1
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Chevallay M, Goulet P, Madsen PT, Campagna J, Campagna C, Guinet C, Johnson MP. Large sensory volumes enable Southern elephant seals to exploit sparse deep-sea prey. Proc Natl Acad Sci U S A 2023; 120:e2307129120. [PMID: 37844247 PMCID: PMC10614626 DOI: 10.1073/pnas.2307129120] [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: 04/29/2023] [Accepted: 09/08/2023] [Indexed: 10/18/2023] Open
Abstract
The ability of echolocating toothed whales to detect and classify prey at long ranges enables efficient searching and stalking of sparse prey in these time-limited dives. However, nonecholocating deep-diving seals such as elephant seals appear to have much less sensory advantage over their prey. Both elephant seals and their prey rely on visual and hydrodynamic cues that may be detectable only at short ranges in the deep ocean, leading us to hypothesize that elephant seals must adopt a less efficient reactive mode of hunting that requires high prey densities. To test that hypothesis, we deployed high-resolution sonar and movement tags on 25 females to record simultaneous predator and prey behavior during foraging interactions. We demonstrate that elephant seals have a sensory advantage over their prey that allows them to potentially detect prey 5 to 10 s before striking. The corresponding prey detection ranges of 7 to 17 m enable stealthy approaches and prey-specific capture tactics. In comparison, prey react at a median range of 0.7 m, close to the neck extension range of striking elephant seals. Estimated search swathes of 150 to 900 m2 explain how elephant seals can locate up to 2,000 prey while swimming more than 100 km per day. This efficient search capability allows elephant seals to subsist on prey densities that are consonant with the deep scattering layer resources estimated by hydroacoustic surveys but which are two orders of magnitude lower than the prey densities needed by a reactive hunter.
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Affiliation(s)
- Mathilde Chevallay
- Centre d’Etudes Biologiques de Chizé, Centre National de la Recherche Scientifique, Villiers-en-Bois79360, France
| | - Pauline Goulet
- Centre d’Etudes Biologiques de Chizé, Centre National de la Recherche Scientifique, Villiers-en-Bois79360, France
| | | | - Julieta Campagna
- Centro Nacional Patagónico, Centro Científico Tecnológico del Consejo Nacional de Investigaciones Científicas y Técnicas, Puerto Madryn9120, Argentina
| | | | - Christophe Guinet
- Centre d’Etudes Biologiques de Chizé, Centre National de la Recherche Scientifique, Villiers-en-Bois79360, France
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2
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Findlay CR, Rojano-Doñate L, Tougaard J, Johnson MP, Madsen PT. Small reductions in cargo vessel speed substantially reduce noise impacts to marine mammals. Sci Adv 2023; 9:eadf2987. [PMID: 37343089 PMCID: PMC10284543 DOI: 10.1126/sciadv.adf2987] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/01/2023] [Indexed: 06/23/2023]
Abstract
Global reductions in the underwater radiated noise levels from cargo vessels are needed to reduce increasing cumulative impacts to marine wildlife. We use a vessel exposure simulation model to examine how reducing vessel source levels through slowdowns and technological modifications can lessen impacts on marine mammals. We show that the area exposed to ship noise reduces markedly with moderate source-level reductions that can be readily achieved with small reductions in speed. Moreover, slowdowns reduce all impacts to marine mammals despite the longer time that a slower vessel takes to pass an animal. We conclude that cumulative noise impacts from the global fleet can be reduced immediately by slowdowns. This solution requires no modification to ships and is scalable from local speed reductions in sensitive areas to ocean basins. Speed reductions can be supplemented by routing vessels away from critical habitats and by technological modifications to reduce vessel noise.
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Affiliation(s)
| | - Laia Rojano-Doñate
- Zoophysiology, Department of Biology, Aarhus University, Aarhus 8000, Denmark
- Department of Ecoscience, Aarhus University, Aarhus 8000, Denmark
| | - Jakob Tougaard
- Department of Ecoscience, Aarhus University, Aarhus 8000, Denmark
| | - Mark P. Johnson
- Zoophysiology, Department of Biology, Aarhus University, Aarhus 8000, Denmark
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3
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Welsch J, Smalley TB, Matlack JK, Avalon NE, Binning JM, Johnson MP, Allcock AL, Baker BJ. Tuaimenals B-H, Merosesquiterpenes from the Irish Deep-Sea Soft Coral Duva florida with Bioactivity against Cervical Cancer Cell Lines. J Nat Prod 2023; 86:182-190. [PMID: 36580354 PMCID: PMC9887596 DOI: 10.1021/acs.jnatprod.2c00898] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Indexed: 06/17/2023]
Abstract
Previous chemical investigation of the Irish deep-sea soft coral Duva florida led to the identification of tuaimenal A (10), a new merosesquiterpene containing a highly substituted chromene core and modest cytotoxicity against cervical cancer. Further MS/MS and NMR-guided investigation of this octocoral has resulted in the isolation and characterization of seven additional tuaimenal analogs, B-H (1-7), as well as two known A-ring aromatized steroids (8, 9), and additional tuaimenal A (10). Tuaimenals B, F, and G (1, 5, 6), bearing an oxygen at the C5 position, as well as monocyclic tuaimenal H (7), show increased cervical cancer inhibition profiles in comparison to that of 10. Tuaimenal G further displayed potent, selective cytotoxicity with an EC50 value of 0.04 μM against the C33A cell line compared to the CaSki cell line (EC50 20 μM). These data reveal the anticancer properties of tuaimenal analogs and suggest unique antiproliferation mechanisms across these secondary metabolites.
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Affiliation(s)
- Joshua
T. Welsch
- Department
of Chemistry, University of South Florida, 4202 E. Fowler Avenue, CHE205, Tampa, Florida 33620, United States
| | - Tracess B. Smalley
- Department
of Molecular Oncology, H. Lee Moffitt Cancer
Center and Research Institute, Tampa, Florida 33612, United States
| | - Jenet K. Matlack
- Department
of Molecular Oncology, H. Lee Moffitt Cancer
Center and Research Institute, Tampa, Florida 33612, United States
| | - Nicole E. Avalon
- Department
of Chemistry, University of South Florida, 4202 E. Fowler Avenue, CHE205, Tampa, Florida 33620, United States
| | - Jennifer M. Binning
- Department
of Molecular Oncology, H. Lee Moffitt Cancer
Center and Research Institute, Tampa, Florida 33612, United States
| | - Mark P. Johnson
- School
of Natural Sciences and Ryan Institute, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - A. Louise Allcock
- School
of Natural Sciences and Ryan Institute, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Bill J. Baker
- Department
of Chemistry, University of South Florida, 4202 E. Fowler Avenue, CHE205, Tampa, Florida 33620, United States
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4
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Johnson MP. Low cost macroalgal canopy biomass monitoring using light attenuation. PeerJ 2022; 10:e14368. [PMID: 36405024 PMCID: PMC9673772 DOI: 10.7717/peerj.14368] [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: 07/07/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
Macroalgal canopies are productive and diverse habitats that export material to other marine ecosystems. Macroalgal canopy cover and composition are considered an Essential Ocean Variable by the research community. Although several techniques exist to both directly and remotely measure algal canopies, frequent measures of biomass are challenging. Presented here is a technique of using the relative attenuation of light inside and outside canopies to derive a proxy for algal biomass. If canopy attenuation coefficients are known, the proxy can be converted to an area of algal thallus per seabed area (thallus area index). An advantage of the approach is that light loggers are widely available and relatively inexpensive. Deployment for a year in the intertidal demonstrated that the method has the sensitivity to resolve summertime peaks in macroalgal biomass, despite the inherent variation in light measurements. Relative attenuation measurements can complement existing monitoring, providing point proxies for biomass and adding seasonal information to surveys that sample shores at less frequent intervals.
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Affiliation(s)
- Mark P. Johnson
- School of Natural Sciences and Ryan Institute, University of Galway, Galway, Ireland
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5
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Welsch J, Young RM, Allcock AL, Johnson MP, Baker BJ. Crannenols A-D, Sesquiterpenoids from the Irish Deep-Sea Soft Coral Acanella arbuscula. J Nat Prod 2022; 85:2395-2398. [PMID: 36122192 PMCID: PMC9623587 DOI: 10.1021/acs.jnatprod.2c00602] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Indexed: 06/15/2023]
Abstract
Four undescribed sesquiterpenoids, crannenols A-D (1-4), have been isolated from CHCl2 and MeOH extracts of the deep-sea bamboo coral Acanella arbuscula. The corals were collected from a submarine canyon on the edge of Ireland's Porcupine Bank via a remotely operated vehicle. The structure elucidation of these (Z,E)-α-farnesene derivatives was achieved using a combination of 1D and 2D NMR, electron impact (1, 2), and electrospray ionization (3, 4) mass spectrometry.
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Affiliation(s)
- Joshua
T. Welsch
- Department
of Chemistry, University of South Florida, 4202 E. Fowler Avenue, CHE205, Tampa, Florida 33620, United States
| | - Ryan M. Young
- School
of Natural Sciences and Ryan Institute, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - A. Louise Allcock
- School
of Natural Sciences and Ryan Institute, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Mark P. Johnson
- School
of Natural Sciences and Ryan Institute, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Bill J. Baker
- Department
of Chemistry, University of South Florida, 4202 E. Fowler Avenue, CHE205, Tampa, Florida 33620, United States
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6
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Babcock JC, Johnson DR, Benson JC, Kim DK, Luetmer PH, Shlapak DP, Cross CP, Johnson MP, Cutsforth-Gregory JK, Carr CM. Diffuse Calvarial Hyperostosis and Spontaneous Intracranial Hypotension: A Case-Control Study. AJNR Am J Neuroradiol 2022; 43:978-983. [PMID: 35772803 DOI: 10.3174/ajnr.a7557] [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] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/06/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Diagnosing spontaneous intracranial hypotension and associated CSF leaks can be challenging, and additional supportive imaging findings would be useful to direct further evaluation. This retrospective study evaluated whether there was a difference in the prevalence of calvarial hyperostosis in a cohort of patients with spontaneous intracranial hypotension compared with an age- and sex-matched control population. MATERIALS AND METHODS Cross-sectional imaging (CT of the head or brain MR imaging examinations) for 166 patients with spontaneous intracranial hypotension and 321 matched controls was assessed by neuroradiologists blinded to the patient's clinical status. The readers qualitatively evaluated the presence of diffuse or layered calvarial hyperostosis and measured calvarial thickness in the axial and coronal planes. RESULTS A significant difference in the frequency of layered hyperostosis (31.9%, 53/166 subjects versus 5.0%, 16/321 controls, P < .001, OR = 11.58) as well as the frequency of overall (layered and diffuse) hyperostosis (38.6%, 64/166 subjects versus 13.2%, 42/321 controls, P < .001, OR = 4.66) was observed between groups. There was no significant difference in the frequency of diffuse hyperostosis between groups (6.6%, 11/166 subjects versus 8.2%, 26/321 controls, P = .465). A significant difference was also found between groups for calvarial thickness measured in the axial (P < .001) and coronal (P < .001) planes. CONCLUSIONS Layered calvarial hyperostosis is more prevalent in spontaneous intracranial hypotension compared with the general population and can be used as an additional noninvasive brain imaging marker of spontaneous intracranial hypotension and an underlying spinal CSF leak.
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Affiliation(s)
- J C Babcock
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - D R Johnson
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - J C Benson
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - D K Kim
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - P H Luetmer
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - D P Shlapak
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - C P Cross
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - M P Johnson
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - C M Carr
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
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7
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Avalon N, Nafie J, De Marco Verissimo C, Warrensford LC, Dietrick SG, Pittman AR, Young RM, Kearns FL, Smalley T, Binning JM, Dalton JP, Johnson MP, Woodcock HL, Allcock AL, Baker BJ. Tuaimenal A, a Meroterpene from the Irish Deep-Sea Soft Coral Duva florida, Displays Inhibition of the SARS-CoV-2 3CLpro Enzyme. J Nat Prod 2022; 85:1315-1323. [PMID: 35549259 PMCID: PMC9127705 DOI: 10.1021/acs.jnatprod.2c00054] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Indexed: 06/15/2023]
Abstract
Cold water benthic environments are a prolific source of structurally diverse molecules with a range of bioactivities against human disease. Specimens of a previously chemically unexplored soft coral, Duva florida, were collected during a deep-sea cruise that sampled marine invertebrates along the Irish continental margin in 2018. Tuaimenal A (1), a cyclized merosesquiterpenoid representing a new carbon scaffold with a highly substituted chromene core, was discovered through exploration of the soft coral secondary metabolome via NMR-guided fractionation. The absolute configuration was determined through vibrational circular dichroism. Functional biochemical assays and in silico docking experiments found tuaimenal A selectively inhibits the viral main protease (3CLpro) of SARS-CoV-2.
