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Paladini D. Umbilical artery Doppler: is it all said and done? Ultrasound Obstet Gynecol 2024. [PMID: 38642345 DOI: 10.1002/uog.27665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/22/2024]
Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit - IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Paladini D, Biancotto G, Della Sala F, Acharya PV. 'Choroid bar': easy-to-seek marker of normal posterior fossa at 12-14 weeks' gestation. Ultrasound Obstet Gynecol 2024; 63:497-501. [PMID: 38145551 DOI: 10.1002/uog.27566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/29/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES Our objectives were: (1) to assess the visualization rate of the choroid bar in a consecutive series of 306 first-trimester scans; (2) to verify, in this cohort of fetuses, the normality of the posterior fossa later in pregnancy; and (3) to confirm the non-visualization of the choroid bar in a retrospective series of fetuses with posterior fossa malformations. METHODS This study included a prospective and a retrospective series. The former comprised 306 fetuses undergoing routine obstetric ultrasound at our unit in both the first and second trimesters over a 6-month period, while the latter comprised 12 cases of posterior fossa malformations. In the prospective study, the presence of the choroid bar, which is defined as a visually continuous, homogeneously hyperechogenic, thick structure bridging the cisterna magna from side to side, was evaluated at the end of the first-trimester nuchal translucency scan. In the retrospective study, previously acquired three-dimensional volume datasets were processed in order to assess whether the choroid bar could be visualized in cases of open spinal dysraphisms and vermian cystic anomalies. In the prospective study, confirmation of a normal posterior fossa was based on the sonographic features of this anatomical region at the time of the second-trimester anomaly scan at 19-21 weeks' gestation, while, in the retrospective study, it was based on autopsy results, when available, or further direct imaging of the defect later in pregnancy. RESULTS In the prospective study, the choroid bar could be visualized in all 306 fetuses, on transabdominal ultrasound in 287 (93.8%) cases and on transvaginal ultrasound in 19 (6.2%) cases. The choroid bar was displayed with a ventral/dorsal approach in 67 (21.9%) cases, with a lateral approach in 56 (18.3%) cases and with both in 183 (59.8%) cases. All 306 cases were confirmed to have a sonographically normal posterior fossa at 19-21 weeks. On the other hand, in the retrospective study, it was not possible to visualize the choroid bar in any of the fetuses with posterior fossa malformations. CONCLUSIONS We have described a new sign, the choroid bar, consistent with a normal posterior fossa at 12-14 weeks' gestation. The choroid bar provides the option of screening for major abnormalities of the posterior fossa, since its absence raises suspicion of both open spinal dysraphisms and posterior fossa cystic malformations. At the same time, it is easy to visualize, as it can be seen with all lines of insonation. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit - IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Dipartimento Universitario di Neuroscienze, Scienze Riproduttive e Odontostomatoogiche - University Federico II of Naples, Naples, Italy
| | - G Biancotto
- Fetal Medicine and Surgery Unit - IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - F Della Sala
- Fetal Medicine and Surgery Unit - IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - P V Acharya
- Paras Advanced Center for Fetal Medicine, Naranpura, Ahmedabad, Gujarat, India
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Paladini D, Biancotto G, Della Sala F, Severino M, Rossi A. Neurosonographic and MRI diagnosis of fetal cerebral lesions heralding polymicrogyria. Ultrasound Obstet Gynecol 2024; 63:293-302. [PMID: 37671454 DOI: 10.1002/uog.27460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 09/07/2023]
Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit - IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G Biancotto
- Fetal Medicine and Surgery Unit - IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - F Della Sala
- Fetal Medicine and Surgery Unit - IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M Severino
- Neuroradiology Unit - IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - A Rossi
- Neuroradiology Unit - IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Casella A, Bano S, Vasconcelos F, David AL, Paladini D, Deprest J, De Momi E, Mattos LS, Moccia S, Stoyanov D. Learning-based keypoint registration for fetoscopic mosaicking. Int J Comput Assist Radiol Surg 2024; 19:481-492. [PMID: 38066354 PMCID: PMC10881678 DOI: 10.1007/s11548-023-03025-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 09/20/2023] [Indexed: 02/22/2024]
Abstract
PURPOSE In twin-to-twin transfusion syndrome (TTTS), abnormal vascular anastomoses in the monochorionic placenta can produce uneven blood flow between the two fetuses. In the current practice, TTTS is treated surgically by closing abnormal anastomoses using laser ablation. This surgery is minimally invasive and relies on fetoscopy. Limited field of view makes anastomosis identification a challenging task for the surgeon. METHODS To tackle this challenge, we propose a learning-based framework for in vivo fetoscopy frame registration for field-of-view expansion. The novelties of this framework rely on a learning-based keypoint proposal network and an encoding strategy to filter (i) irrelevant keypoints based on fetoscopic semantic image segmentation and (ii) inconsistent homographies. RESULTS We validate our framework on a dataset of six intraoperative sequences from six TTTS surgeries from six different women against the most recent state-of-the-art algorithm, which relies on the segmentation of placenta vessels. CONCLUSION The proposed framework achieves higher performance compared to the state of the art, paving the way for robust mosaicking to provide surgeons with context awareness during TTTS surgery.
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Affiliation(s)
- Alessandro Casella
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) and Department of Computer Science, University College London, London, UK
| | - Sophia Bano
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) and Department of Computer Science, University College London, London, UK.
| | - Francisco Vasconcelos
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) and Department of Computer Science, University College London, London, UK
| | - Anna L David
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, London, UK
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
- Department of Development and Regeneration, University Hospital Leuven, Leuven, Belgium
| | - Dario Paladini
- Department of Fetal and Perinatal Medicine, Istituto Giannina Gaslini, Genoa, Italy
| | - Jan Deprest
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
- Department of Development and Regeneration, University Hospital Leuven, Leuven, Belgium
| | - Elena De Momi
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Leonardo S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Sara Moccia
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) and Department of Computer Science, University College London, London, UK
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Bano S, Casella A, Vasconcelos F, Qayyum A, Benzinou A, Mazher M, Meriaudeau F, Lena C, Cintorrino IA, De Paolis GR, Biagioli J, Grechishnikova D, Jiao J, Bai B, Qiao Y, Bhattarai B, Gaire RR, Subedi R, Vazquez E, Płotka S, Lisowska A, Sitek A, Attilakos G, Wimalasundera R, David AL, Paladini D, Deprest J, De Momi E, Mattos LS, Moccia S, Stoyanov D. Placental vessel segmentation and registration in fetoscopy: Literature review and MICCAI FetReg2021 challenge findings. Med Image Anal 2024; 92:103066. [PMID: 38141453 DOI: 10.1016/j.media.2023.103066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 12/25/2023]
Abstract
Fetoscopy laser photocoagulation is a widely adopted procedure for treating Twin-to-Twin Transfusion Syndrome (TTTS). The procedure involves photocoagulation pathological anastomoses to restore a physiological blood exchange among twins. The procedure is particularly challenging, from the surgeon's side, due to the limited field of view, poor manoeuvrability of the fetoscope, poor visibility due to amniotic fluid turbidity, and variability in illumination. These challenges may lead to increased surgery time and incomplete ablation of pathological anastomoses, resulting in persistent TTTS. Computer-assisted intervention (CAI) can provide TTTS surgeons with decision support and context awareness by identifying key structures in the scene and expanding the fetoscopic field of view through video mosaicking. Research in this domain has been hampered by the lack of high-quality data to design, develop and test CAI algorithms. Through the Fetoscopic Placental Vessel Segmentation and Registration (FetReg2021) challenge, which was organized as part of the MICCAI2021 Endoscopic Vision (EndoVis) challenge, we released the first large-scale multi-center TTTS dataset for the development of generalized and robust semantic segmentation and video mosaicking algorithms with a focus on creating drift-free mosaics from long duration fetoscopy videos. For this challenge, we released a dataset of 2060 images, pixel-annotated for vessels, tool, fetus and background classes, from 18 in-vivo TTTS fetoscopy procedures and 18 short video clips of an average length of 411 frames for developing placental scene segmentation and frame registration for mosaicking techniques. Seven teams participated in this challenge and their model performance was assessed on an unseen test dataset of 658 pixel-annotated images from 6 fetoscopic procedures and 6 short clips. For the segmentation task, overall baseline performed was the top performing (aggregated mIoU of 0.6763) and was the best on the vessel class (mIoU of 0.5817) while team RREB was the best on the tool (mIoU of 0.6335) and fetus (mIoU of 0.5178) classes. For the registration task, overall the baseline performed better than team SANO with an overall mean 5-frame SSIM of 0.9348. Qualitatively, it was observed that team SANO performed better in planar scenarios, while baseline was better in non-planner scenarios. The detailed analysis showed that no single team outperformed on all 6 test fetoscopic videos. The challenge provided an opportunity to create generalized solutions for fetoscopic scene understanding and mosaicking. In this paper, we present the findings of the FetReg2021 challenge, alongside reporting a detailed literature review for CAI in TTTS fetoscopy. Through this challenge, its analysis and the release of multi-center fetoscopic data, we provide a benchmark for future research in this field.
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Affiliation(s)
- Sophia Bano
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) and Department of Computer Science, University College London, UK.
| | - Alessandro Casella
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy
| | - Francisco Vasconcelos
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) and Department of Computer Science, University College London, UK
| | | | | | - Moona Mazher
- Department of Computer Engineering and Mathematics, University Rovira i Virgili, Spain
| | | | - Chiara Lena
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy
| | | | - Gaia Romana De Paolis
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy
| | - Jessica Biagioli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy
| | | | | | - Bizhe Bai
- Medical Computer Vision and Robotics Group, Department of Mathematical and Computational Sciences, University of Toronto, Canada
| | - Yanyan Qiao
- Shanghai MicroPort MedBot (Group) Co., Ltd, China
| | - Binod Bhattarai
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) and Department of Computer Science, University College London, UK
| | | | - Ronast Subedi
- NepAL Applied Mathematics and Informatics Institute for Research, Nepal
| | | | - Szymon Płotka
- Sano Center for Computational Medicine, Poland; Quantitative Healthcare Analysis Group, Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Arkadiusz Sitek
- Sano Center for Computational Medicine, Poland; Center for Advanced Medical Computing and Simulation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - George Attilakos
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, UK; EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, UK
| | - Ruwan Wimalasundera
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, UK; EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, UK
| | - Anna L David
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, UK; EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, UK; Department of Development and Regeneration, University Hospital Leuven, Belgium
| | - Dario Paladini
- Department of Fetal and Perinatal Medicine, Istituto "Giannina Gaslini", Italy
| | - Jan Deprest
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, UK; Department of Development and Regeneration, University Hospital Leuven, Belgium
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy
| | - Leonardo S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Italy
| | - Sara Moccia
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Italy
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) and Department of Computer Science, University College London, UK
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Salomon LJ, Paladini D. Fetal corpus callosum anomalies: from disease of classification to classification of disease. Ultrasound Obstet Gynecol 2023. [PMID: 38112568 DOI: 10.1002/uog.27564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/06/2023] [Accepted: 12/09/2023] [Indexed: 12/21/2023]
Affiliation(s)
- L J Salomon
- Médecine, Chirurgie et Imagerie Foetales, Maternité Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris (AP- HP) URP 7328 FETUS Université Paris Cité, Paris, France
| | - D Paladini
- Fetal Medicine and Surgery Unit - IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Dipartimento Universitario di neuroscienze, scienze riproduttive e odontostomatoogiche - University Federico II of Naples, Naples, Italy
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Casella A, Lena C, Moccia S, Paladini D, De Momi E, Mattos LS. Toward a navigation framework for fetoscopy. Int J Comput Assist Radiol Surg 2023; 18:2349-2356. [PMID: 37587389 PMCID: PMC10632301 DOI: 10.1007/s11548-023-02974-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/23/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE Fetoscopic laser photocoagulation of placental anastomoses is the most effective treatment for twin-to-twin transfusion syndrome (TTTS). A robust mosaic of placenta and its vascular network could support surgeons' exploration of the placenta by enlarging the fetoscope field-of-view. In this work, we propose a learning-based framework for field-of-view expansion from intra-operative video frames. METHODS While current state of the art for fetoscopic mosaicking builds upon the registration of anatomical landmarks which may not always be visible, our framework relies on learning-based features and keypoints, as well as robust transformer-based image-feature matching, without requiring any anatomical priors. We further address the problem of occlusion recovery and frame relocalization, relying on the computed features and their descriptors. RESULTS Experiments were conducted on 10 in-vivo TTTS videos from two different fetal surgery centers. The proposed framework was compared with several state-of-the-art approaches, achieving higher [Formula: see text] on 7 out of 10 videos and a success rate of [Formula: see text] in occlusion recovery. CONCLUSION This work introduces a learning-based framework for placental mosaicking with occlusion recovery from intra-operative videos using a keypoint-based strategy and features. The proposed framework can compute the placental panorama and recover even in case of camera tracking loss where other methods fail. The results suggest that the proposed framework has large potential to pave the way to creating a surgical navigation system for TTTS by providing robust field-of-view expansion.
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Affiliation(s)
- Alessandro Casella
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy.
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy.
| | - Chiara Lena
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Sara Moccia
- Department of Excellence in Robotics and AI, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Dario Paladini
- Department of Fetal and Perinatal Medicine, Istituto Giannina Gaslini, Genoa, Italy
| | - Elena De Momi
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Leonardo S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
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Paladini D, Cecchi A, Gandolfo C, Rossi A. PHACE syndrome: not always 'tilting telephones' and Dandy-Walker malformations…. Ultrasound Obstet Gynecol 2023; 62:769-770. [PMID: 38041632 DOI: 10.1002/uog.27526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/07/2023] [Accepted: 07/26/2023] [Indexed: 12/03/2023]
Abstract
Linked article: This Editorial comments on Pomar et al. Click here to view the article.
