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Neurosurgical Review Jun 2024After myelomeningocele (MMC) repair, a secondary tethered spinal cord occurs in almost all patients. The tethered spinal cord may result in progressive neurological...
After myelomeningocele (MMC) repair, a secondary tethered spinal cord occurs in almost all patients. The tethered spinal cord may result in progressive neurological deterioration and walking disability. This retrospective cohort study aimed to highlight the walking recovery one year after tethered cord release and its relation to the preoperative conus level. We reviewed the medical records at our university hospital from January 2014 to December 2022. The patients who underwent spinal cord untethering following lumbosacral MMC repair were included. We assessed the walking recovery one year after cord release using the modified Benzel scale. Thirty-seven patients met our selection criteria. There were 19 girls (51.4%) and 18 boys (48.6%). Their mean age at presentation was 8.6 years. The preoperative conus vertebral levels ranged between L4 and S3. One year after spinal cord release, 37.8% of the patients regained their walking ability. All the patients whose preoperative conus level was at S2 or S3 regained their walking ability. In contrast, all the patients with preoperative conus levels at L4 or L5 didn't regain their ability to walk. One-third (33.3%) of patients whose conus was at the S1 level regained their walking ability one year after cord release. One year after tethered cord release, 37.8% of the patients regained their walking ability. We found that the walking recovery was statistically associated with the preoperative conus level. A multicenter prospective study is required to support the results of this study.
Topics: Humans; Male; Female; Walking; Child; Recovery of Function; Retrospective Studies; Neural Tube Defects; Child, Preschool; Adolescent; Meningomyelocele; Treatment Outcome; Neurosurgical Procedures
PubMed: 38914693
DOI: 10.1007/s10143-024-02497-8 -
Toxicology and Applied Pharmacology Jun 2024Aripiprazole (ARI) is a recently developed antipsychotic medication that belongs to the second generation of antipsychotics. The literature has contradictory information...
INTRODUCTION
Aripiprazole (ARI) is a recently developed antipsychotic medication that belongs to the second generation of antipsychotics. The literature has contradictory information regarding ARI, which has been classified as pregnant use category C by the FDA.
METHODS
125 pathogen-free fertilized eggs were incubated for 28 h and divided into five groups of 25 eggs each (including the control group), and 18 eggs with intact integrity were selected from each group. After the experimental groups were divided, ARI was administered subblastodermally with a Hamilton micro-injector at 4 different doses (1 mg/kg, 5 mg/kg, 10 mg/kg, 20 mg/kg). At the 48th hour of incubation, all eggs were hatched and embryos were removed from the embryonic membranes. And then morphologic (position of the neural tube (open or closed), crown-rump length, number of somites, embryological development status), histopathologic (apoptosis (caspase 3), cell proliferation (PCNA), in situ recognition of DNA breaks (tunnel)), genetic (BRE gene expression) analyzes were performed.
RESULTS
According to the results of the morphological analysis, when the frequency of neural tube patency was evaluated among the experimental groups, a statistically significant difference was determined between the control group and all groups (p < 0.001). In addition, the mean crown-rump length and somite number of the embryos decreased in a dose-dependent manner compared to the control group. It was determined that mRNA levels of the BRE gene decreased in embryos exposed to ARI compared to the control group (p < 0.001).
CONCLUSION
Morphologically, histopathologically, and genetically, aripiprazole exposure delayed neurogenesis and development in early chick embryos. These findings suggest its use in pregnant women may be teratogenic. We note that these results are preliminary for pregnant women, but they should be expanded and studied with additional and other samples.
PubMed: 38906509
DOI: 10.1016/j.taap.2024.117009 -
The New England Journal of Medicine Jun 2024
Review
Topics: Humans; Arnold-Chiari Malformation; Female; Magnetic Resonance Imaging
PubMed: 38899696
DOI: 10.1056/NEJMra2308055 -
Congenital Anomalies Jun 2024There is an increase in the worldwide prevalence of congenital abdominal wall defects (CAWD), with gastroschisis (GS) and omphalocele (OC) being the most common. It is... (Review)
Review
There is an increase in the worldwide prevalence of congenital abdominal wall defects (CAWD), with gastroschisis (GS) and omphalocele (OC) being the most common. It is widely accepted that folic acid supplementation (FAS) in the maternal diet decreases the incidence of anomalies such as neural tube defects, but there is controversy regarding the possible beneficial role for other congenital malformations. Several epidemiological studies raise controversy regarding a possible relationship between vitamin supplementation with the occurrence of abdominal wall malformations. The aim of the present study is to obtain an updated review of the global frequency of CAWD in neonates and the relationship with FAS in the mothers. For this we have carried out a systematic search of epidemiological studies in different article databases between 2011 and 2022. The analysis of 25 studies conducted in different countries where cases of OC and/or GS are registered directly or together with other congenital defects shows that 60% inquire into the relationship of FAS with the incidence of CAWD. Half of them proposes a beneficial effect of FAS and the other half find no association, concluding that there is no unanimous evidence that FAS in the maternal diet decreases the incidence of CAWD. However, it seems that an influential factor to take into account is the nutritional habits of the mothers.
