Open Defects Research Articles

Subsequent fertility, pregnancy, and gynaecological and psychological outcomes after maternal-fetal surgery for open spina bifida: A prospective cohort study.

To determine the medium-term maternal impact of open fetal spina bifida repair. Prospective cohort study. University Hospitals Leuven, Belgium. Mothers who had open maternal-fetal spina bifida repair between March 2012 and December 2021. A patient-reported survey on subsequent fertility, pregnancy, and gynaecological and psychological outcomes. Complications during subsequent pregnancies, and gynaecological and psychological problems. Seventy-two out of 100 invited women completed the questionnaire (72%). Despite being advised not to, seven of 13 women attempting to conceive became pregnant within 2 years after fetal surgery and one woman delivered vaginally. Two of the 16 subsequent pregnancies were complicated by an open neural tube defect. One pregnancy was complicated by a placenta accreta and one pregnancy was complicated by a uterine rupture, both with good neonatal outcomes. Nearly half of respondents who did not attempt to conceive reported that this was because of their experience of the index pregnancy and caring for the index child. Three out of four respondents reported medium-term psychological problems, mostly anxiety for the health of the index child, fear for recurrence in subsequent pregnancies and feelings of guilt. Open maternal-fetal surgery for spina bifida did not appear to affect fertility in our cohort. Half of the attempts to conceive took place within 2 years. One uterine rupture and one placenta accreta occurred in 16 subsequent pregnancies. Most respondents reported psychological problems linked to the index pregnancy, which reinforces the need for long-term psychological support.

Gallic acid-grafted chitosan antibacterial hydrogel incorporated with polydopamine-modified hydroxyapatite for enhancing bone healing.

An open critical-size bone defect is a major medical problem because of the difficulty in self-healing, leading to an increased risk of bacterial infection owing to wound exposure, resulting in treatment failure. Herein, a composite hydrogel was synthesized by chitosan, gallic acid, and hyaluronic acid, termed "CGH." Hydroxyapatite was modified with polydopamine (PDA@HAP) and introduced to CGH to obtain a mussel-inspired mineralized hydrogel (CGH/PDA@HAP). The CGH/PDA@HAP hydrogel exhibited excellent mechanical performances, including self-healing and injectable properties. Owing to its three-dimensional porous structure and polydopamine modifications, the cellular affinity of the hydrogel was enhanced. When adding PDA@HAP into CGH, Ca2+ and PO4 3- could release and then promoted differentiation of BMSCs into osteoblasts. Without any osteogenic agent or stem cells, the area of new bone at the site of defect was enhanced and the newly formed bone had a dense trabecular structure after implanting of the CGH/PDA@HAP hydrogel for 4 and 8 weeks. Moreover, the growth of Staphylococcus aureus and Escherichia coli was effectively inhibited through the grafting of gallic acid onto chitosan. Above, this study provides a reasonable alternative strategy to manage open bone defects.

A socio-ecological framework for examining foodborne parasitic infection risk

Human liver fluke infection through the consumption of raw freshwater fish is one of the foodborne parasitic infections of global concern. Despite decades of health campaign efforts, high prevalence of infection remains in different areas of the Lower Mekong Basin. This necessitates the consideration of the infection differences between places and the human-environment complexities of disease transmission. This paper used the socio-ecological model as a framework to unraveled the social science dimensions of liver fluke infection. We conducted questionnaire surveys in Northeast Thailand to gather participants’ knowledge on liver fluke infection and reasons for raw fish consumption. We synthesized our findings with prior work to identify factors influencing liver fluke infection at four socio-ecological levels. At the individual level, gender and age differences in food consumption habits and personal hygiene of open defection presented the behavioral risks. At the interpersonal level, family tradition and social gathering affected the disease risk. At the community level, physical-social-economic environments of land use and modernization, community health infrastructure and health volunteer support accounted for the varying degree of infection. At the policy level, impacts of regional and national regulations on disease control, health system organization structure, and government development projects were of concerned. The findings provide insights into how infection risks are shaped by people's behavior, social connectedness, interactions with places, and the interplay of these multi-level socio-ecological influences. The framework therefore allows a more comprehensive understanding of liver fluke infection risks to inform a culturally sensitive and sustainable disease control program.