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Affiliation(s)
- Nicole
E. Avalon
- Department
of Chemistry, University of South Florida, Tampa, Florida 33620, United States
| | - Jordan Nafie
- BioTools,
Inc., Jupiter, Florida 33458, United
States
| | - Carolina De Marco Verissimo
- Molecular
Parasitology Laboratory (MPL), Centre for One Health and Ryan Institute,
School of Natural Science, National University
of Ireland Galway, H91 TK33 Galway, Republic of
Ireland
| | - Luke C. Warrensford
- Department
of Chemistry, University of South Florida, Tampa, Florida 33620, United States
| | - Sarah G. Dietrick
- Department
of Chemistry, University of South Florida, Tampa, Florida 33620, United States
| | - Amanda R. Pittman
- Department
of Chemistry, University of South Florida, Tampa, Florida 33620, United States
| | - Ryan M. Young
- School
of Natural Sciences and Ryan Institute, National University of Ireland Galway, H91 TK33 Galway, Republic of Ireland
| | - Fiona L. Kearns
- Department
of Chemistry, University of South Florida, Tampa, Florida 33620, United States
| | - Tracess Smalley
- Department
of Molecular Oncology, H. Lee Moffitt Cancer
Center and Research Institute, Tampa, Florida 33612, United States
| | - Jennifer M. Binning
- Department
of Molecular Oncology, H. Lee Moffitt Cancer
Center and Research Institute, Tampa, Florida 33612, United States
| | - John P. Dalton
- Molecular
Parasitology Laboratory (MPL), Centre for One Health and Ryan Institute,
School of Natural Science, National University
of Ireland Galway, H91 TK33 Galway, Republic of
Ireland
| | - Mark P. Johnson
- School
of Natural Sciences and Ryan Institute, National University of Ireland Galway, H91 TK33 Galway, Republic of Ireland
| | - H. Lee Woodcock
- Department
of Chemistry, University of South Florida, Tampa, Florida 33620, United States
| | - A. Louise Allcock
- School
of Natural Sciences and Ryan Institute, National University of Ireland Galway, H91 TK33 Galway, Republic of Ireland
| | - Bill J. Baker
- Department
of Chemistry, University of South Florida, Tampa, Florida 33620, United States
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8
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Laguionie-Marchais C, Allcock AL, Baker BJ, Conneely EA, Dietrick SG, Kearns F, McKeever K, Young RM, Sierra CA, Soldatou S, Woodcock HL, Johnson MP. Not Drug-like, but Like Drugs: Cnidaria Natural Products. Mar Drugs 2021; 20:42. [PMID: 35049897 PMCID: PMC8779300 DOI: 10.3390/md20010042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 12/26/2022] Open
Abstract
Phylum Cnidaria has been an excellent source of natural products, with thousands of metabolites identified. Many of these have not been screened in bioassays. The aim of this study was to explore the potential of 5600 Cnidaria natural products (after excluding those known to derive from microbial symbionts), using a systematic approach based on chemical space, drug-likeness, predicted toxicity, and virtual screens. Previous drug-likeness measures: the rule-of-five, quantitative estimate of drug-likeness (QED), and relative drug likelihoods (RDL) are based on a relatively small number of molecular properties. We augmented this approach using reference drug and toxin data sets defined for 51 predicted molecular properties. Cnidaria natural products overlap with drugs and toxins in this chemical space, although a multivariate test suggests that there are some differences between the groups. In terms of the established drug-likeness measures, Cnidaria natural products have generally lower QED and RDL scores than drugs, with a higher prevalence of metabolites that exceed at least one rule-of-five threshold. An index of drug-likeness that includes predicted toxicity (ADMET-score), however, found that Cnidaria natural products were more favourable than drugs. A measure of the distance of individual Cnidaria natural products to the centre of the drug distribution in multivariate chemical space was related to RDL, ADMET-score, and the number of rule-of-five exceptions. This multivariate similarity measure was negatively correlated with the QED score for the same metabolite, suggesting that the different approaches capture different aspects of the drug-likeness of individual metabolites. The contrasting of different drug similarity measures can help summarise the range of drug potential in the Cnidaria natural product data set. The most favourable metabolites were around 210-265 Da, quite often sesquiterpenes, with a moderate degree of complexity. Virtual screening against cancer-relevant targets found wide evidence of affinities, with Glide scores <-7 in 19% of the Cnidaria natural products.
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Affiliation(s)
- Claire Laguionie-Marchais
- School of Natural Sciences and Ryan Institute, National University of Ireland Galway, H91 TK33 Galway, Ireland; (C.L.-M.); (A.L.A.); (E.-A.C.); (K.M.); (R.M.Y.)
| | - A. Louise Allcock
- School of Natural Sciences and Ryan Institute, National University of Ireland Galway, H91 TK33 Galway, Ireland; (C.L.-M.); (A.L.A.); (E.-A.C.); (K.M.); (R.M.Y.)
| | - Bill J. Baker
- Department of Chemistry, University of South Florida, Tampa, FL 33620-5250, USA; (B.J.B.); (S.G.D.); (F.K.); (C.A.S.); (S.S.); (H.L.W.)
| | - Ellie-Ann Conneely
- School of Natural Sciences and Ryan Institute, National University of Ireland Galway, H91 TK33 Galway, Ireland; (C.L.-M.); (A.L.A.); (E.-A.C.); (K.M.); (R.M.Y.)
| | - Sarah G. Dietrick
- Department of Chemistry, University of South Florida, Tampa, FL 33620-5250, USA; (B.J.B.); (S.G.D.); (F.K.); (C.A.S.); (S.S.); (H.L.W.)
| | - Fiona Kearns
- Department of Chemistry, University of South Florida, Tampa, FL 33620-5250, USA; (B.J.B.); (S.G.D.); (F.K.); (C.A.S.); (S.S.); (H.L.W.)
| | - Kate McKeever
- School of Natural Sciences and Ryan Institute, National University of Ireland Galway, H91 TK33 Galway, Ireland; (C.L.-M.); (A.L.A.); (E.-A.C.); (K.M.); (R.M.Y.)
| | - Ryan M. Young
- School of Natural Sciences and Ryan Institute, National University of Ireland Galway, H91 TK33 Galway, Ireland; (C.L.-M.); (A.L.A.); (E.-A.C.); (K.M.); (R.M.Y.)
- School of Chemistry, National University of Ireland Galway, H91 TK33 Galway, Ireland
| | - Connor A. Sierra
- Department of Chemistry, University of South Florida, Tampa, FL 33620-5250, USA; (B.J.B.); (S.G.D.); (F.K.); (C.A.S.); (S.S.); (H.L.W.)
| | - Sylvia Soldatou
- Department of Chemistry, University of South Florida, Tampa, FL 33620-5250, USA; (B.J.B.); (S.G.D.); (F.K.); (C.A.S.); (S.S.); (H.L.W.)
- School of Chemistry, National University of Ireland Galway, H91 TK33 Galway, Ireland
| | - H. Lee Woodcock
- Department of Chemistry, University of South Florida, Tampa, FL 33620-5250, USA; (B.J.B.); (S.G.D.); (F.K.); (C.A.S.); (S.S.); (H.L.W.)
| | - Mark P. Johnson
- School of Natural Sciences and Ryan Institute, National University of Ireland Galway, H91 TK33 Galway, Ireland; (C.L.-M.); (A.L.A.); (E.-A.C.); (K.M.); (R.M.Y.)
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9
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Abstract
Like many sectors, the expansion of aquaculture has issues related to sustainable resource use and environmental change. These challenges are widely recognised and are addressed with sectoral strategies. Even when culturing a single species, the specifics of impacts, constraints, and pressures are likely to vary in effects for different farm types. On the other hand, production efficiencies can drive farms towards homogeneity. A simple model is used in this study to demonstrate farm-scale budgets and the pressure to intensify production towards an optimum. A range of interventions can provide incentives for less intensive production: these include price premiums and altered cost bases. Integrated multitrophic aquaculture (IMTA) does not offer a route to less intensive production systems if the productivity of the extractive species (e.g., algae) is linked to the intensity of the fish farm, although alternative incentives for IMTA are possible. Increases in the intensity of production (as stocking density) can be mitigated by increasing farm capacity. An expanded production model suggests that this will lead to larger farms at relatively high stocking densities. Where farms are subject to variable economic and biological processes, this can lead to some combinations of intensity and capacity to have less variable earnings than others. The promotion of diverse aquaculture sectors may allow some of the ecological and social synergies available to smaller farms to be combined at a regional scale with the greater production of large farms. Cost, price and/or regulatory incentives are needed to create diverse production systems.
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10
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Moldenhauer JS, Soni S, Jatres J, Gebb J, Khalek N, Paidas Teefey C, Johnson MP, Flake AW, Hedrick HL, Peranteau WH, Heuer GG, Adzick NS. Open Fetal Surgical Outcomes for Myelomeningocele Closure Stratified by Maternal Body Mass Index in a Large Single-Center Cohort. Fetal Diagn Ther 2020; 47:889-893. [PMID: 33166958 DOI: 10.1159/000511781] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 09/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Open maternal-fetal surgery for in utero closure of myelomeningocele (MMC) has become an accepted treatment option for prenatally diagnosed open neural tube defects. Historically, this option has been limited to women with BMI < 35 due to concern for increasing complications in patients with obesity. OBJECTIVE The aim of this study was to evaluate maternal, obstetric, and fetal/neonatal outcomes stratified by maternal BMI classification in women who undergo open maternal-fetal surgery for fetal myelomeningocele (fMMC) closure. METHODS A single-center fMMC closure registry was queried for maternal demographics, preoperative factors, fetal surgery outcomes, delivery outcomes, and neonatal outcomes. Data were stratified based on maternal BMI: <30, 30-34.99, and ≥35-40, corresponding to normal weight/overweight, obesity class I, and obesity class II. Statistical analysis was performed using statistical software SAS v.9.4 (SAS Institute Inc., Cary, NC, USA). RESULTS A total of 264 patients were analyzed, including 196 (74.2%) with BMI <30, 54 (20.5%) with BMI 30-34.99, and 14 (5.3%) with BMI ≥ 35-40. Maternal demographics and preoperative characteristics were similar among the groups. Operative time increased with increasing BMI; otherwise, perioperative outcomes were similar among the groups. Obstetric and neonatal outcomes were similar among the groups. CONCLUSION Increasing maternal BMI did not result in a negative impact on maternal, obstetric, and fetal/neonatal outcomes in a large cohort of patients undergoing open maternal-fetal surgery for fMMC closure. Further study is warranted to determine the generalizability of these results.
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Affiliation(s)
- Julie S Moldenhauer
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA, .,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,
| | - Shelly Soni
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jillian Jatres
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Juliana Gebb
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nahla Khalek
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christina Paidas Teefey
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark P Johnson
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alan W Flake
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Holly L Hedrick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - William H Peranteau
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory G Heuer
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - N Scott Adzick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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11
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Joyeux L, Danzer E, De Bie F, Russo FM, Javaux A, Peralta CFA, De Salles AAF, Pastuszka A, Olejek A, Van Mieghem T, De Coppi P, Moldenhauer J, Whitehead WE, Belfort MA, Lapa DA, Acacio GL, Devlieger R, Hirose S, Farmer DL, Van Calenbergh F, Adzick NS, Johnson MP, Deprest J. Reply. Ultrasound Obstet Gynecol 2020; 56:634-635. [PMID: 33001498 DOI: 10.1002/uog.23104] [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: 06/11/2023]
Affiliation(s)
- L Joyeux
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Women and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - E Danzer
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - F De Bie
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - F M Russo
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Women and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - A Javaux
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - C F A Peralta
- Department of Fetal Medicine, The Heart Hospital, University of São Paulo, São Paulo, Brazil
- Department of Fetal Medicine, Pro Matre Hospital, São Paulo, Brazil
| | - A A F De Salles
- Neuroscience Institute, The Heart Hospital, University of São Paulo, São Paulo, Brazil
| | - A Pastuszka
- Department of Descriptive and Topografic Anatomy, Medical University of Silesia, Katowice, Poland
- Division of Dentistry, School of Medicine, Medical University of Silesia, Zabrze, Poland
| | - A Olejek
- Department of Gynecology, Obstetrics and Gynecologic Oncology, Medical University of Silesia, Bytom, Poland
| | - T Van Mieghem
- Department of Obstetrics and Gynecology, Sinai Health System, Mount Sinai Hospital, Toronto, ON, Canada
| | - P De Coppi
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Women and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Specialist Neonatal and Paediatric Surgery Unit, Great Ormond Street Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - J Moldenhauer
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - W E Whitehead
- Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Fetal Center, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - M A Belfort
- Texas Children's Fetal Center, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - D A Lapa
- Fetal Therapy Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - G L Acacio
- Department of Obstetrics and Gynecology, Taubate University, São Paulo, Brazil
| | - R Devlieger
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Women and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - S Hirose
- Fetal Care and Treatment Center, UC Davis Children's Hospital, Sacramento, CA, USA
| | - D L Farmer
- Fetal Care and Treatment Center, UC Davis Children's Hospital, Sacramento, CA, USA
| | - F Van Calenbergh
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - N S Adzick
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M P Johnson
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - J Deprest
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Women and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Institute of Women's Health, University College London Hospitals, London, UK
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12
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Riley JS, Antiel RM, Flake AW, Johnson MP, Rintoul NE, Lantos JD, Traynor MD, Adzick NS, Feudtner C, Heuer GG. Pediatric neurosurgeons' views regarding prenatal surgery for myelomeningocele and the management of hydrocephalus: a national survey. Neurosurg Focus 2020; 47:E8. [PMID: 31574481 DOI: 10.3171/2019.7.focus19406] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/26/2019] [Accepted: 07/18/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Management of Myelomeningocele Study (MOMS) compared prenatal with postnatal surgery for myelomeningocele (MMC). The present study sought to determine how MOMS influenced the clinical recommendations of pediatric neurosurgeons, how surgeons' risk tolerance affected their views, how their views compare to those of their colleagues in other specialties, and how their management of hydrocephalus compares to the guidelines used in the MOMS trial. METHODS A cross-sectional survey was sent to all 154 pediatric neurosurgeons in the American Society of Pediatric Neurosurgeons. The effect of surgeons' risk tolerance on opinions and counseling of prenatal closure was determined by using ordered logistic regression. RESULTS Compared to postnatal closure, 71% of responding pediatric neurosurgeons viewed prenatal closure as either "very favorable" or "somewhat favorable," and 51% reported being more likely to recommend prenatal surgery in light of MOMS. Compared to pediatric surgeons, neonatologists, and maternal-fetal medicine specialists, pediatric neurosurgeons viewed prenatal MMC repair less favorably (p < 0.001). Responders who believed the surgical risks were high were less likely to view prenatal surgery favorably and were also less likely to recommend prenatal surgery (p < 0.001). The management of hydrocephalus was variable, with 60% of responders using endoscopic third ventriculostomy in addition to ventriculoperitoneal shunts. CONCLUSIONS The majority of pediatric neurosurgeons have a favorable view of prenatal surgery for MMC following MOMS, although less so than in other specialties. The reported acceptability of surgical risks was strongly predictive of prenatal counseling. Variation in the management of hydrocephalus may impact outcomes following prenatal closure.
