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Advances in Fetal Surgical Repair of Open Spina Bifida. Obstet Gynecol 2023; 141:505-521. [PMID: 36735401 DOI: 10.1097/aog.0000000000005074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/03/2022] [Indexed: 02/04/2023]
Abstract
Spina bifida remains a common congenital anomaly of the central nervous system despite national fortification of foods with folic acid, with a prevalence of 2-4 per 10,000 live births. Prenatal screening for the early detection of this condition provides patients with the opportunity to consider various management options during pregnancy. Prenatal repair of open spina bifida, traditionally performed by the open maternal-fetal surgical approach through hysterotomy, has been shown to improve outcomes for the child, including decreased need for cerebrospinal fluid diversion surgery and improved lower neuromotor function. However, the open maternal-fetal surgical approach is associated with relatively increased risk for the patient and the overall pregnancy, as well as future pregnancies. Recent advances in minimally invasive prenatal repair of open spina bifida through fetoscopy have shown similar benefits for the child but relatively improved outcomes for the pregnant patient and future childbearing.
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Akar M, Çetin G, İnal M, Helvaci M, Dündar NO, Ergin F, Uygur Ö, Akbay S, Özdemir N, Arslan MK, Öncel MY. Postnatal surgery for myelomeningocele in neonates: neurodevelopmental outcomes. Turk J Med Sci 2023; 53:88-93. [PMID: 36945937 PMCID: PMC10388020 DOI: 10.55730/1300-0144.5561] [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: 08/26/2022] [Accepted: 11/30/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The study aims to evaluate the neurodevelopmental outcomes of neonates with myelomeningocele (MMC) operated in the postnatal period. METHODS This is a prospective follow-up study in a tertiary neonatal intensive care unit. Neurodevelopmental outcomes of term neonates operated for MMC and healthy term newborns were compared with the Bayley Scales of Infant and Toddler Development -Third Edition (BSID III) at 12-18 months. RESULTS A total of 57 cases were included in the study (patient group = 27; control group = 30). Demographic data between the groups were similar. Cognitive, linguistic, and motor composite scores of the patient group were lower than those of the control group (p < 0.001). In the patient group, those who underwent ventriculoperitoneal shunt had lower cognitive, language and motor scores than those without shunt (p < 0.05). The cognitive, linguistic, and motor composite scores in the patient group who underwent surgery before 72 h were better than those who underwent surgery after 72 h. DISCUSSION In our study, it was found that the neurodevelopmental prognosis of MMC cases requiring ventriculoperitoneal shunt in the postnatal period was significantly worse than those without shunt. It is the first study in which the neurodevelopment of patients with MMC who were operated in the postnatal period was evaluated with BSID III evaluated and delays in all areas were shown in cases with MMC compared to normal cases. Better neurodevelopmental outcomes in patients operated in the first 72 h suggest that early surgery will improve neurodevelopmental outcomes in patients with MMC.
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Affiliation(s)
- Melek Akar
- Division of Neonatology, İzmir Tepecik Training and Research Hospital, University of Health Sciences, İzmir, Turkey ; Department of Pediatrics, Division of Neonatology, İzmir Faculty of Medicine, University of Health Sciences, İzmir, Turkey
| | - Gülşah Çetin
- Division of Neonatology, İzmir Tepecik Training and Research Hospital, University of Health Sciences, İzmir, Turkey
| | - Mine İnal
- Division of Child Development, İzmir Tepecik Training and Research Hospital, University of Health Sciences, İzmir, Turkey
| | - Mehmet Helvaci
- Division of Pediatrics, İzmir Tepecik Training and Research Hospital, University of Health Sciences, İzmir, Turkey ; Division of Pediatrics, İzmir Faculty of Medicine, University of Health Sciences, İzmir, Turkey
| | - Nihal Olgaç Dündar
- Department of Pediatrics, Division of Pediatric Neurology, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - Firat Ergin
- Division of Neonatology, İzmir Tepecik Training and Research Hospital, University of Health Sciences, İzmir, Turkey
| | - Özgün Uygur
- Division of Neonatology, İzmir Tepecik Training and Research Hospital, University of Health Sciences, İzmir, Turkey
| | - Sinem Akbay
- Division of Neonatology, İzmir Tepecik Training and Research Hospital, University of Health Sciences, İzmir, Turkey
| | - Nail Özdemir
- Department of Neurosurgery, İzmir Tepecik Training and Research Hospital, University of Health Sciences, İzmir, Turkey
| | - Meltem Koyuncu Arslan
- Division of Neonatology, İzmir Tepecik Training and Research Hospital, University of Health Sciences, İzmir, Turkey
| | - Mehmet Yekta Öncel
- Department of Pediatrics, Division of Neonatology, İzmir Kâtip Çelebi University, İzmir, Turkey
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3
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Gober J, Thomas SP, Gater DR. Pediatric Spina Bifida and Spinal Cord Injury. J Pers Med 2022; 12:jpm12060985. [PMID: 35743769 PMCID: PMC9225638 DOI: 10.3390/jpm12060985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 11/25/2022] Open
Abstract
Pediatric spina bifida (SB) and spinal cord injury (SCI) are unfortunately common in our society, and their unique findings and comorbidities warrant special consideration. This manuscript will discuss the epidemiology, pathophysiology, prevention, and management strategies for children growing and developing with these unique neuromuscular disorders. Growth and development of the maturing child places them at high risk of spinal cord tethering, syringomyelia, ascending paralysis, pressure injuries, and orthopedic abnormalities that must be addressed frequently and judiciously. Similarly, proper neurogenic bladder and neurogenic bowel management is essential not just for medical safety, but also for optimal psychosocial integration into the child’s expanding social circle.
