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Alabbad FA, Alali R, Alquraini M, Alghannam ZM, Alabdullah MB, AlMousa HH. Cri-Du-Chat Syndrome Associated With Meningomyelocele: A Case Report. Cureus 2023; 15:e46279. [PMID: 37908952 PMCID: PMC10614104 DOI: 10.7759/cureus.46279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Cri-du-chat syndrome (CdCS) is a rare genetic disorder in which the short arm of chromosome 5 is deleted. This report aims to highlight a rare association with the syndrome. We present a preterm male delivered at 35 weeks gestation with an antenatal diagnosis of meningomyelocele. The patient's clinical examination revealed ruptured lumbosacral meningomyelocele, lower limb hypotonia, and hyporeflexia. The patient also displayed dysmorphic features, including microcephaly, a rounded face, low-set ears, and club feet. In addition, he is noted to have a high-pitched cry. Diagnosis of Chiari tonsil hernia type II was made by magnetic resonance imaging, and whole exome sequencing has confirmed CdCS. The spina bifida was surgically corrected, and the patient has since been cared for by a multidisciplinary team. The patient's short-term follow-up revealed a significant developmental delay. Few cases of CdCS associated with meningomyelocele have been reported. More evidence is needed to support a relevant association between CdCS and meningomyelocele.
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Affiliation(s)
- Fatimah A Alabbad
- Neonatology Department, Maternity and Children Hospital, Alahsa, SAU
| | - Roqaia Alali
- Neonatology Department, Maternity and Children Hospital, Alahsa, SAU
| | - Mohammed Alquraini
- Paediatrics and Child Health Department, King Faisal University, Hofuf, SAU
| | | | | | - Haider H AlMousa
- Neonatology Department, Maternity and Children Hospital, Alahsa, SAU
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Kress GT, Swerdlow M, Mohan N, Patel K, Shin L. Remission Strategies with Fat Grafting to Prevent Recurrence of Pedal Ulcerations and Pain: A Case Series. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5232. [PMID: 37662474 PMCID: PMC10473342 DOI: 10.1097/gox.0000000000005232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/12/2023] [Indexed: 09/05/2023]
Abstract
Background Foot deformities and gait abnormalities can result in locally elevated peak pedal pressures or atypical pedal biomechanics. Combined with underlying comorbidities such as neuropathy, stroke, atrophic fat padding and history of ulcerations, this can lead to recurrent ulcerations and pain. Pedal fat grafting (PFG) is a treatment modality that has been shown to reduce peak pressures and accelerate wound healing. This study aimed to investigate the utility of PFG to treat and prevent ulcerations. Methods We retrospectively analyzed medical history, demographics, wound volume at time of procedure, volume of fat injected, surgical outcomes, and presence of new wounds in 15 patients who underwent PFG at Keck Hospital between 2018 and 2023. Results Seventeen feet from 15 patients (63 ± 12 years old, body mass index 30.9 ± 3.1) received PFG with an average volume of fat injected of 10.7 mL and procedure time of 84.6 minutes. At the time of PFG, nine wounds were present on nine feet with an average wound volume of 1.6 ± 2.7 cm3. Average follow-up was 6.9 months (range 1-36 months), with no complications or recurrent ulcerations since the procedure. Conclusions PFG is a promising treatment option for reducing peak pedal pressure and preventing ulcer recurrence in patients with various conditions. Further study is warranted for long-term follow-up.
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Affiliation(s)
- Gavin Thomas Kress
- From Keck School of Medicine of the University of Southern California (USC), Los Angeles, Calif
| | - Mark Swerdlow
- From Keck School of Medicine of the University of Southern California (USC), Los Angeles, Calif
| | - Natasha Mohan
- From Keck School of Medicine of the University of Southern California (USC), Los Angeles, Calif
| | - Ketan Patel
- Department of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, Calif
- Division of Plastic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Laura Shin
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, Calif
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53
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Keuls RA, Finnell RH, Parchem RJ. Maternal metabolism influences neural tube closure. Trends Endocrinol Metab 2023; 34:539-553. [PMID: 37468429 PMCID: PMC10529122 DOI: 10.1016/j.tem.2023.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023]
Abstract
Changes in maternal nutrient availability due to diet or disease significantly increase the risk of neural tube defects (NTDs). Because the incidence of metabolic disease continues to rise, it is urgent that we better understand how altered maternal nutrient levels can influence embryonic neural tube development. Furthermore, primary neurulation occurs before placental function during a period of histiotrophic nutrient exchange. In this review we detail how maternal metabolites are transported by the yolk sac to the developing embryo. We discuss recent advances in understanding how altered maternal levels of essential nutrients disrupt development of the neuroepithelium, and identify points of intersection between metabolic pathways that are crucial for NTD prevention.
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Affiliation(s)
- Rachel A Keuls
- Development, Disease Models, and Therapeutics Graduate Program, Baylor College of Medicine. Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA; Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX 77030, USA; Stem Cells and Regenerative Medicine Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA
| | - Richard H Finnell
- Departments of Molecular and Human Genetics and Medicine, Baylor College of Medicine, Houston, TX 77030, USA; Center for Precision Environmental Health, Department of Molecular and Cellular Biology and Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Ronald J Parchem
- Development, Disease Models, and Therapeutics Graduate Program, Baylor College of Medicine. Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA; Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX 77030, USA; Stem Cells and Regenerative Medicine Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA.
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54
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Crane-Smith Z, De Castro SCP, Nikolopoulou E, Wolujewicz P, Smedley D, Lei Y, Mather E, Santos C, Hopkinson M, Pitsillides AA, Finnell RH, Ross ME, Copp AJ, Greene NDE. A non-coding insertional mutation of Grhl2 causes gene over-expression and multiple structural anomalies including cleft palate, spina bifida and encephalocele. Hum Mol Genet 2023; 32:2681-2692. [PMID: 37364051 PMCID: PMC10460492 DOI: 10.1093/hmg/ddad094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/19/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023] Open
Abstract
Orofacial clefts, including cleft lip and palate (CL/P) and neural tube defects (NTDs) are among the most common congenital anomalies, but knowledge of the genetic basis of these conditions remains incomplete. The extent to which genetic risk factors are shared between CL/P, NTDs and related anomalies is also unclear. While identification of causative genes has largely focused on coding and loss of function mutations, it is hypothesized that regulatory mutations account for a portion of the unidentified heritability. We found that excess expression of Grainyhead-like 2 (Grhl2) causes not only spinal NTDs in Axial defects (Axd) mice but also multiple additional defects affecting the cranial region. These include orofacial clefts comprising midline cleft lip and palate and abnormalities of the craniofacial bones and frontal and/or basal encephalocele, in which brain tissue herniates through the cranium or into the nasal cavity. To investigate the causative mutation in the Grhl2Axd strain, whole genome sequencing identified an approximately 4 kb LTR retrotransposon insertion that disrupts the non-coding regulatory region, lying approximately 300 base pairs upstream of the 5' UTR. This insertion also lies within a predicted long non-coding RNA, oriented on the reverse strand, which like Grhl2 is over-expressed in Axd (Grhl2Axd) homozygous mutant embryos. Initial analysis of the GRHL2 upstream region in individuals with NTDs or cleft palate revealed rare or novel variants in a small number of cases. We hypothesize that mutations affecting the regulation of GRHL2 may contribute to craniofacial anomalies and NTDs in humans.
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Affiliation(s)
- Zoe Crane-Smith
- Developmental Biology and Cancer Department, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Sandra C P De Castro
- Developmental Biology and Cancer Department, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Evanthia Nikolopoulou
- Developmental Biology and Cancer Department, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Paul Wolujewicz
- Center for Neurogenetics, Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York 10065, USA
| | - Damian Smedley
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Yunping Lei
- Center for Precision Environmental Health, Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Emma Mather
- Developmental Biology and Cancer Department, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Chloe Santos
- Developmental Biology and Cancer Department, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Mark Hopkinson
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London NW1 0TU, UK
| | - Andrew A Pitsillides
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London NW1 0TU, UK
| | | | - Richard H Finnell
- Center for Precision Environmental Health, Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas 77030, USA
| | - M Elisabeth Ross
- Center for Neurogenetics, Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York 10065, USA
| | - Andrew J Copp
- Developmental Biology and Cancer Department, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Nicholas D E Greene
- Developmental Biology and Cancer Department, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
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Copp AJ, Clark M, Greene NDE. Morphological phenotyping after mouse whole embryo culture. Front Cell Dev Biol 2023; 11:1223849. [PMID: 37601098 PMCID: PMC10435082 DOI: 10.3389/fcell.2023.1223849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Morphological phenotyping of the mouse embryo is described at neurulation stages, primarily as a guide to evaluating the outcome of whole embryo cultures between embryonic days 8.5 and 9.5. During this period, neural tube closure is initiated and progresses to completion in the cranial region. Spinal closure is still underway at the end of the culture period. The focus of this article is particularly on phenotyping that can be performed at the bench, using a stereomicroscope. This involves assessment of embryonic health, through observation and scoring of yolk sac blood circulation, measurement of developmental stage by somite counting, and determination of crown-rump length as a measure of growth. Axial rotation ("turning") can also be assessed using a simple scoring system. Neural tube closure assessment includes: 1) determining whether closure has been initiated at the Closure 1 site; 2) evaluating the complex steps of cranial neurulation including initiation at Closure sites 2 and 3, and completion of closure at the anterior and hindbrain neuropores; 3) assessment of spinal closure by measurement of posterior neuropore length. Interpretation of defects in neural tube closure requires an appreciation of, first, the stages that particular events are expected to be completed and, second, the correspondence between embryonic landmarks, for example, somite position, and the resulting adult axial levels. Detailed embryonic phenotyping, as described in this article, when combined with the versatile method of whole embryo culture, can form the basis for a wide range of experimental studies in early mouse neural development.
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Affiliation(s)
- Andrew J. Copp
- Developmental Biology and Cancer, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Lutz CM, Onwuka A, Fuchs ME, Carey M, Griffey J, Hobensack VL, Sharpe Scandinaro J, McCracken K. Sexual and reproductive health education for patients with myelomeningocele. Dev Med Child Neurol 2023; 65:1105-1111. [PMID: 36631940 DOI: 10.1111/dmcn.15494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 01/13/2023]
Abstract
AIM To evaluate the sexual and reproductive health education received by patients with myelomeningocele, the most severe form of spina bifida. METHOD A survey designed to assess the sexual and reproductive health education given by a healthcare provider to patients with myelomeningocele was offered to all English-speaking patients aged 12 years or older with a myelomeningocele clinic visit. RESULTS In total, 67 surveys were completed. Menstruation and menstrual management were discussed at a rate of 85% in females. Few patients had discussions with a provider about fertility (42%), sexuality (37%), risk of sexually transmitted infections (45%), or had a relationship with a reproductive healthcare provider (54%). Differences by sex were observed for contraceptive education. The rate of discussions increased with age. A total of 67% of female patients and 33% of male patients requested a referral to a reproductive healthcare provider. INTERPRETATION Sexual and reproductive health education is part of comprehensive care for all patients and those with disabilities should not be excluded. The lack of consistent education received by patients supports the need for increased attention to this topic. We encourage multidisciplinary myelomeningocele clinics to establish a process for delivering complete and patient-specific sexual and reproductive health education.
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Affiliation(s)
- Carley M Lutz
- Center for Surgical Outcomes Research, Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amanda Onwuka
- Center for Surgical Outcomes Research, Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Molly E Fuchs
- Department of Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Margaret Carey
- Myelomeningocele Clinic, Nationwide Children's Hospital, Columbus, OH, USA
| | - Judy Griffey
- Myelomeningocele Clinic, Nationwide Children's Hospital, Columbus, OH, USA
| | | | | | - Kate McCracken
- Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, OH, USA
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Adebayo BO, Tiamiyu LO, Adetunmbi B, Adegboyega RO, Etagar CO, Kanu OO, Bankole O. Female monozygotic twins with sacral myelomeningocele. Surg Neurol Int 2023; 14:234. [PMID: 37560560 PMCID: PMC10408598 DOI: 10.25259/sni_339_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/21/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Concurrent myelomeningocele in twins is a rare clinical presentation, only reported twice in Nigeria. CASE DESCRIPTION We present a set of identical female twins from Nigeria. Both twins were females that presented at 3 years with low back swelling since birth, associated with bisphincteric dysfunction but normal motor and sensory functions in the lower extremities. They had repair of myelomeningocele 2 months after presentation and there was no new deficit postoperatively.There was no family history of neural tube defects and it would have been good to do genetic studies in this case but we do not have facilities for such. CONCLUSION This is the first reported case of identical twins with concurrent myelomeningocele and preserved motor functions in the lower limbs in Nigeria and West Africa.