PubMed: 38897927
DOI: 10.1111/cga.12576 -
Revista Da Associacao Medica Brasileira... 2024The aim of this study was to understand the dynamics of families with children with myelomeningocele undergoing intrauterine fetal surgery.
OBJECTIVE
The aim of this study was to understand the dynamics of families with children with myelomeningocele undergoing intrauterine fetal surgery.
METHODS
A retrospective cohort pilot study was carried out with 11 mothers of children who had undergone intrauterine myelomeningocele repair. Participants in this study responded to an electronic questionnaire (via Google Forms), developed by the study authors, that consisted of 22 multiple-choice questions, of which 17 were closed-ended and 5 had a standardized format.
RESULTS
The mean (± standard deviation) of the mothers' age was 37.6 (± 3.5) years. The median of gestational age at delivery and birthweight were 34.9 (range, 33 to 36.1) weeks and 2,300 (range, 1,950 to 2,763) g, respectively. The majority of mothers were white (81.8%), had university degree (81.8%), were Catholic (63.6%), and were married (100%). The majority of mothers rated their relationship with their husband, family, and friends as excellent (54.5, 72.7, and 54.5%, respectively). All 11 mothers reported that the newborn with myelomeningocele was born <37 weeks gestation and the birthweight most often<2,500 g. Approximately 64% of the mothers reported that their child required adaptations or had special needs, of which walking aids (50%) and bladder control (50%) were the most common ones.
CONCLUSION
Telemedicine proved to be a useful tool in the long-term follow-up of children who underwent intrauterine surgery to correct myelomeningocele.
Topics: Humans; Meningomyelocele; Pilot Projects; Female; Adult; Retrospective Studies; Mothers; Telemedicine; Surveys and Questionnaires; Pregnancy; Infant, Newborn; Family Relations; Gestational Age
PubMed: 38896734
DOI: 10.1590/1806-9282.20231327 -
Nutrients Jun 2024The nutritional status of the mother-to-be has a key impact on the proper development of the fetus. Although all nutrients are important for the developing baby, recent... (Review)
Review
The nutritional status of the mother-to-be has a key impact on the proper development of the fetus. Although all nutrients are important for the developing baby, recent research indicates the importance of adequate choline intake during the periconceptional period, pregnancy, and lactation. Choline plays a key role in the biosynthesis of cell membranes, supporting liver function, neurotransmission, brain development, and DNA and histone methylation. Choline participates in the formation of a child's nervous system, supports its cognitive development, and reduces the risk of neural tube defects. The human body is incapable of producing sufficient choline to meet its needs; therefore, it must be obtained from the diet. Current data indicate that most women in their reproductive years do not achieve the recommended daily intake of choline. The presented narrative review indicates the importance of educating mothers-to-be and thereby increasing their awareness of the effects of choline on maternal and child health, which can lead to a more aware and healthy pregnancy and proper child development.
Topics: Humans; Choline; Female; Pregnancy; Maternal Nutritional Physiological Phenomena; Diet; Nutritional Status; Child Development; Mothers
PubMed: 38892700
DOI: 10.3390/nu16111767 -
International Journal of Molecular... May 2024Neural tube defects (NTDs), which are caused by impaired embryonic neural tube closure, are one of the most serious and common birth defects. Peptidyl-prolyl cis/trans...
Neural tube defects (NTDs), which are caused by impaired embryonic neural tube closure, are one of the most serious and common birth defects. Peptidyl-prolyl cis/trans isomerase 1 (Pin1) is a prolyl isomerase that uniquely regulates cell signaling by manipulating protein conformation following phosphorylation, although its involvement in neuronal development remains unknown. In this study, we explored the involvement of Pin1 in NTDs and its potential mechanisms both in vitro and in vivo. The levels of Pin1 expression were reduced in NTD models induced by all-trans retinoic acid (Atra). Pin1 plays a significant role in regulating the apoptosis, proliferation, differentiation, and migration of neurons. Moreover, Pin1 knockdown significantly was found to exacerbate oxidative stress (OS) and endoplasmic reticulum stress (ERs) in neuronal cells. Further studies showed that the Notch1-Nrf2 signaling pathway may participate in Pin1 regulation of NTDs, as evidenced by the inhibition and overexpression of the Notch1-Nrf2 pathway. In addition, immunofluorescence (IF), co-immunoprecipitation (Co-IP), and GST pull-down experiments also showed that Pin1 interacts directly with Notch1 and Nrf2. Thus, our study suggested that the knocking down of Pin1 promotes NTD progression by inhibiting the activation of the Notch1-Nrf2 signaling pathway, and it is possible that this effect is achieved by disrupting the interaction of Pin1 with Notch1 and Nrf2, affecting their proteostasis. Our research identified that the regulation of Pin1 by retinoic acid (RA) and its involvement in the development of NTDs through the Notch1-Nrf2 axis could enhance our comprehension of the mechanism behind RA-induced brain abnormalities.
