | - Massimo Candiani
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Luca Valsecchi
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Maddalena Smid
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Federica Pasi
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Mirko Pozzoni
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Maria Castoldi
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Michele Vignali
- Department of Biomedical Sciences for Health, Università degli Studi di Milano Facoltà di Medicina e Chirurgia, Milano, Italy
- Department of Obstetrics and Gynecology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Giulia Dal Molin
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Alice Guarano
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Antonio Pellegrino
- Department of Obstetrics and Gynaecology, Alessandro Manzoni Hospital, ASST di Lecco, Lecco, Italy
| | - Clelia Callegari
- Department of Obstetrics and Gynaecology, Alessandro Manzoni Hospital, ASST di Lecco, Lecco, Italy
| | - Marta Betti
- Department of Obstetrics and Gynaecology, Alessandro Manzoni Hospital, ASST di Lecco, Lecco, Italy
| | - Sara Lazzarin
- Department of Obstetrics and Gynaecology, Alessandro Manzoni Hospital, ASST di Lecco, Lecco, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
- School of Medicine and Surgery, University of Brescia, Brescia, Lombardia, Italy
| | - Cristina Zanardini
- Department of Obstetrics and Gynaecology, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
- School of Medicine and Surgery, University of Brescia, Brescia, Lombardia, Italy
| | - Valentina Parolin
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Anna Catalano
- Department of Obstetrics and Gynaecology, Poliambulanza Foundation Hospitals, Brescia, Italy
| | - Edoardo Barbolini
- Department of Obstetrics and Gynaecology, Poliambulanza Foundation Hospitals, Brescia, Italy
| | - Patrizio Antonazzo
- Department of Obstetrics and Gynaecology, Maurizio Bufalini Hospital, Cesena, Italy
| | - Lucrezia Pignatti
- Department of Obstetrics and Gynaecology, Maurizio Bufalini Hospital, Cesena, Italy
| | - Mauro Tintoni
- Department of Obstetrics and Gynaecology, Maurizio Bufalini Hospital, Cesena, Italy
| | - Federico Spelzini
- Department of Obstetrics and Gynaecology, Infermi Hospital Rimini, Rimini, Italy
| | - Anna Martinelli
- Department of Obstetrics and Gynaecology, Infermi Hospital Rimini, Rimini, Italy
| | - Fabio Facchinetti
- Obstetric Unit, Mother Infant Department, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy
- Department of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - G Chiossi
- Obstetric Unit, Mother Infant Department, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy
- Department of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynaecology, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Monza, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
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9
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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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10
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Moscheni M, Vergani P, Cetin I, Cromi A, Ghezzi F, Locatelli A, Iurlano E, Marconi A, Auxilia F, Bevilacqua L, Dell'Oro S, Picchetti CM, Scotti L, Trivelli M, Burato E. [The use of RCGO triggers in the obstetric - gynecological procedures: the impact on the reduction of adeverse events. The experience of the Lombardia Region]. Ig Sanita Pubbl 2020; 76:241-255. [PMID: 33161421] [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: 06/11/2023]
Abstract
The last few weeks of pregnancy are critical to a baby's health because important organs, including the brain and lungs, are not completely developed until the end of pregnancy. The adverse events during labor and childbirth can have very serious physical, psychological and financial consequences for the child, the family, health professionals and the whole community. These events can be reduced through interventions aimed at improving the safety and quality of care, based on evidence-based knowledge, guidelines and practices that must be widely and effectively applied. This work reports the experience of the Lombardy Region on improvement actions in the obstetric and gynecological procedures for the reduction of adverse events and sentinel events through the monitoring and management of the RCGS trigger tool.
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Affiliation(s)
- M Moscheni
- Coordinatore del Gruppo di Lavoro regionale Trigger in sala parto
| | - P Vergani
- Direttore della Scuola di Specialità di Ostetricia e Ginecologia Università degli Studi di Milano Bicocca
| | - I Cetin
- Professore Ordinario di Ostetricia e Ginecologia, Università degli Studi di Milano
| | - A Cromi
- Professore Associato Ostetricia e Ginecologia Università degli Studi dell'Insubria
| | - F Ghezzi
- Professore Ordinario di Ostetricia e Ginecologia, Università degli Studi dell'Insubria
| | - A Locatelli
- Direttore S.C. Ostetricia e Ginecologia ASST Vimercate
| | - E Iurlano
- Dirigente Medico. Responsabile Sala Parto IRCCS Policlinico Milano
| | - A Marconi
- Professore Ordinario di Ostetricia e Ginecologia, Università degli Studi di Milano
| | - F Auxilia
- Risk Manager, ASST Fatebenefratelli Sacco
| | | | - S Dell'Oro
- Scuola di Specializzazione in Ostetricia e Ginecologia Università degli studi Milano Biccocca
| | - C M Picchetti
- Centro Regionale gestione del rischio in sanità e sicurezza del paziente, DG Welfare - Regione Lombardia
| | - L Scotti
- Centro Regionale gestione del rischio in sanità e sicurezza del paziente, DG Welfare - Regione Lombardia
| | - M Trivelli
- Direttore DG Welfare - Regione Lombardia
| | - E Burato
- Coordinatore Centro Regionale gestione del rischio in sanità e sicurezza del paziente, DG Welfare - Regione Lombardia
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Ferrazzi E, Frigerio L, Savasi V, Vergani P, Prefumo F, Barresi S, Bianchi S, Ciriello E, Facchinetti F, Gervasi MT, Iurlaro E, Kustermann A, Mangili G, Mosca F, Patanè L, Spazzini D, Spinillo A, Trojano G, Vignali M, Villa A, Zuccotti GV, Parazzini F, Cetin I. Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis. BJOG 2020; 127:1116-1121. [PMID: 32339382 PMCID: PMC7267664 DOI: 10.1111/1471-0528.16278] [Citation(s) in RCA: 190] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To report mode of delivery and immediate neonatal outcome in women infected with COVID-19. DESIGN Retrospective study. SETTING Twelve hospitals in northern Italy. PARTICIPANTS Pregnant women with COVID-19-confirmed infection who delivered. EXPOSURE COVID 19 infection in pregnancy. METHODS SARS-CoV-2-infected women who were admitted and delivered from 1 to 20 March 2020 were eligible. Data were collected from the clinical records using a standardised questionnaire on maternal general characteristics, any medical or obstetric co-morbidity, course of pregnancy, clinical signs and symptoms, treatment of COVID 19 infection, mode of delivery, neonatal data and breastfeeding. MAIN OUTCOME AND MEASURES Data on mode of delivery and neonatal outcome. RESULTS In all, 42 women with COVID-19 delivered at the participating centres; 24 (57.1%, 95% CI 41.0-72.3) delivered vaginally. An elective caesarean section was performed in 18/42 (42.9%, 95% CI 27.7-59.0) cases: in eight cases the indication was unrelated to COVID-19 infection. Pneumonia was diagnosed in 19/42 (45.2%, 95% CI 29.8-61.3) cases: of these, 7/19 (36.8%, 95% CI 16.3-61.6) required oxygen support and 4/19 (21.1%, 95% CI 6.1-45.6) were admitted to a critical care unit. Two women with COVID-19 breastfed without a mask because infection was diagnosed in the postpartum period: their newborns tested positive for SARS-Cov-2 infection. In one case, a newborn had a positive test after a vaginal operative delivery. CONCLUSIONS Although postpartum infection cannot be excluded with 100% certainty, these findings suggest that vaginal delivery is associated with a low risk of intrapartum SARS-Cov-2 transmission to the newborn. TWEETABLE ABSTRACT This study suggests that vaginal delivery may be associated with a low risk of intrapartum SARS-Cov-2 transmission to the newborn.
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Affiliation(s)
- E Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - L Frigerio
- Dept of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - V Savasi
- Department of Woman, Mother and Neonate, Sacco Hospital-ASST Fatebenefratelli-Sacco, Milan, Italy.,Dept of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - P Vergani
- Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, Monza, Italy.,University of Milano Bicocca, Monza, Italy
| | - F Prefumo
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Brescia, Italy.,University of Brescia, Brescia, Italy
| | - S Barresi
- Dept of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - S Bianchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - E Ciriello
- Dept of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - F Facchinetti
- Obstetrics Unit, Mother Infant Department, AOU of Modena, Modena, Italy
| | - M T Gervasi
- Obstetrics and Gynecology Unit, Department of Woman's and Child's, Health University Hospital of Padua, Padua, Italy
| | - E Iurlaro
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Kustermann
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Mangili
- Department of Neonatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - F Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore, Milano, Italy
| | - L Patanè
- Dept of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - D Spazzini
- Obstetrics and Gynecology Unit, Azienda Ospedaliera Bolognini, Seriate, Italy
| | - A Spinillo
- Department of Obstetrics and Gynecology, University of Pavia, Pavia, Italy.,IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - G Trojano
- Obstetrics and Gynecology Department "Madonna delle Grazie" Hospital, Matera, Italy
| | - M Vignali
- Obstetrics and Gynecology Unit, P.O. Macedonio Melloni-ASST Fatebenefratelli-Sacco, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - A Villa
- Obstetrics and Gynecology Unit, Hospital of Treviglio-Caravaggio, Bergamo, Italy
| | - G V Zuccotti
- Dept of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.,Department of Pediatrics, Ospedale dei Bambini V. Buzzi, Milan, Italy
| | - F Parazzini
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - I Cetin
- Dept of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.,Department of Woman, Mother and Neonate, Buzzi Children's Hospital-ASST Fatebenefratelli-Sacco Milan, Italy
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Abstract
This study is a single-center, retrospective analysis of postmenopausal women presenting with dyspareunia and vulvar pain, aiming to evaluate relative effectiveness of vestibular CO2 laser therapy as a treatment. Three monthly sessions of laser were performed to each patient and thereafter a three-months follow-up was stablished. A total number of 72 patients undergoing vestibular laser treatment were recruited from patient files in the period between 2016 and 2018. Among these, 39 women also received a concomitant treatment with ospemifene (60 mg/day) during the study period. There was a statistically significant reduction of all the symptoms in both groups up to the three month follow-up. Regarding dryness and dyspareunia, the relief tent to be more prominent in the ospemifene + laser group at all follow-ups and remained statistically significant at three-month follow-up. Specifically, vestibular dryness was significantly lower in the ospemifene + laser group compared with the laser treatment group (-87% vs - 34%, respectively), and the vestibular health score started declining faster in the ospemifene + laser group. Although, additional research is needed to understand the mechanism of action, our data shows that a combination regimen of laser and ospemifene may improve clinical effectiveness for long-term treatment of symptoms associated with the under-recognized genitourinary syndrome of menopause.