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Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit-IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - A Cecchi
- Centro Unico Regionale SODS Diagnosi Prenatale di II livello OdC, Loreto, Italy
| | - C Gandolfo
- Interventional and Functional Neuroradiology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - A Rossi
- Neuroradiology Unit-IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Buratti S, Mallamaci M, Tuo G, Severino M, Tortora D, Parodi C, Rossi A, Pasetti F, Castellan L, Capra V, Romano F, De Marco P, Pavanello M, Piatelli G, Paladini D, Calevo MG, Moscatelli A. Vein of Galen aneurysmal malformation in newborns: a retrospective study to describe a paradigm of treatment and identify risk factors of adverse outcome in a referral center. Front Pediatr 2023; 11:1193738. [PMID: 37587977 PMCID: PMC10426803 DOI: 10.3389/fped.2023.1193738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/03/2023] [Indexed: 08/18/2023] Open
Abstract
Background Vein of Galen aneurysmal malformation (VGAM) is a rare cerebral vascular malformation associated with significant morbidity and mortality. Newborns with VGAM without adequate treatment may develop rapidly deteriorating high output heart failure (HOHF) and are at risk for severe neurological outcomes. Objective To describe the clinical course and management of newborns with VGAM, and identify which echocardiographic and neuroradiologic factors may be associated with severe heart failure at birth and adverse short term outcomes. Methods This is a single center retrospective cohort study including all consecutive newborns with VGAM admitted to Gaslini Children's Hospital between 2009 and 2022. We reviewed clinical data, intensive care support, fetal and neonatal cardiologic and neuroradiologic findings and we studied the association with severe HOHF, endovascular complications and death. Results Out of 40 newborns, 17 (42.5%) developed severe HOHF requiring early endovascular procedures. Medical treatment was focused on the main components of HOHF by providing inotropic support and peripheral vasodilation. Pulmonary vasodilators were avoided to reduce the negative effects of pulmonary overflow and prevent vascular remodeling. Reduction of the obligatory left to right shunt through the VGAM was possible only through endovascular treatment. Fetal cardiothoracic ratio was significantly associated with severe HOHF at birth and death. Cardiologic parameters of right ventricular overload, pulmonary hypertension and systemic steal were the leading findings associated with haemodynamic compromise at birth. The mediolateral diameter of the straight or falcine sinus at its shortest section (SS-MD), and arterial pseudofeeders were significantly associated with severe HOHF at birth in prenatal and postnatal assessments. None of the postnatal echocardiographic and MRI variables, nor a higher inotropic support were associated with major periprocedural complications or death. Mortality was due to palliation for congenital severe brain damage (4/40, 10%), or major periprocedural complications (3/40, 7.5%). None of the patients died due to HOHF and multiorgan failure. Overall survival at discharge was 82.5% (33/40). Conclusions The complexity of neonatal VGAM pathophysiology requires a multidisciplinary approach, specialized intensive care management, and early endovascular treatment to reduce mortality and optimize clinical outcomes. Cardiologic and neuroradiologic parameters are key to define risk stratification and treatment strategies.
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Affiliation(s)
- Silvia Buratti
- Neonatal and Pediatric Intensive Care Unit, Acceptance and Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
| | - Marisa Mallamaci
- Neonatal and Pediatric Intensive Care Unit, Acceptance and Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giulia Tuo
- Pediatric Cardiology and Cardiac Surgery Unit, Surgery Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Mariasavina Severino
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
- Neuroradiology Unit, Services Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Domenico Tortora
- Neuroradiology Unit, Services Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Costanza Parodi
- Neuroradiology Unit, Services Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Pediatric Cardiology and Cardiac Surgery Unit, Surgery Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Neuroradiology Unit, Services Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Francesco Pasetti
- Pediatric Radiology Unit, Services Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Lucio Castellan
- Neuroradiology Unit, Diagnostic Imaging and Radiotherapy Department, San Martino Polyclinic Hospital, Genoa, Italy
| | - Valeria Capra
- Genomics and Clinical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Ferruccio Romano
- Genomics and Clinical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Patrizia De Marco
- Medical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Pavanello
- Neurosurgery Unit, Surgery Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gianluca Piatelli
- Neurosurgery Unit, Surgery Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Dario Paladini
- Fetal Medicine and Surgery Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Maria Grazia Calevo
- Epidemiology, Biostatistics Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Andrea Moscatelli
- Neonatal and Pediatric Intensive Care Unit, Acceptance and Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Carvalho JS, Axt-Fliedner R, Chaoui R, Copel JA, Cuneo BF, Goff D, Gordin Kopylov L, Hecher K, Lee W, Moon-Grady AJ, Mousa HA, Munoz H, Paladini D, Prefumo F, Quarello E, Rychik J, Tutschek B, Wiechec M, Yagel S. ISUOG Practice Guidelines (updated): fetal cardiac screening. Ultrasound Obstet Gynecol 2023; 61:788-803. [PMID: 37267096 DOI: 10.1002/uog.26224] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 06/04/2023]
Affiliation(s)
- J S Carvalho
- Royal Brompton Hospital, Guy's & St Thomas' NHS Foundation Trust; and Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - R Axt-Fliedner
- Division of Prenatal Medicine & Fetal Therapy, Department of Obstetrics & Gynecology, Justus-Liebig-University Giessen, University Hospital Giessen & Marburg, Giessen, Germany
| | - R Chaoui
- Center of Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - J A Copel
- Departments of Obstetrics, Gynecology & Reproductive Sciences, and Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - B F Cuneo
- Children's Hospital Colorado, The Heart Institute, Aurora, CO, USA
| | - D Goff
- Pediatrix Cardiology of Houston and Loma Linda University School of Medicine, Houston, TX, USA
| | - L Gordin Kopylov
- Obstetrical Unit, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel; and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - W Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - A J Moon-Grady
- Clinical Pediatrics, UC San Francisco, San Francisco, CA, USA
| | - H A Mousa
- Fetal Medicine Unit, University of Leicester, Leicester, UK
| | - H Munoz
- Obstetrics and Gynecology, Universidad de Chile and Clinica Las Condes, Santiago, Chile
| | - D Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - F Prefumo
- Obstetrics and Gynecology Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - E Quarello
- Image 2 Center, Obstetrics and Gynecologic Department, St Joseph Hospital, Marseille, France
| | - J Rychik
- Fetal Heart Program at Children's Hospital of Philadelphia, and Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - B Tutschek
- Pränatal Zürich, Zürich, Switzerland; and Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - M Wiechec
- Department of Gynecology and Obstetrics, Jagiellonian University in Krakow, Krakow, Poland
| | - S Yagel
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Mt. Scopus and the Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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11
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Bottelli L, Franzè V, Tuo G, Buffelli F, Paladini D. Prenatal detection of congenital heart disease at 12-13 gestational weeks: detailed analysis of false-negative cases. Ultrasound Obstet Gynecol 2023; 61:577-586. [PMID: 36240512 DOI: 10.1002/uog.26094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/28/2022] [Accepted: 09/08/2022] [Indexed: 05/04/2023]
Abstract
OBJECTIVES To report on the early detection of congenital heart disease (CHD) in low- and high-risk populations managed at our hospital; and perform a detailed analysis of false-negative diagnoses, in order to derive possible recommendations on how to reduce their incidence. METHODS This was a retrospective observational study analyzing cases which underwent an ultrasound examination at the end of the first trimester at the Fetal Medicine and Surgery Unit of Gaslini Children's Hospital, Genoa, Italy, in the period January 2015 to December 2021. The study population included both low-risk pregnancies that underwent standard first-trimester combined screening and high-risk ones referred to our unit because of a positive combined test or suspicion of fetal anomalies raised in a regional community hospital. For each case, the following variables were retrieved and analyzed: number of fetuses, maternal body mass index, gestational age at first-trimester screening, whether the pregnancy was low or high risk, nuchal translucency thickness (normal or > 99th centile), type of CHD, associated extracardiac anomalies, karyotype and pregnancy outcome. For low-risk pregnancies, suspicion of CHD was also recorded. In low-risk cases, sonographic cardiac screening comprised evaluation of the four-chamber view (grayscale and color/power Doppler) and three-vessel-and-trachea view (color/power Doppler). High-risk cases underwent early fetal echocardiography. False-negative cases were categorized according to likely cause of the missed diagnosis, as follows: human factor; technical factor; acoustic-window factor. RESULTS Gestational age at ultrasound ranged from 12 + 0 to 13 + 6 weeks (crown-rump length (CRL), 50.1-84.0 mm) in the low-risk group and from 11 + 5 to 13 + 6 weeks (CRL, 45.1-84.0 mm) in the high-risk group. Over the 7-year study period, 7080 pregnancies were evaluated in the first trimester. Of these, 6879 (7167 fetuses) were low-risk and 201 were high-risk cases. In the low-risk group, there were 30 fetuses with CHD (including 15 major and 15 minor CHD), yielding a prevalence of 4.2/1000 (2.1/1000 for major CHD). Nine of the 30 CHD cases were suspected at screening ultrasound (7/15 major CHD). Excluding cases in which the CHD would not be expected to be associated with a modification of the screening views and would therefore not be detectable on screening ultrasound, 7/12 cases of major CHD were detected, corresponding to a sensitivity of 58.3%. Among the 201 high-risk cases, there were 46 fetuses with CHD (including 44 major and two minor CHD), of which 43 were detected, corresponding to a sensitivity for early fetal echocardiography of 93.5%, or 97.7% if the two cases that were unlikely to be detectable on first-trimester screening were excluded. Analysis of the 11 (of 24) false-negative cases that would be expected to be picked up on screening views revealed that human error (image interpretation and/or scanning approach) was involved in all 11 cases and technical factors (excessive color priority (color-balance function) and/or incorrect plane alignment) were present in two. There was impairment of the acoustic window (associated with maternal obesity and/or twin gestation) as a cofactor in five of the 11 cases. CONCLUSIONS The sensitivity for detection of major CHD of early cardiac screening in low-risk pregnancy is under 60%, partly due to the natural history of CHD and, it seems, partly relating to human error and technical issues with image quality. Factors associated with false-negative diagnoses may be categorized into three types: human error, technical factors and acoustic-window impairment. We recommend: appropriate assessment with fetal posterior spine; that sufficient time is spent on assessment of the fetal situs; and that color/power Doppler settings are adapted to the individual case. A lower threshold for referring doubtful cases for early fetal echocardiography should be adopted in cases of maternal obesity and in twin gestation. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Bottelli
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - V Franzè
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G Tuo
- Pediatric Cardiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - F Buffelli
- Fetopathology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - D Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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12
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Fileva N, Severino M, Tortora D, Ramaglia A, Paladini D, Rossi A. Second trimester fetal MRI of the brain: Through the ground glass. J Clin Ultrasound 2023; 51:283-299. [PMID: 36785503 DOI: 10.1002/jcu.23423] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 06/18/2023]
Abstract
Fetal MRI is an important tool for the prenatal diagnosis of brain malformations and is often requested after second-trimester ultrasonography reveals a possible abnormality. Despite the immature state of the fetal brain at this early stage, early suggestive signs of the presence of brain malformations can be recognized. To differentiate between the normal dynamics of the growing brain and the developing pathological conditions can be challenging and requires extensive knowledge of normal central nervous system developmental stages and their neuroradiological counterparts at those different stages. This article reviews the second-trimester appearances of some commonly encountered brain malformations, focusing on helpful tricks and subtle signs to aid in the diagnosis of such conditions as rhombencephalosynapsis, various causes of vermian rotation, molar tooth spectrum anomalies, diencephalic-mesencephalic junction dysplasia, ganglionic eminence anomalies, and the most common malformations of cortical development.
