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Backley S, Bergh EP, Garnett J, Li R, Maroufy V, Jain R, Fletcher S, Tsao K, Austin M, Johnson A, Papanna R. Fetal cardiovascular changes during open and fetoscopic in-utero spina bifida closure. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 64:193-202. [PMID: 38207160 DOI: 10.1002/uog.27579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/30/2023] [Accepted: 12/21/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Fetoscopic closure of spina bifida using heated and humidified carbon dioxide gas (hhCO2) has been associated with lower maternal morbidity compared with open closure. Fetal cardiovascular changes during these surgical interventions are poorly defined. Our objective was to compare fetal bradycardia (defined as fetal heart rate (FHR) < 110 bpm for 10 min) and changes in umbilical artery (UA) Doppler parameters during open vs fetoscopic closure. METHODS This was a prospective cohort study of 22 open and 46 fetoscopic consecutive in-utero closures conducted between 2019 and 2023. Both cohorts had similar preoperative counseling and clinical management. FHR and UA Doppler velocimetry were obtained systematically during preoperative assessment, every 5 min during the intraoperative period, and during the postoperative assessment. FHR, UA pulsatility index (PI) and UA end-diastolic flow (EDF) were segmented into hourly periods during surgery, and the lowest values were averaged for analysis. Umbilical vein maximum velocity was measured in the fetoscopic cohort. At each timepoint at which FHR was recorded, maternal heart rate and systolic and diastolic blood pressure were measured. RESULTS Fetal bradycardia occurred in 4/22 (18.2%) cases of open closure and 21/46 (45.7%) cases of fetoscopic closure (P = 0.03). FHR decreased gradually in both cohorts after administration of general anesthesia and decreased further during surgery. FHR was significantly lower during hour 2 of surgery in the fetoscopic-repair cohort compared with the open-repair cohort. The change in FHR from baseline in the final stage of fetal surgery was significantly more pronounced in the fetoscopic-repair cohort compared with the open-repair cohort (mean, -32.4 (95% CI, -35.7 to -29.1) bpm vs -23.5 (95% CI, -28.1 to -18.8) bpm; P = 0.002). Abnormal UA-EDF (defined as absent or reversed EDF) occurred in 3/22 (13.6%) cases in the open-repair cohort and 23/46 (50.0%) cases in the fetoscopic-repair cohort (P = 0.004). There were no differences in UA-EDF or UA-PI between closure techniques at the individual stages of assessment. CONCLUSIONS We observed a decrease in FHR and abnormalities in UA Doppler parameters during both open and fetoscopic spina bifida closure. Fetal bradycardia was more prominent during fetoscopic closure following hhCO2 insufflation, but FHR recovered after cessation of hhCO2. Changes in FHR and UA Doppler parameters during in-utero spina bifida closure were transient, no cases required emergency delivery and no fetoscopic closure was converted to open closure. These observations should inform algorithms for the perioperative management of fetal bradycardia associated with in-utero spina bifida closure. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Backley
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - E P Bergh
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - J Garnett
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - R Li
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX, USA
| | - V Maroufy
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX, USA
| | - R Jain
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
- Division of Pediatric Anesthesia, Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - S Fletcher
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
- Division of Pediatric Neurosurgery, Department of Pediatric Surgery and Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - K Tsao
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
- Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - M Austin
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
- Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - A Johnson
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - R Papanna
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
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Mann LK, Pandiri S, Agarwal N, Northrup H, Au KS, Grundberg E, Bergh EP, Austin MT, Patel R, Miller B, Zhu S, Feinberg JS, Lai D, Tsao K, Fletcher SA, Papanna R. Morphometric Analysis of Spina Bifida after Fetal Repair Shows New Subtypes with Associated Outcomes. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.29.24308088. [PMID: 38853851 PMCID: PMC11160825 DOI: 10.1101/2024.05.29.24308088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Importance The binary classification of spina bifida lesions as myelomeningocele (with sac) or myeloschisis (without sac) belies a spectrum of morphologies, which have not been correlated to clinical characteristics and outcomes. Objective To characterize spina bifida lesion types and correlate them with preoperative presentation and postoperative outcomes. Design Secondary analysis of images and videos obtained during fetoscopic spina bifida repair surgery from 2020-2023. Setting Fetal surgery was performed at a quaternary care center. Participants A prospective cohort of patients referred for fetal spina bifida underwent fetoscopic repair under an FDA-approved protocol. Of 60 lesions repaired, 57 had available images and were included in the analysis. Interventions or Exposures We evaluated lesion morphology on high-resolution intraoperative images and videos to categorize lesions based on placode exposure and nerve root stretching. Main Outcomes and Measures The reproducibility of the lesion classification was assessed via Kappa interrater agreement. Preoperative characteristics analyzed include ventricle size, tonsillar herniation level, lower extremities movement, and lesion dimensions. Outcomes included surgical time, need for patch for skin closure, gestational age at delivery, preterm premature rupture of membranes (PPROM), and neonatal cerebrospinal fluid (CSF) diversion. Results We distinguished five lesion types that differ across a range of sac sizes, nerve root stretching, and placode exposure, with 93% agreement between examiners (p<0.001). Fetal characteristics at preoperative evaluation differed significantly by lesion type, including lesion volume (p<0.001), largest ventricle size (p=0.008), tonsillar herniation (p=0.005), and head circumference (p=0.03). Lesion level, talipes, and lower extremities movement did not differ by type. Surgical and perinatal outcomes differed by lesion type, including need for patch skin closure (p<0.001), gestational age at delivery (p=0.01), and NICU length of stay (p<0.001). PPROM, CSF leakage at birth, and CSF diversion in the NICU did not differ between lesion groups. Linear regression associated severity of ventriculomegaly with lesion type, but not with tonsillar herniation level. Conclusions and Relevance There is a distinct phenotypic spectrum in open spina bifida with differential baseline presentation and outcomes. Severity of ventriculomegaly is associated with lesion type, rather than tonsillar herniation level. Our findings expand the classification of spina bifida to reveal a spectrum that warrants further study.
