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Morris JK, Bergman JEH, Barisic I, Wellesley D, Tucker D, Limb E, Addor MC, Cavero-Carbonell C, Matias Dias C, Draper ES, Echevarría-González-de-Garibay LJ, Gatt M, Klungsøyr K, Lelong N, Luyt K, Materna-Kiryluk A, Nelen V, Neville A, Perthus I, Pierini A, Randrianaivo-Ranjatoelina H, Rankin J, Rissmann A, Rouget F, Sayers G, Wertelecki W, Kinsner-Ovaskainen A, Garne E. Surveillance of multiple congenital anomalies; searching for new associations. Eur J Hum Genet 2024; 32:407-412. [PMID: 38052905 PMCID: PMC10999451 DOI: 10.1038/s41431-023-01502-w] [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: 02/08/2023] [Revised: 10/09/2023] [Accepted: 11/16/2023] [Indexed: 12/07/2023] Open
Abstract
Many human teratogens are associated with a spectrum of congenital anomalies rather than a single defect, and therefore the identification of congenital anomalies occurring together more frequently than expected may improve the detection of teratogens. Thirty-two EUROCAT congenital anomaly registries covering 6,599,765 births provided 123,566 cases with one or more major congenital anomalies (excluding chromosomal and genetic syndromes) for the birth years 2008-2016. The EUROCAT multiple congenital anomaly algorithm identified 8804 cases with two or more major congenital anomalies in different organ systems, that were not recognized as part of a syndrome or sequence. For each pair of anomalies, the odds of a case having both anomalies relative to having only one anomaly was calculated and the p value was estimated using a two-sided Fisher's exact test. The Benjamini-Hochberg procedure adjusted p values to control the false discovery rate and pairs of anomalies with adjusted p values < 0.05 were identified. A total of 1386 combinations of two anomalies were analyzed. Out of the 31 statistically significant positive associations identified, 20 were found to be known associations or sequences already described in the literature and 11 were considered "potential new associations" by the EUROCAT Coding and Classification Committee. After a review of the literature and a detailed examination of the individual cases with the anomaly pairs, six pairs remained classified as new associations. In summary, systematically searching for congenital anomalies occurring together more frequently than expected using the EUROCAT database is worthwhile and has identified six new associations that merit further investigation.
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Affiliation(s)
- Joan K Morris
- Population Health Research Institute, St George's, University of London, London, UK.
| | - Jorieke E H Bergman
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ingeborg Barisic
- Children's Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | - Diana Wellesley
- Clinical Genetics, University of Southampton and Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - David Tucker
- Congenital Anomaly Register & Information Service for Wales (CARIS) Public Health Knowledge and Research, Public Health Wales, Swansea, Wales, UK
| | - Elizabeth Limb
- Population Health Research Institute, St George's, University of London, London, UK
| | - Marie-Claude Addor
- Department of Woman-Mother-Child, University Medical Center CHUV, Lausanne, Switzerland
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Carlos Matias Dias
- Epidemiology Department, National Institute of Health Doutor Ricardo Jorge, Lisboa, Portugal
| | - Elisabeth S Draper
- Department of Population Health Sciences, Georg Davies Centre, University of Leicester, Leicester, UK
| | | | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, Guardamangia, Malta
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Nathalie Lelong
- Université Paris Cité, CRESS, Équipe de recherche en épidémiologie obstétricale périnatale et pédiatrique (EPOPé), INSERM, INRA, Paris, France
| | - Karen Luyt
- South West Congenital Anomaly Register, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anna Materna-Kiryluk
- Polish Registry of Congenital Malformations, Chair and Department of Medical Genetics, University of Medical Sciences, 61-701, Poznan, Poland
| | - Vera Nelen
- Provincial Institute for Hygiene, Antwerp, Belgium
| | - Amanda Neville
- Center for Clinical and Epidemiological Research, University of Ferrara, Ferrara, Italy
| | - Isabelle Perthus
- Auvergne Registry of Congenital Anomalies (CEMC-Auvergne), Department of Clinical Genetics, Centre de Référence des Maladies Rares, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Anna Pierini
- Unit of Epidemiology of Rare diseases and Congenital anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | - Judith Rankin
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University-Magdeburg, Magdeburg, Germany
| | - Florence Rouget
- Brittany Registry of Congenital Anomalies, CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Geraldine Sayers
- Health Intelligence, Research and Development Health Service Executive, Dublin, Ireland
| | | | | | - Ester Garne
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
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Grzymkowski JK, Chiu YC, Jima DD, Wyatt BH, Jayachandran S, Stutts WL, Nascone-Yoder NM. Developmental regulation of cellular metabolism is required for intestinal elongation and rotation. Development 2024; 151:dev202020. [PMID: 38369735 PMCID: PMC10911142 DOI: 10.1242/dev.202020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/15/2024] [Indexed: 02/20/2024]
Abstract
Malrotation of the intestine is a prevalent birth anomaly, the etiology of which remains poorly understood. Here, we show that late-stage exposure of Xenopus embryos to atrazine, a widely used herbicide that targets electron transport chain (ETC) reactions, elicits intestinal malrotation at high frequency. Interestingly, atrazine specifically inhibits the cellular morphogenetic events required for gut tube elongation, including cell rearrangement, differentiation and proliferation; insufficient gut lengthening consequently reorients the direction of intestine rotation. Transcriptome analyses of atrazine-exposed intestines reveal misexpression of genes associated with glycolysis and oxidative stress, and metabolomics shows that atrazine depletes key glycolytic and tricarboxylic acid cycle metabolites. Moreover, cellular bioenergetics assays indicate that atrazine blocks a crucial developmental transition from glycolytic ATP production toward oxidative phosphorylation. Atrazine-induced defects are phenocopied by rotenone, a known ETC Complex I inhibitor, accompanied by elevated reactive oxygen species, and rescued by antioxidant supplementation, suggesting that malrotation may be at least partly attributable to redox imbalance. These studies reveal roles for metabolism in gut morphogenesis and implicate defective gut tube elongation and/or metabolic perturbations in the etiology of intestinal malrotation.