Морфологические особенности регенерации слизистой оболочки полости рта при применении полимерных пьезоэлектрических мембран

Wound defects of the oral mucosa are a common pathology the treatment of which often involves synthetic membranes. Development of varieties of such membranes is an ongoing process. This study aimed to register morphological features of the oral mucosa regeneration process in the presence of one of the varieties, the polymer piezoelectric membranes. The study involved 45 Wistar rats divided into 3 groups: 1) animals with an open wound defect; 2) animals with a wound defect covered with a copper-coated polymer membrane; 3) intact animals. The samples for morphometric study were collected on the 3rd, 7th and 12th days. On the 3rd day, rats of group 1 had the specific area of granulation tissue 1.4 times greater than that in group 2 (p = 0.033). In group 1 rats, endotheliocytes expressed more VEGF than in the animals of group 2. In group 2, the defect was ultimately completely covered with the epithelial layer, which was not the case in group 1. On the 7th day, the epithelium in rats of group 2 was twice as thick as the layer registered in group 1 (p = 0.019). Granulation tissue was replaced by loose fibrous connective tissue. In group 1, the specific area of inflammatory infiltration was greater than that of loose fibrous connective tissue, and the VEGF expression level was lower than in group 2. On the 12th day, the predominant tissue in group 2 was the loose fibrous connective tissue, the VEGF expression level equaled that of group 3, and peripheral nerves began to grow. In group 1, the specific area of dense fibrous tissue was 3.9 times greater than that in group 2 (p = 0.012), the epithelium had pathological changes and the VEGF expression was below control values. Thus, a polymer piezoelectric membrane had a positive effect on the post-wound restoration of the oral mucosa tissues.

Comparative Analysis of Welding Mechanical Properties FCAW Welding Joint of A36 and A53

A36 and A53 steels are low carbon steel with relatively similar carbon percentage, respectively 0,25-0,30% and 0,25-0,29%. Both steels are often used within the marine industry. The objective of this research is to figure out the effect of the variation of the groove angle and the heat input to the process of welding two different steel plates towards a metallography, tensile, and bending test with E71T electrode, as well as figuring out the groove angle and heat input to weld 18 mm thick steel plates. The variation of the groove angle used are 55°, 60°, and 70° with heat input variation of 140 and 180 A. Results of this experimental study shows that specimen with groove angle 70° and heat input 180 A with the largest sum of HAZ length, which is 8,4 mm, as well as the largest perlite phase, which are respectively, 67% within A36 base metal, 65% on A36 HAZ, 62% on weld metal,63% on A53 HAZ, and 66% on A53 base metal. The largest open defect value in bending tests is 1.87 mm owned by specimens with groove angle of 55° and heat input of 140 A.

Characterization of defect microstructure in MgRE (RE=Ce, Nd) alloys after processing by high-pressure torsion using positron annihilation spectroscopy and a high resolution X-ray diffraction

Two MgRE (RE = Ce, Nd) alloys with ultrafine-grain (UFG) microstructures were prepared by high-pressure torsion (HPT) at room temperature. The in-depth distribution of defects was characterized by Doppler broadening –variable energy positron annihilation spectroscopy (DB-VEPAS). The characteristic S parameter increases in bulk after HPT processing relative to an as-received sample and shows a relative stability between ½ and 10 turns, which suggests a rise in the open volume defect density. However, a theoretical analysis of the S(E) depth profile reveals an increase in the positron diffusion length from ∼115 nm for the as-received state to ∼207 nm after 10 HPT turns. Almost all the open volume defect consisted of dislocations (positron lifetime of τ = 260 ps). The dislocation density deduced from high-resolution X-ray diffraction in the HPT disc radial direction was reasonably homogeneous (around 4–6 × 1014 m−2).