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Affiliation(s)
- Lovepreet K. Mann
- Division of Fetal Intervention, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School, UTHealth Science Center, Houston, TX 77030
| | - Shreya Pandiri
- Division of Fetal Intervention, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School, UTHealth Science Center, Houston, TX 77030
| | - Neha Agarwal
- Division of Fetal Intervention, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School, UTHealth Science Center, Houston, TX 77030
| | - Hope Northrup
- Department of Pediatrics, McGovern Medical School, UTHealth Science Center, Houston, TX 77030
| | - Kit Sing Au
- Department of Pediatrics, McGovern Medical School, UTHealth Science Center, Houston, TX 77030
| | - Elin Grundberg
- Genomic Medicine Center, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO 64108
| | - Eric P. Bergh
- Division of Fetal Intervention, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School, UTHealth Science Center, Houston, TX 77030
| | - Mary T. Austin
- Department of Pediatric Surgery, McGovern Medical School, UTHealth Science Center, Houston, TX 77030
| | - Rajan Patel
- Neuroradiology Section, Department of Radiology, Texas Children’s Hospital, Houston, TX 77030
| | - Brandon Miller
- Department of Pediatric Surgery, McGovern Medical School, UTHealth Science Center, Houston, TX 77030
| | - Sen Zhu
- Division of Fetal Intervention, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School, UTHealth Science Center, Houston, TX 77030
| | - Jonathan S. Feinberg
- Division of Fetal Intervention, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School, UTHealth Science Center, Houston, TX 77030
| | - Dejian Lai
- Department of Biostatistics, School of Public Health, UTHealth Houston, Houston, TX
| | - KuoJen Tsao
- Department of Pediatric Surgery, McGovern Medical School, UTHealth Science Center, Houston, TX 77030
| | - Stephen A. Fletcher
- Department of Pediatric Surgery, McGovern Medical School, UTHealth Science Center, Houston, TX 77030
| | - Ramesha Papanna
- Division of Fetal Intervention, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School, UTHealth Science Center, Houston, TX 77030
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Fishel Bartal M, Bergh EP, Tsao K, Austin MT, Moise KJ, Fletcher SA, Garnett J, Mann L, Hernandez-Andrade E, Johnson A, Papanna R. Primary vs patch-based skin closure for in-utero spina bifida repair. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:666-672. [PMID: 35751885 DOI: 10.1002/uog.26018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/31/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE During in-utero spina bifida (SB) repair, closure of large defects is often challenging, requiring tissue graft for watertight skin closure. No prior studies have compared primary skin closure vs patch-based repair. Our objective was to compare neonatal and 1-year outcomes associated with these two types of skin closure for in-utero SB repair. METHODS This was a prospective cohort study of 102 patients undergoing open prenatal SB repair from September 2011 to August 2021 at a single institution. All patients met the inclusion criteria of the Management of Myelomeningocele Study (MOMS), and the surgical procedure for in-utero SB repair was similar to that described in the MOMS trial. During the surgery, if primary skin approximation was not feasible due to the large size of the defect, the decision was at the discretion of the pediatric neurosurgeon to utilize a patch for closure. Neonatal outcomes at birth and 1-year outcomes were compared between the primary skin and patch-based closure groups. RESULTS Of 102 patients included in the study, 70 (68.6%) underwent primary skin closure and 32 (31.4%) patch-based closure. The patch type included acellular bovine skin matrix (Durepair®; n = 31) and human acellular dermal matrix (Alloderm®; n = 1). Fetuses with myeloschisis were more likely to require patch-based repair than those with myelomeningocele. The median time of fetal repair was 4 min longer for patch-based compared with primary skin closure (37 vs 33 min; P = 0.001). Following patch-based repair, neonates had a longer length of stay in the neonatal intensive care unit (NICU) by 24 days (adjusted risk ratio, 2.40 (95% CI, 1.41-4.29)) compared to those that underwent primary skin closure. There was no difference between the two groups in the other neonatal outcomes, including the need for ventriculoperitoneal shunt placement and cerebrospinal fluid leakage. Outcome at 1 year of age was available for 90 infants. Need for wound revision within their first year after birth was more common in infants who underwent patch-based vs those with primary skin closure (19.4% vs 5.1%; P = 0.05). There was no difference between the two groups in other 1-year outcomes, including the need for ventriculoperitoneal shunt placement by 1 year of age and surgery for tethered cord. CONCLUSIONS Patch-based closure during SB repair is often needed in fetuses with myeloschisis and is associated with prolonged fetal surgery time, long NICU stay and need for wound revision within the first year after birth. Further studies are required to identify optimal patches for SB repair or alternative methods to improve outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Fishel Bartal
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - E P Bergh
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - K Tsao
- Department of Pediatric Surgery, Children's Memorial Hermann Hospital, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - M T Austin
- Department of Pediatric Surgery, Children's Memorial Hermann Hospital, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - K J Moise
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - S A Fletcher
- Pediatric Neurosurgery, Department of Pediatric Surgery, Children's Memorial Hermann Hospital, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - J Garnett
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - L Mann
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - E Hernandez-Andrade
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - A Johnson
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - R Papanna
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Use of Cryopreserved Human Umbilical Cord for Wound Healing of the Nose after Mohs Micrographic Surgery. Case Rep Dermatol Med 2022; 2022:2107629. [PMID: 35300172 PMCID: PMC8923802 DOI: 10.1155/2022/2107629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/22/2022] [Indexed: 11/17/2022] Open
Abstract
Mohs micrographic surgery (MMS) is microscopically controlled surgery used to treat common skin cancers including primary and recurrent basal cell carcinoma (BCC). Unfortunately, postexcisional MMS wounds, particularly down to periosteum or perichondrium, are susceptible to potentially poor cosmetic outcomes, including wound contracture, hypopigmentation and hyperpigmentation, and contour mismatch. Herein, we report a case to show how adjunctive application of human cryopreserved umbilical cord tissue (UC) may expedite wound healing with improved aesthetic outcome. A 53-year-old Caucasian female with a slight natural lifelong depression between her lower nasal tip alar cartilages suffered from a recurrent BCC mostly of the right nasal tip. After MMS down to the perichondrium, UC was immediately applied to the surgical wound. Prolific granulation developed at one week followed by rapid reepithelialization at two weeks. This resulted in complete closure at four weeks and a pleasing aesthetic nasal tip at 6 weeks. At one year and 5 months after MMS, there continued to be excellent aesthetic outcome as evaluated by surrounding skin color, contour, and texture with a minimal residual scar. In this case, the adjunctive use of cryopreserved human UC accelerated the postsurgical MMS wound healing in the nasal tip particularly in patients with significant comorbidities or are unwilling to undergo a formal surgical reconstruction. This encouraging finding warrants further controlled studies in the future.
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Mann LK, Won JH, Patel R, Bergh EP, Garnett J, Bhattacharjee MB, Narayana PA, Jain R, Fletcher SA, Lai D, Papanna R. Allografts for Skin Closure during In Utero Spina Bifida Repair in a Sheep Model. J Clin Med 2021; 10:4928. [PMID: 34768448 PMCID: PMC8584988 DOI: 10.3390/jcm10214928] [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: 09/16/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Use of off-label tissue graft materials, such as acellular dermal matrix (ADM), for in utero repair of severe spina bifida (SB), where primary skin layer closure is not possible, is associated with poor neurological outcomes. The cryopreserved human umbilical cord (HUC) patch has regenerative, anti-inflammatory, and anti-scarring properties, and provides watertight SB repair. We tested the hypothesis that the HUC is a superior skin patch to ADM for reducing inflammation at the repair site and preserving spinal cord function. METHODS In timed-pregnant ewes with twins, on gestational day (GD) 75, spina bifida was created without a myelotomy (functional model). On GD 95, repair was performed using HUC vs. ADM patches (randomly assigned) by suturing them to the skin edges. Additionally, full thickness skin closure as a primary skin closure (PSC) served as a positive control. Delivery was performed on GD 140, followed by blinded to treatment neurological assessments of the lambs using the Texas Spinal Cord Injury Scale (TSCIS) for gait, proprioception, and nociception. Lambs without spina bifida were used as controls (CTL). Ex vivo magnetic resonance imaging of spines at the repair site were performed, followed by quantitative pathological assessments. Histological assessments (blinded) included Masson's trichrome, and immunofluorescence for myeloperoxidase (MPO; neutrophils) and for reactive astrocytes (inflammation) by co-staining vimentin and GFAP. RESULTS The combined hind limbs' TSCIS was significantly higher in the HUC group than in ADM and PSC groups, p = 0.007. Both ADM and PSC groups exhibited loss of proprioception and mild to moderate ataxia compared to controls. MRI showed increased pathological findings in the PSC group when compared to the HUC group, p = 0.045. Histologically, the meningeal layer was thickened (inflammation) by 2-3 fold in ADM and PSC groups when compared to HUC and CTL groups, p = 0.01. There was lower MPO positive cells in the HUC group than in the ADM group, p = 0.018. Posterior column astrocyte activation was increased in ADM and PSC lambs compared to HUC lambs, p = 0.03. CONCLUSION The HUC as a skin patch for in utero spina bifida repair preserves spinal cord function by reducing underlying inflammation when compared to ADM.