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Affiliation(s)
- Julia K. Grzymkowski
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - Yu-Chun Chiu
- Molecular Education, Technology and Research Innovation Center (METRIC), Raleigh, NC 27695, USA
| | - Dereje D. Jima
- Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina 27695, USA
- Bioinformatics Research Center, North Carolina State University, Raleigh, NC 27607, USA
| | - Brent H. Wyatt
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - Sudhish Jayachandran
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - Whitney L. Stutts
- Molecular Education, Technology and Research Innovation Center (METRIC), Raleigh, NC 27695, USA
- Department of Molecular and Structural Biochemistry, North Carolina State University, Raleigh, NC 27695, USA
| | - Nanette M. Nascone-Yoder
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
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Logsdon NT, Sampaio FJB, Favorito LA. The role of intra-abdominal pressure in human testicular migration. Int Braz J Urol 2021; 47:36-44. [PMID: 32758302 PMCID: PMC7712702 DOI: 10.1590/s1677-5538.ibju.2021.99.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/01/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives: This review aims to study the role of the abdominal wall in testicular migration process during the human fetal period. Materials and Methods: We performed a descriptive review of the literature about the role of the abdominal wall in testicular migration during the human fetal period. Results: The rise in intra-abdominal pressure is a supporting factor for testicular migration. This process has two phases: the abdominal and the inguinal-scrotal stages. The passage of the testis through the inguinal canal occurs very quickly between 21 and 25 WPC. Bilateral cryptorchidism in Prune Belly syndrome is explained by the impaired contraction of the muscles of the abdominal wall; mechanical obstruction due to bladder distention and structural alteration of the inguinal canal, which hampers the passage of the testis during the inguinoscrotal stage of testicular migration. Abdominal wall defects as gastroschisis and omphaloceles are associated with undescended testes in around 30 to 40% of the cases. Conclusions: Abdominal pressure wound is an auxiliary force in testicular migration. Patients with abdominal wall defects are associated with undescendend testis in more than 30% of the cases probably due to mechanical factors; the Prune Belly Syndrome has anatomical changes in the anterior abdominal wall that hinder the increase of intra-abdominal pressure which could be the cause of cryptorchidism in this syndrome.
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Affiliation(s)
- Natasha T Logsdon
- Unidade de Pesquisa Urogenital, Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Francisco J B Sampaio
- Unidade de Pesquisa Urogenital, Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Luciano Alves Favorito
- Unidade de Pesquisa Urogenital, Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
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Investigation of a connection between abdominal wall defects and severity of the herniation in fetuses with gastroschisis and omphalocele. Sci Rep 2021; 11:27. [PMID: 33420099 PMCID: PMC7794425 DOI: 10.1038/s41598-020-79599-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/09/2020] [Indexed: 11/29/2022] Open
Abstract
Analyze the biometric parameters and the size (area) of abdominal wall defect (AWD) in fetuses with gastroschisis and omphaloceles and correlate them with the herniated internal organs. We studied 22 fetuses (11 with AWDs and 11 without anomalies). In all fetuses we evaluated the xiphopubic distance (XPD) and iliac crest distance (ICD). In fetuses with AWDs we dissected the abdominal wall and measured the width and length of the defect for calculating its area and studying the correlation between the size of the defect with the organs that were herniated. For statistical analysis, the Anova and Tukey post-test were used (p < 0.05). The XPD in the control group had mean of 4.2 mm (2.3–5.9; SD ± 1.11), while in the AWDs it was 4.2 mm (2.9–5.5; SD ± 0.98) (p = 0.4366). The ICD had mean values of 2.5 mm (1.6–3.4; SD ± 0.58) in the control group, and 2.3 mm (1.2–3.0; SD ± 0.56) in AWDs fetuses (p = 0.6963). The number of herniate organs do not have significant correlation with the area of the defect (r2 = 0.2504, p = 0.5068). There is no correlation between the size (area) of abdominal wall defects and the number of the internal organs that herniated. Therefore, the hole size is not a predictor of the severity of the gastroschisis or omphalocele.
