scholarly journals Update on the Pathophysiological Implications and Clinical Role of Angiogenic Factors in Pregnancy

2015 ◽  
Vol 37 (2) ◽  
pp. 81-92 ◽  
Author(s):  
Elisa Llurba ◽  
Fatima Crispi ◽  
Stefan Verlohren
Keyword(s):  
Cardiac Development ◽  
Current Knowledge ◽  
Peripartum Cardiomyopathy ◽  
Angiogenic Factors ◽  
Clinical Role ◽  
Clinical Consequences ◽  
Vasculogenesis And Angiogenesis ◽  
Fetal Cardiac Development ◽  
In Pregnancy

Angiogenic markers are now being incorporated into clinical practice for the screening, diagnosing, and monitoring of preeclampsia. Pregnancy requires both vasculogenesis and angiogenesis in the fetal compartment and angiogenesis in the maternal compartment. Abnormal angiogenesis in the placenta determines impaired remodeling of the maternal spiral arteries and placental underperfusion that may ultimately lead to fetal growth restriction and maternal preeclampsia. The dysregulation of angiogenesis in the placenta and maternal-fetal circulation has emerged as one of the main pathophysiological features in the development of placental insufficiency and its clinical consequences. Abnormal angiogenesis has also been related to other obstetric and fetal conditions such as peripartum cardiomyopathy and fetal cardiac defects. This opens up new challenges for our understanding of angiogenic involvement in maternal cardiovascular function and fetal cardiac development, and it offers new clinical opportunities. This review summarizes the current knowledge of the pathophysiological implications and the clinical role of angiogenic factors in pregnancy.

scholarly journals The role of arterial hypertension in the development of cerebrovascular diseases in pregnancy

2018 ◽  
Vol 24 (5) ◽  
pp. 508-514
Author(s):  
M. L. Chukhlovina ◽  
S. E. Medvedev
Keyword(s):  
Arterial Hypertension ◽  
Pregnant Women ◽  
Postpartum Period ◽  
Interdisciplinary Approach ◽  
Cerebrovascular Diseases ◽  
Angiogenic Factors ◽  
Coagulation System ◽  
Childbearing Age ◽  
In Pregnancy

Nowadays, the risk factors, improvement of diagnosis and treatment of cardiovascular diseases are of particular interest. Arterial hypertension (HTN) is known to contribute to cardiovascular disease and to be a risk factor for cerebrovascular diseases. HTN during pregnancy and in the postpartum period draws particular attention. Throughout the world, hypertension during pregnancy remains the leading cause of maternal and child morbidity and mortality. To our knowledge, only a few works studied neurological disorders associated with HTN in pregnant women. In this connection, the purpose of our review was to analyze the role of HTN in the development of cerebrovascular diseases in pregnancy. Pregnant women with HTN show 5,2-fold higher frequency of strokes than normotensive women. The risk of stroke increases from the third trimester of pregnancy to six weeks of the postpartum period. The pregnant women with HTN develop changes in the coagulation system leading to the formation of arterial and venous thromboses in the cerebrovascular circulation. The presence of preeclampsia (PE) is associated with the 7–9-fold increase in the risk of stroke. Endothelial dysfunction is one of the leading links in the pathogenesis of PE. The PE is associated with an increase in anti-angiogenic factors and a decrease in angiogenic factors. Thus, the measures preventing the development of cerebrovascular diseases in pregnant women with HTN, include identification of prehypertension in women of childbearing age, the improvement of HTB management strategies, and an interdisciplinary approach to the diagnostic and treatment process involving the obstetrician, the therapist, the cardiologist and the neurologist.