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Affiliation(s)
- Lovepreet K. Mann
- Division of Maternal-Fetal Medicine, The Fetal Center at Children’s Memorial Hermann Hospital, Department of Obstetrics, Gynecology and Reproductive Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA; (J.H.W.); (E.P.B.); (J.G.)
| | - Jong Hak Won
- Division of Maternal-Fetal Medicine, The Fetal Center at Children’s Memorial Hermann Hospital, Department of Obstetrics, Gynecology and Reproductive Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA; (J.H.W.); (E.P.B.); (J.G.)
| | - Rajan Patel
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA; (R.P.); (P.A.N.)
| | - Eric P. Bergh
- Division of Maternal-Fetal Medicine, The Fetal Center at Children’s Memorial Hermann Hospital, Department of Obstetrics, Gynecology and Reproductive Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA; (J.H.W.); (E.P.B.); (J.G.)
| | - Jeannine Garnett
- Division of Maternal-Fetal Medicine, The Fetal Center at Children’s Memorial Hermann Hospital, Department of Obstetrics, Gynecology and Reproductive Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA; (J.H.W.); (E.P.B.); (J.G.)
| | - Meenakshi B. Bhattacharjee
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA;
| | - Ponnada A. Narayana
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA; (R.P.); (P.A.N.)
| | - Ranu Jain
- Department of Anesthesia, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA;
| | - Stephen A. Fletcher
- Division of Pediatric Neurosurgery, Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA;
| | - Dejian Lai
- Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA;
| | - Ramesha Papanna
- Division of Maternal-Fetal Medicine, The Fetal Center at Children’s Memorial Hermann Hospital, Department of Obstetrics, Gynecology and Reproductive Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA; (J.H.W.); (E.P.B.); (J.G.)
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Penner M, Younger A, Wing K, Cresswell M, Veljkovic A. Arthroscopic Repair of Talar Osteochondral Defects With Umbilical Cord Allograft: A Prospective, Single-Center, Pilot Study. Foot Ankle Spec 2021; 14:193-200. [PMID: 32172597 DOI: 10.1177/1938640020910953] [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] [Indexed: 11/16/2022]
Abstract
Cryopreserved umbilical cord (UC) allografts have been shown to promote postoperative wound healing by suppressing inflammation and reducing scar formation. The purpose of this study was to determine whether adjunctive use of UC may improve clinical and functional outcomes following arthroscopic repair of talar osteochondral defects (OCDs). A total of 10 patients with talar OCDs that failed nonoperative treatment were enrolled in this single-center, prospective, pilot study. Clinical and functional outcomes were assessed using the Ankle Osteoarthritis Scale (AOS), Foot and Ankle Ability Measure, and Visual Analog Scale (VAS) pain scale at 6, 12, 24, and 52 weeks postoperatively. Results showed a consistent improvement in all outcome measures. VAS pain scores significantly improved from 4.2 ± 2.9 to 1.3 ± 2.2 at 52 weeks (P = .015). AOS difficulty and pain scores nonsignificantly improved from 27.0 ± 24.6 and 33.1 ± 28.3 at baseline to 15.3 ± 20.5 and 14.8 ± 18.7 at 52 weeks, respectively. The clinical outcome improvement was accompanied by significant reduction in OCD defect size and associated bone marrow lesion. This pilot study suggests that adjunctive use of UC during arthroscopic repair of talar OCD may lead to clinical and functional improvement.Levels of Evidence: Level II: Prospective Cohort Study.
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Affiliation(s)
- Murray Penner
- Department of Orthopaedics (MP, AY, KW, AV).,Department of Radiology (MC), University of British Columbia, Vancouver, BC, Canada
| | - Alastair Younger
- Department of Orthopaedics (MP, AY, KW, AV).,Department of Radiology (MC), University of British Columbia, Vancouver, BC, Canada
| | - Kevin Wing
- Department of Orthopaedics (MP, AY, KW, AV).,Department of Radiology (MC), University of British Columbia, Vancouver, BC, Canada
| | - Mark Cresswell
- Department of Orthopaedics (MP, AY, KW, AV).,Department of Radiology (MC), University of British Columbia, Vancouver, BC, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics (MP, AY, KW, AV).,Department of Radiology (MC), University of British Columbia, Vancouver, BC, Canada
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Yamashiro KJ, Farmer DL. Fetal myelomeningocele repair: a narrative review of the history, current controversies and future directions. Transl Pediatr 2021; 10:1497-1505. [PMID: 34189108 PMCID: PMC8192992 DOI: 10.21037/tp-20-87] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Fetal surgery is a relatively new field of medicine. The purpose of this narrative review is to present the history of how fetal surgery became the standard of care for myelomeningocele (MMC), the current controversies of this treatment, and active areas of research that may change how MMC is treated. Fetal surgery for MMC emerged out of the University of California, San Francisco in the 1980s in the laboratory of Dr. Michael Harrison. Initial research focused on testing the hypothesis that the in utero repair of MMC could improve outcomes in the ovine model. Evidence from this model suggested that in utero repair decreases the secondary damage to the exposed neural tissue and improves post-natal neurologic outcomes, opening the door for human intervention. This was followed by the Management of Myelomeningocele Study (MOMS), which was a multicenter randomized controlled trial comparing the prenatal versus postnatal MMC repair. The MOMS trial was stopped early due to the improved outcomes of the prenatal repair, establishing the open fetal MMC repair as the standard of care. Since the MOMS trial, two primary areas of controversy have arisen: the operative approach and criteria for the repair. The three operative approaches include open, endoscopic and a hybrid approach combining open and endoscopic. Several of the inclusion and exclusion criteria from the MOMS trial have been challenged, to include body mass index, gestational diabetes, other fetal abnormalities, maternal infections and Rh alloimmunization. New areas of research have also emerged, exploring cell based therapies to improve fetal outcomes, alternatives to fetal surgery and alternatives to primary skin closure of the fetus.