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Affiliation(s)
- John S Riley
- 1Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ryan M Antiel
- 2Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Alan W Flake
- 3University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Pennsylvania.,4The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Pennsylvania
| | - Mark P Johnson
- 3University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Pennsylvania.,4The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Pennsylvania
| | - Natalie E Rintoul
- 3University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Pennsylvania.,4The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Pennsylvania
| | - John D Lantos
- 5Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri; and
| | | | - N Scott Adzick
- 3University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Pennsylvania.,4The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Pennsylvania
| | - Chris Feudtner
- 3University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Pennsylvania
| | - Gregory G Heuer
- 3University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Pennsylvania.,4The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Pennsylvania.,6Division of Neurosurgery, Children's Hospital of Philadelphia, Pennsylvania
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13
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Joyeux L, De Bie F, Danzer E, Russo FM, Javaux A, Peralta CFA, De Salles AAF, Pastuszka A, Olejek A, Van Mieghem T, De Coppi P, Moldenhauer J, Whitehead WE, Belfort MA, Lapa DA, Acacio GL, Devlieger R, Hirose S, Farmer DL, Van Calenbergh F, Adzick NS, Johnson MP, Deprest J. Learning curves of open and endoscopic fetal spina bifida closure: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2020; 55:730-739. [PMID: 31273862 DOI: 10.1002/uog.20389] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 06/18/2019] [Accepted: 06/24/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The Management of Myelomeningocele Study (MOMS) trial demonstrated the safety and efficacy of open fetal surgery for spina bifida aperta (SBA). Recently developed alternative techniques may reduce maternal risks without compromising the fetal neuroprotective effects. The aim of this systematic review was to assess the learning curve (LC) of different fetal SBA closure techniques. METHODS MEDLINE, Web of Science, EMBASE, Scopus and Cochrane databases and the gray literature were searched to identify relevant articles on fetal surgery for SBA, without language restriction, published between January 1980 and October 2018. Identified studies were reviewed systematically and those reporting all consecutive procedures and with postnatal follow-up ≥ 12 months were selected. Studies were included only if they reported outcome variables necessary to measure the LC, as defined by fetal safety and efficacy. Two authors independently retrieved data, assessed the quality of the studies and categorized observations into blocks of 30 patients. For meta-analysis, data were pooled using a random-effects model when heterogeneous. To measure the LC, we used two complementary methods. In the group-splitting method, competency was defined when the procedure provided results comparable to those in the MOMS trial for 12 outcome variables representing the immediate surgical outcome, short-term neonatal neuroprotection and long-term neuroprotection at ≥ 12 months of age. Then, when raw patient data were available, we performed cumulative sum analysis based on a composite binary outcome defining successful surgery. The composite outcome combined four clinically relevant variables for safety (absence of extreme preterm delivery < 30 weeks, absence of fetal death ≤ 7 days after surgery) and efficacy (reversal of hindbrain herniation and absence of any neonatal treatment of dehiscence or cerebrospinal fluid leakage at the closure site). RESULTS Of 6024 search results, 17 (0.3%) studies were included, all of which had low, moderate or unclear risk of bias. Fetal SBA closure was performed using standard hysterotomy (11 studies), mini-hysterotomy (one study) or fetoscopy by either exteriorized-uterus single-layer closure (one study), percutaneous single-layer closure (three studies) or percutaneous two-layer closure (one study). Only outcomes for standard hysterotomy could be meta-analyzed. Overall, outcomes improved significantly with experience. Competency was reached after 35 consecutive cases for standard hysterotomy and was predicted to be achieved after ≥ 57 cases for mini-hysterotomy and ≥ 56 for percutaneous two-layer fetoscopy. For percutaneous and exteriorized-uterus single-layer fetoscopy, competency was not reached in the 81 and 28 cases available for analysis, respectively, and LC prediction analysis could not be performed. CONCLUSIONS The number of cases operated is correlated with the outcome of fetal SBA closure, and the number of operated cases required to reach competency ranges from 35 for standard hysterotomy to ≥ 56-57 for minimally invasive modifications. Our observations provide important information for institutions looking to establish a new fetal center, develop a new fetal surgery technique or train their team, and inform referring clinicians, potential patients and third parties. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- L Joyeux
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Women and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - F De Bie
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - E Danzer
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - F M Russo
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Women and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - A Javaux
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - C F A Peralta
- Department of Fetal Medicine, The Heart Hospital, University of São Paulo, São Paulo, Brazil
- Department of Fetal Medicine, Pro Matre Hospital, São Paulo, Brazil
| | - A A F De Salles
- Neuroscience Institute, The Heart Hospital, University of São Paulo, São Paulo, Brazil
| | - A Pastuszka
- Department of Descriptive and Topografic Anatomy, Medical University of Silesia, Katowice, Poland
- Division of Dentistry, School of Medicine, Zabrze, Poland
| | - A Olejek
- Department of Gynecology, Obstetrics and Gynecologic Oncology, Medical University of Silesia, Bytom, Poland
| | - T Van Mieghem
- Department of Obstetrics and Gynecology, Sinai Health System, Mount Sinai Hospital, Toronto, ON, Canada
| | - P De Coppi
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Women and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Specialist Neonatal and Paediatric Surgery Unit, Great Ormond Street Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - J Moldenhauer
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - W E Whitehead
- Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Fetal Center, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - M A Belfort
- Texas Children's Fetal Center, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - D A Lapa
- Fetal Therapy Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - G L Acacio
- Department of Obstetrics and Gynecology, Taubate University, São Paulo, Brazil
| | - R Devlieger
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Women and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - S Hirose
- Fetal Care and Treatment Center, UC Davis Children's Hospital, Sacramento, CA, USA
| | - D L Farmer
- Fetal Care and Treatment Center, UC Davis Children's Hospital, Sacramento, CA, USA
| | - F Van Calenbergh
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - N S Adzick
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M P Johnson
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - J Deprest
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Women and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Institute of Women's Health, University College London Hospitals, London, UK
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14
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Johnson MP. Estimating intertidal seaweed biomass at larger scales from quadrat surveys. Mar Environ Res 2020; 156:104906. [PMID: 32056800 DOI: 10.1016/j.marenvres.2020.104906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/02/2019] [Revised: 01/28/2020] [Accepted: 02/03/2020] [Indexed: 06/10/2023]
Abstract
The amount of macroalgal biomass is an important ecosystem variable. Estimates can be made for a sampled area or values can be extrapolated to represent biomass over a larger region. Typically biomass is scaled-up using the area multiplied by the mean: a non-spatial method. Where algal biomass is patchy or shows gradients, non-spatial estimates for an area may be improved by spatial interpolation. A separate issue with scaling-up biomass estimates is that conventional confidence intervals based on the standard error (SE) of the sample may not be appropriate. The issues around interpolation and confidence intervals were examined for three fucoid species using data from 40 × 0.25 m-2 quadrats thrown in a 0.717 ha sampling plot on the shore of Galway Bay. Despite evidence of spatial autocorrelation, interpolation did not appear to improve estimates of the total plot biomass of Fucus serratus and F. vesiculosus. In contrast, interpolated estimates for Ascophyllum nodosum had less error than those based on the non-spatial method. Bootstrapped confidence intervals had several benefits over those based on the SE. These benefits include the avoidance of negative confidence limits at low sample sizes and no assumptions of normality in the data. If there is reason to expect strong patchiness or a gradient of biomass in the area of interest, interpolation is likely to produce more accurate estimates of biomass than non-spatial methods. Development of methodologies for biomass would benefit from more definition of local and regional gradients in biomass and their associated covariates.
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Affiliation(s)
- Mark P Johnson
- School of Natural Sciences and Ryan Institute, NUI Galway, University Road, Galway, Ireland.
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15
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Houtrow AJ, Thom EA, Fletcher JM, Burrows PK, Adzick NS, Thomas NH, Brock JW, Cooper T, Lee H, Bilaniuk L, Glenn OA, Pruthi S, MacPherson C, Farmer DL, Johnson MP, Howell LJ, Gupta N, Walker WO. Prenatal Repair of Myelomeningocele and School-age Functional Outcomes. Pediatrics 2020; 145:peds.2019-1544. [PMID: 31980545 PMCID: PMC6993457 DOI: 10.1542/peds.2019-1544] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [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] [Accepted: 11/15/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The Management of Myelomeningocele Study (MOMS), a randomized trial of prenatal versus postnatal repair for myelomeningocele, found that prenatal surgery resulted in reduced hindbrain herniation and need for shunt diversion at 12 months of age and better motor function at 30 months. In this study, we compared adaptive behavior and other outcomes at school age (5.9-10.3 years) between prenatal versus postnatal surgery groups. METHODS Follow-up cohort study of 161 children enrolled in MOMS. Assessments included neuropsychological and physical evaluations. Children were evaluated at a MOMS center or at a home visit by trained blinded examiners. RESULTS The Vineland composite score was not different between surgery groups (89.0 ± 9.6 in the prenatal group versus 87.5 ± 12.0 in the postnatal group; P = .35). Children in the prenatal group walked without orthotics or assistive devices more often (29% vs 11%; P = .06), had higher mean percentage scores on the Functional Rehabilitation Evaluation of Sensori-Neurologic Outcomes (92 ± 9 vs 85 ± 18; P < .001), lower rates of hindbrain herniation (60% vs 87%; P < .001), had fewer shunts placed for hydrocephalus (49% vs 85%; P < .001) and, among those with shunts, fewer shunt revisions (47% vs 70%; P = .02) than those in the postnatal group. Parents of children repaired prenatally reported higher mean quality of life z scores (0.15 ± 0.67 vs 0.11 ± 0.73; P = .008) and lower mean family impact scores (32.5 ± 7.8 vs 37.0 ± 8.9; P = .002). CONCLUSIONS There was no significant difference between surgery groups in overall adaptive behavior. Long-term benefits of prenatal surgery included improved mobility and independent functioning and fewer surgeries for shunt placement and revision, with no strong evidence of improved cognitive functioning.
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Affiliation(s)
- Amy J. Houtrow
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth A. Thom
- Biostatistics Center, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | | | - Pamela K. Burrows
- Biostatistics Center, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - N. Scott Adzick
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nina H. Thomas
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - John W. Brock
- Medical Center, Vanderbilt University, Nashville, Tennessee
| | - Timothy Cooper
- Medical Center, Vanderbilt University, Nashville, Tennessee
| | - Hanmin Lee
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | | | - Orit A. Glenn
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Sumit Pruthi
- Medical Center, Vanderbilt University, Nashville, Tennessee
| | - Cora MacPherson
- Biostatistics Center, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Diana L. Farmer
- Departments of Neurological Surgery and Pediatrics, University of California, Davis, Davis, California; and
| | - Mark P. Johnson
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lori J. Howell
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nalin Gupta
- Department of Surgery, University of California, San Francisco, San Francisco, California
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16
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Merder J, Browne P, Freund JA, Fullbrook L, Graham C, Johnson MP, Wieczorek A, Power AM. Density-dependent growth in 'catch-and-wait' fisheries has implications for fisheries management and Marine Protected Areas. Ambio 2020; 49:107-117. [PMID: 30852778 PMCID: PMC6889112 DOI: 10.1007/s13280-019-01158-1] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/17/2018] [Accepted: 02/04/2019] [Indexed: 06/09/2023]
Abstract
Stock enhancement activities provide an opportunity to examine density-dependent suppression of population biomass which is a fundamental issue for resource management and design of no-take-zones. We document 'catch-and-wait' fisheries enhancement where all but the largest lobsters are thrown back, recapturing them later after they have grown to a larger size. The residency, rate of return, and potential negative density-dependent effects of this activity are described using a combination of tagging and v-notching and by relating spatial growth patterns to population density defined with Catch Per Unit Effort. The results successfully demonstrated the concept of catch-and-wait practices. However, a density-dependent suppression of growth (in body size) was observed in male lobsters. This demonstrates a mechanism to explain differences in lobster sizes previously observed across EU fishing grounds with different stock densities. This negative effect of density could also affect individual biomass production in marine reserve or no-take zones.