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Affiliation(s)
- F Murina
- Lower Genital Tract Disease Unit, V. Buzzi Hospital, University of Milan, Milan, Italy
| | - R Felice
- Lower Genital Tract Disease Unit, V. Buzzi Hospital, University of Milan, Milan, Italy
| | - S Di Francesco
- Lower Genital Tract Disease Unit, V. Buzzi Hospital, University of Milan, Milan, Italy
| | - L Nelvastellio
- Lower Genital Tract Disease Unit, V. Buzzi Hospital, University of Milan, Milan, Italy
| | - I Cetin
- Lower Genital Tract Disease Unit, V. Buzzi Hospital, University of Milan, Milan, Italy
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13
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Monari F, Parazzini F, Cetin I, Ballarini M, Facchinetti F. Iatrogenic late preterm birth: when is it recommended? A Delphi survey promoted by the Italian Society of Perinatal Medicine. Eur J Obstet Gynecol Reprod Biol 2019; 240:23-28. [PMID: 31212221 DOI: 10.1016/j.ejogrb.2019.05.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The rate of iatrogenic Late Preterm (LP) Birth varies in different settings. This is due to the lack of strong evidence/guidelines on the management of the different maternal, fetal and placental complications affecting pregnancy in the LP window. Steroid prophylaxis is also under discussion. AIM To build recommendations about the management of main medical complications (pregestational diabetes, placenta previa, preeclampsia, cholestasis, p-PROM, intrauterine growth restriction -IUGR-) occurring in the LP period to reduce clinical heterogeneity. METHODS A group of Italian Perinatal experts were identified by Scientific Societies. A Delphi consensus methodology was used to reach agreement on different clinical sceneries. Two rounds of consultation by using a purpose built on-line survey and a third open panel discussion were performed. RESULTS The panel of 50 experts reached agreement for the vast majority of clinical sceneries (Placenta Previa, Preeclampsia, Diabetes, Cholestasis). Overall, there was agreement to be conservative at 34 weeks and in favor of delivery at 36 weeks. The management of p-PROM and mostly of IUGR were characterized by a minor degree of consensus. Corticosteroids were found necessary at the 34th week and unnecessary at the 36th week. CONCLUSIONS Besides providing some guidance on clinical indications for LP iatrogenic delivery, these results represent a stimulus for designing future trials investigating the grey areas in this field.
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Affiliation(s)
- F Monari
- Obstetrics Unit, Mother Infant Department, University Hospital Policlinico of Modena, Via del Pozzo 71, 41124. Modena, Italy
| | - F Parazzini
- Dipartimento della Donna, del Neonato e del Bambino, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - I Cetin
- Unit of Obstetrics and Gynecology, Buzzi Children's Hospital, Department of Clinical and Biological Sciences, University of Milan, Milan, Italy
| | - M Ballarini
- Obstetrics Unit, Mother Infant Department, University Hospital Policlinico of Modena, Via del Pozzo 71, 41124. Modena, Italy
| | - F Facchinetti
- Obstetrics Unit, Mother Infant Department, University Hospital Policlinico of Modena, Via del Pozzo 71, 41124. Modena, Italy
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14
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Floridia M, Masuelli G, Ravizza M, Tassis B, Cetin I, Sansone M, Degli Antoni A, Simonazzi G, Maccabruni A, Francisci D, Frisina V, Liuzzi G, Dalzero S, Tamburrini E. Atazanavir and darunavir in pregnant women with HIV: evaluation of laboratory and clinical outcomes from an observational national study. J Antimicrob Chemother 2019; 73:1025-1030. [PMID: 29244115 DOI: 10.1093/jac/dkx478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/18/2017] [Indexed: 11/13/2022] Open
Abstract
Background Atazanavir and darunavir represent the main HIV PIs recommended in pregnancy, but comparative data in pregnant women are limited. We assessed the safety and activity profile of these two drugs in pregnancy using data from a national observational study. Methods Women with atazanavir or darunavir exposure in pregnancy were evaluated for laboratory measures and main pregnancy outcomes (e.g. preterm delivery, low birthweight, non-elective caesarean section and neonatal gestational age-adjusted birthweight Z-score). Results Final analysis included 500 pregnancies with either atazanavir (n = 409) or darunavir (n = 91) exposure. No differences in pregnancy outcomes, weight gain in pregnancy, drug discontinuations, undetectable HIV-RNA, haemoglobin, ALT, total cholesterol, HDL cholesterol and LDL cholesterol were observed between the two groups. At third trimester, exposure to darunavir was associated with higher levels of plasma triglycerides (median 235.5 versus 179 mg/dL; P = 0.032) and a higher total cholesterol/HDL cholesterol ratio (median 4.03 versus 3.27; P = 0.028) and exposure to atazanavir was associated with higher levels of plasma bilirubin (1.54 versus 0.32 mg/dL; P < 0.001). Conclusions In this observational study, the two main HIV PIs currently recommended by perinatal guidelines showed similar safety and activity in pregnancy, with no evidence of differences between the two drugs in terms of main pregnancy outcomes. Based on the minor differences observed in laboratory measures, prescribing physicians might prefer either drug in some particular situations where the different impacts of treatment on lipid profile and bilirubin may have clinical relevance.
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Affiliation(s)
- M Floridia
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - G Masuelli
- Department of Obstetrics and Neonatology, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - M Ravizza
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - B Tassis
- Obstetric and Gynaecology Unit, Fondazione IRCCS Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - I Cetin
- Department of Obstetrics and Gynaecology, Luigi Sacco Hospital and University of Milan, Milan, Italy
| | - M Sansone
- Department of Neurosciences, Reproductive and Dentistry Science, University Federico II, Naples, Italy
| | - A Degli Antoni
- Department of Infectious Diseases and Hepatology, Azienda Ospedaliera di Parma, Parma, Italy
| | - G Simonazzi
- Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi and University of Bologna, Bologna, Italy
| | - A Maccabruni
- IRCCS S. Matteo and Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - D Francisci
- Clinic of Infectious Diseases, Azienda Ospedaliera 'Santa Maria', Terni and University of Perugia, Perugia, Italy
| | - V Frisina
- Department of Obstetrics and Neonatology, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - G Liuzzi
- I.N.M.I. Lazzaro Spallanzani, Rome, Italy
| | - S Dalzero
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - E Tamburrini
- Department of Infectious Diseases, Catholic University, Rome, Italy
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Ozyigit G, Onal H, Hurmuz P, Iribas A, Cetin I, Gorken I, Yalman D, Akyol F. EP-1534 Clinical Outcomes for Patients with Gleason Score 10 Prostate Adenocarcinoma: TROD 09-004 Study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31954-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Parisi F, di Bartolo I, Savasi VM, Cetin I. Micronutrient supplementation in pregnancy: Who, what and how much? Obstet Med 2019; 12:5-13. [PMID: 30891086 PMCID: PMC6416688 DOI: 10.1177/1753495x18769213] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/05/2018] [Indexed: 12/22/2022] Open
Abstract
Pregnancy represents a period of major physiological and metabolic change, aiming to ensure proper fetal growth and development, as well as maternal preservation. This review focuses on maternal nutrition, and particularly on micronutrient deficiencies and supplementation during pregnancy. Nutrient deficiencies and consequences in pregnant women are presented, with an overview of current recommendations for dietary supplementation in pregnancy, even considering the risk of micronutrient overload. Appropriate universal supplementation and prophylaxis/treatment of nutritional needs currently appear to be the most cost-effective goal in low-income countries, thus ensuring adequate intake of key elements including folate, iron, calcium, vitamin D and A. In high-income countries, a proper nutritional assessment and counselling should be mandatory in obstetric care in order to normalize pregestational body mass index, choose a healthy dietary pattern and evaluate the risk of deficiencies.
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Affiliation(s)
- F Parisi
- Center for Fetal Research Giorgio Pardi, Department
of Biomedical and Clinical Sciences, Università degli Studi di Milano, Hospital
Luigi Sacco, Unit of Obstetrics and Gynecology, Milan, Italy
| | - I di Bartolo
- Center for Fetal Research Giorgio Pardi, Department
of Biomedical and Clinical Sciences, Università degli Studi di Milano, Hospital
Luigi Sacco, Unit of Obstetrics and Gynecology, Milan, Italy
| | - VM Savasi
- Center for Fetal Research Giorgio Pardi, Department
of Biomedical and Clinical Sciences, Università degli Studi di Milano, Hospital
Luigi Sacco, Unit of Obstetrics and Gynecology, Milan, Italy
| | - I Cetin
- Center for Fetal Research Giorgio Pardi, Department
of Biomedical and Clinical Sciences, Università degli Studi di Milano, Hospital
Luigi Sacco, Unit of Obstetrics and Gynecology, Milan, Italy
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17
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Hirfanoglu T, Serdaroglu A, Cetin I, Kurt G, Capraz IY, Ekici F, Arhan E, Bilir E. Effects of vagus nerve stimulation on heart rate variability in children with epilepsy. Epilepsy Behav 2018; 81:33-40. [PMID: 29462779 DOI: 10.1016/j.yebeh.2018.01.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/22/2018] [Accepted: 01/26/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effects of vagus nerve stimulation (VNS) on heart rate variability (HRV) in children with epilepsy. METHODS The subgroups of HRV, namely time domain (Standard deviation of NN interval (SDNN), SDNN index, Standard deviation of the averages of NN intervals (SDANN), Root mean square of successive differences (RMMSD), Adjacent NN intervals differing by more than 50 ms in the entire recording divided by the total number of all NN intervals (PNN50), triangular index) and frequency domain (Low-frequency (LF), High-frequency (HF), LF/HF), were investigated in 20 pediatric patients before and after 6 and 12months of VNS treatment during day and night by comparing their data with those of 20 control subjects. In addition, subgroups of age, epilepsy duration and localization, and antiepileptic drugs (AEDs) were also evaluated if they had further effects on basal HRV levels. RESULTS Increased heart rates (HRs); decreased SDNN, SDANN, RMMSD, and PNN50; and increased LF/HF ratios were identified before VNS therapy (p<0.05). Even though remarkable improvement was seen after 6months of VNS treatment (p<0.05), no further changes were observed in 12-month compared with 6-month levels (p>0.05) in all parameters, still even significantly lower than those of controls (p<0.05). Longer duration of epilepsy and localization of epileptic focus, such as in the temporal lobe, were also found to further contribute to diminished basal HRV levels (p<0.05). CONCLUSION The cardiovascular system is under deep sympathetic influence in children with epilepsy. Although VNS seems to provide a substantial improvement by achieving increased parasympathetic effects in short-term therapy, the levels were still lower than those of healthy children after either short- or long-term therapy. Therefore, impaired cardiovascular autonomic regulation may be associated with the epileptic process itself as well as with the contribution of some additional factors. Overall, different aspects such as age, epilepsy duration, epileptic focus, seizure frequency, and AEDs should also be considered for their further possible effects on HRV during VNS therapy.