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Affiliation(s)
| | | | | | | | | | - Okezie Obasi Kanu
- Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olufemi Bankole
- Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
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58
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Bartonek Å, Eriksson M. Physical function and activity, pain, and health status in adults with myelomeningocele after orthotic management from childhood: a descriptive study. BMC Musculoskelet Disord 2023; 24:545. [PMID: 37400860 DOI: 10.1186/s12891-023-06673-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/28/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Individuals with myelomeningocele (MMC) exhibit neurological deficits below the lesion level involving both motor and sensory functions. Ambulation and functional outcomes in patients offered orthotic management since childhood were investigated. METHODS Physical function, physical activity, pain, and health status were assessed in a descriptive study. RESULTS Of 59 adults with MMC, aged 18-33 years, 12 were in the community ambulation (Ca), 19 in the household ambulation (Ha), six in the non-functional (N-f), and 22 in the non-ambulation (N-a) groups. Orthoses were used by 78% (n = 46), i.e., by 10/12 in the Ca, 17/19 in the Ha, 6/6 in the N-f, and 13/22 in the N-a groups. In the ten-metre walking test, the non-orthosis group (NO) walked faster than those wearing ankle-foot orthoses (AFOs) or free-articulated knee-ankle-foot orthoses (KAFO-Fs), the Ca group faster than the Ha and N-f groups, and the Ha group faster than the N-f group. In the six-minute walking test, the Ca group walked farther than the Ha group. In the five times sit-to-stand test, the AFO and KAFO-F groups required longer than the NO group, and the KAFO-F group longer than the foot orthosis (FO) group. Lower extremity function with orthoses was higher in the FO than the AFO and KAFO-F groups, higher in the KAFO-F than the AFO group, and higher in the AFO group than in those using trunk-hip-knee-ankle-foot orthoses. Functional independence increased with ambulatory function. Time spent in physical recreation was higher in the Ha than the Ca and N-a groups. There were no differences between the ambulation groups in rated pain or reported health status. CONCLUSION The physical function results in persons with MMC improve our understanding of this population's heterogeneity and shed light on the importance of individualized orthotic management. The similarities between the various ambulatory levels in physical activity, pain, and health status may mirror opportunities to achieve equal results regardless of disability level. A clinical implication of the study is that orthotic management is likely to be beneficial for the patient with MMC of which the majority used their orthoses for most time of the day.
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Affiliation(s)
- Åsa Bartonek
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Motoriklab QA: 27, Karolinska vägen 37 A, S-17176, Stockholm, Sweden.
| | - Marie Eriksson
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Motoriklab QA: 27, Karolinska vägen 37 A, S-17176, Stockholm, Sweden
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Madrid L, Vyas KJ, Kancherla V, Leulseged H, Suchdev PS, Bassat Q, Sow SO, El Arifeen S, Madhi SA, Onyango D, Ogbuanu I, Scott JAG, Blau D, Mandomando I, Keita AM, Gurley ES, Mahtab S, Akelo V, Sannoh S, Tilahun Y, Varo R, Onwuchekwa U, Rahman A, Adam Y, Omore R, Lako S, Xerinda E, Islam KM, Wise A, Tippet-Barr BA, Kaluma E, Ajanovic S, Kotloff KL, Hossain MZ, Mutevedzi P, Tapia MD, Rogena E, Moses F, Whitney CG, Assefa N. Neural tube defects as a cause of death among stillbirths, infants, and children younger than 5 years in sub-Saharan Africa and southeast Asia: an analysis of the CHAMPS network. Lancet Glob Health 2023; 11:e1041-e1052. [PMID: 37271162 PMCID: PMC10282076 DOI: 10.1016/s2214-109x(23)00191-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/26/2023] [Accepted: 04/04/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Neural tube defects are common birth defects resulting in severe morbidity and mortality; they can largely be prevented with periconceptional maternal intake of folic acid. Understanding the occurrence of neural tube defects and their contribution to mortality in settings where their burden is highest could inform prevention and health-care policy. We aimed to estimate the mortality attributed to neural tube defects in seven countries in sub-Saharan Africa and southeast Asia. METHODS This analysis used data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network and health and demographic surveillance systems from South Africa, Mozambique, Bangladesh, Kenya, Mali, Ethiopia, and Sierra Leone. All stillbirths and infants and children younger than 5 years who died, who were enrolled in CHAMPS, whose families consented to post-mortem minimally invasive tissue sampling (MITS) between Jan 1, 2017, and Dec 31, 2021, and who were assigned a cause of death by a determination of cause of death panel as of May 24, 2022, were included in this analysis, regardless the cause of death. MITS and advanced diagnostic methods were used to describe the frequency and characteristics of neural tube defects among eligible deaths, identify risk factors, and estimate the mortality fraction and mortality rate (per 10 000 births) by CHAMPS site. FINDINGS Causes of death were determined for 3232 stillbirths, infants, and children younger than 5 years, of whom 69 (2%) died with a neural tube defect. Most deaths with a neural tube defect were stillbirths (51 [74%]); 46 (67%) were neural tube defects incompatible with life (ie, anencephaly, craniorachischisis, or iniencephaly) and 22 (32%) were spina bifida. Deaths with a neural tube defect were more common in Ethiopia (adjusted odds ratio 8·09 [95% CI 2·84-23·02]), among female individuals (4·40 [2·44-7·93]), and among those whose mothers had no antenatal care (2·48 [1·12-5·51]). Ethiopia had the highest adjusted mortality fraction of deaths with neural tube defects (7·5% [6·7-8·4]) and the highest adjusted mortality rate attributed to neural tube defects (104·0 per 10 000 births [92·9-116·4]), 4-23 times greater than in any other site. INTERPRETATION CHAMPS identified neural tube defects, a largely preventable condition, as a common cause of death among stillbirths and neonatal deaths, especially in Ethiopia. Implementing interventions such as mandatory folic acid fortification could reduce mortality due to neural tube defects. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Lola Madrid
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Kartavya J Vyas
- Emory Global Health Institute, Emory University, Atlanta, GA, USA
| | - Vijaya Kancherla
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Haleluya Leulseged
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Parminder S Suchdev
- Emory Global Health Institute, Emory University, Atlanta, GA, USA; Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ICREA, Barcelona, Spain; Paediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Dianna Blau
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Instituto Nacional de Saúde, Maputo, Mozambique
| | - Adama M Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Emily S Gurley
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Victor Akelo
- US Centers for Disease Control and Prevention Kenya, Kisumu, Kenya
| | | | - Yenenesh Tilahun
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Rosauro Varo
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Uma Onwuchekwa
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Afruna Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Yasmin Adam
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Elisio Xerinda
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Amy Wise
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Sara Ajanovic
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Karen L Kotloff
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Portia Mutevedzi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Milagritos D Tapia
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Emily Rogena
- Department of Pathology, School of Medicine, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Francis Moses
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Naicker D, Leola K, Mkhaliphi MM, Mpanza MN, Ouma J, Nakwa FL, Velaphi S, Profyris C. Single surgeon case series of myelomeningocele repairs in a developing world setting: Challenges and lessons. World Neurosurg X 2023; 19:100213. [PMID: 37260695 PMCID: PMC10227453 DOI: 10.1016/j.wnsx.2023.100213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 06/02/2023] Open
Abstract
Purpose Neural Tube Defects are the second most common group of birth malformations following congenital heart anomalies, with myelomeningoceles being the most severe manifestation (MMC). They require expedited surgical repair, preferably within 72 h of birth. In low- and middle-income countries (LMIC) where resources are limited, timing to MMC repair is not optimal and leads to undesirable outcomes. The purpose of this study was to determine whether a proactive approach in a setting from a LMIC could achieve repair within 72 h. Methods A concerted effort to expedite repair of all neonates referred with a MMC was undertaken from 01 January 2014 to 1 August 2015. A consensus was reached between neonatologists and neurosurgeons that neonates born or admitted with a MMC are referred immediately to surgeons and that repair will be performed within 72 h of birth. Hospital records of neonates who had MMC repaired during this period were reviewed for infant characteristics and hospital outcomes. Results 24 patients with a MMC were operated upon by the senior author (CP) during the study period. Only 13 of these patients were born at the treating institution and 11 were referred from outside hospitals. Most MMCs were in the lumbosacral region and mean MMC surface area was 19.4 cm2. Mean time to repair for the entire series was 13.6 days. Patients born at the treating institution has a mean time to repair of 10.5 days and patients referred from outside had a mean time to repair of 17.3 days. Series wide, only 21% of neonates were operated upon in less than 72 h. Conclusion Despite a pro-active commitment to repairing MMCs within 72 h for the duration of this series, satisfactory time to repair was not achieved. Late referral, referral from outside hospitals and operating theatre availability were the predominant factors leading to delay in MMC repair. Nevertheless, time to repair in our series was significantly shorter than that reported in MMC repair series based in similar environments. This suggests that even if the gold-standard of a 72-h window cannot be achieved, neonates benefit from much quicker repair when a concerted effort to minimise repair time is employed. This study also highlights the urgent need to address health care constraints in LMIC to improve outcomes for this vulnerable group.
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Affiliation(s)
- Denver Naicker
- Department of Neurosurgery, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Keletso Leola
- Department of Neurosurgery, Helen Joseph Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mlamuli Mzamo Mkhaliphi
- Department of Neurosurgery, Helen Joseph Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Morena Nthuse Mpanza
- Department of Neurosurgery, Helen Joseph Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - John Ouma
- Department of Neurosurgery, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Firdose Lambey Nakwa
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sithembiso Velaphi
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Christos Profyris
- Department of Neurosurgery, Helen Joseph Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Peard LM, Pope JC, Dmochowski R. An evaluation of onobotulinumtoxinA as a therapeutic option for pediatric neurogenic detrusor overactivity. Expert Rev Neurother 2023; 23:763-774. [PMID: 37556757 DOI: 10.1080/14737175.2023.2246661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Neurogenic detrusor overactivity (NDO) results in involuntary detrusor contractions during bladder filling or storage risking transmission of pressure to the upper urinary tracts and/or significant incontinence. The goals of bladder management in children with NDO prioritize the preservation of renal function, prevention of UTIs, and optimizing quality of life. First-line measures include intermittent catheterization and anticholinergic medication. However, when conservative measures fail, surgical intervention may be indicated. Historically, the next step was major reconstructive surgery to create a low-pressure urinary reservoir. The introduction of intravesical botulinum neurotoxin A (BoNT/A) for use in children in 2002 offered a less invasive option for management. However, its exact role is still evolving. AREAS COVERED This article summarizes the mechanism of action of BoNT/A for management of NDO and evaluates the current literature defining common practice and clinical efficacy in children with NDO. The findings of the recently completed phase III trial for intravesical onabotulinumtoxinA in children are discussed in detail. EXPERT OPINION As the first BoNT/A approved for use in children with NDO, onabotulinumtoxinA appears to be a safe and less invasive alternative to major reconstructive surgery. However, data defining appropriate patient selection and its role as a long-term treatment option continue to develop.
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Affiliation(s)
- Leslie M Peard
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - John C Pope
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Roger Dmochowski
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
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Caceres A, Jimenez-Chaverri AL, Alpizar-Quiros PA, Wong-McClure R. Pre and postnatal care characteristics and management features of children born with myelomeningocele in the post-folate fortification era of staple foods in Costa Rica (2004-2022). Childs Nerv Syst 2023; 39:1755-1764. [PMID: 37129604 DOI: 10.1007/s00381-023-05951-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/05/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE To describe the clinical characteristics of pre- and postnatal care of children born with myelomeningocele in Costa Rica from 2004 to 2022 after the introduction of mandatory fortification of four major staple foods, describing the clinical features of this cohort including the size of the meningomyelocele, neurological level, presence of symptomatic Chiari II at birth, kyphosis, and the severity of hydrocephalus requiring cerebrospinal fluid (CSF) shunting. These results were compared against the pre-fortification historical data to determine favorable outcomes from this health policy. METHODS We performed a retrospective review of the clinical records of patients with myelomeningocele at the spina bifida clinic from the National Children's Hospital of Costa Rica who were born between 2004 and 2022, a period when staple food fortification was implemented in the country for four food staples (wheat and corn flour, rice, and dairy products). Pre and postnatal care data pertaining to the number of obstetric ultrasound studies, the trimester in which they were performed, the detection of myelomeningocele and associated hydrocephalus, gestational age and route of delivery, neurological level, myelomeningocele defect size, associated kyphosis and symptomatic Chiari II malformation at birth, time periods of myelomeningocele repair, and CSF shunting were examined. A descriptive comparative frequency analysis between myelomeningocele (MMC) defect size, CSF shunt insertion, symptomatic Chiari II, and kyphosis between the different functional levels was performed with the estimation of the Fisher's exact chi-square test by contingency tables, and 0.05 was set as significance level. Additionally, the postnatal features of this cohort were compared against pre-fortification historical data obtained from 100 live-born patients between 1995 and 1996. RESULTS A total of 215 patients that were live born between 2004 and 2022 were eligible for analysis with a follow up ranging from 1 to 19 years (median follow up: 7.9 years). Among 99.1% of the mothers of patients who had prenatal consultations, 95.8% had an average of 3.8 obstetric ultrasound studies which led to a 59% prenatal detection rate of myelomeningocele. The pre and post fortification features showed a male/female ratio that changed from 0.92 to 1.25 respectively. Among these newborns, there was an increase from 54 to 64% cesarean sections as method for delivery. Only 26% of the pre fortification patients had the MMC defect repaired in the first 24 h, 32% from 24 to 72 h, 20% from 72 h to 1 week, and 22% later than 10 days respectively which deeply contrasted with the post fortification cohort where 7.5% had the MMC defect repaired in less than 8 h, 12.2% from 8 to 12 h, 66.5% 12-24 h, and 12.7% from 24 to 48 h and 1% later than 48 h, respectively (P < 0.01). Regarding the post fortification myelomeningocele anatomic and functional characteristics, defect size was measured as less than 3 cm in 7% of cases, 3 to 5 cm in 50% of cases, 5 to 7 cm in 42% of cases, and greater than 7 cm in 1% of cases. Thirteen percent of the cases had paraplegia due to a thoracic level, 10% had a high lumbar level, 58% had a middle lumbar level, 13% a lower lumbar level, and 6% only sacral compromise. When the data from the pre and post fortification cohorts were adjusted and compared, there was a reduction from thoracic/high lumbar cases from 26 to 23% (P < 0.56), with an increase of middle lumbar cases from 43 to 58% and a reduction from 25 to 13% of low lumbar cases (P < 0.01) while there was no change in the 6% percentage of sacral cases respectively. Lesions that were considered too extensive or larger than 7 cm decreased from 7 to 1% while associated kyphotic deformities decreased from 6 to 1.4% (P < 0.01); symptomatic Chiari II malformation at birth also decreased from 7 to 2% in the pre- and post-fortification cohorts respectively with all these changes being statistically significant (P < 0.01). Seventy-nine percent and 80% of the pre and post FAF cohorts required CSF VP shunting with a mean time for insertion of 10 days after spinal defect closure with no significant statistical change between the two groups. CONCLUSIONS This study describes a four-staple folate fortified population of live-born patients with myelomeningocele lesions whose neurological level, defect size, and associated deformities such as spinal kyphosis and symptomatic Chiari II at birth suggest that folate fortification could have diminished the severity of this congenital disease.