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Affiliation(s)
- Julian Merder
- Institute for Chemistry and Biology of the Marine Environment, University of Oldenburg, Oldenburg, Lower Saxony Germany
| | - Patricia Browne
- Ryan Institute, National University of Ireland Galway, University Road, Galway, Ireland
| | - Jan A. Freund
- Institute for Chemistry and Biology of the Marine Environment, University of Oldenburg, Oldenburg, Lower Saxony Germany
| | - Liam Fullbrook
- Ryan Institute, National University of Ireland Galway, University Road, Galway, Ireland
| | - Conor Graham
- Marine & Freshwater Research Centre, Galway-Mayo Institute of Technology, Dublin Road, Galway, Ireland
| | - Mark P. Johnson
- Ryan Institute, National University of Ireland Galway, University Road, Galway, Ireland
| | - Alina Wieczorek
- Ryan Institute, National University of Ireland Galway, University Road, Galway, Ireland
| | - Anne Marie Power
- Ryan Institute, National University of Ireland Galway, University Road, Galway, Ireland
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17
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Fletcher JG, DeLone DR, Kotsenas AL, Campeau NG, Lehman VT, Yu L, Leng S, Holmes DR, Edwards PK, Johnson MP, Michalak GJ, Carter RE, McCollough CH. Evaluation of Lower-Dose Spiral Head CT for Detection of Intracranial Findings Causing Neurologic Deficits. AJNR Am J Neuroradiol 2019; 40:1855-1863. [PMID: 31649155 DOI: 10.3174/ajnr.a6251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/21/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Despite the frequent use of unenhanced head CT for the detection of acute neurologic deficit, the radiation dose for this exam varies widely. Our aim was to evaluate the performance of lower-dose head CT for detection of intracranial findings resulting in acute neurologic deficit. MATERIALS AND METHODS Projection data from 83 patients undergoing unenhanced spiral head CT for suspected neurologic deficits were collected. Cases positive for infarction, intra-axial hemorrhage, mass, or extra-axial hemorrhage required confirmation by histopathology, surgery, progression of findings, or corresponding neurologic deficit; cases negative for these target diagnoses required negative assessments by two neuroradiologists and a clinical neurologist. A routine dose head CT was obtained using 250 effective mAs and iterative reconstruction. Lower-dose configurations were reconstructed (25-effective mAs iterative reconstruction, 50-effective mAs filtered back-projection and iterative reconstruction, 100-effective mAs filtered back-projection and iterative reconstruction, 200-effective mAs filtered back-projection). Three neuroradiologists circled findings, indicating diagnosis, confidence (0-100), and image quality. The difference between the jackknife alternative free-response receiver operating characteristic figure of merit at routine and lower-dose configurations was estimated. A lower 95% CI estimate of the difference greater than -0.10 indicated noninferiority. RESULTS Forty-two of 83 patients had 70 intracranial findings (29 infarcts, 25 masses, 10 extra- and 6 intra-axial hemorrhages) at routine head CT (CT dose index = 38.3 mGy). The routine-dose jackknife alternative free-response receiver operating characteristic figure of merit was 0.87 (95% CI, 0.81-0.93). Noninferiority was shown for 100-effective mAs iterative reconstruction (figure of merit difference, -0.04; 95% CI, -0.08 to 0.004) and 200-effective mAs filtered back-projection (-0.02; 95% CI, -0.06 to 0.02) but not for 100-effective mAs filtered back-projection (-0.06; 95% CI, -0.10 to -0.02) or lower-dose levels. Image quality was better at higher-dose levels and with iterative reconstruction (P < .05). CONCLUSIONS Observer performance for dose levels using 100-200 eff mAs was noninferior to that observed at 250 effective mAs with iterative reconstruction, with iterative reconstruction preserving noninferiority at a mean CT dose index of 15.2 mGy.
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Affiliation(s)
- J G Fletcher
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - D R DeLone
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - A L Kotsenas
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - N G Campeau
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - V T Lehman
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - L Yu
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - S Leng
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - D R Holmes
- Biomedical Imaging Resource (D.R.H., P.E.)
| | | | - M P Johnson
- Biomedical Statistics and Informatics (M.P.J.), Mayo Clinic, Rochester, Minnesota
| | - G J Michalak
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - R E Carter
- Health Sciences Research (R.E.C.), Mayo Clinic, Jacksonville, Florida
| | - C H McCollough
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
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18
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Russell MW, Moldenhauer JS, Rychik J, Burnham NB, Zullo E, Parry SI, Simmons RA, Elovitz MA, Nicolson SC, Linn RL, Johnson MP, Yu S, Sampson MG, Hakonarson H, Gaynor JW. Damaging Variants in Proangiogenic Genes Impair Growth in Fetuses with Cardiac Defects. J Pediatr 2019; 213:103-109. [PMID: 31227283 PMCID: PMC6765419 DOI: 10.1016/j.jpeds.2019.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine the impact of damaging genetic variation in proangiogenic pathways on placental function, complications of pregnancy, fetal growth, and clinical outcomes in pregnancies with fetal congenital heart defect. STUDY DESIGN Families delivering a baby with a congenital heart defect requiring surgical repair in infancy were recruited. The placenta and neonate were weighed and measured. Hemodynamic variables were recorded from a third trimester (36.4 ± 1.7 weeks) fetal echocardiogram. Exome sequencing was performed on the probands (N = 133) and consented parents (114 parent-child trios, and 15 parent-child duos) and the GeneVetter analysis tool used to identify damaging coding sequence variants in 163 genes associated with the positive regulation of angiogenesis (PRA) (GO:0045766). RESULTS In total, 117 damaging variants were identified in PRA genes in 133 congenital heart defect probands with 73 subjects having at least 1 variant. Presence of a damaging PRA variant was associated with increased umbilical artery pulsatility index (mean 1.11 with variant vs 1.00 without; P = .01). The presence of a damaging PRA variant was also associated with lower neonatal length and head circumference for age z score at birth (mean -0.44 and -0.47 with variant vs 0.23 and -0.05 without; P = .01 and .04, respectively). During median 3.1 years (IQR 2.0-4.1 years) of follow-up, deaths occurred in 2 of 60 (3.3%) subjects with no PRA variant and in 9 of 73 (12.3%) subjects with 1 or more PRA variants (P = .06). CONCLUSIONS Damaging variants in proangiogenic genes may impact placental function and are associated with impaired fetal growth in pregnancies involving a fetus with congenital heart defect.
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Affiliation(s)
- Mark W Russell
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI.
| | - Julie S Moldenhauer
- Center for Fetal Diagnosis and Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jack Rychik
- Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Nancy B Burnham
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Erin Zullo
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Samuel I Parry
- Division of Maternal Fetal Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA
| | - Rebecca A Simmons
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Michal A Elovitz
- Division of Maternal Fetal Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA
| | - Susan C Nicolson
- Division of Cardiothoracic Anesthesiology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Rebecca L Linn
- Division of Anatomic Pathology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Mark P Johnson
- Center for Fetal Diagnosis and Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sunkyung Yu
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Matthew G Sampson
- Division of Pediatric Nephrology, Department of Pediatrics, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
| | - Hakon Hakonarson
- The Center for Applied Genomics, The Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - J William Gaynor
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
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19
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MacGregor-Chatwin C, Jackson PJ, Sener M, Chidgey JW, Hitchcock A, Qian P, Mayneord GE, Johnson MP, Luthey-Schulten Z, Dickman MJ, Scanlan DJ, Hunter CN. Membrane organization of photosystem I complexes in the most abundant phototroph on Earth. Nat Plants 2019; 5:879-889. [PMID: 31332310 PMCID: PMC6699766 DOI: 10.1038/s41477-019-0475-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 06/13/2019] [Indexed: 05/20/2023]
Abstract
Prochlorococcus is a major contributor to primary production, and globally the most abundant photosynthetic genus of picocyanobacteria because it can adapt to highly stratified low-nutrient conditions that are characteristic of the surface ocean. Here, we examine the structural adaptations of the photosynthetic thylakoid membrane that enable different Prochlorococcus ecotypes to occupy high-light, low-light and nutrient-poor ecological niches. We used atomic force microscopy to image the different photosystem I (PSI) membrane architectures of the MED4 (high-light) Prochlorococcus ecotype grown under high-light and low-light conditions in addition to the MIT9313 (low-light) and SS120 (low-light) Prochlorococcus ecotypes grown under low-light conditions. Mass spectrometry quantified the relative abundance of PSI, photosystem II (PSII) and cytochrome b6f complexes and the various Pcb proteins in the thylakoid membrane. Atomic force microscopy topographs and structural modelling revealed a series of specialized PSI configurations, each adapted to the environmental niche occupied by a particular ecotype. MED4 PSI domains were loosely packed in the thylakoid membrane, whereas PSI in the low-light MIT9313 is organized into a tightly packed pseudo-hexagonal lattice that maximizes harvesting and trapping of light. There are approximately equal levels of PSI and PSII in MED4 and MIT9313, but nearly twofold more PSII than PSI in SS120, which also has a lower content of cytochrome b6f complexes. SS120 has a different tactic to cope with low-light levels, and SS120 thylakoids contained hundreds of closely packed Pcb-PSI supercomplexes that economize on the extra iron and nitrogen required to assemble PSI-only domains. Thus, the abundance and widespread distribution of Prochlorococcus reflect the strategies that various ecotypes employ for adapting to limitations in light and nutrient levels.
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Affiliation(s)
- C MacGregor-Chatwin
- Department of Molecular Biology and Biotechnology, University of Sheffield, Sheffield, UK
| | - P J Jackson
- Department of Molecular Biology and Biotechnology, University of Sheffield, Sheffield, UK
- ChELSI Institute, Department of Chemical and Biological Engineering, University of Sheffield, Sheffield, UK
| | - M Sener
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - J W Chidgey
- Department of Molecular Biology and Biotechnology, University of Sheffield, Sheffield, UK
| | - A Hitchcock
- Department of Molecular Biology and Biotechnology, University of Sheffield, Sheffield, UK
| | - P Qian
- Department of Molecular Biology and Biotechnology, University of Sheffield, Sheffield, UK
| | - G E Mayneord
- Department of Molecular Biology and Biotechnology, University of Sheffield, Sheffield, UK
| | - M P Johnson
- Department of Molecular Biology and Biotechnology, University of Sheffield, Sheffield, UK
| | - Z Luthey-Schulten
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - M J Dickman
- ChELSI Institute, Department of Chemical and Biological Engineering, University of Sheffield, Sheffield, UK
| | - D J Scanlan
- School of Life Sciences, University of Warwick, Coventry, UK
| | - C N Hunter
- Department of Molecular Biology and Biotechnology, University of Sheffield, Sheffield, UK.
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20
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Russell MW, Moldenhauer JS, Rychik J, Burnham NB, Zullo E, Parry SI, Simmons RA, Elovitz MA, Nicolson SC, Linn RL, Johnson MP, Yu S, Sampson MG, Hakonarson H, Gaynor JW. Effect of parental origin of damaging variants in pro-angiogenic genes on fetal growth in patients with congenital heart defects: Data and analyses. Data Brief 2019; 25:104311. [PMID: 31453292 PMCID: PMC6700409 DOI: 10.1016/j.dib.2019.104311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/14/2019] [Accepted: 07/17/2019] [Indexed: 11/03/2022] Open
Abstract
The placenta is a highly vascular structure composed of both maternal and fetal elements. We have determined that damaging variants in genes responsible for the positive regulation of angiogenesis (PRA) (GO:0045766) that are inherited by the fetus impair fetal growth and placental function in pregnancies involving critical congenital cardiac defects (Russell et al., 2019). In this dataset, we present the specific genetic variants identified, describe the parental origin of each variant where possible and present the analyses regarding the potential effects of parental origin of the variant on placental function and fetal growth. The data presented are related to the research article "Damaging variants in pro-angiogenic genes impair growth in fetuses with cardiac defects" (Russell et al., 2019).
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Affiliation(s)
- Mark W. Russell
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Julie S. Moldenhauer
- Center for Fetal Diagnosis and Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jack Rychik
- Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nancy B. Burnham
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erin Zullo
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Samuel I. Parry
- Division of Maternal Fetal Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca A. Simmons
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michal A. Elovitz
- Division of Maternal Fetal Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Susan C. Nicolson
- Division of Cardiothoracic Anesthesiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rebecca L. Linn
- Division of Anatomic Pathology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark P. Johnson
- Center for Fetal Diagnosis and Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sunkyung Yu
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Matthew G. Sampson
- Division of Pediatric Nephrology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Hakon Hakonarson
- The Center for Applied Genomics, The Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - J. William Gaynor
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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21
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Gaynor JW, Parry S, Moldenhauer JS, Simmons RA, Rychik J, Ittenbach RF, Russell WW, Zullo E, Ward JL, Nicolson SC, Spray TL, Johnson MP. The impact of the maternal-foetal environment on outcomes of surgery for congenital heart disease in neonates. Eur J Cardiothorac Surg 2019; 54:348-353. [PMID: 29447332 DOI: 10.1093/ejcts/ezy015] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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] [Received: 09/13/2017] [Accepted: 01/04/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Pregnancies with congenital heart disease in the foetus have an increased prevalence of pre-eclampsia, small for gestational age and preterm birth, which are evidence of an impaired maternal-foetal environment (MFE). METHODS The impact of an impaired MFE, defined as pre-eclampsia, small for gestational age or preterm birth, on outcomes after cardiac surgery was evaluated in neonates (n = 135) enrolled in a study evaluating exposure to environmental toxicants and neuro-developmental outcomes. RESULTS The most common diagnoses were transposition of the great arteries (n = 47) and hypoplastic left heart syndrome (n = 43). Impaired MFE was present in 28 of 135 (21%) subjects, with small for gestational age present in 17 (61%) patients. The presence of an impaired MFE was similar for all diagnoses, except transposition of the great arteries (P < 0.006). Postoperative length of stay was shorter for subjects without an impaired MFE (14 vs 38 days, P < 0.001). Hospital mortality was not significantly different with or without impaired MFE (11.7% vs 2.8%, P = 0.104). However, for the entire cohort, survival at 36 months was greater for those without an impaired MFE (96% vs 68%, P = 0.001). For patients with hypoplastic left heart syndrome, survival was also greater for those without an impaired MFE (90% vs 43%, P = 0.007). CONCLUSIONS An impaired MFE is common in pregnancies in which the foetus has congenital heart disease. After cardiac surgery in neonates, the presence of an impaired MFE was associated with lower survival at 36 months of age for the entire cohort and for the subgroup with hypoplastic left heart syndrome.
