Wednesday, October 30, 2013

Modeling anterior development in mice: Diet as modulator of risk for neural tube defects.


Kappen C. (2013). Modeling anterior development in mice: Diet as modulator of risk for neural tube defectsAmerican Journal of Medical Genetics Part C Seminars in Medical Genetics. 163(4):333-56. doi: 10.1002/ajmg.c.31380. Epub 2013 Oct 4.

Abstract

Head morphogenesis is a complex process that is controlled by multiple signaling centers. The most common defects of cranial development are craniofacial defects, such as cleft lip and cleft palate, and neural tube defects, such as anencephaly and encephalocoele in humans. More than 400 genes that contribute to proper neural tube closure have been identified in experimental animals, but only very few causative gene mutations have been identified in humans, supporting the notion that environmental influences are critical. The intrauterine environment is influenced by maternal nutrition, and hence, maternal diet can modulate the risk for cranial and neural tube defects. This article reviews recent progress toward a better understanding of nutrients during pregnancy, with particular focus on mouse models for defective neural tube closure. At least four major patterns of nutrient responses are apparent, suggesting that multiple pathways are involved in the response, and likely in the underlying pathogenesis of the defects. Folic acid has been the most widely studied nutrient, and the diverse responses of the mouse models to folic acid supplementation indicate that folic acid is not universally beneficial, but that the effect is dependent on genetic configuration. If this is the case for other nutrients as well, efforts to prevent neural tube defects with nutritional supplementation may need to become more specifically targeted than previously appreciated. Mouse models are indispensable for a better understanding of nutrient-gene interactions in normal pregnancies, as well as in those affected by metabolic diseases, such as diabetes and obesity. © 2013 Wiley Periodicals, Inc.
 
PMID:24124024

A systematic review on bowel management and the success rate of the various treatment modalities in spina bifida patients

Velde SV, Biervliet SV, Bruyne RD, Winckel MV. (2013). A systematic review on bowel management and the success rate of the various treatment modalities in spina bifida patients.
Spinal Cord. 2013 Oct 15. doi: 10.1038/sc.2013.123. [Epub ahead of print]

Abstract

Study design:Systematic review.Objectives:To determine the different treatment modalities aimed at achieving fecal continence in spina bifida (SB) patients and their effectiveness.Setting:International literature.Method:Electronic databases were searched ('Pubmed', 'Web of science', 'CINAHL' and 'Cochrane') identifying studies published since the mid-eighties and screened for relevance according to the Centre for Reviews and Dissemination procedure guidelines. A total of 37 studies were selected for inclusion.Results:Studies on toilet sitting, biofeedback, anal plug, retrograde colon enemas (RCE) and antegrade colon enemas were found. Fecal continence was achieved in 67% of SB patients using conservative methods (n=509). In patients using RCE (n=190) an 80% continence rate was reached. Patients following surgical treatment (n=469) reached an 81% continence rate, however, 23% needed redo surgery because of complications. Better fecal continence was associated with an improved quality of life, which was negatively influenced by the amount of time spent on bowel management.Conclusion:Evidence favors an individually tailored stepwise approach with surgery as a final step in case of failure of conservative measures. Continued specialized support throughout life remains important to maintain continence. Cross-over and comparative trials are needed in order to optimize treatment.Spinal Cord advance online publication, 15 October 2013; doi:10.1038/sc.2013.123.
 
PMID:24126852

Estimate of the potential impact of folic acid fortification of corn masa flour on the prevention of neural tube defects.

Tinker SC, Devine O, Mai C, Hamner HC, Reefhuis J, Gilboa SM, Dowling NF, Honein MA. (2013) Estimate of the potential impact of folic acid fortification of corn masa flour on the prevention of neural tube defects. Birth Defects Res A Clin Mol Teratol.  97(10):649-57. doi: 10.1002/bdra.23158.

Abstract

BACKGROUND:

Hispanics in the US have a higher prevalence of neural tube defect (NTD) -affected pregnancies than non-Hispanic whites, and lower median total folic acid (FA) intake. FA fortification of corn masa flour (CMF) is a policy-level intervention for NTD prevention; however, the impact on NTD prevalence has not been estimated.

METHODS:

We developed a model to estimate the percentage reduction in prevalence of spina bifida and anencephaly (NTDs) that could occur with FA fortification of CMF. Model inputs included estimates of the percentage reduction in United States NTD prevalence attributed to FA fortification of enriched cereal grain products (1995-1996 vs. 1998-2002), the increase in median FA intake after enriched cereal grain product fortification, and the estimated increase in median FA intake that could occur with CMF fortification at the same level as enriched cereal grain products (140 μg/100 g). We used Monte Carlo simulation to quantify uncertainty. We stratified analyses by racial/ethnic group and rounded results to the nearest 10.

RESULTS:

We estimated CMF fortification could prevent 30 Hispanic infants from having spina bifida (95% uncertainty interval: 0, 80) and 10 infants from having anencephaly (95% uncertainty interval: 0, 40) annually. The estimated impact among non-Hispanic whites and blacks was smaller.

CONCLUSION:

CMF fortification with FA could prevent from 0 to 120 infants, with the most likely value of approximately 40, from having spina bifida or anencephaly among Hispanics, the population most likely to benefit from the proposed intervention. While this estimated reduction is unlikely to be discernible using current birth defect surveillance methods, it still suggests an important benefit to the target population. Birth Defects Research (Part A) 97:649-657, 2013. © 2013 Wiley Periodicals, Inc.

