Laterality patterns in infants with external birth defects

Mandibular Radiomorphometric Characteristics of Individuals with Bilateral or Unilateral Cleft Lip and Palate

OBJECTIVE

This study aimed to investigate and compare the mandibular radiomorphometric characteristics of patients with unilateral or bilateral cleft lip and palate (CLP) with those of individuals without CLP and to determine whether there was a difference.

DESIGN

Retrospective cohort study.

SETTING

Orthodontic Department in Faculty of Dentistry.

PATIENTS AND INTERVENTIONS

Mandibular cortical bone thickness was measured on high-quality panoramic radiographs taken from 46 patients with unilateral or bilateral CLP aged 13-15 years and 21 control patients.

MAIN OUTCOME MEASURES

Three radiomorphometric indices [antegonial index (AI), mental index (MI), and panoramic mandibular index (PMI)] were measured bilaterally. AutoCAD software was used for MI, PMI, and AI measurements.

RESULTS

Left MI values were significantly lower in individuals with unilateral cleft lip and palate (UCLP; 0.029 ± 0.04) than in individuals with bilateral cleft lip and palate (BCLP; 0.033 ± 0.07). In addition, right MI values of individuals with right UCLP (0.26 ± 0.06) were significantly lower than those of individuals with left UCLP (0.34 ± 0.06) or BCLP (0.32 ± 0.08). No difference was observed between individuals with BCLP and left UCLP. These values did not differ between groups.

CONCLUSIONS

Antegonial index and PMI values did not differ between individuals with different types of CLP or when compared with control patients. In patients with UCLP, cortical bone thickness was found to be reduced on the cleft side compared to the intact side. Patients with UCLP with a right-sided cleft had a more substantial decrease in cortical bone thickness.

The Implications of Laterality in Unilateral Cleft Lip Reconstruction: A Global Survey of Cleft Surgeons

OBJECTIVE

To explore the impact of directional laterality in complete Unilateral Cleft Lip (UCL) amongst the global cleft surgeon community.

DESIGN

Cross-sectional survey study.

SETTING

Global distribution of online survey distributed in English and Spanish.

PARTICIPANTS

Cleft surgeons from around the world.

MAIN OUTCOME MEASURES

Survey participant perception of the impact of laterality on: (1) cleft presentation (2) surgical challenge and (3) surgical outcomes.

RESULTS

Responses were received from 453 cleft surgeons located in 54 countries around the world. 221 (49%) had previously considered differences in patients presenting with a left- versus right-sided UCL. 95 (21%) considered right-sided clefts more difficult to reconstruct, 37 (8%) reported left-sided clefts to be more difficult and 321 (71%) reported no difference in difficulty between the cleft sides. Higher volume cleft surgeons, characterised by those reporting cleft as their principal area of practice and performing >20 cleft operations per year, were more likely to have both previously considered differences in laterality in cleft and to report right-sided unilateral cleft lip to be more difficult to primarily reconstruct. 395 (87%) did not consider surgical outcomes to be influenced by cleft laterality.

CONCLUSIONS

This survey reports perceptions on cleft laterality from a large body of global surgeons and suggests a trend for increased difficulty in right-sided compared to left-sided cleft lip reconstruction, where such laterality-associated difficulty is perceived.

Cleft lip Sidedness and the Association with Additional Congenital Malformations

OBJECTIVE

To investigate the association between the sidedness of orofacial clefts and additional congenital malformations.

DESIGN

Linkage of a national registry of cleft births to national administrative data of hospital admissions.

SETTING

National Health Service, England.

PARTICIPANTS

2007 children born with cleft lip ± alveolus (CL ± A) and 2724 with cleft lip and palate (CLP) born between 2000 and 2012.

MAIN OUTCOME MEASURE

The proportion of children with ICD-10 codes for additional congenital malformations by the sidedness (left, right or bilateral) of orofacial clefts.

RESULTS

For CL ± A phenotypes, there was no evidence for a difference in the prevalence of additional anomalies between left (22%, reference), right (22%, aOR 1.02, 95% CI 0.80 to 1.28; P = .90) and bilateral clefts (23%, aOR 1.09, 95% CI 0.75 to 1.57; P = .66). For CLP phenotypes, there was evidence of a lower prevalence of additional malformations in left (23%, reference) compared to right (32%, aOR 1.54, 95% CI 1.25 to 1.91; P < .001) and bilateral clefts (33%, aOR 1.64, 95% CI 1.35 to 1.99; P < .001).

CONCLUSIONS

The prevalence of additional congenital malformations was similar across sidedness subtypes with CL ± A phenotypes but was different for sidedness subtypes within CLP cases. These data support the hypothesis that CL ± A has a different underlying aetiology from CLP and that within the CLP phenotype, right sided CLP may lie closer in aetiology to bilateral CLP than it does to left sided CLP.

Cleft Laterality Dental Arch Relationship Outcomes for Children with Unilateral Cleft Lip and Palate in New Zealand

OBJECTIVES

To investigate cleft laterality dental arch relationship outcomes of children with non-syndromic complete unilateral cleft lip and palate (UCLP) in New Zealand.

DESIGN

A retrospective nationwide study.

SETTINGS

Virtual 3D orthodontic study models collected prior to undertaking secondary alveolar bone grafting.

PARTICIPANTS

A total of 104 patients with UCLP (L = 80: R = 24).

OUTCOME MEASURES

Four calibrated assessors used the GOSLON Yardstick and 100 mm Visual Analogue Scale (VAS) to score the randomised models on 2 separate assessment sessions. Weighted Kappa were used to determine the intra/inter-rater reliability for the GOSLON and correlations for the VAS.

RESULTS

Intra-rater reliability ranged from 0.57-0.88 (GOSLON) and 0.45-0.93 (VAS). Inter-rater reliability ranged from 0.62-0.86 (GOSLON) and 0.64-0.93 (VAS).GOSLON scores for the left UCLP were 31.2% for good/very good; 26.3% for fair; 42.5% for poor/very poor while the right UCLP scored 8.3% for good/very good; 37.5% for fair; 54.2% for poor/very poor. The mean VAS for left and right UCLP were 53.4 (sd 22.5) and 44.6 (sd 17.1) respectively. Neither the GOSLON nor VAS differences reached statistical significance (both P = .08).

CONCLUSIONS

From a clinical perspective right UCLP had worse dental arch relationship outcomes, however, these differences failed to reach statistical significance. Further studies using larger sample sizes are required to determine if cleft laterality is an important consideration when investigating UCLP dental arch outcomes.

Ultrasonographic screening for developmental dysplasia of the hip: the Graf method revisited

Until the 1980s, the diagnosis of developmental dysplasia of the hip (DDH) was based on clinical examination and radiographic imaging. In 1980, Reinhard Graf developed his own ultrasonographic method for the examination of the infant hip joint. Graf's method evaluates the osseous and cartilaginous coverage of the femoral head by the acetabulum in the infantile hip joint by measuring the angles α and β. The validity of Graf method is that with these measurements the hip joint is further classified by Graf classification into types I to IV that guide treatment. Currently, Graf method is considered the gold standard examination for the diagnosis of DDH in many European countries. This review article aims to discuss the incidence, risk factors and pathophysiology of DDH, and to emphasize on the Graf method for the evaluation, classification, prevention and further management of this entity.