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Affiliation(s)
- Tugba Hirfanoglu
- Gazi University School of Medicine, Department of Pediatric Neurology, Ankara, Turkey.
| | - Ayse Serdaroglu
- Gazi University School of Medicine, Department of Pediatric Neurology, Ankara, Turkey
| | - Ilker Cetin
- Ankara Children's Hematology Oncology Training and Research Hospital, Department of Pediatric Cardiology, Ankara, Turkey
| | - Gokhan Kurt
- Gazi University School of Medicine, Department of Neurosurgery, Ankara, Turkey
| | - Irem Y Capraz
- Gazi University School of Medicine, Department of Neurology, Ankara, Turkey
| | - Filiz Ekici
- Akdeniz University School of Medicine, Department of Pediatric Cardiology, Antalya, Turkey
| | - Ebru Arhan
- Gazi University School of Medicine, Department of Pediatric Neurology, Ankara, Turkey
| | - Erhan Bilir
- Gazi University School of Medicine, Department of Neurology, Ankara, Turkey
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18
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Parisi F, Rousian M, Koning AHJ, Willemsen SP, Cetin I, Steegers-Theunissen RPM. Periconceptional maternal one-carbon biomarkers are associated with embryonic development according to the Carnegie stages. Hum Reprod 2018; 32:523-530. [PMID: 28104698 DOI: 10.1093/humrep/dew349] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/14/2016] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Is periconceptional maternal one-carbon (I-C) metabolism associated with embryonic morphological development in non-malformed ongoing pregnancies? SUMMARY ANSWER Serum vitamin B12, red blood cell (RBC) folate and plasma total homocysteine (tHcy) are associated with embryonic development according to the Carnegie stages. WHAT IS KNOWN ALREADY Derangements in maternal I-C metabolism affect reproductive and pregnancy outcomes, as well as future health of the offspring. STUDY DESIGN, SIZE, DURATION Between 2010 and 2014, women with singleton ongoing pregnancies were enrolled in a prospective periconceptional cohort study. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 234 pregnancies, including 138 spontaneous or IUI pregnancies with strict pregnancy dating and 96 pregnancies derived from IVF, ICSI or cryopreserved embryo transfer (IVF/ICSI pregnancies), underwent longitudinal transvaginal three-dimensional ultrasound (3D US) scans from 6+0 up to 10+2 weeks of gestation. Carnegie stages were defined using internal and external morphologic criteria in a virtual reality system. Maternal venous blood samples were collected at enrollment for serum vitamin B12, RBC folate and plasma tHcy assessment. Associations between biomarker concentrations and longitudinal Carnegie stages were investigated using linear mixed models. MAIN RESULTS AND THE ROLE OF CHANCE We performed a median of three 3D US scans per pregnancy (range 1-5) resulting in 600 good quality data sets for the Carnegie stage annotation (80.5%). Vitamin B12 was positively associated with embryonic development in the total study population (β = 0.001 (95% CI: 0.000; 0.002), P < 0.05) and in the subgroup of strictly dated spontaneous pregnancies (β = 0.002 (95% CI: 0.001; 0.003), P < 0.05). Low vitamin B12 concentrations (-2SD, 73.4 pmol/l) were associated with delayed embryonic development by 1.4 days (95% CI: 1.3-1.4) compared with high concentrations (+2SD, 563.1 pmol/l). RBC folate was positively associated with Carnegie stages only in IVF/ICSI pregnancies (β = 0.001 (95% CI: 0.0005; 0.0015), P < 0.05). In this group, low RBC folate concentrations (-2SD, 875.4 nmol/l) were associated with a 1.8-day delay (95% CI: 1.7-1.8) in development compared with high concentrations (+2SD, 2119.9 nmol/l). tHcy was negatively associated with embryonic development in the total study population (β = -0.08 (95% CI: -0.14; -0.02), P < 0.01), as well as in the IVF/ICSI subgroup (β = -0.08 (95% CI: -0.15; -0.01), P < 0.05). High tHcy concentrations (+2SD, 10.4 µmol/l) were associated with a delay of 1.6 days (95% CI: 1.5-1.7) in embryonic development compared with low concentrations (-2SD, 3.0 µmol/l). LIMITATIONS, REASONS FOR CAUTION The study was performed in a tertiary care center, resulting in high rates of folic acid supplement use and comorbidity that may reduce the external validity of our findings. WIDER IMPLICATIONS OF THE FINDINGS In periconceptional care, maternal I-C biomarkers should be taken into account as predictors of embryonic morphological development. Combining embryonic size measurements with morphological assessment could better define normal embryonic development. STUDY FUNDING/COMPETING INTEREST(S) The work was funded by the Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands. RPMST is CSO of the startup company Slimmere Zorg and CEO of eHealth Care Solutions. The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- F Parisi
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - M Rousian
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - A H J Koning
- Department of Bioinformatics, Erasmus MC, University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - S P Willemsen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands.,Department of Biostatistics, Erasmus MC, University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - I Cetin
- Centre for Fetal Research Giorgio Pardi, Department of Biomedical and Clinical Sciences, Hospital Luigi Sacco, Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milan, Italy
| | - R P M Steegers-Theunissen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands.,Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands
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19
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Parisi F, Rousian M, Huijgen NA, Koning AHJ, Willemsen SP, de Vries JHM, Cetin I, Steegers EAP, Steegers-Theunissen RPM. Periconceptional maternal 'high fish and olive oil, low meat' dietary pattern is associated with increased embryonic growth: The Rotterdam Periconceptional Cohort (Predict) Study. Ultrasound Obstet Gynecol 2017; 50:709-716. [PMID: 28078758 DOI: 10.1002/uog.17408] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 08/25/2016] [Revised: 01/02/2017] [Accepted: 01/10/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate the association between periconceptional maternal dietary pattern and first-trimester embryonic growth. METHODS This was a prospective cohort study of 228 women with a singleton ongoing pregnancy, of which 135 were strictly dated spontaneous pregnancies and 93 were pregnancies achieved after in-vitro fertilization or intracytoplasmatic sperm injection (IVF/ICSI). All women underwent serial transvaginal three-dimensional ultrasound (3D-US) examinations from 6 + 0 to 13 + 0 weeks' gestation. Crown-rump length (CRL) and embryonic volume (EV) measurements were performed using a virtual reality system. Information on periconceptional maternal dietary intake was collected via food frequency questionnaires. Principal component analysis was performed to identify dietary patterns. Associations between dietary patterns and CRL and EV trajectories were investigated using linear mixed models adjusted for potential confounders. RESULTS A median of five (range, one to seven) 3D-US scans per pregnancy were performed. Of 1162 datasets, quality was sufficient to perform CRL measurements in 991 (85.3%) and EV measurements in 899 (77.4%). A dietary pattern comprising high intake of fish and olive oil and a very low intake of meat was identified as beneficial for embryonic growth. In strictly dated spontaneous pregnancies, strong adherence to the 'high fish and olive oil, low meat' dietary pattern was associated with a 1.9 mm (95% CI, 0.1-3.63 mm) increase in CRL (+14.6%) at 7 weeks and a 3.4 mm (95% CI, 0.2-7.81 mm) increase (+6.9%) at 11 weeks, whereas EV increased by 0.06 cm3 (95% CI, 0.01-0.13 cm3 ) (+20.4%) at 7 weeks and 1.43 cm3 (95% CI, 0.99-1.87 cm3 ) (+14.4%) at 11 weeks. No significant association was observed in the total study population or in the IVF/ICSI subgroup. CONCLUSION Periconceptional maternal adherence to a high fish and olive oil, low meat dietary pattern is positively associated with embryonic growth in spontaneously conceived pregnancies. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Parisi
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - M Rousian
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - N A Huijgen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - A H J Koning
- Department of Bioinformatics, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - S P Willemsen
- Department of Biostatistics, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - J H M de Vries
- Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - I Cetin
- Center for Fetal Research Giorgio Pardi, Department of Biomedical and Clinical Sciences, Hospital Luigi Sacco, Università degli Studi di Milano, Milan, Italy
| | - E A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - R P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
- Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
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Anelli GM, Cardellicchio M, Novielli C, Antonazzo P, Mazzocco MI, Cetin I, Mandò C. Mitochondrial content and hepcidin are increased in obese pregnant mothers. J Matern Fetal Neonatal Med 2017. [PMID: 28625088 DOI: 10.1080/14767058.2017.1344209] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Maternal obesity is characterized by systemic low-grade inflammation and oxidative stress (OxS) with the contribution of fetal sex dimorphism. We recently described increased mitochondrial content (mtDNA) in placentas of obese pregnancies. Here, we quantify mtDNA and hepcidin as indexes of OxS and systemic inflammation in the obese maternal circulation. METHODS Forty-one pregnant women were enrolled at elective cesarean section: 16 were normal weight (NW) and 25 were obese (OB). Obese women were further classified according to the presence/absence of maternal gestational diabetes mellitus (GDM); [OB/GDM(-)]: n = 15, [OB/GDM(+)]: n = 10. mtDNA and hepcidin were evaluated in blood (real-time PCR) and plasma (ELISA). RESULTS mtDNA and hepcidin levels were significantly increased in OB/GDM(-) versus NW, significantly correlating with pregestational BMI. Male/female (M/F) ratio was equal in study groups, and overall F-carrying pregnancies showed significantly higher mtDNA and hepcidin levels than M-carrying pregnancies both in obese and normal weight mothers. CONCLUSIONS Our results indicate a potential compensatory mechanism to increased obesity-related OxS and inflammation, indicated by the higher hepcidin levels found in obese mothers. Increased placental mitochondrial biogenesis, due to lipotoxic environment, may account for the greater mtDNA amount released in maternal circulation. This increase is namely related to F-carrying pregnancies, suggesting a gender-specific placental response.
