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Wachsmuth L, Bieli C, Grehten P, Moehrlen T, Moehrlen U, Bernet V, Hagmann C, Grass B. Sleep-disordered breathing on respiratory polygraphy in neonates with spina bifida. Pediatr Pulmonol 2024. [PMID: 38888157 DOI: 10.1002/ppul.27137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/15/2024] [Accepted: 06/06/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Studies have shown a high prevalence of sleep-disordered breathing (SDB) in children with spina bifida. International standards for regular testing for SDB in this population are lacking. While there are studies investigating the prevalence of SDB in children with spina bifida, there are close to no studies in neonates. AIM AND OBJECTIVE To evaluate if routine respiratory polygraphy (RPG) testing is indicated for neonates with spina bifida and if yes, with what therapeutic consequence. METHODS We conducted a retrospective cohort study of all neonates with spina bifida at the University (Children's) Hospital Zurich after fetal spina bifida repair born between 2017 and 2022, who had undergone at least 1 RPG evaluation during hospitalization on the neonatal ward. RPG were evaluated by a blinded group of experienced pediatric pulmonologists. Based on the neonatal RPG results and pediatric pulmonologist's recommendation for caffeine therapy the spina bifida cohort was divided into two groups. Neonatal baseline RPG and follow-up RPG at the age of the 3 months were evaluated. RESULTS 48 neonates with RPG were included. Compared to the standard values in healthy neonates, the RPG results of this spina bifida cohort showed findings of SDB with central apnea and hypopnea. 22 (45.8%) neonatal RPG evaluations detected central SDB, prompting caffeine therapy. Follow-up RPG conducted after 3 months showed significant improvement of SDB with (almost) no need for continuation of caffeine. CONCLUSION We recommend the implementation of routine RPG testing in neonates with spina bifida to detect SDB and facilitate early targeted treatment.
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Affiliation(s)
- Lorine Wachsmuth
- Division of Intensive Care and Neonatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Christian Bieli
- Department of Pediatric Pulmonology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Patrice Grehten
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Theres Moehrlen
- Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Ueli Moehrlen
- Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - Vera Bernet
- Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Department of Neonatology, Hospital Zollikerberg, Zurich, Switzerland
| | - Cornelia Hagmann
- Division of Intensive Care and Neonatology, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Beate Grass
- Division of Intensive Care and Neonatology, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Newborn Research, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Pontiggia L, Michalak-Micka K, Hürlimann N, Yosef HK, Böni R, Klar AS, Ehrbar M, Ochsenbein-Kölble N, Biedermann T, Moehrlen U. Raman spectroscopy analysis of human amniotic fluid cells from fetuses with myelomeningocele. Exp Cell Res 2024; 439:114048. [PMID: 38697275 DOI: 10.1016/j.yexcr.2024.114048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 05/04/2024]
Abstract
Prenatal surgery for the treatment of spina bifida (myelomeningocele, MMC) significantly enhances the neurological prognosis of the patient. To ensure better protection of the spinal cord by large defects, the application of skin grafts produced with cells gained from the amniotic fluid is presently studied. In order to determine the most appropriate cells for this purpose, we tried to shed light on the extremely complex amniotic fluid cellular composition in healthy and MMC pregnancies. We exploited the potential of micro-Raman spectroscopy to analyse and characterize human amniotic fluid cells in total and putative (cKit/CD117-positive) stem cells of fetuses with MMC in comparison with amniotic fluid cells from healthy individuals, human fetal dermal fibroblasts and adult adipose derived stem cells. We found that (i) the differences between healthy and MMC amniocytes can be attributed to specific spectral regions involving collagen, lipids, sugars, tryptophan, aspartate, glutamate, and carotenoids, (ii) MMC amniotic fluid contains two particular cell populations which are absent or reduced in normal pregnancies, (iii) the cKit-negative healthy amniocyte subpopulation shares molecular features with human fetal fibroblasts. On the one hand we demonstrate a different amniotic fluid cellular composition in healthy and MMC pregnancies, on the other our work confirms micro-Raman spectroscopy to be a valuable tool for discriminating cell populations in unknown mixtures of cells.
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Affiliation(s)
- Luca Pontiggia
- Tissue Biology Research Unit, Department of Pediatric Surgery, University Children's Hospital Zurich, 8032, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, 8032, Zurich, Switzerland
| | - Katarzyna Michalak-Micka
- Tissue Biology Research Unit, Department of Pediatric Surgery, University Children's Hospital Zurich, 8032, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, 8032, Zurich, Switzerland
| | - Nadine Hürlimann
- Tissue Biology Research Unit, Department of Pediatric Surgery, University Children's Hospital Zurich, 8032, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, 8032, Zurich, Switzerland
| | | | - Roland Böni
- White House Center for Liposuction, Zurich, Switzerland
| | - Agnes S Klar
- Tissue Biology Research Unit, Department of Pediatric Surgery, University Children's Hospital Zurich, 8032, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, 8032, Zurich, Switzerland; University of Zurich, 8091, Zurich, Switzerland
| | - Martin Ehrbar
- Zurich Center for Fetal Diagnosis and Treatment, 8032 Zurich, Switzerland; University of Zurich, 8091, Zurich, Switzerland; Department of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | - Nicole Ochsenbein-Kölble
- Zurich Center for Fetal Diagnosis and Treatment, 8032 Zurich, Switzerland; Department of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | - Thomas Biedermann
- Tissue Biology Research Unit, Department of Pediatric Surgery, University Children's Hospital Zurich, 8032, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, 8032, Zurich, Switzerland; University of Zurich, 8091, Zurich, Switzerland
| | - Ueli Moehrlen
- Tissue Biology Research Unit, Department of Pediatric Surgery, University Children's Hospital Zurich, 8032, Zurich, Switzerland; Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland; Zurich Center for Fetal Diagnosis and Treatment, 8032 Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, 8032, Zurich, Switzerland; University of Zurich, 8091, Zurich, Switzerland.
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Peiffer S, Gyimah M, Powell P, Lepard JR, King C, Passoni N, Whitehead WE, King A. Characteristics and Outcomes of Patients With Spina Bifida in Texas by Patient Age. J Surg Res 2024; 300:231-240. [PMID: 38824853 DOI: 10.1016/j.jss.2024.05.001] [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: 12/01/2023] [Revised: 03/20/2024] [Accepted: 05/03/2024] [Indexed: 06/04/2024]
Abstract
INTRODUCTION Spina bifida (SB) occurs in 3.5/10,000 live births and is associated with significant long-term neurologic and urologic morbidity. We explored the characteristics and outcomes of pediatric patients with SB and the facilities that treat them in Texas. METHODS We retrospectively reviewed a statewide hospital inpatient discharge database (2013-2021) to identify patients aged <18 y with SB using International Classification of Diseases 9/10 codes. Patients transferred to outside hospitals were excluded to avoid double-counting. Descriptive statistics and chi-square test were performed. RESULTS Seven thousand five hundred thirty one inpatient hospitalizations with SB were analyzed. Most SB care is provided by a few facilities. Two facilities (1%) averaged >100 SB admissions per year (33% of patients), while 15 facilities (8%) treat 10-100 patients per year (51% of patients). Most facilities (145/193, 75%) average less than one patient per year. Infants tended to be sicker (17% extreme illness severity, P < 0.001). Overall mortality is low (1%), primarily occurring in the neonatal period (8%, P < 0.001). Most admissions are associated with surgical intervention, with 63% of encounters having operating room charges with an average cost of $25,786 ± 24,884. Admissions for spinal procedures were more common among infants, whereas admissions for genitourinary procedures were more common among older patients (P < 0.001). The average length of stay was 8 ± 16 d with infants having the longest length of stay (19 ± 33, P < 0.001). CONCLUSIONS Patients have significant long-term health needs with evolving pediatric surgical indications as they grow. Pediatric SB care is primarily provided by a small number of facilities in Texas. Longitudinal care coordination of their multidisciplinary surgical care is needed to optimize patient care.
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Affiliation(s)
- Sarah Peiffer
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Mike Gyimah
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Paulina Powell
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Jacob R Lepard
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; Department of Neurosurgery, Texas Children's Hospital, Houston, Texas; Department of Neurosurgery, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Cyrus King
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Niccolo Passoni
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas; Department of Urology, Texas Children's Hospital, Houston, Texas
| | - William E Whitehead
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; Department of Neurosurgery, Texas Children's Hospital, Houston, Texas
| | - Alice King
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas.
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Levy S, Dequirez PL, Mercier J, Taha F, Goujon A, Seguier D, Mesnard B, Seizilles de Mazancourt E, Joussen G, Margue G, Berchiche W, Anastay V, Deleuze C, Kaulanjan K, Cotte J, Peyrottes A, Gamé X, Peyronnet B. [Current state of knowledge of urology residents and fellows on the neuro-urological management of spina bifida patients in France]. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102580. [PMID: 38417189 DOI: 10.1016/j.fjurol.2024.102580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/04/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To assess the current knowledge of French urology residents and fellows about neurogenic lower urinary tract dysfunction and their management in patients with spina bifida. MATERIAL AND METHOD A 7-question questionnaire, covering the responder's experience and the various stages in the neuro-urological management of spina bifida, was drafted by an expert urologist. Responses were collected within 5days of being e-mailed to members of the Association française des urologues en formation (AFUF), and a descriptive analysis was carried out. RESULTS Of the 448 members, 155 completed the questionnaire. Of the participants, 83.8% said they knew the definition of spina bifida, and 76.8% had already had to care for a spina bifida patient. Of the participants, 48.4% correctly estimated the number of spina bifida patients in France. Neurogenic lower urinary tract dysfunction to look for and the specificities of management seemed to have been acquired by a majority of respondents (correct response rates of 70.7% and 75.4%, respectively), unlike the extra-urological aspects (53.9%), and the choice of examinations useful for the initial work-up and follow-up (55.8%). CONCLUSION While the expected neurogenic lower urinary tract dysfunction and the specificities of therapeutic management of spina bifida patients appear to be well known to urologists in training, knowledge of extra-urological symptoms and the choice of examinations could be improved. These results could be used to adjust the teaching given to French urologists in training on the urological management of spina bifida patients. LEVEL OF EVIDENCE Grade 4.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Juliette Cotte
- Hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, université Paris Cité, Paris, France
| | - Arthur Peyrottes
- Hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, université Paris Cité, Paris, France
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Hoxha M, Malaj V, Zappacosta B, Firza N. Pharmacoeconomic Evaluation of Costs of Myelomeningocele and Meningocele Treatment and Screening. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:69-80. [PMID: 38352115 PMCID: PMC10863461 DOI: 10.2147/ceor.s443120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/18/2024] [Indexed: 02/16/2024] Open
Abstract
Background The prevention of myelomeningocele (MMC) and meningocele (MC) is a public health concern. A systematic review on economic factors associated with MMC and MC can help the policy makers to evaluate the cost-effectiveness of screening and treatment. To our knowledge, this is the first systematic review to provide up-to date pharmacoeconomic evidence of all economic studies present in literature on different aspects of MMC and MC. Methods We searched in the National Health Service Economic Evaluation Database (NHSEED), PubMed, Cost-effectiveness Analysis Registry (CEA Registry), Centre for Reviews and Dissemination (CRD), Health Technology Assessment Database (HTAD), Cochrane Library, and Econlit. The PRISMA guidelines were followed in the search and evaluation of literature. Only articles in English not limited by the year of publication that fulfilled the eligibility criteria were included in this systematic review. Results Nineteen papers were included in the study. The studies were very heterogeneous and reported a comparison of the costs between prenatal versus postnatal repair, the cost of fetoscopic approach versus open surgery, the cost of ventriculoperitoneal shunting (VPS) versus endoscopic third ventriculostomy (ETV), and ETV with choroid plexus cauterization (ETV/CPC), the cost of hospitalization, and the cost of diagnosis for MMC. Conclusion The results of this study can help in implementing new policies in different countries to assist MC and MMC patients with the cost of treatment and screening.
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Affiliation(s)
- Malvina Hoxha
- Department of Chemical-Toxicological and Pharmacological Evaluation of Drugs, Catholic University Our Lady of Good Counsel, Tirana, Albania
| | - Visar Malaj
- Department of Economics, University of Tirana, Tirana, Albania
- CERGE-EI, Center for Economic Research and Graduate Education-Economics Institute, Prague, Czech Republic
| | - Bruno Zappacosta
- Department of Chemical-Toxicological and Pharmacological Evaluation of Drugs, Catholic University Our Lady of Good Counsel, Tirana, Albania
| | - Najada Firza
- Department of Economics and Finance, University of Bari ”Aldo Moro”, Bari, Italy
- Department of Economics and Business, Catholic University Our Lady of Good Counsel, Tirana, Albania
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6
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Karataş ME, Bayram Y, Şafak H, Kar İ, Sağlam N, Uçar BY. Kyphectomy and sliding growing rod technique in patients with congenital lumbar kyphosis deformity with myelomeningocele. J Orthop Surg Res 2024; 19:114. [PMID: 38308272 PMCID: PMC10837965 DOI: 10.1186/s13018-024-04577-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/23/2024] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVE Neural tube defects are the most common congenital disorders after cardiac anomalies. Lumbar kyphosis deformity is observed in 8-15% of these patients. This deformity severely limits the daily lives of these patients. In our study, we aimed to correct the kyphosis angle of the patients with lumbar kyphosis associated with myelomeningocele (MMC) and allow them to continue their growth without limiting their lung capacity by applying kyphectomy and sliding growing rod technique. PATIENTS AND METHODS In this study, we retrospectively evaluated 24 patients with congenital lumbar kyphosis deformity associated with MMC, aged between 4 and 9 years, and who applied to Umraniye Training and Research Hospital between the dates of 2018 and 2021. We evaluated preoperative and postoperative kyphosis angles, correction rates, bleeding during operations, operation time, level of instrumentation, number of the resected vertebrae, initial levels of the posterior defects, duration of hospital stays, annual lengthening, and weight of the patients. RESULTS Mean age was 5.04 (between 4 and 9). Mean preoperative and early postoperative kyphosis angles were 129.8° (87-175°) and 0.79° (- 20-24°), respectively. The kyphotic deformity correction rate was 99.1%. A difference was found regarding kyphosis measurements between preoperative and early period values (p < 0.05). The annual height lengthening of patients was calculated as 0.74 cm/year and 0.77 cm/year between T1-T12 and T1-S1, respectively. Mean preoperative level of hemoglobin (Hgb) was 11.95, postoperative Hgb value was 10.02, and the decrease was significant (p < 0.05). In terms of complications, 50% (12) had broken/loosen screws, 50% (12) had undergone debridement surgery, 37.5% (9) had vacuum-assisted closure therapy, and 33.3% (8) had to get all of their implants removed. CONCLUSION We believe that our sliding growing rod technique is a new and updated surgical method that can be applied in these patient groups, facilitating the life, rehabilitation process, and daily care of MMC patients with lumbar kyphosis. This technique seems to be a safe and reliable method which preserves lung capacity and allows lengthening.
