Patient and hospital characteristics associated with severe maternal morbidity among postpartum readmissions.

OBJECTIVE: To examine the influence of socioeconomic, clinical, and hospital characteristics on the risk of severe maternal morbidity among postpartum readmissions. STUDY DESIGN: A cross-sectional analysis was conducted using the National Inpatient Sample 2006-2012 to estimate the risk of severe maternal morbidity and identify potential risk factors. Odds ratios were calculated using multivariate logistic regression. RESULTS: Women aged ≥35 years (ages 35-39: OR 1.12 [CI 1.06, 1.19]; ages 40+: OR 1.27 [CI 1.17, 1.39]), non-Hispanic blacks (OR 1.16 [CI 1.10, 1.22]), and women with pre-existing medical conditions (OR 1.62 [CI 1.56, 1.68]) were at greater risk of severe maternal morbidity during postpartum readmissions. Women hospitalized outside the Northeast region (Midwest: OR 1.20 [CI 1.10, 1.30]; South: OR 1.29 [CI 1.20, 1.38]; West: OR 1.33 [CI 1.22, 1.44]) were also at increased risk. CONCLUSION: The risk of severe maternal morbidity is heightened beyond delivery hospitalization for a subset of high-risk women.

Trichloroethylene disrupts cardiac gene expression and calcium homeostasis in rat myocytes.

We have been investigating the molecular mechanisms by which trichloroethylene (TCE) might induce cardiac malformations in the embryonic heart. Previous results indicated that TCE disrupted expression of genes encoding proteins involved in regulation of intracellular Ca2+, [Ca2+](i), in cardiac cells, including ryanodine receptor isoform 2 (Ryr2), and sarcoendoplasmatic reticulum Ca2+ ATPase, Serca2a. These observations are important in light of the notion that altered cardiac contractility can produce morphological defects. The hypothesis tested in this study is that the TCE-induced changes in gene expression of Ca2+-associated proteins resulted in altered Ca2+ flux regulation. We used real-time PCR and digital imaging microscopy to characterize effects of various doses of TCE on gene expression and Ca2+ response to vasopressin (VP) in rat cardiac H9c2 myocytes. We observed a reduction in Serca2a and Ryr2 expression at 12 and 48 h after exposure to TCE. In addition, we found significant differences in Ca2+ response to VP in cells treated with TCE doses as low as 10 parts per billion. Taken all together, our data strongly indicate that exposure to TCE disrupts the ability of myocytes to regulate cellular Ca2+ fluxes. Perturbation of calcium signaling alters cardiac cell physiology and signal transduction and may hint to morphogenetic consequences in the context of heart development. These results point to a novel area of TCE biology and, if confirmed in vivo, may help to explain the apparent cardio-specific toxicity of TCE exposure in the rodent embryo.

Transcriptional activation of the membrane-bound progesterone receptor (mPR) by dioxin, in endocrine-responsive tissues.

We originally identified the membrane-bound progesterone receptor (mPR) using a screening for genes differentially expressed in liver of rats exposed to dioxin. Recent findings have suggested a role for the mPR in sperm cells, ovary, and brain; however, its mechanisms of action are largely unknown. In this study, we examined the expression pattern of the mPR in liver of rats exposed to dioxin and identified possible mechanisms of its regulation. We observed that mPR expression was induced by dioxin, but was also dependent on the hormonal responsiveness of the tissue. In particular, in male, but not female liver, dioxin induced the expression of the mPR. However, in control, untreated female liver the level of mPR transcript was higher than in control males. Moreover, in breast cancer cells MCF-7 dioxin induced mPR expression. Promoter studies using the luciferase assay indicated that a fragment of approximately 350 bp of the mPR promoter was able to induce luciferase activity in the presence of dioxin, suggesting that the presumptive XREs sites contained in this mPR promoter region are responsive to dioxin. Analysis of mPR protein level confirmed the results observed at the RNA level, both in rat liver and MCF-7 cells. Taken together, these observations suggest the existence of a novel cross-talk between steroid and aromatic hydrocarbon receptors (AhR), and underline the importance of the mPR as a mediator of physiologic effects of the sex hormones.

Trichloroethylene effects on gene expression during cardiac development.