Topics: Tretinoin; NIMA-Interacting Peptidylprolyl Isomerase; Animals; Mice; Neural Tube Defects; Receptor, Notch1; NF-E2-Related Factor 2; Signal Transduction; Down-Regulation; Apoptosis; Oxidative Stress; Neurons; Female; Neural Tube; Endoplasmic Reticulum Stress; Cell Proliferation; Cell Differentiation; Cell Movement; Humans
PubMed: 38891776
DOI: 10.3390/ijms25115588 -
Birth Defects Research Jun 2024Associations between maternal periconceptional exposure to disinfection by-products (DBPs) in drinking water and neural tube defects (NTDs) in offspring are...
BACKGROUND
Associations between maternal periconceptional exposure to disinfection by-products (DBPs) in drinking water and neural tube defects (NTDs) in offspring are inconclusive, limited in part by exposure misclassification.
METHODS
Maternal interview reports of drinking water sources and consumption from the National Birth Defects Prevention Study were linked with DBP concentrations in public water system monitoring data for case children with an NTD and control children delivered during 2000-2005. DBPs analyzed were total trihalomethanes, the five most common haloacetic acids combined, and individual species. Associations were estimated for all NTDs combined and selected subtypes (spina bifida, anencephaly) with maternal periconceptional exposure to DBPs in public water systems and with average daily periconceptional ingestion of DBPs accounting for individual-level consumption and filtration information. Mixed effects logistic regression models with maternal race/ethnicity and educational attainment at delivery as fixed effects and study site as a random intercept were applied.
RESULTS
Overall, 111 case and 649 control children were eligible for analyses. Adjusted odds ratios for maternal exposure to DBPs in public water systems ranged from 0.8-1.5 for all NTDs combined, 0.6-2.0 for spina bifida, and 0.7-1.9 for anencephaly; respective ranges for average daily maternal ingestion of DBPs were 0.7-1.1, 0.5-1.5, and 0.6-1.8. Several positive estimates (≥1.2) were observed, but all confidence intervals included the null.
CONCLUSIONS
Using community- and individual-level data from a large, US, population-based, case-control study, we observed statistically nonsignificant associations between maternal periconceptional exposure to total and individual DBP species in drinking water and NTDs and subtypes.
Topics: Humans; Female; Drinking Water; Neural Tube Defects; Pregnancy; Maternal Exposure; Disinfection; Adult; Case-Control Studies; Disinfectants; Water Purification; Trihalomethanes; Male; Water Pollutants, Chemical; Prenatal Exposure Delayed Effects; Spinal Dysraphism
PubMed: 38888449
DOI: 10.1002/bdr2.2370 -
BMJ Case Reports Jun 2024The authors were presented with a term female neonate with a large occipital mass, who was already being treated for neonatal pneumonia at another hospital. On...
The authors were presented with a term female neonate with a large occipital mass, who was already being treated for neonatal pneumonia at another hospital. On assessment, apart from the mass, the patient presented with an unremarkable systemic and neurological physical examination. She underwent repair of the occipital mass, which was complicated by nosocomial ventriculitis. However, the patient was discharged well after completing antibiotic treatment. On regular outpatient follow-ups, the patient presented with a good cry, suck, and activity. There have been no reports of seizures, decrease in sensorium, aspiration episodes, stridor or any other complaints, apart from poor head and sitting control. The workup also showed profound bilateral hearing loss. Despite these complications, the patient currently exhibits good visual and social development. This is attributed to timely intervention as well as the minimal amount of herniated cerebellar tissue that the patient presented with, highlighting the individualised management and outcomes for cases of Chiari malformation type III.
Topics: Humans; Female; Arnold-Chiari Malformation; Infant, Newborn; Magnetic Resonance Imaging; Treatment Outcome
PubMed: 38886000
DOI: 10.1136/bcr-2023-259479 -
Advances in Experimental Medicine and... 2024The major events of cardiac development, including early heart formation, chamber morphogenesis and septation, and conduction system and coronary artery development, are... (Review)
Review
The major events of cardiac development, including early heart formation, chamber morphogenesis and septation, and conduction system and coronary artery development, are briefly reviewed together with a short introduction to the animal species commonly used to study heart development and model congenital heart defects (CHDs).
Topics: Animals; Heart Defects, Congenital; Disease Models, Animal; Heart; Humans; Mice; Morphogenesis
PubMed: 38884705
DOI: 10.1007/978-3-031-44087-8_3