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Affiliation(s)
- Muhammed Enes Karataş
- Department of Orthopaedics and Traumatology, Kartal Dr.Lütfi Kırdar City Hospital, Istanbul, Turkey.
| | - Yusuf Bayram
- Department of Orthopaedics and Traumatology, Hisar İntercontinental Hospital, Istanbul, Turkey
| | - Halid Şafak
- Department of Orthopaedics and Traumatology, Gumushane State Hospital, Istanbul, Turkey
| | - İlyas Kar
- Department of Orthopaedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Necdet Sağlam
- Department of Orthopaedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Bekir Yavuz Uçar
- Department of Orthopaedics and Traumatology, Istanbul Medipol University, Istanbul, Turkey
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Yiğit H, Güler H, Yılmaz H, Gümü ÜÖ, Karaman ZF, Güneş T. Effect of cervical and lumbosacral spina bifida cystica on volumes of intracranial structures in children. Childs Nerv Syst 2024; 40:527-535. [PMID: 37698650 DOI: 10.1007/s00381-023-06153-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE Spina bifida is a major disorder that occurs when the membranes of the spinal cord and medulla fail to close during the embryonic period and affects the individual for the rest of life. Some physical, mental, and social difficulties can be observed in the lives of children with spina bifida after surgery. The aim of this study is to determine what kind of volumetric changes occur in the brain when spina bifida occurs in different regions of the cord. METHODS The volume of intracranial structures of 14 children aged 1 to 9 years (7 cervical, 7 lumbosacral) with different levels of spina bifida compared with vol2Brain. RESULTS Spina bifida occurring in the cervical region was found to cause a greater volumetric reduction in subcortical structures, cortex and gyrus than spina bifida occurring in the lumbosacral region. CONCLUSION We believe that our study will help clinicians involved in the management of this disorder.
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Affiliation(s)
- Hüseyin Yiğit
- Cappadocia Vocational School, Department of Medical Services and Techniques, Cappadocia University, Nevsehir, Turkey.
| | - Hatice Güler
- Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Halil Yılmaz
- Department of Anatomy, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Ümmügülsüm Özgül Gümü
- Department of Pediatric Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Zehra Filiz Karaman
- Department of Pediatric Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Tamer Güneş
- Department of Child Health and Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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8
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Gilbertson KE, Liu T, Wiener JS, Walker WO, Smith K, Castillo J, Castillo H, Wilson P, Peterson P, Clayton GH, Valdez R. Age-Specific Probability of 4 Major Health Outcomes in Children with Spina Bifida. J Dev Behav Pediatr 2023; 44:e633-e641. [PMID: 37816172 PMCID: PMC10926062 DOI: 10.1097/dbp.0000000000001218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/28/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVE This study aimed to estimate the age-specific probability of 4 health outcomes in a large registry of individuals with spina bifida (SB). METHODS The association between age and 4 health outcomes was examined in individuals with myelomeningocele (MMC, n = 5627) and non-myelomeningocele (NMMC, n = 1442) from the National Spina Bifida Patient Registry. Sixteen age categories were created, 1 for each year between the ages of 5 and 19 years and 1 for those aged 20 years or older. Generalized linear models were used to calculate the adjusted probability and 95% prediction intervals of each outcome for each age category, adjusting for sex and race/ethnicity. RESULTS For the MMC and NMMC groups, the adjusted coefficients for the correlation between age and the probability of each outcome were -0.933 and -0.657 for bladder incontinence, -0.922 and -0.773 for bowel incontinence, 0.942 and 0.382 for skin breakdown, and 0.809 and 0.619 for lack of ambulation, respectively. CONCLUSION In individuals with SB, age is inversely associated with the probability of bladder and bowel incontinence and directly associated with the probability of skin breakdown and lack of ambulation. The estimated age-specific probabilities of each outcome can help SB clinicians estimate the expected proportion of patients with the outcome at specific ages and explain the probability of the occurrence of these outcomes to patients and their families.
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Grants
- U01DD001279 ACL HHS
- U01 DD001268 NCBDD CDC HHS
- U01 DD001279 NCBDD CDC HHS
- U01DD001093 ACL HHS
- U01DD001062 ACL HHS
- U01 DD001057 NCBDD CDC HHS
- U01DD001280 ACL HHS
- U01 DD001275 NCBDD CDC HHS
- U01DD001272 ACL HHS
- DD000738, DD000740, DD000743, DD000774, DD001057, DD001062, DD001065, DD001093, DD001235, DD001237, DD001240, DD001262, DD001265, DD001266, DD001268, DD001270, DD001272, DD001274, DD001275, DD001278, DD001279, and DD001280. CDC HHS
- U01DD001057 ACL HHS
- U01 DD000738 NCBDD CDC HHS
- U01DD001065 ACL HHS
- U01 DD001280 NCBDD CDC HHS
- U01DD001235 ACL HHS
- U01 DD001235 NCBDD CDC HHS
- U01DD001268 ACL HHS
- U01DD001275 ACL HHS
- U01 DD001093 NCBDD CDC HHS
- U01DD001240 ACL HHS
- U01 DD001278 NCBDD CDC HHS
- U01DD001270 ACL HHS
- U01DD001274 ACL HHS
- U01 DD000740 NCBDD CDC HHS
- U01DD001266 ACL HHS
- U01 DD000774 NCBDD CDC HHS
- CC999999 Intramural CDC HHS
- U01 DD001265 NCBDD CDC HHS
- U01 DD001062 NCBDD CDC HHS
- U01 DD001240 NCBDD CDC HHS
- U01 DD001274 NCBDD CDC HHS
- U01 DD001270 NCBDD CDC HHS
- U01 DD001065 NCBDD CDC HHS
- U01 DD000743 NCBDD CDC HHS
- U01DD001265 ACL HHS
- U01 DD001266 NCBDD CDC HHS
- U01 DD001272 NCBDD CDC HHS
- U01DD001278 ACL HHS
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Affiliation(s)
- Kendra E. Gilbertson
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Chamblee, GA
| | - Tiebin Liu
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Chamblee, GA
| | - John S. Wiener
- Division of Pediatric Urology, Department of Urology, Duke University School of Medicine, Durham, NC
| | - William O. Walker
- Department of Pediatrics, Division of Developmental Medicine, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, WA
| | - Kathryn Smith
- Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jonathan Castillo
- Developmental Pediatrics, Department of Pediatrics, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX
| | - Heidi Castillo
- Developmental Pediatrics, Department of Pediatrics, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX
| | - Pamela Wilson
- Department of Rehabilitation and Therapy, Children’s Hospital Colorado, Aurora, CO
| | - Paula Peterson
- Brain and Spine Center, Primary Children’s Hospital, Salt Lake City, UT
| | - Gerald H. Clayton
- Department of Rehabilitation and Therapy, Children’s Hospital Colorado, Aurora, CO
| | - Rodolfo Valdez
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Chamblee, GA
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Rocchi M, Jarl J, Lundkvist Josenby A, Alriksson-Schmidt AI. Survival and causes of death in adults with spina bifida in Sweden: a population-based case-control study. J Rehabil Med 2023; 55:jrm18244. [PMID: 38010218 PMCID: PMC11064288 DOI: 10.2340/jrm.v55.18244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/26/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE To analyse survival rates and causes of death in adults with spina bifida in Sweden compared with a matched control group. DESIGN AND METHODS This population-based study included 11,900 adults born between 1950 and 1997. Three national Swedish registers were used to identify individuals with a diagnosis of spina bifida and a matched control group without spina bifida in the period 1990-2015. International Classification of Diseases codes were used to identify causes of death. Survival analysis was conducted and causes of death in the 2 groups were compared. RESULTS There was a lower probability of survival for people with spina bifida in all age groups (p < 0.001) compared with the control group. The most prevalent causes of death in people with spina bifida were congenital, respiratory, nervous, cardiovascular, genitourinary, and injuries. People with spina bifida had a higher probability of dying from congenital (p < 0.001), respiratory (p = 0.002), genitourinary (p < 0.002), and nervous-related (p < 0.001) and lower probability of injury-related deaths (p < 0.001). CONCLUSION Adults with spina bifida in Sweden have a lower survival rate compared with the general population, with the frequency of certain causes of death differing between the two groups. In order to reduce excess premature mortality, prevention and careful management of potentially fatal conditions are essential throughout a patient's lifespan.
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Affiliation(s)
- Melinda Rocchi
- Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.
| | - Johan Jarl
- Health Economics, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Annika Lundkvist Josenby
- Department of Health Sciences, Lund University, Lund, Sweden; Children's Hospital, Skåne University Hospital, Lund, Sweden
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10
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Chen Y, Su D, Sun X, Gui W. Open spina bifida characterisation in a dog foetus. Vet Med Sci 2023; 9:2452-2457. [PMID: 37705413 PMCID: PMC10650236 DOI: 10.1002/vms3.1266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/07/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Open spina bifida is an uncommon malformation in animals, and there is a lack of imaging, clinical, and pathological characterisation of this condition in dogs. OBJECTIVE Open spina bifida is rarely observed in animals due to high levels of perinatal mortality and frequent euthanasia. To the best of our knowledge, we present the first case of spina bifida in a dog was diagnosed in-utero and then followed post-partum. METHODS A 3-year-old Poodle was presented with twin pregnancy. Radiographic and ultrasonographic findings were suggestive of vertebral malformation and open spina bifida with myelomeningocele in one foetus. Conservative treatment was given but the puppy died 3 days after birth. Thereafter, anatomical and histopathological analysis of several organs was performed to characterise the disease. RESULTS When the twins were born, one puppy had a linear dorsal midline cutaneous defect extending from the level of vertebrae L2-L6. R Radiographic examination showed several congenital vertebral malformations involving the thoracic segment, lumbar segment, sacrum and scapula. Histopathological examinations confirmed the presence of open spina bifida and identified additional abnormalities in several internal organs. CONCLUSIONS This case presents a complete characterisation of open spina bifida, before birth and after death, using imaging and histopathology techniques.
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Affiliation(s)
- Yue Chen
- Chengdu Bio‐HT Company LimitedChengduSichuanChina
| | - Dan Su
- Chengdu Bio‐HT Company LimitedChengduSichuanChina
| | - Xiaorong Sun
- Chengdu Bio‐HT Company LimitedChengduSichuanChina
| | - Wenjuan Gui
- General Hospital of Ningxia Medical UniversityYinchuanNingxiaChina
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11
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Verkhratsky A, Butt A, Li B, Illes P, Zorec R, Semyanov A, Tang Y, Sofroniew MV. Astrocytes in human central nervous system diseases: a frontier for new therapies. Signal Transduct Target Ther 2023; 8:396. [PMID: 37828019 PMCID: PMC10570367 DOI: 10.1038/s41392-023-01628-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 10/14/2023] Open
Abstract
Astroglia are a broad class of neural parenchymal cells primarily dedicated to homoeostasis and defence of the central nervous system (CNS). Astroglia contribute to the pathophysiology of all neurological and neuropsychiatric disorders in ways that can be either beneficial or detrimental to disorder outcome. Pathophysiological changes in astroglia can be primary or secondary and can result in gain or loss of functions. Astroglia respond to external, non-cell autonomous signals associated with any form of CNS pathology by undergoing complex and variable changes in their structure, molecular expression, and function. In addition, internally driven, cell autonomous changes of astroglial innate properties can lead to CNS pathologies. Astroglial pathophysiology is complex, with different pathophysiological cell states and cell phenotypes that are context-specific and vary with disorder, disorder-stage, comorbidities, age, and sex. Here, we classify astroglial pathophysiology into (i) reactive astrogliosis, (ii) astroglial atrophy with loss of function, (iii) astroglial degeneration and death, and (iv) astrocytopathies characterised by aberrant forms that drive disease. We review astroglial pathophysiology across the spectrum of human CNS diseases and disorders, including neurotrauma, stroke, neuroinfection, autoimmune attack and epilepsy, as well as neurodevelopmental, neurodegenerative, metabolic and neuropsychiatric disorders. Characterising cellular and molecular mechanisms of astroglial pathophysiology represents a new frontier to identify novel therapeutic strategies.
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Affiliation(s)
- Alexei Verkhratsky
- International Joint Research Centre on Purinergic Signalling/School of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
- Department of Forensic Analytical Toxicology, School of Forensic Medicine, China Medical University, Shenyang, China.
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
- Achucarro Centre for Neuroscience, IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.
