The purpose of this study was to examine the efficacy of nonvisualization of the fourth ventricle... more The purpose of this study was to examine the efficacy of nonvisualization of the fourth ventricle for first-trimester detection of spina bifida. A total of 250 digitally stored sonographic examinations at gestational ages of 11 weeks to 13 weeks 6 days (245 normal and 5 randomly interspersed spina bifida cases) were retrospectively analyzed by 4 blinded reviewers for the presence or absence of the fourth ventricle followed by an anteroposterior ventricular dimension measurement. The ventricle size was related to the crown-rump length and gestational age by linear regression analysis and Pearson correlation. The fourth ventricle was identified in 971 of 1000 image readings (97.1%). False-negative and false-positive readings occurred in 11 of 20 (55.0%) and 20 of 980 (2.0%) cases, respectively (sensitivity, 0.45; specificity, 0.98.). False-negative and false-positive readings were evenly distributed throughout the gestational age range. When the ventricular size was measurable, its mean dimensions increased linearly with gestational age and were below the fifth percentile in 10 of 245 (4.0%) normal and 0 of 4 spina bifida cases, respectively. Intraclass correlation coefficient estimates were calculated based on the 2-way analysis of variance model and found to be 0.30 for a single rater and 0.64 for the mean of 4 raters. Nonvisualization of the first-trimester fourth ventricle is a less robust screening parameter for spina bifida than previously published.
American Journal of Obstetrics and Gynecology, 2011
Ca2ϩ signaling is due to the underlying vascular derangement of chronic disease (DM) versus an ap... more Ca2ϩ signaling is due to the underlying vascular derangement of chronic disease (DM) versus an apparently transient disease of pregnancy (GDM). STUDY DESIGN: HUVEC of normal (Nϭ5), DM (Nϭ5), and GDM (Nϭ5) subjects were imaged using FURA-2 to detect Ca 2ϩ in real time in response to stimulation with ATP (100 uM). Ca2ϩ bursts and area under the curve (AUC) for the sustained phase were quantified. RESULTS: Analyses of fluorescent image intensity show that while Ca2ϩ signaling in the HUVEC of DM and GDM subjects is qualtitatively similar to that of normal pregnancy, with an initial peak followed by repeated Ca2ϩ bursts synchronized between cells, there is also a significant (pϽ0.05) increase in the number of bursts in the sustained phase of Ca 2ϩ response in DM relative to normal. There is no statistically significant difference in burst number between GDM and normal or DM and GDM. AUC is increased in DM relative to normal and GDM (not statistically significant). CONCLUSIONS: These results demonstrate a more rapid and potentially greater overall Ca 2ϩ response in DM subjects relative to normal and GDM. This suggests a unique vascular adaptation in DM HUVEC that mobilizes increased Ca2ϩ in the setting of blunted NO response. We previously demonstrated that DM HUVEC dysfunction in vivo is the result of ROS destruction of eNOS, however, other mechanisms may also be involved at the level of altered cell signaling.
The purpose of this study was to examine the efficacy of nonvisualization of the fourth ventricle... more The purpose of this study was to examine the efficacy of nonvisualization of the fourth ventricle for first-trimester detection of spina bifida. A total of 250 digitally stored sonographic examinations at gestational ages of 11 weeks to 13 weeks 6 days (245 normal and 5 randomly interspersed spina bifida cases) were retrospectively analyzed by 4 blinded reviewers for the presence or absence of the fourth ventricle followed by an anteroposterior ventricular dimension measurement. The ventricle size was related to the crown-rump length and gestational age by linear regression analysis and Pearson correlation. The fourth ventricle was identified in 971 of 1000 image readings (97.1%). False-negative and false-positive readings occurred in 11 of 20 (55.0%) and 20 of 980 (2.0%) cases, respectively (sensitivity, 0.45; specificity, 0.98.). False-negative and false-positive readings were evenly distributed throughout the gestational age range. When the ventricular size was measurable, its mean dimensions increased linearly with gestational age and were below the fifth percentile in 10 of 245 (4.0%) normal and 0 of 4 spina bifida cases, respectively. Intraclass correlation coefficient estimates were calculated based on the 2-way analysis of variance model and found to be 0.30 for a single rater and 0.64 for the mean of 4 raters. Nonvisualization of the first-trimester fourth ventricle is a less robust screening parameter for spina bifida than previously published.
American Journal of Obstetrics and Gynecology, 2011
Ca2ϩ signaling is due to the underlying vascular derangement of chronic disease (DM) versus an ap... more Ca2ϩ signaling is due to the underlying vascular derangement of chronic disease (DM) versus an apparently transient disease of pregnancy (GDM). STUDY DESIGN: HUVEC of normal (Nϭ5), DM (Nϭ5), and GDM (Nϭ5) subjects were imaged using FURA-2 to detect Ca 2ϩ in real time in response to stimulation with ATP (100 uM). Ca2ϩ bursts and area under the curve (AUC) for the sustained phase were quantified. RESULTS: Analyses of fluorescent image intensity show that while Ca2ϩ signaling in the HUVEC of DM and GDM subjects is qualtitatively similar to that of normal pregnancy, with an initial peak followed by repeated Ca2ϩ bursts synchronized between cells, there is also a significant (pϽ0.05) increase in the number of bursts in the sustained phase of Ca 2ϩ response in DM relative to normal. There is no statistically significant difference in burst number between GDM and normal or DM and GDM. AUC is increased in DM relative to normal and GDM (not statistically significant). CONCLUSIONS: These results demonstrate a more rapid and potentially greater overall Ca 2ϩ response in DM subjects relative to normal and GDM. This suggests a unique vascular adaptation in DM HUVEC that mobilizes increased Ca2ϩ in the setting of blunted NO response. We previously demonstrated that DM HUVEC dysfunction in vivo is the result of ROS destruction of eNOS, however, other mechanisms may also be involved at the level of altered cell signaling.
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