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Affiliation(s)
- Nevena Fileva
- Department of Radiology, Medical University of Sofia, Sofia, Bulgaria
| | | | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Antonia Ramaglia
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Dario Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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13
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Aprile A, Calì G, Chianchiano N, Chiappa V, Corbella P, D'Addario V, Dall'Asta A, De Robertis V, Exacustos C, Familiari A, Fichera A, Formigoni C, Frusca T, Ghi T, Guerriero S, Iuculano A, Labate F, Martinelli P, Monni G, Morlano M, Nonino F, Olivieri C, Paladini D, Peddes C, Prefumo F, Rizzo G, Rustico M, Sarno L, Sciacovelli I, Sciarrone A, Stampalija T, Taddei F, Todros T, Valensise H, Vergani P, Volpe N, Volpe P, Votino C, Bettoncelli G, Bracalente G, Collini Ceccatelli M, Costantini M, D'Aloia A, Ferrazzi E, Giorlandino C, Locci M, Verrotti di Pianella C, Viora E, Zoia R, Bilardo K, Vicar M. Corrigendum to "The Italian guidelines on ultrasound in obstetrics and gynecology: Executive summary of recommendations for practice" [Eur. J. Obstetrics Gynecol. 279 (2022) 176-182]. Eur J Obstet Gynecol Reprod Biol 2023; 281:85-86. [PMID: 36584523 DOI: 10.1016/j.ejogrb.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Anna Aprile
- Complex Operative Unit of Legal Medicine and Toxicology AOP, D.M.M. University of Padua, Italy
| | - Giuseppe Calì
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Unit, AO Villa Sofia/Cervello, Palermo, Italy
| | - Nicola Chianchiano
- Fetal Medicine Unit, Bucchieri La Ferla-Fatebenefratelli Hospital, Palermo, Italy
| | - Valentina Chiappa
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Paola Corbella
- Maternal Infant Department SC, Obstetrics and Gynecology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Andrea Dall'Asta
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | | | - Caterina Exacustos
- Academic Department of Surgical Sciences, University of Rome "Tor Vergata", Italy
| | - Alessandra Familiari
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Anna Fichera
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | | | - Tiziana Frusca
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Tullio Ghi
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Stefano Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Cagliari, Italy
| | - Ambra Iuculano
- Pathophysiology of Human Reproduction and Prenatal Diagnosis, Microcythemia Hospital Unit "A. CaO", ARNAS Brotzu, Cagliari, Italy
| | - Francesco Labate
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Unit, AO Villa Sofia/Cervello, Palermo, Italy
| | | | - Giovanni Monni
- Pathophysiology of Human Reproduction and Prenatal Diagnosis, Microcythemia Hospital Unit "A. CaO", ARNAS Brotzu, Cagliari, Italy
| | - Maddalena Morlano
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Nonino
- Operative Unit of Epidemiology and Statistics, IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Claudiana Olivieri
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL BA, Bari, Italy
| | - Dario Paladini
- Complex Operative Unit of Maternal-Fetal Risk Pregnancy, G. Gaslini Institute, Genova, Italy
| | - Cristina Peddes
- Pathophysiology of Human Reproduction and Prenatal Diagnosis, Microcythemia Hospital Unit "A. CaO", ARNAS Brotzu, Cagliari, Italy
| | - Federico Prefumo
- Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Giuseppe Rizzo
- Unità Operativa Complessa di Ginecologia ed Ostetricia Fondazione Policlinico Tor Vergata, Italy
| | - Mariangela Rustico
- Prenatal Diagnosis and Fetal Therapy "Umberto Nicolini", Hospital "V. Buzzi", Milan, Italy
| | - Laura Sarno
- Gynaecology and Obstetrics, University of Naples Federico II, Italy
| | - Irene Sciacovelli
- Gynecology and Obstetrics, Rovereto and Trento Hospitals, ASST, Trento, Italy
| | - Andrea Sciarrone
- Obstetrics and Gynecological Ultrasound and Prenatal Diagnosis Center, Citta' della Salute e della Scienza, Torino, Italy
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, University of Trieste, Italy
| | - Fabrizio Taddei
- Gynecology and Obstetrics, Rovereto and Trento Hospitals, ASST, Trento, Italy
| | - Tullia Todros
- Professor of Gynaecology and Obstetrics, University of Torino, Italy
| | - Herbert Valensise
- Operative Unit of Gynaecology and Obstetrics, Casilino Polyclinic, University of Rome "Tor Vergata", Italy
| | | | - Nicola Volpe
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Paolo Volpe
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL BA, Bari, Italy
| | - Carmela Votino
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL BA, Bari, Italy
| | - Germano Bettoncelli
- Councillor of the Medical Association and Head of the Culture Commission of the Board of Physicians of Brescia, Italy
| | | | | | | | | | - Enrico Ferrazzi
- Obstetrics and Gynaecological Clinic, IRCCS Foundation, Ca' Granda Hospital Maggiore Policlinico of Milan, University of Milan, SIGO Delegate, Italy
| | | | | | | | - Elsa Viora
- Gynaecology and Obstetrics, Turin, President of AOGOI, Italy
| | - Riccardo Zoia
- Legal Medicine and Insurance, University of Milan, President of the Italian Society of Legal Medicine, Italy
| | | | - Maria Vicar
- Midwife, Department of Obstetrics of the University Consortium Universalus, Naples, past President of FNOPO, Italy
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14
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Paladini D, Franzè V, Morena M, Prefumo F. INDIAMAN-20 (INstant DIAgnosis of 20 Major ANomalies) protocol: application of IOTA diagnostic strategy to fetal anomalies. Ultrasound Obstet Gynecol 2022. [PMID: 36484491 DOI: 10.1002/uog.26138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/26/2022] [Accepted: 11/24/2022] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To compile a list of instant diagnoses of major fetal anomalies, and to present their sonographic descriptors and test them in a retrospective series of fetuses with congenital anomalies managed at our center. METHODS The first step was to identify major anomalies that meet the following criteria: (1) can be diagnosed directly and unequivocally on the basis of a set of descriptors evident on a single sonographic view; (2) are among those more commonly diagnosed in utero; (3) represent major lethal or life-threatening malformations or anomalies for which no or only palliative surgery can be performed. For each of these anomalies, a sonographic descriptor was produced. The second step was to test the descriptors of the instant diagnoses in all cases with these anomalies evaluated since January 2000 in our Fetal Medicine Unit, retrieved from our electronic database. For each congenital anomaly-sonographic descriptor pair we then evaluated the presence vs absence of an unequivocal relationship between anomaly and descriptor, assessing: whether a particular descriptor in a set reference plane identified unequivocally the anomaly, i.e. the same descriptor could not be found in any other malformation; and whether a particular anomaly presented the corresponding descriptor in all cases. Finally, we evaluated whether the sonographic descriptors could be applied in all trimesters or only selectively, considering the natural history of the 20 instant diagnoses. RESULTS Of the 20 instant diagnoses, five involved the central/peripheral nervous system (exencephaly/anencephaly, alobar/semilobar holoprosencephaly, cephalocele, open spinal dysraphism, complete agenesis of corpus callosum), five involved the heart (hypoplastic left heart syndrome, complete atrioventricular septal defect, severe Ebstein's anomaly, critical aortic stenosis, transposition of the great arteries), five involved the abdominal wall (left-sided congenital diaphragmatic hernia, exomphalos, gastroschisis, body-stalk anomaly) or gastrointestinal tract (duodenal atresia), and five involved the remaining systems (three urinary (autosomal recessive polycystic kidney disease, multicystic dysplastic kidney, lower urinary tract obstruction), two skeletal (transverse limb defect, radial ray defect)). All of the descriptors were found to identify unequivocally the related malformations, whereas four of the malformations were not associated with their reference descriptors in every case. For example, congenital diaphragmatic hernia (left-sided) presented without the stomach in the thorax in 42/93 (45.2%) cases. Due to the natural history of the condition, not all signs were recognizable in the first trimester, some becoming evident only from the second trimester onwards. CONCLUSION We have defined sonographic descriptors that enable an unequivocal instant diagnosis for a list of 20 major congenital anomalies: the 'INDIAMAN-20' (INstant DIAgnosis of Major ANomalies) protocol. We believe that using this approach may facilitate focused training of less experienced operators and that it may be incorporated into artificial intelligence and deep learning protocols, further boosting the instant prenatal recognition of these lethal or life-threatening malformations. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - V Franzè
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M Morena
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - F Prefumo
- Obstetrics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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15
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Gerbino M, Parodi S, Ballarini M, Paladini D. Comparison of fetal and neonatal sonographic measurements of ventricular size in second- and third-trimester fetuses with or without ventriculomegaly: cross-sectional three-dimensional ultrasound study. Ultrasound Obstet Gynecol 2022; 60:766-773. [PMID: 35869902 DOI: 10.1002/uog.26033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/23/2022] [Accepted: 07/14/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To assess, in a population comprising normal fetuses and fetuses with primary or post-hemorrhagic ventriculomegaly, the reproducibility of measurement of neonatal ultrasound indices in the fetus and to compare the performance of various cut-offs of these parameters to diagnose ventriculomegaly and classify its severity. METHODS This was a retrospective cross-sectional study including 182 singleton fetuses assessed by transvaginal neurosonography. The sample populations included 116 normal fetuses and 66 fetuses with primary (n = 56) or post-hemorrhagic (n = 10) ventriculomegaly. In all cases, the atrial width (AW) was measured according to standard protocols and the findings were compared with four sonographic indices developed in the neonate: the anterior horn width (AHW), the ventricular index (VI), the thalamo-occipital distance (TOD) and the fronto-occipital horn ratio (FOHR). Reproducibility of measurements was assessed using the intraclass correlation coefficient (ICC) and diagnostic accuracy of the neonatal indices was assessed against AW using areas under the receiver-operating-characteristics curves (AUC). RESULTS The intra- and interoperator reproducibility of measurement of AW and the neonatal measurements was excellent, with ICCs > 0.99 for all measures. The association in the fetus of all four variables developed in the neonate with the degree of ventriculomegaly as defined by the AW was strong for severe ventriculomegaly (AW > 15.0 mm; all AUC > 0.95), whereas the separation of cases with mild ventriculomegaly (AW, 10.0-15.0 mm) from those with normal AW (< 10.0 mm) was less effective. CONCLUSIONS When applied in the fetus, all four indices of ventriculomegaly developed in neonates (AHW, VI, TOD, FOHR) were associated strongly with fetal AW when the AW measurement indicated severe fetal ventriculomegaly. However, for mild ventriculomegaly, the association was weaker, probably due to the fact that, in the fetus, mild ventriculomegaly is not caused by obstruction of the ventricular system. Considering the similar performance of the four neonatal variables and the technical issues involved in determination of TOD and FOHR in the fetus, use of VI and AHW is preferred. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Gerbino
- Fetal Medicine and Surgery Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - S Parodi
- Scientific Directorate, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - M Ballarini
- Fetal Medicine and Surgery Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - D Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
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16
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Paladini D, Bottelli L, Lops G, Tuo G. Color Doppler visualization of fetal coronary arteries is enhanced by high resolution and Radiantflow. Ultrasound Obstet Gynecol 2022; 60:432-434. [PMID: 35900844 DOI: 10.1002/uog.26038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/18/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - L Bottelli
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G Lops
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G Tuo
- Pediatric Cardiology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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17
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Costa A, Balbi C, Garbati P, Palamà MEF, Reverberi D, De Palma A, Rossi R, Paladini D, Coviello D, De Biasio P, Ceresa D, Malatesta P, Mauri P, Quarto R, Gentili C, Barile L, Bollini S. Investigating the Paracrine Role of Perinatal Derivatives: Human Amniotic Fluid Stem Cell-Extracellular Vesicles Show Promising Transient Potential for Cardiomyocyte Renewal. Front Bioeng Biotechnol 2022; 10:902038. [PMID: 35757808 PMCID: PMC9214211 DOI: 10.3389/fbioe.2022.902038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/27/2022] [Indexed: 11/15/2022] Open
Abstract
Cardiomyocyte renewal represents an unmet clinical need for cardiac regeneration. Stem cell paracrine therapy has attracted increasing attention to resurge rescue mechanisms within the heart. We previously characterized the paracrine effects that human amniotic fluid–derived stem cells (hAFSC) can exert to provide cardioprotection and enhance cardiac repair in preclinical models of myocardial ischemia and cardiotoxicity. Here, we analyze whether hAFSC secretome formulations, namely, hAFSC conditioned medium (hAFSC-CM) over extracellular vesicles (hAFSC-EVs) separated from it, can induce cardiomyocyte renewal. c-KIT+ hAFSC were obtained by leftover samples of II trimester prenatal amniocentesis (fetal hAFSC) and from clinical waste III trimester amniotic fluid during scheduled C-section procedures (perinatal hAFSC). hAFSC were primed under 1% O2 to enrich hAFSC-CM and EVs with cardioactive factors. Neonatal mouse ventricular cardiomyocytes (mNVCM) were isolated from cardiac tissue of R26pFUCCI2 mice with cell cycle fluorescent tagging by mutually exclusive nuclear signal. mNVCM were stimulated by fetal versus perinatal hAFSC-CM and hAFSC-EVs to identify the most promising formulation for in vivo assessment in a R26pFUCCI2 neonatal mouse model of myocardial infarction (MI) via intraperitoneal delivery. While the perinatal hAFSC secretome did not provide any significant cardiogenic effect, fetal hAFSC-EVs significantly sustained mNVCM transition from S to M phase by 2-fold, while triggering cytokinesis by 4.5-fold over vehicle-treated cells. Treated mNVCM showed disorganized expression of cardiac alpha-actinin, suggesting cytoskeletal re-arrangements prior to cell renewal, with a 40% significant downregulation of Cofilin-2 and a positive trend of polymerized F-Actin. Fetal hAFSC-EVs increased cardiomyocyte cell cycle progression by 1.8-fold in the 4-day-old neonatal left ventricle myocardium short term after MI; however, such effect was lost at the later stage. Fetal hAFSC-EVs were enriched with a short isoform of Agrin, a mediator of neonatal heart regeneration acting by YAP-related signaling; yet in vitro application of YAP inhibitor verteporfin partially affected EV paracrine stimulation on mNVCM. EVs secreted by developmentally juvenile fetal hAFSC can support cardiomyocyte renewal to some extension, via intercellular conveyance of candidates possibly involving Agrin in combination with other factors. These perinatal derivative promising cardiogenic effects need further investigation to define their specific mechanism of action and enhance their potential translation into therapeutic opportunity.
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Affiliation(s)
- Ambra Costa
- Experimental Biology Unit, Department of Experimental Medicine (DIMES), University of Genova, Genova, Italy
| | - Carolina Balbi
- Laboratory of Cellular and Molecular Cardiology, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.,Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Patrizia Garbati
- Experimental Biology Unit, Department of Experimental Medicine (DIMES), University of Genova, Genova, Italy
| | | | - Daniele Reverberi
- Molecular Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Antonella De Palma
- Proteomics and Metabolomics Unit, Institute for Biomedical Technologies (ITB-CNR), Milan, Italy
| | - Rossana Rossi
- Proteomics and Metabolomics Unit, Institute for Biomedical Technologies (ITB-CNR), Milan, Italy
| | - Dario Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Domenico Coviello
- Laboratory of Human Genetics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Pierangela De Biasio
- Prenatal Diagnosis Perinatal Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Davide Ceresa
- Cellular Oncology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Paolo Malatesta
- Experimental Biology Unit, Department of Experimental Medicine (DIMES), University of Genova, Genova, Italy.,Cellular Oncology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Pierluigi Mauri
- Proteomics and Metabolomics Unit, Institute for Biomedical Technologies (ITB-CNR), Milan, Italy
| | - Rodolfo Quarto
- Experimental Biology Unit, Department of Experimental Medicine (DIMES), University of Genova, Genova, Italy.,Cellular Oncology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Gentili
- Experimental Biology Unit, Department of Experimental Medicine (DIMES), University of Genova, Genova, Italy
| | - Lucio Barile
- Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Laboratory for Cardiovascular Theranostics, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università Svizzera Italiana, Lugano, Switzerland
| | - Sveva Bollini
- Experimental Biology Unit, Department of Experimental Medicine (DIMES), University of Genova, Genova, Italy
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18
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Costa A, Balbi C, Garbati P, De Palma A, Ceresa D, Santamaria S, Cortese K, Coviello D, De Biasio P, Paladini D, Barile L, Malatesta P, Mauri P, Bollini S. Human amniotic fluid stem cell-extracellular vesicles as paracrine candidates to rejuvenate cardiomyocyte renewal. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac066.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): University of Genova
Background
Reactivation of cardiomyocyte renewal represents a milestone for cardiac regeneration. While broadly active in the early neonatal mammalian myocardium, such mechanism is lost soon after birth, with transition to defective repair. We previously showed that human amniotic fluid stem cells (hAFS) possess cardioprotective and cardioactive paracrine potential in a preclinical adult mouse model of myocardial infarction (MI)1, by sustaining cardiomyocyte cell cycle re-entry up to DNA duplication.
Purpose
Here we analyse whether hAFS secretome formulations, namely hAFS-conditioned medium (hAFS-CM) over extracellular vesicles (hAFS-EVs) separated from that, can enhance cardiomyocyte renewal in vitro and in vivo.