- Department of Stem Cell Biology, State Research Institute Centre for Innovative Medicine, LT-01102, Vilnius, Lithuania.
| | - Arthur Butt
- Institute of Biomedical and Biomolecular Sciences, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Baoman Li
- Department of Forensic Analytical Toxicology, School of Forensic Medicine, China Medical University, Shenyang, China
| | - Peter Illes
- International Joint Research Centre on Purinergic Signalling/School of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Rudolf Boehm Institute for Pharmacology and Toxicology, University of Leipzig, 04109, Leipzig, Germany
| | - Robert Zorec
- Celica Biomedical, Lab Cell Engineering, Technology Park, 1000, Ljubljana, Slovenia
- Laboratory of Neuroendocrinology-Molecular Cell Physiology, Institute of Pathophysiology, University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - Alexey Semyanov
- Department of Physiology, Jiaxing University College of Medicine, 314033, Jiaxing, China
| | - Yong Tang
- International Joint Research Centre on Purinergic Signalling/School of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
- Key Laboratory of Acupuncture for Senile Disease (Chengdu University of TCM), Ministry of Education/Acupuncture and Chronobiology Key Laboratory of Sichuan Province, Chengdu, China.
| | - Michael V Sofroniew
- Department of Neurobiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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12
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Leach GA, Pflibsen LR, Roberts AD, O'Connor MJ, Bristol RE, Mabee MK, Almader-Douglas D, Schaub TA. Meningomyelocele Reconstruction: Comparison of Repair Methods via Systematic Review. J Craniofac Surg 2023; 34:2040-2045. [PMID: 37622546 DOI: 10.1097/scs.0000000000009675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
PURPOSE The purpose of this article was to appraise the various methods of reconstruction for meningomyelocele (MMC) defects. METHODS A systematic review of the literature was performed to evaluate all reconstructions for MMC. The method of reconstruction was categorized by: primary closure with and without fascial flaps, random pattern flaps, VY advancement flaps (VY), perforator flaps, and myocutaneous flaps. Perforator flaps were subsequently subcategorized based on the type of flap. RESULTS Upon systematic review, 567 articles were screened with 104 articles assessed for eligibility. Twenty-nine articles were further reviewed and included for qualitative synthesis. Two hundred seventy patients underwent MMC repair. The lowest rates of major wound complications (MWC) were associated with myocutaneous and random pattern flaps. A majority of MWC was in the lumbrosacral/sacral region (87.5% of MWC). In this region, random patterns and perforator flaps demonstrated the lowest rate of MWC (4.5, 8.1%). CONCLUSIONS Plastic surgery consultation should be strongly considered for MMC with defects in the lumbosacral/sacral region. Perforator flaps are excellent options for the reconstruction of these defects.
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Affiliation(s)
- Garrison A Leach
- Department of Surgery, Division of Plastic Surgery, University of California San Diego, San Diego, CA
| | - Lacey R Pflibsen
- Department of Surgery, Division of Plastic Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | | | | | - Ruth E Bristol
- Division of Neurosurgery, Barrow Neurological Institute, Phoenix Children's Hospital
| | | | - Diana Almader-Douglas
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic Arizona, Phoenix, AZ
| | - Timothy A Schaub
- Department of Surgery, Division of Plastic Surgery, Mayo Clinic Arizona, Phoenix, AZ
- Division of Plastic Surgery, Phoenix Children's Hospital
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Çinar Yusuf B, Uzun C, Alagöz MŞ. Re: El-Shaier M, Abdelhamid MS, Abdelaal M, Abdel-Tawab M, Morsy A, Askalany A. A New Dissection Ladder Approach for Perforator Vessels in Infant Meningomyelocele Soft Tissue Reconstruction. Ann Plast Surg 2022;89(6):e31-e38. Ann Plast Surg 2023; 91:503. [PMID: 37556570 DOI: 10.1097/sap.0000000000003654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
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14
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Liwinski T, Lang UE. Folate and Its Significance in Depressive Disorders and Suicidality: A Comprehensive Narrative Review. Nutrients 2023; 15:3859. [PMID: 37686891 PMCID: PMC10490031 DOI: 10.3390/nu15173859] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/21/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Depressive disorders pose significant challenges to global public health, necessitating effective prevention and management strategies. Notably, the occurrence of suicide frequently coincides with depressive episodes. Suicide is as a paramount global health concern that demands efficacious preventive strategies. Current psychiatric approaches heavily rely on pharmacological interventions but have had limited success in addressing the global burden of mental health issues. Suboptimal nutrition, with its impact on the neuroendocrine system, has been implicated in the underlying pathology of depressive disorders. Folate, a group of water-soluble compounds, plays a crucial role in various central nervous system functions. Depressed individuals often exhibit low levels of serum and red blood cell folate. Multiple studies and systematic reviews have investigated the efficacy of folic acid and its derivative, L-methylfolate, which can cross the blood-brain barrier, as stand-alone or adjunct therapies for depression. Although findings have been mixed, the available evidence generally supports the use of these compounds in depressed individuals. Recent studies have established links between the one-carbon cycle, folate-homocysteine balance, immune system function, glutamate excitation via NMDA (N-methyl-D-aspartate) receptors, and gut microbiome eubiosis in mood regulation. These findings provide insights into the complex neurobiological mechanisms underlying the effects of folate and related compounds in depression. Through a comprehensive review of the existing literature, this study aims to advance our understanding of the therapeutic potential of folic acid and related compounds in depression treatment. It also seeks to explore their role in addressing suicidal tendencies and shed light on the neurobiological mechanisms involved, leveraging the latest discoveries in depression research.
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Affiliation(s)
- Timur Liwinski
- Clinic for Adult Psychiatry, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland;
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15
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Domínguez-Muñoz A, De La Torre L, Santos-Jasso K, Schneider L, Merritt A, Wickham M, Ketzer J, Rodriguez V, Peña A, Bischoff A. Identifying predictive factors for bowel control in patients with spina bifida and spinal cord injuries. Pediatr Surg Int 2023; 39:231. [PMID: 37432519 DOI: 10.1007/s00383-023-05509-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE This study aimed to assess our bowel management program (BMP) and identify predictive factors for bowel control in patients with Spina Bifida (SB) and Spinal Cord Injuries (SCI). Additionally, in patients with SB, we examined the impact of fetal repair (FRG) on bowel control. METHODS We included all patients with SB and SCI seen in the Multidisciplinary Spinal Defects Clinic at Children's Hospital Colorado from 2020 to 2023. RESULTS 336 patients included. Fecal incontinence was present in 70% and bowel control in 30%. All patients with urinary control also had bowel control. Fecal incontinence prevalence was higher in patients with ventriculoperitoneal (VP) shunt (84%), urinary incontinence (82%), and wheelchair users (79%) compared to those who did not need a VP shunt (56%), had urinary continence (0%) and non-wheelchair users (52%), respectively (p = < 0.001 in all three scenarios). After completing BMP, 90% remained clean for stool. There was no statistical significance when comparing bowel control in FRG with non-fetal repair group. CONCLUSIONS Urinary continence predicts bowel control in patients with SB and SCI. Risk factors for fecal incontinence were the need for a VP shunt, urinary incontinence, and wheelchair usage. We did not find any positive impact of fetal repair on bowel and urinary control.
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Affiliation(s)
- Alfredo Domínguez-Muñoz
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, Department of Surgery, School of Medicine, Anschutz Medical Campus, University of Colorado, 13213 E 16th Ave, Box 323, Aurora, CO, 80045, USA
| | - Luis De La Torre
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, Department of Surgery, School of Medicine, Anschutz Medical Campus, University of Colorado, 13213 E 16th Ave, Box 323, Aurora, CO, 80045, USA
| | - Karla Santos-Jasso
- Deptartment of General Pediatric Surgery, Instituto Nacional de Pediatría, Insurgentes Sur 3700 C, Colonia Insurgentes Cuicuilco, Delegación Coyoacán, 04530, Ciudad de Mexico, CP, Mexico
| | - Lauren Schneider
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, Department of Surgery, School of Medicine, Anschutz Medical Campus, University of Colorado, 13213 E 16th Ave, Box 323, Aurora, CO, 80045, USA
| | - Anne Merritt
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, Department of Surgery, School of Medicine, Anschutz Medical Campus, University of Colorado, 13213 E 16th Ave, Box 323, Aurora, CO, 80045, USA
| | - Maura Wickham
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, Department of Surgery, School of Medicine, Anschutz Medical Campus, University of Colorado, 13213 E 16th Ave, Box 323, Aurora, CO, 80045, USA
| | - Jill Ketzer
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, Department of Surgery, School of Medicine, Anschutz Medical Campus, University of Colorado, 13213 E 16th Ave, Box 323, Aurora, CO, 80045, USA
| | - Victor Rodriguez
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, Department of Surgery, School of Medicine, Anschutz Medical Campus, University of Colorado, 13213 E 16th Ave, Box 323, Aurora, CO, 80045, USA
| | - Alberto Peña
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, Department of Surgery, School of Medicine, Anschutz Medical Campus, University of Colorado, 13213 E 16th Ave, Box 323, Aurora, CO, 80045, USA
| | - Andrea Bischoff
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, Department of Surgery, School of Medicine, Anschutz Medical Campus, University of Colorado, 13213 E 16th Ave, Box 323, Aurora, CO, 80045, USA.
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16
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Xu Z, Zhu M, Jiang W, Zhang T, Ma M, Shi F. A simple synthesis method of microsphere immunochromatographic test strip for time-resolved luminescence detection of folic acid. Food Chem 2023; 413:135599. [PMID: 36750007 DOI: 10.1016/j.foodchem.2023.135599] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/11/2022] [Accepted: 01/28/2023] [Indexed: 02/01/2023]
Abstract
Folic acid (FA) is an ingredient that must be added to infant milk powder to avoid potential defects. Rapid, sensitive and reliable detection methods are needed to determined FA addition levels. Thus, this study established a microsphere immunochromatographic test strip for time-resolved luminescence detection (TRLM-ICTS) based on carboxyl-functionalized time-resolved luminescent microspheres (Eu-TRLMs) prepared by a one-step method as fluorescent markers for the immediate quantitative detection of FA in milk powder. Eu-TRLMs prepared by the one-step method showed good dispersion, high stability and strong fluorescence intensity, which is improving the sensitivity of TRLM-ICTS. In the performance evaluation of TRLM-ICTS, the detection limit was 0.487 ng mL-1, the recovery rate was 97.3-105 %, and the actual sample detection results were in line with those of UPLC-MS/MS. TRLM-ICTS has the advantages of rapid, high sensitivity and strong specificity and could as a practical quantitative detection method for the detection of FA in milk powder.
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Affiliation(s)
- Zhihua Xu
- College of Life Science, Shihezi University, Shihezi 832003, China
| | - Mingsong Zhu
- College of Biological Science and Medical Engineering, Southeast University, Nanjing 214135, China
| | - Wenxuan Jiang
- College of Life Science, Shihezi University, Shihezi 832003, China
| | - Tieying Zhang
- College of Life Science, Shihezi University, Shihezi 832003, China
| | - Mingze Ma
- College of Life Science, Shihezi University, Shihezi 832003, China
| | - Feng Shi
- College of Life Science, Shihezi University, Shihezi 832003, China.
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17
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Oliveira RTC, Dantas DB, de Andrade EM, de Gouveia Affonso MV, de Marin ABR, de Campos Gomes F, Gonçalves NV, de Melo-Neto JS. Influence of social, demographic, and clinical factors in live births with spinal dysraphism in Brazil: an ecological study of 21 years. Childs Nerv Syst 2023; 39:1773-1782. [PMID: 36609513 DOI: 10.1007/s00381-022-05779-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This study aimed to verify possible associations between sociodemographic and clinical factors in live births with spinal dysraphism. METHODS An analytical (descriptive and inferential) and ecological study was carried out based on secondary data of 11,308 live births with spinal dysraphism registered in the Live Birth Information System (SINASC) in Brazil from 1999 to 2019. Demographic factors analyzed were age, education, mothers' marital status and geographic region. The clinical factors analyzed were duration, gestation period, birthweight, and number of prenatal visits performed by women who underwent medical follow-up. RESULTS There was an increase in the number of cases of spinal dysraphism in recent years in Brazil with an annual percentage variation of 3.52%. However, the period from 2005 to 2009 showed a reduction in live births with spinal dysraphism. The regions with the highest incidence were the South and Southeast. The risk increased in mothers born after 1980, older than 30 years and with a high level of education. The risk was increased in live births of whites and blacks, born from double pregnancy and with body weight less than 3000 g. The absence of prenatal care was associated with a higher incidence. CONCLUSION Sociodemographic and clinical factors have specific characteristics that can predict spinal dysraphism in newborns in Brazil.
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Affiliation(s)
- Raissa Tereza Casseb Oliveira
- Urogenital System Clinical and Experimental Research Unit (UPCEURG), Federal University of Pará (UFPA), Belém, Brazil
| | - Diego Bessa Dantas
- Urogenital System Clinical and Experimental Research Unit (UPCEURG), Federal University of Pará (UFPA), Belém, Brazil
| | - Edila Monteiro de Andrade
- Urogenital System Clinical and Experimental Research Unit (UPCEURG), Federal University of Pará (UFPA), Belém, Brazil
| | | | - Ana Beatriz Rocha de Marin
- Urogenital System Clinical and Experimental Research Unit (UPCEURG), Federal University of Pará (UFPA), Belém, Brazil
| | - Fabiana de Campos Gomes
- Genetics and Molecular Biology Research Unit (UPGEM), São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, Brazil
| | | | - João Simão de Melo-Neto
- Urogenital System Clinical and Experimental Research Unit (UPCEURG), Federal University of Pará (UFPA), Belém, Brazil.
- School of Physiotherapy and Occupational Therapy, Urogenital System Clinical and Experimental Research Unit (UPCEURG), Federal University of Pará (UFPA), José Silveira Neto, Street Augusto Corrêa, Guamá, Belém, 0166075-110, PA, Brazil.
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18
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Fabijan A, Polis B, Zakrzewski K, Zawadzka-Fabijan A, Korabiewska-Pluta S, Nowosławska E. Congenital Anterior Dislocation of the Sacrococcygeal Bone in a Newborn. Diagnostics (Basel) 2023; 13:2108. [PMID: 37371003 DOI: 10.3390/diagnostics13122108] [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: 05/25/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
We present a case of a child who was transported to the Neurosurgery Clinic from another hospital for the purpose of performing a surgical procedure of the spinal myelomeningocele. On the first day of the stay, a set of tests was performed, including an anterior-posterior (AP) projection X-ray, which clearly showed a developmental defect in the lumbar-sacral section of the spine. In the follow-up physical examination, there was a depression of the skin on the right side of the surgical scar after closing the open myelomeningocele. In the follow-up MRI of the lumbar-sacral section, an extremely rare congenital anterior dislocation of the sacrococcygeal bone was unexpectedly visualized. Despite recommendations for further diagnostics, the patient did not attend the required follow-up examinations. In the final section, we provide a general summary of the literature on rare developmental defects of the spine in children.