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Affiliation(s)
- Adrian Caceres
- Neurosurgery Department, Hospital Nacional de Niños, "Dr. Carlos Sáenz Herrera", San José, Costa Rica.
| | | | | | - Roy Wong-McClure
- Epidemiology Surveillance Unit, Caja Costarricense de Seguro Social, San José, Costa Rica
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Oliveira RTC, Dantas DB, de Andrade EM, de Gouveia Affonso MV, de Marin ABR, de Campos Gomes F, Gonçalves NV, de Melo-Neto JS. Influence of social, demographic, and clinical factors in live births with spinal dysraphism in Brazil: an ecological study of 21 years. Childs Nerv Syst 2023; 39:1773-1782. [PMID: 36609513 DOI: 10.1007/s00381-022-05779-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This study aimed to verify possible associations between sociodemographic and clinical factors in live births with spinal dysraphism. METHODS An analytical (descriptive and inferential) and ecological study was carried out based on secondary data of 11,308 live births with spinal dysraphism registered in the Live Birth Information System (SINASC) in Brazil from 1999 to 2019. Demographic factors analyzed were age, education, mothers' marital status and geographic region. The clinical factors analyzed were duration, gestation period, birthweight, and number of prenatal visits performed by women who underwent medical follow-up. RESULTS There was an increase in the number of cases of spinal dysraphism in recent years in Brazil with an annual percentage variation of 3.52%. However, the period from 2005 to 2009 showed a reduction in live births with spinal dysraphism. The regions with the highest incidence were the South and Southeast. The risk increased in mothers born after 1980, older than 30 years and with a high level of education. The risk was increased in live births of whites and blacks, born from double pregnancy and with body weight less than 3000 g. The absence of prenatal care was associated with a higher incidence. CONCLUSION Sociodemographic and clinical factors have specific characteristics that can predict spinal dysraphism in newborns in Brazil.
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Affiliation(s)
- Raissa Tereza Casseb Oliveira
- Urogenital System Clinical and Experimental Research Unit (UPCEURG), Federal University of Pará (UFPA), Belém, Brazil
| | - Diego Bessa Dantas
- Urogenital System Clinical and Experimental Research Unit (UPCEURG), Federal University of Pará (UFPA), Belém, Brazil
| | - Edila Monteiro de Andrade
- Urogenital System Clinical and Experimental Research Unit (UPCEURG), Federal University of Pará (UFPA), Belém, Brazil
| | | | - Ana Beatriz Rocha de Marin
- Urogenital System Clinical and Experimental Research Unit (UPCEURG), Federal University of Pará (UFPA), Belém, Brazil
| | - Fabiana de Campos Gomes
- Genetics and Molecular Biology Research Unit (UPGEM), São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, Brazil
| | | | - João Simão de Melo-Neto
- Urogenital System Clinical and Experimental Research Unit (UPCEURG), Federal University of Pará (UFPA), Belém, Brazil.
- School of Physiotherapy and Occupational Therapy, Urogenital System Clinical and Experimental Research Unit (UPCEURG), Federal University of Pará (UFPA), José Silveira Neto, Street Augusto Corrêa, Guamá, Belém, 0166075-110, PA, Brazil.
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Bartonek Å, Eriksson M, Ericson A, Reimeringer M, Lidbeck C. Evaluation of Knee Position Sense in Children with Motor Disabilities and Children with Typical Development: A Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1056. [PMID: 37371287 DOI: 10.3390/children10061056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND In children with motor disabilities, knee position during walking is often of concern in rehabilitation. This study aimed to investigate knee joint position sense. Thirty-seven children with Cerebral Palsy (CP), 21 with Myelomeningocele (MMC), 19 with Arthrogryposis (AMC), and 42 TD children participated in the study. Knee joint position sense, i.e., the difference between the criterion angle and the reproduced angle (JPS-error), was assessed in sitting while 3D motion capture was recorded at flexed knee 70 (Knee70), 45 (Knee45), and 20 (Knee20) degrees, and after three seconds at maintained criterion angle (CAM) and maintained reproduced angle (RAM). No differences were found between the groups in JPS-error, CAM, and RAM. At Knee70, CAM differed between the right and left legs in the TD group (p = 0.014) and RAM in the MMC group (p = 0.021). In the CP group, CAM was greater than RAM at Knee70 in the left leg (p = 0.002), at Knee45 in both legs (p = 0.004, p = 0.025), and at Knee20 in the right leg (p = 0.038). Difficulties in maintaining the knee position at CAM in the CP group sheds light on the need for complementary judgments of limb proprioception in space to explore the potential influence on knee position during walking.
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Affiliation(s)
- Åsa Bartonek
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Marie Eriksson
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Annika Ericson
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
- Motor Control Laboratory QA:27, Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Karolinska Vägen 37A, 17176 Stockholm, Sweden
| | - Mikael Reimeringer
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
- Motor Control Laboratory QA:27, Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Karolinska Vägen 37A, 17176 Stockholm, Sweden
| | - Cecilia Lidbeck
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
- Motor Control Laboratory QA:27, Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Karolinska Vägen 37A, 17176 Stockholm, Sweden
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Yun H, Choi EK, Kim HW, Ha JS, Kim DS, Park KB. Foot deformity and quality of life among independently ambulating children with spina bifida in South Korea. BMC Pediatr 2023; 23:281. [PMID: 37277711 DOI: 10.1186/s12887-023-04100-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 05/29/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Children with spina bifida (SB) may have congenital or acquired foot deformities due to neurological defects in the spinal cord. As the musculoskeletal system keeps growing, foot deformities can develop or become aggravated. Thus, healthcare providers should provide constant monitoring and proper orthopedic management. Since foot deformities can affect not only the gait but also the daily life of children with SB, it is necessary to investigate the impact of foot deformities on everyday life. The purpose of this study was to examine the relationship between foot deformity and health-related quality of life (HRQoL) among independently ambulating children with SB. METHODS This cross-sectional study examined the associations between foot deformity and HRQoL using two patient-reported outcome measures (Oxford Ankle Foot Questionnaire, Pediatric Outcomes Data Collection Instrument) in 93 children with SB aged 7-18 years between January 2020 and July 2021. RESULTS Children with foot deformity (n = 54) reported lower scores in all subscales (physical, school and play, emotional, and footwear) of the Oxford Ankle Foot Questionnaire for children than those without foot deformity (n = 39; p < 0.001). Additionally, in terms of the Pediatric Outcomes Data Collection Instrument, children with foot deformity also reported poorer scores in four subscales (transfer and basic mobility, sports and physical functioning, comfort and pain, happiness with physical functioning; p < 0.001) than those without foot deformity, whereas upper extremity functioning was not significantly affected. Children with foot deformities, particularly those with bilateral foot deformities, equinus deformities, or mixed deformities, which are different types of right and left foot deformities, have a lower perceived HRQoL (p < 0.05). CONCLUSIONS Among independently ambulating children with SB, those with foot deformities showed lower HRQoL. Moreover, children with foot deformities tend to have other clinical problems, including bladder and bowel dysfunction. Therefore, orthopedic management should consider the multifaceted factors that affect children's daily life and HRQoL.
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Affiliation(s)
- Hyeseon Yun
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Eun Kyoung Choi
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - Hyun Woo Kim
- Division of Pediatric Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jeong Sook Ha
- Severance Children's Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Doo Sung Kim
- Division of Pediatric Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kun-Bo Park
- Division of Pediatric Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Pastora Bucardo DM, González F, Montes Pastora M, Pimienta Ramirez PA, Bonilla IL, Vielot NA, Finnell RH. Neural tube defects: Prevalence, mortality, and maternal characteristics in two departmental hospitals in the northwestern region of Nicaragua, 2006-2018. Birth Defects Res 2023; 115:945-953. [PMID: 37025002 DOI: 10.1002/bdr2.2174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Congenital anomalies are the fifth most common cause of neonatal mortality in Nicaragua, and neural tube defects (NTDs) are the most common of all cases of lethality associated with a birth defect. Prevalence and mortality estimates are needed to propose effective intervention strategies that prevent NTDs over time. METHODS A cross-sectional study was carried out in northwestern Nicaragua from January 2006 to December 2018. All cases of NTDs (anencephaly, spina bifida, and encephalocele) were registered in hospital surveillance systems, and the medical histories of the mothers and newborns were reviewed. Prevalence was calculated by considering the number of live births and stillbirths older than 20 weeks of gestation with NTDs, divided by the total number of live births and stillbirths in each study year. Neonatal mortality rate (NMR) for NTD, and case fatality for spina bifida was calculated. RESULTS Two hundred fifty cases of NTDs were identified from 178,498 deliveries (177,316 live births and 1,182 stillbirths). The prevalence of NTDs during this time period was 14.01 (95% CI: 12.27-15.74) per 10,000 births. The prevalence of spina bifida (n = 140), anencephaly (n = 97), and encephalocele (n = 13) was 7.84, (95% CI: 6.54-9.14), 5.43 (95% CI: 4.30-6.45), and 0.73 (95% CI: 0.33-1.12) per 10,000 births, respectively. Mothers with fetus or newborns affected with NTDs did not use folic acid prior to conception, and 11% experienced periods of hyperthermia during the first trimester of pregnancy. NMR for NTDs was 0.55 per 1.000 livebirths. Case fatality for all NTDs and for spina bifida were 55% and 18%, respectively. CONCLUSION The prevalence and mortality of NTDs in the northwestern region of Nicaragua present peaks and troughs during the study period. Spina bifida was the most frequent type of NTD. We believe that these findings could be of use by health policy makers to strengthen the primary prevention of NTDs in the region through the monitoring of the food fortification policy and folic acid supplementation to women of childbearing age. Additional etiologic studies of NTDs should be considered to identify additional prevention measures.
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Affiliation(s)
| | - Fredman González
- Department of Microbiology, Faculty of Medical Sciences, National Autonomous University of Nicaragua-León, León, Nicaragua
| | - María Montes Pastora
- Department of Public Health, National Autonomous University of Nicaragua, León, Nicaragua
| | - Paula Andrea Pimienta Ramirez
- Center for Precision Environmental Health, Departments of Molecular and Human Genetics, Molecular and Cellular Biology and Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Indiana López Bonilla
- Department of Public Health, National Autonomous University of Nicaragua, León, Nicaragua
| | - Nadja A Vielot
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Richard H Finnell
- Center for Precision Environmental Health, Departments of Molecular and Human Genetics, Molecular and Cellular Biology and Medicine, Baylor College of Medicine, Houston, Texas, USA
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Hosseini-Siyanaki MR, Liu S, Dagra A, Reddy R, Reddy A, Carpenter SL, Khan M, Lucke-Wold B. Surgical Management of Myelomeningocele. NEONATAL 2023; 4:08. [PMID: 38179156 PMCID: PMC10766379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Myelomeningocele (MMC) is one of the most common abnormalities of the central nervous system that causes significant neurological impairment. Traditionally, treatment consisted of postnatal closure with the management of the complications, such as ventricular shunting. MMC is a plausible candidate for in-utero surgery because of the mechanism of neurologic damage that begins with abnormal neurulation and continues throughout gestation. Researchers discussed the benefits of in-utero closure prior to the publication of the prospective randomized multicenter Management of Myelomeningocele Study (MOMS trial). Compared to postnatal repair with maternal complications and prematurity as trade-offs, prenatal repair reduced shunting, reversed hindbrain herniation, and improved neurological function. This article discusses the diagnosis, evaluation, long-term follow-up, surgical options, and innovative treatment for fetal myelomeningocele.