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Affiliation(s)
- Kaeli J Yamashiro
- Department of Surgery, University of California-Davis, Sacramento, CA, USA
| | - Diana L Farmer
- Department of Surgery, University of California-Davis, Sacramento, CA, USA
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Prenatal and Postnatal Imaging Findings After Fetal Repair of Spinal Dysraphisms Using Cryopreserved Human Umbilical Cord Patch: A Case Series of 4 Patients. J Comput Assist Tomogr 2020; 44:998-1007. [PMID: 32976267 DOI: 10.1097/rct.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe a case series of imaging findings of 4 patients who underwent spinal dysraphisms repair in utero with novel patch material, cryopreserved human umbilical cord, in our institution. In our study, the prenatal and postnatal magnetic resonance imaging and ultrasound are reviewed and showed cord tethering and syrinx progression in all cases. Our report is the first description of magnetic resonance imaging and ultrasound findings in the context of using this novel patch in severe cases of spinal dysraphisms.
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Tseng SCG, Chen SY, Mead OG, Tighe S. Niche regulation of limbal epithelial stem cells: HC-HA/PTX3 as surrogate matrix niche. Exp Eye Res 2020; 199:108181. [PMID: 32795525 DOI: 10.1016/j.exer.2020.108181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/15/2020] [Accepted: 07/31/2020] [Indexed: 12/13/2022]
Abstract
Homeostasis of the corneal epithelium is ultimately maintained by stem cells that reside in a specialized microenvironment within the corneal limbus termed palisades of Vogt. This limbal niche nourishes, protects, and regulates quiescence, self-renewal, and fate decision of limbal epithelial stem/progenitor cells (LEPCs) toward corneal epithelial differentiation. This review focuses on our current understanding of the mechanism by which limbal (stromal) niche cells (LNCs) regulate the aforementioned functions of LEPCs. Based on our discovery and characterization of a unique extracellular matrix termed HC-HA/PTX3 (Heavy chain (HC1)-hyaluronan (HA)/pentraxin 3 (PTX3) complex, "-" denotes covalent linkage; "/" denotes non-covalent binding) in the birth tissue, i.e., amniotic membrane and umbilical cord, we put forth a new paradigm that HC-HA/PTX3 serves as a surrogate matrix niche by maintaining the in vivo nuclear Pax6+ neural crest progenitor phenotype to support quiescence and self-renewal but prevent corneal fate decision of LEPCs. This new paradigm helps explain how limbal stem cell deficiency (LSCD) develops in aniridia due to Pax6-haplotype deficiency and further explains why transplantation of HC-HA/PTX3-containing amniotic membrane prevents LSCD in acute chemical burns and Stevens Johnson syndrome, augments the success of autologous LEPCs transplantation in patients suffering from partial or total LSCD, and assists ex vivo expansion (engineering) of a graft containing LEPCs. We thus envisage that this new paradigm based on regenerative matrix HC-HA/PTX3 as a surrogate niche can set a new standard for regenerative medicine in and beyond ophthalmology.
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Affiliation(s)
- Scheffer C G Tseng
- Research & Development Department, TissueTech, Inc., Miami, FL, 33126, USA; Ocular Surface Center and Ocular Surface Research & Education Foundation, Miami, FL, 33126, USA.
| | - Szu-Yu Chen
- Research & Development Department, TissueTech, Inc., Miami, FL, 33126, USA
| | - Olivia G Mead
- Research & Development Department, TissueTech, Inc., Miami, FL, 33126, USA
| | - Sean Tighe
- Research & Development Department, TissueTech, Inc., Miami, FL, 33126, USA; Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA; Department of Ophthalmology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA
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10
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Vu T, Mann LK, Fletcher SA, Jain R, Garnett J, Tsao K, Austin MT, Moise KJ, Johnson A, Shah MN, Papanna R. Suture techniques and patch materials using an in-vitro model for watertight closure of in-utero spina bifida repair. J Pediatr Surg 2020; 55:726-731. [PMID: 31255327 DOI: 10.1016/j.jpedsurg.2019.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/17/2019] [Accepted: 05/26/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Despite proven benefits of in-utero spina bifida (SB) repair, ≥30% of children at birth have Chiari II malformation or cerebrospinal fluid (CSF) leakage from the repair site. Our study's purpose was to determine CSF pressures in the myelomeningocele sac during mid-gestation in order to design an in-vitro model for evaluating different surgical methods used for watertight closure during in-utero SB repair. METHODS CSF pressures were measured during in-utero SB repair at mid-gestation. An in-vitro chicken thigh model, simulating fetal tissue, tested watertight closure when attached to the base of a water column. Primary closure methods were evaluated using defect sizes of 20 × 3 mm for minimal traction or 20 × 8 mm for moderate traction. Additionally, 3 common in-utero repair patches were compared using 15 × 15 mm defects. RESULTS Using 6-12.5 cm pre-determined CSF pressures, 165 in-vitro experiments were performed. Regardless of methodology we found that in 66 primary-based closures that minimal versus moderate wound edge traction provided better seals. The locking method was superior to the non-locking technique for watertight closure in 99 patch-based closures. CONCLUSIONS Minimal wound edge traction was best for primary closures, and locking sutures ideal for patch-based closures, however surgical techniques should be individualized to improve upon clinical outcomes.
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Affiliation(s)
- Thai Vu
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School - University Health Science Center at Houston, the Fetal Center and the Memorial Hermann Hospital, Houston, TX
| | - Lovepreet K Mann
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School - University Health Science Center at Houston, the Fetal Center and the Memorial Hermann Hospital, Houston, TX
| | - Stephen A Fletcher
- Pediatric Neurosurgery, Department of Pediatric Surgery, McGovern Medical School - University Health Science Center at Houston, the Fetal Center and the Memorial Hermann Hospital, Houston, TX; Department of Anesthesiology, McGovern Medical School - University Health Science Center at Houston, the Fetal Center and the Memorial Hermann Hospital, Houston, TX
| | - Ranu Jain
- Department of Anesthesiology, McGovern Medical School - University Health Science Center at Houston, the Fetal Center and the Memorial Hermann Hospital, Houston, TX
| | - Jeannine Garnett
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School - University Health Science Center at Houston, the Fetal Center and the Memorial Hermann Hospital, Houston, TX
| | - Kuojen Tsao
- Department of Pediatric Surgery, McGovern Medical School - University Health Science Center at Houston, the Fetal Center and the Memorial Hermann Hospital, Houston, TX
| | - Mary T Austin
- Department of Pediatric Surgery, McGovern Medical School - University Health Science Center at Houston, the Fetal Center and the Memorial Hermann Hospital, Houston, TX
| | - Kenneth J Moise
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School - University Health Science Center at Houston, the Fetal Center and the Memorial Hermann Hospital, Houston, TX
| | - Anthony Johnson
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School - University Health Science Center at Houston, the Fetal Center and the Memorial Hermann Hospital, Houston, TX
| | - Manish N Shah
- Pediatric Neurosurgery, Department of Pediatric Surgery, McGovern Medical School - University Health Science Center at Houston, the Fetal Center and the Memorial Hermann Hospital, Houston, TX
| | - Ramesha Papanna
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School - University Health Science Center at Houston, the Fetal Center and the Memorial Hermann Hospital, Houston, TX.