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Affiliation(s)
- James William Gaynor
- Division of Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Samuel Parry
- Division of Maternal Fetal Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Julie S Moldenhauer
- Center for Fetal Diagnosis and Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rebecca A Simmons
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jack Rychik
- Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Richard F Ittenbach
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - William W Russell
- Division of Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erin Zullo
- Division of Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John Laurenson Ward
- Division of Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan C Nicolson
- Division of Pediatric Cardiac Anesthesiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas L Spray
- Division of Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark P Johnson
- Center for Fetal Diagnosis and Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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22
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Ritter A, Cuddapah S, Degenhardt K, Kasperski S, Johnson MP, O'Connor MJ, Ahrens-Nicklas R. Fetal cardiomyopathy in neurofibromatosis type I: Novel phenotype and review of the literature. Am J Med Genet A 2019; 179:1042-1046. [PMID: 30919579 DOI: 10.1002/ajmg.a.61123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/31/2018] [Revised: 02/05/2019] [Accepted: 02/11/2019] [Indexed: 11/10/2022]
Abstract
Neurofibromatosis type I (NF1) is a relatively common genetic disorder characterized by neurocutaneous lesions, neurofibromas, skeletal anomalies, iris hamartomas, and predisposition to other tumors. NF1 results from heterozygous loss-of-function mutations in neurofibromin (NF1), and diagnosis is most often made using clinical diagnostic criteria. Cardiac manifestations of NF1 include congenital heart disease (such as valvar pulmonary stenosis), left ventricular hypertrophy, and adult-onset pulmonary hypertension. Prenatal features of NF1 are often nonspecific and diagnoses are infrequently made prenatally without a known family history. Herein, we report the first case, to the best of our knowledge, of fetal cardiomyopathy as the presenting feature in NF1 and review NF1-related left ventricular hypertrophy. NF1 should be considered in the differential diagnosis for fetuses with cardiomyopathy, even in the absence of a known family history of the condition.
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Affiliation(s)
- Alyssa Ritter
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Divison of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sanmati Cuddapah
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karl Degenhardt
- Divison of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stefanie Kasperski
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mark P Johnson
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew J O'Connor
- Divison of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rebecca Ahrens-Nicklas
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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23
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Russell MW, Moldenhauer JS, Rychik J, Burnham N, Parry SI, Simmons R, Elovitz M, Nicolson S, Linn R, Johnson MP, Yu S, Sampson M, Hakonarson H, Gaynor JW. DAMAGING GENETIC VARIANTS IN PRO-ANGIOGENIC GENES IMPAIR GROWTH IN FETUSES WITH CRITICAL CONGENITAL CARDIAC DEFECTS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31193-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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24
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Laje P, Fraga MV, Peranteau WH, Hedrick HL, Khalek N, Gebb JS, Moldenhauer JS, Johnson MP, Flake AW, Adzick NS. Complex gastroschisis: Clinical spectrum and neonatal outcomes at a referral center. J Pediatr Surg 2018; 53:1904-1907. [PMID: 29628208 DOI: 10.1016/j.jpedsurg.2018.03.011] [Citation(s) in RCA: 22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/05/2018] [Accepted: 03/08/2018] [Indexed: 02/07/2023]
Abstract
AIM OF THE STUDY To evaluate the outcomes of neonates with complex gastroschisis (GC), and correlate outcomes with each type of complication. METHODS Retrospective review of patients with complex GC owing to prenatal and/or postnatal abdominal complications; 2008-2016. Primary outcomes: time to discontinue parenteral nutrition (off-PN), length of stay (LOS) and neonatal survival. MAIN RESULTS We treated 58 patients with complex gastroschisis owing to abdominal complications, which were: intestinal necrosis at birth (n=9), intestinal atresia (n=16), medical necrotizing enterocolitis (NEC) (n=15), surgical NEC (n=1), in utero volvulus (n=1), vanishing gastroschisis (n=2), severe intestinal dysmotility (n=1), delayed abdominal closure (n=3), abdominal compartment syndrome (n=2) and hiatal hernia/severe gastroesophageal reflux disease (GERD; n=11). The off-PN time and LOS of the whole group were 92 (35-255) and 119 (42-282) days, significantly longer than those of a demographically equivalent contemporaneous series of 125 patients with uncomplicated gastroschisis (off-PN 32 [12-105] days [p<0.001]; LOS 41 [18-150] days [p<0.001]). Patients with intestinal necrosis at birth or with intestinal atresia had the longest off-PN and LOS times (133 [38-255] / 157 [43-282] and 114 [36-222] / 143 [42-262] days, respectively), followed by patients with complications of the abdominal wall closure (n=5) (69 [43-93] / 89 [58-110] days), patients with hiatal hernias/severe GERD who required fundoplication (63 [35-84] / 89 [57-123] days) and patients who developed medical NEC (67 [35-103] / 76 [50-113] days). Short-bowel syndrome/PN-dependence occurred in 6/58 (10%) patients (2 vanishing gastroschisis, 1 in utero volvulus, 2 intestinal atresias and 1 bowel necrosis at birth). There were no neonatal mortalities. CONCLUSION Gastroschisis can be complicated by a wide variety of prenatal and postnatal events. The most severe outcomes occur in patients with bowel necrosis at birth, intestinal atresias, or vanishing gastroschisis. Complications, however, did not affect neonatal survival in our experience. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Pablo Laje
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Maria V Fraga
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - William H Peranteau
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Holly L Hedrick
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nahla Khalek
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Juliana S Gebb
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Julie S Moldenhauer
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark P Johnson
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alan W Flake
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - N Scott Adzick
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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25
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Schindewolf E, Khalek N, Johnson MP, Gebb J, Coleman B, Crowley TB, Zackai EH, McDonald-McGinn DM, Moldenhauer JS. Expanding the fetal phenotype: Prenatal sonographic findings and perinatal outcomes in a cohort of patients with a confirmed 22q11.2 deletion syndrome. Am J Med Genet A 2018; 176:1735-1741. [PMID: 30055034 DOI: 10.1002/ajmg.a.38665] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 07/03/2017] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 01/17/2023]
Abstract
22q deletion syndrome (22q11.2DS) is most often correlated prenatally with congenital heart disease and or cleft palate. The extracardiac fetal phenotype associated with 22q11.2DS is not well described. We sought to review both the fetal cardiac and extracardiac findings associated with a cohort of cases ascertained prenatally, confirmed or suspected to have 22q11.2DS, born and cared for in one center. A retrospective chart review was performed on a total of 42 cases with confirmed 22q11.2DS to obtain prenatal findings, perinatal outcomes and diagnostic confirmation. The diagnosis was confirmed prenatally in 67% (28/42) and postnatally in 33% (14/42). The majority (81%) were associated with the standard LCR22A-LCR22D deletion. 95% (40/42) of fetuses were prenatally diagnosed with congenital heart disease. Extracardiac findings were noted in 90% (38/42) of cases. Additional findings involved the central nervous system (38%), gastrointestinal (14%), genitourinary (16.6%), pulmonary (7%), skeletal (19%), facial dysmorphism (21%), small/hypoplastic thymus (26%), and polyhydramnios (30%). One patient was diagnosed prenatally with a bilateral cleft lip and cleft palate. No fetus was diagnosed with intrauterine growth restriction. The average gestational age at delivery was 38 weeks and average birth weight was 3,105 grams. Sixty-two percentage were delivered vaginally and there were no fetal demises. A diagnosis of 22q11.2 deletion syndrome should be considered in all cases of prenatally diagnosed congenital heart disease, particularly when it is not isolated. Microarray is warranted in all cases of structural abnormalities diagnosed prenatally. Prenatal diagnosis of 22q11.2 syndrome can be used to counsel expectant parents regarding pregnancy outcome and guide neonatal management.
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Affiliation(s)
- Erica Schindewolf
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nahla Khalek
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mark P Johnson
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Juliana Gebb
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Beverly Coleman
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Terrence Blaine Crowley
- Division of Human Genetics, Department of Pediatrics, 22q and You Center and Clinical Genetics Center, Children's Hospital of Philadelphia, the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elaine H Zackai
- Division of Human Genetics, Department of Pediatrics, 22q and You Center and Clinical Genetics Center, Children's Hospital of Philadelphia, the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Donna M McDonald-McGinn
- Division of Human Genetics, Department of Pediatrics, 22q and You Center and Clinical Genetics Center, Children's Hospital of Philadelphia, the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julie S Moldenhauer
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Vrecenak JD, Pearson EG, Todorow CA, Li H, Johnson MP, Flake AW. Preclinical Canine Model of Graft-versus-Host Disease after In Utero Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2018; 24:1795-1801. [PMID: 29802901 DOI: 10.1016/j.bbmt.2018.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 03/23/2018] [Accepted: 05/15/2018] [Indexed: 12/12/2022]
Abstract
In utero hematopoietic cell transplantation (IUHCT) offers the potential to achieve allogeneic engraftment and associated donor-specific tolerance without the need for toxic conditioning, as we have previously demonstrated in the murine and canine models. This strategy holds great promise in the treatment of many hematopoietic disorders, including the hemoglobinopathies. Graft-versus-host disease (GVHD) represents the greatest theoretical risk of IUHCT and has never been characterized in the context of IUHCT. We recently described a preclinical canine model of IUHCT, allowing further study of the technique and its complications. We aimed to establish a threshold T cell dose for IUHCT-induced GVHD in the haploidentical canine model and to define the GVHD phenotype. Using a range of T cell concentrations within the donor inoculum, we were able to characterize the phenotype of IUHCT-induced GVHD and establish a clear threshold for its induction between 3% and 5% graft CD3+ cell content. Given the complete absence of GVHD at CD3 doses of 1% to 3% and the excellent engraftment with the lowest dose, there is a safe therapeutic index for a clinical trial of IUHCT.
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Affiliation(s)
- Jesse D Vrecenak
- Children's Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Pediatric Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Erik G Pearson
- Children's Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Carlyn A Todorow
- Children's Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Haiying Li
- Children's Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mark P Johnson
- Children's Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alan W Flake
- Children's Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
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Baumgarten HD, Gebb JS, Khalek N, Moldenhauer JS, Johnson MP, Peranteau WH, Hedrick HL, Adzick NS, Flake AW. Preemptive Delivery and Immediate Resection for Fetuses with High-Risk Sacrococcygeal Teratomas. Fetal Diagn Ther 2018; 45:137-144. [PMID: 29734172 DOI: 10.1159/000487542] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/29/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Fetuses with "high-risk" sacrococcygeal teratoma (SCT) have a mortality rate of 40-50%. While fetal surgery may benefit select fetuses prior to 27 weeks' gestation, many fetuses die due to consequences of rapid tumor growth after 27 weeks. Here we report our experience applying "preemptive" delivery to fetuses who manifest signs of decompensation between 27 and 32 weeks. METHODS A retrospective review of SCT fetuses delivered between 2010 and 2016 at ≤32 weeks' gestation was performed. Patients who decompensated prior to 27 weeks and were treated with fetal surgery or neonatal palliation were excluded. RESULTS Forty-two SCT fetuses were evaluated, and 11 were preemptively delivered in response to impending fetal or maternal decompensation. Nine (81.8%) survived. One death was due to pulmonary hypoplasia in a neonate with significant intra-abdominal tumor burden, and the other was due to in utero tumor rupture. There were no deaths related to prematurity in this cohort. CONCLUSIONS Many fetuses with SCT manifest signs of decompensation between 27 and 32 weeks. In the absence of fetal hydrops prior to 27 weeks or tumor rupture in utero, early delivery is associated with favorable outcomes. Our single-center experience supports a management algorithm change to incorporate "preemptive" delivery for selected cases.
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Fraga MV, Laje P, Peranteau WH, Hedrick HL, Khalek N, Gebb JS, Moldenhauer JS, Johnson MP, Flake AW, Adzick NS. The influence of gestational age, mode of delivery and abdominal wall closure method on the surgical outcome of neonates with uncomplicated gastroschisis. Pediatr Surg Int 2018; 34:415-419. [PMID: 29417204 DOI: 10.1007/s00383-018-4233-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2018] [Indexed: 11/29/2022]
Abstract
AIM OF THE STUDY To evaluate if gestational age (GA), mode of delivery and abdominal wall closure method influence outcomes in uncomplicated gastroschisis (GTC). METHODS Retrospective review of NICU admissions for gastroschisis, August 2008-July 2016. Primary outcomes were: time to start enteral feeds (on-EF), time to discontinue parenteral nutrition (off-PN), and length of stay (LOS). MAIN RESULTS A total of 200 patients with GTC were admitted to our NICU. Patients initially operated elsewhere (n = 13) were excluded. Patients with medical/surgical complications (n = 62) were analyzed separately. The study included 125 cases of uncomplicated GTC. There were no statistically significant differences in the outcomes of patients born late preterm (34 0/7-36 6/7; n = 70) and term (n = 40): on-EF 19 (5-54) versus 17 (7-34) days (p = 0.29), off-PN 32 (12-101) versus 30 (16-52) days (p = 0.46) and LOS 40 (18-137) versus 37 (21-67) days (p = 0.29), respectively. Patients born before 34 weeks GA (n = 15) had significantly longer on-EF, off-PN and LOS times compared to late preterm patients: 26 (12-50) days (p = 0.01), 41 (20-105) days (p = 0.04) and 62 (34-150) days (p < 0.01), respectively. There were no significant differences in outcomes between patients delivered by C-section (n = 62) and patients delivered vaginally (n = 63): on-EF 20 (5-50) versus 19 (7-54) days (p = 0.72), off-PN 32 (12-78) versus 33 (15-105) days (p = 0.83), LOS 42 (18-150) versus 41 (18-139) days (p = 0.68), respectively. There were significant differences in outcomes between patients who underwent primary reduction (n = 37) and patients who had a silo (88): on-EF 15 (5-37) versus 22 (6-54) days (p < 0.01), off-PN 28 (12-52) versus 34 (15-105) days (p = 0.04), LOS 36 (18-72) versus 44 (21-150) days (p = 0.04), respectively. CONCLUSION In our experience, late preterm delivery did not affect outcomes compared to term delivery in uncomplicated GTC. Outcomes were also not influenced by the mode of delivery. Patients who underwent primary reduction had better outcomes than patients who underwent silo placement.