Methods
hAFS were obtained by leftover samples of prenatal screening amniocentesis and primed under 1% O2 preconditioning to enrich hAFS-CM and hAFS-EVs with cardioactive factors. hAFS-EVs were concentrated from hAFS-CM by serial ultracentrifugation. hAFS-EVs were profiled by electron microscopy, nanoparticle tracking analysis, proteomics and RNA sequencing (RNAseq). Neonatal mouse ventricular cardiomyocytes (mNVCM) were enzymatically isolated from R26pFUCCI2 mice with fluorescent tagging of cell-cycle by nuclear signal (G1-phase by Cdt1-mCherry; S-G2-M-phases by Geminin-mVenus1)2. mNVCM were stimulated by hAFS-CM or hAFS-EVs to identify the most promising formulation for further analysis in a R26pFUCCI2 4-day-old MI mouse model via intra-peritoneal delivery, according to principles of laboratory animal care and in compliance with authorization from the Italian Ministry of Health.
Results
hAFS-EVs sustained R26pFUCCI2 mNVCM transition from S- to M-phase by 2.1-fold (*p<0.05) in vitro, while triggering cytokinesis by 4.5-fold (*p<0.05) increase by Aurora B kinase expression at midbodies. Treated mNVCM showed disorganized expression of cardiac α-actinin, suggesting cytoskeletal re-arrangements prior to cell renewal, with significant down-regulation (0.6-fold, ****p<0.0001) of Cofilin-2 (CFL-2) an actin cytoskeleton regulator antagonizing cardiomyocyte proliferation3. RNAseq on hAFS-EVs revealed some of the mostly enriched microRNAs (miRNAs) targeting CFL-2 (miR-93-5p; miR-152-3p; miR-200b-3p; miR-429; miR-199a-3p; miR-20a-5p; miR-425-5p), while proteomics reported enrichment of a secreted form of Agrin, an important mediator for neonatal heart regeneration4. hAFS-EVs increased cardiomyocyte S- to M phase transition by 1.8-fold (*p<0.05) in the mouse neonatal left ventricle 3 days post-MI.
Conclusions
Our current findings suggest that EVs secreted by developmentally juvenile hAFS may be endowed with relevant potential to support cardiomyocyte renewal for future paracrine therapy in regenerative medicine with putative molecular candidate(s) of action in their cargo content including Agrin and non-coding miRNAs.
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Affiliation(s)
- A Costa
- University of Genova, Department of Experimental Medicine (DIMES) , Genoa , Italy
| | - C Balbi
- Cardiocentro Ticino, Molecular and Cell Cardiology Laboratory , Lugano , Switzerland
| | - P Garbati
- University of Genova, Department of Experimental Medicine (DIMES) , Genoa , Italy
| | - A De Palma
- CNR Institute of Genetic and Biomedical Research, Institute of Biomedical Technologies (ITB) , Milan , Italy
| | - D Ceresa
- Ospedale Policlinico San Martino IRCCS, Cellular Oncology Unit , Genoa , Italy
| | - S Santamaria
- University of Genova, Department of Experimental Medicine (DIMES) , Genoa , Italy
| | - K Cortese
- University of Genova, Department of Experimental Medicine (DIMES) , Genoa , Italy
| | - D Coviello
- Giannina Gaslini Institute, Human Genetics , Genoa , Italy
| | - P De Biasio
- Policlinc San Martino Hospital, Dept. of Obstetrics and Gynecology , Genoa , Italy
| | - D Paladini
- Giannina Gaslini Institute, Fetal and Perinatal Medicine Unit , Genoa , Italy
| | - L Barile
- Cardiocentro Ticino Foundation, Laboratory for Cardiovascular Theranostics , Lugano , Switzerland
| | - P Malatesta
- University of Genova, Department of Experimental Medicine (DIMES) , Genoa , Italy
| | - P Mauri
- CNR Institute of Genetic and Biomedical Research, Institute of Biomedical Technologies (ITB) , Milan , Italy
| | - S Bollini
- University of Genova, Department of Experimental Medicine (DIMES) , Genoa , Italy
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Salomon LJ, Alfirevic Z, Berghella V, Bilardo CM, Chalouhi GE, Da Silva Costa F, Hernandez-Andrade E, Malinger G, Munoz H, Paladini D, Prefumo F, Sotiriadis A, Toi A, Lee W. ISUOG Practice Guidelines (updated): performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2022; 59:840-856. [PMID: 35592929 DOI: 10.1002/uog.24888] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 06/15/2023]
Affiliation(s)
- L J Salomon
- Department of Obstetrics and Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Cité University, Paris, France
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - V Berghella
- Thomas Jefferson University, Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Philadelphia, PA, USA
| | - C M Bilardo
- University Medical Centre, Fetal Medicine Unit, Department of Obstetrics & Gynecology, Groningen, The Netherlands
| | - G E Chalouhi
- Maternité Necker-Enfants Malades, Université Paris Descartes, AP-HP, Paris, France
| | - F Da Silva Costa
- Maternal Fetal Medicine Unit, Gold Coast University Hospital and School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | | | - G Malinger
- Division of Ob-Gyn Ultrasound, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Munoz
- University of Chile Hospital, Fetal Medicine Unit, Obstetrics & Gynecology, Santiago, Chile
| | - D Paladini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - F Prefumo
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Toi
- Medical Imaging, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - W Lee
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, TX, USA
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20
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Pretti N, Paladini D, Panzeri S, Becchio C. Why 4D ultrasound has not (yet) revolutionized fetal-movement research. Ultrasound Obstet Gynecol 2022; 59:569-573. [PMID: 34435711 DOI: 10.1002/uog.24757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Affiliation(s)
- N Pretti
- Cognition, Motion and Neuroscience Unit, Center for Human Technologies, Istituto Italiano di Tecnologia, Genoa, Italy
- Department of Psychology, Università di Torino, Turin, Italy
| | - D Paladini
- Fetal Medicine and Surgery Unit, IRCCS G. Gaslini, Genoa, Italy
| | - S Panzeri
- Department of Neural Information Processing, Center for Molecular Neurobiology (ZMNH), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - C Becchio
- Cognition, Motion and Neuroscience Unit, Center for Human Technologies, Istituto Italiano di Tecnologia, Genoa, Italy
- Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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21
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Pomar L, Ochoa J, Cabet S, Huisman TAGM, Paladini D, Klaritsch P, Galmiche A, Prayer F, Gacio S, Haratz K, Malinger G, Van Mieghem T, Baud D, Bromley B, Lebon S, Dubruc E, Vial Y, Guibaud L. Prenatal diagnosis of Aicardi syndrome based on a suggestive imaging pattern: A multicenter case-series. Prenat Diagn 2022; 42:484-494. [PMID: 34984691 PMCID: PMC9302986 DOI: 10.1002/pd.6085] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 12/02/2022]
Abstract
Objectives To characterize a suggestive prenatal imaging pattern of Aicardi syndrome using ultrasound and MR imaging. Methods Based on a retrospective international series of Aicardi syndrome cases from tertiary centers encountered over a 20‐year period (2000–2020), we investigated the frequencies of the imaging features in order to characterize an imaging pattern highly suggestive of the diagnosis. Results Among 20 cases included, arachnoid cysts associated with a distortion of the interhemispheric fissure were constantly encountered associated with complete or partial agenesis of the corpus callosum (19/20, 95%). This triad in the presence of other CNS disorganization, such as polymicrogyria (16/17, 94%), heterotopias (15/17, 88%), ventriculomegaly (14/20, 70%), cerebral asymmetry [14/20, 70%]) and less frequently extra‐CNS anomaly (ocular anomalies [7/11, 64%], costal/vertebral segmentation defect [4/20, 20%]) represent a highly suggestive pattern of Aicardi syndrome in a female patient. Conclusion Despite absence of genetic test to confirm prenatal diagnosis of AS, this combination of CNS and extra‐CNS fetal findings allows delineation of a characteristic imaging pattern of AS, especially when facing dysgenesis of the corpus callosum.
What is already known about this topic?
Aicardi syndrome (AS) is a rare developmental encephalopathy, characterized by the classic triad of infantile spasms, agenesis of the corpus callosum, and chorioretinal lacunae As the genetic etiology of AS is unknown and its classic triad cannot be extrapolated to prenatal diagnosis, to establish a prenatal imaging pattern is of major interest
What does this study add?
We confirmed and completed a prenatal imaging pattern highly suggestive of AS, based on the most frequent features encountered in a large series: arachnoid cysts associated with a distortion of the interhemispheric fissure, agenesis of the corpus callosum, cortical malformations and heterotopias, and less frequently extra‐CNS anomaly (ocular anomalies, costal/vertebral segmentation defect)
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Affiliation(s)
- Léo Pomar
- Ultrasound and Fetal Medicine, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.,School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - José Ochoa
- Diagnus SA, Prenatal Diagnosis and Fetal Medicine Centre, Córdoba, Argentina
| | - Sara Cabet
- Pediatric and Fœtal Imaging, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Dario Paladini
- Fetal Medicine and Surgery Unit, Gaslini Children's Hospital, Genoa, Italy
| | - Philipp Klaritsch
- Research Unit for Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Aurore Galmiche
- Ultrasound and Fetal Medicine, Department of Obstetrics, Hospital of Niort, Niort, France
| | - Florian Prayer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sebastián Gacio
- Division of Pediatric Neurology, Hospital of Children Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | - Karina Haratz
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Gustavo Malinger
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Tim Van Mieghem
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - David Baud
- Ultrasound and Fetal Medicine, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Bryann Bromley
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sébastien Lebon
- Pediatric Neurology Unit, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - Estelle Dubruc
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Yvan Vial
- Ultrasound and Fetal Medicine, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Laurent Guibaud
- Pediatric and Fœtal Imaging, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
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22
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Tuo G, Paladini D, Marasini L, Buratti S, De Tonetti G, Calevo MG, Marasini M. Fetal aortic coarctation: A combination of third-trimester echocardiographic parameters to improve the prediction of postnatal outcome. Front Pediatr 2022; 10:866994. [PMID: 36299692 PMCID: PMC9589048 DOI: 10.3389/fped.2022.866994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aims to determine a combination of third-trimester echocardiographic parameters for improving the prenatal prediction of coarctation of the aorta (CoA) after birth. METHODS We included all cases of suspected CoA during fetal echocardiography performed in the second and/or third trimester of pregnancy at Gaslini Children's Hospital between January 2010 and December 2020. The last prenatal ultrasound evaluation was reviewed considering most of the echocardiographic criteria were already published for prenatal CoA diagnosis. Associated minor cardiac anomalies, such as a ventricular septal defect, persistent left superior vena cava (PLSCV), and redundant foramen ovale (FO) membrane, as well as postnatal outcomes, were reported. Initial perinatal management was defined based on the risk stratification of CoA during prenatal echocardiography. Neonates were divided into two groups depending on the presence or absence of CoA after birth. RESULTS A total of 91 fetuses with CoA suspicion were selected, of which 27 (30%) were confirmed with CoA after birth and underwent surgical repair. All cardiac parameters except redundant FO membrane and PLSCV showed a significant correlation with CoA. Statistical analysis confirmed that cardiovascular disproportion with right predominance carries an increased risk for occurrence of CoA, especially if already evident during the ultrasound evaluation in the second trimester. Aortic valve (AV) z-score and distal transverse aortic arch (TAA) z-score resulted as the best predictors of CoA after birth. The best cutoff point for CoA discrimination with ROC analysis was an AV z-score of -1.25 and a distal TAA z-score of -0.37. A total of 46% of those without CoA were diagnosed with a cardiac defect, which was not diagnosed in utero, pulmonary hypertension, or a genetic syndrome. CONCLUSION The current criteria for diagnosing CoA in utero allow accurate diagnosis of most severe cases but the rate of false positives remains relatively high for milder cases. A combination of anatomic and functional echocardiographic parameters might be used in stratifying the risk of CoA. We proposed the AV and the TAA diameter z-scores as the best predictors of CoA after birth. In addition, neonates without CoA deserve proper monitoring at birth because prenatal evidence of a significant cardiovascular discrepancy between the right and left cardiac structures has an inherent risk for additional morbidity postnatally.