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Affiliation(s)
| | - Sophie Liu
- Department of Neuroscience, University of Johns Hopkins, Baltimore, MD, USA
| | - Abeer Dagra
- University of Florida, College of Medicine, Gainesville, FL, USA
| | - Ramya Reddy
- University of Florida, College of Medicine, Gainesville, FL, USA
| | - Akshay Reddy
- University of Florida, College of Medicine, Gainesville, FL, USA
| | | | - Majid Khan
- University of Nevada, Reno School of Medicine, Reno, NV, USA
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Ridosh MM, Adams W, Magaña F, Sawin KJ, Holmbeck GN. Trajectories of self-management and independence in youth with spina bifida: Demographic predictors of growth. Child Care Health Dev 2023; 49:508-517. [PMID: 36206540 PMCID: PMC10079778 DOI: 10.1111/cch.13065] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/30/2022] [Indexed: 11/26/2022]
Abstract
AIM The purpose of this study was to examine the trajectories of condition and independent living self-management in youth with spina bifida (SB). METHODS A diverse sample of adolescents and young adults (AYAs) with SB completed the Adolescent/Young Adult Self-Management and Independence Scale (AMIS-II) across four time points. Parents reported on demographic characteristics including age, sex, race/ethnicity, and family income. Growth in self-management and its subscales (condition and independent living) were estimated using linear mixed-effect models as a function of respondents' demographics. RESULTS This study included 99 respondents age 18 to 27 years old. About half were female (52.5%) and White (52.5%); 15.2% were Black, and about a third were Hispanic/Latino (32.3%). Eighty-seven AYAs (87.9%) had myelomeningocele. The lesion level was 31.3% sacral, 48.5% lumbar and 18.2% thoracic. A third of the families earned less than 50K. Overall, self-management growth was dependent on age, sex, and race/ethnicity, but not income. Growth in condition self-management depended on sex; only males demonstrated increasing growth ( β ̂ = 0.11, p < 0.001). Black participants endorsed higher increasing total and condition self-management when compared with White ( β ̂ diff = 0.17 and 0.17, respectively, both p < 0.05) and Hispanic/Latino ( β ̂ diff = 0.18 and 0.21, respectively, both p = 0.02) respondents. CONCLUSION This study provides evidence of differences in growth of self-management by demographic/social determinants of health. Possible reasons for differences are discussed. Predictors of changes in self-management behaviours over time in young adults with SB can identify subgroups in need of further study.
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Affiliation(s)
- Monique M Ridosh
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois, USA
| | - William Adams
- Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, USA
| | - Fabiola Magaña
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois, USA
| | - Kathleen J Sawin
- Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, Wisconsin, USA
- Self-Management Science Center, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Grayson N Holmbeck
- Department of Psychology, Loyola University Chicago, Chicago, Illinois, USA
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Msheik A, Abbass D, Bayram M, Awde A, Al Mokdad Z. Cervical Myelocystocele: A One-in-50,000 Congenital Abnormality of the Spinal Cord. Cureus 2023; 15:e37278. [PMID: 37168187 PMCID: PMC10165719 DOI: 10.7759/cureus.37278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/13/2023] Open
Abstract
Neural tube defects are a group of birth defects that affect the development of the spinal cord and brain. Myelomeningocele is a type of neural tube defect that results in the protrusion of the spinal cord and meninges through a defect in the vertebral column. While myelomeningocele is a relatively rare condition, cervical myelomeningocele is extremely uncommon. The condition can lead to various neurological problems and atrophies and is typically diagnosed in the first trimester of pregnancy using an ultrasound examination. Surgical intervention is typically recommended to repair the affected vertebral column. In this report, we describe the case of a four-month-old baby boy who was diagnosed with a cervical myelocystocele and successfully treated surgically. The patient had an excellent postoperative status, and this case highlights the importance of early diagnosis and intervention in the management of this rare condition.
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Affiliation(s)
- Ali Msheik
- Neurological Surgery, Zahraa Hospital University Medical Center, Beirut, LBN
- Neurological Surgery, Lebanese University Faculty of Medical Sciences, Hadath, LBN
| | - Daniel Abbass
- Neurological Surgery, Al Rassoul Al-Aazam Hospital, Beirut, LBN
| | - Mohamad Bayram
- Neurological Surgery, Al Rassoul Al-Aazam Hospital, Beirut, LBN
| | - Ahmad Awde
- Neurosurgery, Endovascular Neurosurgery, Al Rassoul Al-Aazam Hospital, Beirut, LBN
| | - Zeinab Al Mokdad
- Medical Sciences, Public Health, Lebanese University Faculty of Medical Sciences, Hadath, LBN
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Neves da Rocha LS, Bunduki V, Cardeal DD, de Amorim Filho AG, Nani FS, Peres SV, de Carvalho WB, de Francisco RPV, de Carvalho MHB. Risk factors for shunting at 12 months following open fetal repair of spina bifida by mini-hysterotomy. J Perinat Med 2023:jpm-2022-0212. [PMID: 36976874 DOI: 10.1515/jpm-2022-0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 02/22/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVES Open spina bifida (OSB) is the most common neural tube defect. Prenatal repair reduces the need for ventriculoperitoneal shunting (VPS) due to hydrocephalus from 80-90% to 40-50%. We aimed to determine which variables work as risk factors for VPS at 12 months of age in our population. METHODS Thirty-nine patients underwent prenatal repair of OSB by mini-hysterotomy. The main outcome was occurrence of VPS in the first 12 months of life. Logistic regression was used to estimate the odds ratios (OR) between prenatal variables and the need for shunting. RESULTS VPS at 12 months occurred in 34.2% of the children. Larger ventricle size before surgery (62.5% ≥15 mm; 46.2% between 12 and 15 mm; 11.8% <12 mm; p=0.008), higher lesion level (80% >L2, vs. 17.9% ≤L3; p=0.002; OR, 18.4 [2.96-114.30]), and later gestational age at surgery (25.25 ± 1.18 vs. 24.37 ± 1.06 weeks; p=0.036; OR, 2.23 [1.05-4.74]) were related to increased need for shunting. In the multivariate analysis, larger ventricle size before surgery (≥15 mm vs. <12 mm; p=0.046; OR, 1.35 [1.01-1.82]) and higher lesion level (>L2 vs. ≤L3; p=0.004; OR, 39.52 [3.25-480.69]) were risk factors for shunting. CONCLUSIONS Larger ventricle size before surgery (≥15 mm) and higher lesion level (>L2) are independent risk factors for VPS at 12 months of age in fetuses undergoing prenatal repair of OSB by mini-hysterotomy in the studied population.
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Affiliation(s)
- Luana Sarmento Neves da Rocha
- Obstetrics, Department of Obstetrics and Ginecology, FMUSP School of Medicine, São Paulo University, São Paulo, Brazil
| | - Victor Bunduki
- Obstetrics, Department of Obstetrics and Ginecology, FMUSP School of Medicine, São Paulo University, São Paulo, Brazil
| | - Daniel Dante Cardeal
- Neurosurgery, Department of Neurology/Neurosurgery, FMUSP School of Medicine, São Paulo University, São Paulo, Brazil
| | - Antônio Gomes de Amorim Filho
- Obstetrics Clinic Division, Hospital das Clínicas HCFMUSP, School of Medicine, São Paulo University, São Paulo, Brazil
| | - Fernando Souza Nani
- Anesthesiology, Department of Anesthesiology/Sugery, FMUSP School of Medicine, São Paulo University, São Paulo, Brazil
| | - Stela Verzinhasse Peres
- Obstetrics, Department of Obstetrics and Ginecology, FMUSP School of Medicine, São Paulo University, São Paulo, Brazil
| | - Werther Brunow de Carvalho
- Neonatology Division, Child Institute at Hospital das Clínicas HCFMUSP, FMUSP School of Medicine, São Paulo University, São Paulo, Brazil
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71
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Khalil AF, Badr HI, Zaher A, Elshirbiny MF, Elnaggar AM, Badran M, Zayed AE, Abdelhalim MM, Amen MM. Repair of spina bifida cystica: an institutional experience. EGYPTIAN JOURNAL OF NEUROSURGERY 2023. [DOI: 10.1186/s41984-023-00185-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
Abstract
Objective
Although most cases with spina bifida cystica could be closed by primary skin closure with or without undermining its edges, about 25% of patients have large defects not amenable for closure by these simple methods. We conducted this study to review our techniques in closing spina bifida cystica defects.
Methods
We retrospectively reviewed the data of consecutive 21 patients diagnosed with spina bifida cystica in our setting. According to the surface area of the defect, the approach was decided; primary closure for small defects (11 cases) and flap-based approach for large defects (10 patients).
Results
The age of the included pediatric patients ranged between 3 and 75 days. For the primary closure cases, a vertical incision was done in seven cases. For the flap-based group, bilateral rotation transposition flap was done for circular defects (7 cases) while elliptical ones were repaired via bilateral V–Y flap. Complete skin healing was achieved after two weeks (range 12–18 days) in most cases. Complications were as follows; for the primary closure group, cerebrospinal fluid leakage (18.18%%), partial wound dehiscence (18.18%) and superficial surgical site infection (9.09%). In the flap-based group, CSF leakage (20%), superficial surgical site infection (10%), and distal flap necrosis (30%) were detected. Reoperation for wound complication was needed only in one case in the flap-based group.
Conclusions
Flap-based procedures are recommended for patients with large spina bifida cystica defects because of less tissue dissection and low complication rates. Primary closure should be kept for small defects.
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72
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Fletcher JM, Houtrow AJ, MacPherson C, Thomas NH, Gupta N, Adzick NS, Thom EA. Hydrocephalus and school-age neurodevelopmental outcomes in the management of myelomeningocele prenatal surgery trial: a secondary analysis. J Neurosurg Pediatr 2023:1-11. [PMID: 36883627 PMCID: PMC10193500 DOI: 10.3171/2022.10.peds22358] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/25/2022] [Indexed: 03/09/2023]
Abstract
OBJECTIVE The purpose of this secondary analysis was to assess the role of hydrocephalus on neurodevelopmental outcomes in a cohort of school-age children enrolled in the Management of Myelomeningocele Study (MOMS) clinical trial. METHODS The sample analyzed in this report consisted of 150 of 183 children aged 5-10 years (mean ± SD 7 years 8 months ± 1.2) who were randomly assigned between 20 and 26 weeks of gestational age to undergo either prenatal or postnatal surgery and were enrolled in the school-age follow-up study of MOMS. These 150 children (76 prenatal and 74 postnatal) were placed into three groups: no hydrocephalus (n = 22), unshunted hydrocephalus (n = 31), and shunted hydrocephalus (n = 97). Comparisons were made on the basis of measures of adaptive behavior, intelligence, reading and math skills, verbal and nonverbal memory, fine motor dexterity, and sensorimotor skills. Parent ratings of executive functions, inattention, and hyperactivity-impulsivity were also compared. RESULTS There were no statistically significant differences in neurodevelopmental outcomes between the groups with no hydrocephalus and unshunted hydrocephalus, or between the prenatal and postnatal groups with shunted hydrocephalus, so these groups were combined (no/unshunted vs shunted hydrocephalus). The no/unshunted group showed significantly better performance (p < 0.05) than the shunted group in terms of adaptive behavior, intelligence, verbal and nonverbal memory, reading skills (but not math), fine motor dexterity, sensorimotor skills (but not visual-motor integration), and inattention (but not hyperactivity-impulsivity or executive function ratings). An assessment of the prenatal surgery group showed that the combined no/unshunted group performed better than the shunted group in terms of adaptive behavior and verbal memory skills. Both the prenatal and postnatal surgery subgroups with unshunted hydrocephalus performed as well as the group with no hydrocephalus despite significantly enlarged ventricles. CONCLUSIONS Although the primary assessment of school-age outcomes in the MOMS clinical trial did not show better adaptive behavior and cognitive skills in the prenatal group, hydrocephalus and shunting were associated with poorer neurodevelopmental outcomes (both prenatal and postnatal groups). Disease severity and dynamic changes in hydrocephalus status may be the primary factors in the need for shunting and a major determinant of adaptive behavior and cognitive outcomes after prenatal surgery.