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Affiliation(s)
- Maria V Fraga
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Pablo Laje
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - William H Peranteau
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Holly L Hedrick
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Nahla Khalek
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Juliana S Gebb
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Julie S Moldenhauer
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Mark P Johnson
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Alan W Flake
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - N Scott Adzick
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
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Antiel RM, Curlin FA, Lantos JD, Collura CA, Flake AW, Johnson MP, Rintoul NE, Brown SD, Feudtner C. Attitudes of paediatric and obstetric specialists towards prenatal surgery for lethal and non-lethal conditions. J Med Ethics 2018; 44:234-238. [PMID: 29018178 DOI: 10.1136/medethics-2017-104377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/14/2017] [Revised: 07/14/2017] [Accepted: 09/24/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND While prenatal surgery historically was performed exclusively for lethal conditions, today intrauterine surgery is also performed to decrease postnatal disabilities for non-lethal conditions. We sought to describe physicians' attitudes about prenatal surgery for lethal and non-lethal conditions and to elucidate characteristics associated with these attitudes. METHODS Survey of 1200 paediatric surgeons, neonatologists and maternal-fetal medicine specialists (MFMs). RESULTS Of 1176 eligible physicians, 670 (57%) responded (range by specialty, 54%-60%). In the setting of a lethal condition for which prenatal surgery would likely result in the child surviving with a severe disability, most respondents either disagreed (59%) or strongly disagreed (19%) that they would recommend the surgery. Male physicians were twice as likely to recommend surgery for the lethal condition, as were physicians who believe that abortion is morally wrong (OR 1.75; 95%CI 1.0 to 3.05). Older physicians were less likely to recommend surgery (OR 0.57; 95%CI 0.36 to 0.88). For non-lethal conditions, most respondents agreed (66% somewhat, 4% strongly) that they would recommend prenatal surgery, even if the surgery increases the risk of prematurity or fetal death. Compared with MFMs, surgeons were less likely to recommend such surgery, as were physicians not affiliated with a fetal centre, and physicians who were religious (ORs range from 0.45 to 0.64). CONCLUSION Physician's attitudes about prenatal surgery relate to physicians' beliefs about disability as well as demographic, cultural and religious characteristics. Given the variety of views, parents are likely to receive different recommendations from their doctors about the preferable treatment choice.
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Affiliation(s)
- Ryan M Antiel
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of General Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Farr A Curlin
- Trent Center for Bioethics, Humanities and History of Medicine, Duke University, Durham, North Carolina, USA
| | - John D Lantos
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA
| | | | - Alan W Flake
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mark P Johnson
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Natalie E Rintoul
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Stephen D Brown
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Chris Feudtner
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
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Farmer DL, Thom EA, Brock JW, Burrows PK, Johnson MP, Howell LJ, Farrell JA, Gupta N, Adzick NS. The Management of Myelomeningocele Study: full cohort 30-month pediatric outcomes. Am J Obstet Gynecol 2018; 218:256.e1-256.e13. [PMID: 29246577 DOI: 10.1016/j.ajog.2017.12.001] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/28/2017] [Accepted: 12/01/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Previous reports from the Management of Myelomeningocele Study demonstrated that prenatal repair of myelomeningocele reduces hindbrain herniation and the need for cerebrospinal fluid shunting, and improves motor function in children with myelomeningocele. The trial was stopped for efficacy after 183 patients were randomized, but 30-month outcomes were only available at the time of initial publication in 134 mother-child dyads. Data from the complete cohort for the 30-month outcomes are presented here. Maternal and 12-month neurodevelopmental outcomes for the full cohort were reported previously. OBJECTIVE The purpose of this study is to report the 30-month outcomes for the full cohort of patients randomized to either prenatal or postnatal repair of myelomeningocele in the original Management of Myelomeningocele Study. STUDY DESIGN Eligible women were randomly assigned to undergo standard postnatal repair or prenatal repair <26 weeks gestation. We evaluated a composite of mental development and motor function outcome at 30 months for all enrolled patients as well as independent ambulation and the Bayley Scales of Infant Development, Second Edition. We assessed whether there was a differential effect of prenatal surgery in subgroups defined by: fetal leg movements, ventricle size, presence of hindbrain herniation, gender, and location of the myelomeningocele lesion. Within the prenatal surgery group only, we evaluated these and other baseline parameters as predictors of 30-month motor and cognitive outcomes. We evaluated whether presence or absence of a shunt at 1 year was associated with 30-month motor outcomes. RESULTS The data for the full cohort of 183 patients corroborate the original findings of Management of Myelomeningocele Study, confirming that prenatal repair improves the primary outcome composite score of mental development and motor function (199.4 ± 80.5 vs 166.7 ± 76.7, P = .004). Prenatal surgery also resulted in improvement in the secondary outcomes of independent ambulation (44.8% vs 23.9%, P = .004), WeeFIM self-care score (20.8 vs 19.0, P = .006), functional level at least 2 better than anatomic level (26.4% vs 11.4%, P = .02), and mean Bayley Scales of Infant Development, Second Edition, psychomotor development index (17.3% vs 15.1%, P = .03), but does not affect cognitive development at 30 months. On subgroup analysis, there was a nominally significant interaction between gender and surgery, with boys demonstrating better improvement in functional level and psychomotor development index. For patients receiving prenatal surgery, the presence of in utero ankle, knee, and hip movement, absence of a sac over the lesion and a myelomeningocele lesion of ≤L3 were significantly associated with independent ambulation. Postnatal motor function showed no correlation with either prenatal ventricular size or postnatal shunt placement. CONCLUSION The full cohort data of 30-month cognitive development and motor function outcomes validate in utero surgical repair as an effective treatment for fetuses with myelomeningocele. Current data suggest that outcomes related to the need for shunting should be counseled separately from the outcomes related to distal neurologic functioning.
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Abstract
The broad categories of surgical fetal therapy can be separated into either open surgical techniques or minimally invasive endoscopic/ultrasound-guided techniques that require only puncture of the uterus with single or multiple small ports. Benefits of fetoscopic or ultrasound-guided fetal intervention include decreased uterine irritability, decreased incidence of preterm labor, and avoidance of risks associated with hysterotomy and commitment to cesarean delivery for future pregnancies. Fetal abnormalities potentially amenable to ultrasound-guided drainage techniques include thoracic fluid-filled lesions and lower urinary tract obstruction.
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Affiliation(s)
- Mark P Johnson
- The Center for Fetal Diagnosis and Therapy, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - R Douglas Wilson
- Departments of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
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Antiel RM, Flake AW, Collura CA, Johnson MP, Rintoul NE, Lantos JD, Curlin FA, Tilburt JC, Brown SD, Feudtner C. Weighing the Social and Ethical Considerations of Maternal-Fetal Surgery. Pediatrics 2017; 140:peds.2017-0608. [PMID: 29101225 DOI: 10.1542/peds.2017-0608] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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] [Accepted: 09/19/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The ethics of maternal-fetal surgery involves weighing the importance of potential benefits, risks, and other consequences involving the pregnant woman, fetus, and other family members. We assessed clinicians' ratings of the importance of 9 considerations relevant to maternal-fetal surgery. METHODS This study was a discrete choice experiment contained within a 2015 national mail-based survey of 1200 neonatologists, pediatric surgeons, and maternal-fetal medicine physicians, with latent class analysis subsequently used to identify groups of physicians with similar ratings. RESULTS Of 1176 eligible participants, 660 (56%) completed the discrete choice experiment. The highest-ranked consideration was of neonatal benefits, which was followed by consideration of the risk of maternal complications. By using latent class analysis, we identified 4 attitudinal groups with similar patterns of prioritization: "fetocentric" (n = 232), risk-sensitive (n = 197), maternal autonomy (n = 167), and family impact and social support (n = 64). Neonatologists were more likely to be in the fetocentric group, whereas surgeons were more likely to be in the risk-sensitive group, and maternal-fetal medicine physicians made up the largest percentage of the family impact and social support group. CONCLUSIONS Physicians vary in how they weigh the importance of social and ethical considerations regarding maternal-fetal surgery. Understanding these differences may help prevent or mitigate disagreements or tensions that may arise in the management of these patients.
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Affiliation(s)
- Ryan M Antiel
- Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Biomedical Ethics Program.,Department of General Surgery, Mayo Clinic, Rochester, Minnesota
| | - Alan W Flake
- Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Mark P Johnson
- Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Natalie E Rintoul
- Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - John D Lantos
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | - Farr A Curlin
- Trent Center for Bioethics, Humanities, and History of Medicine, Duke University, Durham, North Carolina; and
| | - Jon C Tilburt
- Biomedical Ethics Program.,General Internal Medicine, and
| | - Stephen D Brown
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Chris Feudtner
- Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
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Walls AM, Kennedy R, Edwards MD, Johnson MP. Impact of kelp cultivation on the Ecological Status of benthic habitats and Zostera marina seagrass biomass. Mar Pollut Bull 2017; 123:19-27. [PMID: 28751026 DOI: 10.1016/j.marpolbul.2017.07.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 03/20/2017] [Revised: 07/06/2017] [Accepted: 07/19/2017] [Indexed: 06/07/2023]
Abstract
The Ecological Status of subtidal benthic communities within a commercial kelp farm on the southwest coast of Ireland was not impacted by macroalgal cultivation. Additionally, there was no effect on the biomass of Zostera marina, a key habitat under the EU Habitats Directive and OSPAR Commission. However, sediment grain size and total organic matter (TOM) were influenced by abiotic and biotic aspects of the farm. A temporal effect on univariate and multivariate species data, Infaunal Quality Index (IQI) and Z. marina biomass was observed. This effect was likely a community response to high storm disturbance in winter 2013/14. The use of IQI to assess the impact of macroalgal cultivation on benthic communities is a novel approach. This study supports a view that environmental impacts of macroalgal cultivation are relatively benign compared to other forms of aquaculture. Further research must be conducted to understand all interactions between aquaculture activities and the environment.
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Affiliation(s)
- A M Walls
- Irish Seaweed Research Group, Ryan Institute, National University of Ireland, Galway, Ireland.
| | - R Kennedy
- Marine Ecosystem Research Laboratory, Zoology, Ryan Institute, National University of Ireland, Galway, Ireland
| | - M D Edwards
- Irish Seaweed Research Group, Ryan Institute, National University of Ireland, Galway, Ireland
| | - M P Johnson
- Irish Seaweed Research Group, Ryan Institute, National University of Ireland, Galway, Ireland
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Antiel RM, Collura CA, Flake AW, Johnson MP, Rintoul NE, Lantos JD, Curlin FA, Tilburt JC, Brown SD, Feudtner C. Physician views regarding the benefits and burdens of prenatal surgery for myelomeningocele. J Perinatol 2017; 37:994-998. [PMID: 28617430 DOI: 10.1038/jp.2017.75] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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] [Received: 01/29/2017] [Accepted: 04/07/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Examine how pediatric and obstetrical subspecialists view benefits and burdens of prenatal myelomeningocele (MMC) closure. STUDY DESIGN Mail survey of 1200 neonatologists, pediatric surgeons and maternal-fetal medicine specialists (MFMs). RESULTS Of 1176 eligible physicians, 670 (57%) responded. Most respondents disagreed (68%, 11% strongly) that open fetal surgery places an unacceptable burden on women and their families. Most agreed (65%, 10% strongly) that denying the benefits of open maternal-fetal surgery is unfair to the future child. Most (94%) would recommend prenatal fetoscopic over open or postnatal MMC closure for a hypothetical fetoscopic technique that had similar shunt rates (40%) but decreased maternal morbidity. When the hypothetical shunt rate for fetoscopy was increased to 60%, physicians were split (49% fetoscopy versus 45% open). Views about burdens and fairness correlated with the likelihood of recommending postnatal or fetoscopic over open closure. CONCLUSION Individual and specialty-specific values may influence recommendations about prenatal surgery.
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Affiliation(s)
- R M Antiel
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA.,Department of General Surgery, Mayo Clinic, Rochester, MN, USA
| | - C A Collura
- Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA.,Division of Neonatal Medicine, Mayo Clinic, Rochester, MN, USA
| | - A W Flake
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M P Johnson
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - N E Rintoul
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - J D Lantos
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
| | - F A Curlin
- Trent Center for Bioethics, Humanities, and History of Medicine, Duke University, Durham, NC, USA
| | - J C Tilburt
- Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA.,Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S D Brown
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - C Feudtner
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Kim AG, Danzer E, Moldenhauer JS, Khalek N, McClain LE, Waqar LN, Hedrick HL, Johnson MP, Adzick NS, Peranteau WH, Flake AW. Amniotic Fluid Concentrations of Glial Fibrillary Acidic Protein Do Not Correlate with Prenatal Metrics in Fetuses with Myelomeningocele. Fetal Diagn Ther 2017; 43:297-303. [DOI: 10.1159/000478258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 06/06/2017] [Indexed: 11/19/2022]
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Morrison L, Bennion M, McGrory E, Hurley W, Johnson MP. Talitrus saltator as a biomonitor: An assessment of trace element contamination on an urban coastline gradient. Mar Pollut Bull 2017; 120:232-238. [PMID: 28521934 DOI: 10.1016/j.marpolbul.2017.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/01/2017] [Revised: 05/06/2017] [Accepted: 05/09/2017] [Indexed: 06/07/2023]
Abstract
This study reports the first ever application of the trace element pollution index (TEPI) along a coastal, urban gradient using trace element concentrations (Ti, Mn, Co, Cu, As, Mo, Ag, Cd, Pb, Cr, Fe, Zn and Se) in the amphipod crustacean Talitrus saltator. Samples were collected from 10 sites in Galway Bay (Ireland) and concentrations of Pb showed the greatest spatial variation, likely due to the proximity of some sites to a former landfill and busy harbour. The TEPI used alongside the quartile method allowed for the assigning of sites to contamination level categories. Mapping these class levels allowed for straightforward visualisation of trace element contamination along the urban gradient. In addition, this study presents trace elements levels in T. saltator form the Atlantic Coast of Europe for the first time and the concentrations observed were comparatively lower than previously reported for T. saltator from the Baltic and Mediterranean seas.