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Affiliation(s)
- G M Anelli
- a Department of Biomedical and Clinical Sciences, Unit of Obstetrics and Gynecology , "Luigi Sacco Hospital", Università degli Studi di Milano , Milano , Italy
| | - M Cardellicchio
- a Department of Biomedical and Clinical Sciences, Unit of Obstetrics and Gynecology , "Luigi Sacco Hospital", Università degli Studi di Milano , Milano , Italy
| | - C Novielli
- a Department of Biomedical and Clinical Sciences, Unit of Obstetrics and Gynecology , "Luigi Sacco Hospital", Università degli Studi di Milano , Milano , Italy
| | - P Antonazzo
- a Department of Biomedical and Clinical Sciences, Unit of Obstetrics and Gynecology , "Luigi Sacco Hospital", Università degli Studi di Milano , Milano , Italy
| | - M I Mazzocco
- a Department of Biomedical and Clinical Sciences, Unit of Obstetrics and Gynecology , "Luigi Sacco Hospital", Università degli Studi di Milano , Milano , Italy
| | - I Cetin
- a Department of Biomedical and Clinical Sciences, Unit of Obstetrics and Gynecology , "Luigi Sacco Hospital", Università degli Studi di Milano , Milano , Italy
| | - C Mandò
- a Department of Biomedical and Clinical Sciences, Unit of Obstetrics and Gynecology , "Luigi Sacco Hospital", Università degli Studi di Milano , Milano , Italy
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Cetin E, Yibar A, Yesilbag D, Cetin I, Cengiz SS. The effect of volatile oil mixtures on the performance and ilio-caecal microflora of broiler chickens. Br Poult Sci 2016; 57:780-787. [PMID: 27465109 DOI: 10.1080/00071668.2016.1214682] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was to investigate the individual and combined effects of rosemary, oregano and fennel volatile oil (FVO) supplementation on the performance and ilio-caecal bacteriological flora of broiler chickens. A total of 800 male Ross-308 broiler chickens were divided equally into 8 groups; each contained 100 chickens. The study included a control treatment (NC) with no dietary additives that was supplemented with oils according to the following 7 treatments: 200 mg α-tocopherol acetate/kg (PC), 100 mg oregano volatile oil (OVO)/kg, 100 mg rosemary volatile oil (RVO)/kg, 100 mg FVO/kg and an equal mixture of oregano+rosemary+fennel VO (100, 200, 400 mg/kg, VOM-1, VOM-2 and VOM-3, respectively). The experiment lasted for 6 weeks. At the end of the experiment, dietary supplementation with α-tocopherol, oregano, rosemary and FVO and two different volatile oil mixtures (VOMs) (VOM-2; VOM-3) significantly increased the body weights (BWs) of broilers at 7, 14 and 21 d of age compared to the negative control (NC) (-) and VOM-1 groups. At 0-42 d, birds fed on VOM-3 were considerably heavier and also gained more weight than NC (-) and VOM-1 groups. The blend of VOs at 400 mg/kg significantly increased Lactobacillus spp. in faeces. The blends of oregano, rosemary and FVOs (VOM-3) at 400 mg/kg concentration and also VOM-3 group exhibited stronger antibacterial activity against coliform bacteria compared to the NC (-) group. In conclusion, the blend of oregano, rosemary and fennel VOs at higher concentrations (400 mg/kg concentration) in diets can be used to stimulate the growth and can improve the intestinal microbial balance (including a reduction of coliform bacteria and an increase in Lactobacillus spp. counts) of broiler chickens.
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Affiliation(s)
- E Cetin
- a Department of Food Hygiene and Technology, Faculty of Veterinary Medicine , University of Uludag , Bursa , Turkey
| | - A Yibar
- a Department of Food Hygiene and Technology, Faculty of Veterinary Medicine , University of Uludag , Bursa , Turkey
| | - D Yesilbag
- b Department of Animal Nutrition, Faculty of Veterinary Medicine , University of Uludag , Bursa , Turkey
| | - I Cetin
- b Department of Animal Nutrition, Faculty of Veterinary Medicine , University of Uludag , Bursa , Turkey
| | - S S Cengiz
- b Department of Animal Nutrition, Faculty of Veterinary Medicine , University of Uludag , Bursa , Turkey
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Yesilbag D, Biricik H, Cetin I, Kara C, Meral Y, Cengiz SS, Orman A, Udum D. Effects of juniper essential oil on growth performance, some rumen protozoa, rumen fermentation and antioxidant blood enzyme parameters of growing Saanen kids. J Anim Physiol Anim Nutr (Berl) 2016; 101:e67-e76. [PMID: 27747957 DOI: 10.1111/jpn.12560] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/30/2016] [Indexed: 12/01/2022]
Abstract
This study aimed to evaluate the effects of juniper essential oil on the growth performance, rumen fermentation parameters, rumen protozoa population, blood antioxidant enzyme parameters and faecal content in growing Saanen kids. Thirty-six male Saanen kids (36 ± 14 days of age) were used in the study. Each group consisted of 9 kids. The control group (G1) was fed with a diet that consisted of the above concentrated feed and oat hay, whereas the experimental groups consumed the same diet but with the concentrated feed uniformly sprayed with juniper essential oil 0.4 ml/kg (G2), 0.8 ml/kg (G3) or 2 ml/kg (G4). There were no differences (p > 0.05) in live weight, live weight gain or feed consumption between the control and experimental groups. There was a significant improvement (p < 0.05) in feed efficiency in the G3 group. There were no differences in the rumen pH, rumen volatile fatty acid (VFA) profile or faecal pH of the control and experimental groups. The rumen NH3 N values were similar at the middle and end of the experiment, but at the start of the experiment, the rumen NH3 N values differed between the control and experimental groups (p < 0.05). The faecal score value was significantly (p < 0.05) decreased in the experimental groups. The addition of juniper essential oil supplementation to the rations caused significant effects on the kids' antioxidant blood parameters. Although the superoxide dismutase (SOD) activity, total antioxidant capacity (TAC) and catalase values were significantly (p < 0.05) increased in the experimental groups (G2, G3 and G4), especially group G4, the blood glutathione peroxidase (GPX) value significantly decreased in the experimental groups. The results of this study suggest that supplementation of juniper oil is more effective on antioxidant parameters than on performance parameters and may be used as a natural antioxidant product.
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Affiliation(s)
- D Yesilbag
- Department of Animal Nutrition and Nutritional Diseases, Faculty of Veterinary Medicine, Uludag University, Bursa, Turkey
| | - H Biricik
- Department of Animal Nutrition and Nutritional Diseases, Faculty of Veterinary Medicine, Uludag University, Bursa, Turkey
| | - I Cetin
- Department of Animal Nutrition and Nutritional Diseases, Faculty of Veterinary Medicine, Uludag University, Bursa, Turkey
| | - C Kara
- Department of Animal Nutrition and Nutritional Diseases, Faculty of Veterinary Medicine, Uludag University, Bursa, Turkey
| | - Y Meral
- Department of Animal Nutrition and Nutritional Diseases, Faculty of Veterinary Medicine, Uludag University, Bursa, Turkey
| | - S S Cengiz
- Department of Animal Nutrition and Nutritional Diseases, Faculty of Veterinary Medicine, Uludag University, Bursa, Turkey
| | - A Orman
- Department of Zootechnics, Faculty of Veterinary Medicine, Uludag University, Bursa, Turkey
| | - D Udum
- Department of Biochemistry, Faculty of Veterinary Medicine, Uludag University, Bursa, Turkey
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Berti C, Cetin I, Agostoni C, Desoye G, Devlieger R, Emmett PM, Ensenauer R, Hauner H, Herrera E, Hoesli I, Krauss-Etschmann S, Olsen SF, Schaefer-Graf U, Schiessl B, Symonds ME, Koletzko B. Pregnancy and Infants' Outcome: Nutritional and Metabolic Implications. Crit Rev Food Sci Nutr 2016; 56:82-91. [PMID: 24628089 DOI: 10.1080/10408398.2012.745477] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pregnancy is a complex period of human growth, development, and imprinting. Nutrition and metabolism play a crucial role for the health and well-being of both mother and fetus, as well as for the long-term health of the offspring. Nevertheless, several biological and physiological mechanisms related to nutritive requirements together with their transfer and utilization across the placenta are still poorly understood. In February 2009, the Child Health Foundation invited leading experts of this field to a workshop to critically review and discuss current knowledge, with the aim to highlight priorities for future research. This paper summarizes our main conclusions with regards to maternal preconceptional body mass index, gestational weight gain, placental and fetal requirements in relation to adverse pregnancy and long-term outcomes of the fetus (nutritional programming). We conclude that there is an urgent need to develop further human investigations aimed at better understanding of the basis of biochemical mechanisms and pathophysiological events related to maternal-fetal nutrition and offspring health. An improved knowledge would help to optimize nutritional recommendations for pregnancy.
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Affiliation(s)
- C Berti
- a Unit of Obstetrics & Gynecology, Department of Biomedical and Clinical Sciences, Hospital 'L. Sacco', and Center for Fetal Research Giorgio Pardi , University of Milan , Milan , Italy
| | - I Cetin
- a Unit of Obstetrics & Gynecology, Department of Biomedical and Clinical Sciences, Hospital 'L. Sacco', and Center for Fetal Research Giorgio Pardi , University of Milan , Milan , Italy.,b Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - C Agostoni
- b Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - G Desoye
- c Department of Obstetrics & Gynaecology , Medical University of Graz , Graz , Austria
| | - R Devlieger
- d Department of Obstetrics & Gynaecology , University Hospitals K.U. Leuven , Leuven , Belgium
| | - P M Emmett
- e Centre for Child & Adolescent Health, School of Social & Community Medicine , University of Bristol , Bristol , United Kingdom
| | - R Ensenauer
- f Research Center, Dr. von Hauner Children's Hospital, Klinikum der Ludwig-Maximilians-Universität München , Munich , Germany
| | - H Hauner
- g Else Kroener-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar , Technical University of Munich , Munich , Germany
| | - E Herrera
- h Unit of Biochemistry & Molecular Biology, Universidad San Pablo CEU , Madrid , Spain
| | - I Hoesli
- i Department of Obstetrics and Gynaecology , University Hospital of Basel , Basel , Switzerland
| | - S Krauss-Etschmann
- j Comprehensive Pneumology Center, Ludwig Maximilians University Hospital , Munich , Germany.,k Helmholtz Zentrum München , Munich , Germany
| | - S F Olsen
- l Centre for Fetal Programming, Statens Serum Institut , Copenhagen , Denmark
| | - U Schaefer-Graf
- m Department of Obstetrics & Gynecology , Berlin Center for Diabetes & Pregnancy, St. Joseph Hospital , Berlin , Germany
| | - B Schiessl
- n Fetal Maternal Unit, Department of Obstetrics & Gynecology , University of Munich , Munich , Germany
| | - M E Symonds
- o The Early Life Nutrition Research Unit, Academic Child Health, School of Clinical Sciences, University Hospital of Nottingham , Nottingham , United Kingdom
| | - B Koletzko
- p Dr. von Hauner Children's Hospital , University of Munich Medical Centre , Munich , Germany
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Savasi V, Laoreti A, Oneta M, Antonazzo P, Cetin I. HIV-1 infection and antiretroviral therapy on semen parameters and sperm dna integrity. Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2016.07.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Floridia M, Pirillo MF, Degli Antoni A, Molinari A, Tamburrini E, Pinnetti C, Guaraldi G, Nardini G, Masuelli G, Dalzero S, Cetin I, Sansone M, Amici R, Ravizza M. Pregnancy outcomes and cytomegalovirus DNAaemia in HIV-infected pregnant women with CMV. Clin Microbiol Infect 2016; 22:818-820. [PMID: 27404366 DOI: 10.1016/j.cmi.2016.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/07/2016] [Accepted: 06/22/2016] [Indexed: 11/24/2022]
Affiliation(s)
- M Floridia
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy.