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Affiliation(s)
- Giulia Tuo
- Department of Surgery, Pediatric Cardiology and Cardiac Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genova, Italy
| | - Dario Paladini
- Department of Critical Care and Perinatal Medicine Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Lucia Marasini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), IRCCS Istituto Giannina Gaslini, University of Genoa, Genova, Italy
| | - Silvia Buratti
- Critical Care and Emergency Department, Neonatal and Pediatric Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Gabriele De Tonetti
- Department of Critical Care and Perinatal Medicine, Obstetric Anesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Maria G Calevo
- Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Maurizio Marasini
- Department of Surgery, Pediatric Cardiology and Cardiac Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genova, Italy
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23
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Krajden Haratz K, Oliveira Szejnfeld P, Govindaswamy M, Leibovitz Z, Gindes L, Severino M, Rossi A, Paladini D, Garcia Rodriguez R, Ben-Sira L, Borkowski Tillman T, Gupta R, Lotem G, Raz N, Hamamoto TENK, Kidron D, Arad A, Birnbaum R, Brussilov M, Pomar L, Vial Y, Leventer RJ, McGillivray G, Fink M, Krzeszowski W, Fernandes Moron A, Lev D, Tamarkin M, Shalev J, Har Toov J, Lerman-Sagie T, Malinger G. Prenatal diagnosis of rhombencephalosynapsis: neuroimaging features and severity of vermian anomaly. Ultrasound Obstet Gynecol 2021; 58:864-874. [PMID: 33942916 DOI: 10.1002/uog.23660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/24/2021] [Accepted: 04/16/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To describe the prenatal neuroimaging spectrum of rhombencephalosynapsis (RES) and criteria for its classification according to the severity of vermian anomaly. METHODS In this multicenter retrospective study of fetuses with RES between 2002 and 2020, the medical records and brain ultrasound and magnetic resonance images were evaluated comprehensively to determine the severity of the vermian anomaly and the presence of associated brain findings. RES was classified, according to the pattern of vermian agenesis and the extent of the fusion of the hemispheres, as complete RES (complete absence of the vermis) or partial RES (further classified according to the part of the vermis that was missing and, consequently, the region of hemispheric fusion, as anterior, posterior, severe or mixed RES). Findings were compared between cases with complete and those with partial RES. RESULTS Included in the study were 62 fetuses with a gestational age ranging between 12 and 37 weeks. Most had complete absence of the vermis (complete RES, 77.4% of cases), a 'round-shaped' cerebellum on axial views (72.6%) and a transverse cerebellar diameter (TCD) < 3rd centile (87.1%). Among the 22.6% of cases with partial RES, 6.5% were classified as severe partial, 6.5% as partial anterior, 8.1% as partial mixed and 1.6% as partial posterior. Half of these cases presented with normal or nearly normal cerebellar morphology and 28.5% had a TCD within the normal limits. Infratentorially, the fourth ventricle was abnormal in 88.7% of cases overall, and anomalies of the midbrain and pons were frequent (93.5% and 77.4%, respectively). Ventriculomegaly was observed in 80.6% of all cases, being more severe in cases with complete RES than in those with partial RES, with high rates of parenchymal and septal disruption. CONCLUSIONS This study provides prenatal neuroimaging criteria for the diagnosis and classification of RES, and identification of related features, using ultrasound and magnetic resonance imaging. According to our findings, a diagnosis of RES should be considered in fetuses with a small TCD (severe cerebellar hypoplasia) and/or a round-shaped cerebellum on axial views, during the second or third trimester, especially when associated with ventriculomegaly. Partial RES is more common than previously thought, but presents an extreme diagnostic challenge, especially in cases with normal or nearly-normal cerebellar morphobiometric features. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K Krajden Haratz
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - P Oliveira Szejnfeld
- Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, Brazil
- DDI UNIFESP, São Paulo, Brazil
- Fundação Instituto de Pesquisa e Estudo de Diagnostico por Imagem, São Paulo, Brazil
| | - M Govindaswamy
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Z Leibovitz
- Ultrasound in Obstetrics and Gynecology Unit, Bnai-Zion Medical Center, Haifa, Israel
- Technion Faculty of Medicine, Haifa, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - L Gindes
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - M Severino
- Neuroradiology Unit, IRCCS Istituto Giannini Gaslini, Genoa, Italy
| | - A Rossi
- Neuroradiology Unit, IRCCS Istituto Giannini Gaslini, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - D Paladini
- Fetal Medicine Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - R Garcia Rodriguez
- Complejo Hospitalario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - L Ben-Sira
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Radiology Unit, Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - T Borkowski Tillman
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - R Gupta
- Sunehri Devi Hospital, Sonepat India, Indraprastha Apollo Hospital, New Delhi, India
| | - G Lotem
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - N Raz
- Technion Faculty of Medicine, Haifa, Israel
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hedera, Israel
| | - T E N K Hamamoto
- Departamento de Obstetrícia da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - D Kidron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - A Arad
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pathology, Bnai Zion Medical Center, Haifa, Israel
| | - R Birnbaum
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Brussilov
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Pomar
- Ultrasound and Fetal Medicine Unit, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Y Vial
- Ultrasound and Fetal Medicine Unit, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - R J Leventer
- Department of Neurology, The Royal Children's Hospital, Murdoch Children's Research Institute and University of Melbourne Department of Pediatrics, Melbourne, Australia
| | - G McGillivray
- Royal Women's Hospital, Mercy Hospital for Women and Murdoch Children's Research Institute, Melbourne, Australia
| | - M Fink
- Department of Medical Imaging, The Royal Children's Hospital and Perinatal Unit, The Mercy Hospital for Women, Melbourne, Australia
| | | | - A Fernandes Moron
- Departamento de Obstetrícia da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - D Lev
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
- Institute of Genetics, Wolfson Medical Center, Holon, Israel
| | - M Tamarkin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - J Shalev
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
- Institute of Genetics, Wolfson Medical Center, Holon, Israel
| | - J Har Toov
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Lerman-Sagie
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
| | - G Malinger
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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24
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Johnsson V, Tolsgaard M, Hyett J, Gembruch U, Windrim R, Khalil A, Tiblad E, Slaghekke F, Paladini D, Nayahangan L, Sundberg KM, Nørgaard LN, Petersen OB. Consensus on Training and Assessment of Competence in Performing Chorionic Villus Sampling and Amniocentesis: An International Delphi Survey. Fetal Diagn Ther 2021; 48:720-737. [PMID: 34818226 DOI: 10.1159/000519116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/17/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to obtain expert consensus on the content of a curriculum for learning chorionic villus sampling (CVS) and amniocentesis (AC) and the items of an assessment tool to evaluate CVS and AC competence. METHODS We used a 3-round iterative Delphi process. A steering committee supervised all processes. Seven international collaborators were identified to expand the breadth of the study internationally. The collaborators invited fetal medicine experts to participate as panelists. In the first round, the panelists suggested content for a CVS/AC curriculum and an assessment tool. The steering committee organized and condensed the suggested items and presented them to the panelists in round 2. In the second round, the panelists rated and commented on the suggested items. The results were processed by the steering committee and presented to the panelists in the third round, where final consensus was obtained. Consensus was defined as support by more than 80% of the panelists for an item. RESULTS Eighty-six experts agreed to participate in the study. The panelists represented 16 countries across 4 continents. The final list of curricular content included 12 theoretical and practical items. The final assessment tool included 11 items, systematically divided into 5 categories: pre-procedure, procedure, post-procedure, nontechnical skills, and overall performance. These items were provided with behavioral scale anchors to rate performance, and an entrustment scale was used for the final overall assessment. CONCLUSION We established consensus among international fetal medicine experts on content to be included in a CVS/AC curriculum and on an assessment tool to evaluate CVS/AC skills. These results are important to help transition current training and assessment methods from a time- and volume-based approach to a competency-based approach which is a key step in improving patient safety and outcomes for the 2 most common invasive procedures in fetal medicine.
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Affiliation(s)
- Vilma Johnsson
- Department of Fetal Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Martin Tolsgaard
- Department of Fetal Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, the Capital Region of Denmark, Copenhagen, Denmark
| | - Jon Hyett
- Department of Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Clinic Bonn, Bonn, Germany
| | - Rory Windrim
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Asma Khalil
- Fetal Medicine Unit, St George's University Hospitals, London, United Kingdom
| | - Eleonor Tiblad
- Center for Fetal Medicine, Karolinska University Hospital, Huddinge, Sweden
| | - Femke Slaghekke
- Department of Obstetrics and Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Dario Paladini
- Department of Fetal Medicine and Surgery, Gaslini Hospital, Genoa, Italy
| | - Leizl Nayahangan
- Copenhagen Academy for Medical Education and Simulation, the Capital Region of Denmark, Copenhagen, Denmark
| | - Karin M Sundberg
- Department of Fetal Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lone N Nørgaard
- Department of Fetal Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Olav B Petersen
- Department of Fetal Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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25
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Paladini D. The hidden story of the fourth ventricular choroid plexus: the flower basket of an old anatomist…. Ultrasound Obstet Gynecol 2021; 58:505-508. [PMID: 34173694 DOI: 10.1002/uog.23726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 06/13/2023]
Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
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26
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Accogli A, Goergen S, Izzo G, Mankad K, Krajden Haratz K, Parazzini C, Fahey M, Menzies L, Baptista J, Carpineta L, Tortora D, Fulcheri E, Gaetano Vellone V, Paladini D, Spaccini L, Toto V, Trayers C, Ben Sira L, Reches A, Malinger G, Salpietro V, De Marco P, Srour M, Zara F, Capra V, Rossi A, Severino M. L1CAM variants cause two distinct imaging phenotypes on fetal MRI. Ann Clin Transl Neurol 2021; 8:2004-2012. [PMID: 34510796 PMCID: PMC8528460 DOI: 10.1002/acn3.51448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 01/10/2023] Open
Abstract
Data on fetal MRI in L1 syndrome are scarce with relevant implications for parental counseling and surgical planning. We identified two fetal MR imaging patterns in 10 fetuses harboring L1CAM mutations: the first, observed in 9 fetuses was characterized by callosal anomalies, diencephalosynapsis, and a distinct brainstem malformation with diencephalic–mesencephalic junction dysplasia and brainstem kinking. Cerebellar vermis hypoplasia, aqueductal stenosis, obstructive hydrocephalus, and pontine hypoplasia were variably associated. The second pattern observed in one fetus was characterized by callosal dysgenesis, reduced white matter, and pontine hypoplasia. The identification of these features should alert clinicians to offer a prenatal L1CAM testing.
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Affiliation(s)
- Andrea Accogli
- Medical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Stacy Goergen
- Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | - Giana Izzo
- Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital, Milan, Italy
| | - Kshitij Mankad
- Neuroradiology Unit, Great Ormond Street Hospital for Children, London, UK
| | - Karina Krajden Haratz
- Division of Ultrasound in ObGyn, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Cecilia Parazzini
- Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital, Milan, Italy
| | - Michael Fahey
- Paediatric Neurology and Neurogenetics Units, Monash Children's Hospital Clayton, Clayton, Victoria, Australia
| | - Lara Menzies
- Department of Clinical Genetics, Great Ormond Street Hospital, London, UK
| | - Julia Baptista
- Exeter Genomics Laboratory, Royal Devon and Exeter NHS Hospital, Exeter, UK.,College of Medicine and Health, University of Exeter, Exeter, UK
| | - Lucia Carpineta
- Department of Pediatric Medical Imaging, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Ezio Fulcheri
- Fetal-Perinatal Pathology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, Università di Genova, Genoa, Italy
| | - Valerio Gaetano Vellone
- Department of Surgical Sciences and Integrated Diagnostics, Università di Genova, Genoa, Italy
| | - Dario Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Luigina Spaccini
- Clinical Genetics Unit, Department of Obstetrics and Gynecology, V. Buzzi Children's Hospital, Milan, Italy
| | - Valentina Toto
- Pathology Division, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Claire Trayers
- Department of Paediatric Pathology, Addenbrooke's Hospital, Cambridge, UK
| | - Liat Ben Sira
- Pediatric Radiology, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Reches
- Wolfe PGD- Stem Cell Lab, Racine IVF Unit Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv Israel, Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Gustavo Malinger
- Division of Ultrasound in ObGyn, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vincenzo Salpietro
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Pediatric Neurology and Muscular Diseases Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Patrizia De Marco
- Medical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Myriam Srour
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center (MUHC), Montreal, Canada
| | - Federico Zara
- Medical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Valeria Capra
- Medical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Health Sciences DISSAL, University of Genoa, Genoa, Italy
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Paladini D. Reply: large choroid plexus cysts are indeed large choroid plexus cysts. Ultrasound Obstet Gynecol 2021; 58:496. [PMID: 34468060 DOI: 10.1002/uog.23751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- D Paladini
- Fetal Medicine & Surgery Unit, Istituto G.Gaslini, Genoa, Italy
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28
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Villa F, Bruno S, Costa A, Li M, Russo M, Cimino J, Altieri P, Ruggeri C, Gorgun C, De Biasio P, Paladini D, Coviello D, Quarto R, Ameri P, Ghigo A, Ravera S, Tasso R, Bollini S. The Human Fetal and Adult Stem Cell Secretome Can Exert Cardioprotective Paracrine Effects against Cardiotoxicity and Oxidative Stress from Cancer Treatment. Cancers (Basel) 2021; 13:cancers13153729. [PMID: 34359631 PMCID: PMC8345068 DOI: 10.3390/cancers13153729] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 12/28/2022] Open
Abstract
Simple Summary Anthracyclines, such as doxorubicin (Dox), are an important class of chemotherapeutic drugs. However, their use is hampered by the risk of developing heart failure. The aim of this study was to assess and compare the cardioprotective effects exerted by a set of factors, collectively named secretomes, secreted by either adult or fetal human stem cells. Both secretome formulations were effective in counteracting Dox-induced apoptosis and mitochondrial impairment in cardiomyocytes and cardiac fibroblasts. In vivo experiments in a mouse model of Dox-induced cardiomyopathy (DIC) indicated that early administration of both secretomes during Dox treatment exerted beneficial long-term effects, preserving cardiac function and body mass. These findings suggest that the stem cell secretome could represent a feasible option for future paracrine cardioprotective therapy against Dox-related cardiotoxicity during cancer treatment. Abstract Cardiovascular side effects are major shortcomings of cancer treatments causing cardiotoxicity and late-onset cardiomyopathy. While doxorubicin (Dox) has been reported as an effective chemotherapy agent, unspecific impairment in cardiomyocyte mitochondria activity has been documented. We demonstrated that the human fetal amniotic fluid-stem cell (hAFS) secretome, namely the secreted paracrine factors within the hAFS-conditioned medium (hAFS-CM), exerts pro-survival effects on Dox-exposed cardiomyocytes. Here, we provide a detailed comparison of the cardioprotective potential of hAFS-CM over the secretome of mesenchymal stromal cells from adipose tissue (hMSC-CM). hAFS and hMSC were preconditioned under hypoxia to enrich their secretome. The cardioprotective effects of hAFS/hMSC-CM were evaluated on murine neonatal ventricular cardiomyocytes (mNVCM) and on their fibroblast counterpart (mNVFib), and their long-term paracrine effects were investigated in a mouse model of Dox-induced cardiomyopathy. Both secretomes significantly contributed to preserving mitochondrial metabolism within Dox-injured cardiac cells. hAFS-CM and hMSC-CM inhibited body weight loss, improved myocardial function, reduced lipid peroxidation and counteracted the impairment of mitochondrial complex I activity, oxygen consumption, and ATP synthesis induced by Dox. The hAFS and hMSC secretomes can be exploited for inhibiting cardiotoxic detrimental side effects of Dox during cancer therapy, thus ensuring cardioprotection via combinatorial paracrine therapy in association with standard oncological treatments.
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Affiliation(s)
- Federico Villa
- Cellular Oncology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (F.V.); (C.G.); (R.Q.)
| | - Silvia Bruno
- Department of Experimental Medicine (DIMES), University of Genova, 16132 Genova, Italy; (S.B.); (A.C.); (S.R.)
| | - Ambra Costa
- Department of Experimental Medicine (DIMES), University of Genova, 16132 Genova, Italy; (S.B.); (A.C.); (S.R.)
| | - Mingchuan Li
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (M.L.); (M.R.); (J.C.); (A.G.)
| | - Michele Russo
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (M.L.); (M.R.); (J.C.); (A.G.)
| | - James Cimino
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (M.L.); (M.R.); (J.C.); (A.G.)
| | - Paola Altieri
- Laboratory of Cardiovascular Biology, Department of Internal Medicine (DIMI), University of Genova, 16132 Genova, Italy; (P.A.); (C.R.); (P.A.)
| | - Clarissa Ruggeri
- Laboratory of Cardiovascular Biology, Department of Internal Medicine (DIMI), University of Genova, 16132 Genova, Italy; (P.A.); (C.R.); (P.A.)
| | - Cansu Gorgun
- Cellular Oncology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (F.V.); (C.G.); (R.Q.)