BACKGROUND: Halogenated hydrocarbon exposure is associated with changes in gene expression in adult and embryonic tissue. Our study was undertaken to identify differentially expressed mRNA transcripts in embryonic hearts from Sprague-Dawley rats exposed to trichloroethylene (TCE) or potential bio-transformation products dichloroethylene (DCE) and trichloroacetic acid (TCAA). METHODS: cDNA subtractive hybridization was used to selectively amplify expressed mRNA obtained from control or halogenated hydrocarbon exposed rat embryos. The doses used were 1100 and 110 ppm (8300 and 830 microM) TCE, 110 and 11 ppm (1100 and 110 microM) DCE, and 27.3 and 2.75 mg/ml (100 and 10 mM) TCAA. Control animals were given distilled drinking water throughout the period of experiments. RESULTS: Sequencing of over 100 clones derived from halogenated hydrocarbon exposed groups resulted in identification of numerous differentially regulated gene sequences. Up-regulated transcripts identified include genes associated with stress response (Hsp 70) and homeostasis (several ribosomal proteins). Down-regulated transcripts include extracellular matrix components (GPI-p137 and vimentin) and Ca(2+) responsive proteins (Serca-2 Ca(2+)-ATPase and beta-catenin). Two possible markers for fetal TCE exposure were identified: Serca-2 Ca(2+)-ATPase and GPI-p137, a GPI-linked protein of unknown function. Differential regulation of expression of both markers by TCE was confirmed by dot blot analysis and semi-quantitative RT-PCR with levels of TCE exposure between 100 and 250 ppb (0.76 and 1.9 microM) sufficient to decrease expression. CONCLUSIONS: Sequences down-regulated with TCE exposure appear to be those associated with cellular housekeeping, cell adhesion, and developmental processes, while TCE exposure up-regulates expression of numerous stress response and homeostatic genes.

Threshold of trichloroethylene contamination in maternal drinking waters affecting fetal heart development in the rat.

Halogenated hydrocarbons such as trichloroethylene (TCE) are among the most common water supply contaminants in the United States and abroad. Epidemiologic studies have found an association but not a cause-and-effect relation between halogenated hydrocarbon contamination and increased incidence of congenital cardiac malformations or other defective birth outcomes. Avian and rat studies demonstrated statistically significant increases in the number of congenital cardiac malformations in those treated with high doses of TCE, either via intrauterine pump or in maternal drinking water, compared with controls. This study attempts to determine if there is a threshold dose exposure to TCE above which the developing heart is more likely to be affected. Sprague-Dawley rats were randomly placed in test groups and exposed to various concentrations of TCE (2.5 ppb, 250 ppb, 1.5 ppm, 1,100 ppm) in drinking water or distilled water (control group) throughout pregnancy. The percentage of abnormal hearts in the treated groups ranged from 0 to 10.48%, with controls having 2.1% abnormal hearts, and the number of litters with fetuses with abnormal hearts ranged from 0 to 66.7%, and the control percentage was 16.4%. The data from this study indicate not only that there is a statistically significant probability overall of a dose response to increasing levels of TCE exposure, but also that this trend begins to manifest at relatively low levels of exposure (i.e., < 250 ppb). Maternal rats exposed to more than this level of TCE during pregnancy showed an associated increased incidence of cardiac malformations in their developing rat fetuses.

Practical aspects of experimental design in animal research.

A brief overview is presented of the key steps involved in designing a research animal experiment, with reference to resources that specifically address each topic of discussion in more detail. After an idea for a research project is conceived, a thorough review of the literature and consultation with experts in that field are pursued to refine the problem statement and to assimilate background information that is necessary for the experimental design phase. A null and an alternate hypothesis that address the problem statement are then formulated, and only then is the specific design of the experiment developed. Likely the most critical step in designing animal experiments is the identification of the most appropriate animal model to address the experimental question being asked. Other practical considerations include defining the necessary control groups, randomly assigning animals to control/treatment groups, determining the number of animals needed per group, evaluating the logistics of the actual performance of the animal experiments, and identifying the most appropriate statistical analyses and potential collaborators experienced in the area of study. All of these factors are critical to designing an experiment that will generate scientifically valid and reproducible data, which should be considered the ultimate goal of any scientific investigation.