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Oluwafemi OO, Benjamin RH, Navarro Sanchez ML, Scheuerle AE, Schaaf CP, Mitchell LE, Langlois PH, Canfield MA, Swartz MD, Scott DA, Northrup H, Ray JW, McLean SD, Ludorf KL, Chen H, Lupo PJ, Agopian AJ. Birth defects that co-occur with non-syndromic gastroschisis and omphalocele. Am J Med Genet A 2020; 182:2581-2593. [PMID: 32885608 DOI: 10.1002/ajmg.a.61830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/22/2020] [Accepted: 07/30/2020] [Indexed: 01/24/2023]
Abstract
Gastroschisis and omphalocele are the two most common abdominal wall birth defects, and epidemiologic characteristics and frequency of occurrence as part of a syndromic condition suggest distinct etiologies between the two defects. We assessed complex patterns of defect co-occurrence with these defects separately using the Texas Birth Defects Registry. We used co-occurring defect analysis (CODA) to compute adjusted observed-to-expected (O/E) ratios for all observed birth defect patterns. There were 2,998 non-syndromic (i.e., no documented syndrome diagnosis identified) cases with gastroschisis and 789 (26%) of these had additional co-occurring defects. There were 720 non-syndromic cases with omphalocele, and 404 (56%) had additional co-occurring defects. Among the top 30 adjusted O/E ratios for gastroschisis, most of the co-occurring defects were related to the gastrointestinal system, though cardiovascular and kidney anomalies were also present. Several of the top 30 combinations co-occurring with omphalocele appeared suggestive of OEIS (omphalocele, exstrophy of cloaca, imperforate anus, spinal defects) complex. After the exclusion of additional cases with features suggestive of OEIS in a post-hoc sensitivity analysis, the top combinations involving defects associated with OEIS (e.g., spina bifida) were no longer present. The remaining top combinations involving omphalocele included cardiovascular, gastrointestinal, and urogenital defects. In summary, we identified complex patterns of defects that co-occurred more frequently than expected with gastroschisis and omphalocele using a novel software platform. Better understanding differences in the patterns between gastroschisis and omphalocele could lead to additional etiologic insights.
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Affiliation(s)
- Omobola O Oluwafemi
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
| | - Renata H Benjamin
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
| | - Maria Luisa Navarro Sanchez
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
| | - Angela E Scheuerle
- Department of Pediatrics, Division of Genetics and Metabolism, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christian P Schaaf
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.,Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas, USA.,Heidelberg University, Institute of Human Genetics, Heidelberg, Germany
| | - Laura E Mitchell
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
| | - Peter H Langlois
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, Texas, USA
| | - Daryl A Scott
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.,Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas, USA
| | - Hope Northrup
- Department of Pediatrics, Division of Medical Genetics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Joseph W Ray
- Department of Pediatrics, Division of Medical Genetics and Metabolism, University of Texas Medical Branch, Galveston, Texas, USA
| | - Scott D McLean
- Clinical Genetics Section, Children's Hospital of San Antonio, San Antonio, Texas, USA
| | - Katherine L Ludorf
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
| | - Han Chen
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA.,Center for Precision Health, UTHealth School of Public Health and UTHealth School of Biomedical Informatics, Houston, Texas, USA
| | - Philip J Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - A J Agopian
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
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6
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Wright NJ. Management and outcomes of gastrointestinal congenital anomalies in low, middle and high income countries: protocol for a multicentre, international, prospective cohort study. BMJ Open 2019; 9:e030452. [PMID: 31481373 PMCID: PMC6731898 DOI: 10.1136/bmjopen-2019-030452] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Congenital anomalies are the fifth leading cause of death in children <5 years of age globally, contributing an estimated half a million deaths per year. Very limited literature exists from low and middle income countries (LMICs) where most of these deaths occur. The Global PaedSurg Research Collaboration aims to undertake the first multicentre, international, prospective cohort study of a selection of common congenital anomalies comparing management and outcomes between low, middle and high income countries (HICs) globally. METHODS AND ANALYSIS The Global PaedSurg Research Collaboration consists of surgeons, paediatricians, anaesthetists and allied healthcare professionals involved in the surgical care of children globally. Collaborators will prospectively collect observational data on consecutive patients presenting for the first time, with one of seven common congenital anomalies (oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation and Hirschsprung's disease).Patient recruitment will be for a minimum of 1 month from October 2018 to April 2019 with a 30-day post-primary intervention follow-up period. Anonymous data will be collected on patient demographics, clinical status, interventions and outcomes using REDCap. Collaborators will complete a survey regarding the resources and facilities for neonatal and paediatric surgery at their centre.The primary outcome is all-cause in-hospital mortality. Secondary outcomes include the occurrence of post-operative complications. Chi-squared analysis will be used to compare mortality between LMICs and HICs. Multilevel, multivariate logistic regression analysis will be undertaken to identify patient-level and hospital-level factors affecting outcomes with adjustment for confounding factors. ETHICS AND DISSEMINATION At the host centre, this study is classified as an audit not requiring ethical approval. All participating collaborators have gained local approval in accordance with their institutional ethical regulations. Collaborators will be encouraged to present the results locally, nationally and internationally. The results will be submitted for open access publication in a peer reviewed journal. TRIAL REGISTRATION NUMBER NCT03666767.