- Department of Experimental Medicine (DIMES), University of Genova, 16132 Genova, Italy; (S.B.); (A.C.); (S.R.)
| | - Pierangela De Biasio
- Unit of Prenatal Diagnosis and Perinatal Medicine, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Dario Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Domenico Coviello
- Human Genetics Laboratory, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Rodolfo Quarto
- Cellular Oncology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (F.V.); (C.G.); (R.Q.)
- Department of Experimental Medicine (DIMES), University of Genova, 16132 Genova, Italy; (S.B.); (A.C.); (S.R.)
| | - Pietro Ameri
- Laboratory of Cardiovascular Biology, Department of Internal Medicine (DIMI), University of Genova, 16132 Genova, Italy; (P.A.); (C.R.); (P.A.)
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Alessandra Ghigo
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (M.L.); (M.R.); (J.C.); (A.G.)
| | - Silvia Ravera
- Department of Experimental Medicine (DIMES), University of Genova, 16132 Genova, Italy; (S.B.); (A.C.); (S.R.)
| | - Roberta Tasso
- Cellular Oncology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (F.V.); (C.G.); (R.Q.)
- Department of Experimental Medicine (DIMES), University of Genova, 16132 Genova, Italy; (S.B.); (A.C.); (S.R.)
- Correspondence: (R.T.); (S.B.); Tel.: +39-010-555-8394 (R.T.); +39-010-555-8257 (S.B.)
| | - Sveva Bollini
- Department of Experimental Medicine (DIMES), University of Genova, 16132 Genova, Italy; (S.B.); (A.C.); (S.R.)
- Correspondence: (R.T.); (S.B.); Tel.: +39-010-555-8394 (R.T.); +39-010-555-8257 (S.B.)
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29
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Paladini D, Donarini G, Bottelli L, Rossi A, Coltri A, Fulcheri E. Isolated, persisting, large choroid plexus cysts should warrant neurosonographic follow-up. Ultrasound Obstet Gynecol 2021; 57:1006-1008. [PMID: 32449310 DOI: 10.1002/uog.22095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G Donarini
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - L Bottelli
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - A Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - E Fulcheri
- Fetopathology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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30
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Paladini D. Power Doppler as second-stage test in adnexal tumors that are difficult to classify: a plea to use the potential offered by new-generation tools. Ultrasound Obstet Gynecol 2021; 57:1015-1016. [PMID: 34077609 DOI: 10.1002/uog.23659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/19/2021] [Indexed: 06/12/2023]
Affiliation(s)
- D Paladini
- Fetal Medicine & Surgery Unit, Istituto G. Gaslini, Genoa, Italy
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31
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Paladini D, Finarelli A, Donarini G, Parodi S, Lombardo V, Tuo G, Birnbaum R. Frontal lobe growth is impaired in fetuses with congenital heart disease. Ultrasound Obstet Gynecol 2021; 57:776-782. [PMID: 32573836 DOI: 10.1002/uog.22127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/18/2020] [Accepted: 06/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The primary objective of this study was to assess whether fetuses with congenital heart disease (CHD) have smaller frontal brain areas compared with normal controls. The secondary objective was to evaluate whether there are any differences in frontal brain area between cases with different types of CHD, grouped according to their impact on hemodynamics. METHODS This was a retrospective cross-sectional study, including 421 normal fetuses and 101 fetuses with isolated CHD evaluated between 20 and 39 gestational weeks at our fetal medicine and surgery unit in the period January 2016-December 2019. The study group was subdivided, according to the CHD hemodynamics, as follows: (1) hypoplastic left heart syndrome and other forms of functionally univentricular heart defect; (2) transposition of the great arteries; (3) conotruncal defects and other CHDs with large shunts; (4) right ventricular outflow tract obstruction, without a hypoplastic right ventricle; (5) left outflow tract obstruction; (6) others. The transventricular axial view of the fetal head was used as the reference view, on which the frontal lobe anteroposterior diameter (FAPD) and the occipitofrontal diameter (OFD) were measured, assuming the former to be representative of the area of the frontal lobes. The FAPD/OFD ratio was then calculated as FAPD/OFD × 100. These two variables (FAPD and FAPD/OFD ratio) were then evaluated and compared between the study and control groups. Adjustment for gestational age, both via multiple linear regression and by using a-posteriori matching based on the propensity score, was employed. RESULTS In normal fetuses, FAPD showed a linear positive correlation with gestational age. In fetuses with CHD, the FAPD was shorter than in normal fetuses from the 20th gestational week onwards, with the difference increasing after 30 gestational weeks. FAPD/OFD ratio was significantly smaller in fetuses with CHD than in normal fetuses (P < 0.0001) at all gestational ages, with no apparent differences among the various CHD categories, all of which had smaller FAPD/OFD ratio compared with controls. CONCLUSIONS Fetuses with CHD have a shorter FAPD and a smaller FAPD/OFD ratio compared with normal fetuses. This impaired growth of the frontal area of the brain seems to occur in all types of CHD, regardless of their impact on hemodynamics. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - A Finarelli
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - G Donarini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - S Parodi
- Unit of Epidemiology and Biostatistics, Istituto G. Gaslini, Genoa, Italy
| | - V Lombardo
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - G Tuo
- Pediatric Cardiology, Istituto G. Gaslini, Genoa, Italy
| | - R Birnbaum
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
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32
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Costa A, Ceresa D, De Palma A, Rossi R, Turturo S, Santamaria S, Balbi C, Villa F, Reverberi D, Cortese K, De Biasio P, Paladini D, Coviello D, Ravera S, Malatesta P, Mauri P, Quarto R, Bollini S. Comprehensive Profiling of Secretome Formulations from Fetal- and Perinatal Human Amniotic Fluid Stem Cells. Int J Mol Sci 2021; 22:ijms22073713. [PMID: 33918297 PMCID: PMC8038201 DOI: 10.3390/ijms22073713] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 12/14/2022] Open
Abstract
We previously reported that c-KIT+ human amniotic-fluid derived stem cells obtained from leftover samples of routine II trimester prenatal diagnosis (fetal hAFS) are endowed with regenerative paracrine potential driving pro-survival, anti-fibrotic and proliferative effects. hAFS may also be isolated from III trimester clinical waste samples during scheduled C-sections (perinatal hAFS), thus offering a more easily accessible alternative when compared to fetal hAFS. Nonetheless, little is known about the paracrine profile of perinatal hAFS. Here we provide a detailed characterization of the hAFS total secretome (i.e., the entirety of soluble paracrine factors released by cells in the conditioned medium, hAFS-CM) and the extracellular vesicles (hAFS-EVs) within it, from II trimester fetal- versus III trimester perinatal cells. Fetal- and perinatal hAFS were characterized and subject to hypoxic preconditioning to enhance their paracrine potential. hAFS-CM and hAFS-EV formulations were analyzed for protein and chemokine/cytokine content, and the EV cargo was further investigated by RNA sequencing. The phenotype of fetal- and perinatal hAFS, along with their corresponding secretome formulations, overlapped; yet, fetal hAFS showed immature oxidative phosphorylation activity when compared to perinatal ones. The profiling of their paracrine cargo revealed some differences according to gestational stage and hypoxic preconditioning. Both cell sources provided formulations enriched with neurotrophic, immunomodulatory, anti-fibrotic and endothelial stimulating factors, and the immature fetal hAFS secretome was defined by a more pronounced pro-vasculogenic, regenerative, pro-resolving and anti-aging profile. Small RNA profiling showed microRNA enrichment in both fetal- and perinatal hAFS-EV cargo, with a stably- expressed pro-resolving core as a reference molecular signature. Here we confirm that hAFS represents an appealing source of regenerative paracrine factors; the selection of either fetal or perinatal hAFS secretome formulations for future paracrine therapy should be evaluated considering the specific clinical scenario.
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Affiliation(s)
- Ambra Costa
- Experimental Biology Unit, Department of Experimental Medicine (DIMES), University of Genova, 16132 Genova, Italy; (A.C.); (S.T.); (P.M.)
| | - Davide Ceresa
- Cellular Oncology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Antonella De Palma
- Proteomics and Metabolomics Unit, Institute for Biomedical Technologies (ITB-CNR), 20054 Milan, Italy; (A.D.P.); (R.R.); (P.M.)
| | - Rossana Rossi
- Proteomics and Metabolomics Unit, Institute for Biomedical Technologies (ITB-CNR), 20054 Milan, Italy; (A.D.P.); (R.R.); (P.M.)
| | - Sara Turturo
- Experimental Biology Unit, Department of Experimental Medicine (DIMES), University of Genova, 16132 Genova, Italy; (A.C.); (S.T.); (P.M.)
| | - Sara Santamaria
- Human Anatomy Unit, Department of Experimental Medicine (DIMES), University of Genova, 16132 Genova, Italy; (S.S.); (K.C.); (S.R.)
| | - Carolina Balbi
- Laboratory of Cellular and Molecular Cardiology, Cardiocentro Ticino Foundation, 6900 Lugano, Switzerland;
- Center for Molecular Cardiology, University of Zurich, 8952 Zurich, Switzerland
| | - Federico Villa
- Molecular Oncology and Angiogenesis Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Daniele Reverberi
- Molecular Pathology Unit, IRCCS Ospedale Policlinico, San Martino, 16132 Genova, Italy;
| | - Katia Cortese
- Human Anatomy Unit, Department of Experimental Medicine (DIMES), University of Genova, 16132 Genova, Italy; (S.S.); (K.C.); (S.R.)
| | - Pierangela De Biasio
- Prenatal Diagnosis and Perinatal Medicine Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Dario Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Domenico Coviello
- Laboratory of Human Genetics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Silvia Ravera
- Human Anatomy Unit, Department of Experimental Medicine (DIMES), University of Genova, 16132 Genova, Italy; (S.S.); (K.C.); (S.R.)
| | - Paolo Malatesta
- Experimental Biology Unit, Department of Experimental Medicine (DIMES), University of Genova, 16132 Genova, Italy; (A.C.); (S.T.); (P.M.)
- Cellular Oncology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Pierluigi Mauri
- Proteomics and Metabolomics Unit, Institute for Biomedical Technologies (ITB-CNR), 20054 Milan, Italy; (A.D.P.); (R.R.); (P.M.)
| | - Rodolfo Quarto
- Experimental Biology Unit, Department of Experimental Medicine (DIMES), University of Genova, 16132 Genova, Italy; (A.C.); (S.T.); (P.M.)
- Cellular Oncology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
- Correspondence: (R.Q.); (S.B.); Tel.: +39-010-5558-257 (S.B.)
| | - Sveva Bollini
- Experimental Biology Unit, Department of Experimental Medicine (DIMES), University of Genova, 16132 Genova, Italy; (A.C.); (S.T.); (P.M.)
- Correspondence: (R.Q.); (S.B.); Tel.: +39-010-5558-257 (S.B.)
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Dell'Orso G, Giardino S, Pierri F, Volpi S, Mesini A, Paladini D, Faraci M. Spontaneous pregnancy after hematopoietic stem cell transplantation for chronic granulomatous disease. Pediatr Blood Cancer 2021; 68:e28783. [PMID: 33112030 DOI: 10.1002/pbc.28783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Gianluca Dell'Orso
- Hematopoietic Stem Cell Transplant Unit, Department of Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Stefano Giardino
- Hematopoietic Stem Cell Transplant Unit, Department of Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Filomena Pierri
- Hematopoietic Stem Cell Transplant Unit, Department of Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Stefano Volpi
- Centro Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Alessio Mesini
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Dario Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Maura Faraci
- Hematopoietic Stem Cell Transplant Unit, Department of Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Genova, Italy
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Paladini D, Malinger G, Birnbaum R, Monteagudo A, Pilu G, Salomon LJ, Timor-Tritsch IE. ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 2: performance of targeted neurosonography. Ultrasound Obstet Gynecol 2021; 57:661-671. [PMID: 33734522 DOI: 10.1002/uog.23616] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - G Malinger
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Centre, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Birnbaum
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Centre, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Monteagudo
- Carnegie Imaging for Women, Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - G Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - L J Salomon
- Hôpital Necker Enfants Malades, AP-HP, and LUMIERE platform, EA 7328 Université de Paris, Paris, France
| | - I E Timor-Tritsch
- Division of Obstetrical and Gynecological Ultrasound, NYU School of Medicine, New York, NY, USA
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Casella A, Moccia S, Paladini D, Frontoni E, De Momi E, Mattos LS. A shape-constraint adversarial framework with instance-normalized spatio-temporal features for inter-fetal membrane segmentation. Med Image Anal 2021; 70:102008. [PMID: 33647785 DOI: 10.1016/j.media.2021.102008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 12/17/2020] [Accepted: 02/16/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES During Twin-to-Twin Transfusion Syndrome (TTTS), abnormal vascular anastomoses in the monochorionic placenta can produce uneven blood flow between the fetuses. In the current practice, this syndrome is surgically treated by closing the abnormal connections using laser ablation. Surgeons commonly use the inter-fetal membrane as a reference. Limited field of view, low fetoscopic image quality and high inter-subject variability make the membrane identification a challenging task. However, currently available tools are not optimal for automatic membrane segmentation in fetoscopic videos, due to membrane texture homogeneity and high illumination variability. METHODS To tackle these challenges, we present a new deep-learning framework for inter-fetal membrane segmentation on in-vivo fetoscopic videos. The framework enhances existing architectures by (i) encoding a novel (instance-normalized) dense block, invariant to illumination changes, that extracts spatio-temporal features to enforce pixel connectivity in time, and (ii) relying on an adversarial training, which constrains macro appearance. RESULTS We performed a comprehensive validation using 20 different videos (2000 frames) from 20 different surgeries, achieving a mean Dice Similarity Coefficient of 0.8780±0.1383. CONCLUSIONS The proposed framework has great potential to positively impact the actual surgical practice for TTTS treatment, allowing the implementation of surgical guidance systems that can enhance context awareness and potentially lower the duration of the surgeries.