| | - M F Pirillo
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - A Degli Antoni
- Department of Infectious Diseases and Hepatology, Azienda Ospedaliera di Parma, Italy
| | - A Molinari
- Department of Infectious Diseases and Hepatology, Azienda Ospedaliera di Parma, Italy
| | - E Tamburrini
- Department of Infectious Diseases, Catholic University, Rome, Italy
| | - C Pinnetti
- I.N.M.I. Lazzaro Spallanzani, Rome, Italy
| | - G Guaraldi
- Department of Medical Specialties, Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - G Nardini
- Department of Medical Specialties, Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - G Masuelli
- Department of Obstetrics and Neonatology, Città della Salute e della Scienza Hospital, and University of Turin, Italy
| | - S Dalzero
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Italy
| | - I Cetin
- Department of Obstetrics and Gynaecology, Luigi Sacco Hospital and University of Milan, Italy
| | - M Sansone
- Department of Neurosciences, Reproductive and Dentistry Science, University Federico II, Naples, Italy
| | - R Amici
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - M Ravizza
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Italy
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Floridia M, Masuelli G, Meloni A, Cetin I, Tamburrini E, Cavaliere AF, Dalzero S, Sansone M, Alberico S, Guerra B, Spinillo A, Chiadò Fiorio Tin M, Ravizza M. Amniocentesis and chorionic villus sampling in HIV-infected pregnant women: a multicentre case series. BJOG 2016; 124:1218-1223. [PMID: 27319948 DOI: 10.1111/1471-0528.14183] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess in pregnant women with HIV the rates of amniocentesis and chorionic villus sampling (CVS), and the outcomes associated with such procedures. DESIGN Observational study. Data from the Italian National Program on Surveillance on Antiretroviral Treatment in Pregnancy were used. SETTING University and hospital clinics. POPULATION Pregnant women with HIV. METHODS Temporal trends were analysed by analysis of variance and by the Chi-square test for trend. Quantitative variables were compared by Student's t-test and categorical data by the Chi-square test, with odds ratios and 95% confidence intervals calculated. MAIN OUTCOME MEASURES Rate of invasive testing, intrauterine death, HIV transmission. RESULTS Between 2001 and 2015, among 2065 pregnancies in women with HIV, 113 (5.5%) had invasive tests performed. The procedures were conducted under antiretroviral treatment in 99 cases (87.6%), with a significant increase over time in the proportion of tests performed under highly active antiretroviral therapy (HAART) (100% in 2011-2015). Three intrauterine deaths were observed (2.6%), and 14 pregnancies were terminated because of fetal anomalies. Among 96 live newborns, eight had no information available on HIV status. Among the remaining 88 cases with either amniocentesis (n = 75), CVS (n = 12), or both (n = 1), two HIV transmissions occurred (2.3%). No HIV transmission occurred among the women who were on HAART at the time of invasive testing, and none after 2005. CONCLUSIONS The findings reinforce the assumption that invasive prenatal testing does not increase the risk of HIV vertical transmission among pregnant women under suppressive antiretroviral treatment. TWEETABLE ABSTRACT No HIV transmission occurred among women who underwent amniocentesis or CVS under effective anti-HIV regimens.
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Affiliation(s)
- M Floridia
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - G Masuelli
- Department of Obstetrics and Neonatology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - A Meloni
- Division of Gynaecology and Obstetrics, S. Giovanni di Dio Hospital, University of Cagliari, Cagliari, Italy
| | - I Cetin
- Department of Obstetrics and Gynaecology, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - E Tamburrini
- Department of Infectious Diseases, Catholic University, Rome, Italy
| | - A F Cavaliere
- Department of Obstetrics & Gynaecology, Catholic University, Rome, Italy
| | - S Dalzero
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - M Sansone
- Department of Neurosciences, Reproductive and Dentistry Science, University Federico II, Naples, Naples, Italy
| | - S Alberico
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - B Guerra
- St. Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy
| | - A Spinillo
- Department of Obstetrics and Gynaecology, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - M Chiadò Fiorio Tin
- Department of Obstetrics and Neonatology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - M Ravizza
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
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Isik DU, Bas AY, Demirel N, Kavurt S, Aydemir O, Kavurt AV, Cetin I. Increased asymmetric dimethylarginine levels in severe transient tachypnea of the newborn. J Perinatol 2016; 36:459-62. [PMID: 26866680 DOI: 10.1038/jp.2016.9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/23/2015] [Accepted: 01/15/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Nitric oxide (NO) is synthesized by NO synthase (NOS), and asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NOS. We aimed to investigate l-arginine and ADMA levels in transient tachypnea of the newborn (TTN) and their relationship with systolic pulmonary artery pressure (PAP) and disease severity. STUDY DESIGN Infants born at ⩾35 weeks gestational age with clinical signs and chest X-ray findings consistent with TTN were enrolled; controls were recruited at the same time. l-arginine and ADMA levels were measured at 12 to 24 h (first samples) and at 48 to 72 h (second samples). Systolic PAP was evaluated on the second day. Patients were divided according to the duration of tachypnea and designated as group A (duration ⩽72 h) and group B (duration >72 h). RESULTS In the first samples, the ADMA levels were significantly higher in patients with TTN compared with controls (P<0.001). In the second samples, the ADMA levels were significantly higher in group B compared with that in group A (P=0.019). In group A patients, the second ADMA levels were significantly lower compared with that in the first samples (P<0.001), whereas the second ADMA levels remained unchanged compared with the first samples in group B. Systolic PAP values were significantly higher in group B compared with that in group A patients (P=0.033). CONCLUSION Increased ADMA concentration may reduce NO synthesis, leading to increased PAP and thus longer duration of tachypnea.
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Affiliation(s)
- D U Isik
- Neonatal Intensive Care Unit, Department of Neonatology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - A Y Bas
- Neonatal Intensive Care Unit, Department of Neonatology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - N Demirel
- Neonatal Intensive Care Unit, Department of Neonatology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - S Kavurt
- Neonatal Intensive Care Unit, Department of Neonatology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - O Aydemir
- Neonatal Intensive Care Unit, Department of Neonatology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - A V Kavurt
- Department of Pediatric Cardiology, Türkiye Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| | - I Cetin
- Department of Pediatric Cardiology, Ankara Children's Hematology Oncology Research and Training Hospital, Ankara, Turkey
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Ok Bozkaya I, Cetin I, Yarali N, Bayram C, Ozisik K, Ari ME, Tunc B. The successful non-invasive management of pulmonary thromboembolism in a child with acute lymphoblastic leukemia. ARCH ARGENT PEDIATR 2016; 114:e17-20. [PMID: 26914084 DOI: 10.5546/aap.2016.eng.e17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 03/08/2015] [Indexed: 11/12/2022]
Abstract
In childhood, pulmonary thromboembolism (PTE) is an uncommonbut potentially life-threatening disease. The greater numbers of venous thromboembolism (VTE) are complications of underlying risk factors such as malignancies, chemotherapy (L-asparaginase), and central venous catheter. We report a patient with acute lymphoblastic leukemia and PTE, who presented with near-syncope, and was successfully treated with low molecular weight heparin and calcium channel blockers.
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Affiliation(s)
- Ikbal Ok Bozkaya
- Department of Pediatric Hematology, Ankara Çocuk Sağlığı Hastalıkları Hemotoloji Onkoloji Eğitim Araştırma Hastanesi, Ankara, 06110, Turkey.