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Affiliation(s)
- Naomi Jane Wright
- King's Centre for Global Health and Health Partnerships, King's College London, London, UK
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Wright N, Abantanga F, Amoah M, Appeadu-Mensah W, Bokhary Z, Bvulani B, Davies J, Miti S, Nandi B, Nimako B, Poenaru D, Tabiri S, Yifieyeh A, Ade-Ajayi N, Sevdalis N, Leather A. Developing and implementing an interventional bundle to reduce mortality from gastroschisis in low-resource settings. Wellcome Open Res 2019; 4:46. [PMID: 30984879 PMCID: PMC6456836 DOI: 10.12688/wellcomeopenres.15113.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Gastroschisis is associated with less than 4% mortality in high-income countries and over 90% mortality in many tertiary paediatric surgery centres across sub-Saharan Africa (SSA). The aim of this trial is to develop, implement and prospectively evaluate an interventional bundle to reduce mortality from gastroschisis in seven tertiary paediatric surgery centres across SSA. Methods: A hybrid type-2 effectiveness-implementation, pre-post study design will be utilised. Using current literature an evidence-based, low-technology interventional bundle has been developed. A systematic review, qualitative study and Delphi process will provide further evidence to optimise the interventional bundle and implementation strategy. The interventional bundle has core components, which will remain consistent across all sites, and adaptable components, which will be determined through in-country co-development meetings. Pre- and post-intervention data will be collected on clinical, service delivery and implementation outcomes for 2-years at each site. The primary clinical outcome will be all-cause, in-hospital mortality. Secondary outcomes include the occurrence of a major complication, length of hospital stay and time to full enteral feeds. Service delivery outcomes include time to hospital and primary intervention, and adherence to the pre-hospital and in-hospital protocols. Implementation outcomes are acceptability, adoption, appropriateness, feasibility, fidelity, coverage, cost and sustainability. Pre- and post-intervention clinical outcomes will be compared using Chi-squared analysis, unpaired t-test and/or Mann-Whitney U test. Time-series analysis will be undertaken using Statistical Process Control to identify significant trends and shifts in outcome overtime. Multivariate logistic regression analysis will be used to identify clinical and implementation factors affecting outcome with adjustment for confounders. Outcome: This will be the first multi-centre interventional study to our knowledge aimed at reducing mortality from gastroschisis in low-resource settings. If successful, detailed evaluation of both the clinical and implementation components of the study will allow sustainability in the study sites and further scale-up. Registration: ClinicalTrials.gov Identifier NCT03724214.
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Affiliation(s)
- Naomi Wright
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, SE5 9RJ, UK
| | - Francis Abantanga
- Department of Surgery, Tamale Teaching Hospital, Tamale, P.O. Box TL 16, Ghana
| | - Michael Amoah
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, P.O.Box 1934, Ghana
| | | | - Zaitun Bokhary
- Department of Paediatric Surgery, Muhimbili National Hospital, Dar es Salaam, P.O Box 65000, Tanzania
| | - Bruce Bvulani
- Department of Paediatric Surgery, University Teaching Hospital of Lusaka, Lusaka, 10101, Zambia
| | - Justine Davies
- Global Health and Education Department, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sam Miti
- Department of Paediatrics, Arthur Davison Children's Hospital, Ndola, Zambia
| | - Bip Nandi
- Department of Paediatric Surgery, Kamuzu Central Hospital, Lilongwe, P.O. Box 149, Malawi
| | - Boateng Nimako
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, P.O.Box 1934, Ghana
| | - Dan Poenaru
- McGill University, Montreal, Quebec, H3A 0G4, Canada
| | - Stephen Tabiri
- Department of Surgery, Tamale Teaching Hospital, Tamale, P.O. Box TL 16, Ghana
| | - Abiboye Yifieyeh
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, P.O.Box 1934, Ghana
| | - Niyi Ade-Ajayi
- Department of Paediatric Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Nick Sevdalis
- Centre for Implementation Science, King's College London, London, SE5 8AF, UK
| | - Andy Leather
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, SE5 9RJ, UK
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Intestinal malrotation in infants with omphalocele: A systematic review and meta-analysis. J Pediatr Surg 2019; 54:378-382. [PMID: 30309732 DOI: 10.1016/j.jpedsurg.2018.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/05/2018] [Accepted: 09/17/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE The management of intestinal malrotation in infants with omphalocele varies among surgeons. Herein, we aimed to determine whether infants with omphalocele should be investigated for malrotation. METHODS Using a defined search strategy, three investigators identified all studies reporting patients with omphalocele and malrotation. Outcome measures included: 1. incidence of malrotation; 2. correlation with the abdominal size defect in patients with omphalocele; 3. risk of volvulus in those not investigated for malrotation; 4. incidence of adhesive bowel obstruction in those who underwent Ladd's procedure. The meta-analysis was conducted according to PRISMA guidelines and using RevMan 5.3. RESULTS Of 111 articles analyzed, 12 (3888 children) reported malrotation in 136 patients (3.5%). Malrotation was equally found in patients with major (15.2%) and minor (13.6%; p = 0.52) omphalocele. A volvulus was more common in children who had Ladd's procedure (8%) than in those who did not (1%; p = 0.03). Adhesive bowel obstruction rate was similar in both groups (5% vs. 3%; p = 0.21). CONCLUSION The incidence of malrotation in infants with omphalocele is low but probably underreported, and is not influenced by the size of the defect. At present, there is no evidence in the literature to support investigations to detect malrotation in infants with omphalocele. TYPE OF STUDY Therapeutic. LEVEL OF EVIDENCE III.