Phenotypically Discordant Anomalies in Conjoined Twins: Quirks of Nature Governed by Molecular Pathways?

A multitude of additional anomalies can be observed in virtually all types of symmetrical conjoined twins. These concomitant defects can be divided into different dysmorphological patterns. Some of these patterns reveal their etiological origin through their topographical location. The so-called shared anomalies are traceable to embryological adjustments and directly linked to the conjoined-twinning mechanism itself, inherently located within the boundaries of the coalescence area. In contrast, discordant patterns are anomalies present in only one of the twin members, intrinsically distant from the area of union. These dysmorphological entities are much more difficult to place in a developmental perspective, as it is presumed that conjoined twins share identical intra-uterine environments and intra-embryonic molecular and genetic footprints. However, their existence testifies that certain developmental fields and their respective developmental pathways take different routes in members of conjoined twins. This observation remains a poorly understood phenomenon. This article describes 69 cases of external discordant patterns within different types of otherwise symmetrical mono-umbilical conjoined twins and places them in a developmental perspective and a molecular framework. Gaining insights into the phenotypes and underlying (biochemical) mechanisms could potentially pave the way and generate novel etiological visions in the formation of conjoined twins itself.

Congenital ear malformation (CEM)

BACKGROUND

At present, there are not international unified standards and reports on Congenital Ear Malformation (CEM) in the world, which makes it difficult to transfer information and compare the literature.

AIMS/OBJECTIVES

Through the statistical analysis of a large sample of CEM, a unified standard of all aspects of CEM is proposed and the data are provided for reference, which is convenient for the international work and literature comparison in this field.

MATERIALS AND METHODS

Based on the author's 30 years of clinical and scientific research work on CEM and the relevant cases of 3231 (4714 ears) in our hospital, and combined with literature, statistical analysis was made.

RESULTS

This paper summarizes the classification, definition, epidemiology, embryonic development, pathogenic factors of CEM and elaborates on the clinical manifestations, examination and sequence therapy of representative Congenital Malformation of the Middle and Outer Ear (CMMOE). We also introduce malformation of the auricle and inner ear, so as to cover the outer, middle and inner ear. At the same time, we introduce our achievements and contributions in this field.

CONCLUSIONS AND SIGNIFICANCE

This study provides reference to the international unified standard and treatment principle of the CEM.

Bilateral Congenital Preauricular Fistula of the Cavum Conchae

A 16-year-old female who had left auricular sinus infections was admitted to our hospital. On physical examination, bilateral sinus tract openings were noted at the cavum conchae. We used a surgical microscope to complete the total resection of the bilateral sinus at the cavum conchae. Also dissected was the cartilage from the cavum conchae. To our knowledge, surgical excision of cavum conchae sinuses has not been previously described.

Comparison of Presurgical Anthropometric Measures of Right and Left Complete Unilateral Cleft Lip and/or Palate

BACKGROUND

Left clefts occur twice as frequently as right ones. The sidedness has been suggested to influence certain outcomes. Some surgeons consider a right cleft more challenging to repair. This is often attributed to their reduced prevalence. The authors question whether this may be caused by morphologic differences. The authors' hypothesis is that there are anthropometric differences between left and right complete cleft lips.

METHODS

Patients with complete unilateral cleft lip, with or without cleft palate, operated on at the age of 3 to 6 months, between 2000 and 2018, by a single surgeon, were included. Eight standardized anthropometric measurements of the cleft lip, collected just before cleft lip repair, compare lip and vermillion dimensions and ratios between left and right clefts.

RESULTS

One hundred thirty-nine left and 80 right unilateral cleft lips were compared. A significant difference was found between left and right clefts for cleft-side to non-cleft-side ratios comparing the lateral lip element vertical heights and vermillion heights.

CONCLUSIONS

Patients with right cleft lips have a greater degree of lateral lip element hypoplasia, demonstrating greater deficiencies of lateral lip element vertical height and vermillion height when compared to patients with left clefts. This has clinical implications for preoperative assessment, choice of surgical technique, and postoperative and long-term outcomes.

Exploration of possible cell chirality using material techniques of surface patterning

Consistent left-right (LR) asymmetry or chirality is critical for embryonic development and function maintenance. While chirality on either molecular or organism level has been well established, that on the cellular level has remained an open question for a long time. Although it remains unclear whether chirality exists universally on the cellular level, valuable efforts have recently been made to explore this fundamental topic pertinent to both cell biology and biomaterial science. The development of material fabrication techniques, surface patterning, in particular, has afforded a unique platform to study cell-material interactions. By using patterning techniques, chirality on the cellular level has been examined for cell clusters and single cells in vitro in well-designed experiments. In this review, we first introduce typical fabrication techniques of surface patterning suitable for cell studies and then summarize the main aspects of preliminary evidence of cell chirality on patterned surfaces to date. We finally indicate the limitations of the studies conducted thus far and describe the perspectives of future research in this challenging field. STATEMENT OF SIGNIFICANCE: While both biomacromolecules and organisms can exhibit chirality, it is not yet conclusive whether a cell has left-right (LR) asymmetry. It is important yet challenging to study and reveal the possible existence of cell chirality. By using the technique of surface patterning, the recent decade has witnessed progress in the exploration of possible cell chirality within cell clusters and single cells. Herein, some important preliminary evidence of cell chirality is collected and analyzed. The open questions and perspectives are also described to promote further investigations of cell chirality in biomaterials.

Impact of Maternal Smoking on Nonsyndromic Clefts: Sex-Specific Associations With Side and Laterality

OBJECTIVE

To compare the incidence of right-sided versus left-sided, and unilateral versus bilateral, nonsyndromic clefting in the affected offspring of smoking and nonsmoking mothers.

DESIGN

Self-report data on periconceptual and first trimester smoking behavior were collected from 842 mothers of children with nonsyndromic orofacial clefting. Differences in the incidence of left- versus right-sided clefts, and of unilateral versus bilateral clefts, were analyzed between the children of smoking and nonsmoking mothers.

SETTING

Interviews and clinical examinations took place at 8 specialist centers in Germany.

PATIENTS AND PARTICIPANTS

Children with nonsyndromic clefts were recruited during the course of surgical or orthodontic treatment, or within the context of the annual control consultation. Patients with cleft palate only or missing data were excluded. The final cohort comprised 842 patients (540 males and 302 females) with unilateral or bilateral clefts. The respective mothers were interviewed.

MAIN OUTCOME MEASURE

Side and laterality of nonsyndromic clefts were the main outcome measures.

