Roberto Romero

Bio: Roberto Romero is an academic researcher from National Institutes of Health. The author has contributed to research in topics: Amniotic fluid & Chorioamnionitis. The author has an hindex of 151, co-authored 1516 publications receiving 108321 citations. Previous affiliations of Roberto Romero include University of Michigan & Weizmann Institute of Science.

Tests to Predict Preeclampsia

Abstract: This is a comprehensive review of biophysical and biochemical tests for the prediction of preeclampsia. At present, there is no single test to predict preeclampsia. Multivariable prediction models (based on combinations of maternal demographic characteristics and medical and obstetrical history with biophysical and biochemical tests performed in the first or early second trimesters) have shown a high predictive accuracy for early-onset preeclampsia in populations at low to moderate risk of developing this disorder. Replication of such models to confirm their accuracy in the prediction of preeclampsia is needed. Maternal plasma/serum concentrations of angiogenic and antiangiogenic factors in the second trimester of pregnancy coupled with uterine artery Doppler velocimetry appear to have a moderate to high predictive accuracy for early-onset preeclampsia. Discovery approaches have promise for the identification of potential biomarkers. Preeclampsia is a syndrome, and therefore it is unlikely that a single test (or a combination of tests) to identify a particular phenotype (e.g. early-onset disease, late-onset disease, HELLP syndrome) would be effective in predicting all cases of the disorder.

C-reactive protein concentration in vaginal fluid as a marker for intra-amniotic inflammation/infection in preterm premature rupture of membranes.

Abstract: Objective. The purpose of this study was to determine whether C-reactive protein (CRP) concentrations in vaginal fluid can identify patients with intra-amniotic inflammation/infection (IAI) and predict adverse outcome in preterm premature rupture of membranes (PROM).Methods. The study population consisted of 121 singleton pregnant women with preterm PROM (⩽36 weeks of gestation) who had an amniocentesis and vaginal fluid collection. A Dacron polyester-tipped applicator was soaked with vaginal fluid for 10 seconds and diluted with 1 mL buffer solution. Amniotic fluid was cultured for aerobic and anaerobic bacteria, as well as mycoplasmas. Vaginal fluid CRP and amniotic fluid matrix metalloproteinase-8 (MMP-8) were determined by specific immunoassays. IAI was defined as an amniotic fluid MMP-8 concentration >23 ng/mL and/or a positive amniotic fluid culture. Nonparametric tests and survival techniques were used for statistical analysis.Results. Patients with IAI had a significantly higher median vaginal flu...

Insights into the physiology of childbirth using transcriptomics.

Abstract: Few biological processes as central to the survival of viviparous species are so incompletely understood as childbirth (parturition) [ 1]. Premature labor and prolonged gestation due to failure of labor to commence are associated with an increased risk for perinatal death and long-term handicap. Even when labor begins at term, “failure to progress” is so frequently diagnosed that at least 20% of all births occur through cesarean delivery, the most common operation performed worldwide. The rationale for performing a cesarean delivery in women whose cervix has failed to dilate in active labor (arrest of dilatation), or in whom the fetal head does not descend after complete dilatation of the cervix (arrest of descent), is that “failure to progress” is an indicator of cephalopelvic disproportion. However, this explanation is unlikely to be true in many cases, because a proportion of mothers with a previous cesarean delivery due to “failure to progress” in labor will deliver a larger baby vaginally in a subsequent pregnancy. Thus, a central question in reproductive biology is: what is “failure to progress” in labor? A “functional disorder,” rather than cephalopelvic disproportion, may be the underlying reason for a proportion of cesarean deliveries performed after labor has begun. Such “functional disorders” could be due to inadequate preparation of the uterine muscle (myometrium) and/or the cervix for labor. Indeed, accumulating evidence suggests that the myometrium develops a contractile phenotype as pregnancy approaches term and the cervix also undergoes preparatory changes [ 2]. The cellular and biochemical phenomena underpinning preparation of the uterine muscle and the cervix [ 3] are different and have been the focus of intensive investigation [ 4, 5].

Vaginal Progesterone to Reduce the Rate of Preterm Birth and Neonatal Morbidity: A Solution at Last:

Abstract: ISSN 1745-5057 Women's Health (2011) 7(5), 501–504 10.2217/WHE.11.60 shortand long-term complications. However, age alone does not tell us why the preterm birth occurred, and this has profound consequences as to the prognosis of the newborn and the likelihood that we will ever be able to prevent the different types of preterm birth. When we look at the other end of the spectrum of life (i.e., geriatrics), the older an individual is, the more likely it is that she/he would have disease due to organ senescence or cumulative insults experienced during life. Yet, we do not define disease purely on the basis of age, and we treat an elderly individual differently if the cause of the disorder is cardiac failure, pneumonia, renal failure or cancer, and so forth. In obstetrics, we may be guilty of oversimplification by not considering the cause of preterm birth or other obstetrical syndromes with sufficient depth to allow meaningful prevention. It is now clear that preterm birth is not a single condition. Two-thirds of preterm births occur because women go into spontaneous preterm labor (with intact or ruptured membranes). The remainder are due to preterm deliveries indicated for potentially life-threatening complications of the mother, such as pre-eclampsia, or fetal complications, such as intrauterine growth restriction. The complexity of the problem extends further than just whether a preterm birth was spontaneous or induced. A deeper examination reveals that preterm labor with intact membranes, premature rupture of membranes, pre-eclampsia and intrauterine growth restriction are all syndromes caused by multiple mechanisms of disease: ‘the great obstetrical syndromes’ [3,4]. Therefore, since preterm birth is not a single condition, there will never be a single test to predict it, a single intervention to treat it, or one approach to prevent it all. I believe that oversimplification of the nature of disease in obstetrics has been an obstacle to Preterm delivery: an important healthcare issue for women & their families Preterm delivery has been, and remains, the most important challenge to modern obstetrics. In 2009, 13 million babies were born preterm: 11 million in Africa and Asia and 500,000 in the USA [1]. The highest rates of preterm birth are in Africa (11.9%) and North America (10.6%). Premature neonates are at increased risk of death and short-term complications such as respiratory distress syndrome, intraventricular hemorrhage, neonatal sepsis and necrotizing enterocolitis. Long-term complications include neurodevelopmental disorders such as cerebral palsy, chronic lung disease, blindness and deafness [2]. The financial cost of preterm birth has been estimated to be US $26 billion per year in the USA alone, but that is only part of the story: the less-appreciated burden of preterm birth is borne by the families caring for preterm babies.

limma powers differential expression analyses for RNA-sequencing and microarray studies

Abstract: limma is an R/Bioconductor software package that provides an integrated solution for analysing data from gene expression experiments. It contains rich features for handling complex experimental designs and for information borrowing to overcome the problem of small sample sizes. Over the past decade, limma has been a popular choice for gene discovery through differential expression analyses of microarray and high-throughput PCR data. The package contains particularly strong facilities for reading, normalizing and exploring such data. Recently, the capabilities of limma have been significantly expanded in two important directions. First, the package can now perform both differential expression and differential splicing analyses of RNA sequencing (RNA-seq) data. All the downstream analysis tools previously restricted to microarray data are now available for RNA-seq as well. These capabilities allow users to analyse both RNA-seq and microarray data with very similar pipelines. Second, the package is now able to go past the traditional gene-wise expression analyses in a variety of ways, analysing expression profiles in terms of co-regulated sets of genes or in terms of higher-order expression signatures. This provides enhanced possibilities for biological interpretation of gene expression differences. This article reviews the philosophy and design of the limma package, summarizing both new and historical features, with an emphasis on recent enhancements and features that have not been previously described.

STRING v11: protein-protein association networks with increased coverage, supporting functional discovery in genome-wide experimental datasets.

Abstract: Proteins and their functional interactions form the backbone of the cellular machinery. Their connectivity network needs to be considered for the full understanding of biological phenomena, but the available information on protein-protein associations is incomplete and exhibits varying levels of annotation granularity and reliability. The STRING database aims to collect, score and integrate all publicly available sources of protein-protein interaction information, and to complement these with computational predictions. Its goal is to achieve a comprehensive and objective global network, including direct (physical) as well as indirect (functional) interactions. The latest version of STRING (11.0) more than doubles the number of organisms it covers, to 5090. The most important new feature is an option to upload entire, genome-wide datasets as input, allowing users to visualize subsets as interaction networks and to perform gene-set enrichment analysis on the entire input. For the enrichment analysis, STRING implements well-known classification systems such as Gene Ontology and KEGG, but also offers additional, new classification systems based on high-throughput text-mining as well as on a hierarchical clustering of the association network itself. The STRING resource is available online at https://string-db.org/.

SPAdes, a new genome assembly algorithm and its applications to single-cell sequencing ( 7th Annual SFAF Meeting, 2012)

Abstract: The lion's share of bacteria in various environments cannot be cloned in the laboratory and thus cannot be sequenced using existing technologies. A major goal of single-cell genomics is to complement gene-centric metagenomic data with whole-genome assemblies of uncultivated organisms. Assembly of single-cell data is challenging because of highly non-uniform read coverage as well as elevated levels of sequencing errors and chimeric reads. We describe SPAdes, a new assembler for both single-cell and standard (multicell) assembly, and demonstrate that it improves on the recently released E+V-SC assembler (specialized for single-cell data) and on popular assemblers Velvet and SoapDeNovo (for multicell data). SPAdes generates single-cell assemblies, providing information about genomes of uncultivatable bacteria that vastly exceeds what may be obtained via traditional metagenomics studies. SPAdes is available online ( http://bioinf.spbau.ru/spades ). It is distributed as open source software.

Standards of Medical Care in Diabetes

Abstract: XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.