Single-Molecule Biophysical Techniques to Study Actomyosin Force Transduction.

Inside the cellular environment, molecular motors can work in concert to conduct a variety of important physiological functions and processes that are vital for the survival of a cell. However, in order to decipher the mechanism of how these molecular motors work, single-molecule microscopy techniques have been popular methods to understand the molecular basis of the emerging ensemble behavior of these motor proteins.In this chapter, we discuss various single-molecule biophysical imaging techniques that have been used to expose the mechanics and kinetics of myosins. The chapter should be taken as a general overview and introductory guide to the many existing techniques; however, since other chapters will discuss some of these techniques more thoroughly, the readership should refer to those chapters for further details and discussions. In particular, we will focus on scattering-based single-molecule microscopy methods, some of which have become more popular in the recent years and around which the work in our laboratories has been centered.

SMFM Special Report: Putting the "M" back in MFM: Addressing education about disparities in maternal outcomes and care.

At the 36th Annual meeting of the Society for Maternal-Fetal Medicine (SMFM), leaders in the field of maternal-fetal medicine (MFM) convened to address maternal outcome and care inequities from 3 perspectives: (1) education, (2) clinical care, and (3) research. Meeting attendees identified knowledge gaps regarding disparities within the provider community; reviewed possible frameworks to address these knowledge gaps; and identified models with which to address key clinical issues. Collaboration and communication between all stakeholders will be needed to gain a better understanding of these prevailing disparities and formulate strategies to eliminate them.

SMFM Special Report: Putting the "M" back in MFM: Reducing racial and ethnic disparities in maternal morbidity and mortality: A call to action.

Racial and ethnic disparities in maternal morbidity and mortality rates are an important public health problem in the United States. Because racial and ethnic minorities are expected to comprise more than one-half of the US population by 2050, this issue needs to be addressed urgently. Research suggests that the drivers of health disparities occur at 3 levels: patient, provider, and system. Although we have recognized this issue and identified elements that contribute to it, knowledge must be converted into action to address it. In addition, despite available funding and databases, research directed towards understanding and reducing these disparities is lacking. This document summarizes findings of a workshop convened at the 2016 Society for Maternal-Fetal Medicine's 36th Annual Pregnancy meeting in Atlanta, GA, to review and make recommendations about immediate actions in clinical care and research that will serve to reduce racial and ethnic disparities in maternal morbidity and mortality rates in the United States.

Society for maternal-fetal medicine (SMFM) special report: the maternal-fetal medicine subspecialists' role within a health care system.

A maternal-fetal medicine (MFM) subspecialist has advanced knowledge of the medical, surgical, obstetrical, fetal, and genetic complications of pregnancy and their effects on both the mother and fetus. MFM subspecialists are complementary to obstetric care providers in providing consultations, co-management, or transfer of care for complicated patients before, during, and after pregnancy. The MFM subspecialist provides peer and patient education and performs research concerning the most recent approaches and treatments for obstetrical problems, thus promoting risk-appropriate care for these complicated pregnancies. The relationship between the obstetric care provider and the MFM subspecialist depends on the acuity of the maternal and/or fetal condition and the local resources. To achieve the goal of promoting early access and sustained adequate prenatal care for all pregnant women, we encourage collaboration with obstetricians, family physicians, certified midwives, and others, and we also encourage providing preconception, prenatal, and postpartum care counseling and coordination. Effective communication between all obstetric care team members is imperative. This special report was written with the intent that it would be broad in scope and appeal to a diverse readership, including administrators, allowing it to be applied to various systems of care both horizontally and vertically. We understand that these relationships are often complex and there are more models of care than could be addressed in this document. However, we aimed to promote the development of a highly effective team approach to the care of the high-risk pregnancy that will be useful in the most common models for obstetric care in the United States. The MFM subspecialist functions most effectively within a fully integrated and collaborative health care environment. This document defines the various roles that the MFM subspecialist can fulfill within different heath care systems through consultation, co-management, and transfer of care, as well as education, research, and leadership.

Ethical implications of the shifting borderline of viability.

