scholarly journals Association of uterine activity and maternal volatile anesthetic exposure during open fetal surgery for spina bifida: a retrospective analysis

2021 ◽  
Vol 46 ◽  
pp. 102974
Author(s):  
S. Tra ◽  
N. Ochsenbein-Kölble ◽  
P. Stein ◽  
M. Meuli ◽  
U. Moehrlen ◽  
...  
Genetics ◽  
2002 ◽  
Vol 161 (2) ◽  
pp. 563-574
Author(s):  
Laura K Palmer ◽  
Darren Wolfe ◽  
Jessica L Keeley ◽  
Ralph L Keil

Abstract Volatile anesthetics affect all cells and tissues tested, but their mechanisms and sites of action remain unknown. To gain insight into the cellular activities of anesthetics, we have isolated genes that, when overexpressed, render Saccharomyces cerevisiae resistant to the volatile anesthetic isoflurane. One of these genes, WAK3/TAT1, encodes a permease that transports amino acids including leucine and tryptophan, for which our wild-type strain is auxotrophic. This suggests that availability of amino acids may play a key role in anesthetic response. Multiple lines of evidence support this proposal: (i) Deletion or overexpression of permeases that transport leucine and/or tryptophan alters anesthetic response; (ii) prototrophic strains are anesthetic resistant; (iii) altered concentrations of leucine and tryptophan in the medium affect anesthetic response; and (iv) uptake of leucine and tryptophan is inhibited during anesthetic exposure. Not all amino acids are critical for this response since we find that overexpression of the lysine permease does not affect anesthetic sensitivity. These findings are consistent with models in which anesthetics have a physiologically important effect on availability of specific amino acids by altering function of their permeases. In addition, we show that there is a relationship between nutrient availability and ubiquitin metabolism in this response.


2021 ◽  
Author(s):  
Neeltje Crombag ◽  
Adalina Sacco ◽  
Bernadette Stocks ◽  
Philippe De Vloo ◽  
Johannes Van Der Merwe ◽  
...  

2021 ◽  
Vol 58 (S1) ◽  
pp. 306-306
Author(s):  
L. Lara‐Ávila ◽  
M. Martinez‐Rodriguez ◽  
R. Villalobos‐Gómez ◽  
H. López‐Briones ◽  
R. Cruz‐Martinez

2018 ◽  
Vol 45 (6) ◽  
pp. 430-434 ◽  
Author(s):  
Luca Mazzone ◽  
Ueli Moehrlen ◽  
Barbara Casanova ◽  
Samira Ryf ◽  
Nicole Ochsenbein-Kölble ◽  
...  

Author(s):  
Luc Joyeux ◽  
Enrico Danzer ◽  
Alan W Flake ◽  
Jan Deprest

Spina bifida aperta (SBA) is one of the most common congenital malformations. It can cause severe lifelong physical and neurodevelopmental disabilities. Experimental and clinical studies have shown that the neurological deficits associated with SBA are not simply caused by incomplete neurulation at the level of the lesion. Additional damage is caused by prolonged exposure of the spinal cord and nerves to the intrauterine environment and a suction gradient due to cerebrospinal fluid leakage, leading to progressive downward displacement of the hindbrain. This natural history can be reversed by prenatal repair. A randomised controlled trial demonstrated that mid-gestational maternal-fetal surgery for SBA decreases the need for ventriculoperitoneal shunting and hindbrain herniation at 12 months and improves neurological motor function at 30 months of age. This came at the price of maternal and fetal risks, the most relevant ones being increased prematurity and a persistent uterine corporeal scar. Recently minimally invasive fetal approaches have been introduced clinically yet they lack extensive experimental or clinical trials. We aim to provide clinicians with the essential information necessary to counsel SBA parents as the basis for considering referral of selected patients to expert fetal surgery centres. We review the reported clinical outcomes and discuss recent developments of potentially less invasive fetal SBA approaches.


The Lancet ◽  
1999 ◽  
Vol 353 (9150) ◽  
pp. 406 ◽  
Author(s):  
Gary Magram
Keyword(s):  

2017 ◽  
Vol 50 ◽  
pp. 357-357
Author(s):  
S. Sarmento ◽  
H.J. Milani ◽  
M.M. Barbosa ◽  
S. Cavalheiro ◽  
I. Suriano ◽  
...  

2020 ◽  
Vol 29 (3) ◽  
pp. 480-493
Author(s):  
VIRGINIA L. BARTLETT ◽  
MARK J. BLITON

Open-uterine surgery to repair spina bifida, or ‘fetal surgery of open neural tube defects,’ has generated questions throughout its history—and continues to do so in a variety of contexts. As clinical ethics consultants who worked (Mark J. Bliton) and trained (Virginia L. Bartlett) at Vanderbilt University—where the first successful cases of open-uterine repair of spina bifida were carried out—we lived with these questions for nearly two decades. We worked with clinicians as they were developing and offering the procedure, with researchers in refining and studying the procedure, and with pregnant women and their partners as they considered whether to undergo the procedure. From this experience in the early studies at Vanderbilt, we learned that pregnant women and their partners approach the clinical uncertainty of such a risky procedure with a curious and unique combination of practicality, self-reflection, fear, and overwhelming hope. These early experiences were a major contributing factor to the inclusion of an ethics-focused interview in the informed consent process for the Management of Myelomeningocele Study (MOMS) trial study design.


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