Electronic structure and nanoindentation properties of electrochemical hydrogen-charged Zr-based metallic glasses

Zr55Cu30Ni5Al10 metallic glasses were treated by an electrochemical hydrogen- (H-)charging method. Samples with different H content were obtained by changing the H-charging current density and charging time. X-ray diffraction, nanoindentation, X-ray photoelectron spectroscopy (XPS), ultraviolet photoelectron spectroscopy, and positron annihilation experiments were used to investigate amorphous structure, nanomechanical properties, electronic structure, and positron annihilation behavior of Zr55Cu30Ni5Al10 metallic glasses after electrochemical hydrogenation treatment. The results showed that the diffraction angle corresponding to the diffuse scattering peak gradually moved to a low angle with increased H content. At the same time, the hardness and elastic modulus of the MG were significantly increased with increased H-charging content. When the H content was high, the sawtooth rheological phenomenon disappeared in the load displacement curve of the MG during nanoindentation. XPS narrow spectrum analysis showed that the Zr-3d peak in samples shifted to higher binding energies, while the other elements shifted toward lower binding energy, indicating that H addition led to the transfer of valence electrons from Zr-3d to the Zr–H bond state, resulting in hardening. Three lifetime components are observed in the uncharged and charged sample, indicating the presence of three size ranges of open volume sites. After electrochemical hydrogen charging it causes a significant decrease in the size (lifetime) of the three open volume defects, indicating that the hydrogen occupies those sites. With the increase of hydrogen content, the concentration (intensity) of the first two open volume defects gradually decreases, while the third open volume defect gradually enhances, indicating that hydrogen atom mainly occupies the first two open volume defects. Positron annihilation experiments showed that H addition reduced the average annihilation lifetime of positron vacancies in these MGs, but no new defects were produced.

Clinical application and evaluation of health economics for non-invasive prenatal testing of fetuses in Tianjin

To assess the clinical efficacy and health economic value of non-invasive prenatal testing (NIPT) for the prenatal screening of common fetal chromosomal aneuploidies. 10 612 pregnant women from October 2017 to December 2019 presented at the antenatal screening clinic of the General Hospital of Tianjin Medical University were selected as the study subjects. Results of NIPT and invasive prenatal diagnosis and follow-up outcome for the 10 612 pregnant women were retrospectively analyzed and compared. Meanwhile, NIPT data for two periods were analyzed for assessing the health economic value of NIPT as the second- or first-tier screening strategy for the prenatal diagnosis of fetal trisomies 21, 18 and 13. The NIPT was successful in 10 528 (99.72%) subjects, with the sensitivity for fetal trisomies 21, 18 and 13 being 100%, 92.86% and 100%, and the positive predictive value (PPV) being 89.74%, 61.90% and 44.44%, respectively. The PPV of NIPT for sex chromosome aneuploidies was 34.21%. Except for one false negative case of trisomy 18, the negative predictive value for trisomy 21, trisomy 13 and other chromosomal abnormalities were 100%. For pregnant women with high risk by serological screening, advanced maternal age or abnormal ultrasound soft markers, NIPT has yielded a significantly increased high risk ratio. There was no statistical difference in the PPV of NIPT among pregnant women from each subgroup. NIPT would have higher health economic value as a second-tier screening until 2019, while compared to 2015 ~ 2017, its incremental cost-effectiveness ratio as a first-tier screening had declined clearly. The screening efficacy of NIPT for trisomies 21, 18 and 13 for a mixed population is significantly better than conventional serological screening, but it is relatively low for sex chromosomal abnormalities. NIPT can also be recommended for populations with relatively high risks along with detailed pre- and post-test genetic counselling. From the perspective of health economics, except for open neural tube defects, it is possible for NIPT to replace the conventional serological screening in the future as its cost continues to decrease.