| | - Ilker Cetin
- Department of Pediatric Cardiology, Ankara Çocuk Sağlığı Hastalıkları Hemotoloji Onkoloji Eğitim Araştırma Hastanesi, Ankara, 06110, Turkey
| | - Nese Yarali
- Department of Pediatric Hematology, Ankara Çocuk Sağlığı Hastalıkları Hemotoloji Onkoloji Eğitim Araştırma Hastanesi, Ankara, 06110, Turkey
| | - Cengiz Bayram
- Department of Pediatric Hematology, Ankara Çocuk Sağlığı Hastalıkları Hemotoloji Onkoloji Eğitim Araştırma Hastanesi, Ankara, 06110, Turkey
| | - Kanat Ozisik
- Department of Cardiovascular Surgery, Dışkapı Yıldırım Beyazıt Eğitim Ve Araştırma Hastanesi, Altındağ/Ankara, Turkey
| | - Mehmet E Ari
- Department of Pediatric Cardiology, Ankara Çocuk Sağlığı Hastalıkları Hemotoloji Onkoloji Eğitim Araştırma Hastanesi, Ankara, 06110, Turkey
| | - Bahattin Tunc
- Department of Pediatric Hematology, Ankara Çocuk Sağlığı Hastalıkları Hemotoloji Onkoloji Eğitim Araştırma Hastanesi, Ankara, 06110, Turkey
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29
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Floridia M, Mastroiacovo P, Ravizza M, Todros T, Chiadò Fiorio Tin M, Marconi AM, Cetin I, Maruotti GM, Liuzzi G, Pinnetti C, Degli Antoni A, Spinillo A, Guerra B, Tamburrini E. Good prenatal detection rate of major birth defects in HIV-infected pregnant women in Italy. Prenat Diagn 2015; 35:1374-8. [DOI: 10.1002/pd.4696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/09/2015] [Accepted: 09/20/2015] [Indexed: 11/12/2022]
Affiliation(s)
- M. Floridia
- Department of Therapeutic Research and Medicines Evaluation; Istituto Superiore di Sanità; Rome Italy
| | - P. Mastroiacovo
- ICBD, Alessandra Lisi International Centre on Birth Defects and Prematurity; Rome Italy
| | - M. Ravizza
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School; University of Milan; Milan Italy
| | - T. Todros
- Department of Obstetrics and Neonatology; Città della Salute e della Scienza Hospital and University of Turin; Italy
| | - M. Chiadò Fiorio Tin
- Department of Obstetrics and Neonatology; Città della Salute e della Scienza Hospital and University of Turin; Italy
| | - A. M. Marconi
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School; University of Milan; Milan Italy
| | - I. Cetin
- Department of Obstetrics and Gynaecology; Luigi Sacco Hospital and University of Milan; Italy
| | - G. M. Maruotti
- Department of Neurosciences, Reproductive and Dentistry Science; University Federico II; Naples Italy
| | - G. Liuzzi
- I.N.M.I. Lazzaro Spallanzani; Rome Italy
| | | | - A. Degli Antoni
- Department of Infectious Diseases and Hepatology; Azienda Ospedaliera di Parma; Italy
| | - A. Spinillo
- University of Pavia, Department of Obstetrics and Gynaecology; IRCCS Policlinico San Matteo; Pavia Italy
| | - B. Guerra
- St. Orsola-Malpighi General Hospital; University of Bologna; Bologna Italy
| | - E. Tamburrini
- Department of Infectious Diseases; Catholic University; Rome Italy
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Cengiz S, Yesilbag D, Meral Y, Cetin I, Biricik H. Juniper oil improves oxidative stability and eggshell and albumin quality of quail eggs. Br Poult Sci 2015; 56:58-65. [DOI: 10.1080/00071668.2014.988123] [Citation(s) in RCA: 5] [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: 10/24/2022]
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Burke O, Benton S, Szafranski P, von Dadelszen P, Buhimschi C, Cetin I, Chapell L, Figueras F, Galindo A, Herraiz I, Holzman C, Hubel C, Knudsen U, Kronborg C, Laivuori H, McElrath T, Moertl M, Meyers J, Ness RB, Oliviera L, Olson G, Poston L, Ris-Stalpers C, Roberts J, Schistermann E, Steegers E, Stepan H, Lapaire O, Schlemback D, Timmermans S, Tsatsaris V, van der Post J, Verlohren S, Villa P, Williams D, Zeisler H, Zhang C, Redman C, Staff A. [94-OR]. Pregnancy Hypertens 2015. [DOI: 10.1016/j.preghy.2014.10.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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Akan B, Yıldırım T, Güçlü B, Kaya A, Karagüven D, Cetin I. Outcomes for revision total knee replacement after unicompartmental knee replacement. Acta Orthop Traumatol Turc 2014; 48:419-23. [PMID: 25230265 DOI: 10.3944/aott.2014.13.0067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this retrospective, observational study was to describe the outcomes of total knee replacement (TKR) after failed Oxford phase 3 medial unicompartmental knee replacement (UKR). METHODS The study included 24 revision TKRs (20 females, 4 males; mean age: 61 years) performed following failed aseptic UKR. Outcomes were assessed using the Knee Society Score (KSS). RESULTS The most common causes for revision were mobile bearing dislocation and unexplained pain. Mean preoperative KSS was 50.3 (range: 37 to 66) and 82.2 (range: 58 to 97) after TKR. There were 17 excellent, 4 good, 2 fair and 1 poor results. CONCLUSION The type of UKR performed (cemented versus uncemented) had no effect on TKR success. Revision for failed UKR with TKR appears to be a technically straightforward procedure with satisfactory early clinical results.
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Affiliation(s)
- Burak Akan
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ufuk University, Ankara, Turkey.
| | - Tuğrul Yıldırım
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ufuk University, Ankara, Turkey
| | - Berk Güçlü
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ufuk University, Ankara, Turkey
| | - Alper Kaya
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ufuk University, Ankara, Turkey
| | - Doğaç Karagüven
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ufuk University, Ankara, Turkey
| | - Ilker Cetin
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ufuk University, Ankara, Turkey
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Yesilbag D, Cengiz S, Cetin I, Meral Y, Biricik H. Influence of Juniper (Juniperus communis) oil on growth performance and meat quality as a natural antioxidant in quail diets. Br Poult Sci 2014; 55:495-500. [DOI: 10.1080/00071668.2014.932335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Floridia M, Pinnetti C, Ravizza M, Frisina V, Cetin I, Fiscon M, Sansone M, Antoni AD, Guaraldi G, Vimercati A, Guerra B, Placido G, Dalzero S, Tamburrini E. Rate, predictors, and consequences of late antenatal booking in a national cohort study of pregnant women with HIV in Italy. HIV Clin Trials 2014; 15:104-15. [PMID: 24947534 DOI: 10.1310/hct1503-104] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the prevalence and consequences of late antenatal booking (13 or more weeks gestation) in a national observational study of pregnant women with HIV. METHODS The clinical and demographic characteristics associated with late booking were evaluated in univariate analyses using the Mann-Whitney U test for quantitative data and the chi-square test for categorical data. The associations that were found were re-evaluated in multivariable logistic regression models. Main outcomes were preterm delivery, low birthweight, nonelective cesarean section, birth defects, undetectable (<50 copies/mL) HIV plasma viral load at third trimester, delivery complications, and gender-adjusted and gestational age-adjusted Z scores for birthweight. RESULTS Rate of late booking among 1,643 pregnancies was 32.9%. This condition was associated with younger age, African provenance, diagnosis of HIV during pregnancy, and less antiretroviral exposure. Undetectable HIV RNA at third trimester and preterm delivery were significantly more prevalent with earlier booking (67.1% vs 46.3%, P < .001, and 23.2% vs 17.6, P = .010, respectively), whereas complications of delivery were more common with late booking (8.2% vs 5.0%, P = .013). Multivariable analyses confirmed an independent role of late booking in predicting detectable HIV RNA at third trimester (adjusted odds ratio [AOR], 1.7; 95% CI, 1.3-2.3; P < .001) and delivery complications (AOR, 1.8; 95% CI, 1.2-2.8; P = .005). CONCLUSIONS Late antenatal booking was associated with detectable HIV RNA in late pregnancy and with complications of delivery. Measures should be taken to ensure an earlier entry into antenatal care, particularly for African women, and to facilitate access to counselling and antenatal services. These measures can significantly improve pregnancy management and reduce morbidity and complications in pregnant women with HIV.
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Affiliation(s)
- M Floridia
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - C Pinnetti
- I.N.M.I. Lazzaro Spallanzani, Rome, Italy
| | - M Ravizza
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - V Frisina
- Department of Obstetrics and Neonatology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - I Cetin
- Department of Obstetrics and Gynaecology, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - M Fiscon
- Department of Pediatrics, University of Padova, Padova, Italy
| | - M Sansone
- Department of Obstetrics and Gynaecology, University Federico II of Naples, Naples, Italy
| | - A Degli Antoni
- Department of Infectious Diseases and Hepatology, Azienda Ospedaliera di Parma, Parma, Italy
| | - G Guaraldi
- Department of Medical Specialties, Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - A Vimercati
- Department of Obstetrics and Gynaecology, University of Bari and Policlinic Hospital, Bari, Italy
| | - B Guerra
- University of Bologna and St. Orsola Malpighi General Hospital, Bologna, Italy
| | - G Placido
- Unit of Infectious Diseases, Pescara General Hospital, Pescara, Italy
| | - S Dalzero
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - E Tamburrini
- Department of Infectious Diseases, Catholic University, Rome, Italy
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Kocabaş A, Salman N, Ekici F, Cetin I, Akcan FA. Evaluation of cardiac functions and atrial electromechanical delay in children with adenotonsillar hypertrophy. Pediatr Cardiol 2014; 35:785-92. [PMID: 24343731 DOI: 10.1007/s00246-013-0853-7] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 11/28/2013] [Indexed: 11/26/2022]
Abstract
Deterioration of the right ventricular (RV) functions and the increase in the pulmonary arterial pressure (PAP) of children with moderate to severe adenotonsillar hypertrophy (ATH) have been well described. In addition to these complications, this study aimed to investigate the influence of ATH on the conduction system. The study investigated 46 patients with a diagnosis of ATH and 46 healthy control subjects. Conventional echocardiography, P-wave dispersion (Pd), tissue Doppler imaging (TDI) findings, and atrial electromechanical delay (AED) were compared between the patients and the control subjects before and after adenotonsillectomy. The maximum P-wave duration and Pd were significantly higher in the patients than in the control subjects (p < 0.001). The patient group showed significantly greater RV end-diastolic dimension (p = 0.01), right atrial area (p < 0.001), and mean PAP (p = 0.03) but lower E/A ratios for the mitral (p = 0.04) and tricuspid (p = 0.01) valves and a shorter pulmonary flow trace acceleration time (p = 0.03). The tricuspid annular-plane systolic excursion was similar between these groups (p = 0.21). In the patient group, TDI studies showed significantly lower E'/A' ratios for the tricuspid lateral (p = 0.006) and mitral septal (p = 0.003) segments than in the control group. The myocardial performance index was lower for the mitral lateral, mitral septal, and tricuspid lateral segments in patient group (p < 0.001). Similarly, AED was prolonged in the patient group at all three segments (p < 0.001). Also, the patient group showed a significantly longer interatrial (p = 0.03) and intraatrial (p = 0.04) electromechanical delay. However, all the electro- and echocardiographic parameters were similar between the patients and the control subjects after adenotonsillectomy (p > 0.05). The prolongations in P-wave duration, Pd, and inter- and intraatrial electromechanical delays were first shown in this population. The cardiac changes induced by ATH-associated hypoxia may facilitate arrhythmias during the long term.
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Affiliation(s)
- Abdullah Kocabaş
- Department of Pediatric Cardiology, Ankara Children's Hematology and Oncology Research and Training Hospital, Ankara, Turkey,
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Tezer H, Ozkaya Parlakay A, Gülhan B, Cetin I. Bradycardia related to ribavirin in four pediatric patients with Crimean-Congo hemorrhagic fever. Vector Borne Zoonotic Dis 2014; 14:464-5. [PMID: 24745325 DOI: 10.1089/vbz.2012.1294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is a potentially fatal fever due to infection with the CCHF virus, which belongs to the genus Nairovirus in the Bunyaviridae family and causes severe disease in humans, with reported mortality rates of 15-70% (Centers for Disease Control and Prevention 1983 ). Humans become infected through the bites of ticks, by contact with blood or tissue from viremic livestock, or by contact with a patient with CCHF during the acute phase of infection (Khan et al. 1997 ). Uysal et al. ( 2012 ) reported bradycardia in a patient with CCHF related to ribavirin treatment. We have observed the same side effect in four pediatric patients that also resolved with discontinuation of ribavirin.