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Affiliation(s)
| | - Amy J. Houtrow
- Departments of Physical Medicine & Rehabilitation and
- Pediatrics, University of Pittsburgh, Pennsylvania
| | - Cora MacPherson
- The Biostatistics Center, Milken Institute of Public Health, George Washington University, Washington, DC
| | - Nina H. Thomas
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Psychiatry, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nalin Gupta
- Departments of Neurological Surgery and
- Pediatrics, University of California, San Francisco, California; and
| | - N. Scott Adzick
- Department of Surgery, Children’s Hospital of Philadelphia, Pennsylvania
| | - Elizabeth A. Thom
- The Biostatistics Center, Milken Institute of Public Health, George Washington University, Washington, DC
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Flanders TM, Franco AJ, Lincul KL, Pierce SR, Oliver ER, Moldenhauer JS, Adzick NS, Heuer GG. Tethered cord release in patients after open fetal myelomeningocele closure: intraoperative neuromonitoring data and patient outcomes. Childs Nerv Syst 2023; 39:663-670. [PMID: 36380051 DOI: 10.1007/s00381-022-05756-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of the study was to better understand the clinical course and impact of tethered cord release surgery on patients who have previously undergone open spinal dysraphism closure in utero. METHODS This is a single-center retrospective observational study on patients undergoing tethered cord release after having previously had open fetal myelomeningocele (MMC) closure. All patients underwent tethered cord release surgery with a single neurosurgeon. A detailed analysis of the patients' preoperative presentation, intraoperative neuromonitoring (IONM) data, and postoperative course was performed. RESULTS From 2009 to 2021, 51 patients who had previously undergone fetal MMC closure had tethered cord release surgery performed. On both preoperative and postoperative manual motor testing, patients were found to have on average 2 levels better than would be expected from the determined anatomic level from fetal imaging. The electrophysiologic functional level was found on average to be 2.5 levels better than the anatomical fetal level. Postoperative motor levels when tested on average at 4 months were largely unchanged when compared to preoperative levels. Unlike the motor signals, 46 (90%) of patients had unreliable or undetectable lower extremity somatosensory evoked potentials (SSEPs) prior to the tethered cord release. CONCLUSION Tethered cord surgery can be safely performed in patients after open fetal MMC closure without clinical decline in manual motor testing. Patients often have functional nerve roots below the anatomic level. Sensory function appears to be more severely affected in patients leading to a consistent motor-sensory imbalance.
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Affiliation(s)
| | | | | | | | | | | | - N Scott Adzick
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Milani HJF, Barreto EQDS, Araujo Júnior E, Cavalheiro S, Barbosa MM, Peixoto AB, Moron AF. Assessment of lower limb trophism in fetuses with open spina bifida using fractional thigh volume of three-dimensional ultrasound. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:409-414. [PMID: 36223260 DOI: 10.1002/jcu.23364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/12/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To assess the trophism of the lower limbs of fetuses with open spina bifida using fractional thigh volume (TVOL) of three-dimensional (3D) ultrasound. METHODS A prospective cross-sectional study was carried out with normal fetuses and with open spina bifida (myelomeningocele and rachischisis) at 26 weeks' gestation. The TVOL (delimitation of five cross-sectional areas of the middle portion of the limb) was evaluated, as well as the subjective assessment of hypotrophy and lower limb movement. RESULTS Thirty-one fetuses with open spina bifida, 21 with myelomeningocele and 10 with rachischisis, and 51 normal fetuses were included. There were no significant differences in the TVOL between normal and spina bifida fetuses (p = 0.623), as well as between normal fetuses, with myelomeningocele and with rachischisis (p = 0.148). There was no significant difference in the TVOL of fetuses with spina bifida with or without lower limb hypotrophy (p = 0.148). Fetuses with spina bifida and with lower limb movement had higher TVOL values than fetuses without lower limb movement (p = 0.002). CONCLUSION There were no significant differences in the TVOL measurement of normal and spina bifida fetuses (rachischisis and myelomeningocele). Fetuses with spina bifida without spontaneous movement of the lower limbs had lower TVOL values.
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Affiliation(s)
- Hérbene José Figuinha Milani
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
- Department of Fetal Medicine, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Sérgio Cavalheiro
- Department of Neurology and Neurosurgery, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
- Department of Fetal Neurosurgery, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil
| | - Maurício Mendes Barbosa
- Department of Fetal Medicine, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil
- Service of Gynecology and Obstetrics, Israeli Faculty of Health Sciences Albert Einstein, São Paulo, SP, Brazil
| | - Alberto Borges Peixoto
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
- Gynecology and Obstetrics Service, Mário Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba, MG, Brazil
| | - Antonio Fernandes Moron
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
- Department of Fetal Medicine, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil
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Sasaoka AKS, Moron AF, Araujo Júnior E, Sañudo A, Barbosa MM, Milani HJF, Sarmento SGP, Cavalheiro S. Ultrasound evaluation of uterine scar thickness after open fetal surgery for myelomeningocele. Childs Nerv Syst 2023; 39:655-661. [PMID: 35939128 DOI: 10.1007/s00381-022-05642-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to analyse the evolution of uterine scar thickness after open fetal surgery for myelomeningocele (MMC) by ultrasonography, and to establish a cut-off point for uterine scar thickness associated with high-risk of uterine rupture. METHODS A prospective longitudinal study was conducted with 77 pregnant women who underwent open fetal surgery for MMC between 24 and 27 weeks of gestation. After fetal surgery, ultrasound follow-up was performed once a week, and the scar on the uterine wall was evaluated and its thickness was measured by transabdominal ultrasound. At least five measurements of the uterine scar thickness were performed during pregnancy. A receiver operating characteristics (ROC) curve was constructed to obtain a cut-off point for the thickness of the scar capable of detecting the absence of thinning. Kaplan-Meier curves were constructed to evaluate the probability of thinning during pregnancy follow-up. RESULTS The mean ± standard deviation of maternal age (years), gestational age at surgery (weeks), gestational age at delivery (weeks), and birth weight (g) were 30.6 ± 4.5, 26.1 ± 0.8, 34.3 ± 1.2 and 2287.4 ± 334.4, respectively. Thinning was observed in 23 patients (29.9%). Pregnant women with no thinning had an average of 17.1 ± 5.2 min longer surgery time than pregnant women with thinning. A decrease of 1.0 mm in the thickness of the uterine scar was associated with an increased likelihood of thinning by 1.81-fold (95% confidence interval [CI]: 1.32-2.47; p < 0.001). The area below the ROC curve was 0.899 (95% CI: 0.806-0.954; p < 0.001), and the cut-off point was ≤ 3.0 mm, which simultaneously presented greater sensitivity and specificity. After 63 days of surgery, the probability of uterine scarring was 50% (95% CI: 58-69). CONCLUSION A cut-off point of ≤ 3.0 mm in the thickness of the uterine scar after open fetal surgery for MMC may be used during ultrasonography monitoring for decision-making regarding the risk of uterine rupture and indication of caesarean section.
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Affiliation(s)
- Alexandre Kim Sangalan Sasaoka
- Department of Obstetrics, Paulista School of Medicina - Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, 05089-030, Brazil
| | - Antonio Fernandes Moron
- Department of Obstetrics, Paulista School of Medicina - Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, 05089-030, Brazil
- Paulista Center of Fetal Medicine, São Paulo, SP, Brazil
- Santa Joana Maternity and Hospital, São Paulo, SP, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicina - Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, 05089-030, Brazil.
| | - Adriana Sañudo
- Department of Preventive Medicine, Paulista School of Medicina - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Mauricio Mendes Barbosa
- Paulista Center of Fetal Medicine, São Paulo, SP, Brazil
- Santa Joana Maternity and Hospital, São Paulo, SP, Brazil
| | - Herbene José Figuinha Milani
- Department of Obstetrics, Paulista School of Medicina - Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, 05089-030, Brazil
- Paulista Center of Fetal Medicine, São Paulo, SP, Brazil
- Santa Joana Maternity and Hospital, São Paulo, SP, Brazil
| | | | - Sergio Cavalheiro
- Paulista Center of Fetal Medicine, São Paulo, SP, Brazil
- Santa Joana Maternity and Hospital, São Paulo, SP, Brazil
- Department of Neurology and Neurosurgery, Paulista School of Medicina - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
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Sciscent BY, Bhanja D, Daggubati LC, Ryan C, Hallan DR, Rizk EB. Pregnancy in spina bifida patients: a comparative analysis of peripartum procedures and complications. Childs Nerv Syst 2023; 39:625-632. [PMID: 36278978 DOI: 10.1007/s00381-022-05705-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/13/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Spina bifida (SB) is caused by a failure in neural tube closure that can present with lower extremity sensory deficits, paralysis, and hydrocephalus. Medical advances have allowed increased pregnancies among SB patients, but management and pregnancy-associated complications have not been thoroughly investigated. The objective is to delineate peripartum procedures and complications in patients with SB. METHODS A national de-identified database, TriNetX, was retrospectively queried to evaluate pregnant SB patients and the general population. Procedures and complications were investigated using corresponding ICD-10 and CPT codes within 1 year of pregnancy diagnosis. RESULTS 11,405 SB patients were identified and compared to 9,269,084 non-SB patients. SB patients were significantly more likely to undergo cesarean delivery (1.200; 95% CI [1.133-1.271]) and less likely to receive neuraxial analgesia (0.406; 95% CI [0.383-0.431]). Additionally, patients with SB had an increased risk of seizures (3.922; 95% CI [3.529-4.360]) and venous thromboembolism (VTE) (3.490; 95% CI [3.070-3.969]). Risks of preeclampsia and hemorrhage were comparable. SB patients with hydrocephalus and Chiari malformation type 1 (CM-1) or type 2 (CM-2) were compared to patients without these comorbid conditions. This sub-group analysis showed a significantly increased risk of having cesarean deliveries (SB with hydrocephalus: 12.55%, S.B. with CM-1 or CM-2: 12.81% vs. SB without hydrocephalus or CM, 6.16%) and VTE (3.74%, 2.43% vs. 0.81%). There were also increased risks of hemorrhage and seizures and decreased use of neuraxial analgesia, but the sample size was insufficient. CONCLUSION SB patients were more likely to undergo cesarean section and exhibit peripartum complications compared to those without SB.
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Affiliation(s)
- Bao Y Sciscent
- Department of Neurosurgery, Penn State Health, Hershey, PA, 17033, USA.
- Penn State College of Medicine, 700 HMC Crescent Rd, Hershey, PA, 17033, USA.
| | - Debarati Bhanja
- Department of Neurosurgery, Penn State Health, Hershey, PA, 17033, USA
- Penn State College of Medicine, 700 HMC Crescent Rd, Hershey, PA, 17033, USA
| | | | - Casey Ryan
- Department of Neurosurgery, Penn State Health, Hershey, PA, 17033, USA
| | - David R Hallan
- Department of Neurosurgery, Penn State Health, Hershey, PA, 17033, USA
| | - Elias B Rizk
- Department of Neurosurgery, Penn State Health, Hershey, PA, 17033, USA
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Stiles-Shields C, Kritikos TK, Winning AM, Starnes M, Holmbeck GN. Caregiver Expressed Emotion in Families of Youth With Spina Bifida: Demographic, Medical, and Family Correlates. J Pediatr Psychol 2023; 48:144-155. [PMID: 36164839 PMCID: PMC9941830 DOI: 10.1093/jpepsy/jsac073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/17/2022] [Accepted: 09/14/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Caregiver expressed emotion (EE), an interview-based measure of emotional valence within an interpersonal relationship, is associated with psychosocial outcomes across multiple conditions. Guided by a model implicating a bidirectional role of "Chronic Family Stress" in the unfolding of EE in family environments, the current study examined demographic, medical, and family-level variables in association with EE in caregivers of children with spina bifida (SB). METHODS Data were combined from 2 distinct studies of families with a child with SB, resulting in a sample of 174 (ages 8-17). Linear regressions examined the family stressors and child variables in association with maternal and paternal warmth and criticism, as coded from EE interviews. RESULTS Higher levels of family stress were associated with paternal criticism (p = .03), while having non-Hispanic White children was associated with both maternal and paternal criticism (ps < .005). Having children younger in age (ps < .01) and without a shunt (ps < .01) was associated with higher warmth. CONCLUSIONS Family stressors, absence of the negative impacts of systemic racism, shunt status, and age appear to be associated with the expression of EE in caregivers of a child with SB. Findings highlight multiple assessment considerations, including assessing EE when children are younger to engage caregivers with children with SB when they are more likely to be expressing more warmth. Pinpointing factors associated with caregiver EE in SB will help to better identify families at risk for high levels of criticism and also aid in the development of targeted prevention and intervention programs.
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Affiliation(s)
- Colleen Stiles-Shields
- Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, USA
| | - Tessa K Kritikos
- Department of Clinical, Health, and Applied Sciences, University of Houston Clear Lake, USA
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Choi EK, Park J, Kim K, Bae E, Ji Y, Yang SH, Chinbayar A, Yun H. Factors affecting the transition to adulthood of Korean young adults with spina bifida: a qualitative study. BMC Nurs 2023; 22:46. [PMID: 36803401 PMCID: PMC9940440 DOI: 10.1186/s12912-023-01194-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 01/31/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Transition to adulthood to live independently while self-managing health and daily life without parental help is crucial for young adults with chronic conditions. Despite its importance as a precursor to effectively managing lifelong conditions, little is known about the experiences of young adults with spina bifida (SB) in transition to adulthood in Asian countries. This study aimed to explore the experiences of Korean young adults with SB to identify the facilitators or barriers to the transition from adolescence to adulthood from their perspectives. METHODS This study used a qualitative descriptive design. The data were collected in South Korea through three focus group interviews with 16 young adults with SB, aged 19-26, from August to November 2020. We conducted a qualitative content analysis using a conventional approach to identify the factors that facilitated and hindered the participants' transition to adulthood. RESULTS Two themes emerged as facilitators and barriers to the transition to adulthood. a) Facilitators: understanding and acceptance of SB, acquiring self-management skills, parenting styles encouraging autonomy, parents' emotional support, school teachers' thoughtful consideration, and participation in self-help groups. b) Barriers: overprotective parenting style, experience of being bullied by peers, damaged self-concept, concealing one's chronic condition from others, and the lack of privacy in school restrooms. CONCLUSIONS Korean young adults with SB shared their experiences of struggling to properly manage their chronic conditions on their own, particularly concerning regular bladder emptying, during the transition from adolescence to adulthood. To facilitate the transition to adulthood, education on the SB and self-management for adolescents with SB and on parenting styles for their parents are important. To eliminate barriers to the transition to adulthood, improving negative perceptions of disability among students and teachers and making school restrooms CIC-friendly are needed.