Single-Stage Titanium Mesh Cranioplasty for the Treatment of Depressed Skull Fractures

Historically, depressed skull fractures that warranted surgery were treated in 2 stages: the first stage involved debridement and craniectomy, followed by the second stage of delayed cranioplasty. More recently, single-stage autologous cranioplasty has been proven to be safe. However, there is a paucity of literature regarding single-stage titanium mesh cranioplasty when autologous repair is not possible. A retrospective review identified 22 patients who underwent single-stage titanium mesh cranioplasty for the acute treatment of comminuted depressed skull fractures. Fracture location, fracture etiology, timing of surgery, neurologic complications, infection, and cosmetic deformity were recorded. Average follow-up was 9months. The mean age of the patients was 34years (range: 3-77); 83% were male. Seventeen (77%) involved the frontal bone, with 7 (32%) involving the frontal sinus. Eighteen (82%) had open defects at presentation. Sixteen (73%) were neurologically normal. Average time from presentation to repair was 11hours (range: 1-28hours). There were no neurologic worsening, seizures, or infections postoperatively. Antibiotic prophylaxis was prescribed in 13 cases (57%). One patient required revision surgery for persistent cosmetic deformity. Autologous cranioplasty for depressed skull fractures is not always possible especially in cases of significant comminution. From our case series, single-stage titanium mesh cranioplasty appears to be a safe option.

Identifying Resistive Open Defects in Embedded Cells under Variations

Small Delay Faults (SDFs) due to weak defects and marginalities have to be distinguished from extra delays due to process variations, since they may form a reliability threat even if the resulting timing is within the specification. In this paper, it is shown that these faults can still be identified, even if the corresponding defect cell is deeply embedded into a combinational circuit and its observability is restricted. The results of a few delay tests at different voltages and frequencies serve as the input to machine learning procedures which can classify a circuit as marginal due to defects or just slow due to variations. Several machine learning techniques are investigated and compared with respect to accuracy, precision, and recall for different circuit sizes and defect scales. The classification strategies are powerful enough to sort out defective devices without a major impact on yield.

РАСЧЁТНО-ЭКСПЕРИМЕНТАЛЬНОЕ ИССЛЕДОВАНИЕ СЖАТИЯ ПОСЛЕ УДАРА (CAI-ТЕСТ) ТКАНЕВОГО КОМПОЗИТА СО СКВОЗНЫМ ДЕФЕКТОМ

We examine a new approach to the computational assessment of the compressive fracture load (compression after impact, CAI) of a fabric composite with an open hole defect. The simulation takes into account the possibility of inelastic deformation of the polymer and the failure of fibers. Numerical calculations were conducted in ANSYS WB using standard material models from its library: orthotropic and isotropic elastic-plastic media. The materials used are fixed on common nodes of the finite element mesh, which ensures joint work and complex properties that are not inherent in standard material models (mFEA approach). In the experiments, STEF industrial GFRP 4 mm thick based on type E-type fibers and epoxyphenolic resin was used. Defects from a low-speed impact are replaced in the calculations by an open hole defect. The curves of nonlinear deformation and fracture obtained in the calculations are in good agreement with the experimental ones up to fracture.