RESULTS

Children of smoking mothers more often had right-sided clefts than children of nonsmoking mothers (42% right-sided clefts in children of smoking mothers vs 31% of nonsmoking mothers). Children of smoking mothers more often had bilateral clefts than children of nonsmoking mothers (35% bilateral clefts in children of smoking mothers vs 29% of nonsmoking mothers). Sex-specific analyses confirmed substantially and statistically significant associations only for girls.

CONCLUSIONS

The results suggest that maternal smoking is a sex-specific, exogenous determinant of laterality and side in nonsyndromic clefts.

Surgical results of infected preauricular sinus: No need for delay

OBJECTIVES

This study was performed to propose the proper surgical timing of infected preauricular sinus (PAS) by comparing surgical results of active infection PAS group (AIPASG) to infection-controlled/or non-infected PAS group (IC/NIPASG).

METHODS

Two hundred and twelve patients with PAS who underwent surgical excision using minimal supra-auricular approach by one surgeon (S.N.P) in a tertiary referral center between Apr 1999 and Dec 2016 were enrolled in this study. Medical records of 36 patients of AIPASG at surgical time point and 176 patients of IC/NIPASG were collected and their surgical results were compared. Postoperative wound infection, recurrence, need of drain insertion or external compression dressing and other clinical parameters including age, sex, follow up duration and previous incision & drainage (I&D) history were investigated and statistically compared between two groups.

RESULTS

There were no significant differences of various clinical parameters between two groups, except previous I&D history (24 among 36 patients of AIPASG and 12 among 176 patients of NI/ICPASG, P < 0.05). Post-operative immediate but mild wound erythema was observed in 11 among 212 patients with no statistical difference between two groups (4 among 48 ears of AIPASG and 7 among 219 NI/ICPASG, P = 0.105) and was controlled by short-term antibiotics and conservative management. Only 1 patient of NI/ICPASG needed a revision surgery of wound exploration and curettage. No more recurrence of infection during their long-term follow-up period was observed in both groups.

CONCLUSION

There was no significant difference in the surgical results of minimal supra-auricular approach of PAS excision between AIPASG and NI/ICPASG. Therefore, we suggest that this surgical technique can be performed even in the infected PAS which does not quickly respond to the conservative treatment.

Profiling and bioinformatic analysis reveal differential microRNA expression in the left and right kidneys in normal mice

Physiological and pathophysiological differences exist between the left and right kidneys; however, the molecular bases for these differences remain unknown. Since miRNAs are involved in kidney function and the development of kidney diseases, we examined their differential expression through miRNA profiling of the left and right kidneys of normal mice. We find that 36 miRNAs exhibit higher expression, whereas 22 miRNAs show lower expression in the left than the right kidneys in mice under physiological condition. Ten miRNAs were further examined by quantitative PCR assays, and four of them with high expression level were confirmed by Northern blot. Through bioinformatic analysis, we dissected the function and network of the differentially expressed miRNAs, providing insights into the physiological and pathophysiological differences between the left and the right kidneys.

Asymmetric development of the male mouse mammary gland and its response to a prenatal or postnatal estrogen challenge

The CD-1 mouse mammary gland is sexually dimorphic, with males lacking nipples. Recent studies have revealed that the underlying epithelium in the male mammary gland is sensitive to estrogenic environmental chemicals. In ongoing investigations, we observed asymmetric morphology in the left and right male mouse mammary glands. Here, we quantified these asymmetries in the embryonic, prepubertal, pubertal and adult male mammary gland. We found that the right gland was typically larger with more branching points compared to the left gland. We next evaluated the response of the left and right glands to 17α-ethinyl estradiol (EE2) after perinatal or peripubertal exposures. We found that the right gland was more responsive to EE2 than the left at both periods of exposure. These results reveal novel aspects of male mammary gland biology and suggest that future studies should control for laterality in the evaluation of hazards associated with exposures to estrogenic chemicals.

Soft tissue nasal asymmetry as an indicator of orofacial cleft predisposition

The biological relatives of offspring with nonsyndromic orofacial clefts have been shown to exhibit distinctive facial features, including excess asymmetry, which are hypothesized to indicate the presence of genetic risk factors. The significance of excess soft tissue nasal asymmetry in at-risk relatives is unclear and was examined in the present study. Our sample included 164 unaffected parents from families with a history of orofacial clefting and 243 adult controls. Geometric morphometric methods were used to analyze the coordinates of 15 nasal landmarks collected from three-dimensional facial surface images. Following generalized Procrustes analysis, Procrustes ANOVA and MANOVA tests were applied to determine the type and magnitude of nasal asymmetry present in each group. Group differences in mean nasal asymmetry were also assessed via permutation testing. We found that nasal asymmetry in both parents and controls was directional in nature, although the magnitude of the asymmetry was greater in parents. This was confirmed with permutation testing, where the mean nasal asymmetry was significantly different (p < .0001) between parents and controls. The asymmetry was greatest for midline structures and the nostrils. When subsets of parents were subsequently analyzed and compared (parents with bilateral vs. unilateral offspring; parents with left vs. right unilateral offspring), each group showed a similar pattern of asymmetry and could not be distinguished statistically. Thus, the side of the unilateral cleft (right vs. left) in offspring was not associated with the direction of the nasal asymmetry in parents.

From cytoskeletal dynamics to organ asymmetry: a nonlinear, regulative pathway underlies left-right patterning

Consistent left-right (LR) asymmetry is a fundamental aspect of the bodyplan across phyla, and errors of laterality form an important class of human birth defects. Its molecular underpinning was first discovered as a sequential pathway of left- and right-sided gene expression that controlled positioning of the heart and visceral organs. Recent data have revised this picture in two important ways. First, the physical origin of chirality has been identified; cytoskeletal dynamics underlie the asymmetry of single-cell behaviour and patterning of the LR axis. Second, the pathway is not linear: early disruptions that alter the normal sidedness of upstream asymmetric genes do not necessarily induce defects in the laterality of the downstream genes or in organ situs Thus, the LR pathway is a unique example of two fascinating aspects of biology: the interplay of physics and genetics in establishing large-scale anatomy, and regulative (shape-homeostatic) pathways that correct molecular and anatomical errors over time. Here, we review aspects of asymmetry from its intracellular, cytoplasmic origins to the recently uncovered ability of the LR control circuitry to achieve correct gene expression and morphology despite reversals of key 'determinant' genes. We provide novel functional data, in Xenopus laevis, on conserved elements of the cytoskeleton that drive asymmetry, and comparatively analyse it together with previously published results in the field. Our new observations and meta-analysis demonstrate that despite aberrant expression of upstream regulatory genes, embryos can progressively normalize transcriptional cascades and anatomical outcomes. LR patterning can thus serve as a paradigm of how subcellular physics and gene expression cooperate to achieve developmental robustness of a body axis.This article is part of the themed issue 'Provocative questions in left-right asymmetry'.