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Affiliation(s)
- Hasan Tezer
- Ankara Hematology Oncology Pediatric Training and Research Hospital , Ankara, Turkey
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Franchi F, Cetin I, Todros T, Antonazzo P, De Santis MSN, Cardaropoli S, Piccoli E, Bucciarelli P, Faioni EM, Biguzzi E. Intruterine Growth Restriction (IUGR) and thrombophilic polymorphisms. J Thromb Haemost 2014. [DOI: 10.1111/j.1538-7836.2003.tb03498.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mandò C, De Palma C, Stampalija T, Anelli GM, Figus M, Novielli C, Parisi F, Clementi E, Ferrazzi E, Cetin I. Placental mitochondrial content and function in intrauterine growth restriction and preeclampsia. Am J Physiol Endocrinol Metab 2014; 306:E404-13. [PMID: 24347055 DOI: 10.1152/ajpendo.00426.2013] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Intrauterine growth restriction (IUGR) and pregnancy hypertensive disorders such as preeclampsia (PE) associated with IUGR share a common placental phenotype called "placental insufficiency", originating in early gestation when high availability of energy is required. Here, we assess mitochondrial content and the expression and activity of respiratory chain complexes (RCC) in placental cells of these pathologies. We measured mitochondrial (mt)DNA and nuclear respiratory factor 1 (NRF1) expression in placental tissue and cytotrophoblast cells, gene and protein expressions of RCC (real-time PCR and Western blotting) and their oxygen consumption, using the innovative technique of high-resolution respirometry. We analyzed eight IUGR, six PE, and eight uncomplicated human pregnancies delivered by elective cesarean section. We found lower mRNA levels of complex II, III, and IV in IUGR cytotrophoblast cells but no differences at the protein level, suggesting a posttranscriptional compensatory regulation. mtDNA was increased in IUGR placentas. Both mtDNA and NRF1 expression were instead significantly lower in their isolated cytotrophoblast cells. Finally, cytotrophoblast RCC activity was significantly increased in placentas of IUGR fetuses. No significant differences were found in PE placentas. This study provides genuine new data into the complex physiology of placental oxygenation in IUGR fetuses. The higher mitochondrial content in IUGR placental tissue is reversed in cytotrophoblast cells, which instead present higher mitochondrial functionality. This suggests different mitochondrial content and activity depending on the placental cell lineage. Increased placental oxygen consumption might represent a limiting step in fetal growth restriction, preventing adequate oxygen delivery to the fetus.
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Affiliation(s)
- C Mandò
- Department of Mother and Child, L. Sacco University Hospital, Department of Biomedical and Clinical Sciences School of Medicine, Università degli Studi di Milano, Milan, Italy
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Savasi V, Leone FPG, Fusè F, Parisi F, Cetin I. Assisted reproductive technologies and uterine factors influencing their success. Minerva Ginecol 2013; 65:505-524. [PMID: 24096288] [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: 06/02/2023]
Abstract
Congenital and acquired uterine factors are known to influence the success of assisted reproductive technologies (ARTs). Several studies analyzed the role of uterine septa, adenomyosis, myomas, endometrial polyps and intrauterine adhesions in female infertility. All of them might cause defective endometrial receptivity and consequently decreased embryo implantation and pregnancy rate. In particular, septate uterus represents the most frequent Müllerian anomaly leading to an increased risk of abortion. Many studies evaluated the role of hysteroscopic metroplasty on fertility outcomes, but this topic remains controversial. The role of adenomyosis in infertility is still debated and, even if different mechanisms have been described to explain implantation failure, there are still conflicting findings on the impact of adenomyosis on ART. The effects of myomas on fertility mainly depend on their type, so that submucous have a detrimental impact on fertility, subserous seem to have no effect, while there is no clear consensus regarding the effect of intramural. Consequently, the potential influence of myomectomy on fertility outcomes depends on the type, being mandatory only the hysteroscopic treatment of submucous myomas. The effect of endometrial polyps on endometrial receptivity and fertility is not clear, even if some studies identified improvement in pregnancy rates after hysteroscopic polipectomy. In presence of intrauterine adhesions, infertility represents the most common manifestation and the restoring of normal uterine cavity should be always pursued when possible.
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Affiliation(s)
- V Savasi
- Unit of Obstetrics and Gynaecology Department of Clinical Sciences Hospital L. Sacco, Milan, Italy -
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Topcul M, Cetin I, Ozlem Kolusayin Ozar M. The effects of anastrozole on the proliferation of FM3A cells. J BUON 2013; 18:874-878. [PMID: 24344011] [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: 06/03/2023]
Abstract
PURPOSE In this study, the antiproliferative effects of the aromatase inhibitor anastrozole (arimidex®) was evaluated on estrogen receptor (ER) positive FM3A cell line originated from C3H mouse mammary carcinoma. METHODS For this purpose cell kinetic parameters including viability analysis, mitotic index and labelling index were used. Three different doses of anostrozole (D1= 0.01 μM, D2= 0.1μM, D3= 1μM) were applied to cells for 24 h to determine the most effective dose. A dose of 1μM dose was determined as the most effective and this was used in all subsequent applications for 0-72 h. RESULTS The results showed that there was a significant decrease in viability, mitotic index and labelling index for all experimental groups. The differences between control and all experimental groups were statistically significant (p<0.01) for all applications. CONCLUSIONS Anastrozole offers a promising treatment modality in estrogen sensitive breast cancer.
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Affiliation(s)
- M Topcul
- Istanbul University, Faculty of Science, Department of Biology, Istanbul, Turkey
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Villa A, Abati S, Pileri P, Calabrese S, Capobianco G, Strohmenger L, Ottolenghi L, Cetin I, Campus GG. Oral health and oral diseases in pregnancy: a multicentre survey of Italian postpartum women. Aust Dent J 2013; 58:224-9. [PMID: 23713644 DOI: 10.1111/adj.12058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to explore the oral hygiene practices and oral health status of Italian postpartum women. METHODS A self-administered questionnaire assessed socio-demographic information, oral hygiene habits and frequency of dental visits. All women received a thorough oral examination within five days after delivery. Logistic regression models were used to estimate odds ratios and 95% confidence intervals for exposures of interest and the presence of 'severe' periodontitis. RESULTS Seven hundred and fifty women participated in the study; 99.1% brushed their teeth everyday and 59.9% visited the dentist annually. The mean frequency of sites with bleeding on probing was 16.1% and the median clinical attachment level was 2.1 mm. The mean caries experience score (DMFT) was 8. Severe periodontal disease was present in 21.9% of individuals. Patients who reported visiting a dentist only when in pain and women with three dental caries or more were significantly more likely to have periodontitis (OR: 1.6; 95% CI: 1.1-2.2; p < 0.05 and OR: 2.3; 95% CI: 1.5-3.5; p < 0.01, respectively). CONCLUSIONS Given the possible association between maternal and infant oral health, and between periodontal infection and general health, antenatal care providers should collaborate with dentists to encourage all pregnant women to comply with the oral health professionals' recommendations regarding appropriate dental brushing techniques and the importance of dental visits.
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Affiliation(s)
- A Villa
- Dental Clinic, Department of Health Sciences, University of Milan, Italy.
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Staff A, Burke Ó, Benton S, von Dadelszen P, Szafranski P, Zhang C, Buhimschi C, Cetin I, Figueras F, Holzman C, Hubel C, Laivuori H, McElrath T, Myers, Ness R, Poston L, Ris-Stalpers C, Roberts J, Schistermann E, Steegers E, Timmermans S, van der Post J, Villa P, Williams D, Redman C. Maternal circulating PlGF concentrations and placenta-related pregnancy complications: First results from the CoLab AngF Study. Pregnancy Hypertens 2013; 3:59. [DOI: 10.1016/j.preghy.2013.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cappelletti M, Giannelli S, Martinelli A, Cetin I, Colombo E, Calcaterra F, Mavilio D, Della Bella S. Lack of activation of peripheral blood dendritic cells in human pregnancies complicated by intrauterine growth restriction. Placenta 2012. [PMID: 23182380 DOI: 10.1016/j.placenta.2012.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The state of activation of dendritic cells (DCs) at the feto-maternal interface critically contributes to optimal decidual immune responses needed to support fetal-placental development. We recently demonstrated that during healthy pregnancy also peripheral blood DCs (PBDCs), which are easily accessible, are activated as well. In this study, to investigate a possible involvement of DCs in intrauterine growth restriction (IUGR), we evaluated whether PBDCs in pregnancy complicated by IUGR may be altered compared with PBDCs in healthy pregnancy. METHODS PBDCs from 12 pregnant women with primary IUGR, 21 healthy pregnant and 19 nonpregnant women were analyzed by flow cytometric analysis of whole-blood samples collected at a single time point. RESULTS The number of plasmacytoid PBDCs was significantly reduced in women with IUGR pregnancy. Myeloid and plasmacytoid PBDCs in IUGR lacked the state of activation (assessed as CD80, CD86, CD40 expression) and the shift to a proinflammatory pattern of cytokine production occurring during healthy pregnancy. DISCUSSION To our knowledge, this is the first study investigating the state of PBDC activation in IUGR pregnancy. Our results are in accordance with a previous study reporting a lower expression of activation and maturation markers by decidual DCs in IUGR placentas. CONCLUSIONS The reduced activation of PBDCs in IUGR pregnancy may possibly reflect a reduced activation of decidual DCs. If confirmed at the feto-maternal interface, the alterations of DCs described in IUGR pregnancy have the potential to negatively impact on vascular development during gestation. These observations may therefore broaden our understanding of IUGR pathogenesis.
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Affiliation(s)
- M Cappelletti
- Lab of Immunology, Department of Biomedical Sciences and Technologies, University of Milan, Italy
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Abstract
BACKGROUND Three quarters of individuals infected with human immunodeficiency virus (HIV) are in their reproductive years and may consider pregnancy planning. Techniques have been developed which can minimize the risk of HIV transmission in these couples, and the current literature on this topic is reviewed here. METHODS We reviewed the literature for the following topics: risk of HIV transmission, effects of HIV infection on fertility, reproductive assistance in industrialized and low-income countries, pre-exposure chemoprophylaxis (PrEP) and timed intercourse in HIV-discordant couples for both male and female positivity. Relevant publications were identified through searches of the EMBASE Medline and PubMed databases, the Google-indexed scientific literature and periodic specialized magazines from the on-line Library Service of the University of Milan, Italy. RESULTS In serodiscordant couples in which the man is positive, the primary method used to prevent HIV transmission is 'sperm washing', followed by IUI or IVF. Data show that sperm washing in HIV-positive men has not produced seroconversion in women or their offspring; however, the evidence is limited. Recently, increasing evidence describing PrEP for HIV prevention has been published and PrEP could be an alternative to ART for fertile couples. Usually HIV-infected women undergo self-insemination around the time of ovulation. Few studies have been published on IVF outcome in HIV-infected women. CONCLUSIONS Assisted reproduction programmes should be integrated into global public health services against HIV. For HIV serodiscordant couples with infected men, sperm washing should be the first choice. However, timed intercourse and PrEP for HIV prevention has been reported. Recent data highlight the possible impairment of fertility in HIV-infected women. Efforts to design a multicentric study should be strengthened.