Signal Integrity Analysis of Neuronal Spike Signal in 3-D Packaging

Prompted by the continual advancements in artificial intelligence, the neuromorphic chip based on a spiking neural network (SNN) has attracted considerable attention because of its beneficial architecture of memory computing integration. Unlike traditional artificial neural network (ANN), SNNs process information based on discrete-time spikes. This unique spike signal tends to bring an entire new series of signal integrity problems in 3-D packaging. In this paper, the RLGC equivalent circuit of through-silicon vias (TSV) and redistribution layers (RDL) structure were modeled in 3-D packaging. Furthermore, the spike signal integrity (SI) issues, such as reflection, delay and loss of spike signal, were also analyzed in 3-D packaging. The results illustrated that the corners between RDL and TSV in 3-D packaging could lead to reflections on the spike signals, resulting in distorted waveforms and increased signal loss. The time delay of the spike signal is only related to the electrical characteristics of the transmission link itself but not to the input signal. In addition, the SI of the spike signal was simulated with possible internal voids as well as the open and short defects in the 3-D packaging. The findings also demonstrated that both open and short defects distort the spike signal's waveform, whereas internal voids almost do not affect the signal. This paper presents the first systematic analysis of numerous SI issues of spike signals in 3-D packaging while providing a specific reference for designing neuromorphic chips.

Surgical treatment outcome of children with neural-tube defect: A prospective cohort study in a high volume center in Addis Ababa, Ethiopia

IntroductionPrevalence of neural tube defects (NTD) is high thus many children are born with a neural tube defect in Addis Ababa, and surgical closure is a commonly performed procedure at the pediatric neurosurgical specialty center. Research questionThe primary aim is to study the outcomes in children undergoing surgical closure of NTDs and to identify risk factors for readmission, complications and mortality. Material and methodsSingle-center prospective study of all surgically treated NTDs from April 2019 to May 2020. ResultsA total of 228 children, mean age 11 days (median 4) underwent surgery during the study period. There were no in-hospital deaths. Perioperatively 11 (4.8%) children developed wound complications, none of them needed surgery and there was no perioperative mortality. The one-year follow-up rate was 62.7% (143/228) and neurological status remained stable since discharge in all. The readmission and reoperation rates were 38 % and 8 % and risk factors for readmission were hydrocephalus (80%) and open defects (88%). Hydrocephalus (P = 0.05) and younger age (P = 0.02) were identified as risk factors for mortality. The wound-related complication rate was 55% at and was associated with large defects (P = 0.04) and delayed closure due to late hospital presentation (P = 0.01). Discussion and conclusionThe study reveals good perioperative surgical outcome and further need for systematic improvement in treatment and follow-up of NTD patients especially with hydrocephalus. We identified risk factors for wound-related complications, readmission and mortality.

Live-Imaging Analysis of Epithelial Zippering During Mouse Neural Tube Closure.

Zippering is a phenomenon of tissue morphogenesis whereby fusion between opposing epithelia progresses unidirectionally over significant distances, similar to the travel of a zip fastener, to ultimately ensure closure of an opening. A comparable process can be observed during Drosophila dorsal closure and mammalian wound healing, while zippering is employed by numerous organs such as the optic fissure, palatal shelves, tracheoesophageal foregut, and presumptive genitalia to mediate tissue sealing during normal embryonic development. Particularly striking is zippering propagation during neural tube morphogenesis, where the fusion point travels extensively along the embryonic axis to ensure closure of the neural tube. Advances in time-lapse microscopy and culture conditions have opened the opportunity for successful imaging of whole-mouse embryo development over time, providing insights into the precise cellular behavior underlying zippering propagation. Studies in mouse and the ascidian Ciona have revealed the fine-tuned cell shape changes and junction remodeling which occur at the site of zippering during neural tube morphogenesis. Here, we describe a step-by-step method for imaging at single-cell resolution the process of zippering and tissue remodeling which occurs during closure of the spinal neural tube in mouse. We also provide instructions and suggestions for quantitative morphometric analysis of cell behavior during zippering progression. This procedure can be further combined with genetic mutant models (e.g., knockouts), offering the possibility of studying the dynamics of tissue fusion and zippering propagation, which underlie a wide range of open neural tube defects.

Fetal Surgery for Myelomeningocele: Neurosurgical Perspectives.