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Affiliation(s)
- Artur Fabijan
- Department of Neurosurgery, Polish-Mother's Memorial Hospital Research Institute, 93-338 Lodz, Poland
| | - Bartosz Polis
- Department of Neurosurgery, Polish-Mother's Memorial Hospital Research Institute, 93-338 Lodz, Poland
| | - Krzysztof Zakrzewski
- Department of Neurosurgery, Polish-Mother's Memorial Hospital Research Institute, 93-338 Lodz, Poland
| | | | - Sara Korabiewska-Pluta
- Department of Cardiology, Polish-Mother's Memorial Hospital Research Institute, 93-338 Lodz, Poland
| | - Emilia Nowosławska
- Department of Neurosurgery, Polish-Mother's Memorial Hospital Research Institute, 93-338 Lodz, Poland
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Maiz N, Arévalo S, García-Manau P, Meléndez M, Giné C, Rodó C, López M, Carreras E. Presurgery motor level assessment for prediction of motor level at birth in fetuses undergoing prenatal repair of open spina bifida: time to abandon anatomical level in counseling. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:728-733. [PMID: 36807360 DOI: 10.1002/uog.26180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 05/14/2023]
Abstract
OBJECTIVES First, to investigate the correlation between prenatal presurgery anatomical and motor levels of the lesion with motor level at birth in cases undergoing prenatal repair of open spina bifida and, second, to identify factors leading to a loss of two or more motor levels between the presurgery and postnatal assessments. METHODS This was an observational study of singleton pregnancies undergoing prenatal repair of open spina bifida, conducted between March 2011 and May 2022. All fetuses underwent an ultrasound assessment at 20-24 weeks of gestation to determine the motor and anatomical levels of the lesion before surgery. The anatomical level of the lesion was defined as the highest open posterior vertebral arch. The motor level was determined by systematic observation of the lower limb movements and was defined as the most distal active muscle present. Prenatal repair was performed at 23-26 weeks. At birth, motor level was assessed by a rehabilitation specialist by physical examination. Cases of intrauterine death or termination of pregnancy and those delivered at other sites were excluded from the neonatal assessment. The agreement between presurgery motor level and motor level at birth, and between presurgery anatomical level and motor level at birth, was assessed using the weighted kappa index (wκ). Logistic regression analysis was used to assess factors leading to a loss of two or more motor levels between the presurgery and postnatal assessments. RESULTS Presurgery motor and anatomical levels were assessed in 61 fetuses at a median gestational age of 22.7 (interquartile range (IQR), 21.6-24.4) weeks. Prenatal repair was performed at a median gestational age of 24.6 (IQR, 23.7-25.7) weeks. Motor level at birth was assessed in 52 neonates after exclusion of nine fetuses due to loss to follow-up or fetal loss. There was moderate agreement between presurgery motor level and motor level at birth (wκ = 0.42; 95% CI, 0.21-0.63), with a median difference of 0 (IQR, -2 to 9) levels. Factors leading to a loss of two or more motor levels between the presurgery ultrasound assessment and postnatal examination were higher presurgery anatomical level (odds ratio (OR), 0.59 (95% CI, 0.35-0.98); P = 0.04) and larger difference between the anatomical and motor levels before surgery (OR, 1.85 (95% CI, 1.12-3.06); P = 0.017). None of the other ultrasound, surgery-related or neonatal variables assessed was associated significantly with a loss of two or more motor levels. There was slight agreement between the presurgery anatomical level of the lesion and motor level at birth (wκ = 0.07; 95% CI, -0.02 to 0.15). CONCLUSIONS There is moderate agreement between fetal motor level of the lesion before prenatal repair of open spina bifida and motor level at birth, as opposed to only slight agreement between presurgery anatomical level and motor level at birth. A loss of two or more motor levels between the presurgery and postnatal assessments is associated with a higher presurgery anatomical level and with a larger difference between the presurgery anatomical and motor levels. Consequently, motor level, rather than the anatomical level, should be used for prenatal counseling. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N Maiz
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Arévalo
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P García-Manau
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Meléndez
- Physical Medicine and Rehabilitation, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Giné
- Paediatric Surgery Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Rodó
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M López
- Paediatric Surgery Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Carreras
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
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Roach JT, Baticulon RE, Campos DA, Andrews JM, Qaddoumi I, Boop FA, Moreira DC. The role of neurosurgery in advancing pediatric CNS tumor care worldwide. BRAIN & SPINE 2023; 3:101748. [PMID: 37383442 PMCID: PMC10293316 DOI: 10.1016/j.bas.2023.101748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/16/2023] [Accepted: 04/21/2023] [Indexed: 06/30/2023]
Abstract
Introduction There is substantial inequity in survival outcomes for pediatric brain tumor patients residing in high-income countries (HICs) compared to low- and middle-income countries (LMICs). To address disparities in pediatric cancer survival, the World Health Organization (WHO) established the Global Initiative for Childhood Cancer (GICC) to expand quality care for children with cancer. Research question To provide an overview of pediatric neurosurgical capacity and detail the burden of neurosurgical diseases impacting children. Material and methods A narrative review of the current context of global pediatric neurosurgical capacity as it relates to neurooncology and other diseases relevant to children. Results In this article, we provide an overview of pediatric neurosurgical capacity and detail the burden of neurosurgical diseases impacting children. We highlight concerted advocacy and legislative efforts aimed at addressing unmet neurosurgical needs in children. Finally, we discuss the potential implications of advocacy efforts on treating pediatric CNS tumors and outline strategies to improve global outcomes for children with brain tumors worldwide in the context of the WHO GICC. Discussion and conclusion With both global pediatric oncology and neurosurgical initiatives converging on the treatment of pediatric brain tumors, significant strides toward decreasing the burden of pediatric neurosurgical diseases will hopefully be made.
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Affiliation(s)
- Jordan T. Roach
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Graduate School of Biomedical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Developmental Neurobiology, Division of Brain Tumor Research, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ronnie E. Baticulon
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | | | - Jared M. Andrews
- Department of Developmental Neurobiology, Division of Brain Tumor Research, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ibrahim Qaddoumi
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Frederick A. Boop
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Daniel C. Moreira
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
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21
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Hassan Z, Coelho D, Bossenmeyer-Pourié C, Matmat K, Arnold C, Savladori A, Alberto JM, Umoret R, Guéant JL, Pourié G. Cognitive Impairment Is Associated with AMPAR Glutamatergic Dysfunction in a Mouse Model of Neuronal Methionine Synthase Deficiency. Cells 2023; 12:cells12091267. [PMID: 37174668 PMCID: PMC10177068 DOI: 10.3390/cells12091267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 05/15/2023] Open
Abstract
Impairment of one-carbon metabolism during pregnancy, either due to nutritional deficiencies in B9 or B12 vitamins or caused by specific genetic defects, is often associated with neurological defects, including cognitive dysfunction that persists even after vitamin supplementation. Animal nutritional models do not allow for conclusions regarding the specific brain mechanisms that may be modulated by systemic compensations. Using the Cre-lox system associated to the neuronal promoter Thy1.2, a knock-out model for the methionine synthase specifically in the brain was generated. Our results on the neurobehavioral development of offspring show that the absence of methionine synthase did not lead to growth retardation, despite an effective reduction of both its expression and the methylation status in brain tissues. Behaviors were differently affected according to their functional outcome. Only temporary retardations were recorded in the acquisition of vegetative functions during the suckling period, compared to a dramatic reduction in cognitive performance after weaning. Investigation of the glutamatergic synapses in cognitive areas showed a reduction of AMPA receptors phosphorylation and clustering, indicating an epigenomic effect of the neuronal deficiency of methionine synthase on the reduction of glutamatergic synapses excitability. Altogether, our data indicate that cognitive impairment associated with methionine synthase deficiency may not only result from neurodevelopmental abnormalities, but may also be the consequence of alterations in functional plasticity of the brain.
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Affiliation(s)
- Ziad Hassan
- Inserm UMRS 1256 NGERE-Nutrition, Genetics, and Environmental Risk Exposure, University of Lorraine, F-54000 Nancy, France
| | - David Coelho
- Inserm UMRS 1256 NGERE-Nutrition, Genetics, and Environmental Risk Exposure, University of Lorraine, F-54000 Nancy, France
- National Center of Inborn Errors of Metabolism, University Regional Hospital Center of Nancy, F-54000 Nancy, France
| | - Carine Bossenmeyer-Pourié
- Inserm UMRS 1256 NGERE-Nutrition, Genetics, and Environmental Risk Exposure, University of Lorraine, F-54000 Nancy, France
| | - Karim Matmat
- Inserm UMRS 1256 NGERE-Nutrition, Genetics, and Environmental Risk Exposure, University of Lorraine, F-54000 Nancy, France
| | - Carole Arnold
- Inserm UMRS 1256 NGERE-Nutrition, Genetics, and Environmental Risk Exposure, University of Lorraine, F-54000 Nancy, France
| | - Aurélie Savladori
- Inserm UMRS 1256 NGERE-Nutrition, Genetics, and Environmental Risk Exposure, University of Lorraine, F-54000 Nancy, France
| | - Jean-Marc Alberto
- Inserm UMRS 1256 NGERE-Nutrition, Genetics, and Environmental Risk Exposure, University of Lorraine, F-54000 Nancy, France
| | - Rémy Umoret
- Inserm UMRS 1256 NGERE-Nutrition, Genetics, and Environmental Risk Exposure, University of Lorraine, F-54000 Nancy, France
| | - Jean-Louis Guéant
- Inserm UMRS 1256 NGERE-Nutrition, Genetics, and Environmental Risk Exposure, University of Lorraine, F-54000 Nancy, France
- National Center of Inborn Errors of Metabolism, University Regional Hospital Center of Nancy, F-54000 Nancy, France
| | - Grégory Pourié
- Inserm UMRS 1256 NGERE-Nutrition, Genetics, and Environmental Risk Exposure, University of Lorraine, F-54000 Nancy, France
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22
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Doi M, Sakurai Y, Sakamaki D, Tanaka S, Katori N, Uezono S. Ultrasonographic images of spina bifida before obstetric anesthesia: a case series. BMC Anesthesiol 2023; 23:134. [PMID: 37095440 PMCID: PMC10123987 DOI: 10.1186/s12871-023-02101-4] [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: 12/28/2022] [Accepted: 04/20/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Spina bifida is a relatively common congenital malformation. As the functional prognosis of patients with spina bifida has improved over time, the number of cases resulting in pregnancy and delivery has increased. Lumbar ultrasonography has become a standard and helpful technique before neuraxial anesthesia. We believe that it might be valuable if we use lumbar ultrasonography to evaluate pregnant women with spina bifida before obstetric anesthesia. CASE PRESENTATION We performed lumbar ultrasonography to evaluate four pregnant women with spina bifida. Patient 1 had no history of surgery. Lumbar radiography before pregnancy showed a bone defect from L5 to the sacrum as a result of incomplete fusion. Magnetic resonance imaging showed a spinal lipoma and a bone defect of the sacrum. Lumbar ultrasonography showed similar findings. We performed general anesthesia for emergency cesarean delivery. Patient 2 underwent surgical repair immediately after birth. Lumbar ultrasonography showed the same bone defect as well as a lipoma beyond the bone defect. We performed general anesthesia for cesarean delivery. Patient 3 had vesicorectal disorders but no prior surgery. Lumbar radiography before pregnancy showed congenital abnormalities such as incomplete fusion, scoliosis, rotation, and a notably small sacrum. Lumbar ultrasonography showed the same bone defect. We performed general anesthesia for cesarean section with no complications. Patient 4 complained of lumbago a few years after her first delivery and received a diagnosis of spina bifida occulta by lumbar radiography, with the incomplete fusion of only the 5th vertebra. Lumbar ultrasonography indicated the same abnormalities. We placed an epidural catheter to avoid the bone abnormality and achieved epidural labor analgesia with no complications. CONCLUSIONS Lumbar ultrasonography shows anatomic structures easily, safely, and consistently, without X-ray exposure or the need for more expensive modalities. It is a helpful technique to explore anatomic structures potentially complicated by spina bifida before anesthetic procedures.
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Affiliation(s)
- Mayuko Doi
- Department of Anesthesiology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Yasuyoshi Sakurai
- Department of Anesthesiology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan.
| | - Daisuke Sakamaki
- Department of Anesthesiology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Soichiro Tanaka
- Department of Anesthesiology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Nobuyuki Katori
- Department of Anesthesiology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Shoichi Uezono
- Department of Anesthesiology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan
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23
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Sasaoka AKS, Moron AF, Araujo Júnior E, Sañudo A, Barbosa MM, Milani HJF, Sarmento SGP, Cavalheiro S. Ultrasound evaluation of uterine scar thickness after open fetal surgery for myelomeningocele. Childs Nerv Syst 2023; 39:655-661. [PMID: 35939128 DOI: 10.1007/s00381-022-05642-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to analyse the evolution of uterine scar thickness after open fetal surgery for myelomeningocele (MMC) by ultrasonography, and to establish a cut-off point for uterine scar thickness associated with high-risk of uterine rupture. METHODS A prospective longitudinal study was conducted with 77 pregnant women who underwent open fetal surgery for MMC between 24 and 27 weeks of gestation. After fetal surgery, ultrasound follow-up was performed once a week, and the scar on the uterine wall was evaluated and its thickness was measured by transabdominal ultrasound. At least five measurements of the uterine scar thickness were performed during pregnancy. A receiver operating characteristics (ROC) curve was constructed to obtain a cut-off point for the thickness of the scar capable of detecting the absence of thinning. Kaplan-Meier curves were constructed to evaluate the probability of thinning during pregnancy follow-up. RESULTS The mean ± standard deviation of maternal age (years), gestational age at surgery (weeks), gestational age at delivery (weeks), and birth weight (g) were 30.6 ± 4.5, 26.1 ± 0.8, 34.3 ± 1.2 and 2287.4 ± 334.4, respectively. Thinning was observed in 23 patients (29.9%). Pregnant women with no thinning had an average of 17.1 ± 5.2 min longer surgery time than pregnant women with thinning. A decrease of 1.0 mm in the thickness of the uterine scar was associated with an increased likelihood of thinning by 1.81-fold (95% confidence interval [CI]: 1.32-2.47; p < 0.001). The area below the ROC curve was 0.899 (95% CI: 0.806-0.954; p < 0.001), and the cut-off point was ≤ 3.0 mm, which simultaneously presented greater sensitivity and specificity. After 63 days of surgery, the probability of uterine scarring was 50% (95% CI: 58-69). CONCLUSION A cut-off point of ≤ 3.0 mm in the thickness of the uterine scar after open fetal surgery for MMC may be used during ultrasonography monitoring for decision-making regarding the risk of uterine rupture and indication of caesarean section.