Clinical efficacy of immune checkpoint inhibitors in patients with brain metastases

Immunotherapy ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 419-432
Author(s):  
Vincenzo Di Nunno ◽  
Giacomo Nuvola ◽  
Mirta Mosca ◽  
Ilaria Maggio ◽  
Lidia Gatto ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Standard Treatment ◽  
Current Knowledge ◽  
Checkpoint Inhibitors ◽  
Clinical Role ◽  
Negative Prognostic Factor ◽  
Solid Malignancies

Brain metastases (BMs) represent a negative prognostic factor for patients with solid malignancies. BMs are generally approached with loco-regional treatments and the blood–brain barrier limits the efficacy of some systemic drugs. The aim of this review is to summarize current knowledge about the role of immune checkpoint inhibitors for the management of brain metastases in patients with solid malignancies. We performed a review of available literature. Immune checkpoint inhibitors represent the standard treatment for several advanced solid malignancies. However, with the exception of melanoma their clinical role in other solid malignancies is not completely clear due to the exclusion of patients with BM from approval clinical trials. Immune-checkpoint inhibitors may be an effective treatment of brain metastases of melanoma while their clinical role on brain metastases from other solid malignancies is uncertain.

scholarly journals The Role of Epigenetics in Congenital Heart Disease

Genes ◽  
2021 ◽  
Vol 12 (3) ◽  
pp. 390
Author(s):  
Tingsen Benson Lim ◽  
Sik Yin Roger Foo ◽  
Ching Kit Chen
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Cardiac Development ◽  
Current Knowledge ◽  
Epigenetic Factors ◽  
Genomic Technologies ◽  
Complex Process ◽  
Dose Dependent

Congenital heart disease (CHD) is the most common birth defect among newborns worldwide and contributes to significant infant morbidity and mortality. Owing to major advances in medical and surgical management, as well as improved prenatal diagnosis, the outcomes for these children with CHD have improved tremendously so much so that there are now more adults living with CHD than children. Advances in genomic technologies have discovered the genetic causes of a significant fraction of CHD, while at the same time pointing to remarkable complexity in CHD genetics. For this reason, the complex process of cardiogenesis, which is governed by multiple interlinked and dose-dependent pathways, is a well investigated process. In addition to the sequence of the genome, the contribution of epigenetics to cardiogenesis is increasingly recognized. Significant progress has been made dissecting the epigenome of the heart and identified associations with cardiovascular diseases. The role of epigenetic regulation in cardiac development/cardiogenesis, using tissue and animal models, has been well reviewed. Here, we curate the current literature based on studies in humans, which have revealed associated and/or causative epigenetic factors implicated in CHD. We sought to summarize the current knowledge on the functional role of epigenetics in cardiogenesis as well as in distinct CHDs, with an aim to provide scientists and clinicians an overview of the abnormal cardiogenic pathways affected by epigenetic mechanisms, for a better understanding of their impact on the developing fetal heart, particularly for readers interested in CHD research.

scholarly journals Drug Testing for Newborn Exposure to Illicit Substances in Pregnancy: Pitfalls and Pearls

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Karen J. Farst ◽  
Jimmie L. Valentine ◽  
R. Whit Hall
Keyword(s):  
Drug Testing ◽  
Illicit Drugs ◽  
Independent Predictor ◽  
Healthcare Providers ◽  
Drug Usage ◽  
Clinical Role ◽  
Survey Tool ◽  
Treatment Services ◽  
In Pregnancy

Estimates of the prevalence of drug usage during pregnancy vary by region and survey tool used. Clinicians providing care to newborns should be equipped to recognize a newborn who has been exposed to illicit drugs during pregnancy by the effects the exposure might cause at the time of delivery and/or by drug testing of the newborn. The purpose of this paper is to provide an overview of the literature and assess the clinical role of drug testing in the newborn. Accurate recognition of a newborn whose mother has used illicit drugs in pregnancy cannot only impact decisions for healthcare in the nursery around the time of delivery, but can also provide a key opportunity to assess the mother for needed services. While drug use in pregnancy is not an independent predictor of the mother's ability to provide a safe and nurturing environment for her newborn, other issues that often cooccur in the life of a mother with a substance abuse disorder raise concerns for the safety of the discharge environment and should be assessed. Healthcare providers in these roles should advocate for unbiased and effective treatment services for affected families.