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Salinas-Torres VM, Salinas-Torres RA, Cerda-Flores RM, Gallardo-Blanco HL, Martínez-de-Villarreal LE. A clinical-pathogenetic approach on associated anomalies and chromosomal defects supports novel candidate critical regions and genes for gastroschisis. Pediatr Surg Int 2018; 34:931-943. [PMID: 30094464 DOI: 10.1007/s00383-018-4331-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gastroschisis has been assumed to have a low rate of syndromic and primary malformations. We aimed to systematically review and explore the frequency and type of malformations/chromosomal syndromes and to identify significant biological/genetic roles in gastroschisis. METHODS Population-based, gastroschisis-associated anomalies/chromosomal defects published 1950-2018 (PubMed/MEDLINE) were independently searched by two reviewers. Associated anomalies/chromosomal defects and selected clinical characteristics were subdivided and pooled by race, system/region, isolated, and associated cases (descriptive analysis and chi-square test were performed). Critical regions/genes from representative chromosomal syndromes including an enrichment analysis using Gene Ontology Consortium/Panther Classification System databases were explored. Fisher's exact test with False Discovery Rate multiple test correction was performed. RESULTS Sixty-eight articles and 18525 cases as a base were identified (prevalence of 17.9 and 3% for associated anomalies/chromosomal defects, respectively). There were 3596 associated anomalies, prevailing those cardiovascular (23.3%) and digestive (20.3%). Co-occurring anomalies were associated with male, female, American Indian, Caucasian, prenatally diagnosed, chromosomal defects, and mortality (P < 0.00001). Gene clusters on 21q22.11 and 21q22.3 (KRTAP), 18q21.33 (SERPINB), 18q22.1 (CDH7, CDH19), 13q12.3 (FLT1), 13q22.1 (KLF5), 13q22.3 (EDNRB), and 13q34 (COL4A1, COL4A2, F7, F10) were significantly related to biological processes: blood pressure regulation and/or vessel integrity, angiogenesis, coagulation, cell-cell and/or cell-matrix adhesion, dermis integrity, and wound healing (P < 0.05). CONCLUSIONS Our findings suggest that gastroschisis may result from the interaction of several chromosomal regions in an additive manner as a pool of candidate genes were identified from critical regions supporting a role for vascular disruption, thrombosis, and mesodermal deficiency in the pathogenesis of gastroschisis.
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Affiliation(s)
- Victor M Salinas-Torres
- Departamento de Genética, Facultad de Medicina y Hospital Universitario José Eleuterio González, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos S/N Col. Mitras Centro, CP 64460, Monterrey, Nuevo León, México.
| | - Rafael A Salinas-Torres
- Departamento de Sistemas y Computación, Instituto Tecnológico de Tijuana, Calzada del Tecnológico S/N Fracc. Tomas Aquino, CP 22414, Tijuana, Baja California, México
| | - Ricardo M Cerda-Flores
- Universidad Autónoma de Nuevo León, Facultad de Enfermería, Dr. José Eleuterio González 1500, Mitras Centro, CP 64460, Monterrey, Nuevo León, México
| | - Hugo L Gallardo-Blanco
- Departamento de Genética, Facultad de Medicina y Hospital Universitario José Eleuterio González, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos S/N Col. Mitras Centro, CP 64460, Monterrey, Nuevo León, México
| | - Laura E Martínez-de-Villarreal
- Departamento de Genética, Facultad de Medicina y Hospital Universitario José Eleuterio González, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos S/N Col. Mitras Centro, CP 64460, Monterrey, Nuevo León, México
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10
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Gong TT, Wu QJ, Chen YL, Jiang CZ, Li J, Li LL, Liu CX, Li D, Zhou C, Huang YH. Evaluating the time trends in prevalence of exomphalos in 14 cities of Liaoning province, 2006 to 2015. Sci Rep 2016; 6:32901. [PMID: 27604427 PMCID: PMC5015066 DOI: 10.1038/srep32901] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/17/2016] [Indexed: 01/13/2023] Open
Abstract
To evaluate time trends of exomphalos prevalence using a large population-based study with cases identified by the Liaoning Birth Defects Registry including 14 cities over the course of a 10-year period. Exomphalos prevalence, percent change, annual percent change (APC), and contribution rates of each city were calculated. Additionally, epidemiological characteristics of this malformation were described. We observed 516 cases of exomphalos among 3,248,954 live births. Birth prevalence of exomphalos was 1.59 per 10,000 live births with non-significant change during the observational period (APC = −1.19%, P = 0.48). However, significantly decreasing trends were noticed in three cities: Fushun (APC = −9.15%, P = 0.03), Benxi (APC = −11.49%, P = 0.05), and Yingkou (APC = −16.47%, P = 0.04), contributing 62.77% of the decreasing trend of overall prevalence. The mean maternal age, gestational age, and birth weight was 28.4 years (standard deviation [SD], 6.1 years), 25.6 weeks (SD, 8.6 weeks), and 1236.2 gram (SD, 1164.4 gram). For time of diagnosis, 79.8% (n = 412) cases were diagnosed during pregnancy. In summary, the prevalence of exomphalos in Liaoning province did not change remarkably during 2006 to 2015. Future studies are warranted to investigate the risk factors and create prevention strategies for this disease.