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Affiliation(s)
- Alexandre Kim Sangalan Sasaoka
- Department of Obstetrics, Paulista School of Medicina - Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, 05089-030, Brazil
| | - Antonio Fernandes Moron
- Department of Obstetrics, Paulista School of Medicina - Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, 05089-030, Brazil
- Paulista Center of Fetal Medicine, São Paulo, SP, Brazil
- Santa Joana Maternity and Hospital, São Paulo, SP, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicina - Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, 05089-030, Brazil.
| | - Adriana Sañudo
- Department of Preventive Medicine, Paulista School of Medicina - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Mauricio Mendes Barbosa
- Paulista Center of Fetal Medicine, São Paulo, SP, Brazil
- Santa Joana Maternity and Hospital, São Paulo, SP, Brazil
| | - Herbene José Figuinha Milani
- Department of Obstetrics, Paulista School of Medicina - Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, 05089-030, Brazil
- Paulista Center of Fetal Medicine, São Paulo, SP, Brazil
- Santa Joana Maternity and Hospital, São Paulo, SP, Brazil
| | | | - Sergio Cavalheiro
- Paulista Center of Fetal Medicine, São Paulo, SP, Brazil
- Santa Joana Maternity and Hospital, São Paulo, SP, Brazil
- Department of Neurology and Neurosurgery, Paulista School of Medicina - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
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24
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Gandy K, Castillo H, Kelly M, Bradko V, MacDonald B, Thibadeau J, Queally J, Castillo J. Neurodevelopmental Implications on Urological Self-management Among People Living With Spina Bifida: A Practical Guide for Urology Providers. Urology 2023; 173:17-25. [PMID: 36473589 DOI: 10.1016/j.urology.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/06/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022]
Abstract
Although folic acid fortification and advances in prenatal repair have reduced Spina Bifida (SB) prevalence and the severity of comorbidities, individuals with SB remain at elevated risk for neurocognitive impairments that studies have shown can negatively impact, among other things, urological self-care. Identifying and addressing these impairments with practical interventions can meaningfully improve long-term outcomes for individuals with SB. We review neurocognitive impairments associated with SB and provide practical solutions to support improvement of long-term urological outcomes.
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Affiliation(s)
- Kellen Gandy
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Heidi Castillo
- Department of Pediatrics, Meyer Center for Developmental Pediatrics, Baylor College of Medicine, Houston, TX
| | - Maryellen Kelly
- Department of Urology, Duke University Medical Center, Durham, NC
| | - Viachaslau Bradko
- Department of Pediatrics, Meyer Center for Developmental Pediatrics, Baylor College of Medicine, Houston, TX
| | - Beatriz MacDonald
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX
| | | | - Jennifer Queally
- Department of Psychiatry, Children's Hospital Boston, Boston, MA
| | - Jonathan Castillo
- Department of Pediatrics, Meyer Center for Developmental Pediatrics, Baylor College of Medicine, Houston, TX.
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25
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Haudebert C, Hascoet J, Samson E, Jezequel M, Voiry C, Brochard C, Richard C, Kerdraon J, Siproudhis L, Manunta A, Peyronnet B. Risk factors for upper urinary tract deterioration in adult patients with spina bifida. World J Urol 2023; 41:1187-1192. [PMID: 36808530 DOI: 10.1007/s00345-023-04314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/23/2023] [Indexed: 02/21/2023] Open
Abstract
PURPOSE Neurogenic bladder associated with spina bifida disease remains a major cause for mortality or morbidity due to kidney damages. However, we currently do not know which urodynamic findings are associated with an higher risk of upper tract damages in spina bifida patients. The objective of the present study was to evaluate urodynamic findings associated with functional kidney failure and/or with morphological kidney damages. METHODS A large single-center restrospective study was conducted in our national referral center for spina bifida patients using our patients' files. All urodynamics curves were assessed by the same examinator. Functional and/or morphological evaluation of the upper urinary tract were done at the same moment as the urodynamic exam (between 1 week before and 1 month after). Kidney function was assessed using creatinine serum levels or 24 h urinary creatinine levels (creatinine clearance) for walking patients, or with the 24 h urinary creatinine level for wheelchair-users. RESULTS We included 262 spina bifida patients in this study. Fifty-five patients had a poor bladder compliance (21.4%) and 88 of them had detrusor overactivity (33.6%). Twenty patients had a stage 2 kidney failure (eGFR < 60 ml/min) and 81 patients out of 254 (30.9%) had an abnormal morphological examination. There were three urodynamic findings significantly associated with UUTD: bladder compliance (OR = 0.18; p = 0.007), Pdetmax (OR = 14.7; p = 0.003) and detrusor overactivity (OR = 1.84; p = 0.03). CONCLUSION In this large series of spina bifida patients, maximum detrusor pressure and bladder compliance are the main urodynamic findings determinants of UUTD risk.
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Affiliation(s)
- Camille Haudebert
- Department of Urology, University of Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France.
| | - Juliette Hascoet
- Department of Urology, University of Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
| | - Emmanuelle Samson
- Department of Physical Medicine and Rehabilitation, Department of Urology, Rennes, France
- Referral Center for Spina BIFIDA, NEUROSPHINX Network, Rennes, France
| | - Magali Jezequel
- Referral Center for Spina BIFIDA, NEUROSPHINX Network, Rennes, France
| | - Caroline Voiry
- Department of Physical Medicine and Rehabilitation, Department of Urology, Rennes, France
| | - Charlène Brochard
- Referral Center for Spina BIFIDA, NEUROSPHINX Network, Rennes, France
- Department of Gastro-Enterology, University of Rennes, Rennes, France
| | - Claire Richard
- Department of Physical Medicine and Rehabilitation, Department of Urology, Rennes, France
- Referral Center for Spina BIFIDA, NEUROSPHINX Network, Rennes, France
| | - Jacques Kerdraon
- Referral Center for Spina BIFIDA, NEUROSPHINX Network, Rennes, France
| | - Laurent Siproudhis
- Referral Center for Spina BIFIDA, NEUROSPHINX Network, Rennes, France
- Department of Gastro-Enterology, University of Rennes, Rennes, France
| | - Andréa Manunta
- Department of Urology, University of Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
- Referral Center for Spina BIFIDA, NEUROSPHINX Network, Rennes, France
| | - Benoit Peyronnet
- Department of Urology, University of Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
- Referral Center for Spina BIFIDA, NEUROSPHINX Network, Rennes, France
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26
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Brochard C, Jezequel M, Blanchard-Dauphin A, Kerdraon J, Perrouin-Verbe B, Leroi AM, Reymann JM, Peyronnet B, Morçet J, Siproudhis L. Transanal irrigation is a better choice for bowel dysfunction in adults with Spina bifida: A randomised controlled trial. Colorectal Dis 2023. [PMID: 36799340 DOI: 10.1111/codi.16518] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/02/2022] [Accepted: 12/11/2022] [Indexed: 02/18/2023]
Abstract
AIM To compare transanal irrigation with conservative bowel management for the treatment of bowel dysfunction in Spina bifida (SB) patients. METHODS Patients with SB and bowel dysfunction were randomly assigned to receive either transanal irrigation or conservative bowel management. The effectiveness of the treatment was defined as a decrease of 4 points in the neurogenic bowel dysfunction (NBD) score at week 10. Data on incontinence (Cleveland scores; Jorge-Wexner [JW]) and constipation (Knowles-Eccersley-Scott Symptom Constipation Score [KESS]) were recorded at 10 and 24 weeks after inclusion. Data were analysed on an intention-to-treat basis. RESULTS A total of 34 patients were randomised: 16 patients to conservative bowel management and 18 patients to transanal irrigation. A total of 19/31 (61%) patients improved at week 10, 13 (76%) in the transanal irrigation group versus six (43%) in the conservative group (p = 0.056). In the irrigation group, the decrease in NBD score was -6.9 (-9.9 to -4.02) versus -1.9 (-6.5 to -2.8) in the conservative group (p = 0.049 in univariate and p = 0.004 in multivariate analysis). The NBD, Cleveland (JW and KESS) and Rosenberg scores were significantly lower in the transanal irrigation group than in the conservative bowel management group at week 10. CONCLUSIONS This prospective, randomised, controlled, multicentre study in adult patients with SB suggests that transanal irrigation may be more effective than conservative bowel management.
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Affiliation(s)
- Charlène Brochard
- Service d'Explorations Fonctionnelles Digestives, CHRU Pontchaillou, Rennes, France.,The Enteric Nervous System in Gut and Brain Disorders INSERM, TENS, Université de Nantes, Nantes, France.,Centre Référence Maladies Rares Spina Bifida, CHRU Pontchaillou, Rennes, France
| | - Magali Jezequel
- Centre Référence Maladies Rares Spina Bifida, CHRU Pontchaillou, Rennes, France
| | | | | | - Brigitte Perrouin-Verbe
- The Enteric Nervous System in Gut and Brain Disorders INSERM, TENS, Université de Nantes, Nantes, France.,Service universitaire de Médecine Physique et Réadaptation Neurologique, Nantes Université, Nantes, France
| | | | | | - Benoît Peyronnet
- Centre Référence Maladies Rares Spina Bifida, CHRU Pontchaillou, Rennes, France.,INSERM CIC 1414, INPHY, Université de Rennes 1, Rennes, France.,Service d'Urologie, CHRU Pontchaillou, Rennes, France
| | - Jeff Morçet
- INSERM CIC 1414, INPHY, Université de Rennes 1, Rennes, France
| | - Laurent Siproudhis
- Centre Référence Maladies Rares Spina Bifida, CHRU Pontchaillou, Rennes, France.,INSERM CIC 1414, INPHY, Université de Rennes 1, Rennes, France.,Service des Maladies de l'Appareil Digestif, CHRU Pontchaillou, Université de Rennes 1, Rennes, France
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27
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Zhang K, Li B, Gu Z, Hou Z, Liu T, Zhao J, Ruan M, Zhang T, Yu Q, Yu X, Lv Q. Association between dietary folate intake and cognitive impairment in older US adults: National Health and Nutrition Examination Survey. Arch Gerontol Geriatr 2023; 109:104946. [PMID: 36764201 DOI: 10.1016/j.archger.2023.104946] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine the association between dietary folate intake and low cognitive performance in older adults. METHODS In this cross-sectional observational study, 2011-2014 data from the 2010 National Health and Nutrition Examination Survey, including 2,524 adults aged 60 years and older, included 24-hour dietary intakes. Total folic acid intake was calculated as the sum of folic acid supplements and dietary folic acid. Cognitive function was assessed using three tests. The association between folate intake and cognitive function was assessed using a multivariate conditional logistic regression model. RESULTS 2524 participants from two survey cycles (2011-2014) in the NHANES aged 60 years and over. In the multivariate logistic regression, the OR of developing folate was 0.96 (95% CI: 0.94∼0.98) in participants with Z test. Folate intake was negatively associated with cognitive function. Compared with Q1, Q4(≥ 616.3mg/day) in the AFT and DSST tests reduced the risk of cognitive impairment by 31% (OR = 0.69, 95% CI: 0.52-0.93) and 44% (OR = 0.56). 95% confidence interval: 0.44-0.7). In the comprehensive evaluation of IR and AFT scores, the association between dietary folate intake and low cognitive performance in US adults is linear. We also found a significant interaction between gender and cognitive ability (P value for the interaction was 0.021). CONCLUSIONS Dietary intake of folic acid may be inversely associated with cognitive impairment. The DSST study found an L-shaped association between dietary folate intake and cognitive decline in US adults, with an inflection point of approximately 510,383 mg/day.
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Affiliation(s)
- Kai Zhang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin University, Changchun, Jilin Province, China.
| | - Bingjin Li
- Jilin Engineering Laboratory for Screening of Antidepressant, Changchun, Jilin Province, China
| | - Zhaoxuan Gu
- Jilin Engineering Laboratory for Screening of Antidepressant, Changchun, Jilin Province, China
| | - Zhengyan Hou
- Jilin Engineering Laboratory for Screening of Antidepressant, Changchun, Jilin Province, China
| | - Tianzhou Liu
- Department of Gastrointestinal Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Jiayu Zhao
- Jilin Provicial Key Laboratory on Target of Traditional Chinese Medicine with Anti-Depressive Effect, jilin province, China
| | - Mengyu Ruan
- Jilin Provicial Key Laboratory on Target of Traditional Chinese Medicine with Anti-Depressive Effect, jilin province, China
| | - Tianqi Zhang
- Jilin Provicial Key Laboratory on Target of Traditional Chinese Medicine with Anti-Depressive Effect, jilin province, China
| | - Qin Yu
- Jilin Provicial Key Laboratory on Target of Traditional Chinese Medicine with Anti-Depressive Effect, jilin province, China
| | - Xiaoqi Yu
- Jilin Provicial Key Laboratory on Target of Traditional Chinese Medicine with Anti-Depressive Effect, jilin province, China
| | - Qianyu Lv
- Department of Gastrointestinal Surgery, The Second Hospital of Jilin University, Changchun, China
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28
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Olutoye OO, Joyeux L, King A, Belfort MA, Lee TC, Keswani SG. Minimally Invasive Fetal Surgery and the Next Frontier. Neoreviews 2023; 24:e67-e83. [PMID: 36720693 DOI: 10.1542/neo.24-2-e67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Most patients with congenital anomalies do not require prenatal intervention. Furthermore, many congenital anomalies requiring surgical intervention are treated adequately after birth. However, there is a subset of patients with congenital anomalies who will die before birth, shortly after birth, or experience severe postnatal complications without fetal surgery. Fetal surgery is unique in that an operation is performed on the fetus as well as the pregnant woman who does not receive any direct benefit from the surgery but rather lends herself to risks, such as hemorrhage, abruption, and preterm labor. The maternal risks involved with fetal surgery have limited the extent to which fetal interventions may be performed but have, in turn, led to technical innovations that have significantly advanced the field. This review will examine congenital abnormalities that can be treated with minimally invasive fetal surgery and introduce the next frontier of prenatal management of fetal surgical pathology.