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Affiliation(s)
- V Savasi
- Unit of Obstetrics and Gynecology, Department of Clinical Sciences, Hospital L. Sacco, University of Milan, Via G. B. Grassi, 74, 20157 Milan, Italy.
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Cozzi V, Garlanda C, Nebuloni M, Maina V, Martinelli A, Calabrese S, Cetin I. PTX3 as a potential endothelial dysfunction biomarker for severity of preeclampsia and IUGR. Placenta 2012; 33:1039-44. [PMID: 23062219 DOI: 10.1016/j.placenta.2012.09.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 09/13/2012] [Accepted: 09/17/2012] [Indexed: 12/17/2022]
Abstract
Endothelial dysfunction typical of preeclampsia (PE) is the result of an excessive maternal inflammatory response to pregnancy. We investigated PTX3 in maternal, fetal and placental compartments in complicated pregnancies. Maternal blood samples were collected during the third trimester in 53 PE, 43 IUGR (intrauterine growth restriction) and 50 normal pregnancies. Fetal samples were collected from the umbilical vein in 26 PE, 23 IUGR and 26 normal pregnancies at elective cesarean section. Pattern and site of expression of PTX3 were studied by immunohistochemistry (IHC) on placenta, decidual bed and maternal peritoneum. PE and IUGR pregnancies had significantly higher maternal PTX3 levels compared to normal pregnancies, with IUGR significantly lower than PE. Maternal peritoneum expressed a significantly higher signal in the endothelium of pathological compared to normal pregnancies. The maternal increase of PTX3 correlated with the severity of disease with higher PTX3 concentrations in severe PE. Increased PTX3 levels in PE and IUGR mothers, together with IHC data represent the expression of altered endothelial function on the maternal side. IUGR fetuses had higher PTX3 values than controls and the increase was related to IUGR severity, likely reflecting the hypoxic environment. These data confirm the relevance of PTX3 in support the hypothesis that PE is a disease associated with altered maternal endothelial function. The PTX3 increase in IUGR fetuses deserves further investigation.
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Affiliation(s)
- V Cozzi
- Unit of Obstetrics and Gynecology and Center for Fetal Research Giorgio Pardi, Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Via G.B. Grassi 74, 20151 Milano, Italy
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Cetin I, Topcul M. Cancer stem cells in oncology. J BUON 2012; 17:644-648. [PMID: 23335519] [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: 06/01/2023]
Abstract
Cancer stem cells (CSCs) possess several characteristics including self-renewal, pluripotency and tumorigenicity and constitute a rare population in a tumor mass. Because conventional cancer therapies can not kill CSCs, these cells are responsible for tumor relapse and metastasis. Currently, with advances in the identification of CSCs, the importance of these cells is increasing in the field of cancer diagnosis and prognosis. In addition, clarifying the mechanisms responsible for the maintenance of CSCs properties led to the development of CSC-targeted therapies.
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Affiliation(s)
- I Cetin
- Istanbul University, Institute of Science, Department of General Biology, Istanbul, Turkey.
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Hiden U, Lassance L, Tabrizi NG, Miedl H, Tam-Amersdorfer C, Cetin I, Lang U, Desoye G. Fetal insulin and IGF-II contribute to gestational diabetes mellitus (GDM)-associated up-regulation of membrane-type matrix metalloproteinase 1 (MT1-MMP) in the human feto-placental endothelium. J Clin Endocrinol Metab 2012; 97:3613-21. [PMID: 22893718 DOI: 10.1210/jc.2012-1212] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Gestational diabetes mellitus (GDM)-associated hormonal and metabolic derangements in mother and fetus affect placental development and function. Indeed, in GDM, placentas are characterized by hypervascularization and vascular dysfunction. The membrane-type matrix metalloproteinase 1 (MT1-MMP) is a key player in angiogenesis and vascular expansion. OBJECTIVE Here, we hypothesized elevated placental MT1-MMP levels in GDM induced by components of the diabetic environment. Therefore, we measured placental MT1-MMP in normal vs. GDM pregnancies, identified potential functional consequences, and investigated the contribution of hyperglycemia and the insulin/IGF axis. DESIGN Immunohistochemistry identified placental cell types expressing MT1-MMP. MT1-MMP was compared between normal and GDM placentas by immunoblotting. Quantitative PCR of MT1-MMP in primary feto-placental endothelial cells (fpEC) and trophoblasts isolated from both normal and GDM placentas identified the cells contributing to the GDM-associated changes. A putative MT1-MMP role in angiogenesis was determined using blocking antibodies for in vitro angiogenesis assays. Potential GDM-associated factors and signaling pathways inducing MT1-MMP up-regulation in fpEC were identified using kinase inhibitors. RESULTS Total and active MT1-MMP was increased in GDM placentas (+51 and 54%, respectively, P<0.05) as a result of up-regulated expression in fpEC (2.1-fold, P=0.02). MT1-MMP blocking antibodies reduced in vitro angiogenesis up to 25% (P=0.03). Pathophysiological levels of insulin and IGF-II, but not IGF-I and glucose, stimulated MT1-MMP expression in fpEC by phosphatidylinositol 3-kinase signals relayed through the insulin, but not IGF-I, receptor. CONCLUSIONS GDM up-regulates MT1-MMP in the feto-placental endothelium, and insulin and IGF-II contribute. This may account for GDM-associated changes in the feto-placental vasculature.
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Affiliation(s)
- U Hiden
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria.
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Cetin I, Pileri P, Villa A, Calabrese S, Ottolenghi L, Abati S. Pathogenic mechanisms linking periodontal diseases with adverse pregnancy outcomes. Reprod Sci 2012; 19:633-41. [PMID: 22421445 DOI: 10.1177/1933719111432871] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the last 2 decades, a large proportion of studies have focused on the relationship between maternal periodontal disease and poor obstetric outcomes. The aim of the present review is to summarize the current knowledge about human studies on the pathogenetic mechanisms linking periodontal diseases with adverse pregnancy outcomes. A search of the medical literature was conducted using NIH (National Institute of Health) Pubmed through April 2011. Articles were identified with the Medical Subject Heading (MeSH) and free text terms "small for gestational age (SGA)," "preeclampsia," "preterm labor," and "periodontal disease." Experimental human studies have shown that periodontal pathogens may disseminate toward placental and fetal tissues accompanied by an increase in inflammatory mediators in the placenta. As such, new inflammatory reactions within the placental tissues of the pregnant woman may occur, the physiological levels of prostaglandin E(2) (PGE(2)) and tumor necrosis factor-α (TNF-α) in the amniotic fluid may increase and eventually lead to premature delivery. Although many data from clinical trials suggest that periodontal disease may increase the adverse pregnancy outcome, the exact pathogenetic mechanism involved remains controversial. The findings explain the potential link between periodontal infections and adverse pregnancy outcomes. First, periodontal bacteria can directly cause infections both of the uteroplacenta and the fetus; second, systemic inflammatory changes induced by periodontal diseases can activate responses at the maternal-fetal interface. Of note, associative studies have produced different results in different population groups and no conclusive evidence has still been produced for the potential role of preventive periodontal care to reduce the risk factors of preterm birth.
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Affiliation(s)
- I Cetin
- Unit of Obstetrics and Gynecology, Department of Clinical Sciences L. Sacco, and Center for Fetal Research Giorgio Pardi, University of Milan, Milan, Italy.
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Abstract
OBJECTIVE The aim of the study was to assess myocardial damage in infants due to perinatal hypoxia. METHODS The findings of 29 infants with perinatal hypoxia and 20 healthy infants were compared. Blood gas analysis, serum lactate, cardiac troponin I (cTnI), troponin T (cTnT), creatine kinase-MB (CK-MB) and B-type natriuretic peptide (BNP) were evaluated. Echocardiography together with tissue Doppler imaging was performed. RESULTS cTnT, CK-MB and BNP were higher in patients at the first day. There were positive correlations between the left ventricular (LV) myocardial performance index (MPI) and cTnT at first day and also at first month. LV ejection fraction and fractional shortening were lower at first day and at first month in patients. Myocardial systolic (Sm) and diastolic (Em and Am) velocities at all segments were lower at first day, and interventricular septum Sm, LV Sm, LV Em, right ventricular Em and LV Am were still lower at first month in patients. Isovolumic relaxation time at all segments together with LV MPI was higher at first day, ejection time values were lower and MPI values were higher at all segments at first month in patients. CONCLUSIONS These findings demonstrated that the signs of myocardial damage due to perinatal hypoxia still present at first month.
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Affiliation(s)
- Ilker Cetin
- Ankara Child Health, Hematology, Oncology Education and Research Hospital, Ankara, Turkey
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Berti C, Biesalski HK, Gärtner R, Lapillonne A, Pietrzik K, Poston L, Redman C, Koletzko B, Cetin I. Micronutrients in pregnancy: current knowledge and unresolved questions. Clin Nutr 2011; 30:689-701. [PMID: 21872372 DOI: 10.1016/j.clnu.2011.08.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 07/30/2011] [Accepted: 08/04/2011] [Indexed: 01/11/2023]
Abstract
Micronutrient status is increasingly recognized to play an important role in the health and well-being of pregnant women and in the development and long-term health of the offspring. On 26th - 28th February 2009, The Child Health Foundation invited leading experts in this area to a scientific workshop at Obergurgl, Austria to review and critically discuss current knowledge, to identify issues that may need to be addressed in future recommendations, and to highlight priorities and opportunities for future research. This report summarizes updated key conclusions of the workshop with regards to micronutrients' intake and physiological role related to mother, placenta and fetus, as well as relevance for adverse pregnancy and long-term outcomes.
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Affiliation(s)
- C Berti
- Unit of Obstetrics and Gynecology and Center for Fetal Research Giorgio Pardi, University of Milan, Via G. B. Grassi, 74, 20157 Milano, Italy.
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