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Affiliation(s)
- Joslyn Gober
- Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
- The Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
- Correspondence:
| | - Sruthi P. Thomas
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA;
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
- The Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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4
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Boëx M, Cottin S, Halliez M, Bauché S, Buon C, Sans N, Montcouquiol M, Molgó J, Amar M, Ferry A, Lemaitre M, Rouche A, Langui D, Baskaran A, Fontaine B, Messéant J, Strochlic L. The cell polarity protein Vangl2 in the muscle shapes the neuromuscular synapse by binding to and regulating the tyrosine kinase MuSK. Sci Signal 2022; 15:eabg4982. [PMID: 35580169 DOI: 10.1126/scisignal.abg4982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The development of the neuromuscular junction (NMJ) requires dynamic trans-synaptic coordination orchestrated by secreted factors, including Wnt family morphogens. To investigate how these synaptic cues in NMJ development are transduced, particularly in the regulation of acetylcholine receptor (AChR) accumulation in the postsynaptic membrane, we explored the function of Van Gogh-like protein 2 (Vangl2), a core component of Wnt planar cell polarity signaling. We found that conditional, muscle-specific ablation of Vangl2 in mice reproduced the NMJ differentiation defects seen in mice with global Vangl2 deletion. These alterations persisted into adulthood and led to NMJ disassembly, impaired neurotransmission, and deficits in motor function. Vangl2 and the muscle-specific receptor tyrosine kinase MuSK were functionally associated in Wnt signaling in the muscle. Vangl2 bound to and promoted the signaling activity of MuSK in response to Wnt11. The loss of Vangl2 impaired RhoA activation in cultured mouse myotubes and caused dispersed, rather than clustered, organization of AChRs at the postsynaptic or muscle cell side of NMJs in vivo. Our results identify Vangl2 as a key player of the core complex of molecules shaping neuromuscular synapses and thus shed light on the molecular mechanisms underlying NMJ assembly.
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Affiliation(s)
- Myriam Boëx
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut de Myologie, Centre de Recherche en Myologie, Paris 75013, France
| | - Steve Cottin
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut de Myologie, Centre de Recherche en Myologie, Paris 75013, France
| | - Marius Halliez
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut de Myologie, Centre de Recherche en Myologie, Paris 75013, France
| | - Stéphanie Bauché
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut de Myologie, Centre de Recherche en Myologie, Paris 75013, France
| | - Céline Buon
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut de Myologie, Centre de Recherche en Myologie, Paris 75013, France
| | - Nathalie Sans
- Institut National de la Santé et de la Recherche Médicale, Neurocentre Magendie, UMR-S 1215, Bordeaux 33077, France.,Université Bordeaux, Neurocentre Magendie, Bordeaux, 33000, France
| | - Mireille Montcouquiol
- Institut National de la Santé et de la Recherche Médicale, Neurocentre Magendie, UMR-S 1215, Bordeaux 33077, France.,Université Bordeaux, Neurocentre Magendie, Bordeaux, 33000, France
| | - Jordi Molgó
- Université Paris-Saclay, Commissariat à l'Energie Atomique et aux énergies Alternatives, Institut des Sciences du Vivant Frédéric Joliot, Département Médicaments et Technologies pour la Santé, Equipe Mixte de Recherche CNRS 9004, Service d'Ingénierie Moléculaire pour la Santé, Gif-sur-Yvette 91191, France
| | - Muriel Amar
- Université Paris-Saclay, Commissariat à l'Energie Atomique et aux énergies Alternatives, Institut des Sciences du Vivant Frédéric Joliot, Département Médicaments et Technologies pour la Santé, Equipe Mixte de Recherche CNRS 9004, Service d'Ingénierie Moléculaire pour la Santé, Gif-sur-Yvette 91191, France
| | - Arnaud Ferry
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut de Myologie, Centre de Recherche en Myologie, Paris 75013, France
| | - Mégane Lemaitre