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Affiliation(s)
- Oluyinka O Olutoye
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Luc Joyeux
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.,Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX.,Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - Alice King
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.,Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX.,Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - Michael A Belfort
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Timothy C Lee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.,Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX.,Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - Sundeep G Keswani
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.,Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX.,Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
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Ko HS, Kim A, Wie JH, Yang DH, Kim SH, Jeong GJ, Hyun H, Shin JC, Chun HJ. Visible light-curable methacrylated glycol chitosan hydrogel patches for prenatal closure of fetal myelomeningocele. Carbohydr Polym 2023; 311:120620. [PMID: 37028865 DOI: 10.1016/j.carbpol.2023.120620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/09/2023] [Accepted: 01/22/2023] [Indexed: 01/29/2023]
Abstract
In this study, we prepared visible light-curable methacrylated glycol chitosan (MGC) hydrogel patches for the prenatal treatment of fetal myelomeningocele (MMC) and investigated their feasibility using a retinoic acid-induced fetal MMC rat model. 4, 5, and 6 w/v% of MGC were selected as candidate precursor solutions, and photo-cured for 20 s, because the resulting hydrogels were found to possess concentration dependent tunable mechanical properties and structural morphologies. Moreover, these materials exhibited no foreign body reactions with good adhesive properties in animal studies. The inflammation scoring assessment in vivo exhibited the absence of foreign body reactions in MGC hydrogel treated lesion. The complete epithelial coverage of MMC was made with using 6 w/v% MGC hydrogel followed by well-organized granulation along with noticeable decrease of abortion rate and wound size that highlight the therapeutic potential for the prenatal treatment of fetal MMC.
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30
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Siahaan AMP, Susanto M, Lumbanraja SN, Ritonga DH. Long-term neurological cognitive, behavioral, functional, and quality of life outcomes after fetal myelomeningocele closure: a systematic review. Clin Exp Pediatr 2023; 66:38-45. [PMID: 36470279 PMCID: PMC9815938 DOI: 10.3345/cep.2022.01102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/07/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Myelomeningocele is a lifelong condition that features several comorbidities, such as hydrocephalus, scoliosis, club foot, and lower limb sensory and motor disabilities. Its management has progressed over time, ranging from supportive care to early postnatal closure to prenatal closure of the defect. Recent research discovered that fetal myelomeningocele closure (fMMC) provided superior neurological outcomes to those of postnatal closure. When performed at 12 months of age, fMMC can avert or delay the need for a ventriculoperitoneal shunt and reversed the hindbrain herniation. Moreover, fMMC reportedly enhanced motor function and mental development at 30 months of age. However, its long-term outcomes remain dubious. PURPOSE This systematic review aimed to determine the long-term neurological cognitive, behavioral, functional, and quality of life (QoL) outcomes after fMMC. METHODS The PubMed, Directory of Open Access Journals, EBSCO, and Cochrane databases were extensively searched for articles published in 2007-2022. Meta-analyses, clinical trials, and randomized controlled trials with at least 5 years of follow-up were given priority. RESULTS A total of 11 studies were included. Most studies revealed enhanced long-term cognitive, behavioral, functional, and QoL outcomes after fMMC. CONCLUSION Our results suggest that fMMC substantially enhanced patients' long-term neurological cognitive, behavioral, functional, and QoL outcomes.
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Affiliation(s)
| | - Martin Susanto
- Department of Neurosurgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Sarma Nursani Lumbanraja
- Department of Obstetrics & Gynecology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Dwi Herawati Ritonga
- Division of Pediatrics, H Amri Tambunan General Hospital, Lubuk Pakam, Indonesia
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Avesani G, Perazzolo A, Elia L, Anghelone AG, Gaudino S, Russo L, Genco E, Di Paola V, Massimi L, De Santis M, Tamburrini G, Manfredi R. Fetal MRI prior to intrauterine surgery of open neural tube defects: What does the radiologist need to know. LA RADIOLOGIA MEDICA 2023; 128:113-124. [PMID: 36525177 DOI: 10.1007/s11547-022-01579-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
The management of myelomeningocele study trial showed significant prognostic improvement in fetal repair before 26 weeks of gestation. Hence, surgery in utero represents the best treatment option for open-neural tube defects (NTDs). Fetal surgery of open-NTDs has specific inclusion and exclusion criteria, which can be adequately studied with fetal MRI. The main concern: the spine (spinal defects other than Myelomeningocele and Myeloschisis, the level of the lesion higher than T1 or lower than S1 and the degree of kyphosis ≥ 30°), the skull/brain (no cerebellum herniation and Chiari II malformation and the presence of any intracranial abnormality unrelated to open NTDs), the uterus (cervix length less than 2 cm, multiple gestations and placental and uterine abnormalities) and any other fetal abnormality not attributed to spinal defect. In this review, we describe the fundamental role of fetal MRI in supporting therapeutic decisions in pre-surgery intrauterine planning through the accurate and comprehensive description of findings, providing a proposal of a structured report. In addition, we describe how post-surgical MRI is important in investigating the effectiveness of surgery and detecting repairing complications.
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Affiliation(s)
- Giacomo Avesani
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | | | - Lorenzo Elia
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Simona Gaudino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Russo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Enza Genco
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Valerio Di Paola
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Luca Massimi
- Dipartimento di Scienze dell'invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy
| | - Marco De Santis
- Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy
| | - Gianpiero Tamburrini
- Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Scienze dell'invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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32
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Joyeux L, van der Merwe J, Aertsen M, Patel PA, Khatoun A, Mori da Cunha MGMC, De Vleeschauwer S, Parra J, Danzer E, McLaughlin M, Stoyanov D, Vercauteren T, Ourselin S, Radaelli E, de Coppi P, Van Calenbergh F, Deprest J. Neuroprotection is improved by watertightness of fetal spina bifida repair in the sheep model. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:81-92. [PMID: 35353933 DOI: 10.1002/uog.24907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/01/2022] [Accepted: 03/21/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVES A contributing factor to unsuccessful prenatal spina bifida aperta (SBA) repair via an open approach may be incomplete neurosurgical repair causing persistent in-utero leakage of cerebrospinal fluid (CSF) and exposure of the fetal spinal cord to amniotic fluid. We aimed to investigate the neurostructural and neurofunctional efficacy of watertight prenatal SBA repair in a validated SBA fetal lamb model. METHODS A well-powered superiority study was conducted in the validated SBA fetal lamb model (n = 7 per group). The outcomes of lambs which underwent watertight or non-watertight multilayer repair through an open approach were compared to those of unrepaired SBA lambs (historical controls) at delivery (term = 145 days). At ∼75 days, fetal lambs underwent standardized induction of lumbar SBA. At ∼100 days, they were assigned to an either watertight or non-watertight layered repair group based on an intraoperative watertightness test using subcutaneous fluorescein injection. At 1-2 days postnatally, as primary outcome, we assessed reversal of hindbrain herniation using magnetic resonance imaging (MRI). Secondary proxies of neuroprotection were: absence of CSF leakage at the repair site; hindlimb motor function based on joint-movement score, locomotor grade and Motor Evoked Potential (MEP); four-score neuroprotection scale, encompassing live birth, complete hindbrain herniation reversal, absence of CSF leakage and joint-movement score ≥ 9/15; and brain and spinal cord histology and immunohistochemistry. As the watertightness test cannot be used clinically due to its invasiveness, we developed a potential surrogate intraoperative three-score skin-repair-quality scale based on visual assessment of the quality of the skin repair (suture inter-run distance ≤ 3 mm, absence of tear and absence of ischemia), with high quality defined by a score ≥ 2/3 and low quality by a score < 2/3, and assessed its relationship with improved outcome. RESULTS Compared with unrepaired lambs, lambs with watertight repair achieved a high level of neuroprotection (neuroprotection score of 4/4 in 5/7 vs 0/7 lambs) as evidenced by: a significant 100% (vs 14%) reversal of hindbrain herniation on MRI; low CSF leakage (14% vs 100%); better hindlimb motor function, with higher joint-movement score, locomotor grade and MEP area under the curve and peak-to-peak amplitude; higher neuronal density in the hippocampus and corpus callosum; and higher reactive astrogliosis at the SBA lesion epicenter. Conversely, lambs with non-watertight SBA repair did not achieve the same level of neuroprotection (score of 4/4 in 1/7 lambs) compared with unrepaired lambs, with: a non-significant 86% (vs 14%) reversal of hindbrain herniation; high CSF leakage (43% vs 100%); no improvement in motor function; low brain neuron count in both the hippocampus and corpus callosum; and small spinal astroglial cell area at the epicenter. Both watertight layered repair and high (≥ 2/3) intraoperative skin-repair-quality score were associated with improved outcome, but the watertightness test and skin-repair-quality scale could not be used interchangeably due to result discrepancies. CONCLUSIONS Watertight layered fetal SBA repair is neuroprotective since it improves brain and spinal-cord structure and function in the fetal lamb model. This translational research has important clinical implications. A neurosurgical technique that achieves watertightness should be adopted in all fetal centers to improve neuroprotection. Future clinical studies could assess whether a high skin-repair-quality score (≥ 2/3) correlates with neuroprotection. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Joyeux
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division of Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - J van der Merwe
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division of Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - M Aertsen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - P A Patel
- Radiology Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - A Khatoun
- Exp ORL, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - M G M C Mori da Cunha
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - S De Vleeschauwer
- Animal Research Center, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - J Parra
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- BCNatal, Fetal Medicine Research Center, Hospital Clinic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - E Danzer
- Division of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - M McLaughlin
- Radiology Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - D Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - T Vercauteren
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - S Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - E Radaelli
- Department of Pathobiology, Ryan Veterinary Hospital, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, USA
| | - P de Coppi
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division of Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Specialist Neonatal and Pediatric Surgery Unit, Great Ormond Street Hospital, University College London Hospitals, NHS Foundation Trust, London, UK
| | - F Van Calenbergh
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - J Deprest
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division of Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Institute of Women's Health, University College London Hospitals, London, UK
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Shlobin NA, Roach JT, Kancherla V, Caceres A, Ocal E, Ghotme KA, Lam S, Park KB, Rosseau G, Blount JP, Boop FA. The role of neurosurgeons in global public health: the case of folic acid fortification of staple foods to prevent spina bifida. J Neurosurg Pediatr 2023; 31:8-15. [PMID: 36334286 DOI: 10.3171/2022.9.peds22188] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The global neurosurgery movement arose at the crossroads of unmet neurosurgical needs and public health to address the global burden of neurosurgical disease. The case of folic acid fortification (FAF) of staple foods for the prevention of spina bifida and anencephaly (SBA) represents an example of a new neurosurgical paradigm focused on public health intervention in addition to the treatment of individual cases. The Global Alliance for the Prevention of Spina Bifida-F (GAPSBiF), a multidisciplinary coalition of neurosurgeons, pediatricians, geneticists, epidemiologists, food scientists, and fortification policy experts, was formed to advocate for FAF of staple foods worldwide. This paper serves as a review of the work of GAPSBiF thus far in advocating for universal FAF of commonly consumed staple foods to equitably prevent SBA caused by folic acid insufficiency. METHODS A narrative review was performed using the PubMed and Google Scholar databases. RESULTS In this review, the authors describe the impact of SBA on patients, caregivers, and health systems, as well as characterize the multifaceted requirements for proper spina bifida care, including multidisciplinary clinics and the transition of care, while highlighting the role of neurosurgeons. Then they discuss prevention policy approaches, including supplementation, fortification, and hybrid efforts with folic acid. Next, they use the example of FAF of staple foods as a model for neurosurgeons' involvement in global public health through clinical practice, research, education and training, and advocacy. Last, they describe mechanisms for involvement in the above initiatives as a potential academic tenure track, including institutional partnerships, organized neurosurgery, neurosurgical expert groups, nongovernmental organizations, national or international governments, and multidisciplinary coalitions. CONCLUSIONS The role of neurosurgeons in caring for children with spina bifida extends beyond treating patients in clinical practice and includes research, education and training, and advocacy initiatives to promote context-specific, evidence-based initiatives to public health problems. Promoting and championing FAF serves as an example of the far-reaching, impactful role that neurosurgeons worldwide may play at the intersection of neurosurgery and public health.
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Affiliation(s)
- Nathan A Shlobin
- 1Division of Pediatric Neurosurgery, Lurie Children's Hospital, Chicago, Illinois
- 2Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jordan T Roach
- 3College of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
- 4Graduate School of Biomedical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Vijaya Kancherla
- 5Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Adrian Caceres
- 6Department of Neurosurgery, National Children's Hospital of Costa Rica, "Dr. Carlos Saenz Herrera," San José, Costa Rica
| | - Eylem Ocal
- 7Department of Neurosurgery, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kemel A Ghotme
- 8Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Chía, Colombia
- 9Pediatric Neurosurgery, Department of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Sandi Lam
- 1Division of Pediatric Neurosurgery, Lurie Children's Hospital, Chicago, Illinois
- 2Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kee B Park
- 10Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Gail Rosseau
- 11Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Jeffrey P Blount
- 12Department of Neurosurgery, University of Alabama at Birmingham/Children's of Alabama, Birmingham, Alabama; and
| | - Frederick A Boop
- 13Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
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Li L, Tang L, Bi Y. Intrauterine neuromuscular and stromal dysplasia of the bladder in retinoic acid-induced myelomeningocele fetal rats. Tissue Cell 2022; 78:101872. [DOI: 10.1016/j.tice.2022.101872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 10/17/2022]
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Lal S, Tremblay S, Starcevic D, Mauger-Lavigne M, Anaby D. Mental health problems among adolescents and young adults with childhood-onset physical disabilities: A scoping review. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:904586. [PMID: 36189015 PMCID: PMC9485587 DOI: 10.3389/fresc.2022.904586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022]
Abstract
Aim This scoping review aims to better understand the extent and nature of research activity on the topic of mental health problems in young people with childhood-onset physical disabilities. Specifically, we document what has been investigated in terms of the occurrence and experience of mental health problems among young people with childhood-onset physical disabilities, and their access to mental health services. Methods We searched four databases (Medline, PsycINFO, CINAHL, Embase) for articles published between 2007 and 2019. Studies were included if they addressed: (1) young people between the ages of 13 and 24 with a childhood-onset physical disability, and (2) mental health assessment, treatment, or service access and use. Results We identified 33 peer-reviewed studies that focused mainly on young people with cerebral palsy, juvenile arthritis, and spina bifida. The most common mental health problems investigated were depression and mood related difficulties (73%), anxiety (39%), and social/behavioural issues (33%) and the most common age range was 13 to 17. Ten studies explored access, use, and experiences of mental health services; stigma; caregiver mental health; and value for comprehensive care, using qualitative, quantitative, or mixed methods. Conclusions Findings suggest the importance of developing integrated models of service delivery to identify and address the mental health needs of this population, and consensus on best practices for assessment and reporting rates of subclinical symptoms and psychiatric conditions.
