Objective Our study aims were to establish whether subjects enrolled in current obstetric clinical trials proportionately reflects the contemporary representation of Hispanic ethnicities and their ...birth rates in the United States. Methods Using comprehensive source data over a defined interval (January 2011-September 2015) on birth rates by ethnicity from the Centers for Disease Control and Prevention (CDC), we evaluated the proportional rate by ethnicity, then analyzed the observed to expected relative ratio of enrolled subjects. Results Hispanic women comprise a significant contribution to births in the United States (23% of all births). Systematic analysis of 90 published obstetric clinical trials showed a correlation between inclusion of Hispanic gravidae and the corresponding state's birth rates (r = 0.501, p < 0.001). While the mean was strongly correlated, individual clinical trials may have relatively over-enrolled (n = 31, or 34%) or under-enrolled (n = 33, or 37%) relative to their regional population. In 48% of obstetric clinical trials the Hispanic proportion of the study population was not reported. Conclusion Hispanic gravidae represent a significant number of contemporary U.S. births, and are generally adequately represented as obstetric subjects in clinical trials. However, this is trial-dependent, with significant trial-specific under- and over-enrollment of Hispanic subjects relative to the regional birth population.
Stem cell therapy and aerobic exercise are non-pharmacological therapies following myocardial infarction. The aim of this study was to test whether aerobic exercise training enhances the benefits of ...mesenchymal stem cell (MSC) therapy on remodeling of the extracellular matrix and fetal gene expression in the left ventricle of infarcted rats.
Myocardial infarction was surgically induced in six-week old male Wistar rats. Animals were divided into four groups: sedentary control (SC) and sedentary and stem cell treated (SCMSC); exercised (EX) and exercised and stem cell treated (EXMSC). Bone marrow-derived MSCs were immediately transplanted via the tail vein (concentration: 1×106 cells). Exercise training (five days/week, 60 min/day; 60% of maximal running speed) started 24 hours after myocardial infarction and lasted for 12 weeks.
Exercise capacity was higher in exercised than in sedentary groups. Animals in the SCMSC, EX and EXMSC groups exhibited better cardiac function than those in SC. Collagen content was lower in the SCMSC, EX and EXMSC groups than in SC and skeletal α-actin expression was lower in EX and EXMSC than in SC. The α/β-MHC ratio was higher in EX and EXMSC than in SC. The combination of therapies further reduced collagen content in the remote region of the infarct (∼24%) and skeletal α-actin expression (∼30%).
Aerobic exercise training appears to enhance the beneficial effects of stem cell therapy on remodeling of the extracellular matrix and fetal gene expression in the left ventricle of rats with moderate infarction.
Terapia com células estromais e exercício aeróbio são estratégias não farmacológicas no tratamento pós-enfarte do miocárdio. O objetivo foi testar se o treinamento aeróbio amplia os benefícios da terapia com células mesenquimais estromais (CME) na remodelagem da matriz extracelular e na expressão de genes fetais no ventrículo esquerdo de ratos enfartados.
O enfarte do miocárdio foi induzido cirurgicamente em ratos com seis semanas de idade, divididos em quatro grupos: sedentário controle (SC) e tratado com CME (SCCME); exercício (EX) e exercício tratado com CME (EXCME). CME derivadas da medula óssea foram transplantadas através da veia caudal (concentração: 1 x 106 células). O treinamento aeróbio (5 dias/semana; 60min/dia; 60% da velocidade máxima de corrida) iniciou 24h após enfarte do miocárdio e durou 12 semanas.
A capacidade de exercício foi maior nos grupos exercitados que nos sedentários. Os grupos SCCME, EX e EXCME apresentaram melhor função cardíaca do que o SC. O conteúdo de colagénio foi menor nos grupos SCCME, EX e EXCME que no SC. A expressão da α-actina esquelética foi menor nos grupos EX e EXCME, comparada à do SC. A razão miosina de cadeia pesada α/β foi maior nos grupos EX e EXCME, comparada à do SC. A combinação das terapias reduziu ainda mais o conteúdo de colagénio na região remota (∼24%) e a expressão de α-actina esquelética (∼30%).
O treinamento aeróbio parece potencializar os benefícios da terapia com células mesenquimais estromais na remodelagem da matriz extracelular do ventrículo esquerdo e expressão de genes fetais em ratos com enfarte moderado.
One of the many causes of fetal hydrops is fetomaternal hemorrhage. This report presents a pregnancy with fetomaternal hemorrhage that was treated with serial combined intravascular and ...intrperitoneal fetal transfusions, resulting in a good outcome. A 26-year-old woman seen for ultrasonographic evaluation was found to have a fetus with hydrops fetalis. Fetal blood sampling demonstrated severe fetal anemia (hematocril 16.4%). The initial Kleihauer-Betke test result on maternal blood was 6% fetal cells. The fetus was transfused five times over a 24-day period by means of a combined intravascular and intraperitoneal route. The fetus also received one platelet transfusion for thrombocytopenia. The pregnancy resulted in a good fetal outcome without the need for postpartum transfusion. This case represents successful treatment of fetal anemia and nonimmune hydrops with a serial combined intravascular and intraperitoneal transfusion technique.
Vibroacoustic stimulation is commonly used in antepartum fetal testing and has known benefits. Although the procedure has been deemed safe, questions have been raised as to potentially adverse ...effects, and the adult cardiology literature identifies a link between abrupt sound stimulation and severe tachyarrhythmias.
A fetus with premature atrial contractions converted to supraventricular tachycardia immediately after vibroacoustic stimulation. The tachyarrhythmia spontaneously reverted to baseline after 4 minutes. The infant was treated for junctional reentry tachycardia at birth.
Although the cardiac effects of vibroacoustic stimulation have previously been characterized as benign, the use of this modality may warrant restriction in the setting of known fetal arrhythmias.
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