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Affiliation(s)
- Ting-Ting Gong
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qi-Jun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yan-Ling Chen
- Liaoning Women and Children's Health Hospital, Shenyang, China
| | - Cheng-Zhi Jiang
- School of Environmental and Chemical Engineering, Shenyang Ligong University, Shenyang, China
| | - Jing Li
- Department of science and education, Shenyang Women and Children Health Care Centre, Shenyang, China
| | - Li-Li Li
- Department of children's health prevention, Shenyang Women and Children Health Care Centre, Shenyang, China
| | - Cai-Xia Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Da Li
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chen Zhou
- Department of Information Statistics, Shenyang Women and Children Health Care Centre, Shenyang, China
| | - Yan-Hong Huang
- Department of science and education, Shenyang Women and Children Health Care Centre, Shenyang, China
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11
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Benjamin B, Wilson GN. Registry analysis supports different mechanisms for gastroschisis and omphalocele within shared developmental fields. Am J Med Genet A 2015; 167A:2568-81. [DOI: 10.1002/ajmg.a.37236] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 06/22/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Bonna Benjamin
- Pediatric Surgery; Department of Pediatrics; Texas Tech University Health Science Center; Amarillo Texas
| | - Golder N. Wilson
- Department of Pediatrics; Texas Tech University Health Science Center, Lubbock and Medical City Hospital; Dallas Texas
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12
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Howell H, Fox TB. First Trimester Diagnosis of Omphalocele. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2015. [DOI: 10.1177/8756479315581900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Normal physiologic herniation of the fetal bowel is often seen on first trimester sonogram. An omphalocele is an abdominal wall defect that occurs as a result of herniation into the umbilical cord and is often associated with chromosomal anomalies. This case report presents an omphalocele seen in the first trimester and discusses how to differentiate this finding from normal physiologic bowel herniation.
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Affiliation(s)
| | - Traci B. Fox
- Thomas Jefferson University, Philadelphia, PA, USA
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13
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Corey KM, Hornik CP, Laughon MM, McHutchison K, Clark RH, Smith PB. Frequency of anomalies and hospital outcomes in infants with gastroschisis and omphalocele. Early Hum Dev 2014; 90:421-4. [PMID: 24951080 PMCID: PMC4119722 DOI: 10.1016/j.earlhumdev.2014.05.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 05/15/2014] [Accepted: 05/19/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Gastroschisis and omphalocele are the most common anterior abdominal wall defects affecting infants. There are few large cohort studies describing the frequency of associated anomalies in infants with these 2 conditions. We describe associated anomalies and outcomes in infants with these defects using a large, multi-center clinical database. METHODS We identified all infants with gastroschisis or omphalocele from a prospectively collected database of infants discharged from 348 neonatal intensive care units in North America from 1997 to 2012. Maternal and patient demographic data, associated anomalies, and outcome data were compared between infants with gastroschisis and omphalocele. RESULTS A total of 4687 infants with gastroschisis and 1448 infants with omphalocele were identified. Infants with omphalocele were more likely to be diagnosed with at least 1 other anomaly compared with infants with gastroschisis (35% vs. 8%, p<0.001). Infants with omphalocele were more likely to develop pulmonary hypertension compared with those with gastroschisis (odds ratio [OR] 7.78; 95% confidence interval 5.81, 10.41) and had higher overall mortality (OR 6.81 [5.33, 8.71]). CONCLUSION Infants with omphalocele were more likely to have other anomalies, be diagnosed with pulmonary hypertension, and have higher mortality than infants with gastroschisis.
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MESH Headings
- Abnormalities, Multiple/diagnosis
- Abnormalities, Multiple/epidemiology
- Abnormalities, Multiple/etiology
- Birth Weight
- Cohort Studies
- Confidence Intervals
- Female
- Gastroschisis/diagnosis
- Hernia, Umbilical/complications
- Hernia, Umbilical/diagnosis
- Humans
- Hypertension, Pulmonary/diagnosis
- Infant
- Infant Mortality
- Infant, Newborn
- Infant, Premature
- Intensive Care Units, Neonatal
- North America
- Respiration, Artificial
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Affiliation(s)
| | - Christoph P Hornik
- Duke Clinical Research Institute, Durham, NC, USA; Department of Pediatrics, Duke University, Durham, NC, USA
| | - Matthew M Laughon
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | | | - Reese H Clark
- Pediatrix Medical Group, The Center for Research, Education, and Quality, Sunrise, FL, USA
| | - P Brian Smith
- Duke Clinical Research Institute, Durham, NC, USA; Department of Pediatrics, Duke University, Durham, NC, USA.