Lateral thinking - Interocular symmetry and asymmetry in neurovascular patterning, in health and disease

No biological system or structure is likely to be perfectly symmetrical, or have identical right and left forms. This review explores the evidence for eye and visual pathway asymmetry, in health and in disease, and attempts to provide guidance for those studying the structure and function of the visual system, where recognition of symmetry or asymmetry may be essential. The principal question with regards to asymmetry is not 'are the eyes the same?', for some degree of asymmetry is pervasive, but 'when are they importantly different?'. Knowing if right and left eyes are 'importantly different' could have significant consequences for deciding whether right or left eyes are included in an analysis or for examining the association between a phenotype and ocular parameter. The presence of significant asymmetry would also have important implications for the design of normative databases of retinal and optic nerve metrics. In this review, we highlight not only the universal presence of asymmetry, but provide evidence that some elements of the visual system are inherently more asymmetric than others, pointing to the need for improved normative data to explain sources of asymmetry and their impact on determining associations with genetic, environmental or health-related factors and ultimately in clinical practice.

Mutational analysis of GSC, HOXA2 and PRKRA in 106 Chinese patients with microtia

OBJECTIVE

Microtia is defined as a developmental malformation characterized by a small, abnormal shaped auricle, with atresia or stenosis of the auditory canal. Genes responsible for nonsyndromic microtia have remained elusive. We therefore report a mutational analysis of GSC, HOXA2 and PRKRA in 106 congenital microtia patients without any combined malformation to explore the relationship between GSC, HOXA2, PRKRA and nonsyndromic microtia.

METHODS

A total of 106 patients with a clinical diagnosis of congenital microtia and a control group (100 unaffected controls) were recruited through the Eye and ENT Hospital of Fudan University in China. Genomic DNA was extracted following a standard protocol. DNA sequencing analysis was performed in all exons and the exon-intron borders of GSC, HOXA2 and PRKRA.

RESULTS

We identified 5 genomic variants in GSC, HOXA2 and PRKRA. As to the GSC, we obtained a reported variant g.994C > T in exon 2, which resulted in no change of protein. Our results revealed that g.994C > T was also detected in 10 control cases. We also detected 2 novel variants, g.90G > A and g.114A > C, in the 5'UTR of HOXA2. No class 5 or 4 genomic variant of PRKRA was identified in our microtia patients. Additionally, two previously reported SNVs in GSC and PRKRA were also presented.

CONCLUSIONS

We suggest that g.994C > T is a new SNV, which is different from the previous report. Further study is needed to prove the function of 2 novel variants in the 5'UTR of HOXA2, and to explore the possible mechanism of these variants in the occurrence of microtia.

Does maternal exposure during pregnancy to higher ambient temperature increase the risk of hypospadias?

INTRODUCTION

The association between ambient temperature that the mother is exposed to during pregnancy and hypospadias has not been investigated by the studies, although the recent studies showed the correlation between some congenital malformations (congenital heart disease, neural tube defect, etc.) and ambient temperature.

OBJECTIVE

The aim was to investigate the relation between hypospadias and the ambient temperatures that the mother is exposed to during her pregnancy.

METHODS

The data of patients with hypospadias that had their gestational periods in Ankara and Istanbul regions, and had other urological treatments (circumcision, urinary tract infection, pyeloplasty, nephrolithotomy, etc.) between January 2000 and November 2015 were analyzed retrospectively. The ambient temperature at 8-14 weeks of gestation was investigated for each patient by reviewing the data of the General Directorate of Meteorology, since this period was risky for development of hypospadias. The data including ambient temperature that the pregnant mother was exposed to, maternal age, parity, economical status, gestational age at birth, and birth weight were compared between two groups. The retrospective nature of the study may be a potential source for selection bias.

RESULTS

The data of 1,709 children that had hypospadias repair and 4,946 children that had other urological treatments between 2000 and 2015 were retrospectively analyzed. There were no differences between the groups for maternal age, parity, economical status, gestational age at birth, and birth weight (Table). Analysis of exposed maximum and average ambient temperatures at 8-14 weeks of gestation revealed that July and August, hot periods in summer time, were more prevalent in the hypospadias group (p = 0.01). The average and maximum monthly ambient temperatures during summer increased the risk for hypospadias (OR, 1.32; 95% CI, 1.08-1.52; and OR, 1.22; 95% CI, 0.99-1.54, respectively.

CONCLUSIONS

In this paper, we evaluated the relation between hypospadias and the ambient temperatures that the mother is exposed during her pregnancy. The results of this study indicated that the high ambient temperatures the mother and fetus are exposed to at 8-14 weeks of gestation increased the risk of hypospadias in the offspring.

Prevalence and ethnic variation of pre-auricular sinuses in children

OBJECTIVES

Pre-auricular sinus (PAS) describes a congenital ear malformation presenting as a pit or sinus that may become infected, often requiring antibiotics and/or surgical excision. Although the presentation of PAS in otolaryngology clinics is not uncommon, there is limited epidemiological data regarding this malformation in children. Some evidence also suggests a potential ethnic variation in prevalence rates and potential heritability patterns within families, however these have yet to be proven. This study is the first to use pediatric population level data to investigate prevalence rate, ethnic variation, and to explore the unproven hypotheses of a genetic basis of PAS.

METHODS

In this prospective cross-sectional study, we enrolled 1106 subjects (mean age=6.8, male-to-female ratio=1.15:1) between June and September 2014. Subjects were recruited from B.C. Children's Hospital in Vancouver, Canada. Inclusion criteria was children <18 years of age; exclusion criteria was those seeking care for PAS. Subjects were visually inspected for the presence of PAS by clinical observers followed by verbal questionnaire (demographics, self-identified ethnicity, family history of PAS, chronic medical conditions). Data analysis utilized Pearson Chi-Square Test to determine the potential ethnic variation, and odds ratios of family history were used to determine a potential genetic basis.

RESULTS

26 (7 bilateral, 19 unilateral) of 1106 subjects were positive for PAS (2.4%). Using Pearson Chi-Square Test, a significant ethnic variation was found to exist (χ(2) (6,N=1106)=22.80, p<0.0001), with Asians having the highest prevalence (6.6%), followed by African Americans (4.5%), Middle Easterners (3.4%), First Nations (2.0%), and Caucasians (1.2%). None were found in South Asians (n=124) or Latin Americans (n=18). Subjects with positive family history of PAS had greater likelihood of having PAS (OR=16.7, 95% CI=7.3-38.5, p<0.0001). There was also stronger association between family history and bilateral PAS (OR=26.5, 95% CI=5.8-121.7, p<0.0001) compared to unilateral PAS (OR=12.2, 95% CI=4.6-32.5, p<0.0001).

CONCLUSIONS

This was the largest pediatric population level study to date, and showed the prevalence of PAS was 2.4% in this pediatric population, whose ethnic diversity was representative of B.C.'s community. A significant ethnic variation existed and associations between family history and PAS suggested a potential genetic basis, particularly with bilateral PAS.

The prevalence of preauricular sinus and associated factors in a nationwide population-based survey of South Korea

OBJECTIVE

To investigate the prevalence of preauricular sinus (PAS) using data from a government-centered survey in South Korea and to reveal the relationship between the occurrence of PAS and associated factors.