More than 30years have elapsed since it was recognised that folic acid supplementation could substantially reduce the risk of open neural tube defects (ONTDs). During that time, many countries have adopted policies of food fortification with demonstrable reduction in the incidence of both cranial and spinal ONTDs. Improved prenatal detection and termination has also resulted in a reduction in the number of affected live births. Nonetheless, in the USA about 1500 children, and in the UK around 500 children are born each year with myelomeningocele (MMC) and so the management of MMC and its complications continues to constitute a significant clinical workload for many paediatric neurosurgical units around the world.Until recently, the options available following antenatal diagnosis of MMC were termination of pregnancy or postnatal repair. As a result of the MOMS trial, prenatal repair has become an additional option in selected cases (Adzick et al., N Engl J Med 364(11):993-1004, 2011). Fetal surgery for myelomeningocele is now offered in more than 30 centres worldwide. The aim of this chapter is to review the experimental basis of prenatal repair of MMC, to critically evaluate the neurosurgical implications of this intervention and to describe the technique of 'open' repair, comparing this with emerging minimally invasive alternatives.

Clinical Application of a Synthetic Hybrid-Scale Fiber Matrix in a Pediatric Trauma Patient

Introduction. Large soft tissue defects resulting from trauma in the pediatric population are common. MLLs are a rare subset of these injuries with no standard treatment regimen. Thorough surgical debridement of these lesions is often warranted to remove necrotic tissue and contamination, which results in a large, open soft tissue defect. STSGs may be used to provide tissue coverage; however, they have limitations, including donor site morbidity and additional surgical time and cost. Case Report. A 12-year-old female with a cutaneous thermal contact burn and an MLL of the right lower medial thigh declined STSG to avoid additional operations. The wound was treated with an SHSFM that is engineered to mimic the structure and architecture of human extracellular matrix and supports cellular infiltration and proliferation with minimal inflammatory response. Over a 4-month period, the SHSFM was applied 6 times at 2- to 3-week intervals, resulting in complete regranulation and wound closure with no further surgical procedures required. Conclusions. This case demonstrates the utility of the SHSFM in the management of pediatric surgical wounds and highlights the flexibility of the SHSFM in achieving the goals of both patient and physician alike.

A New Surgical Paradigm for Postnatal Repair of Open Neural Tube Defects Using Intraoperative Neurophysiology Monitoring.

An open neural tube defect (ONTD) features an exposed, unclosed neural plate in the form of an expanded and frequently hefty neural placode. Traditional philosophy of ONTD repair aims at preserving the placode at any cost, which often means stuffing the entire thick and unwieldy but non-functional tissue into a tight dural sac, increasing the likelihood of future tethering of the spinal cord. The same philosophy of attempting to save the whole perimetry of the placode also sometimes leads to inadvertent inclusion of parts of the squamous epithelial membrane surrounding the placode into the reconstructed product, only to form inclusion dermoid cyst causing further injury to the neural tissues. Lastly, unsuccessful neurulation of the caudal primary neural tube almost always adversely affects junctional and secondary neurulation resulting in a defective conus, often with a locally active sacral micturition centre that is isolated from and therefore lacking suprasegmental inhibitory moderation. This frequently leads to the development of a spastic, hyperactive, low-compliance and high-pressure bladder predisposing to upstream kidney damage, without benefits of normal bladder function. We are introducing a new surgical technique designed to minimise or eliminate these three undesirable complications of conventional ONTD closure.

Craniorachischisis in a 33-week-old Female Fetus: A Case Report

We report the case of a 33-week-old female fetus born with craniorachischisis to a gravida 5, para 4 (3104) mother with no previous history of conceiving a child with a neural tube defect. Craniorachischisis is characterized by anencephaly and an open defect extending from the brain to the spine and is the most severe and fatal type of neural tube defect. Although the cause of neural tube defects is hypothesized to be multifactorial and is usually sporadic, the risk is increased in neonates born to mothers with a family history or a previous pregnancy with neural tube defect, both of which are not present in the index case. This case is unique in that only during the fifth pregnancy did the couple conceive a child with a neural tube defect, emphasizing that folic acid supplementation, the sole preventive measure proven to decrease the risk of neural tube defects, remains to be important in the periconceptual period for all women of childbearing age. &nbsp