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11
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Velarde F, Castañeda V, Morales E, Ortega M, Ocaña E, Álvarez-Barreto J, Grunauer M, Eguiguren L, Caicedo A. Use of Human Umbilical Cord and Its Byproducts in Tissue Regeneration. Front Bioeng Biotechnol 2020; 8:117. [PMID: 32211387 PMCID: PMC7075856 DOI: 10.3389/fbioe.2020.00117] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/06/2020] [Indexed: 12/13/2022] Open
Abstract
The fresh or cryopreserved human umbilical cord (HUC) and its byproducts, such as cells and extracts, have different uses in tissue regeneration. Defining what HUC byproduct is more effective in a particular application is a challenge. Furthermore, the methods of isolation, culture and preservation, may affect cell viability and regenerative properties. In this article, we review the HUC and its byproducts' applications in research and clinical practice. We present our results of successful use of HUC as a patch to treat gastroschisis and its potential to be applied in other conditions. Our in vitro results show an increase in proliferation and migration of human fibroblasts by using an acellular HUC extract. Our goal is to promote standardization of procedures and point out that applications of HUC and its byproducts, as well as the resulting advances in regenerative medicine, will depend on rigorous quality control and on more research in this area.
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Affiliation(s)
- Francesca Velarde
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito, Quito, Ecuador
| | - Verónica Castañeda
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito, Quito, Ecuador
- Colegio de Ciencias Biológicas y Ambientales, Escuela de Biotecnología, Universidad San Francisco de Quito, Quito, Ecuador
| | - Emilia Morales
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito, Quito, Ecuador
- Colegio de Ciencias Biológicas y Ambientales, Escuela de Biotecnología, Universidad San Francisco de Quito, Quito, Ecuador
| | - Mayra Ortega
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito, Quito, Ecuador
- Colegio de Ciencias Biológicas y Ambientales, Escuela de Biotecnología, Universidad San Francisco de Quito, Quito, Ecuador
| | - Edwin Ocaña
- Hospital Carlos Andrade Marín, Quito, Ecuador
| | - Jose Álvarez-Barreto
- Instituto para el Desarrollo de Energías y Materiales Alternativos (IDEMA), Colegio de Ciencias e Ingenierías (Politécnico), Universidad San Francisco de Quito, Quito, Ecuador
| | - Michelle Grunauer
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Unidad de Cuidados Intensivos Pediátricos, Hospital de los Valles, Quito, Ecuador
| | - Luis Eguiguren
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Sistemas Médicos, SIME, Universidad San Francisco de Quito, Quito, Ecuador
| | - Andrés Caicedo
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito, Quito, Ecuador
- Sistemas Médicos, SIME, Universidad San Francisco de Quito, Quito, Ecuador
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Mann LK, Won JH, Trenton NJ, Garnett J, Snowise S, Fletcher SA, Tseng SCG, Diehl MR, Papanna R. Cryopreserved human umbilical cord versus acellular dermal matrix patches for in utero fetal spina bifida repair in a pregnant rat model. J Neurosurg Spine 2020; 32:321-331. [PMID: 31675701 DOI: 10.3171/2019.7.spine19468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/31/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite significant improvement in spinal cord function after in utero spina bifida (SB) repair compared with traditional postnatal repair, over half of the children who undergo this procedure do not benefit completely. This lack of benefit has been attributed to closure methods of the defect, with subsequent spinal cord tethering at the repair site. Hence, a regenerative patch or material with antiinflammatory and anti-scarring properties may alleviate comorbidities with improved outcomes. The authors' primary objective was therefore to compare cryopreserved human umbilical cord (HUC) versus acellular dermal matrix (ADM) patches for regenerative repair of in utero SB lesions in an animal model. METHODS In vivo studies were conducted in retinoic acid-induced SB defects in fetuses of Sprague-Dawley rats. HUC or ADM patches were sutured over the SB defects at a gestational age of 20 days. Repaired SB defect tissues were harvested after 48-52 hours. Tissue sections were immunofluorescently stained for the presence of neutrophils, macrophages, keratinocytes, meningeal cells, and astrocytes and for any associated apoptosis. In vitro meningeal or keratinocyte cell coculture experiments with the ADM and HUC patches were performed. All experiments were scored quantitatively in a blinded manner. RESULTS Neutrophil counts and apoptotic cells were lower in the HUC-based repair group (n = 8) than in the ADM patch repair group (n = 7). In the HUC patch repair group, keratinocytes were present on the outer surface of the patch, meningeal cells were present on the inner surface of the patch adjacent to the neural placode, and astrocytes were noted to be absent. In the ADM patch repair group, all 3 cell types were present on both surfaces of the patch. In vitro studies showed that human meningeal cells grew preferentially on the mesenchymal side of the HUC patch, whereas keratinocytes showed tropism for the epithelial side, suggesting an inherent HUC-based cell polarity. In contrast, the ADM patch studies showed no polarity and decreased cellular infiltration. CONCLUSIONS The HUC patch demonstrated reduced acute inflammation and apoptosis together with superior organization in regenerative cellular growth when compared with the ADM patch, and is therefore likely the better patch material for in utero SB defect repair. These properties may make the HUC biomaterial useful as a "meningeal patch" during spinal cord surgeries, thereby potentially reducing tethering and improving on spinal cord function.
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Affiliation(s)
- Lovepreet K Mann
- 1Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston
| | - Jong H Won
- 1Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston
| | | | - Jeannine Garnett
- 1Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston
| | - Saul Snowise
- 1Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston
| | - Stephen A Fletcher
- 3Division of Pediatric Neurosurgery, Department of Pediatrics, and Department of Pediatric Surgery, UTHealth The University of Texas McGovern Medical School, Houston, Texas; and
| | | | | | - Ramesha Papanna
- 1Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston
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Novel Use of Cryopreserved Ultra-thick Human Amniotic Membrane for Management of Anophthalmic Socket Contracture. Ophthalmic Plast Reconstr Surg 2019; 35:193-196. [PMID: 30407993 DOI: 10.1097/iop.0000000000001264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the use of cryopreserved ultra-thick human amniotic membrane for management of anophthalmic socket contracture. METHODS A chart review was performed to identify patients undergoing fornix reconstruction with cryopreserved ultra-thick human amniotic membrane for management of anophthalmic socket contracture. Patient demographics, disease etiology, and data regarding postoperative prosthesis fit and complications were collected. RESULTS The technique is described in 3 female patients with anophthalmic socket contracture who underwent fornix reconstruction using cryopreserved ultra-thick human amniotic membrane. All patients had excellent prosthesis fit at final follow up (range, 10-14 months). There were no clinically significant complications and no reoperations were performed. One pyogenic granuloma developed and was excised without affecting ocular prosthesis fit. CONCLUSIONS Cryopreserved ultra-thick human amniotic membrane is easy to use, well tolerated, and produces good outcomes for management of anophthalmic socket contracture.