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Affiliation(s)
- Alessandro Casella
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.
| | - Sara Moccia
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Dario Paladini
- Department of Fetal and Perinatal Medicine, Istituto "Giannina Gaslini", Genoa, Italy
| | - Emanuele Frontoni
- Department of Information Engineering, Universitá Politecnica delle Marche, Ancona, Italy
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Leonard S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
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Buratti S, Lampugnani E, Faggiolo M, Buffoni I, Paladini D, De Tonetti G, Tuo G, Marasini M, Mattioli G, Moscatelli A. Delivery Room Intensive Care Unit: 5 Years' Experience in Assistance of High-Risk Newborns at a Referral Center. Front Pediatr 2021; 9:647690. [PMID: 33996690 PMCID: PMC8116560 DOI: 10.3389/fped.2021.647690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/16/2021] [Indexed: 11/14/2022] Open
Abstract
Objective: The aim of the study is to describe a delivery room intensive care unit (DRICU) model and evaluate its effectiveness in preventing morbidity and mortality in high-risk newborns. Design: This retrospective case series includes all DRICU procedures performed from 2016 to 2020. Setting: Gaslini Children's Hospital is a major pediatric tertiary care center where high-risk pregnancies are centralized. The Neonatal and Pediatric Intensive Care Unit admits every year about 100 high-risk newborns. Patients: The selected patients are newborns at risk of critical conditions immediately after birth for respiratory or cardiovascular congenital disorders. Interventions: The perinatal plan is defined by the multidisciplinary team of Fetal and Perinatal Medicine. The DRICU procedure provides highly specialized care through a protocol that includes logistics, personnel, equipment, and clinical pathways. Main Outcome Measures: The primary outcome is the prevention of acute complications and mortality in the delivery room and early neonatal period. Results: From 2016 to 2020, 40 DRICU procedures were performed. The main prenatal diagnoses included congenital heart disease with a high risk of life-threatening events immediately after birth (38%), congenital diaphragmatic hernia (35%), and fetal hydrops/hydrothorax (23%). Mean gestational age was 35.9 weeks (range: 31-39), and mean birth weight was 2,740 grams (range: 1,480-3,920). DRICU assistance completed in all patients by neonatal intensivists included tracheal intubation and arterial and central venous cannulation; complex procedures such as ex-utero intrapartum technique and extracorporeal membrane oxygenation cannulation are described. No deaths nor severe acute complications occurred in the delivery room or in the immediate postnatal period. Conclusions: The outcome in critical newborns is potentially affected by planned assistance strategies and specialized competencies through the implementation of a DRICU protocol.
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Affiliation(s)
- Silvia Buratti
- Neonatal and Pediatric Intensive Care Unit, Department of Critical Care and Perinatal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genova, Italy
| | - Elisabetta Lampugnani
- Neonatal and Pediatric Intensive Care Unit, Department of Critical Care and Perinatal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genova, Italy
| | - Monica Faggiolo
- Neonatal and Pediatric Intensive Care Unit, Department of Critical Care and Perinatal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genova, Italy
| | - Isabella Buffoni
- Neonatal and Pediatric Intensive Care Unit, Department of Critical Care and Perinatal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genova, Italy
| | - Dario Paladini
- Fetal Medicine and Surgery Unit, Department of Critical Care and Perinatal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genova, Italy
| | - Gabriele De Tonetti
- Obstetric Anesthesia, Department of Critical Care and Perinatal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genova, Italy
| | - Giulia Tuo
- Pediatric Cardiology and Cardiac Surgery, Department of Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genova, Italy
| | - Maurizio Marasini
- Pediatric Cardiology and Cardiac Surgery, Department of Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genova, Italy
| | - Girolamo Mattioli
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, University of Genova, Genova, Italy.,Paediatric Surgery Unit, Department of Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genova, Italy
| | - Andrea Moscatelli
- Neonatal and Pediatric Intensive Care Unit, Department of Critical Care and Perinatal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genova, Italy
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Malinger G, Paladini D, Haratz KK, Monteagudo A, Pilu G, Timor-Tritsch IE. Reply. Ultrasound Obstet Gynecol 2021; 57:174-175. [PMID: 33387405 DOI: 10.1002/uog.23564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- G Malinger
- Division of Ob-Gyn Ultrasound, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - D Paladini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - K K Haratz
- Division of Ob-Gyn Ultrasound, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - A Monteagudo
- Carnegie Imaging for Women, Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - G Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - I E Timor-Tritsch
- Division of Obstetrical and Gynecological Ultrasound, NYU School of Medicine, New York, NY, USA
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38
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Vena F, Donarini G, Scala C, Tuo G, Paladini D. Redundancy of foramen ovale flap may mimic fetal aortic coarctation. Ultrasound Obstet Gynecol 2020; 56:857-863. [PMID: 32147849 DOI: 10.1002/uog.22008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/25/2020] [Accepted: 02/24/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To assess the relationship between presence of a redundant foramen ovale flap (RFOF), in the absence of a clearly restrictive foramen ovale, and ventricular disproportion, in three groups of fetuses: (1) those with a final diagnosis of aortic coarctation (CoA); (2) those referred for suspicion of ventricular disproportion and/or CoA which did not develop CoA postnatally; and (3) normal fetuses. METHODS This was a retrospective study including 73 fetuses: 12 with a final diagnosis of isolated CoA; 30 referred for suspicion of ventricular disproportion and/or CoA, which did not develop CoA postnatally; and 31 normal fetuses. Four-dimensional volume datasets and clips were assessed offline. Maximum diameters of the FOF (FOFD), left atrium (LAD), right atrium, left and right ventricles and, when available, aortic isthmus, were measured, as were areas of the FOF (FOFA), left atrium (LAA) and right atrium. The left/right ratios for all segments of the heart, as well as the FOFD/LAD ratio and FOFA/LAA ratio, were calculated. Regression analysis was performed to assess the relationship between RFOF and ventricular disproportion and means were compared by ANOVA. RESULTS Repeatability was fair, with all variables having an intraclass correlation coefficient ≥ 83%. In the pooled group of fetuses with no CoA found at birth (normal fetuses plus those with ventricular disproportion (n = 61)), there was a significant linear correlation between redundancy of the FOF and degree of ventricular disproportion (P < 0.01 and P < 0.05 for diameter and area ratios, respectively). Categorizing the FOF redundancy, FOFD/LAD ratio ≥ 0.65 was significantly associated with ventricular disproportion (P = 0.006). Based on the degree of FOF prominence, we described four categories of redundancy, ranging from no redundancy/ventricular disproportion (Stage 0) to severe redundancy/ventricular disproportion with transient obstruction of the foramen ovale or mitral orifice (Stage III). Comparing cases without neonatal evidence of coarctation but FOFD/LAD ratio ≥ 0.65 vs those with neonatal evidence of coarctation, there was no statistically significant difference in the degree of ventricular disproportion or in the Z-score of the aortic isthmus maximum diameter. CONCLUSIONS This study demonstrates that: (1) there is an association between RFOF and ventricular disproportion, independent of the association with a restrictive foramen ovale, and (2) the presence of a RFOF may mimic CoA. In fact, it causes both ventricular disproportion and a significant reduction in the diameter of the aortic isthmus, associated in some cases also with reversed isthmic flow. Future prospective studies are needed to evaluate whether focusing the sonologist's attention on the appearance of the foramen ovale may reduce the rate of false-positive diagnosis of CoA. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Vena
- Fetal Medicine and Surgery, Unit, Istituto G. Gaslini, Genoa, Italy
| | - G Donarini
- Fetal Medicine and Surgery, Unit, Istituto G. Gaslini, Genoa, Italy
| | - C Scala
- Fetal Medicine and Surgery, Unit, Istituto G. Gaslini, Genoa, Italy
| | - G Tuo
- Pediatric Cardiology, Istituto, G. Gaslini, Genoa, Italy
| | - D Paladini
- Fetal Medicine and Surgery, Unit, Istituto G. Gaslini, Genoa, Italy
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Fiorio P, Donarini G, Fulcheri E, Meccariello G, Tassano E, Amico G, Paladini D. Prenatal Diagnosis of an Uncommon 48,XX,+18+21 Karyotype in a Fetus With Malformations Typical of Both Trisomies. J Ultrasound Med 2020; 39:2277-2279. [PMID: 32412111 DOI: 10.1002/jum.15336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Patrizia Fiorio
- Human Genetics Unit, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini, Genoa, Italy
| | - Gloria Donarini
- Fetal Medicine and Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini, Genoa, Italy
| | - Ezio Fulcheri
- Fetal and Perinatal Pathology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini, Genoa, Italy
- Division of Anatomic Pathology, Department of Surgical and Diagnostic Sciences, University of Genoa, Genoa, Italy
| | - Gabriella Meccariello
- Fetal Medicine and Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini, Genoa, Italy
| | - Elisa Tassano
- Human Genetics Unit, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini, Genoa, Italy
| | - Giulia Amico
- Genetics and Genomics of Rare Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Children's Sciences, University of Genoa, Genoa, Italy
| | - Dario Paladini
- Fetal Medicine and Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini, Genoa, Italy
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Malinger G, Paladini D, Haratz KK, Monteagudo A, Pilu GL, Timor-Tritsch IE. ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 1: performance of screening examination and indications for targeted neurosonography. Ultrasound Obstet Gynecol 2020; 56:476-484. [PMID: 32870591 DOI: 10.1002/uog.22145] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 06/11/2023]
Affiliation(s)
- G Malinger
- Division of Ultrasound in Obstetrics & Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Paladini
- Fetal Medicine and Surgery Unit, Istituto G.Gaslini, Genoa, Italy
| | - K K Haratz
- Division of Ultrasound in Obstetrics & Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Monteagudo
- Carnegie Imaging for Women, Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - G L Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - I E Timor-Tritsch
- Division of Obstetrical & Gynecological Ultrasound, NYU School of Medicine, New York, NY, USA
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Iacomino M, Baldassari S, Tochigi Y, Kośla K, Buffelli F, Torella A, Severino M, Paladini D, Mandarà L, Riva A, Scala M, Balagura G, Accogli A, Nigro V, Minetti C, Fulcheri E, Zara F, Bednarek AK, Striano P, Suzuki H, Salpietro V. Loss of Wwox Perturbs Neuronal Migration and Impairs Early Cortical Development. Front Neurosci 2020; 14:644. [PMID: 32581702 PMCID: PMC7300205 DOI: 10.3389/fnins.2020.00644] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/25/2020] [Indexed: 12/18/2022] Open
Abstract
Mutations in the WWOX gene cause a broad range of ultra-rare neurodevelopmental and brain degenerative disorders, associated with a high likelihood of premature death in animal models as well as in humans. The encoded Wwox protein is a WW domain-containing oxidoreductase that participates in crucial biological processes including tumor suppression, cell growth/differentiation and regulation of steroid metabolism, while its role in neural development is less understood. We analyzed the exomes of a family affected with multiple pre- and postnatal anomalies, including cerebellar vermis hypoplasia, severe neurodevelopmental impairment and refractory epilepsy, and identified a segregating homozygous WWOX mutation leading to a premature stop codon. Abnormal cerebral cortex development due to a defective architecture of granular and molecular cell layers was found in the developing brain of a WWOX-deficient human fetus from this family. A similar disorganization of cortical layers was identified in lde/lde rats (carrying a homozygous truncating mutation which disrupts the active Wwox C-terminal domain) investigated at perinatal stages. Transcriptomic analyses of Wwox-depleted human neural progenitor cells showed an impaired expression of a number of neuronal migration-related genes encoding for tubulins, kinesins and associated proteins. These findings indicate that loss of Wwox may affect different cytoskeleton components and alter prenatal cortical development, highlighting a regulatory role of the WWOX gene in migrating neurons across different species.
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Affiliation(s)
- Michele Iacomino
- Unit of Medical Genetics, IRCCS Istituto "Giannina Gaslini", Genoa, Italy
| | - Simona Baldassari
- Unit of Medical Genetics, IRCCS Istituto "Giannina Gaslini", Genoa, Italy
| | - Yuki Tochigi
- Laboratory of Veterinary Physiology, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Musashinoi, Japan
| | - Katarzyna Kośla
- Department of Molecular Carcinogenesis, Medical University of Łódź, Łódź, Poland
| | - Francesca Buffelli
- Fetal and Perinatal Pathology Unit, IRCCS Istituto "Giannina Gaslini", Genoa, Italy
| | - Annalaura Torella
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.,Telethon Institute of Genetics and Medicine (TIGEM), Naples, Italy
| | | | - Dario Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto "Giannina Gaslini", Genoa, Italy
| | - Luana Mandarà
- Medical Genetics Unit, Maria Paternò Arezzo Hospital, Ragusa, Italy
| | - Antonella Riva
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini", Genoa, Italy
| | - Marcello Scala
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini", Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Ganna Balagura
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini", Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Andrea Accogli
- Unit of Medical Genetics, IRCCS Istituto "Giannina Gaslini", Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Vincenzo Nigro
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.,Telethon Institute of Genetics and Medicine (TIGEM), Naples, Italy
| | - Carlo Minetti
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini", Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Ezio Fulcheri
- Fetal and Perinatal Pathology Unit, IRCCS Istituto "Giannina Gaslini", Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), Pathology Division of Anatomic Pathology, University of Genoa, Genoa, Italy
| | - Federico Zara
- Unit of Medical Genetics, IRCCS Istituto "Giannina Gaslini", Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Andrzej K Bednarek
- Department of Molecular Carcinogenesis, Medical University of Łódź, Łódź, Poland
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini", Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Hiroetsu Suzuki
- Laboratory of Veterinary Physiology, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Musashinoi, Japan
| | - Vincenzo Salpietro
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini", Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, United Kingdom
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De Angelis LC, Bellini T, Witte MH, Kylat RI, Bernas M, Boccardo F, Paladini D, Magnano GM, Ramenghi LA, Bellini C. CONGENITAL CHYLOTHORAX: CURRENT EVIDENCE-BASED PRENATAL AND POST-NATAL DIAGNOSIS AND MANAGEMENT. Lymphology 2020. [DOI: 10.2458/lymph.4632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Congenital chylothorax is an uncommon condition but represents the main cause of congenital pleural effusion during the neonatal period. It usually appears before birth, both as an isolated disorder or in association with hydrops fetalis, negatively affecting the subsequent neonatal outcome. Prenatal treatment is usually considered to ensure a satisfactory lung development in case of moderate to severe pleural effusion or in the presence of hydrops, although consensus on treatment timing and modalities has not been reached to date. Both medical and surgical therapeutic strategies are available to treat this condition and novel treatment options have been recently attempted with acceptable results in both prenatal and post-natal setting. The heterogeneous clinical presentation of congenital chylothorax together with its rarity, its numerous etiologies and the absence of a highly effective treatment renders the diagnostic and therapeutic approach difficult to standardize. In addition, adequate visualization of the lymphatic system is complex, especially in small neonates, although new promising techniques have been developed lately and may contribute to improved management of this serious but infrequent condition. This review focuses on the current evidence base for the diagnosis and treatment options for congenital chylothorax, suggesting a rational diagnostic and therapeutic approach both in the prenatal and in the neonatal period.