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Phénotypage du Petit Animal, Paris 75013, France
| | - Andrée Rouche
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut de Myologie, Centre de Recherche en Myologie, Paris 75013, France
| | - Dominique Langui
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut du Cerveau et de la Moelle, Plate-forme d'Imagerie Cellulaire Pitié-Salpêtrière, Paris 75013, France
| | - Asha Baskaran
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut du Cerveau et de la Moelle, Plate-forme d'Imagerie Cellulaire Pitié-Salpêtrière, Paris 75013, France
| | - Bertrand Fontaine
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut de Myologie, Centre de Recherche en Myologie, Paris 75013, France.,Assistance Publique-Hôpitaux de Paris (AP-HP) Service de Neuro-Myologie, Hôpital Universitaire Pitié-Salpêtrière, Paris 75013, France
| | - Julien Messéant
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut de Myologie, Centre de Recherche en Myologie, Paris 75013, France
| | - Laure Strochlic
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut de Myologie, Centre de Recherche en Myologie, Paris 75013, France
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O’Neil J, Fuqua JS. Short stature and the effect of human growth hormone: Guidelines for the care of people with spina bifida. J Pediatr Rehabil Med 2021; 13:549-555. [PMID: 32986629 PMCID: PMC7838964 DOI: 10.3233/prm-200710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
It is estimated that a significant percentage of individuals with spina bifida (SB) are shorter than their age-matched typical peers. Parents of children with spina bifida may ask if human growth hormone is appropriate for their child. This article discusses short stature and the use of human growth hormone among children with SB. This guideline was developed for SB Healthcare Guidelines from the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida.
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Affiliation(s)
- Joseph O’Neil
- Riley Hospital for Children, Section of Developmental Pediatrics, Indianapolis, IN, USA
| | - John S. Fuqua
- Riley Hospital for Children, Section of Pediatric Endocrinology, Indianapolis, IN, USA
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6
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Mendoza MJ, Gollob SD, Lavado D, Koo BHB, Cruz S, Roche ET, Vela EA. A Vacuum-Powered Artificial Muscle Designed for Infant Rehabilitation. MICROMACHINES 2021; 12:971. [PMID: 34442593 PMCID: PMC8400328 DOI: 10.3390/mi12080971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/26/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022]
Abstract
The majority of soft pneumatic actuators for rehabilitation exercises have been designed for adult users. Specifically, there is a paucity of soft rehabilitative devices designed for infants with upper and lower limb motor disabilities. We present a low-profile vacuum-powered artificial muscle (LP-VPAM) with dimensions suitable for infants. The actuator produced a maximum force of 26 N at vacuum pressures of -40 kPa. When implemented in an experimental model of an infant leg in an antagonistic-agonist configuration to measure resultant knee flexion, the actuator generated knee flexion angles of 43° and 61° in the prone and side-lying position, respectively.
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Affiliation(s)
- Mijaíl Jaén Mendoza
- Department of Mechanical Engineering, Universidad de Ingenieria y Tecnologia—UTEC, Lima 15063, Peru; (M.J.M.); (D.L.)
| | - Samuel Dutra Gollob
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (S.D.G.); (B.H.B.K.)
| | - Diego Lavado
- Department of Mechanical Engineering, Universidad de Ingenieria y Tecnologia—UTEC, Lima 15063, Peru; (M.J.M.); (D.L.)
| | - Bon Ho Brandon Koo
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (S.D.G.); (B.H.B.K.)
| | - Segundo Cruz
- Instituto Nacional de Salud del Niño de San Borja, Lima 15037, Peru;
| | - Ellen T. Roche
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (S.D.G.); (B.H.B.K.)
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Emir A. Vela
- Department of Mechanical Engineering, Universidad de Ingenieria y Tecnologia—UTEC, Lima 15063, Peru; (M.J.M.); (D.L.)