scholarly journals Peripartum cardiomyopathy: epidemiology, pathophysiology, and management

2021 ◽  
Vol 10 (1) ◽  
pp. 73-82
Author(s):  
E. V. Rudaeva ◽  
I. A. Khmeleva ◽  
K. B. Moses ◽  
V. G. Moses ◽  
I. S. Zakharov ◽  
...  
Keyword(s):  
Family History ◽  
Current Knowledge ◽  
Geographic Region ◽  
Term Treatment ◽  
Peripartum Cardiomyopathy ◽  
Leading Role ◽  
Long Term Treatment ◽  
Esc Guidelines ◽  
Antiangiogenic Factors

The article summarizes the current knowledge on epidemiology, pathophysiology, and management of patients with peripartum cardiomyopathy. The incidence of peripartum cardiomyopathy varies and largely depends on the geographic region. The overall mortality reaches up to 4-28%. Risk factors for developing peripartum cardiomyopathy include multiple pregnancies and multiple births, family history, smoking, diabetes mellitus, hypertension, preeclampsia, poor nutrition, older or adolescent maternal age, and long-term treatment with beta-adrenergic agonists. Genetic factors play the leading role in the pathophysiology of peripartum cardiomyopathy. It is generally confirmed by family history and the incidence variation depending on the geographical region. The pathogenetic role of vasoinhibin, an isoform of prolactin, is described. Vasoinhibin has antiangiogenic, proapoptotic, proinflammatory, and vasoconstrictor effects. The important role of an imbalance between angiogenic and antiangiogenic factors is discussed. There are no guidelines for obstetricians and gynecologists on the management of pregnant women, parturient women, and postpartum women. One of the reasons is the absence of evidence. An urgent cesarean section is indicated if the pregnant woman has acute heart failure and requires inotropic support and/or invasive therapy. However, 2018 ESC Guidelines for the Management of Cardiovascular Diseases during Pregnancy recommend vaginal delivery in these patients.

scholarly journals VP45.03: COVID‐19 causing HELLP‐like syndrome in pregnancy and the role of angiogenic factors for differential diagnosis

2020 ◽  
Vol 56 (S1) ◽  
pp. 257-258
Author(s):  
F. Figueras ◽  
R.J. Martinez‐Portilla ◽  
E. Llurba ◽  
J. Mora ◽  
F. Crispi ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Angiogenic Factors ◽  
In Pregnancy

scholarly journals Genetics of Peripartum Cardiomyopathy: Current Knowledge, Future Directions and Clinical Implications

Genes ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 103
Author(s):  
Timothy F. Spracklen ◽  
Graham Chakafana ◽  
Peter J. Schwartz ◽  
Maria-Christina Kotta ◽  
Gasnat Shaboodien ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Current Knowledge ◽  
Systolic Dysfunction ◽  
Pathogenic Mutation ◽  
Peripartum Cardiomyopathy ◽  
Family Management ◽  
Familial Dilated Cardiomyopathy ◽  
Sequencing Studies ◽  
Shock Proteins

Peripartum cardiomyopathy (PPCM) is a condition in which heart failure and systolic dysfunction occur late in pregnancy or within months following delivery. Over the last decade, genetic advances in heritable cardiomyopathy have provided new insights into the role of genetics in PPCM. In this review, we summarise current knowledge of the genetics of PPCM and potential avenues for further research, including the role of molecular chaperone mutations in PPCM. Evidence supporting a genetic basis for PPCM has emanated from observations of familial disease, overlap with familial dilated cardiomyopathy, and sequencing studies of PPCM cohorts. Approximately 20% of PPCM patients screened for cardiomyopathy genes have an identified pathogenic mutation, with TTN truncations most commonly implicated. As a stress-associated condition, PPCM may be modulated by molecular chaperones such as heat shock proteins (Hsps). Recent studies have led to the identification of Hsp mutations in a PPCM model, suggesting that variation in these stress-response genes may contribute to PPCM pathogenesis. Although some Hsp genes have been implicated in dilated cardiomyopathy, their roles in PPCM remain to be determined. Additional areas of future investigation may include the delineation of genotype-phenotype correlations and the screening of newly-identified cardiomyopathy genes for their roles in PPCM. Nevertheless, these findings suggest that the construction of a family history may be advised in the management of PPCM and that genetic testing should be considered. A better understanding of the genetics of PPCM holds the potential to improve treatment, prognosis, and family management.