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Affiliation(s)
- Liam Morrison
- Earth and Ocean Sciences, School of Natural Sciences, Ryan Institute, National University of Ireland, Galway, Ireland.
| | - Matthew Bennion
- Earth and Ocean Sciences, School of Natural Sciences, Ryan Institute, National University of Ireland, Galway, Ireland
| | - Ellen McGrory
- Earth and Ocean Sciences, School of Natural Sciences, Ryan Institute, National University of Ireland, Galway, Ireland
| | - William Hurley
- Earth and Ocean Sciences, School of Natural Sciences, Ryan Institute, National University of Ireland, Galway, Ireland
| | - M P Johnson
- Earth and Ocean Sciences, School of Natural Sciences, Ryan Institute, National University of Ireland, Galway, Ireland
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Johnson MP, Danzer E, Koh J, Polzin W, Harman C, O'Shaughnessy R, Brown R, Zaretsky MV. Natural History of Fetal Lower Urinary Tract Obstruction with Normal Amniotic Fluid Volume at Initial Diagnosis. Fetal Diagn Ther 2017; 44:10-17. [PMID: 28700992 DOI: 10.1159/000478011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 04/07/2017] [Accepted: 05/18/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to define the natural history of lower urinary tract obstruction (LUTO) with normal midgestational amniotic fluid volumes. MATERIALS AND METHODS We performed a retrospective review of 32 consecutive patients with LUTO with normal midgestational amniotic fluid volume followed at 11 North American Fetal Therapy Network (NAFTNet) centers from August 2007 to May 2012. Normal amniotic fluid volume was defined as an amniotic fluid index (AFI) of ≥9 cm. RESULTS The mean gestational age (GA) and AFI at enrollment were 23.1 ± 2.1 weeks and 15.8 ± 3.9 cm, respectively. The mean GA at delivery was 37.3 ± 2.8 weeks. The mean creatinine level at discharge was 1.2 ± 0.8 mg/dL. Perinatal survival was 97%. Twenty-five patients returned for serial postnatal assessment. Renal replacement therapy (RRT) was required in 32%. Development of oligohydramnios and/or anhydramnios, development of cortical renal cysts, posterior urethral valves, prematurity, and prolonged neonatal intensive care unit stay were associated with need for RRT (p < 0.05) by univariate analysis. By multivariate analysis, preterm delivery remained predictive of need for RRT (p = 0.004). CONCLUSION Prenatal diagnosis of LUTO with normal midgestational amniotic fluid volumes is associated with acceptable renal function in the majority of patients. Approximately one-third of these children require RRT. Surrogate markers of disease severity appear to be predictive of need for RRT.
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Affiliation(s)
- Mark P Johnson
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Pisapia JM, Sinha S, Zarnow DM, Johnson MP, Heuer GG. Fetal ventriculomegaly: Diagnosis, treatment, and future directions. Childs Nerv Syst 2017; 33:1113-1123. [PMID: 28510072 DOI: 10.1007/s00381-017-3441-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/28/2017] [Indexed: 11/25/2022]
Abstract
Fetal ventriculomegaly (VM) refers to the enlargement of the cerebral ventricles in utero. It is associated with the postnatal diagnosis of hydrocephalus. VM is clinically diagnosed on ultrasound and is defined as an atrial diameter greater than 10 mm. Because of the anatomic detailed seen with advanced imaging, VM is often further characterized by fetal magnetic resonance imaging (MRI). Fetal VM is a heterogeneous condition with various etiologies and a wide range of neurodevelopmental outcomes. These outcomes are heavily dependent on the presence or absence of associated anomalies and the direct cause of the ventriculomegaly rather than on the absolute degree of VM. In this review article, we discuss diagnosis, work-up, counseling, and management strategies as they relate to fetal VM. We then describe imaging-based research efforts aimed at using prenatal data to predict postnatal outcome. Finally, we review the early experience with fetal therapy such as in utero shunting, as well as the advances in prenatal diagnosis and fetal surgery that may begin to address the limitations of previous therapeutic efforts.
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Affiliation(s)
- Jared M Pisapia
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street, 3rd Floor Silverstein Pavilion, Philadelphia, PA, 19104, USA.
| | - Saurabh Sinha
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street, 3rd Floor Silverstein Pavilion, Philadelphia, PA, 19104, USA
| | - Deborah M Zarnow
- Division of Neuroradiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark P Johnson
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gregory G Heuer
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street, 3rd Floor Silverstein Pavilion, Philadelphia, PA, 19104, USA.,The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Victoria T, Danzer E, Oliver ER, Edgar JC, Iyoob S, Partridge EA, Johnson AM, Peranteau WH, Coleman BG, Flake AW, Johnson MP, Hedrick HH, Adzick NS. Right Congenital Diaphragmatic Hernias: Is There a Correlation between Prenatal Lung Volume and Postnatal Survival, as in Isolated Left Diaphragmatic Hernias? Fetal Diagn Ther 2017; 43:12-18. [PMID: 28319942 DOI: 10.1159/000464246] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 10/24/2016] [Accepted: 02/16/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Whereas left-sided congenital diaphragmatic hernias (L-CDH) have been extensively studied and their prognostic parameters delineated, right-sided hernias (R-CDH) have not. Published results remain inconclusive. The aim of this study is to evaluate if proven prognostic indicators of postnatal survival in the fetus with L-CDH apply to the fetus with R-CDH. METHODS Retrospective single-center study of R-CDH fetuses with available prenatal studies assessed for fetal lung volume by means of ultrasound-measured observed versus expected (O/E) lung area to head circumference (LHR) and magnetic resonance-calculated O/E total lung volume (TLV) in a 12-year time period. Percentage of herniated liver volume and postnatal use of extracorporeal membrane oxygenation (ECMO) were also evaluated. RESULTS In a cohort of 24 patients, O/E LHR, O/E TLV, percentage of herniated liver, and postnatal use of ECMO are not prognostic indicators of survival in the fetus with R-CDH. Cut-off values of O/E LHR of ≤45 or O/E TLV ≤25, known to select a population of severe cases for the L-CDH fetus, do not appear to extrapolate to the R-CDH fetus, as survival in both R-CDH groups is 60%. CONCLUSION The findings in this study suggest that L- and R-CDH appear to behave differently, and that factors that make L-CDH fatal (low O/E TLV and O/E LHR, high-volume herniated liver) may not apply to the fetus with R-CDH.
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Affiliation(s)
- Teresa Victoria
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Antiel RM, Flake AW, Johnson MP, Khalek N, Rintoul NE, Lantos JD, Curlin FA, Tilburt JC, Feudtner C. Specialty-Based Variation in Applying Maternal-Fetal Surgery Trial Evidence. Fetal Diagn Ther 2017; 42:210-217. [PMID: 28301843 DOI: 10.1159/000455024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 06/29/2016] [Accepted: 11/25/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The Management of Myelomeningocele Study (MOMS) compared prenatal with postnatal surgery for fetal myelomeningocele (MMC). We sought to understand how subspecialists interpreted the trial results and whether their practice has changed. MATERIALS AND METHODS Cross-sectional, mailed survey of 1,200 randomly selected maternal-fetal medicine (MFM) physicians, neonatologists, and pediatric surgeons. RESULTS Of 1,176 eligible physicians, 670 (57%) responded. Compared to postnatal closure, 33% viewed prenatal closure as "very favorable" and 60% as "somewhat favorable." Most physicians reported being more likely to recommend prenatal surgery (69%), while 28% were less likely to recommend pregnancy termination. In multivariable analysis, neonatologists were more likely to report prenatal closure as "very favorable" (OR 1.6; 95% CI: 1.03-2.5). Pediatric surgeons and neonatologists were more likely to recommend prenatal closure (OR 2.1; 95% CI: 1.3-3.3, and OR 2.9; 95% CI: 1.8-4.6) and less likely to recommend termination (OR 3.8; 95% CI: 2.2-6.7, and OR 4.7; 95% CI: 2.7-8.1). In addition, physicians with a higher tolerance for prematurity were more likely to report prenatal closure as "very favorable" (OR 1.02; 95% CI: 1.00-1.05). DISCUSSION In light of the MOMS trial, the vast majority of pediatric subspecialists and MFMs view prenatal MMC closure favorably. These attitudes vary by specialty and risk tolerance.
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Affiliation(s)
- Ryan M Antiel
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
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41
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Warren VE, Marques TA, Harris D, Thomas L, Tyack PL, Aguilar de Soto N, Hickmott LS, Johnson MP. Spatio-temporal variation in click production rates of beaked whales: Implications for passive acoustic density estimation. J Acoust Soc Am 2017; 141:1962. [PMID: 28372060 DOI: 10.1121/1.4978439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Passive acoustic monitoring has become an increasingly prevalent tool for estimating density of marine mammals, such as beaked whales, which vocalize often but are difficult to survey visually. Counts of acoustic cues (e.g., vocalizations), when corrected for detection probability, can be translated into animal density estimates by applying an individual cue production rate multiplier. It is essential to understand variation in these rates to avoid biased estimates. The most direct way to measure cue production rate is with animal-mounted acoustic recorders. This study utilized data from sound recording tags deployed on Blainville's (Mesoplodon densirostris, 19 deployments) and Cuvier's (Ziphius cavirostris, 16 deployments) beaked whales, in two locations per species, to explore spatial and temporal variation in click production rates. No spatial or temporal variation was detected within the average click production rate of Blainville's beaked whales when calculated over dive cycles (including silent periods between dives); however, spatial variation was detected when averaged only over vocal periods. Cuvier's beaked whales exhibited significant spatial and temporal variation in click production rates within vocal periods and when silent periods were included. This evidence of variation emphasizes the need to utilize appropriate cue production rates when estimating density from passive acoustic data.
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Affiliation(s)
- Victoria E Warren
- Centre for Research into Ecological and Environmental Modelling, The Observatory, Buchanan Gardens, University of St Andrews, St Andrews, Fife, KY16 9LZ, Scotland
| | - Tiago A Marques
- Centre for Research into Ecological and Environmental Modelling, The Observatory, Buchanan Gardens, University of St Andrews, St Andrews, Fife, KY16 9LZ, Scotland
| | - Danielle Harris
- Centre for Research into Ecological and Environmental Modelling, The Observatory, Buchanan Gardens, University of St Andrews, St Andrews, Fife, KY16 9LZ, Scotland
| | - Len Thomas
- Centre for Research into Ecological and Environmental Modelling, The Observatory, Buchanan Gardens, University of St Andrews, St Andrews, Fife, KY16 9LZ, Scotland
| | - Peter L Tyack
- Sea Mammal Research Unit, Scottish Oceans Institute, University of St Andrews, Fife, KY16 8LB, Scotland
| | - Natacha Aguilar de Soto
- Centre for Research into Ecological and Environmental Modelling, The Observatory, Buchanan Gardens, University of St Andrews, St Andrews, Fife, KY16 9LZ, Scotland
| | - Leigh S Hickmott
- Sea Mammal Research Unit, Scottish Oceans Institute, University of St Andrews, Fife, KY16 8LB, Scotland
| | - Mark P Johnson
- Sea Mammal Research Unit, Scottish Oceans Institute, University of St Andrews, Fife, KY16 8LB, Scotland
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Wataganara T, Seshadri S, Leung TY, Matter C, Ngerncham M, Triyasunant N, Mali PV, Biswas A, Nawapun K, Phithakwatchara N, Flake AW, Johnson MP, Biswas A, Choolani M. Establishing Prenatal Surgery for Myelomeningocele in Asia: The Singapore Consensus. Fetal Diagn Ther 2017; 41:161-178. [DOI: 10.1159/000452218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/04/2016] [Indexed: 11/19/2022]
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Wan AHL, Wilkes RJ, Heesch S, Bermejo R, Johnson MP, Morrison L. Assessment and Characterisation of Ireland's Green Tides (Ulva Species). PLoS One 2017; 12:e0169049. [PMID: 28045947 PMCID: PMC5207499 DOI: 10.1371/journal.pone.0169049] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 12/09/2016] [Indexed: 11/19/2022] Open
Abstract
Enrichment of nutrients and metals in seawater associated with anthropogenic activities can threaten aquatic ecosystems. Consequently, nutrient and metal concentrations are parameters used to define water quality. The European Union’s Water Framework Directive (WFD) goes further than a contaminant-based approach and utilises indices to assess the Ecological Status (ES) of transitional water bodies (e.g. estuaries and lagoons). One assessment is based upon the abundance of opportunistic Ulva species, as an indication of eutrophication. The objective of this study was to characterise Ireland’s Ulva blooms through the use of WFD assessment, metal concentrations and taxonomic identity. Furthermore, the study assessed whether the ecological assessment is related to the metal composition in the Ulva. WFD algal bloom assessment revealed that the largest surveyed blooms had an estimated biomass of 2164 metric tonnes (w/w). DNA sequences identified biomass from all locations as Ulva rigida, with the exception of New Quay, which was Ulva rotundata. Some blooms contained significant amounts of As, Cu, Cr, Pb and Sn. The results showed that all metal concentrations had a negative relationship (except Se) with the Ecological Quality Ratio (EQR). However, only in the case of Mn were these differences significant (p = 0.038). Overall, the metal composition and concentrations found in Ulva were site dependent, and not clearly related to the ES. Nevertheless, sites with a moderate or poor ES had a higher variability in the metals levels than in estuaries with a high ES.