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Affiliation(s)
- Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada
- PEPP Montreal and ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, QC, Canada
- Correspondence: Shalini Lal
| | - Stephanie Tremblay
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Danielle Starcevic
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada
| | - Melina Mauger-Lavigne
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada
| | - Dana Anaby
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
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Shlobin NA, Yerkes EB, Swaroop VT, Lam S, McLone DG, Bowman RM. Multidisciplinary spina bifida clinic: the Chicago experience. Childs Nerv Syst 2022; 38:1675-1681. [PMID: 35870009 DOI: 10.1007/s00381-022-05594-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/23/2022] [Indexed: 11/03/2022]
Abstract
Open spina bifida (open SB) is the most complex congenital abnormality of the central nervous system compatible with long-term survival. Multidisciplinary care is required to address the effect of this disease on the neurological, musculoskeletal, genitourinary, and gastrointestinal systems, as well as the complex psychosocial impact on the developing child. Individuals with SB benefit from the involvement of neurosurgeons, orthopedic surgeons, urologists, physical medicine and rehabilitation specialists, pediatricians, psychologists, physical/occupational/speech therapists, social workers, nurse coordinators, and other personnel. Multidisciplinary clinics are the gold standard for coordinated, optimal medical and surgical care. Ann and Robert H. Lurie Children's Hospital, formerly known as Children's Memorial Hospital, was one of the first hospitals in the USA to manage patients with this complex disease in a multidisciplinary manner. We describe the longitudinal experience of the multidisciplinary Spina Bifida Center at our institution and highlight the advances that have arisen from this care model over time. This clinic serves as an exemplar of organized, effective, and patient-centered approach to the comprehensive care of people living with open SB.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth B Yerkes
- Department of Urology, Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Vineeta T Swaroop
- Department of Orthopedic Surgery, Division of Pediatric Orthopedic Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sandi Lam
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David G McLone
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robin M Bowman
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Sacral Spina Bifida Occulta: A Frequency Analysis of Secular Change. ANTHROPOLOGICAL REVIEW 2022. [DOI: 10.18778/1898-6773.85.2.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Substantial relaxation of natural selection beginning around 1900 changed the mutation/selection balance of modern genetic material, producing an increase in variable anatomical structures. While multiple structures have been affected, the temporal increase in variations of the sacrum, specifically, ‘Sacral Spina Bifida Occulta,’ have been reliably demonstrated on a localised scale. Calculation of largescale frequency has been hindered by the localised nature of these publications, the morphological variability of this variation, and potential pathological associations, which have produced divergent classifications, and conflicting reported rates of occurrence. A systematic review of the reported literature was conducted to provide an objective analysis of Sacral Spina Bifida Occulta frequency from 2500 BCE to the present. This review was designed to compensate for observed inconsistencies in reporting and to ascertain, for the first time, the temporal trajectory of this secular trend. A systematic review of Sacral Spina Bifida Occulta literature was conducted through the strict use of clinical meta-analysis criteria. Publications were retrieved from four databases: PubMed, Embase, the Adelaide University Library database, and Google Scholar. Data were separated into three historical groups, (1 = <1900, 2 = 1900 to 1980 and 3 = >1980), and frequency outcomes compared, to determine temporal rates of occurrence.
A total of 39/409 publications were included in the final analysis, representing data for 16,167 sacra, spanning a period of 4,500 years. Statistically significant results were obtained, with total open S1 frequency increasing from 2.34%, (79 to 1900CE), to 4.80%, (1900 to 1980CE) and to 5.43% (>1980CE). These increases were significant at p<0.0001, with Chi-squared analysis. A clear secular increase in the global frequency of Sacral Spina Bifida Occulta has been demonstrated from 1900 to the present. This research provides a novel and adaptable framework for the future assessment of variation distribution, with important implications for the fields of biological anthropology and bioarchaeology.
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Oria M, Pathak B, Li Z, Bakri K, Gouwens K, Varela MF, Lampe K, Murphy KP, Lin CY, Peiro JL. Premature Neural Progenitor Cell Differentiation Into Astrocytes in Retinoic Acid-Induced Spina Bifida Rat Model. Front Mol Neurosci 2022; 15:888351. [PMID: 35782393 PMCID: PMC9249056 DOI: 10.3389/fnmol.2022.888351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/16/2022] [Indexed: 01/25/2023] Open
Abstract
During embryonic spinal cord development, neural progenitor cells (NPCs) generate three major cell lines: neurons, oligodendrocytes, and astrocytes at precise times and locations within the spinal cord. Recent studies demonstrate early astrogenesis in animal models of spina bifida, which may play a role in neuronal dysfunction associated with this condition. However, to date, the pathophysiological mechanisms related to this early astrocytic response in spina bifida are poorly understood. This study aimed to characterize the development of early astrogliosis over time from Pax6+, Olig2+, or Nkx2.2+ NPCs using a retinoic acid-induced spina bifida rat model. At three gestational ages (E15, E17, and E20), spinal cords from fetuses with retinoic acid-induced spina bifida, their healthy sibling controls, or fetuses treated with the vehicle control were analyzed. Results indicated that premature astrogliosis and astrocytic activation were associated with an altered presence of Pax6+, Olig2+, and Nkx2.2+ NPCs in the lesion compared to the controls. Finally, this response correlated with an elevation in genes involved in the Notch-BMP signaling pathway. Taken together, changes in NPC patterning factor expression with Notch-BMP signaling upregulation may be responsible for the altered astrogenesis patterns observed in the spinal cord in a retinoic acid-induced spina bifida model.
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Affiliation(s)
- Marc Oria
- Center for Fetal and Placental Research, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, United States,Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, United States,*Correspondence: Marc Oria,
| | - Bedika Pathak
- Center for Fetal and Placental Research, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, United States
| | - Zhen Li
- Center for Fetal and Placental Research, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, United States
| | - Kenan Bakri
- Center for Fetal and Placental Research, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, United States
| | - Kara Gouwens
- Center for Fetal and Placental Research, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, United States
| | - Maria Florencia Varela
- Center for Fetal and Placental Research, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, United States
| | - Kristin Lampe
- Center for Fetal and Placental Research, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, United States
| | - Kendall P. Murphy
- Center for Fetal and Placental Research, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, United States,Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Chia-Ying Lin
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Jose L. Peiro
- Center for Fetal and Placental Research, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, United States,Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
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Spina Bifida: A Review of the Genetics, Pathophysiology and Emerging Cellular Therapies. J Dev Biol 2022; 10:jdb10020022. [PMID: 35735913 PMCID: PMC9224552 DOI: 10.3390/jdb10020022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/13/2022] [Accepted: 05/23/2022] [Indexed: 12/11/2022] Open
Abstract
Spina bifida is the most common congenital defect of the central nervous system which can portend lifelong disability to those afflicted. While the complete underpinnings of this disease are yet to be fully understood, there have been great advances in the genetic and molecular underpinnings of this disease. Moreover, the treatment for spina bifida has made great advancements, from surgical closure of the defect after birth to the now state-of-the-art intrauterine repair. This review will touch upon the genetics, embryology, and pathophysiology and conclude with a discussion on current therapy, as well as the first FDA-approved clinical trial utilizing stem cells as treatment for spina bifida.
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Dural substitutes for spina bifida repair: past, present, and future. Childs Nerv Syst 2022; 38:873-891. [PMID: 35378616 PMCID: PMC9968456 DOI: 10.1007/s00381-022-05486-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/28/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The use of materials to facilitate dural closure during spina bifida (SB) repair has been a highly studied aspect of the surgical procedure. The overall objective of this review is to present key findings pertaining to the success of the materials used in clinical and pre-clinical studies. Additionally, this review aims to aid fetal surgeons as they prepare for open or fetoscopic prenatal SB repairs. METHODS Relevant publications centered on dural substitutes used during SB repair were identified. Important information from each article was extracted including year of publication, material class and sub-class, animal model used in pre-clinical studies, whether the repair was conducted pre-or postnatally, the bioactive agent delivered, and key findings from the study. RESULTS Out of 1,121 publications, 71 were selected for full review. We identified the investigation of 33 different patches where 20 and 63 publications studied synthetic and natural materials, respectively. From this library, 43.6% focused on clinical results, 36.6% focused on pre-clinical results, and 19.8% focused on tissue engineering approaches. Overall, the use of patches, irrespective of material, have shown to successfully protect the spinal cord and most have shown promising survival and neurological outcomes. CONCLUSION While most have shown significant promise as a therapeutic strategy in both clinical and pre-clinical studies, none of the patches developed so far are deemed perfect for SB repair. Therefore, there is an opportunity to develop new materials and strategies that aim to overcome these challenges and further improve the outcomes of SB patients.
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41
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Ebeling PR, Nguyen HH, Aleksova J, Vincent AJ, Wong P, Milat F. Secondary Osteoporosis. Endocr Rev 2022; 43:240-313. [PMID: 34476488 DOI: 10.1210/endrev/bnab028] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 02/07/2023]
Abstract
Osteoporosis is a global public health problem, with fractures contributing to significant morbidity and mortality. Although postmenopausal osteoporosis is most common, up to 30% of postmenopausal women, > 50% of premenopausal women, and between 50% and 80% of men have secondary osteoporosis. Exclusion of secondary causes is important, as treatment of such patients often commences by treating the underlying condition. These are varied but often neglected, ranging from endocrine to chronic inflammatory and genetic conditions. General screening is recommended for all patients with osteoporosis, with advanced investigations reserved for premenopausal women and men aged < 50 years, for older patients in whom classical risk factors for osteoporosis are absent, and for all patients with the lowest bone mass (Z-score ≤ -2). The response of secondary osteoporosis to conventional anti-osteoporosis therapy may be inadequate if the underlying condition is unrecognized and untreated. Bone densitometry, using dual-energy x-ray absorptiometry, may underestimate fracture risk in some chronic diseases, including glucocorticoid-induced osteoporosis, type 2 diabetes, and obesity, and may overestimate fracture risk in others (eg, Turner syndrome). FRAX and trabecular bone score may provide additional information regarding fracture risk in secondary osteoporosis, but their use is limited to adults aged ≥ 40 years and ≥ 50 years, respectively. In addition, FRAX requires adjustment in some chronic conditions, such as glucocorticoid use, type 2 diabetes, and HIV. In most conditions, evidence for antiresorptive or anabolic therapy is limited to increases in bone mass. Current osteoporosis management guidelines also neglect secondary osteoporosis and these existing evidence gaps are discussed.
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Affiliation(s)
- Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia
| | - Hanh H Nguyen
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Department of Endocrinology and Diabetes, Western Health, Victoria 3011, Australia
| | - Jasna Aleksova
- Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Amanda J Vincent
- Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria 3168, Australia
| | - Phillip Wong
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Frances Milat
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
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Paschereit F, Schindelmann KH, Hummel M, Schneider J, Stoltenburg-Didinger G, Kaindl AM. Cerebral Abnormalities in Spina Bifida: A Neuropathological Study. Pediatr Dev Pathol 2022; 25:107-123. [PMID: 34614376 PMCID: PMC9109215 DOI: 10.1177/10935266211040500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Spina bifida (SB) is the most common neural tube defect in humans. Here, we analyzed systematically the neuropathological findings of the brain in SB cases. METHODS 79 cases with SB aperta (SBA) and 6 cases with SB occulta (SBO) autopsied at the Charité Neuropathology from 1974 to 2000 were re-evaluated retrospectively. For this, case files and spinal cord as well as brain sections were studied. RESULTS While no brain malformations were detected in SBO cases, 95% of SBA cases had brain malformations. Main brain anomalies identified were hydrocephalus (71%), Chiari II malformation (36%), heterotopia (34%), other cerebellar anomalies (36%), gyrification defects (33%), and ependymal denudation (29%). Hydrocephalus was observed as early as gestational week 17 and was highly associated to Chiari II and ependymal denudation. In 55% SBA was accompanied by further anomalies not primarily affecting the CNS. CONCLUSION We confirm using neuropathologic methods brain malformations in most SBA but none in SBO cases. In addition to our previous radiologic study, we now demonstrate the high prevalence of cerebellar malformations and cerebral heterotopias in SBA. The early detection of hydrocephalus and Chiari II malformation in fetuses raises the question whether these arise parallel rather than in strict temporal sequence.
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Affiliation(s)
- Fabienne Paschereit
- Institute of Cell Biology and Neurobiology, Charité—Universitätsmedizin Berlin, Berlin, Germany,Department of Pediatric Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Kim Hannah Schindelmann
- Institute of Cell Biology and Neurobiology, Charité—Universitätsmedizin Berlin, Berlin, Germany,Department of Pediatric Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Hummel
- Institute of Pathology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Joanna Schneider
- Department of Pediatric Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany,Center for Chronically Sick Children (Sozialpädiatrisches Zentrum, SPZ), Charité—Universitätsmedizin Berlin, Berlin, Germany
| | | | - Angela M Kaindl
- Institute of Cell Biology and Neurobiology, Charité—Universitätsmedizin Berlin, Berlin, Germany,Department of Pediatric Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany,Center for Chronically Sick Children (Sozialpädiatrisches Zentrum, SPZ), Charité—Universitätsmedizin Berlin, Berlin, Germany,Angela M Kaindl, Department of Pediatric Neurology, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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Incidence of bladder cancer in neuro-urological patients in France: a nationwide study. World J Urol 2022; 40:1921-1927. [PMID: 35182207 DOI: 10.1007/s00345-022-03955-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/30/2022] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the incidence of bladder cancer (BCa) in patients with the main neurological diseases that induce neurogenic lower urinary tract dysfunction, namely, multiple sclerosis (MS), spinal cord injury (SCI) and spina bifida (SB). METHODS We conducted a retrospective analysis of nationwide data from the French Hospital Discharge Database (PMSI) from January 2010 to December 2018. The incidence of BCa was calculated in patients with MS, SCI and SB. Incidence, sex, age, radical cystectomy after BCa diagnosis and in-hospital deaths were compared between the three groups. The Chi2 and Kruskal-Wallis tests were used for qualitative and quantitative data comparisons, respectively. RESULTS Overall, 2015 neuro-urological patients (mean (± SD) age: 65.4 ± 12.3 years) were hospitalized in France between 2010 and 2018 with a new diagnosis of BCa. In neuro-urological patients, BCa was more frequent in men than in women (sex ratio: 3.08). The incidence of BCa in neuro-urological patients was 174.9/100,000 persons/year. The incidence of BCa was 791.1/100,000 persons/year in SCI compared to 56.6 in MS and 113.8 in SB (p < 0.0001). After the initial diagnosis of BCa, 551 (27.3%) patients underwent a radical cystectomy and 613 (30.4%) died in hospital after BCa diagnosis. CONCLUSIONS The incidence of BCa in France between 2010 and 2018 was 174.9/100 000 persons/year, and was particularly high in patients with SCI.