PMID:24142499
http://onlinelibrary.wiley.com/doi/10.1002/bdra.23158/full

Comparison of prenatal and postnatal treatments of spina bifida in Poland - a randomized, single-center study

Zamłyński J, Olejek A, Bohosiewicz J, Koszutski T, Ziomek G, Horzelska E, Gajewska-Kucharek A, Maruniak-Chudek I, Herman-Sucharska I, Kluczewska E, Horak S, Bodzek P, Zamłyński M, Kowalik J, Horzelski T. (2013).  Comparison of prenatal and postnatal treatments of spina bifida in Poland - a randomized, single-center study.
Journal of Maternal-Fetal and Neonatal Medicine. 2013 Oct 25. [Epub ahead of print]

Abstract

Abstract Objective: The aim of the study was a randomized comparison of the outcomes of intrauterine myelomeningocele repairs (IUMR) in type II Chiari malformation (II CM) fetuses with clinical data of newborns and infants operated on postnatally. Methods: The study group (SG) comprised of 46 pregnant women whose type II CM children underwent IUMR, while 47 pregnant women whose type II CM children were operated on postnatally constituted the control group (CG). A total of 24 SG and 20 CG patients reached the endpoint of the study. Results: High incidence of PROM (24 (52.2%), CI 3.74 (1.69-8.26) (p<0 .001="" 0.35="" 1.86="" 16="" able="" adaptive="" adverse="" after="" and="" are="" as="" can="" cg="" chiari="" children="" ci="" closure="" compared="" conclusions:="" contrast="" controls.="" controls="" course="" equipment.="" especially="" evolution="" for="" from="" further="" group="" ii="" implantation="" in="" independently.="" ipprom="" iumr.="" iumr="" labor="" lower="" lowers="" malformation.="" measures="" mmc="" need="" needed="" none="" noted="" of="" on="" p="" postnatally="" postoperative="" prenatal="" preterm="" preventive="" respectively="" shunt="" significantly="" statistically="" studies="" study="" surgeries="" the="" to="" treated="" two="" type="" vp="" walk="" was="" without="">
 
PMID:24156622

Maternal flu or fever, medications use in the first trimester and the risk for neural tube defects: a hospital-based case-control study in China.

Wang M, Wang ZP, Gong R, Zhao ZT. (2013) Maternal flu or fever, medications use in the first trimester and the risk for neural tube defects: a hospital-based case-control study in China.
Child's Nervous System. 2013 Oct 26. [Epub ahead of print]

Abstract

PURPOSE:

This study aims to evaluate the effects of maternal flu or fever, and medications (antibiotics and antipyretics) use in the first trimester on neural tube defects (NTDs) risk in offspring.

METHODS:

Data came from a hospital-based case-control study conducted between 2006 and 2008 in Shandong/Shanxi provinces including 459 mothers with NTD-affected births and 459 mothers without NTD-affected births. Logistic regression models were used to evaluate the effects of maternal flu, fever, and medications use on NTD risk. The effects were evaluated by adjusted odds ratio (OR) and 95 % confidence intervals (CIs) with SAS9.1.3.software.

RESULTS:

NTDs risks were significantly associated with maternal flu or fever (OR = 2.63, 95 % CI = 1.64-4.23) and antipyretics use (OR = 3.38, 95 % CI = 1.68-6.79), but not with antibiotics use (OR = 1.82, 95 % CI = 0.85-3.93). The risk effect of antipyretics use on anencephaly (OR = 7.81, 95 % CI = 1.96-31.13) was markedly higher than on spina bifida (OR = 3.02, 95 % CI = 1.08-8.42). Maternal flu or fever together with antipyretics use showed a higher OR for total NTDs (3.27 vs.1.87), anencephaly (7.38 vs.2.08), and spina bifida (2.97 vs.2.07) than maternal flu or fever with no antipyretics use.

CONCLUSIONS:

Maternal flu or fever and antipyretics use in the first trimester were risk for NTDs. Maternal flu or fever together with antipyretics use increased NTD risk than only maternal flu or fever.

PMID:24158591

Effect of Pulsed Nd:YAG Laser in the Treatment of Neuropathic Foot Ulcers in Children with Spina Bifida: A Randomized Controlled Study

Ebid AA, Abd El-Kafy EM, Alayat MS. (2013) Effect of Pulsed Nd:YAG Laser in the Treatment of Neuropathic Foot Ulcers in Children with Spina Bifida: A Randomized Controlled Study.
Photomedicine and Laser Surgery. 2013 Oct 25. 

Abstract

Abstract Objective: This study assessed the effects of pulsed Nd:YAG laser treatment of neuropathic foot ulcers in children with spina bifida. Background data: Children with spina bifida face increased risk for developing neuropathic foot ulcers. Methods: In a randomized controlled trial, 39 children and adolescents (ages 6-15 years) with spina bifida and stage III neuropathic foot ulcers were randomly assigned to the laser group or the placebo laser group. The former received pulsed Nd:YAG laser treatments (i.e., total energy of 300-350 J during three sessions/week) plus standard wound care, and the latter received sham laser treatments plus standard wound care. Wound size and wound appearance were assessed for all patients at the beginning of the treatment, after 5 weeks, and after 10 weeks. Results: The decrease in wound surface area at 5 and 10 weeks post- treatment was significantly greater in the laser group (i.e., 2.44±0.33 and 0.29±0.25 cm2, respectively) than in the placebo group (i.e., 3.81±0.18 and 3.24±0.44 cm2, respectively). Also, the decrease in the total score for the Pressure Sore Status Tool (PSST) at 5 and 10 weeks post-treatment was significantly different for the laser group (i.e., 32.76±2.30 and 17.52±1.66, respectively) than for the placebo group (i.e., 46.50±2.12 and 38.11±3.17, respectively). Conclusions: Treatment with pulsed neodymium:yttrium aluminum garnet (Nd:YAG) laser combined with standard wound care decreases wound size and improves wound appearance for stage III neuropathic foot ulcers in children with spina bifida.
PMID: 24160904