- Research Centre in Bioengineering, Universidad de Ingenieria y Tecnologia—UTEC, Lima 15063, Peru
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7
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Abstract
PURPOSE OF REVIEW To review the advance of maternal--fetal surgery, the research of stem cell transplantation and tissue engineering in prenatal management of fetal meningomyelocele (fMMC). RECENT FINDINGS Advance in the imaging study provides more accurate assessment of fMMC in utero. Prenatal maternal--fetal surgery in fMMC demonstrates favourable postnatal outcome. Minimally invasive fetal surgery minimizes uterine wall disruption. Endoscopic fetal surgery is performed via laparotomy-assisted or entirely percutaneous approach. The postnatal outcome for open and endoscopic fetal surgery shares no difference. Single layer closure during repair of fMMC is preferred to reduce postnatal surgical intervention. All maternal--fetal surgeries impose anesthetic and obstetric risk to pregnant woman. Ruptured of membrane and preterm delivery are common complications. Trans-amniotic stem cell therapy (TRASCET) showed potential tissue regeneration in animal models. Fetal tissue engineering with growth factors and dura substitutes with biosynthetic materials promote spinal cord regeneration. This will overcome the challenge of closure in large fMMC. Planning of the maternal--fetal surgery should adhere to ethical framework to minimize morbidity to both fetus and mother. SUMMARY Combination of endoscopic fetal surgery with TRASCET or tissue engineering will be a new vision to achieve to improve the outcome of prenatal intervention in fMMC.
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8
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Gotha L, Pruthi V, Abbasi N, Kulkarni AV, Church P, Drake JM, Carvalho JCA, Diambomba Y, Thakur V, Ryan G, Van Mieghem T. Fetal spina bifida: What we tell the parents. Prenat Diagn 2020; 40:1499-1507. [PMID: 32692418 DOI: 10.1002/pd.5802] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 06/08/2020] [Accepted: 07/19/2020] [Indexed: 12/20/2022]
Abstract
Worldwide, about 150 000 infants are born with spina bifida yearly, making this condition one of the most common fetal central nervous system anomalies compatible with life. Over the last decade, major changes have been introduced in the prenatal diagnosis and management of spina bifida. In this review, we provide a brief summary of the current management of fetal spina bifida and present essential information that should be provided to expecting parents when their fetus has been diagnosed with spina bifida. This information is focused around common parental questions, as encountered in our typical clinical practice, to facilitate knowledge translation.
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Affiliation(s)
- Lara Gotha
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Vagisha Pruthi
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.,Ontario Fetal Centre, Toronto, Canada
| | - Nimrah Abbasi
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.,Ontario Fetal Centre, Toronto, Canada
| | - Abhaya V Kulkarni
- Ontario Fetal Centre, Toronto, Canada.,Division of Neurosurgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Paige Church
- Department of Pediatrics, Sunnybrook Health Sciences Centre, Holland-Bloorview Kids Rehabilitation Hospital and University of Toronto, Toronto, Canada
| | - James M Drake
- Ontario Fetal Centre, Toronto, Canada.,Division of Neurosurgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Jose C A Carvalho
- Ontario Fetal Centre, Toronto, Canada.,Department of Anesthesia, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Yenge Diambomba
- Ontario Fetal Centre, Toronto, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Varsha Thakur
- Ontario Fetal Centre, Toronto, Canada.,Department of Cardiology, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Greg Ryan
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.,Ontario Fetal Centre, Toronto, Canada
| | - Tim Van Mieghem
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.,Ontario Fetal Centre, Toronto, Canada
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9
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Lobelo F, Muth ND, Hanson S, Nemeth BA. Physical Activity Assessment and Counseling in Pediatric Clinical Settings. Pediatrics 2020; 145:peds.2019-3992. [PMID: 32094289 DOI: 10.1542/peds.2019-3992] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Physical activity plays an important role in children's cardiovascular health, musculoskeletal health, mental and behavioral health, and physical, social, and cognitive development. Despite the importance in children's lives, pediatricians are unfamiliar with assessment and guidance regarding physical activity in children. With the release of the 2018 Physical Activity Guidelines by the US Department of Health and Human Services, pediatricians play a critical role in encouraging physical activity in children through assessing physical activity and physical literacy; providing guidance toward meeting recommendations by children and their families; advocating for opportunities for physical activity for all children in schools, communities, and hospitals; setting an example and remaining physically active personally; advocating for the use of assessment tools and insurance coverage of physical activity and physical literacy screening; and incorporating physical activity assessment and prescription in medical school curricula.