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Affiliation(s)
- Eun Kyoung Choi
- grid.15444.300000 0004 0470 5454College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Jisu Park
- grid.15444.300000 0004 0470 5454Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Kyua Kim
- grid.15444.300000 0004 0470 5454Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Eunjeong Bae
- grid.15444.300000 0004 0470 5454College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, 03722 Seoul, Republic of Korea
| | - Yoonhye Ji
- grid.15444.300000 0004 0470 5454Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Seung Hyeon Yang
- grid.15444.300000 0004 0470 5454College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, 03722 Seoul, Republic of Korea
| | - Altantuya Chinbayar
- grid.15444.300000 0004 0470 5454Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Hyeseon Yun
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.
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79
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Spatio-temporal dynamics enhance cellular diversity, neuronal function and further maturation of human cerebral organoids. Commun Biol 2023; 6:173. [PMID: 36788328 PMCID: PMC9926461 DOI: 10.1038/s42003-023-04547-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 02/02/2023] [Indexed: 02/16/2023] Open
Abstract
The bioengineerined and whole matured human brain organoids stand as highly valuable three-dimensional in vitro brain-mimetic models to recapitulate in vivo brain development, neurodevelopmental and neurodegenerative diseases. Various instructive signals affecting multiple biological processes including morphogenesis, developmental stages, cell fate transitions, cell migration, stem cell function and immune responses have been employed for generation of physiologically functional cerebral organoids. However, the current approaches for maturation require improvement for highly harvestable and functional cerebral organoids with reduced batch-to-batch variabilities. Here, we demonstrate two different engineering approaches, the rotating cell culture system (RCCS) microgravity bioreactor and a newly designed microfluidic platform (µ-platform) to improve harvestability, reproducibility and the survival of high-quality cerebral organoids and compare with those of traditional spinner and shaker systems. RCCS and µ-platform organoids have reached ideal sizes, approximately 95% harvestability, prolonged culture time with Ki-67 + /CD31 + /β-catenin+ proliferative, adhesive and endothelial-like cells and exhibited enriched cellular diversity (abundant neural/glial/ endothelial cell population), structural brain morphogenesis, further functional neuronal identities (glutamate secreting glutamatergic, GABAergic and hippocampal neurons) and synaptogenesis (presynaptic-postsynaptic interaction) during whole human brain development. Both organoids expressed CD11b + /IBA1 + microglia and MBP + /OLIG2 + oligodendrocytes at high levels as of day 60. RCCS and µ-platform organoids showing high levels of physiological fidelity a high level of physiological fidelity can serve as functional preclinical models to test new therapeutic regimens for neurological diseases and benefit from multiplexing.
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80
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Acosta-Medina E, Zorro-Guío OF, Abdala-Vargas NJ, Jacomussi-Alzate L, Figueredo LF, Johnson JM, Patiño-Gómez JG, Ordóñez-Rubiano EG. Postnatal Surgical Correction of Myelomeningoceles: Preoperative and Intraoperative Risk Factors Associated with Postoperative Neurologic Outcomes. World Neurosurg 2023; 170:e629-e638. [PMID: 36410703 DOI: 10.1016/j.wneu.2022.11.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Open spina bifida or myelomeningocele (MMC) is a congenital defect that results from failure of caudal neurulation. We present a case series of patients who were treated with postnatal surgical correction for MMC, evaluating the possible preoperative and intraoperative risk factors associated with neurologic outcomes. METHODS A retrospective chart review of patients who underwent postnatal surgical correction for MMCs over 11 years at our institution was performed. MMCs were classified based on their morphologic configuration into 3 types. Type I includes defects without a sac and there is cerebrospinal fluid (CSF) leak. Type II includes where there is a sac ≤4 cm, with or without CSF leak. Type III includes defects with a sac that are greater than 4 cm. RESULTS Fifty patients were included. The median age of gestation at surgery was 37.4 weeks. There were 30 females (60%). All mothers received adequate folate supplementation. All patients underwent surgical correction in the first 48 hours. Lower extremity motor function at the last clinical follow-up was normal in 34 patients (68%). CSF leak, infection, and mortality were 8%, 2%, and 0%, respectively. Twenty-one patients (42%) underwent ventriculoperitoneal shunt for hydrocephalus. CONCLUSIONS Despite there being no statistically significant associations with a timely closure, all cases were treated within the first 48 hours and this could influence the low complication rate. Individuals of Hispanic background who received appropriate folate supplementation still had high rates of MMC and we posit that this may be caused in part by a genetic/molecular predisposition.
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Affiliation(s)
- Enrique Acosta-Medina
- Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia
| | - Oscar F Zorro-Guío
- Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia
| | - Nadin J Abdala-Vargas
- Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia
| | - Lorena Jacomussi-Alzate
- Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia
| | - Luisa F Figueredo
- Department of Neurosurgery, Brain Tumor Stem Cell Laboratory, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Jason M Johnson
- Neuroradiology, Diagnostic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Javier G Patiño-Gómez
- Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia
| | - Edgar G Ordóñez-Rubiano
- Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia; Research Institute, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia; Department of Biomedical Engineering, Universidad de los Andes, Bogotá, Colombia.
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81
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Haug U, Kollhorst B, Schink T, Thöne K, Dathe K, Schaefer C, Onken M. Investigating drug safety in pregnancy based on the German Pharmacoepidemiological Research Database (GePaRD): A proof-of-concept analysis on the association between valproate and spina bifida. Pharmacoepidemiol Drug Saf 2023; 32:148-157. [PMID: 36401747 DOI: 10.1002/pds.5573] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/29/2022] [Accepted: 10/28/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Large health-care databases are increasingly used for research on drug utilization and safety in pregnancy. For the German Pharmacoepidemiological Research Database (GePaRD), covering ~20% of the German population, algorithms have been developed to identify pregnancies, to estimate their date of onset and to link mothers to their babies. Using this methodology, we aimed to conduct a proof-of-concept analysis on the known association between valproate (VPA) exposure in early pregnancy and spina bifida in the exposed child. METHODS We identified all pregnancies in GePaRD between 2006 and 2016 in women aged 12 to 50 years. To each VPA dispensation of these women, an exposure period was assigned, based on the dispensation date and the number of defined daily doses in the dispensed package. A pregnancy was classified as exposed to VPA in the critical time window if this exposure period overlapped with the first 55 days of pregnancy. Risk ratios were calculated for spina bifida in live births and induced abortions comparing VPA-exposed ones to all pregnancies. RESULTS Overall, we identified 1 271 384 pregnancies fulfilling the inclusion criteria. Of these, 668 pregnancies (0.053%) were classified as exposed to VPA in the critical time window regarding spina bifida. An induced abortion accompanied by a diagnosis of spina bifida was observed in one of the VPA-exposed pregnancies (0.15%) and in 154 of all pregnancies (0.012%), yielding a risk ratio of 12.4 (95% confidence interval [CI]: 1.7-88.2). Out of 775 875 pregnancies ending in a live birth, 366 (0.047%) were classified as VPA exposed. A diagnosis of spina bifida was coded in 3 of 366 VPA-exposed live births (0.82%) and in 260 of all live births (0.03%), yielding a relative risk of 24.5 (95% CI: 7.9-76.0). CONCLUSIONS Our proof-of-concept analysis based on GePaRD showed a strong association between intrauterine exposure to VPA and occurrence of spina bifida. The results are plausible and consistent with the literature, supporting the suitability of GePaRD and the developed algorithms to conduct studies on drug safety in pregnancy.
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Affiliation(s)
- Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Bianca Kollhorst
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Tania Schink
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | - Katarina Dathe
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Christof Schaefer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Marlies Onken
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
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82
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Wang X, Yu J, Wang J. Neural Tube Defects and Folate Deficiency: Is DNA Repair Defective? Int J Mol Sci 2023; 24:ijms24032220. [PMID: 36768542 PMCID: PMC9916799 DOI: 10.3390/ijms24032220] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Neural tube defects (NTDs) are complex congenital malformations resulting from failure of neural tube closure during embryogenesis, which is affected by the interaction of genetic and environmental factors. It is well known that folate deficiency increases the incidence of NTDs; however, the underlying mechanism remains unclear. Folate deficiency not only causes DNA hypomethylation, but also blocks the synthesis of 2'-deoxythymidine-5'-monophosphate (dTMP) and increases uracil misincorporation, resulting in genomic instabilities such as base mismatch, DNA breakage, and even chromosome aberration. DNA repair pathways are essential for ensuring normal DNA synthesis, genomic stability and integrity during embryonic neural development. Genomic instability or lack of DNA repair has been implicated in risk of development of NTDs. Here, we reviewed the relationship between folate deficiency, DNA repair pathways and NTDs so as to reveal the role and significance of DNA repair system in the pathogenesis of NTDs and better understand the pathogenesis of NTDs.
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83
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Driscoll CFB, Holmbeck GN. Self-Management in Youth With Spina Bifida: Associations With Parent Factors in the Context of a Summer Camp Intervention. J Pediatr Psychol 2023; 48:51-66. [PMID: 35751436 DOI: 10.1093/jpepsy/jsac058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/16/2022] [Accepted: 06/10/2022] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To investigate cross-sectional and longitudinal associations between parent factors and self-management for youth with spina bifida (SB). METHODS Participants were 89 camper-parent dyads recruited for a summer camp program for youth with SB (Myouthage = 12.2 years); 48 of these families participated across 2 years. Campers and parents completed assessments at Time 1 (pre-camp) and Time 3 (post-camp) for one or two summers. Parents reported on demographics, their own adjustment, perceptions, attitudes, and behaviors, and youth condition-related responsibility and task mastery. Youth also reported on condition-related responsibility. Hierarchical multiple regression analyses and multilevel modeling were used to examine relationships between parent factors and youth self-management. RESULTS Parents' expectations for future goal attainment were positively associated with camper responsibility and task mastery, and these associations were moderated by camper age (only significant for older campers). When examining changes over one summer, parental expectations for the future were significantly associated with changes in campers' condition-related task mastery. When examining trajectories across summers, parental perception of child vulnerability was negatively associated with the slope of condition-related responsibility and parents' expectations for future goal attainment were positively associated with the slope of task mastery. CONCLUSIONS Parent perceptions and behaviors may be important targets for assessment and intervention when promoting condition-related independence for youth with SB.
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Affiliation(s)
- Colleen F Bechtel Driscoll
- Department of Child and Adolescent Psychiatry, NYU Langone Health, USA.,Department of Psychology, Loyola University Chicago, USA
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84
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First Trimester Ultrasound Detection of Fetal Central Nervous System Anomalies. Brain Sci 2023; 13:brainsci13010118. [PMID: 36672099 PMCID: PMC9857041 DOI: 10.3390/brainsci13010118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To evaluate the potential of the first-trimester ultrasound (US) features for the detection of central nervous system (CNS) anomalies. Methods/Methodology: This is a prospective one-center three-year study. Unselected singleton pregnant women were examined using an extended first-trimester anomaly scan (FTAS) that included the CNS assessment: the calvaria shape, the septum (falx cerebri), the aspect of the lateral ventricles, the presence of the third ventricle and aqueduct of Sylvius (AS) and the posterior brain morphometry: the fourth ventricle, namely intracranial translucency (IT), brain stem/brain stem-occipital bone ratio (BS/BSOB) and cisterna magna (CM). The spine and underlying skin were also evaluated. The cases were also followed during the second and third trimesters of pregnancy and at delivery. FTAS efficiency to detect major CNS abnormalities was calculated. RESULTS We detected 17 cases with CNS major abnormalities in a population of 1943 first-trimester (FT) fetuses, including spina bifida with myelomeningocele, exencephaly-anencephaly, holoprosencephaly, hydrocephaly, cephalocele and Dandy-Walker malformation. The CNS features in the abnormal group are presented. In the second trimester (ST), we further diagnosed cases of corpus callosum agenesis, cerebellar hypoplasia, vein of Galen aneurysm and fetal infection features (ventriculomegaly, intraventricular bands, intraventricular cyst and hyperechoic foci), all declared normal at the FTAS. During the third trimester (TT) scan we identified a massive fetal cerebral haemorrhage absent at previous investigations. We report a detection rate of 72.7% of fetal brain anomalies in the FT using the proposed CNS parameters. The sensitivity of the examination protocol was 72.7%, and the specificity was 100%. CONCLUSION A detailed FT CNS scan is feasible and efficient. The majority of cases of major CNS abnormalities can be detected early in pregnancy. The visualization rates of the CNS parameters in the FT are great with short, if any, additional investigation time. FT cerebral disorders such as haemorrhage or infections were missed in the FT even when an extended evaluation protocol was used.