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14
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Mazzone L, Moehrlen U, Ochsenbein-Kölble N, Pontiggia L, Biedermann T, Reichmann E, Meuli M. Bioengineering and in utero transplantation of fetal skin in the sheep model: A crucial step towards clinical application in human fetal spina bifida repair. J Tissue Eng Regen Med 2019; 14:58-65. [PMID: 31595702 DOI: 10.1002/term.2963] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 08/02/2019] [Accepted: 09/05/2019] [Indexed: 11/09/2022]
Abstract
An intricate problem during open human fetal surgery for spina bifida regards back skin closure, particularly in those cases where the skin defect is much too large for primary closure. We hypothesize that tissue engineering of fetal skin might provide an adequate autologous skin substitute for in utero application in such situations. Eight sheep fetuses of four time-mated ewes underwent fetoscopic skin biopsy at 65 days of gestation. Fibroblasts and keratinocytes isolated from the biopsy were used to create fetal dermo-epidermal skin substitutes. These were transplanted on the fetuses by open fetal surgery at 90 days of gestation on skin defects (excisional wounds) created during the same procedure. Pregnancy was allowed to continue until euthanasia at 120 days of gestation. The graft area was analyzed macroscopically and microscopically. The transplanted fetal dermo-epidermal skin substitutes was well discernable in situ in three of the four fetuses available for analysis. Histology confirmed healed grafts with a close to natural histological skin architecture four weeks after in utero transplantation. This experimental study generates evidence that laboratory grown autologous fetal skin analogues can successfully be transplanted in utero. These results have clinical implications as an analogous procedure might be applied in human fetuses undergoing prenatal repair to facilitate primary skin closure. Finally, this study may also fertilize the field of fetal tissue engineering in general, particularly when more interventional, minimally invasive, and open fetal surgical procedures become available.
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Affiliation(s)
- Luca Mazzone
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Zurich Center for Fetal Diagnosis and Treatment, Zurich, Switzerland.,Tissue Biology Research Unit, Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ueli Moehrlen
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Zurich Center for Fetal Diagnosis and Treatment, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nicole Ochsenbein-Kölble
- Zurich Center for Fetal Diagnosis and Treatment, Zurich, Switzerland.,Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| | - Luca Pontiggia
- Tissue Biology Research Unit, Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Thomas Biedermann
- Tissue Biology Research Unit, Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ernst Reichmann
- Tissue Biology Research Unit, Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin Meuli
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Zurich Center for Fetal Diagnosis and Treatment, Zurich, Switzerland.,Tissue Biology Research Unit, Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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15
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The Use of Umbilical Amnion for Conjunctival Socket, Fornix, and Eyelid Margin Reconstruction. Ophthalmic Plast Reconstr Surg 2019; 36:365-371. [PMID: 31770177 DOI: 10.1097/iop.0000000000001555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe outcomes using umbilical amnion for conjunctival fornix, socket, and eyelid margin reconstruction. METHODS A medical record review was performed to identify patients who had received umbilical amnion over a 2-year period in their department. Patient demographics, disease etiology, and data regarding surgical outcomes were collected. The primary outcome was the success rate of the surgical intervention. RESULTS Twenty-one patients received umbilical amnion for anophthalmic socket contracture (n = 16), orbital implant exposure (n = 3), ocular surface burn (n = 1), and cicatricial entropion repair (n = 1). The primary outcome was met in 76% of patients overall. In anophthalmic socket contracture, the primary outcome was met in 86% and 0% of patients with acquired and congenital anophthalmia, respectively. The primary outcome was met in all cases of orbital implant exposure and cicatricial entropion. The primary outcome was not met in a Roper-Hall grade IV ocular surface burn. CONCLUSIONS Umbilical amnion is an ideal substrate graft for reconstruction of the conjunctival fornix, socket, and eyelid margin. Umbilical amnion appears to be efficacious for the management of socket contracture in acquired anophthalmia, orbital implant exposure, and cicatricial entropion. Further experience is needed to determine the efficacy of umbilical amnion in ocular surface burns.
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Abstract
Myelomeningocele is a congenital malformation that causes a spectrum of morbidity. With the standard of care now being in utero repair, the spectrum of morbidity has changed. The purpose of this article is to review the diagnosis, workup and treatment options of fetal myelomeningocele. We also review the obstetrical, neurological, gastrointestinal, urinary, and orthopedic outcomes of the in utero myelomeningocele repair.
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Affiliation(s)
- Kaeli J Yamashiro
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA.
| | - Laura A Galganski
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA
| | - Shinjiro Hirose
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA
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17
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Abstract
Fetal surgery and fetal therapy involve surgical interventions on the fetus in utero to correct or ameliorate congenital abnormalities and give a developing fetus the best chance at a healthy life. Historical use of biomaterials in fetal surgery has been limited, and most biomaterials used in fetal surgeries today were originally developed for adult or pediatric patients. However, as the field of fetal surgery moves from open surgeries to minimally invasive procedures, many opportunities exist for innovative biomaterials engineers to create materials designed specifically for the unique challenges and opportunities of maternal-fetal surgery. Here, we review biomaterials currently used in clinical fetal surgery as well as promising biomaterials in development for eventual clinical translation. We also highlight unmet challenges in fetal surgery that could particularly benefit from novel biomaterials, including fetal membrane sealing and minimally invasive myelomeningocele defect repair. Finally, we conclude with a discussion of the underdeveloped fetal immune system and opportunities for exploitation with novel immunomodulating biomaterials.
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Affiliation(s)
- Sally M Winkler
- Department of Bioengineering, University of California, Berkeley, CA, USA. and University of California, Berkeley-University of California, San Francisco Graduate Program in Bioengineering, Berkeley, CA, USA
| | - Michael R Harrison
- Division of Pediatric Surgery, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Phillip B Messersmith
- Department of Bioengineering, University of California, Berkeley, CA, USA. and Department of Materials Science and Engineering, University of California, Berkeley, CA, USA and Materials Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
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Masini L, De Luca C, Noia G, Caruso A, Lanzone A, Rendeli C, Ausili E, Massimi L, Tamburrini G, Apicella M, De Santis M. Prenatal diagnosis, natural history, postnatal treatment and outcome of 222 cases of spina bifida: experience of a tertiary center. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:302-308. [PMID: 30288814 DOI: 10.1002/uog.20136] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 04/19/2018] [Accepted: 09/28/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To report on the prenatal ultrasonographic diagnosis of spina bifida (SB) and its natural history, treatment and long-term outcome in a large tertiary referral center. METHODS All cases of SB diagnosed between February 1980 and December 2015 in the Obstetric Prenatal Diagnosis Day Unit of the Obstetrics and Gynecology Department at the Catholic University of the Sacred Heart, Rome, were reviewed. All infants with an open defect were delivered by elective Cesarean section and underwent early repair of the spinal defect. A ventriculoperitoneal (VP) shunt and/or third ventriculostomy was performed when needed. Complete postnatal follow-up was carried out by our multidisciplinary team in the majority of cases. The cohort was analyzed in two groups: Group 1 included patients referred between February 1980 and December 1999; Group 2 included patients referred between January 2000 and December 2015. RESULTS There was a total of 222 cases of SB with a prenatal diagnosis rate of 94.6% (n = 210), with the majority of defects being meningomyeloceles (n = 142 (64.0%)), affecting the lumbosacral level (n = 110 (49.5%)) and being ≥ 2 cm in size (n = 163/195 (83.6%)). There were 174 (78.4%) live births, with more terminations in Group 2 (26.1%) than in Group 1 (10.8%; P = 0.003). Postnatal surgical repair was conducted in 157 cases (99.4% of eligible cases), with death of an infant who was operated on occurring more often in Group 1 (14.1%) than in Group 2 (4.2%; P = 0.03). VP shunt placement was required in 60.3% of infants operated on after January 2000. Long-term follow-up was available for 136 children (111 with open defects and 25 with closed defects). Infants born since 2000 with an open defect had normal ambulation or a mild defect in 50% of cases and normal or mild deficit of sphincter function in 37.8% of cases. An intelligence quotient of ≥ 70 was observed in the majority of children (81.4%; 35/43 cases). Worse motor function was associated with progressive prenatal ventriculomegaly, level of lesion and VP shunt placement. CONCLUSIONS We describe the prenatal diagnosis, natural history and long-term outcome of a large contemporary cohort of SB fetuses and infants. In an era of pioneering fetal surgical techniques for in-utero SB repair, it is important to acknowledge that advances in conventional neonatology and pediatric neurosurgery have allowed increased life expectancy and improved quality of life in patients with SB. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- L Masini