Survival rates for babies born at 22 weeks of gestation are steadily improving at centers that offer active treatment to these babies. Still, many centers do not offer such treatment or, if they do, actively discourage it. Thus, parents will be given very different advice at different centers for babies born at the borderline of viability. Those doctors and centers that discourage treatment have concerns about the chances for survival, neurodevelopmental impairment among survivors, and cost. Yet there is strong evidence that many babies born at 22 weeks can survive, most survivors have good neurodevelopmental outcomes, and neonatal intensive care for tiny babies is cost-effective compared to many common and uncontroversial treatments. Given this growing body of evidence, policies discouraging or forbidding treatment of babies born at 22 weeks will require stronger ethical justification than has been given to date.

Virtual platforms as a vehicle to promote international collaboration.

This survey study was conducted to better consider ways that the Society of Maternal-Fetal Medicine (SMFM) can increase their international outreach. Most survey respondents indicated that international representation could be improved and cited barriers of cost and physical distance to annual meetings. This study highlights support for continuation of virtual conferencing to improve international representation and proposes a hybrid model of scientific engagement moving forward.

Organ and tissue-specific distribution of selected polycyclic aromatic hydrocarbons (PAHs) in ApoE-KO mouse.

Polycyclic aromatic hydrocarbons (PAHs) are one of the most prevalent classes of environmental pollutants resulting from the incomplete combustion of hydrocarbons. Exposure to PAHs is implicated in the pathogenesis of the cardiovascular disease, pulmonary disease, and even cancer. However, little is known about organ- and tissue-specific distribution patterns of PAHs in animals at macro-tissue and microscopic levels. Here, by combining GC-MS and single-molecule fluorescence microscopy (SMFM), we revealed the distribution characteristics of four different PAHs (phenanthrene (Phe), pyrene (Pyr), perylene (Per), and benzo[a]pyrene (BaP)) in atherosclerosis model mice (ApoE-KO mice) at macro-tissue and micro-region level after long-term oral exposure. Average PAH concentrations detected by GC-MS in seven tissues ranged from 6.44 to 441 ng/g. The gastrointestinal tract, epididymal fat pat, and lung accumulated higher levels of PAHs, whereas relatively lower PAH residuals were found in the liver, brain, and kidney. Correlation analysis showed that PAHs with higher molecular weight (r: -0.972 to -0.746), Log Kow (r: -0.984 to -0.746) and lower water solubility (r: 0.720 to 0.994) were less prone to bioaccumulate. For the first time, SMFM demonstrated a distinct heterogeneous distribution of Per in the tissue slices. More interestingly, we observed many micro-cluster regions, namely hotspots, showed much higher Per fluorescent intensity than the other common regions. In the area of atherosclerotic plaque, the Per hotspots were colocalized with the micro-regions with the most severe inflammatory response. The hotspots with very high enrichment in PAHs were likely to stimulate the local inflammation and cause excessive damage of the aorta, which resulted in a significant increase of the relative area of atherosclerosis lesion and aggravated atherosclerosis, as observed in PAH exposed mice.

Interconception Care for Primary Care Providers: Consensus Recommendations on Preconception and Postpartum Management of Reproductive-Age Patients With Medical Comorbidities.

Severe maternal morbidity and mortality continue to increase in the United States, largely owing to chronic and newly diagnosed medical comorbidities. Interconception care, or care and management of medical conditions between pregnancies, can improve chronic disease control before, during, and after pregnancy. It is a crucial and time-sensitive intervention that can decrease maternal morbidity and mortality and improve overall health. Despite these potential benefits, interconception care has not been well implemented by the primary care community. Furthermore, there is a lack of guidelines for optimizing preconception chronic disease, risk stratifying postpartum chronic diseases, and recommending general collaborative management principles for reproductive-age patients in the period between pregnancies. As a result, many primary care providers, especially those without obstetric training, are unclear about their specific role in interconception care and may be unsure of effective methods for collaborating with obstetric care providers. In particular, internal medicine physicians, the largest group of primary care physicians, may lack sufficient clinical exposure to medical conditions in the obstetric population during their residency training and may feel uncomfortable in caring for these patients in their subsequent practice. The objective of this article is to review concepts around interconception care, focusing specifically on preconception care for patients with chronic medical conditions (eg, chronic hypertension, chronic diabetes mellitus, chronic kidney disease, venous thromboembolism, and obesity) and postpartum care for those with medically complicated pregnancies (eg, hypertensive disorders of pregnancy, gestational diabetes mellitus, excessive gestational weight gain, peripartum cardiomyopathy, and peripartum mood disorders). We also provide a pragmatic checklist for preconception and postpartum management.