PATIENTS

Data obtained during July 2008 to December 2012 were analyzed. Annually, 10,000 to 12,000 individuals are selected from a panel to represent the population using a multistage clustered and stratified random sampling method based on the National Census Data. A total of 56,592 individuals participated in the survey (25,586 male and 31,006 female).

INTERVENTION

After completion of the otolaryngologic questionnaires, the auricle was examined to check for malformation and PAS in those older than 1 year. Next, an otolaryngologist conducted a physical examination of the head and neck using videoassisted endoscopy.

MAIN OUTCOME MEASURE

Physical examination.

RESULTS

One thousand one hundred thirty-two individuals had PAS representing the overall prevalence of 1.91% in South Korea, with 79.08% of cases occurring unilaterally. Female participants had a significantly higher prevalence than male (p < 0.001), and a significant decrease with age was observed in both male and female populations (p < 0.001). A higher proportion of PAS was found in individuals with external ear anomaly (p < 0.001) and not associated with abnormal otoendoscopic findings such as tympanic membrane perforation, cholesteatomatous condition including retraction pocket, and middle ear effusion.

CONCLUSION

A large-scale government-centered survey demonstrates a high prevalence, female dominance, and age-related decrease of PAS in South Korea.

Hearing outcomes in patients with cleft lip/palate

Objective : Children with cleft lip and palate or cleft palate only have a high incidence of conductive hearing loss from otitis media with effusion. Studies demonstrating longitudinal results are lacking. This study was undertaken to investigate long-term longitudinal hearing outcomes of children with cleft lip and/or cleft palate and cleft palate only. Design : Retrospective chart review. Setting : Clinical charts of patients born with cleft lip and palate or cleft palate only in 1985 to 1994 who were referred to the cleft team in Bergen, Norway. Study findings include 15 years of follow-up. Participants : The study population consisted of 317 children of whom 159 had nonsyndromic cleft lip and palate and 158 had nonsyndromic cleft palate. Main Outcome Measures : Pure tone average calculated from pure tone audiometry at ages 4, 6, and 15 years. Results : The median pure tone average significantly improved with increasing age. For the cleft lip and palate group, the median pure tone average at ages 4, 6, and 15 years was 16 dB hearing level (HL), 13 dB HL, and 9 dB HL, respectively (P ≤ .001). In the cleft palate group the median pure tone average at ages 4, 6, and 15 years was 15 dB HL, 12 dB HL, and 9 dB HL, respectively (P ≤ .001). There was no significant difference in the hearing levels between the two groups. Patients who had surgical closure of the palate at age 18 months had a significantly better pure tone average outcome at age 15 compared with patients who had surgery at 12 months. Conclusions : Hearing improves significantly from childhood to adolescence in patients with cleft lip and palate and cleft palate only.

Measurement of hydroxyproline and nitric oxide, and comparison of sac fluid acidity in different inguinal pathologies

PURPOSE

To compare hydroxyproline and nitric oxide levels, and fluid acidity between sac tissues from inguinal hernia, hydrocele and undescended testis patients.

MATERIAL AND METHOD

Thirty patients were in the inguinal hernia group, 11 patients in the hydrocele group and 5 patients in the undescended testis with inguinal hernia group. Intrasaccular fluid acidity, and nitric oxide and hydroxyproline levels in sac tissues were measured and analyzed statistically between groups.

RESULTS

Intrasaccular fluid could be obtained from 24 inguinal hernia and 6 hydrocele patients. Acidity level (pH) was 7.5 ± 0.74 in the hernia group and 7.86 ± 0.63 in the hydrocele group (p < 0.05). All patients in the three groups were evaluated for nitric oxide and hydroxyproline. Results for hydroxyproline (mg/g dry tissue)/nitric oxide (nmol/g wet tissue) were 3.53 ± 0.54/2.02 ± 0.39 for inguinal hernia, 2.89 ± 0.9/1.92 ± 1.05 for hydrocele and 3.02 ± 1.23/2.86 ± 1.09 for undescended testis group (p > 0.05).

CONCLUSION

Hydroxyproline and nitric oxide pathways do not seem to be responsible for the different characteristics of inguinal diseases. However, differences in the acidity of sac fluid may be evidence of the different mechanisms of hernia and hydrocele formation.

It's never too early to get it Right: A conserved role for the cytoskeleton in left-right asymmetry

For centuries, scientists and physicians have been captivated by the consistent left-right (LR) asymmetry of the heart, viscera, and brain. A recent study implicated tubulin proteins in establishing laterality in several experimental models, including asymmetric chemosensory receptor expression in C. elegans neurons, polarization of HL-60 human neutrophil-like cells in culture, and asymmetric organ placement in Xenopus. The same mutations that randomized asymmetry in these diverse systems also affect chirality in Arabidopsis, revealing a remarkable conservation of symmetry-breaking mechanisms among kingdoms. In Xenopus, tubulin mutants only affected LR patterning very early, suggesting that this axis is established shortly after fertilization. This addendum summarizes and extends the knowledge of the cytoskeleton's role in the patterning of the LR axis. Results from many species suggest a conserved role for the cytoskeleton as the initiator of asymmetry, and indicate that symmetry is first broken during early embryogenesis by an intracellular process.

A unified model for left-right asymmetry? Comparison and synthesis of molecular models of embryonic laterality

Understanding how and when the left-right (LR) axis is first established is a fundamental question in developmental biology. A popular model is that the LR axis is established relatively late in embryogenesis, due to the movement of motile cilia and the resultant directed fluid flow during late gastrulation/early neurulation. Yet, a large body of evidence suggests that biophysical, molecular, and bioelectrical asymmetries exist much earlier in development, some as early as the first cell cleavage after fertilization. Alternative models of LR asymmetry have been proposed that accommodate these data, postulating that asymmetry is established due to a chiral cytoskeleton and/or the asymmetric segregation of chromatids. There are some similarities, and many differences, in how these various models postulate the origin and timing of symmetry breaking and amplification, and these events' linkage to the well-conserved subsequent asymmetric transcriptional cascades. This review examines experimental data that lend strong support to an early origin of LR asymmetry, yet are also consistent with later roles for cilia in the amplification of LR pathways. In this way, we propose that the various models of asymmetry can be unified: early events are needed to initiate LR asymmetry, and later events could be utilized by some species to maintain LR-biases. We also present an alternative hypothesis, which proposes that individual embryos stochastically choose one of several possible pathways with which to establish their LR axis. These two hypotheses are both tractable in appropriate model species; testing them to resolve open questions in the field of LR patterning will reveal interesting new biology of wide relevance to developmental, cell, and evolutionary biology.