- Department of Women and Child Health, Obstetrics and Neonatology Area, Centro Studi per la Tutela della Salute della Madre e del Concepito, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C De Luca
- Department of Women and Child Health, Obstetrics and Neonatology Area, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Noia
- Department of Women and Child Health, Obstetrics and Neonatology Area, Centro Studi per la Tutela della Salute della Madre e del Concepito, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Caruso
- Department of Women and Child Health, Obstetrics and Neonatology Area, Centro Studi per la Tutela della Salute della Madre e del Concepito, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Lanzone
- Department of Women and Child Health, Obstetrics and Neonatology Area, Centro Studi per la Tutela della Salute della Madre e del Concepito, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Rendeli
- Spina Bifida Center, Department of Women and Child Health, Paediatrics Area, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Ausili
- Spina Bifida Center, Department of Women and Child Health, Paediatrics Area, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Massimi
- Paediatric Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Tamburrini
- Paediatric Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Apicella
- Department of Women and Child Health, Obstetrics and Neonatology Area, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M De Santis
- Department of Women and Child Health, Obstetrics and Neonatology Area, Centro Studi per la Tutela della Salute della Madre e del Concepito, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Lapa Pedreira DA, Acacio GL, Gonçalves RT, Sá RAM, Brandt RA, Chmait RH, Kontopoulos EV, Quintero RA. Percutaneous fetoscopic closure of large open spina bifida using a bilaminar skin substitute. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:458-466. [PMID: 29314321 DOI: 10.1002/uog.19001] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/04/2017] [Accepted: 12/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We have described previously our percutaneous fetoscopic technique for the treatment of open spina bifida (OSB). However, approximately 20-30% of OSB defects are too large to allow primary skin closure. Here we describe a modification of our standard technique using a bilaminar skin substitute to allow closure of large spinal defects. The aim of this study was to report our clinical experience with the use of a bilaminar skin substitute and a percutaneous fetoscopic technique for the prenatal closure of large OSB defects. METHODS Surgery was performed between 24.0 and 28.9 gestational weeks with the woman under general anesthesia, using an entirely percutaneous fetoscopic approach with partial carbon dioxide insufflation of the uterine cavity, as described previously. If there was enough skin to be sutured in the midline, only a biocellulose patch was placed over the placode (single-patch group). In cases in which skin approximation was not possible, a bilaminar skin substitute (two layers: one silicone and one dermal matrix) was placed over the biocellulose patch and sutured to the skin edges (two-patch group). The surgical site was assessed at birth, and long-term follow-up was carried out. RESULTS Percutaneous fetoscopic OSB repair was attempted in 47 consecutive fetuses, but surgery could not be completed in two. Preterm prelabor rupture of membranes (PPROM) occurred in 36 of the 45 (80%) cases which formed the study group, and the mean gestational age at delivery was 32.8 ± 2.5 weeks. A bilaminar skin substitute was required in 13/45 (29%) cases; in the remaining 32 cases, direct skin-to-skin suture was feasible. There were 12 cases of myeloschisis, of which 10 were in the two-patch group. In all cases, the skin substitute was located at the surgical site at birth. In five of the 13 (38.5%) cases in the two-patch group, additional postnatal repair was needed. In the remaining cases, the silicone layer detached spontaneously from the dermal matrix (on average, 25 days after birth), and the lesion healed by secondary intention. The mean operating time was 193 (range, 83-450) min; it was significantly longer in cases requiring the bilaminar skin substitute (additional 42 min on average), although the two-patch group had similar PPROM rate and gestational age at delivery compared with the single-patch group. Complete reversal of hindbrain herniation occurred in 68% of the 28 single-patch cases and 33% of the 12 two-patch cases with this information available (P < 0.05). In four cases there was no reversal; half of these occurred in myeloschisis cases. CONCLUSIONS Large OSB defects may be treated successfully in utero using a bilaminar skin substitute over a biocellulose patch through an entirely percutaneous approach. Although the operating time is longer, surgical outcome is similar to that in cases closed primarily. Cases with myeloschisis seem to have a worse prognosis than do those with myelomeningocele. PPROM and preterm birth continue to be a challenge. Further experience is needed to assess the risks and benefits of this technique for the management of large OSB defects. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D A Lapa Pedreira
- Fetal Therapy Program, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - G L Acacio
- Obstetrics Department, University of Taubaté, Taubaté, Brazil
| | - R T Gonçalves
- Fetal Therapy Program, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - R A M Sá
- Fetal Medicine, Perinatal da Barra, Rio de Janeiro, Brazil
| | - R A Brandt
- Pediatric Neurosurgeon, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - R H Chmait
- The USFetus Research Consortium, Miami, Florida, USA
| | | | - R A Quintero
- The USFetus Research Consortium, Miami, Florida, USA
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Abstract
In this review we present current evidence on the possibility of umbilical cord tissue cryopreservation for subsequent clinical use. Protocols for obtaining umbilical cord-derived vessels, Wharton’s jelly-based grafts, multipotent stromal cells, and other biomedical products from cryopreserved umbilical cords are highlighted, and their prospective clinical applications are discussed. Examination of recent literature indicates we should expect high demand for cryopreservation of umbilical cord tissues in the near future.
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Affiliation(s)
- Irina Arutyunyan
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of Ministry of Healthcare of Russian Federation, Moscow, Russia.,Peoples' Friendship University of Russia, Moscow, Russia
| | - Timur Fatkhudinov
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of Ministry of Healthcare of Russian Federation, Moscow, Russia. .,Peoples' Friendship University of Russia, Moscow, Russia.
| | - Gennady Sukhikh
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of Ministry of Healthcare of Russian Federation, Moscow, Russia
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Shaw KA, Parada SA, Gloystein DM, Devine JG. The Science and Clinical Applications of Placental Tissues in Spine Surgery. Global Spine J 2018; 8:629-637. [PMID: 30202718 PMCID: PMC6125928 DOI: 10.1177/2192568217747573] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
STUDY DESIGN Narrative literature review. OBJECTIVES Placental tissue, amniotic/chorionic membrane, and umbilical cord have seen a recent expansion in their clinical application in various fields of surgery. It is important for practicing surgeons to know the underlying science, especially as it relates to spine surgery, to understand the rationale and clinical indication, if any, for their usage. METHODS A literature search was performed using PubMed and MEDLINE databases to identify studies reporting the application of placental tissues as it relates to the practicing spine surgeon. Four areas of interest were identified and a comprehensive review was performed of available literature. RESULTS Clinical application of placental tissue holds promise with regard to treatment of intervertebral disc pathology, preventing epidural fibrosis, spinal dysraphism closure, and spinal cord injury; however, there is an overall paucity of high-quality evidence. As such, evidence-based guidelines for its clinical application are currently unavailable. CONCLUSIONS There is no high-level clinical evidence to support the application of placental tissue for spinal surgery, although it does hold promise for several areas of interest for the practicing spine surgeon. High-quality research is needed to define the clinical effectiveness and indications of placental tissue as it relates to spine surgery.