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85
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Avesani G, Perazzolo A, Elia L, Anghelone AG, Gaudino S, Russo L, Genco E, Di Paola V, Massimi L, De Santis M, Tamburrini G, Manfredi R. Fetal MRI prior to intrauterine surgery of open neural tube defects: What does the radiologist need to know. LA RADIOLOGIA MEDICA 2023; 128:113-124. [PMID: 36525177 DOI: 10.1007/s11547-022-01579-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
The management of myelomeningocele study trial showed significant prognostic improvement in fetal repair before 26 weeks of gestation. Hence, surgery in utero represents the best treatment option for open-neural tube defects (NTDs). Fetal surgery of open-NTDs has specific inclusion and exclusion criteria, which can be adequately studied with fetal MRI. The main concern: the spine (spinal defects other than Myelomeningocele and Myeloschisis, the level of the lesion higher than T1 or lower than S1 and the degree of kyphosis ≥ 30°), the skull/brain (no cerebellum herniation and Chiari II malformation and the presence of any intracranial abnormality unrelated to open NTDs), the uterus (cervix length less than 2 cm, multiple gestations and placental and uterine abnormalities) and any other fetal abnormality not attributed to spinal defect. In this review, we describe the fundamental role of fetal MRI in supporting therapeutic decisions in pre-surgery intrauterine planning through the accurate and comprehensive description of findings, providing a proposal of a structured report. In addition, we describe how post-surgical MRI is important in investigating the effectiveness of surgery and detecting repairing complications.
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Affiliation(s)
- Giacomo Avesani
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | | | - Lorenzo Elia
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Simona Gaudino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Russo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Enza Genco
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Valerio Di Paola
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Luca Massimi
- Dipartimento di Scienze dell'invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy
| | - Marco De Santis
- Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy
| | - Gianpiero Tamburrini
- Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Scienze dell'invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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86
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Lidal IB, Lundberg Larsen K. Anxiety, depression, and fatigue in middle-aged and older persons with spina bifida: a cross-sectional study. Disabil Rehabil 2022; 44:7936-7946. [PMID: 34826231 DOI: 10.1080/09638288.2021.2003453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To study psychological distress and fatigue among persons with spina bifida (SB) 50 years or older and living in Norway. METHODS In 2017, cross-sectional data were collected (n = 30). The Hospital Anxiety and Depression Scale (HADS) and the Fatigue Severity Scale (FSS) were used. Descriptive statistics, non-parametric tests, and Spearman correlations were performed. Relevant information from previous studies on adults with chronic spinal cord injury (SCI) and the general population, were collected for comparison. RESULTS Participants were 18 women and 12 men, mean age 57.5 (SD 5.6), 26 with myelomeningocele, and six with hydrocephalus. Thirty percent scored above the HADS-A- and 20% above the HADS-D thresholds, thus in the same range as previous studies of SB, but higher compared to persons with SCI and norms. HADS-D correlated with pain and FSS scores. Forty percent reported fatigue symptoms (9/15 without hydrocephalus, 3/6 with hydrocephalus). CONCLUSIONS The study revealed a high prevalence of fatigue symptomatology among middle-aged and older adults with SB. Symptoms of anxiety and depression were more common than among persons with chronic SCI and norms. SB follow-ups should include awareness of psychological distress and fatigue, and investigate pain and medication side effects among possible influencing factors.IMPLICATIONS FOR REHABILITATIONClinicians treating adult persons with SB should be aware of possible psychological distress and fatigue symptomatology among these patients.We suggest an initial screening for psychological distress and fatigue in persons with SB during follow-up visits and rehabilitation.Interventions to reduce pain may influence levels of psychological distress and/or fatigue in patients with SB.Clinicians should enquire about the effects of medication on fatigue when assessing and prescribing new medications; a thorough medication review helps to assess the benefits and risks.
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Affiliation(s)
- Ingeborg Beate Lidal
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Kerstin Lundberg Larsen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Oslo, Norway
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87
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Sepulveda F, Montoya F, Vallejos J, Sepulveda W. Prenatal intracranial hypotension syndrome in congenital cephalocele: Insights into pathophysiologic mechanisms and importance of defect coverage. Prenat Diagn 2022; 42:1667-1673. [PMID: 36321562 DOI: 10.1002/pd.6258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/05/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare specific fetal cranial and cerebral findings indicative of prenatal intracranial hypotension (PICH) syndrome between open and closed cephaloceles. METHODS Two groups of fetuses with cephalocele who underwent magnetic resonance imaging scan were selected based on the defect coverage: covered ("closed cephalocele" group, n = 4) and uncovered by skin ("open cephalocele" group, n = 8). The presence of signs associated with PICH syndrome was evaluated and findings compared between groups. RESULTS Cases from the open cephalocele group showed statistically significant differences in comparison with the closed cephalocele group regarding reduction of the interpeduncular angle (p = 0.006), reduced amount of cerebrospinal fluid in the subarachnoid space (p = 0.01), collapsed/severely reduced fourth ventricle (p = 0.03), cephalocele content (p = 0.03), and identification of a vector traction (p = 0.03). There were no differences in the presence of cerebellar tonsillar descent, obstructive ventriculomegaly, and presence of the lemon sign. In comparison with gestational age-matched controls, only the biparietal diameter but not the head circumference was significantly smaller in both the open and closed cephalocele groups (p < 0.05). CONCLUSION Congenital cephaloceles present distinct imaging behavior depending on the defect coverage. Therefore, the classification of cephalocele should include, in addition to location and content, the presence or absence of skin fully covering the defect.
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Affiliation(s)
- Francisco Sepulveda
- Department of Neuroradiology, Institute of Neurosurgery "Dr. Alfonso Asenjo", National Health Service, Santiago, Chile.,Department of Radiology, Clinica Alemana, Santiago, Chile.,FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Francisca Montoya
- Department of Neuroradiology, Institute of Neurosurgery "Dr. Alfonso Asenjo", National Health Service, Santiago, Chile
| | - Joaquin Vallejos
- Department of Neuroradiology, Institute of Neurosurgery "Dr. Alfonso Asenjo", National Health Service, Santiago, Chile
| | - Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
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Fetoscopic Myelomeningocele Repair with Complete Release of the Tethered Spinal Cord Using a Three-Port Technique: Twelve-Month Follow-Up-A Case Report. Diagnostics (Basel) 2022; 12:diagnostics12122978. [PMID: 36552985 PMCID: PMC9776674 DOI: 10.3390/diagnostics12122978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
Open spina bifida is one of the most common congenital defects of the central nervous system. Open fetal surgery, which is one of the available therapeutic options, remains the gold standard for prenatal repairs. Fetoscopic closure may lower the number of maternal complications associated with open fetal surgery. Regardless of the approach, the outcome may be compromised by the development of tethered spinal cord (TSC) syndrome. At 24.2 weeks of gestation, a primipara was admitted due to fetal myelomeningocele and was deemed eligible for fetoscopic repair. Fetal surgery was performed at 25.0 weeks of gestation. It was the first complete untethering of the spinal cord and anatomic reconstruction (dura mater, spinal erectors, skin) achieved during a fetoscopic repair of spina bifida. Cesarean section due to placental abruption was performed at 31.1 weeks of gestation. VP shunting, with no need for revision, was performed at 5 weeks postdelivery due to progressing ventriculomegaly. No clinical or radiological signs of secondary tethering were observed. Neurological examination at 11 months postdelivery revealed cranial nerves without any signs of damage, axial hypotonia, decreased muscle tone in the lower extremities, and absent pathological reflexes. Motor development was slightly retarded. Complete untethering of the neural structures should always be performed, regardless of the surgical approach, as it is the only course of action that lowers the risk for developing secondary TSC.
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89
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Caiaffa CD, Fonteles CSR, Yunping L, Finnell RH. Gene-environment interactions underlying the etiology of neural tube defects. Curr Top Dev Biol 2022; 152:193-220. [PMID: 36707212 DOI: 10.1016/bs.ctdb.2022.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Neural tube defects (NTDs) consist of severe structural malformations of the brain and spinal cord and are the second most common structural birth defect in humans, accounting for approximately 2700 affected pregnancies every year in the United States. These numbers are highly significant, considering that birth defects remain a leading cause of infant mortality in the United States, affecting approximately 120,000 babies born annually. Survivors of these congenital malformations face long-term disability and lifelong challenges imposed by severe physical burdens compromising the afflicted individual's overall quality of life. Clearly, birth defects, and especially NTDs remain a global public health challenge, and the source of significant financial repercussions for healthcare systems worldwide. In order to better understand the role gene-environment interactions play in the etiology of NTDs, this chapter provides an overview of NTD phenotypes and their embryonic origins, discusses the genetic landscape of NTDs as it is currently understood, with a focus on experimental models that best illustrate how environmental factors modulate individual susceptibility to these birth defects. As folic acid interventions have proven to be effective in reducing the prevalence of NTDs, the chapter ends with a discussion on the impact that maternal dietary status has on NTD prevalence from a population perspective.
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Affiliation(s)
- Carlo Donato Caiaffa
- Center for Precision Environmental Health, Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, United States
| | - Cristiane Sá Roriz Fonteles
- Postgraduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceara, Fortaleza, Brazil
| | - Lei Yunping
- Center for Precision Environmental Health, Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, United States
| | - Richard H Finnell
- Center for Precision Environmental Health, Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, United States; Departments of Molecular and Cellular Biology, Molecular and Human Genetics, and Medicine, Baylor College of Medicine, Houston, TX, United States.
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Nontraumatic Spinal Cord Injury: Epidemiology, Etiology and Management. J Pers Med 2022; 12:jpm12111872. [PMID: 36579590 PMCID: PMC9694799 DOI: 10.3390/jpm12111872] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
The spinal cord is a conduit within the central nervous system (CNS) that provides ongoing communication between the brain and the rest of the body, conveying complex sensory and motor information necessary for safety, movement, reflexes, and optimization of autonomic function. After a traumatic spinal cord injury (SCI), supraspinal influences on the peripheral nervous system and autonomic nervous system (ANS) are disrupted, leading to spastic paralysis, sympathetic blunting, and parasympathetic dominance, resulting in cardiac dysrhythmias, systemic hypotension, bronchoconstriction, copious respiratory secretions, and uncontrolled bowel, bladder, and sexual dysfunction. This article outlines the pathophysiology of the less reported nontraumatic SCI (NTSCI), its classification, its influence on sensory/motor function, and introduces the probable comorbidities associated with SCI that will be discussed in more detail in the accompanying manuscripts of this special issue. Finally, management strategies for NTSCI will be provided.
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91
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Kim YS, Bedzhov I. Mechanisms of formation and functions of the early embryonic cavities. Semin Cell Dev Biol 2022; 131:110-116. [PMID: 35513973 DOI: 10.1016/j.semcdb.2022.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/11/2022] [Accepted: 04/27/2022] [Indexed: 12/14/2022]
Abstract
As the early mouse embryo develops, fundamental steps include the sequential formation of the first lumens in the murine conceptus. The first cavity established in the pre-implantation embryo is the blastocoel, followed by the emergence of the proamniotic cavity during the peri-implantation stages. The mouse embryo is a dynamic system which switches its modes of lumenogenesis before and after implantation. The blastocoel emerges in between the basolateral membranes, whereas the proamniotic cavity is formed on the apical interface. Defects in the sculpting of these luminal spaces are associated with developmental abnormalities and embryonic lethality. Here, we review the mechanisms by which these early embryonic cavities are formed and discuss the cavities in terms of their common and stage-specific principles of lumenogenesis and their functions.
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Affiliation(s)
- Yung Su Kim
- Embryonic Self-Organization Research Group, Max Planck Institute for Molecular Biomedicine, Röntgenstraße 20, 48149 Münster, Germany
| | - Ivan Bedzhov
- Embryonic Self-Organization Research Group, Max Planck Institute for Molecular Biomedicine, Röntgenstraße 20, 48149 Münster, Germany.
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92
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Wei X, Ma W, Gu H, Liu D, Luo W, Cao S, Jia S, Huang T, He Y, Bai Y, Wang W, Yuan Z. Intra-amniotic mesenchymal stem cell therapy improves the amniotic fluid microenvironment in rat spina bifida aperta fetuses. Cell Prolif 2022; 56:e13354. [PMID: 36266504 PMCID: PMC9890536 DOI: 10.1111/cpr.13354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/22/2022] [Accepted: 10/10/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Spina bifida aperta (SBA) is one of the most common neural tube defects. Neural injury in SBA occurs in two stages involving failed neural tube closure and progressive degeneration through contact with the amniotic fluid. We previously suggested that intra-amniotic bone marrow-derived mesenchymal stem cell (BMSC) therapy for fetal rat SBA could achieve beneficial functional recovery through lesion-specific differentiation. The aim of this study is to examine whether the amniotic fluid microenvironment can be improved by intra-amniotic BMSC transplantation. METHODS The intra-amniotic BMSC injection was performed using in vivo rat fetal SBA models. The various cytokine expressions in rat amniotic fluid were screened by protein microassays. Intervention experiments were used to study the function of differentially expressed cytokines. RESULTS A total of 32 cytokines showed significant upregulated expression in the BMSC-injected amniotic fluid. We focused on Activin A, NGF, BDNF, CNTF, and CXCR4. Intervention experiments showed that the upregulated Activin A, NGF, BDNF, and CNTF could inhibit apoptosis and promote synaptic development in fetal spinal cords. Inhibiting the activity of these factors weakened the anti-apoptotic and pro-differentiation effects of transplanted BMSCs. Inhibition of CXCR4 activity reduced the engraftment rate of BMSCs in SBA fetuses. CONCLUSION BMSC transplantation can improve the amniotic fluid environment, and this is beneficial for SBA repair.