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Paladini D. Reply. Ultrasound Obstet Gynecol 2020; 55:140. [PMID: 31894637 DOI: 10.1002/uog.21917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
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Paladini D, Donarini G, Rossi A. Indications for MRI in fetal isolated mild ventriculomegaly… 'And then, there were none'. Ultrasound Obstet Gynecol 2019; 54:151-155. [PMID: 30908809 DOI: 10.1002/uog.20269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/14/2019] [Accepted: 02/20/2019] [Indexed: 06/09/2023]
Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - G Donarini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - A Rossi
- Neuroradiology Unit, Istituto G. Gaslini, Genoa, Italy
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Paladini D, Donarini G, Parodi S, Volpe G, Sglavo G, Fulcheri E. Hindbrain morphometry and choroid plexus position in differential diagnosis of posterior fossa cystic malformations. Ultrasound Obstet Gynecol 2019; 54:207-214. [PMID: 30207001 DOI: 10.1002/uog.20120] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/13/2018] [Accepted: 08/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the differential diagnostic significance of a series of quantitative and qualitative variables of the cerebellar vermis in fetuses with posterior fossa cystic malformation, including Dandy-Walker malformation (DWM), vermian hypoplasia (VH) and Blake's pouch cyst (BPC). METHODS This was a retrospective study of confirmed cases of DWM, VH and BPC, diagnosed at the Fetal Medicine and Surgery Unit of the Federico II University between January 2005 and June 2013 or the Fetal Medicine and Surgery Unit of G. Gaslini Hospital between July 2013 and September 2017. All included cases had good-quality three-dimensional (3D) volume datasets of the posterior fossa, acquired by transvaginal ultrasound through the posterior fontanelle. The midsagittal view of the posterior fossa was the reference view for the study. We assessed brainstem-tentorium angle and brainstem-vermis angle (BVA), as well as craniocaudal (CCVD) and anteroposterior (APVD) vermian diameters and vermian area (VA), which were normalized by biparietal diameter (BPD) to take into account gestational age (CCVD/BPD × 100, APVD/BPD × 100 and VA/BPD × 100, respectively). Finally, the position of the fourth ventricular choroid plexus (4VCP) was defined as normal ('up') or abnormal ('down'), relative to the roof/cyst inlet of the fourth ventricle. RESULTS We analyzed 67 fetuses with posterior fossa malformations (24 cases of DWM, 13 of VH and 30 of BPC). The mean gestational age at diagnosis was 23.6 weeks. Regardless of gestational age, the BVA differed significantly between the three groups, and the VA/BPD was able to differentiate between VH and BPC. In differentiating between VH and BPC, the greatest areas under the receiver-operating characteristics curve were those for VA/BPD ratio. The 4VCP position was down in all cases of DWM and VH, while it was up in all cases of BPC. CONCLUSIONS Our data support the concept that VA/BPD ratio and 4VCP position may be used to differentiate between DWM, VH and BPC in the fetus. In our series, the position of the 4VCP had the highest accuracy, but a larger number of VH cases should be evaluated to confirm that an up position of the 4VCP indicates BPC while a down position indicates DWM or VH. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G Donarini
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - S Parodi
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G Volpe
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G Sglavo
- Department of Obstetrics and Gynecology, University Federico II, Naples, Italy
| | - E Fulcheri
- Fetopathology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Paladini D, Donarini G, Parodi S, Chaoui R. Differentiating features of posterior fossa at 12-13 weeks' gestation in fetuses with Dandy-Walker malformation and Blake's pouch cyst. Ultrasound Obstet Gynecol 2019; 53:850-852. [PMID: 30575134 DOI: 10.1002/uog.20190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 06/09/2023]
Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit, Istituto G.Gaslini, Genoa, Italy
| | - G Donarini
- Fetal Medicine and Surgery Unit, Istituto G.Gaslini, Genoa, Italy
| | - S Parodi
- Biostatistics, Istituto G.Gaslini, Genoa, Italy
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Paladini D, Donarini G, Conti A, Costanza De Angelis L, Witte MH, Genesio R, Bernas M, Bellini T, Boccardo F, Ramenghi LA, Bellini C. EARLY FETAL HYDROPIC CHANGES ARE ASSOCIATED WITH MODERATE DILATATION OF THE BRAIN VENTRICULAR SYSTEM: A CLUE TO A POSSIBLE LINK BETWEEN CERVICAL LYMPHATIC ENGORGEMENT AND VENTRICULAR DILATATION? Lymphology 2019. [DOI: 10.2458/lymph.4620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study is to assess whether early cervical lymphatic obstruction is associated with a sonographically detectable dilatation of the ventricular system in the 1st trimester of pregnancy. In particular, the objective is to assess whether fetuses with non-immune hydrops fetalis (NIHF), cystic hygroma, or enlarged nuchal translucency (NT) have a greater atrial width/biparietal diameter (AW/BPD) ratio than normal at time of the combined first trimester screening scan. This retrospective study included 96 first trimester fetuses (33 normal and 63 with various degree of cervical lymphatic engorgement). Inclusion criteria were CRL in the 45-84 mm range and availability of one or more three-dimensional volume datasets of the fetal head, acquired from the BPD plane. Each three-dimensional volume dataset was opened and multiplanar correlation employed to align the three orthogonal planes. The ratio between the atrial width and the BPD (AW/BPD ratio) was used to evaluate the possible presence of increased amount of cerebrospinal fluid. Abnormal cases were placed into 4 categories: 1)enlarged non-septated NT 2.5-3.9 mm, no hydrops; 2) grossly enlarged non-septated NT/ edema >3.9 mm; 3) cystic hygroma and/or NIHF; 4) major anomalies with NT <2.5 mm. Presence of dilatation of the latero-cervical jugular lymphatic sacs, karyotype and presence of congenital anomalies were also recorded. The One-way ANOVA test was used to compare means. Intra- and inter-observer variability were also assessed. The AW/BPD ratio was found to be significantly higher in fetuses with grossly enlarged NT/nuchal edema and NIHF/septated cystic hygroma than in normal (p <0.05 and p <0.01, respectively). Also, the AW/BPD ratio was significantly higher in NIHF/septated cystic hygroma than in enlarged NT 2.5-3.9 mm (p <0.05). In case of enlarged NT (2.5-3.9 mm), the AW/BPD ratio is significantly higher in presence of JLS (p <0.01). At the end of the first trimester, presence of cervical lymphatic engorgement, in terms of grossly enlarged NT, nuchaledema, septated cystic hygroma, and NIHF, is statistically associated with a moderate dilatation of the ventricular system. Of note, among fetuses with moderately enlarged NT, those with evidence of dilatation of the JLS show a statistically significant increase in the AW/BPD ratio.
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Prayer D, Paladini D, Deprest J. Current Controversies in Prenatal Diagnosis 1: Should MRI be performed on all fetuses with mild ventriculomegaly? Prenat Diagn 2019; 39:331-338. [PMID: 30614017 DOI: 10.1002/pd.5416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/27/2018] [Accepted: 12/29/2018] [Indexed: 12/18/2022]
Abstract
A ventricular diameter of 10 mm correlates with more than two standard deviations of the normal and hence is qualified as ventriculomegaly. The relevance of this is dependent on whether there are associated infectious, genetic, or structural problems. The chance for neurodevelopmental delay in isolated ventriculomegaly less than 15 mm is 7.9% (4.7-11.1), and less if it is unilateral. It can be further divided in mild (10-12) or moderate (13-15), though this is not widely accepted. As part of the workup, structural assessment today may include ultrasound or magnetic resonance imaging, or both. Discussants agreed that the diagnostic performance of both methods is as good as the expertise with which the images are acquired and interpreted. Discussants agreed that when the initial neurosonogram is normal, the likelihood of finding significant findings on MRI is low. Nevertheless, some anomalies may only be picked up or better worked out by fetal MRI. In utero follow-up is advocated, as progression may indicate a poorer outcome, and some conditions are only obvious late in pregnancy. Most benefit for future patients is expected from appropriate training in prenatal neuroimaging.
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Affiliation(s)
- Daniela Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Dario Paladini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - Jan Deprest
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, and Academic Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium.,Institute for Women's Health, University College London, London, UK
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Paladini D, Donarini G, Conti A, Constanza De Angelis L, Witte MH, Genesio R, Bernas M, Bellini T, Boccardo F, Ramenghi LA, Bellini C. Early fetal hydropic changes are associated with moderate dilatation of the brain ventricular system: A clue to a possible link between cervical lymphatic engorgement and ventricular dilatation? Lymphology 2019; 52:11-17. [PMID: 31119910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The aim of this study is to assess whether early cervical lymphatic obstruction is associated with a sonographically detectable dilatation of the ventricular system in the 1st trimester of pregnancy. In particular, the objective is to assess whether fetuses with non-immune hydrops fetalis (NIHF), cystic hygroma, or enlarged nuchal translucency (NT) have a greater atrial width/biparietal diameter (AW/BPD) ratio than normal at time of the combined first trimester screening scan. This retrospective study included 96 first trimester fetuses (33 normal and 63 with various degree of cervical lymphatic engorgement). Inclusion criteria were CRL in the 45-84 mm range and availability of one or more three-dimensional volume datasets of the fetal head, acquired from the BPD plane. Each three-dimensional volume dataset was opened and multiplanar correlation employed to align the three orthogonal planes. The ratio between the atrial width and the BPD (AW/BPD ratio) was used to evaluate the possible presence of increased amount of cerebrospinal fluid. Abnormal cases were placed into 4 categories: 1) enlarged non-septated NT 2.5-3.9 mm, no hydrops; 2) grossly enlarged non-septated NT / edema >3.9 mm; 3) cystic hygroma and/ or NIHF; 4) major anomalies with NT <2.5 mm. Presence of dilatation of the laterocervical jugular lymphatic sacs, karyotype and presence of congenital anomalies were also recorded. The One-way ANOVA test was used to compare means. Intra- and inter-observer variability were also assessed. The AW/BPD ratio was found to be significantly higher in fetuses with grossly enlarged NT/nuchal edema and NIHF/septated cystic hygroma than in normal (p <0.05 and p <0.01, respectively). Also, the AW/BPD ratio was significantly higher in NIHF/septated cystic hygroma than in enlarged NT 2.5-3.9 mm (p <0.05). In case of enlarged NT (2.5-3.9 mm), the AW/BPD ratio is significantly higher in presence of JLS (p <0.01). At the end of the first trimester, presence of cervical lymphatic engorgement, in terms of grossly enlarged NT, nuchal edema, septated cystic hygroma, and NIHF, is statistically associated with a moderate dilatation of the ventricular system. Of note, among fetuses with moderately enlarged NT, those with evidence of dilatation of the JLS show a statistically significant increase in the AW/BPD ratio.
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Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit, Gaslini Institute, Genoa, Italy
| | - G Donarini
- Fetal Medicine and Surgery Unit, Gaslini Institute, Genoa, Italy
| | - A Conti
- Cytogenetics, University Federico II of Naples, Italy
| | - L Constanza De Angelis
- Department of Mother and Child, Neonatal Intensive Care Unit, Gaslini Institute, Genova, Italy
| | - M H Witte
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ
| | - R Genesio
- Department of Mother and Child, Neonatal Intensive Care Unit, Gaslini Institute, Genova, Italy
| | - M Bernas
- Department of Medical Education, TCU and UNTHSC School of Medicine, Fort Worth, TX, USA
| | - T Bellini
- Department of Mother and Child, Neonatal Intensive Care Unit, Gaslini Institute, Genova, Italy
| | - F Boccardo
- Dept. of Surgery, University of Genova, Italy
| | - L A Ramenghi
- Department of Mother and Child, Neonatal Intensive Care Unit, Gaslini Institute, Genova, Italy
| | - C Bellini
- Department of Mother and Child, Neonatal Intensive Care Unit, Gaslini Institute, Genova, Italy
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De Angelis LC, Bellini T, Witte MH, Kylat RI, Bernas M, Boccardo F, Paladini D, Magnano GM, Ramenghi LA, Bellini C. Congenital chylothorax: Current evidence-based prenatal and post-natal diagnosis and management. Lymphology 2019; 52:108-125. [PMID: 31874123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Congenital chylothorax is an uncommon condition but represents the main cause of congenital pleural effusion during the neonatal period. It usually appears before birth, both as an isolated disorder or in association with hydrops fetalis, negatively affecting the subsequent neonatal outcome. Prenatal treatment is usually considered to ensure a satisfactory lung development in case of moderate to severe pleural effusion or in the presence of hydrops, although consensus on treatment timing and modalities has not been reached to date. Both medical and surgical therapeutic strategies are available to treat this condition and novel treatment options have been recently attempted with acceptable results in both prenatal and post-natal setting. The heterogeneous clinical presentation of congenital chylothorax together with its rarity, its numerous etiologies and the absence of a highly effective treatment renders the diagnostic and therapeutic approach difficult to standardize. In addition, adequate visualization of the lymphatic system is complex, especially in small neonates, although new promising techniques have been developed lately and may contribute to improved management of this serious but infrequent condition. This review focuses on the current evidence base for the diagnosis and treatment options for congenital chylothorax, suggesting a rational diagnostic and therapeutic approach both in the prenatal and in the neonatal period.
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Affiliation(s)
- L C De Angelis
- Department Mother & Child, Neonatal Intensive Care Unit, IRCCS Istituto Gaslini, Genova, Italy
| | - T Bellini
- Department Mother & Child, Neonatal Intensive Care Unit, IRCCS Istituto Gaslini, Genova, Italy
| | - M H Witte
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - R I Kylat
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - M Bernas
- Department of Medical Education, TCU and UNTHSC School of Medicine, Fort Worth, Texas, USA
| | - F Boccardo
- Department of Surgery, University of Genova, Italy
| | - D Paladini
- Radiology Department, IRCCS, Istituto Giannina Gaslini, Genova, Italy
| | - G M Magnano
- Department of Fetal Medicine & Surgery Unit, IRCCS Istituto Gaslini, Genova, Italy
| | - L A Ramenghi
- Department Mother & Child, Neonatal Intensive Care Unit, IRCCS Istituto Gaslini, Genova, Italy
| | - C Bellini
- Department Mother & Child, Neonatal Intensive Care Unit, IRCCS Istituto Gaslini, Genova, Italy
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