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Affiliation(s)
- K. Aaron Shaw
- Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA,K. Aaron Shaw, Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, 300 East Hospital Road, Fort Gordon, GA 30905, USA.
| | | | | | - John G. Devine
- Medical College of Georgia, Augusta University, Augusta, GA, USA
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23
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Joyeux L, De Bie F, Danzer E, Van Mieghem T, Flake AW, Deprest J. Safety and efficacy of fetal surgery techniques to close a spina bifida defect in the fetal lamb model: A systematic review. Prenat Diagn 2018; 38:231-242. [PMID: 29388237 DOI: 10.1002/pd.5222] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/16/2017] [Accepted: 01/23/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the safety and efficacy of different neurosurgical techniques for closure of spina bifida (SB) in the fetal lamb model. METHOD Systematic review of studies reporting on fetal lambs undergoing induction and closure of SB compared with non-operated normal lambs (negative controls) and/or lambs not undergoing closure of the defect (positive controls). Primary outcomes were (1) survival at birth (safety) and/or (2) presence of Somatosensory Evoked Potentials on hind limbs and/or improvement in quantitative histological spinal cord findings and/or reversal of hindbrain herniation (efficacy). RESULTS Out of 1311, 36 full-text articles were eligible. Nineteen were included for quality assessment. Due to high bias, only 2 adequately powered studies were included in the final analysis. An open approach using a 2-layer closure (muscle flap or acellular-dermal-matrix patch plus skin) was the only safe (patch + skin) and effective (both techniques) technique for prenatal closure in this animal model. No comparable level of evidence was identified for other techniques. CONCLUSION The experimental literature on prenatal SB closure underscores the lack of standardization. At present, there is animal experimental evidence that a 2-layer closure by hysterotomy is safe and effective. This technique is currently clinically used in a subset of patients. As new clinical techniques are introduced, it would seem logic to preclinically validate them against this experimental standard.
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Affiliation(s)
- Luc Joyeux
- Academic Department Development and Regeneration, Cluster Organ Systems, Biomedical Sciences, Faculty of Medicine, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Felix De Bie
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Enrico Danzer
- Center for Fetal Diagnosis and Treatment, the Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, Children's Center for Fetal Research, Abramson Research center, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tim Van Mieghem
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, Mt. Sinai Hospital, University of Toronto, Toronto, Canada
| | - Alan W Flake
- Center for Fetal Diagnosis and Treatment, the Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, Children's Center for Fetal Research, Abramson Research center, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jan Deprest
- Academic Department Development and Regeneration, Cluster Organ Systems, Biomedical Sciences, Faculty of Medicine, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospital Gasthuisberg UZ Leuven, Leuven, Belgium
- Institute of Women's Health, University College London Hospitals, London, UK
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Snowise S, Mann L, Morales Y, Moise KJ, Johnson A, Fletcher S, Grill RJ, Tseng SCG, Papanna R. Cryopreserved human umbilical cord versus biocellulose film for prenatal spina bifida repair in a physiologic rat model. Prenat Diagn 2017; 37:473-481. [PMID: 28295455 DOI: 10.1002/pd.5035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 02/28/2017] [Accepted: 03/05/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Prenatal spina bifida (SB) repair with a regenerative patch may improve neurological outcomes by decreasing inflammatory scarring. OBJECTIVE This study aims to compare cryopreserved human umbilical cord (HUC) and biocellulose film (BCF) patches sutured over SB lesions for regeneration of native cells and inflammatory response. STUDY DESIGN Sprague-Dawley rats were gavaged with retinoic acid (RA) on embryonic day 10 to induce SB. Hysterotomy was performed on embryonic day 20 and on HUC or BCF patches sutured over the defect. Pups were harvested 30 to 34 h later, and hematoxylin and eosin staining and Trichrome staining assessed basic cellular migration. Immunohistochemistry demonstrated the exact nature of the cellular migration. Patches and surrounding exudates were evaluated with microscopy and cells quantified. RESULTS Histology showed cellular migration with all HUC patches compared with none with BCF patches. Epithelial cells were noted migrating over the dorsal HUC surface, astrocytes were noted along the HUC surface adjacent to the lesion, and endothelial cells were noted within the HUC. HUC patches showed minimal inflammatory cells. Exudates surrounding the HUC patches had fewer inflammatory cells than exudates around BCF patches. CONCLUSION HUC promotes cellular migration of native cells with minimal inflammatory response compared with BCF. HUC may be the superior patch material for prenatal SB repair. © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Saul Snowise
- Department of Obstetrics, Gynecology and Reproductive Medicine, Division of Maternal-Fetal Medicine, UTHealth School of Medicine and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Lovepreet Mann
- Department of Obstetrics, Gynecology and Reproductive Medicine, Division of Maternal-Fetal Medicine, UTHealth School of Medicine and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Yisel Morales
- Department of Obstetrics, Gynecology and Reproductive Medicine, Division of Maternal-Fetal Medicine, UTHealth School of Medicine and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Kenneth J Moise
- Department of Obstetrics, Gynecology and Reproductive Medicine, Division of Maternal-Fetal Medicine, UTHealth School of Medicine and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Anthony Johnson
- Department of Obstetrics, Gynecology and Reproductive Medicine, Division of Maternal-Fetal Medicine, UTHealth School of Medicine and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Stephen Fletcher
- The Department of Pediatrics, Division of Pediatric Neurosurgery, UTHealth School of Medicine and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA.,Department of Pediatric Surgery, UTHealth School of Medicine and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Raymond J Grill
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Ramesha Papanna
- Department of Obstetrics, Gynecology and Reproductive Medicine, Division of Maternal-Fetal Medicine, UTHealth School of Medicine and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
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Belfort M, Deprest J, Hecher K. Current controversies in prenatal diagnosis 1: in utero therapy for spina bifida is ready for endoscopic repair. Prenat Diagn 2016; 36:1161-1166. [DOI: 10.1002/pd.4972] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/05/2016] [Accepted: 11/16/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Michael Belfort
- Department Obstetrics and Gynecology; Baylor College of Medicine, Texas Medical Center; Houston TX USA
| | - Jan Deprest
- Department of Obstetrics and Gynecology; University Hospitals Leuven and Development and Regeneration, Biomedical Sciences; Leuven Belgium
- Research Department of Maternal Fetal Medicine, Institute for Women's Health; University College London; London UK
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine; University Medical Center; Hamburg Germany
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