Systematic classification and comparison of maternal and obstetrical complications following 2 different methods of fetal surgery for the repair of open neural tube defects

In utero repair of open neural tube defect (ONTD) using an open hysterotomy approach (hereafter referred to as "Open") has been shown to reduce the need for ventriculo-peritoneal shunting and to improve motor outcomes for affected infants. Laparotomy-assisted fetoscopic repair (hereafter referred to as "Hybrid") is an alternate approach that may confer similar neurological benefits, while reducing the incidence of hysterotomy related complications. In this study we aimed to analyze procedure related maternal and fetal complications of in-utero repair using the Clavien-Dindo classification, and to compare the outcomes of the Hybrid and Open approaches. This was a retrospective cohort study conducted in a single center between September 2011 and July 2021. All patients who met the MOMS criteria and who underwent either Hybrid or Open fetal surgery were included, Maternal complications were classified using a unique adapatation of the Clavien-Dindo scoring system allowing the development of a comprehensive complication index score specific to fetal surgery. Primary fetal outcome was defined as gestational age at delivery and summarized according to the World Health Organization definitions of preterm delivery. There were 146 fetuses with ONTD who were eligible for, and underwent, in utero repair during the study period. Of these, 102 underwent Hybrid fetoscopic repair and 44 underwent Open hysterotomy repair. Gestational age at the time of surgery was higher in the Hybrid group when compared with the Open group (25.1 vs. 24.8 weeks, p=0.004). Maternal body mass index was lower in the Hybrid compared to the Open group (25.4 vs 27.1 kg\m2, p=0.02). The duration of Hybrid fetoscopic surgery was significantly longer than for the Open repair (250 min vs 164 min, p<0.001). There was a significantly lower Clavien-Dindo grade III complication rate (4.9% vs. 43.2%, p<0.001), as well as a significantly lower overall comprehensive maternal complication index (8.7 vs. 22.6, p=0.021), in the Hybrid group vs. the Open group. Gestational age at delivery was significantly higher in the Hybrid group (38.1 weeks) compared to the Open group (35.8 weeks) p<0.001, and this finding persisted when gestational age at delivery was analyzed using the WHO definitions of preterm delivery. Utilization of our adaptation of the standardized Clavien-Dindo classification to assess the maternal complications associated with in utero ONTD repair provides a new method to objectively assess different fetal surgical approaches. It also provides a much-needed standardized tool to allow objective comparisons between methods, which can be used when counseling patients. The Hybrid ONTD repair was associated with a lower rate of maternal adverse events than the Open approach, and was associated with later gestational age at delivery and less preterm delivery.

Apert Syndrome: Radiologist’s Perspective

Background: Apert syndrome (acrocephalosyndactyly type 1) is a rare syndrome, well known by severe syndactyly, dysmorphic face and craniosynostosis and is caused by FGF (fibroblast growth factor) receptor-2 gene mutations. Case Report: This is a case report of one year old girl child who presented with syndactyly of bilateral hands and feet, delayed milestones and dysmorphic facial features. Radiograph of the hands and feet of the patient revealed bilateral soft tissue and bony syndactyly, single broadened dysplastic phalanx in both great toes and presence of only two phalanges in 2nd to 5th toes. Non-contrast computed tomography of the head revealed bi-coronal synostosis and a widely open midline calvarial defect extending from posterior fontanelle to the root of the nose with hypoplastic bilateral maxillae. Intra-parenchymal findings including ventriculomegaly, corpus callosum thinning, absent cavum septum pellucidum and enlarged cystic space in posterior fossa were also present. Conclusion: Recognition of characteristic clinical and imaging abnormalities are crucial to radiologists and clinicians in the diagnosis and management of these patients. Since there is multi-system involvement, a multidisciplinary approach is needed in the management of patients.