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Affiliation(s)
- Xiaowei Wei
- Key Laboratory of Health Ministry for Congenital Malformation, Department of Pediatric Surgery, Shengjing HospitalChina Medical UniversityShenyangPeople's Republic of China
| | - Wei Ma
- Key Laboratory of Health Ministry for Congenital Malformation, Department of Pediatric Surgery, Shengjing HospitalChina Medical UniversityShenyangPeople's Republic of China
| | - Hui Gu
- Key Laboratory of Health Ministry for Congenital Malformation, Department of Pediatric Surgery, Shengjing HospitalChina Medical UniversityShenyangPeople's Republic of China
| | - Dan Liu
- Key Laboratory of Health Ministry for Congenital Malformation, Department of Pediatric Surgery, Shengjing HospitalChina Medical UniversityShenyangPeople's Republic of China
| | - Wenting Luo
- Key Laboratory of Health Ministry for Congenital Malformation, Department of Pediatric Surgery, Shengjing HospitalChina Medical UniversityShenyangPeople's Republic of China
| | - Songying Cao
- Key Laboratory of Health Ministry for Congenital Malformation, Department of Pediatric Surgery, Shengjing HospitalChina Medical UniversityShenyangPeople's Republic of China
| | - Shanshan Jia
- Key Laboratory of Health Ministry for Congenital Malformation, Department of Pediatric Surgery, Shengjing HospitalChina Medical UniversityShenyangPeople's Republic of China
| | - Tianchu Huang
- Key Laboratory of Health Ministry for Congenital Malformation, Department of Pediatric Surgery, Shengjing HospitalChina Medical UniversityShenyangPeople's Republic of China
| | - Yiwen He
- Key Laboratory of Health Ministry for Congenital Malformation, Department of Pediatric Surgery, Shengjing HospitalChina Medical UniversityShenyangPeople's Republic of China
| | - Yuzuo Bai
- Department of Pediatric Surgery, Shengjing HospitalChina Medical UniversityShenyangPeople's Republic of China
| | - Weilin Wang
- Department of Pediatric Surgery, Shengjing HospitalChina Medical UniversityShenyangPeople's Republic of China
| | - Zhengwei Yuan
- Key Laboratory of Health Ministry for Congenital Malformation, Department of Pediatric Surgery, Shengjing HospitalChina Medical UniversityShenyangPeople's Republic of China
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93
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Gualberto IJN, Medeiros GA, Santos MV, da Silva Lopes L, Machado HR, Sbragia L. Is there a role in the central nervous system development for using corticosteroids to treat meningomyelocele and hydrocephalus? Childs Nerv Syst 2022; 38:1849-1854. [PMID: 35907004 DOI: 10.1007/s00381-022-05615-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/23/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Myelomeningocele (MMC) is the most frequent neural tube defect and is frequently associated (around 80% of cases) with hydrocephalus (HC). Both diseases can have severe clinical consequences, insomuch as they require surgical treatment whose complications are not negligible, either when performed in utero or after birth. Therefore, clinical therapies that could have an impact on the incidence and progression of MMC and HC would be certainly valuable; however, this is not the current picture, and there are no effective pharmacological treatments for such patients to this day. AIM AND METHODS Therefore, knowing that an inflammatory process comes associated with these disorders, mostly due to nervous tissue distension, the present article aimed at reviewing the role of corticosteroids in reducing inflammation and thus improving the outcome of patients with HC and MMC, considering the well-established anti-inflammatory effects of CS. RESULTS The systematic review performed herein has found varying results regarding the role of steroids (even though a positive trend was observed) on the treatment and prevention of hydrocephalus, whereas for MMC. CONCLUSION There are many reports demonstrating beneficial effects of CS therapy, from a clinical and histopathological point of view.
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Affiliation(s)
- I José Nogueira Gualberto
- Bauru Medical School, Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - G Araújo Medeiros
- Bauru Medical School, Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - M Volpon Santos
- Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - L da Silva Lopes
- Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - H Rubens Machado
- Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - L Sbragia
- Division of Pediatric Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, 10th floor, Ribeirão Preto, São Paulo, Brazil.
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94
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Pelvic Organ Prolapse in Patients with Congenital Genitourinary Conditions. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00669-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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95
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Michalak-Micka K, Rütsche D, Mazzone L, Büchler VL, Moehrlen U, Klar AS, Biedermann T. Human fetal skin derived merkel cells display distinctive characteristics in vitro and in bio-engineered skin substitutes in vivo. Front Bioeng Biotechnol 2022; 10:983870. [PMID: 36185452 PMCID: PMC9520781 DOI: 10.3389/fbioe.2022.983870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Human skin contains specialized neuroendocrine Merkel cells responsible for fine touch sensation. In the present study, we performed in-depth analysis of Merkel cells in human fetal back skin. We revealed that these Merkel cells expressed cytokeratin 20 (CK20), were positive for the neuroendocrine markers synaptophysin and chromogranin A, and the mechanosensitive ion channel Piezo2. Further, we demonstrated that Merkel cells were present in freshly isolated human fetal epidermal cells in vitro, and in tissue-engineered human dermo-epidermal skin substitutes 4 weeks after transplantation on immune-compromised rats. Merkel cells retained the expression of CK20, synaptophysin, chromogranin A, and Piezo2 after isolation and in culture, and in the skin substitutes after transplantation. Interestingly, we observed that in fetal skin and in skin substitutes, only Merkel cells were positive for CK8, while in culture, also non-Merkel cells showed positivity for CK8. In summary, human fetal Merkel cells showed phenotypical features confirming their cell identity. This findings are of pivotal importance for the future application of fetal tissue-engineered skin in clinics.
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Affiliation(s)
- Katarzyna Michalak-Micka
- Tissue Biology Research Unit, Department of Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center (CRC), University Children’s Hospital Zurich, Zurich, Switzerland
| | - Dominic Rütsche
- Tissue Biology Research Unit, Department of Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center (CRC), University Children’s Hospital Zurich, Zurich, Switzerland
| | - Luca Mazzone
- Children’s Research Center (CRC), University Children’s Hospital Zurich, Zurich, Switzerland
- Spina Bifida Center, University Children’s Hospital Zurich, Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - Vanessa L. Büchler
- Tissue Biology Research Unit, Department of Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center (CRC), University Children’s Hospital Zurich, Zurich, Switzerland
| | - Ueli Moehrlen
- Children’s Research Center (CRC), University Children’s Hospital Zurich, Zurich, Switzerland
- Spina Bifida Center, University Children’s Hospital Zurich, Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Agnes S. Klar
- Tissue Biology Research Unit, Department of Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center (CRC), University Children’s Hospital Zurich, Zurich, Switzerland
| | - Thomas Biedermann
- Tissue Biology Research Unit, Department of Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center (CRC), University Children’s Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- *Correspondence: Thomas Biedermann,
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Safari H, Jahangiri Babadi A, Alizadeh P, Ajudani R, Hamidi S. Huge unrepaired myelocystocele, progressive sac enlargement in later stages of life: a case report. Br J Neurosurg 2022:1-4. [PMID: 36074342 DOI: 10.1080/02688697.2022.2118235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 03/22/2022] [Accepted: 08/23/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Spinal dysraphism is characterized by failure of fusion at dorsal midline structures through the embryonic developmental stages. A terminal myelocystocele consists of a skin-covered lumbosacral spina bifida and meningocele that directly continuous with the spinal subarachnoid space. OBSERVATION A 43-year-old woman who was diagnosed at birth with myelocystocele in the lower segments of the lumbar spine. She was not operated in the early stages of life. At the 43th years of her old, during 9-months, the sac began to progressively increase in size. In our initial examination before surgery, an extremely large skin-covered myelocystocele sac was observed in the thoracolumbar with a diameter of approximately 60 * 70 * 40 cm. patient operated and sac repaired. More than 20 liter of cerebrospinal fluid drainaged from cyst during surgery. LESSONS The mechanism of cyst enlargement is not well understood. Progressive and severe increase in size of unrepaired myelocystocele sac is possible in old ages even without cerebral hydrocephalus.
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Affiliation(s)
- Hosein Safari
- Department of Neurosurgery, Ahvaz Anesthesiology and Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Armin Jahangiri Babadi
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Pooyan Alizadeh
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Ajudani
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Soroor Hamidi
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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97
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Avoiding the antenatal counselling faux pas: bridging the gap between prenatal prognostication and postnatal outcome of closed spina bifida. Childs Nerv Syst 2022; 38:1751-1762. [PMID: 35665838 DOI: 10.1007/s00381-022-05562-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/24/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Closed spina bifida (CSB) is rare in prenatal literature, and various lesions are grouped under this broad nosological entity CSB, leading to confusing and misleading prognostic conclusions. METHODS This is a retrospective observational cohort study of prenatally detected CSB cases using two-dimensional ultrasound, complemented by three-dimensional ultrasonography and foetal MRI in indicated cases, from October 2014 to October 2021 in a tertiary-level single centre. RESULTS The most common upper vertebral level of CSB was lumbar in 66.6% (10/15). The sub-classification of lesions based on prenatal ultrasound showed an agreement in 53% of the cases. Sixty percent had associated abnormalities identified postnatally, the most common being anorectal malformation seen in 33.3%. On postnatal follow-up, 46.6% had bowel incontinence and bladder dysfunction, and 33.3% developed lower limb deformities. CONCLUSIONS All CSBs do not have a uniformly favourable prognosis. The prognosis of CSB depends on the pathological type, the presence of associated abnormalities and the management.
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98
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Gour-Provençal G, Costa C. Metabolic Syndrome in Children With Myelomeningocele and the Role of Physical Activity: A Narrative Review of the Literature. Top Spinal Cord Inj Rehabil 2022; 28:15-40. [PMID: 36017122 DOI: 10.46292/sci21-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives The purpose of this review is to describe the current scientific literature on the prevalence of metabolic syndrome in children with myelomeningocele and to gain insight into the baseline levels of aerobic fitness, endurance, and strength in this population in order to identify gaps in knowledge, suggest potential primary prevention strategies, and provide recommendations for future studies. Methods A literature review of articles published in English and French between 1990 and April 2020 was conducted. Results Obese adolescents with myelomeningocele have an increased prevalence of components of the metabolic syndrome. Children and adolescents with myelomeningocele have decreased aerobic fitness and muscular strength, decreased lean mass, and increased fat mass, all of which, when combined with higher levels of physical inactivity, put them at higher risk of developing metabolic syndrome and cardiovascular diseases. Conclusion Until more research is conducted, addressing weight-related challenges and promoting healthy habits (such as optimal activity levels) could be easily integrated into yearly myelomeningocele clinics. An actionable suggestion might be to systematically weigh and measure children in these clinics and utilize the results and trends as a talking point with the parents and children. The follow-up appointments could also be used to develop physical activity goals and monitor progress. We recommend that the health care practitioner tasked with this intervention (physician, nurse, etc.) should be aware of locally available accessible sports platforms and have knowledge of motivational interviewing to facilitate removal of perceived barriers to physical activity.
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Affiliation(s)
| | - Camille Costa
- Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada
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99
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Gerami R, Agahi T, Barkhordari S, Kargar J. Evaluation of sensitivity and accuracy of maternal serum alpha fetoprotein to the diagnosis of open spina bifida in comparison with sonographic findings of open spina bifida and Chiari II malformation in pregnant women. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00855-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
NTD is one of the most important problems of the nervous system and the second fetal anomaly that is associated with high mortality and morbidity. Therefore, its prenatal diagnosis is very important. AFP has a high false positive, which reduces its diagnostic value, so the discovery of ultrasound findings in OSB is very important and can replace AFP testing.
Results
4 patients with positive OSB were detected and their diagnosis was confirmed during pathological follow-up (100% diagnostic accuracy) and the rest of the patients with high AFP (51 patients) were negative for OSB. Therefore, the diagnostic accuracy of AFP during statistical analysis was about 7%, which is a very low value.
Conclusion
According to the results of this study, IT, BS, BSOB, BS/BSOB ultrasound criteria in the first screening and decreased BPD and ventriculomegaly in the second screening ultrasound in OSB diagnosis have a higher diagnostic value than the AFP laboratory level. It should pay more attention to MS-AFP results in OSB screening.
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100
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Affiliation(s)
- Bermans J Iskandar
- From the Department of Neurological Surgery, University of Wisconsin-Madison, Madison (B.J.I.); and the Departments of Molecular and Human Genetics, Molecular and Cellular Biology, and Medicine, Baylor College of Medicine, Houston (R.H.F.)
| | - Richard H Finnell
- From the Department of Neurological Surgery, University of Wisconsin-Madison, Madison (B.J.I.); and the Departments of Molecular and Human Genetics, Molecular and Cellular Biology, and Medicine, Baylor College of Medicine, Houston (R.H.F.)
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