Micropatterning of cells reveals chiral morphogenesis

Invariant left-right (LR) patterning or chirality is critical for embryonic development. The loss or reversal of LR asymmetry is often associated with malformations and disease. Although several theories have been proposed, the exact mechanism of the initiation of the LR symmetry has not yet been fully elucidated. Recently, chirality has been detected within single cells as well as multicellular structures using several in vitro approaches. These studies demonstrated the universality of cell chirality, its dependence on cell phenotype, and the role of physical boundaries. In this review, we discuss the theories for developmental LR asymmetry, compare various in vitro cell chirality model systems, and highlight possible roles of cell chirality in stem cell differentiation. We emphasize that the in vitro cell chirality systems have great promise for helping unveil the nature of chiral morphogenesis in development.

Clinical and epidemiological study of orofacial clefts

OBJECTIVE

Cleft lip with or without cleft palate (CL±P) or cleft palate (CP) are groups of malformations named orofacial clefts (OC), which are the second leading cause of birth defects. This study aimed to analyze clinical and epidemiological features of Brazilian patients with OC, studying cases treated in the reference center of the state of Paraná (PR).

METHODS

2,356 charts were reviewed and 1,838 were evaluated by the same clinical geneticist. Data were collected in the reference center, and compared with those of the Health Department of the state of Paraná. Clinical characteristics, presence of other anomalies, and birth prevalence were evaluated.

RESULTS

389 (21.2%) patients had CP, 437 (23.8%) had cleft lip (CL), and 1,012 (55%) had cleft lip and palate (CLP). Syndromic OC were identified in 15.3% of patients, 10.4% of patients with CL±P, and 33.9% of patients with CP. Common additional anomalies were: central nervous system, limbs, cardiovascular, and musculoskeletal defects. The number of syndromic cases was lower when clinical evaluation was performed by other medical specialists when compared to that of the clinical geneticist. Birth prevalence was 1/1,010 live births. Lack of notification with the national birth registry was observed in 49.9% of CL±P. The present data suggests a decrease of 18.52% in the prevalence of non-syndromic OC after folic acid fortification in Brazil.

CONCLUSION

Better understanding of clinical and epidemiological aspects of OC is crucial to improve the understanding of pathogenesis, promote preventive strategies, and guide clinical care, including the presence of clinical geneticists in the multidisciplinary team for OC treatment.

Neurally Derived Tissues in Xenopus laevis Embryos Exhibit a Consistent Bioelectrical Left-Right Asymmetry

Consistent left-right asymmetry in organ morphogenesis is a fascinating aspect of bilaterian development. Although embryonic patterning of asymmetric viscera, heart, and brain is beginning to be understood, less is known about possible subtle asymmetries present in anatomically identical paired structures. We investigated two important developmental events: physiological controls of eye development and specification of neural crest derivatives, in Xenopus laevis embryos. We found that the striking hyperpolarization of transmembrane potential (V_mem) demarcating eye induction usually occurs in the right eye field first. This asymmetry is randomized by perturbing visceral left-right patterning, suggesting that eye asymmetry is linked to mechanisms establishing primary laterality. Bilateral misexpression of a depolarizing channel mRNA affects primarily the right eye, revealing an additional functional asymmetry in the control of eye patterning by V_mem. The ATP-sensitive K⁺ channel subunit transcript, SUR1, is asymmetrically expressed in the eye primordia, thus being a good candidate for the observed physiological asymmetries. Such subtle asymmetries are not only seen in the eye: consistent asymmetry was also observed in the migration of differentiated melanocytes on the left and right sides. These data suggest that even anatomically symmetrical structures may possess subtle but consistent laterality and interact with other developmental left-right patterning pathways.

Anatomical Variations in Clefts of the Lip with or without Cleft Palate

Objective. Few orofacial cleft (OFC) studies have examined the severity of clefts of the lip or palate. This study examined associations between the severity of cleft of the lip with cleft type, laterality, and sex in four regional British Isles cleft registers whilst also looking for regional variations. Design. Retrospective analysis of cleft classification in the data contained in these four cleft registers. Sample. Three thousand and twelve patients from cleft registers based in Scotland, East England, Merseyside, and Belfast were sourced from the period 2002-2010. Submucous clefts and syndromic clefts were included whilst stillbirths, abortuses, and atypical orofacial clefts were excluded. Results. A cleft of the lip in CLP patients is more likely to be complete in males. A cleft of the lip in isolated CL patients is more likely to be complete in females. Variation in the proportion of cleft types was evident between Scotland and East England. Conclusions. Association between severity of cleft of the lip and sex was found in this study with females having a significantly greater proportion of more severe clefts of the lip (CL) and CLP males being more severe (P < 0.0003). This finding supports a fundamental difference between cleft aetiology between CL and CLP.

The epidemiology and demographics of hip dysplasia

The etiology of developmental dysplasia of the hip (DDH) is unknown. There are many insights, however, from epidemiologic/demographic information. A systematic medical literature review regarding DDH was performed. There is a predominance of left-sided (64.0%) and unilateral disease (63.4%). The incidence per 1000 live births ranges from 0.06 in Africans in Africa to 76.1 in Native Americans. There is significant variability in incidence within each racial group by geographic location. The incidence of clinical neonatal hip instability at birth ranges from 0.4 in Africans to 61.7 in Polish Caucasians. Predictors of DDH are breech presentation, positive family history, and gender (female). Children born premature, with low birth weights, or to multifetal pregnancies are somewhat protected from DDH. Certain HLA A, B, and D types demonstrate an increase in DDH. Chromosome 17q21 is strongly associated with DDH. Ligamentous laxity and abnormalities in collagen metabolism, estrogen metabolism, and pregnancy-associated pelvic instability are well-described associations with DDH. Many studies demonstrate an increase of DDH in the winter, both in the northern and southern hemispheres. Swaddling is strongly associated with DDH. Amniocentesis, premature labor, and massive radiation exposure may increase the risk of DDH. Associated conditions are congenital muscular torticollis and congenital foot deformities. The opposite hip is frequently abnormal when using rigorous radiographic assessments. The role of acetabular dysplasia and adult hip osteoarthritis is complex. Archeological studies demonstrate that the epidemiology of DDH may be changing.

Association of prolactin-induced protein with preputial development of hypospadias

OBJECTIVE

To investigate the molecular aetiology of hypospadias during a critical developmental period by identifying differentially regulated genes in the tissues of individuals with hypospadias and comparing these genes with similar genes in the tissues of control individuals.

MATERIALS AND METHODS

Pregnant Sprague-Dawley rats were administered flutamide (7.5 mg) on gestational days 15-17 to produce hypospadiac pups. Dams were killed on gestational day 17, and the genital tubercles (GTs) of male pups were harvested. Gene expression of RNA isolated from the GTs was analysed using an oligonucleotide microarray containing 20,500 genes. The results of microarray analysis were confirmed using quantitative real-time PCR (qPCR). Protein expression levels were studied using Western blot analysis. The distribution of genes associated with GT development in rats was histologically examined. Prepuces harvested from patients with hypospadias and phimosis were immunohistochemically examined for gene distribution.