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Affiliation(s)
| | - Natalie D Muth
- Children's Primary Care Medical Group, Carlsbad, California; and
| | - Sara Hanson
- Nutrition and Health Sciences Program, Laney Graduate School and Exercise is Medicine Global Research and Collaboration Center, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Blaise A Nemeth
- American Family Children's Hospital and School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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10
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Panda PK, Mallik KC, Patel R, Barik M. Molecular Basis of Spina Bifida: Recent Advances and Future Prospectives. J Pediatr Neurosci 2019; 14:16-19. [PMID: 31316638 PMCID: PMC6601120 DOI: 10.4103/jpn.jpn_20_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Spina bifida (SB) (spinal neural tube [NT] defects) is basically caused by an abnormality at the closure of the NT. Materials and Methods: Molecular researchers have now got new etiopathogenesis of the defective neural tube closure. Although molecular mechanisms in the SB is really important taxation for further work. We understand through the unique novel mutant responsible genes and modifying genes and included the different molecular aspects of SB from the available tools and databases and excluded the case reports. Statistical Analysis: We use here simple statistics (percentage, mean, median, and average) through the Statistical Package for the Social Sciences (SPSS), version 14, and found P > 0.0001 to be significant. Results: We have reported that the majority of 90% genes are responsible in SB and their associated diseases. These innovative unique patterns of responsible genes attached with the result abnormalities at the neuronal and non neuronal tissues are equally important for the SB and NTC. Conclusion: Our present ideology is aiming to understand the inductive and direct interactions of the downstream target sites among responsible regulating genes (RRGs). It is an unique pattern of genetic roadmap to control and guides the neurulation and may provide further insights into the causes of SB and may help to develop new molecular-targeted therapy (MTT).
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Affiliation(s)
- Prateek Kumar Panda
- Department of Paediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kanhu Charan Mallik
- Department of Radiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ranjankumar Patel
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mayadhar Barik
- Department of Paediatric Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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11
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Schwartz GG, Hillman PR, Omoruyi EV, Mazur LJ. Enuresis and Constipation in a 12-Year-Old. Clin Pediatr (Phila) 2018; 57:121-124. [PMID: 28952347 DOI: 10.1177/0009922816688738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Paul R Hillman
- 1 University of Texas Medical School at Houston, Houston, TX, USA
| | - Emma V Omoruyi
- 1 University of Texas Medical School at Houston, Houston, TX, USA
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12
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Abstract
Myelomeningocele, commonly known as spina bifida, is a birth defect in which the spinal cord does not develop properly due to incomplete closure of the neural tube at 28 days of gestation. With advances in treatment modalities, technologies, and medical knowledge, people with spina bifida in the United States are living well into adulthood. Myelomeningocele management includes life-long comprehensive neurologic, urologic, musculoskeletal, skin, and habilitation management. We describe approaches to the same, with an emphasis on the signs and symptoms of medical urgencies and emergencies of which every pediatrician must be aware.
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Affiliation(s)
- Leslie A Phillips
- Pediatric Rehabilitation Medicine, Children's National Health Systems, Washington, DC
| | - Justin M Burton
- Pediatric Rehabilitation Medicine, Children's National Health Systems, Washington, DC
| | - Sarah Helen Evans
- Pediatric Rehabilitation Medicine, Children's National Health Systems, Washington, DC
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13
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From Wheelchair to Cane: Elective Transtibial Amputations in a Patient with Spina Bifida. Am J Phys Med Rehabil 2015; 94:e107-10. [PMID: 26259056 PMCID: PMC4608485 DOI: 10.1097/phm.0000000000000363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Spina bifida is associated with foot deformities, which may lead to foot ulcers, osteomyelitis, and limb amputation. Calcanectomy and Symes amputations have been reported successful in spina bifida. There is lack of evidence for transtibial amputations. This case describes a 27-yr-old woman with L4 level spina bifida who underwent bilateral transtibial amputations. She ambulated with bilateral ankle foot orthoses and canes until age 22. At age 22, she had bilateral foot reconstructive surgeries complicated by nonunion, ulcerations, and osteomyelitis. She was using a wheelchair by age 25. She had elective bilateral transtibial amputations at age 27 for progressive osteomyelitis. Four weeks after amputations, she was fit with bilateral prostheses. On completion of 2 mos of rehabilitation, she ambulated with a cane. This case demonstrates good functional outcomes after transtibial amputations in a young spina bifida patient. Prosthetic fitting should be considered for similar, previously high functioning spina bifida patients with transtibial amputation(s).
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