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Affiliation(s)
- Alex H. L. Wan
- Irish Seaweed Research Group, Ryan Institute and School of Natural Sciences, National University of Ireland, Galway, Co. Galway, Ireland
| | | | - Svenja Heesch
- Irish Seaweed Research Group, Ryan Institute and School of Natural Sciences, National University of Ireland, Galway, Co. Galway, Ireland
| | - Ricardo Bermejo
- Earth and Ocean Sciences, Ryan Institute and School of Natural Sciences, National University of Ireland, Galway, Ireland
| | - Mark P. Johnson
- Irish Seaweed Research Group, Ryan Institute and School of Natural Sciences, National University of Ireland, Galway, Co. Galway, Ireland
| | - Liam Morrison
- Earth and Ocean Sciences, Ryan Institute and School of Natural Sciences, National University of Ireland, Galway, Ireland
- * E-mail:
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Peranteau WH, Iyoob SD, Boelig MM, Khalek N, Moldenhauer JS, Johnson MP, Hedrick HL, Flake AW, Coleman BG, Adzick NS. Prenatal growth characteristics of lymphatic malformations. J Pediatr Surg 2017; 52:65-68. [PMID: 27836363 DOI: 10.1016/j.jpedsurg.2016.10.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/20/2016] [Indexed: 01/08/2023]
Abstract
PURPOSE The natural history of prenatally diagnosed lymphatic malformations (LM) remains unknown. The ability to predict growth of a lesion is important to prenatal counseling and any future prenatal intervention. We describe the prenatal growth patterns of LMs as they relate to gestational age, anatomical location, and postnatal management. METHODS A retrospective review of fetuses prenatally diagnosed with an LM who were followed with serial ultrasounds from 2003 to 2014 was performed with attention to the growth of the lesion as indicated by the lesion volume ratio (LVR). RESULTS Thirty patients with LM had serial ultrasound measurements between 19 and 39weeks gestation. The LVR increased in 53%, decreased in 23%, and remained stable in 23% of fetuses from the initial to the final ultrasound. Unlike other locations that demonstrated both positive and negative growth profiles, axillary lesions only demonstrated increased growth. Lesions with positive growth increased throughout gestation (peak LVR at 35±3weeks). Twenty-four patients had postnatal interventions, including surgical resection, sclerotherapy, and surgery + sclerotherapy. CONCLUSION LMs have variable prenatal growth profiles. The majority of lesions, especially axillary LMs, will continue to grow throughout gestation and will not reach a growth plateau until the end of gestation. LEVEL OF EVIDENCE Level III (Retrospective cohort study).
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Affiliation(s)
- William H Peranteau
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | - Suzanne D Iyoob
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Matthew M Boelig
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Nahla Khalek
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Julie S Moldenhauer
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Mark P Johnson
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Holly L Hedrick
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Alan W Flake
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Beverly G Coleman
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - N Scott Adzick
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Gebb JS, Khalek N, Qamar H, Ozcan T, Johnson MP, Rendon N, Oliver ER, Coleman BG, Peranteau WH, Hedrick HL, Flake AW, Adzick NS, Moldenhauer JS. 178: Tumor volume to fetal weight ratio > 0.12 is associated with worse perinatal outcomes in fetuses with sacrococcygeal teratoma. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Johnson MP, Bennett KA, Rand L, Burrows PK, Thom EA, Howell LJ, Farrell JA, Dabrowiak ME, Brock JW, Farmer DL, Adzick NS. The Management of Myelomeningocele Study: obstetrical outcomes and risk factors for obstetrical complications following prenatal surgery. Am J Obstet Gynecol 2016; 215:778.e1-778.e9. [PMID: 27496687 DOI: 10.1016/j.ajog.2016.07.052] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [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: 05/23/2016] [Revised: 07/21/2016] [Accepted: 07/27/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Management of Myelomeningocele Study was a multicenter randomized trial to compare prenatal and standard postnatal closure of myelomeningocele. The trial was stopped early at recommendation of the data and safety monitoring committee and outcome data for 158 of the 183 randomized women published. OBJECTIVE In this report, pregnancy outcomes for the complete trial cohort are presented. We also sought to analyze risk factors for adverse pregnancy outcome among those women who underwent prenatal myelomeningocele repair. STUDY DESIGN Pregnancy outcomes were compared between the 2 surgery groups. For women who underwent prenatal surgery, antecedent demographic, surgical, and pregnancy complication risk factors were evaluated for the following outcomes: premature spontaneous membrane rupture ≤34 weeks 0 days (preterm premature rupture of membranes), spontaneous membrane rupture at any gestational age, preterm delivery at ≤34 weeks 0 days, nonintact hysterotomy (minimal uterine wall tissue between fetal membranes and uterine serosa, or partial or complete dehiscence at delivery), and chorioamniotic membrane separation. Risk factors were evaluated using χ2 and Wilcoxon tests and multivariable logistic regression. RESULTS A total of 183 women were randomized: 91 to prenatal and 92 to postnatal surgery groups. Analysis of the complete cohort confirmed initial findings: that prenatal surgery was associated with an increased risk for membrane separation, oligohydramnios, spontaneous membrane rupture, spontaneous onset of labor, and earlier gestational age at birth. In multivariable logistic regression of the prenatal surgery group adjusting for clinical center, earlier gestational age at surgery and chorioamniotic membrane separation were associated with increased risk of spontaneous membrane rupture (odds ratio, 1.49; 95% confidence interval, 1.01-2.22; and odds ratio, 2.96, 95% confidence interval, 1.05-8.35, respectively). Oligohydramnios was associated with an increased risk of subsequent preterm delivery (odds ratio, 9.21; 95% confidence interval, 2.19-38.78). Nulliparity was a risk factor for nonintact hysterotomy (odds ratio, 3.68; 95% confidence interval, 1.35-10.05). CONCLUSION Despite the confirmed benefits of prenatal surgery, considerable maternal and fetal risk exists compared with postnatal repair. Early gestational age at surgery and development of chorioamniotic membrane separation are risk factors for ruptured membranes. Oligohydramnios is a risk factor for preterm delivery and nulliparity is a risk factor for nonintact hysterotomy at delivery.
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Affiliation(s)
- Mark P Johnson
- Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | | | - Larry Rand
- University of California San Francisco Benioff Children's Hospital and the University of California, San Francisco School of Medicine, San Francisco, CA
| | - Pamela K Burrows
- George Washington University Biostatistics Center, Washington, DC
| | - Elizabeth A Thom
- George Washington University Biostatistics Center, Washington, DC
| | - Lori J Howell
- Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jody A Farrell
- University of California San Francisco Benioff Children's Hospital and the University of California, San Francisco School of Medicine, San Francisco, CA
| | | | - John W Brock
- Vanderbilt University Medical Center, Nashville, TN
| | - Diana L Farmer
- University of California San Francisco Benioff Children's Hospital and the University of California, San Francisco School of Medicine, San Francisco, CA
| | - N Scott Adzick
- Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Rychik J, Khalek N, Gaynor JW, Johnson MP, Adzick NS, Flake AW, Hedrick HL. Fetal intrapericardial teratoma: natural history and management including successful in utero surgery. Am J Obstet Gynecol 2016; 215:780.e1-780.e7. [PMID: 27530489 DOI: 10.1016/j.ajog.2016.08.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 05/04/2016] [Revised: 07/21/2016] [Accepted: 08/08/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intrapericardial teratoma is a rare, lethal tumor often detected in fetal life. Tumor mass and pericardial effusion cause cardiac tamponade that, if relieved, could be life-saving. Optimal timing of intervention and methods for effective fetal treatment are unknown. OBJECTIVE We describe our single-center experience with fetal intrapericardial teratoma including the first report of successful in utero surgical resection with survival to term. STUDY DESIGN We reviewed our database for suspected fetal intrapericardial teratoma. On fetal ultrasound and echocardiography tumor size was estimated by calculation of an ellipse and analyzed in relation to Doppler-derived fetal cardiac output, venous flow patterns, hydrops, and outcome. RESULTS Eight fetuses with suspected intrapericardial teratoma were seen from 2009 through 2015. Gestational age at initial presentation ranged from 21-34 (median 26) weeks. Two cases mimicked the appearance of intrapericardial teratoma, but had no serial change in cardiac output over time and were ultimately determined to be other types of tumor. In 6 cases of true intrapericardial teratoma, tumor growth was extremely rapid and associated with progressive decline in cardiac output (to <400 mL/kg/min) manifesting in hydrops and death if left untreated. One case was treated successfully at 31 weeks through ex utero intrapartum delivery with tumor resection while on placental support. Another case underwent open fetal surgery and resection at 24 weeks, with resumption of gestation until delivery at 37 weeks with excellent outcome. CONCLUSION Fetal intrapericardial teratoma can be successfully managed utilizing serial surveillance and by treatment in a timely manner prior to the predictable onset of hydrops, determined through increasing tumor size and a declining cardiac output. Surgical resection in utero is possible, with good results.
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Affiliation(s)
- Jack Rychik
- Fetal Heart Program, Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | - Nahla Khalek
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - J William Gaynor
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Mark P Johnson
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - N Scott Adzick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Alan W Flake
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Holly L Hedrick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Evans MI, Dommergues M, Wapner RJ, Goldberg JD, Lynch L, Zador IE, Carpenter RJ, Timor-Tritsch I, Brambati B, Nicolaides KH, Dumez Y, Monteagudo A, Johnson MP, Golbus MS, Tului L, Polak SM, Berkowitz RL. International, Collaborative Experience of 1789 Patients Having Multifetal Pregnancy Reduction: A Plateauing of Risks and Outcomes. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/107155769600300106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mark I. Evans
- Departments of Obstetrics and Gynecology, Molecular Medicine and Genetics, and Pathology, Hutzel Hospital/Wayne State University, Detroit, Michigan, and Departments of obstetrics and Gynecology of the following: Maternite Port Royal. Paris, France;Jefferson-Philadelphia, Philadelphia, Pennsylvania, U.C.S.F., San Francisco, California: Mt. Sinai, New York, St. Lukes, Houston, Texas; Columbia University, New York; University of Milan, Milan, Italy; and Kings College, London, United Kingdom; Departments of
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Richard L. Berkowitz
- Departments of Obstetrics and Gynecology, Molecular Medicine and Genetics, and Pathology, Hutzel Hospital/Wayne State University, Detroit, Michigan, and Departments of obstetrics and Gynecology of the following: Maternite Port Royal. Paris, France;Jefferson-Philadelphia, Philadelphia, Pennsylvania, U.C.S.F., San Francisco, California: Mt. Sinai, New York, St. Lukes, Houston, Texas; Columbia University, New York; University of Milan, Milan, Italy; and Kings College, London, United Kingdom
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Moroney NC, Wan AHL, Soler-Vila A, O’Grady MN, FitzGerald RD, Johnson MP, Kerry JP. Influence of Green Seaweed (Ulva rigida) Supplementation on the Quality and Shelf Life of Atlantic Salmon Fillets. Journal of Aquatic Food Product Technology 2016. [DOI: 10.1080/10498850.2015.1046099] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Natasha C. Moroney
- Food Packaging Group, School of Food and Nutritional Sciences, College of Science, Engineering and Food Science, University College Cork, Cork, Ireland
| | - Alex H. L. Wan
- Irish Seaweed Research Group, Ryan Institute, National University of Ireland, Galway, Ireland
| | - Anna Soler-Vila
- Irish Seaweed Research Group, Ryan Institute, National University of Ireland, Galway, Ireland
| | - Michael N. O’Grady
- Food Packaging Group, School of Food and Nutritional Sciences, College of Science, Engineering and Food Science, University College Cork, Cork, Ireland
| | - Richard D. FitzGerald
- Carna Research Station, Ryan Institute, National University of Ireland, Carna, Ireland
| | - Mark P. Johnson
- Irish Seaweed Research Group, Ryan Institute, National University of Ireland, Galway, Ireland
| | - Joseph P. Kerry
- Food Packaging Group, School of Food and Nutritional Sciences, College of Science, Engineering and Food Science, University College Cork, Cork, Ireland
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Murphy JT, Johnson MP, Viard F. A modelling approach to explore the critical environmental parameters influencing the growth and establishment of the invasive seaweed Undaria pinnatifida in Europe. J Theor Biol 2016; 396:105-15. [PMID: 26860657 DOI: 10.1016/j.jtbi.2016.01.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 07/02/2015] [Revised: 01/20/2016] [Accepted: 01/30/2016] [Indexed: 11/22/2022]
Abstract
A key factor to determine the expansion dynamics and future distribution of non-native species is their physiological response to abiotic factors and their changes over time. For this study we developed a spatially explicit, agent-based model of population growth to represent the complex population dynamics of invasive marine macroalgae with heteromorphic biphasic life cycles. The model framework represents this complex life cycle by treating the individual developmental stages (gametophytes/sporophytes) as autonomous agents with unique behaviour/growth parameters. It was parameterised to represent a well-documented invasive algal species, the Asian kelp Undaria pinnatifida, and validated against field results from an in situ population in Brittany, France, showing good quantitative agreement in terms of seasonal changes in abundance/recruitment and growth dynamics. It was then used to explore how local environmental parameters (light availability, temperature and day length) affect the population dynamics of the individual developmental stages and the overall population growth. This type of modelling approach represents a promising tool for understanding the population dynamics of macroalgae from the bottom-up in terms of the individual interactions between the independent life history stages (both microscopic and macroscopic). It can be used to trace back the behaviour of the population as a whole to the underlying physiological and environmental processes impacting each developmental stage and give insights into the roles these play in invasion success.
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Affiliation(s)
- James T Murphy
- Sorbonne Universités, UPMC Univ Paris 6, CNRS, UMR 7144, Department, Adaptation & Diversity in Marine Environment, Divco Team, Station Biologique de Roscoff, Place Georges Teissier, 29680 Roscoff, France; Marine Environment Research Group, Ryan Institute, National University of Ireland Galway, Galway, Ireland.
| | - Mark P Johnson
- Marine Environment Research Group, Ryan Institute, National University of Ireland Galway, Galway, Ireland
| | - Frédérique Viard
- Sorbonne Universités, UPMC Univ Paris 6, CNRS, UMR 7144, Department, Adaptation & Diversity in Marine Environment, Divco Team, Station Biologique de Roscoff, Place Georges Teissier, 29680 Roscoff, France
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