Mesophyll conductance: the leaf corridors for photosynthesis

2020 ◽  
Vol 48 (2) ◽  
pp. 429-439 ◽  
Author(s):  
Jorge Gago ◽  
Danilo M. Daloso ◽  
Marc Carriquí ◽  
Miquel Nadal ◽  
Melanie Morales ◽  
...  
Keyword(s):  
Molecular Mechanisms ◽  
Current Knowledge ◽  
Main Role ◽  
Mesophyll Conductance ◽  
Future Studies ◽  
Cell Structures ◽  
Leaf Tissues ◽  
Change Framework ◽  
Chloroplast Stroma

Besides stomata, the photosynthetic CO2 pathway also involves the transport of CO2 from the sub-stomatal air spaces inside to the carboxylation sites in the chloroplast stroma, where Rubisco is located. This pathway is far to be a simple and direct way, formed by series of consecutive barriers that the CO2 should cross to be finally assimilated in photosynthesis, known as the mesophyll conductance (gm). Therefore, the gm reflects the pathway through different air, water and biophysical barriers within the leaf tissues and cell structures. Currently, it is known that gm can impose the same level of limitation (or even higher depending of the conditions) to photosynthesis than the wider known stomata or biochemistry. In this mini-review, we are focused on each of the gm determinants to summarize the current knowledge on the mechanisms driving gm from anatomical to metabolic and biochemical perspectives. Special attention deserve the latest studies demonstrating the importance of the molecular mechanisms driving anatomical traits as cell wall and the chloroplast surface exposed to the mesophyll airspaces (Sc/S) that significantly constrain gm. However, even considering these recent discoveries, still is poorly understood the mechanisms about signaling pathways linking the environment a/biotic stressors with gm responses. Thus, considering the main role of gm as a major driver of the CO2 availability at the carboxylation sites, future studies into these aspects will help us to understand photosynthesis responses in a global change framework.

Prospective Memory Development Across the Lifespan

2020 ◽  
Vol 25 (3) ◽  
pp. 162-173 ◽  
Author(s):  
Sascha Zuber ◽  
Matthias Kliegel
Keyword(s):  
Prospective Memory ◽  
Healthy Aging ◽  
Present Model ◽  
Current Knowledge ◽  
Well Being ◽  
The Elderly ◽  
Cognitive Factors ◽  
Everyday Functioning ◽  
Integrative Framework

Abstract. Prospective Memory (PM; i.e., the ability to remember to perform planned tasks) represents a key proxy of healthy aging, as it relates to older adults’ everyday functioning, autonomy, and personal well-being. The current review illustrates how PM performance develops across the lifespan and how multiple cognitive and non-cognitive factors influence this trajectory. Further, a new, integrative framework is presented, detailing how those processes interplay in retrieving and executing delayed intentions. Specifically, while most previous models have focused on memory processes, the present model focuses on the role of executive functioning in PM and its development across the lifespan. Finally, a practical outlook is presented, suggesting how the current knowledge can be applied in geriatrics and geropsychology to promote healthy aging by maintaining prospective abilities in the elderly.

Comments on expanding the clinical role of psychologists.

1996 ◽  
Vol 51 (3) ◽  
pp. 216-218 ◽  
Author(s):  
Rachel G. Klein
Keyword(s):  
Clinical Role
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