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14
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Benjamin B, Wilson GN. Anomalies associated with gastroschisis and omphalocele: analysis of 2825 cases from the Texas Birth Defects Registry. J Pediatr Surg 2014; 49:514-9. [PMID: 24726103 DOI: 10.1016/j.jpedsurg.2013.11.052] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 11/08/2013] [Accepted: 11/09/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND/PURPOSE The increasing prevalence of abdominal wall defects prompted analysis of anomalies associated with gastroschisis and omphalocele in the Texas Birth Defects Registry (TDBR). METHODS Cases of gastroschisis (ICD9 code 756.71), omphalocele (756.70), and/or unspecified anomalies of the abdominal wall (756.79) were obtained from the TDBR after IRB approval and analyzed using Microsoft Access© and Excel© databases. RESULTS Analysis began with 2825 cases including 1831 of gastroschisis, 814 of omphalocele, and 180 of unspecified abdominal wall defects plus 9680 associated anomalies that were classified according to system. The overall prevalence of abdominal wall defects among 3,806,299 Texas births from 1999 to 2008 was 7.4 per 10,000 with 4.8 per 10,000 for gastroschisis and 2.1 for omphalocele. After excluding ambiguous cases (8.5% possibly misclassified), anomaly spectra were similar for the two AWD with musculoskeletal (limb contractures or defects), cardiovascular, gastrointestinal, urogenital, and central nervous system defects being most common. Of 1831 cases with gastroschisis, 594 (32%) had associated anomalies compared to 654 (80%) of 814 omphalocele cases. CONCLUSIONS Gastroschisis as well as omphalocele has significant associated anomalies that are important to appreciate during pre- and postnatal management.
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Affiliation(s)
- Bonna Benjamin
- Pediatric Surgery, Department of Pediatrics, Texas Tech University Health Science Center, Amarillo, TX 79106, USA.
| | - Golder N Wilson
- Pediatric Genetics, Departments of Pediatrics, Obstetrics & Gynecology, Texas Tech University Health Science Center, Amarillo and Lubbock (Pediatrics), Amarillo, TX 79106, USA
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15
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Rocha FG, Zalud I, Dye T. Ethnic variation of gastroschisis and omphalocele in the United States of America. J Matern Fetal Neonatal Med 2013; 27:1428-30. [PMID: 24328604 DOI: 10.3109/14767058.2013.876002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Gastroschisis and omphalocele are the most common fetal abdominal wall defects (AWDs). Ethnic factors have been implicated in the incidence data from some states in the United States. Our aim was to examine ethnic variation in the prevalence of gastroschisis and omphalocele in the US live birth population between 2006 and 2010. METHODS AWDs were identified through gastroschisis and omphalocele checkboxes from publicly available US Natality data (2006 to 2010). Ethnicity was evaluated by individual category using National Center for Health Statistics (NCHS) definitions. Adjusted multinomial logistic regression (SPSS v.19) was used to generate odds ratios (OR) in order to quantify the disparities. RESULTS In the US, 7867 live births were identified with AWD. All ethnic groups showed a significantly higher OR when compared with women of East/South Asian descent, which experienced the lowest prevalence. Women of indigenous ethnicity had the highest individual OR while their adjusted OR remained greater than 4.0. CONCLUSIONS Women of indigenous origin from North America and the Pacific had the highest rates of AWD. Within this group, women of Hawaiian descent had the highest point estimate of AWD when compared with other ethnic groups, though not significant.
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Affiliation(s)
- Frederico G Rocha
- Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawaii , Honolulu, HI , USA
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16
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Kim K, Wang Y, Kirby RS, Druschel CM. Prevalence and trends of selected congenital malformations in New York state, 1983 to 2007. ACTA ACUST UNITED AC 2013; 97:619-27. [DOI: 10.1002/bdra.23160] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 05/17/2013] [Accepted: 05/24/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Keewan Kim
- School of Public Health, University at Albany, State University of New York, One University Place; Rensselaer; New York
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17
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Osifo OD, Ovueni ME, Evbuomwan I. Omphalocele management using goal-oriented classification in African centre with limited resources. J Trop Pediatr 2011; 57:286-8. [PMID: 20923791 DOI: 10.1093/tropej/fmq093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In 2000-09, 96 children comprising 57 males and 39 females who were presented between 2 h and 1 week of birth with omphalocele were prospectively managed using goal-oriented classification at the University of Benin Teaching Hospital, Nigeria. All were born through spontaneous vaginal delivery, out of which 9 (9.4%) were preterm. Eighty-two (85.4%) mothers in villages with no supervised antenatal care/delivery and/or prenatal diagnosis presented their babies late. Thirty-three (34.4%) babies in group A, with defect size ≤ 4.5 cm and intact sac, were managed conservatively and had fascial closure after neonatal period, resulting in 32 (97%) survivors. Forty-two (43.8%) babies in group B, with defect size > 4.5 cm and intact sac, were managed conservatively and had fascial closures for 9 months to 5 years, resulting in 40 (95.2%) survivors. Group C comprised of 21 (21.9%) babies with defect of any size/ruptured sac and who had immediate repair, resulting in two (9.5%) survivors owing to lack of facilities (p < 0.0001). Hospital delivery and provision of facilities are advocated.