Gender representation of speakers at the Society for Maternal-Fetal Medicine postgraduate courses: a 20-year review.

BACKGROUND: The percentage of female physicians has grown significantly in past decades, with women currently making up 56% of the Society for Maternal-Fetal Medicine's board-certified membership. OBJECTIVE: We aimed to describe trends in the gender of invited speakers at postgraduate courses, panels, and debates at the annual meetings of the Society for Maternal-Fetal Medicine over the last 2 decades. STUDY DESIGN: We performed a retrospective observational study examining annual meetings of the Society for Maternal-Fetal Medicine in 1999, 2009, and 2015-2019. Invited speakers were identified through publicly available programs and examined by gender, degree, and the session of involvement. Postgraduate lectures (including courses, workshops, and forums), panels, and debates were examined. Speakers with Medicinae Doctor (or equivalent) degrees and obstetrics and gynecology training were included. RESULTS: Among the 3 time points 1999, 2009, and 2019, there were 330 speaker slots. There was a significant difference in gender representation in the 3 time points; female representation was 25% in 1999, 21.5% in 2009, and 55.7% in 2019 (P<.001). There were significantly higher odds of having a female speaker in 2019 than in 2009 (odds ratio, 4.58; 95% confidence interval, 2.40-8.72; P<.001). Between 2015 and 2019, 813 speaker slots were identified, with a significant positive correlation between increasing year and increasing female representation (correlation coefficient=0.099; P=.005). When controlling for type of session, there were higher odds of having a female speaker with a later year (adjusted odds ratio, 1.16; 95% confidence interval, 1.05-1.28; P=.003). There was a significant difference in gender representation among different sessions (P=.028), with females listed in 51.2% of lecture slots but only 42.4% of panels and 38.0% of debates. Male moderators resulted in an average female representation of 29.8%±23.7% in a given session, whereas female moderators and a combination of both genders as moderators had average female representations of 71.6%±25.0% and 43.3%±19.4%, respectively, in a given session (P<.001). There was no correlation between the gender of the postgraduate course chair and either moderator or speaker gender. CONCLUSION: There was a significant increase in the percentage of speaker slots allocated to females over the past 2 decades, a trend that moves toward reflecting the gender composition of the Society for Maternal-Fetal Medicine membership.

Fetal Surgery in the Era of SARS-CoV-2 Pandemic: A Single-Institution Review.

OBJECTIVE: To cope with the changing health care services in the era of SARS-CoV-2 pandemic. We share the institutional framework for the management of anomalous fetuses requiring fetal intervention at Mayo Clinic, Rochester, Minnesota. To assess the success of our program during this time, we compare intraoperative outcomes of fetal interventions performed during the pandemic with the previous year. PATIENTS: We implemented our testing protocol on patients undergoing fetal intervention at our institution between March 1, and May 15, 2020, and we compared it with same period a year before. A total of 17 pregnant patients with anomalous fetuses who met criteria for fetal intervention were included: 8 from 2019 and 9 from 2020. METHODS: Our testing protocol was designed based on our institutional perinatal guidelines, surgical requirements from the infection prevention and control (IPAC) committee, and input from our fetal surgery team, with focus on urgency of procedure and maternal SARS-CoV-2 screening status. We compared the indications, types of procedures, maternal age, gestational age at procedure, type of anesthesia used, and duration of procedure for cases performed at our institution between March 1, 2020, and May 15, 2020, and for the same period in 2019. RESULTS: There were no statistically significant differences among the number of cases, indications, types of procedures, maternal age, gestational age, types of anesthesia, and duration of procedures (P values were all >.05) between the pre-SARS-CoV-2 pandemic in 2019 and the SARS-CoV-2 pandemic in 2020. CONCLUSIONS: Adoption of new institutional protocols during SARS-CoV-2 pandemic, with appropriate screening and case selection, allows provision of necessary fetal intervention with maximal benefit to mother, fetus, and health care provider.