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Chen G, Wang Y, Ying X, Pang D, Liao L. [Effectiveness and safety of sacral neuromodulation on neurogenic bladder and bowel dysfunction in patients with spina bifida]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1374-1379. [PMID: 34779161 DOI: 10.7507/1002-1892.202105112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the effectiveness and safety of sacral neuromodulation (SNM) in the treatment of neurogenic bladder and bowel dysfunction in patients with spina bifida. Methods The clinical data of 33 patients with neurogenic bladder and bowel dysfunction caused by spina bifida treated with SNM between July 2012 and May 2021 were retrospectively analyzed. There were 19 males and 14 females, with an average age of 26.0 years (range, 18.5-36.5 years). The disease duration ranged from 12 to 456 months, with an average of 195.8 months. The types of spina bifida included 8 cases of occult spina bifida and 25 cases of meningocele/myelomeningocele. Clinical symptoms included 19 cases of urgency-frequent urination, 18 cases of urinary incontinence, 27 cases of chronic urinary retention, and 29 cases of bowel dysfunction. Image urodynamics showed that 4 patients had detrusor overactivity (DO) and 29 patients had detrusor underactivity (DU). Vesicoureteral reflux (VUR) was found in 5 ureters (4 patients). SNM procedure was divided into experiential treatment and permanent implantation. Patients who were evaluated as successful or willing to be permanently implanted after experiential treatment would implant the permanent pulse generator. Results The duration of experiential treatment was 14-28 days, with an average of 19.2 days; there was no complication during this period, and the overall success rate was 69.69% (23/33). At the end of experiential treatment, the urination frequency in 24 hours, urine volume per time, urinary urgency score, and urine leakage of patients were significantly improved when compared with those before experiential treatment ( P<0.05); there was no significant difference in postvoid residual volume between before and after experiential treatment ( t=1.383, P=0.179). The success rate of patients with chronic urinary retention after experiential treatment (25.93%) was significantly lower than that of urgency-frequent urination (63.16%) and urinary incontinence (61.11%) ( χ 2=7.260, P=0.064). Compared with those before experiential treatment, the maximum cystometric capacity and compliance increased and the maximum detrusor pressure during filling decreased significantly ( P<0.05). Among the 4 patients with DO before experiential treatment, DO disappeared in 2 cases; 27 patients with DU before experiential treatment did not recover the normal contraction of detrusor during micturition. Among the 5 ureters with VUR before experiential treatment, 2 VUR disappeared at the end of experiential treatment, and the VUR grade or the bladder volume before VUR of the other 3 ureters were improved. At the end of experiential treatment, the neurogenic bowel dysfunction (NBD) score and the grade of bowel dysfunction significantly improved ( P<0.05). A total of 19 patients received permanent implantation, of which 11 patients needed to empty the bladder in combination with intermittent catheterization. Conclusion SNM is effective for neurogenic bladder and bowel dysfunction in patients with spina bifida. At the same time, it can significantly improve the urodynamic parameters during urine storage and avoid upper urinary tract damage.
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Affiliation(s)
- Guoqing Chen
- Department of Urology, Beijing Boai Hospital, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, 100068, P.R.China
| | - Yiming Wang
- Department of Urology, Beijing Boai Hospital, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, 100068, P.R.China
| | - Xiaoqian Ying
- Department of Urology, Beijing Boai Hospital, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, 100068, P.R.China
| | - Dongqing Pang
- Department of Urology, Beijing Boai Hospital, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, 100068, P.R.China
| | - Limin Liao
- Department of Urology, Beijing Boai Hospital, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, 100068, P.R.China
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Zhu H, Wang L, Ren A. [Research progress on the etiology and pathogenesis of spina bifida]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1368-1373. [PMID: 34779160 DOI: 10.7507/1002-1892.202106052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the research progress on etiology and pathogenesis of spina bifida. Methods By consulting relevant domestic and foreign research literature on spina bifida, the classification, epidemic trend, pathogenesis, etiology, prevention and treatment of it were analyzed and summarized. Results Spina bifida, a common phenotype of neural tube defects, is classified based on the degree and pattern of malformation associated with neuroectodermal involvement and is due to the disturbance of neural tube closure 28 days before embryonic development. The prevalence of spina bifida varies greatly among different ethnic groups and regions, and its etiology is complex. Currently, some spina bifida patients can be prevented by folic acid supplements, and with the improvement of treatment technology, the short-term and long-term survival rate of children with spina bifida has improved. Conclusion The research on the pathogenesis of spina bifida will be based on the refined individual information on exposure, genetics, and complex phenotype, and will provide a theoretical basis for improving prevention and treatment strategies through multidisciplinary cooperation.
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Affiliation(s)
- Haiyan Zhu
- Institute of Reproductive Health, National Health Commission Key Laboratory of Reproductive Health, Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, P.R.China
| | - Linlin Wang
- Institute of Reproductive Health, National Health Commission Key Laboratory of Reproductive Health, Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, P.R.China
| | - Aiguo Ren
- Institute of Reproductive Health, National Health Commission Key Laboratory of Reproductive Health, Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, P.R.China
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WORLEY GORDON, GREENBERG RACHELG, ROCQUE BRANDONG, LIU TIEBIN, DICIANNO BRADE, CASTILLO JONATHANP, WARD ELISABETHA, WILLIAMS TONYAR, BLOUNT JEFFREYP, WIENER JOHNS. Neurosurgical procedures for children with myelomeningocele after fetal or postnatal surgery: a comparative effectiveness study. Dev Med Child Neurol 2021; 63:1294-1301. [PMID: 33386749 PMCID: PMC8603138 DOI: 10.1111/dmcn.14792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 12/17/2022]
Abstract
AIM To compare the frequencies of neurosurgical procedures to treat comorbid conditions of myelomeningocele in patients who underwent fetal surgery versus postnatal surgery for closure of the placode. METHOD By utilizing the National Spina Bifida Patient Registry in a comparative effectiveness study, 298 fetal surgery patients were matched by birthdate (±3mo) and spina bifida clinic site with one to three postnatal surgery patients (n=648). Histories were obtained by record review on enrollment and yearly subsequently. Multivariable Poisson regression was used to compare frequencies of procedures between cohorts, with adjustments for sex, ethnicity, insurance status, spinal segmental level of motor function, age at last visit recorded in the Registry, and, for shunt revision in shunted patients, age at cerebrospinal fluid (CSF) diversion. RESULTS The median age at last visit was 4 years. In fully adjusted analyses in patients aged at least 12 months old, fetal surgery was associated with decreased frequency of CSF diversion for hydrocephalus by ventriculoperitoneal shunt insertion or endoscopic third ventriculostomy compared with postnatal surgery (46% vs 79%; incidence rate ratio=0.61; 95% confidence interval [CI] 0.53-0.71; p<0.01). Over all ages, fetal surgery was associated with decreased frequency of Chiari decompression for brainstem dysfunction (3% vs 7%; incidence rate ratio=0.41; 95% CI 0.19-0.88; p=0.02). Also over all ages, differences were not significant in frequencies of shunt revision in shunted patients (53% vs 55%; incidence rate ratio=0.87; 95% CI 0.69-1.11; p=0.27), nor tethered cord release for acquired spinal cord dysfunction (18% vs 16%; incidence rate ratio=1.11; 95% CI 0.84-1.47; p=0.46). INTERPRETATION Even with the variations inherent in clinical practice, fetal surgery was associated with lower frequencies of CSF diversion and of Chiari decompression, independent of covariates. What this paper adds Fetal surgery was associated with lower frequencies of cerebrospinal fluid diversion and decompression of Chiari II malformation than postnatal surgery. Frequencies of ventriculoperitoneal shunt revision and tethered cord release were not significantly different between cohorts.
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Affiliation(s)
- GORDON WORLEY
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - RACHEL G GREENBERG
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, Durham, NC;,Duke Clinical Research Institute, Durham, NC
| | - BRANDON G ROCQUE
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children’s Hospital of Alabama, University of Alabama at Birmingham, Birmingham, AL
| | - TIEBIN LIU
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - BRAD E DICIANNO
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - JONATHAN P CASTILLO
- Division of Developmental Pediatrics, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - ELISABETH A WARD
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - TONYA R WILLIAMS
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - JEFFREY P BLOUNT
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children’s Hospital of Alabama, University of Alabama at Birmingham, Birmingham, AL
| | - JOHN S WIENER
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Morel D. Special Needs Insurance: More Stability for a Growing Family's Budget. J Insur Med 2021; 49:1-31. [PMID: 34788842 DOI: 10.17849/insm-49-s1-1-31.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/21/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE.— To propose an insurance product called special needs insurance. The insurance will pay parents a lump sum up to $100,000 if they have a child that is born with or develops a special needs condition such as Down syndrome, cerebral palsy or autism. BACKGROUND.— Raising a child is expensive; raising a child with a special need can be hundreds of thousands of dollars more expensive. These additional costs include direct costs that are not covered by health insurance and indirect costs such as the loss of earnings when a working parent must tend to a special needs child. METHOD.— We analyze a gamut of birth and early childhood disabilities, both physical and cognitive, from the medico-actuarial perspective. We describe each condition using relevant medical literature and calculate prevalence rates from epidemiological studies (appendix A1-A15). After accounting for multiple births, we develop a final premium. RESULTS.— We find that physical impairments are sufficiently well understood to guarantee a fixed payout, whereas cognitive impairments such as autism are less understood, and so for these we propose a cognitive fund that does not guarantee a fixed payout. We find that an average single premium of $4,600 allows the insurer to profitably pay out the proposed benefits. CONCLUSIONS.— Raising a special needs child can put a significant strain on the affected family's budget. We propose an insurance product that provides relief through a large lump sum payout. Although no new insurance product can be guaranteed success, our analysis of this product gives an interested insurer reasonable justification to take on this new risk.
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Garcia-Bonilla M, McAllister JP, Limbrick DD. Genetics and Molecular Pathogenesis of Human Hydrocephalus. Neurol India 2021; 69:S268-S274. [PMID: 35102976 DOI: 10.4103/0028-3886.332249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Hydrocephalus is a neurological disorder with an incidence of 80-125 per 100,000 live births in the United States. The molecular pathogenesis of this multidimensional disorder is complex and has both genetic and environmental influences. This review aims to discuss the genetic and molecular alterations described in human hydrocephalus, from well-characterized, heritable forms of hydrocephalus (e.g., X-linked hydrocephalus from L1CAM variants) to those affecting cilia motility and other complex pathologies such as neural tube defects and Dandy-Walker syndrome. Ventricular zone disruption is one key pattern among congenital and acquired forms of hydrocephalus, with abnormalities in cadherins, which mediate neuroepithelium/ependymal cell junctions and contribute to the pathogenesis and severity of the disease. Given the relationship between hydrocephalus pathogenesis and neurodevelopment, future research should elucidate the genetic and molecular mechanisms that regulate ventricular zone integrity and stem cell biology.
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Affiliation(s)
- Maria Garcia-Bonilla
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - James P McAllister
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - David D Limbrick
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Allen R, James A, Sankaran S. Trends in termination of pregnancy for neural tube defects in England and Wales from 2007 to 2017: Observational prospective study. Prenat Diagn 2021; 41:1624-1633. [PMID: 34671992 DOI: 10.1002/pd.6060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/15/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/OBJECTIVE Neural tube defects (NTDs) affect approximately 300,000 pregnancies worldwide each year. Many of these pregnancies are lost to miscarriage or termination of pregnancy. Here, we have analysed the trends of termination of pregnancy for NTDs from the national data for England and Wales. METHODS Data for all terminations for residents in England and Wales for the period of 2007-2017 were obtained through Health and Social Act 4 (HSA4) submitted to the Department of Health. Using the ICD-10 codes, terminations for NTDs were selected for analysis. The statistical test Chi-squared was performed using SPSS-v25, where appropriate. RESULTS In the 11-year period, there were 28,866 terminations under Ground E; of which 4425 (15.33%) had a diagnosis of NTD. The number of NTD cases increased over the time period from 308 in 2007 to 517 in 2017 (67.9%). Significant results were also seen when analysing the relationship between ethnicity, gestation and terminations where an NTD was diagnosed. CONCLUSION With the availability of routine prenatal ultrasound, the termination for NTDs is on the rise in England and Wales, in spite of the health advice of periconceptional folic acid. This study demonstrates the need for implementation of further programmes to increase public health awareness of folic supplementation and government initiation of fortification to reduce NTDs.
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Affiliation(s)
- Ruth Allen
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Andrew James
- United Kingdom Department of Health and Social Care, London, UK
| | - Srividhya Sankaran
- Department of Obstetrics and Gynaecology, St. Thomas' Hospital, London, UK
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The Unique Properties of Placental Mesenchymal Stromal Cells: A Novel Source of Therapy for Congenital and Acquired Spinal Cord Injury. Cells 2021; 10:cells10112837. [PMID: 34831060 PMCID: PMC8616037 DOI: 10.3390/cells10112837] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 12/28/2022] Open
Abstract
Spinal cord injury (SCI) is a devasting condition with no reliable treatment. Spina bifida is the most common cause of congenital SCI. Cell-based therapies using mesenchymal stem/stromal cells (MSCS) have been largely utilized in SCI. Several clinical trials for acquired SCI use adult tissue-derived MSC sources, including bone-marrow, adipose, and umbilical cord tissues. The first stem/stromal cell clinical trial for spina bifida is currently underway (NCT04652908). The trial uses early gestational placental-derived mesenchymal stem/stromal cells (PMSCs) during the fetal repair of myelomeningocele. PMSCs have been shown to exhibit unique neuroprotective, angiogenic, and antioxidant properties, all which are promising applications for SCI. This review will summarize the unique properties and current applications of PMSCs and discuss their therapeutic role for acquired SCI.
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