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Affiliation(s)
- Osarumwense David Osifo
- Pediatric Surgery Unit, Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
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18
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Ruano R, Picone O, Bernardes L, Martinovic J, Dumez Y, Benachi A. The association of gastroschisis with other congenital anomalies: how important is it? Prenat Diagn 2011; 31:347-50. [DOI: 10.1002/pd.2689] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 11/02/2010] [Accepted: 11/02/2010] [Indexed: 11/07/2022]
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19
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Reed RA, Womble MA, Dush MK, Tull RR, Bloom SK, Morckel AR, Devlin EW, Nascone-Yoder NM. Morphogenesis of the primitive gut tube is generated by Rho/ROCK/myosin II-mediated endoderm rearrangements. Dev Dyn 2010; 238:3111-25. [PMID: 19924810 DOI: 10.1002/dvdy.22157] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
During digestive organogenesis, the primitive gut tube (PGT) undergoes dramatic elongation and forms a lumen lined by a single-layer of epithelium. In Xenopus, endoderm cells in the core of the PGT rearrange during gut elongation, but the morphogenetic mechanisms controlling their reorganization are undetermined. Here, we define the dynamic changes in endoderm cell shape, polarity, and tissue architecture that underlie Xenopus gut morphogenesis. Gut endoderm cells intercalate radially, between their anterior and posterior neighbors, transforming the nearly solid endoderm core into a single layer of epithelium while concomitantly eliciting "radially convergent" extension within the gut walls. Inhibition of Rho/ROCK/Myosin II activity prevents endoderm rearrangements and consequently perturbs both gut elongation and digestive epithelial morphogenesis. Our results suggest that the cellular and molecular events driving tissue elongation in the PGT are mechanistically analogous to those that function during gastrulation, but occur within a novel cylindrical geometry to generate an epithelial-lined tube.
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Affiliation(s)
- Rachel A Reed
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina 27606, USA
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20
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Chen CP, Liu YP, Tsai FJ, Chen CY, Lin HH, Wu PC, Wang W. Concomitant Craniorachischisis Andomphalocele in a Male Fetus: Prenatal Magnetic Resonance Imaging Findings and Literature Review. Taiwan J Obstet Gynecol 2009; 48:286-91. [DOI: 10.1016/s1028-4559(09)60306-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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21
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Abstract
Colonic atresia, unlike small intestine atresia, is a rare congenital malformation. Congenital absence of the entire colon is exceptionally rare. Moreover, an association of omphalocele and complete absence of the colon has not yet been reported in the literature. We present an infant born with such combination of congenital anomalies.
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22
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Payne NR, Pfleghaar K, Assel B, Johnson A, Rich RH. Predicting the outcome of newborns with gastroschisis. J Pediatr Surg 2009; 44:918-23. [PMID: 19433170 PMCID: PMC2703663 DOI: 10.1016/j.jpedsurg.2009.01.036] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 01/15/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of the study was to determine factors predicting outcome in newborns with gastroschisis. METHODS A retrospective analysis of 155 consecutive cases admitted from 1 January 1990 to 31 December 2007 was performed. Prenatal ultrasound findings were available for 89 of 155 (57%) patients and were compared with final outcome. Both univariate and multiple regression analyses were used. RESULTS All patients survived to discharge home. The primary outcome measure was length of stay. Multiple regression identified 4 factors associated with length of stay: (1) gestational age (P = .004), (2) nonelective silo (P < .001), (3) gastrointestinal (GI) complication (intestinal atresia, perforation, or resection) (P < .001), and (4) non-GI anomaly (P = .029). Non-GI anomalies occurred in 17 of 155 (11%) patients and tended to increase the risk of a nonelective silo or GI complication (59% vs 39%, P = .190). Dilated bowel (>10 mm) on prenatal ultrasound was associated with GI complications (22% vs 3%, P = .010). However, 78% of patients with dilated bowel on prenatal ultrasound did not have a GI complication. The absence of dilated bowel on prenatal ultrasound accurately predicted the absence of GI complications in 97% of cases. CONCLUSION Prematurity, nonelective silo, GI complications, and non-GI anomalies predict the short-term outcome of newborns with gastroschisis. Prenatal ultrasound serves primarily to predict the absence of GI complications.
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Affiliation(s)
- Nathaniel R Payne
- Division of Neonatology, Children's Hospital and Clinics of Minnesota, Minneapolis, MN 55404, USA.
| | - Kathleen Pfleghaar
- Division of Perinatology, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Barbara Assel
- Division of Perinatology, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Aubrey Johnson
- Division of Neonatology, Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota
| | - R, Hampton Rich
- Division of Surgery, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, and Pediatric Surgical Associates, Ltd., Minneapolis, Minnesota
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