RESULTS

Of the 20, 500 genes, 23 annotated genes, including prolactin-induced protein (Pip), in the GTs of the hypospadiac rats were expressed at levels less than half of that of similar genes in the GTs of the control rats. Findings from qPCR and Western blot analysis revealed significantly lower Pip/PIP expression in the GTs of the hypospadiac rats than in those of the control rats. Immunohistochemical analysis revealed PIP expression in the prepuces of the GTs of the control and hypospadiac rats. PIP was expressed in the human prepuces of the patients with hypospadias and phimosis.

CONCLUSIONS

Pip/PIP, expressed at low levels in the GTs of hypospadiac rats, may be associated with preputial development. This model can be useful to elucidate the molecular mechanisms underlying penile and urethral development as well as preputial development. Further studies should provide detailed information regarding the molecular aetiology of hypospadias.

Unilateral anomalies of kidney development: why is left not right?

Abnormal renal development results in congenital anomalies of the kidney and urinary tract. As many studies suggest that renal malformations are more often found on the left side, a meta-analysis was performed on the distribution of five different unilateral anomalies: multicystic dysplastic kidney, renal agenesis/aplasia, renal ectopia, pelviureteral junction obstruction, and non-obstructive non-refluxing megaureter. Of these anomalies, the left side was affected in 53%, 57%, 56.9%, 63.2%, and 62.5% of patients, respectively, significantly different when compared with an anticipated 50% of left-sided anomalies. An exception to this left-side predominance was found in females with combined genital anomalies and unilateral renal agenesis that commonly present on the right side. The exact mechanisms leading to these lateralizations remain to be determined but may involve vascular development, differential gene expression, or susceptibility to environmental factors such as hypoxia. This remains largely speculative, however, illustrating our limited knowledge of embryogenesis in general and nephrogenesis in particular.

Effects of unilateral clefts on brain structure

OBJECTIVE

To evaluate potential abnormalities in brain structure of children and adolescents with unilateral clefts.

DESIGN

Case-control study.

SETTING

Tertiary care center.

PARTICIPANTS

Boys aged 7 to 17 years with right (n=14) and left (n=19) clefts were compared with healthy age-matched boys (n=57).

MAIN EXPOSURES

Structural brain measures were obtained using magnetic resonance imaging.

OUTCOME MEASURE

It was explored whether laterality of clefts had a significant effect on brain structure. To this end, volumes of tissue types and various brain regions were evaluated.

RESULTS

Total white matter was significantly lower in boys with right clefts compared with boys with left clefts and healthy boys. Gross regional analyses demonstrated that reductions in white matter were evident in both the cerebellum and the cerebrum in boys with right clefts. Furthermore, within the cerebrum, white matter volumes were particularly low in the frontal lobes and the occipital lobes.

CONCLUSIONS

These preliminary results suggest that right clefts may be associated with more abnormalities in brain structure. More generally, laterality of a birth defect may have a significant effect on a developing organism.

Pedigree and genetic study of a bilateral congenital microtia family

BACKGROUND

Microtia can be defined as a malformation of the auricle; the varying severity that results can range from mild distortion of the anatomic landmarks to the complete absence of the ear. No specific study has been reported analyzing a family of several generations with bilateral congenital concha-type microtia so far.

METHODS

The authors obtained medical records and blood samples from a Chinese family with bilateral congenital concha-type microtia that involved 56 members of five generations. There were 20 patients with bilateral congenital concha-type microtia in this pedigree, and 14 patients were still alive. Pedigree analysis and genetic study were carried out to obtain the information in this family.

RESULTS

With regard to pedigree, 35.7 percent of the members of this family were affected by bilateral congenital concha-type microtia and showed the possibility of autosomal dominant inheritance model. Missense mutation A deletion on site 76234730 in goosecoid gene exon 3 occurred in eight cases in the family, which resulted in a frame shift mutation.

CONCLUSIONS

The goosecoid gene mutation in exon 3 may be involved in the malformation events in this family. The mutation can be accompanied by potential environmental risk factors, such as exposure to poison and hazardous materials, alcohol abuse, and disease during the mother's pregnancy. Further study is needed to clarify the relationship between the genetic and environmental factors associated with the congenital malformation.

Genetic modification of the inner ear lateral semicircular canal phenotype of the Bmp4 haplo-insufficient mouse

In the mouse, development of the lateral semicircular canal of the inner ear is sensitive to Bmp4 heterozygosity. In the C57BL6 background 30% of the heterozygotes display circling behavior, 66% have a specific defect in the vestibular part of the inner ear, namely the constriction, interruption or absence of the lateral semicircular canal. Only mice having both ears affected display circling behavior. In the (C57BL6xCBA)N1 background, the penetrance of the canal phenotype is greatly reduced, and bilateral lateral canal defect is not sufficient to induce circling. We found association of the canal phenotype with the genotype of markers on chromosome 14 and 4, co-localizing with Ecs and Eclb identified in the Ecl mouse with similar lateral canal defects. Candidate genes to contain the causal mutation are Bmp4 on chromosome 14, and Rere on chromosome 4.

Asymmetry of the craniofacial skeleton in the parents of children with a cleft lip, with or without a cleft palate, or an isolated cleft palate

The objective of this study was to evaluate asymmetry of the parental craniofacial skeleton of subjects with a cleft lip, with or without cleft palate [CL(P)], and isolated cleft palate (CP). The postero-anterior (PA) cephalograms of 52 parents of children with CL(P) and 40 parents of children with CP from a sample of 196 children with non-syndromic clefts in the west of Scotland were analysed. A conventional cephalometric asymmetry analysis was used to evaluate size-related right:left asymmetry comprising eight linear distances, nine angular, and three facial area measurements. Right:left ratios of the mean values identified the direction of the asymmetry and two-sample t-tests determined statistical significance. A shape-related asymmetry analysis was also undertaken. The configurations of landmarks were optimally superimposed and scaled using Procrustes algorithms. Euclidean distance matrix analysis (EDMA) was then compared and the shape of the left and the right landmark configurations were statistically tested using a non-parametric bootstrap technique. For the parents of CL(P) children, size-related asymmetry was identified and the area of the craniofacial polygon was statistically significantly larger on the right than on the left side. EDMA detected the presence of shape-related asymmetry (T statistic = 1.304; P = 0.003). For the parents of CP children, although size-related asymmetry was identified, EDMA did not identify shape-related asymmetry (T statistic = 1.281; P = 0.065). Size and shape directional asymmetries are characteristic features of the parental craniofacial skeleton in CL(P). Although directional size asymmetry is present in the parental craniofacial skeleton in CP, shape asymmetry is not a characteristic feature.

Environmental and genetic factors associated with congenital microtia: a case-control study in Jiangsu, China, 2004 to 2007

BACKGROUND

The objectives of this study were to filter out the environmental and genetic risk factors in microtia patients and to demonstrate the relationship between environmental and inherited factors in congenital microtia.

METHODS

A case-control study was carried out in 121 congenital microtia patients and 152 controls. Epidemiologic data related to environmental exposure were gathered through personal interviews with the target group. Polymerase chain reaction and DNA sequence analysis were performed to analyze the Gsc gene and BMP5 gene mutation in the case and control groups. The logistic regression model was used to analyze environmental and genetic risk factors and their relationships to microtia.

RESULTS

The main risk factors were disease during pregnancy (odds ratio, 5.890; 95 percent CI, 2.358 to 14.715), toxicity exposure during pregnancy (odds ratio, 4.764; 95 percent CI, 1.659 to 13.680), and resident area (odds ratio, 5.114; 95 percent CI, 2.086 to 12.535). The synthetic attributable risks amount to 0.7185. As to the Gsc gene, six of these patients had a same-sense mutation C-->T on 197 bp in exon 2; a missense mutation on A-->G 125 bp in exon 3 occurred in two cases; and amino acid changes from glutamic acid to glutamine. A heterozygosity on 196 TTT-->ACA resulting in missense mutation was detected in four patients, causing the amino acid to change from phenylalanine to threonine in BMP5 maternal peptide gene. However, no mutations were detected in the control subjects.

CONCLUSIONS

The results suggested that both environmental and genetic factors contribute to congenital microtia. The Gsc gene and the BMP5 maternal peptide gene may act as the predisposing genes of microtia. Further research is needed to clarify the relationship between the risk factors and microtia.

Impact and risk factors of craniofacial malformations in a Colombian population

OBJECTIVE

Craniofacial malformations comprise diverse diagnoses, implying a wide range of morbidity and disability among populations. Our aim was to study them as a group and describe their epidemiological factors inside a population as well as finding common risk factors for their presentation in Colombia.

METHODS

We conducted a case-control study in several Colombian hospitals participating in the ECLAMC (Spanish acronym for Latin-American Collaborative Study of Congenital Malformations) program. For the analysis we included 374 cases of isolated malformations and 728 controls, out of 44,701 births.

RESULTS

A rate of 83.67 cases per 10,000 births was found for craniofacial malformations as a group, with an overall sex ratio of 1. We found predominance for their presentation on the right side. As main associations we obtained a positive family history of another craniofacial malformation (OR: 3.10 CI 95% [2.24-4.30]), particularly preauricular tags (OR 52.36 CI 95% [12.62-217.16]), preauricular pits (OR: 36.35 CI 95% [4.82-274.27]) and cleft lip with or without palate (OR: 2.50 CI 95% [1.07-5.84]). Medication use during pregnancy was also linked to malformations (OR: 2.00 CI 95% [1.38-2.89]). Specific agents such as ferrous sulfate (OR: 1.46 CI 95% [1.13-1.89]), folic acid (OR: 1.35 CI 95% [1.02-1.79]) and nifedipine (OR: 2.88 CI 95% [1.22-6.79]) also showed a significant correlation. Maternal alcohol use was also identified as a possible risk factor (OR: 2.45 CI 95% [1.39-4.29]).

CONCLUSIONS

Craniofacial malformations are frequently encountered among the group of congenital defects. When they present in an isolated fashion, familial history is an important risk factor, although some prenatal factors such as alcohol and some medications may have influence over their prevalence.

What's left in asymmetry?

Left-right patterning is a fascinating problem of morphogenesis, linking evolutionary and cellular signaling mechanisms across many levels of organization. In the past 15 years, enormous progress has been made in elucidating the molecular details of this process in embryos of several model species. While many outside the field seem to believe that the fundamental aspects of this pathway are now solved, workers on asymmetry are faced with considerable uncertainties over the details of specific mechanisms, a lack of conceptual unity of mechanisms across phyla, and important questions that are not being pursued in any of the popular model systems. Here, we suggest that data from clinical syndromes, cryptic asymmetries, and bilateral gynandromorphs, while not figuring prominently in the mainstream work on LR asymmetry, point to crucial and fundamental gaps of knowledge about asymmetry. We identify 12 big questions that provide exciting opportunities for fundamental new advances in this field.

Preauricular skin tags and ear pits are associated with permanent hearing impairment in newborns

OBJECTIVES

Our goals were to (1) study the prevalence of hearing impairment in a large cohort of infants with preauricular skin tags or ear pits and compare it with that among all other newborns participating in our universal newborn hearing screening program during the same period and (2) evaluate the effectiveness of transient evoked otoacoustic emissions as a hearing-screening tool in this population.

PATIENTS AND METHODS

During the study period of 7.5 years, 68484 infants were screened for hearing impairment, of whom 637 (0.93%) had preauricular skin tags and/or ear pits. The population was divided into 3 groups: (1) a low-risk group for hearing impairment; (2) a high-risk group for hearing impairment; and (3) a very high-risk group for hearing impairment. The screening results and audiological follow-up for these infants were examined retrospectively.

RESULTS

A significantly higher prevalence of permanent hearing impairment was found among infants with preauricular skin tags or ear pits (8 of 1000), compared with infants without tags or pits (1.5 of 1000). In the low-risk group, the prevalence was 3.4 of 1000, compared with 0.5 of 1000 in infants with and without preauricular tags or pits, respectively. In the high-risk group, the prevalence was 77 of 1000, compared with 20 of 1000 in infants with and without preauricular tags or pits, respectively. The odds ratio for hearing impairment associated with preauricular skin tags and/or ear pits after adjusting for level of risk group was 4.9. All infants diagnosed with permanent hearing impairment, with the exception of 1 with late-onset impairment, were detected by in-hospital transient-evoked otoacoustic emissions screening.

CONCLUSIONS

Infants with preauricular skin tags or ear pits are at increased risk for permanent hearing impairment. Transient-evoked otoacoustic emissions were found to be an effective hearing-screening tool in this population.

Rhinal cortex asymmetries in patients with mesial temporal sclerosis

PURPOSE

The rhinal cortex, comprising the entorhinal (ErC) and perirhinal (PrC) cortices, is one component of the limbic system that may be affected in patients with epilepsy and other temporal lobe pathologies. This study extended quantitative examination of the limbic system through development and validation of volumetric protocols to measure the ErC and PrC.

METHODS

Volumes were calculated from MRI studies using ANALYZE 7.5 and based on detailed anatomical definitions developed for the study. Subjects were 61 temporal lobe epilepsy patients with mesial temporal sclerosis (MTS: 33 left, 28 right) and 20 neurologically normal controls. Inter-rater reliabilities for the ErC and PrC volume protocols were found to be high (range 0.86-0.92).

RESULTS

Ipsilateral hippocampal volume was reduced in patients with MTS, while contralateral volume did not differ significantly from controls. In the patients, rhinal cortex volumes were reduced as a function of laterality of disease. The pattern of correlations between ErC and PrC differed between disease groups. Hippocampal and rhinal cortex volumes were not significantly correlated. A significant four-way interaction was found between side of MTS, hemisphere, structure and handedness.

CONCLUSIONS

This quantitative study demonstrates reliable in vivo evidence of morphometric changes in ErC and PrC in a substantial number of patients with unilateral MTS. The relationship observed between handedness, structure and disease status may suggest a role for cerebral dominance in modulating the expression of MTS.