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Letter to the editor: Comments on venlafaxine paper by Laurent et al. 致编辑的信:对Laurent等人文拉法辛论文的评论。
Q Medicine Pub Date : 2016-11-01 DOI: 10.1002/bdra.23579
David Wise
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引用次数: 0
Twenty-five–year survival for aboriginal and caucasian children with congenital heart defects in Western Australia, 1980 to 2010 1980年至2010年西澳大利亚土著和高加索儿童先天性心脏缺陷的25年生存率
Q Medicine Pub Date : 2016-11-01 DOI: 10.1002/bdra.23572
Wendy N. Nembhard, Jenny Bourke, Helen Leonard, Luke Eckersley, Jingyun Li, Carol Bower

Background

Australian Aboriginal children have increased infant and childhood mortality compared with Caucasian children, but their mortality related to congenital heart defects (CHDs) throughout life is unknown.

Methods

We conducted a retrospective cohort study using data on 8,110 live born, singleton infants with CHDs born January 1980 to December 2010 from the Western Australian Register of Developmental Anomalies. Vital status was determined from death and medical records. Data for infants with chromosomal anomalies (except Down syndrome) were excluded. Kaplan-Meier Product-Limit estimates and 95% confidence intervals (CIs) were computed by Aboriginality. Hazard ratios (HRs) and 95% CIs were calculated from multivariable Cox-Proportional Hazard Regression models.

Results

Aboriginal children had lower survival than Caucasians for all CHDs combined but most notably during the neonatal period for functional single ventricle (50.0% vs. 86.1%; p = 0.015) and during the postneonatal period for tetralogy of Fallot (87.0% vs. 97.4%; p = 0.021) and atrioventricular septal defect (60.0% vs. 94.6%; p = 0.010). After adjusting for covariates except remoteness and socioeconomic status (SES), Aboriginal children with all CHDs combined (HR = 1.4; 95% CI, 1.0–1.9), with transposition of the great arteries (HR = 4.3; 95% CI, 1.0–18.9) or functional single ventricle (HR = 8.6; 95% CI, 1.3–57.9) had increased risk of mortality compared with Caucasian children. When remoteness and SES were included, the risks were not statistically significant.

Conclusion

Long-term survival was lower for Aboriginal children with CHDs, and Aboriginal children with specific CHD phenotypes had increased risk of mortality throughout life. Increased risk may be due to SES and environmental factors. Birth Defects Research (Part A), 2016. © 2016 Wiley Periodicals, Inc. Birth Defects Research (Part A) 106:1016–1031, 2016. © 2016 Wiley Periodicals, Inc.

澳大利亚土著儿童的婴儿和儿童死亡率比白种人儿童高,但其一生中与先天性心脏缺陷(CHDs)相关的死亡率尚不清楚。方法:我们对1980年1月至2010年12月出生的8110名CHDs活产单胎婴儿进行了回顾性队列研究,数据来自西澳大利亚发育异常登记处。根据死亡和医疗记录确定生命状况。排除了染色体异常婴儿(唐氏综合征除外)的数据。Kaplan-Meier产品极限估计和95%置信区间(ci)由Aboriginality计算。通过多变量cox -比例风险回归模型计算风险比(hr)和95% ci。结果原住民儿童合并冠心病的生存率均低于白种人,但在新生儿期的单心室功能表现最为明显(50.0% vs. 86.1%;p = 0.015)和新生儿后期法洛四联症(87.0% vs. 97.4%;P = 0.021)和房室间隔缺损(60.0% vs. 94.6%;P = 0.010)。在调整除偏远地区和社会经济地位(SES)以外的协变量后,所有冠心病的原住民儿童合并(HR = 1.4;95% CI, 1.0-1.9),伴有大动脉转位(HR = 4.3;95% CI, 1.0-18.9)或功能性单心室(HR = 8.6;95% CI(1.3-57.9)与白种人儿童相比死亡风险增加。当包括偏远和SES时,风险无统计学意义。结论土著儿童冠心病患者的长期生存率较低,具有特定冠心病表型的土著儿童终生死亡风险较高。增加的风险可能是由于SES和环境因素。出生缺陷研究(上),2016。©2016 Wiley期刊公司出生缺陷研究(A辑)106:1016-1031,2016。©2016 Wiley期刊公司
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引用次数: 4
Maternal autoimmune disease and birth defects in the National Birth Defects Prevention Study. 国家出生缺陷预防研究中的母体自身免疫性疾病与出生缺陷
Q Medicine Pub Date : 2016-11-01 DOI: 10.1002/bdra.23527
M. Howley, M. Browne, Alissa R Van Zutphen, Sandra D Richardson, S. Blossom, C. Broussard, S. Carmichael, C. Druschel
BACKGROUNDLittle is known about the association between maternal autoimmune disease or its treatment and the risk of birth defects. We examined these associations using data from the National Birth Defects Prevention Study, a multi-site, population-based, case-control study.METHODSAnalyses included 25,116 case and 9897 unaffected control infants with estimated delivery dates between 1997 and 2009. Information on autoimmune disease, medication use, and other pregnancy exposures was collected by means of telephone interview. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for birth defects with five or more exposed cases; crude ORs and exact 95% CIs were estimated for birth defects with three to four exposed cases.RESULTSAutoimmune disease was reported by 373 mothers (279 case and 94 control mothers). The majority of birth defects evaluated were not associated with autoimmune disease; however, a statistically significant association between maternal autoimmune disease and encephalocele was observed (OR, 4.64; 95% CI, 1.95-11.04). Eighty-two mothers with autoimmune disease used an immune modifying/suppressing medication during pregnancy; this was associated with encephalocele (OR, 7.26; 95% CI, 1.37-24.61) and atrial septal defects (OR, 3.01; 95% CI, 1.16-7.80).CONCLUSIONOur findings suggest maternal autoimmune disease and treatment are not associated with the majority of birth defects, but may be associated with some defects, particularly encephalocele. Given the low prevalence of individual autoimmune diseases and the rare use of specific medications, we were unable to examine associations of specific autoimmune diseases and medications with birth defects. Other studies are needed to confirm these findings. Birth Defects Research (Part A) 106:950-962, 2016. © 2016 Wiley Periodicals, Inc.
背景:关于母体自身免疫性疾病及其治疗与出生缺陷风险之间的关系,我们知之甚少。我们使用来自国家出生缺陷预防研究的数据来检验这些关联,这是一项多地点、基于人群的病例对照研究。方法纳入1997 - 2009年估计分娩日期的25116例病例和9897例未受影响的对照婴儿进行分析。通过电话访谈收集自身免疫性疾病、药物使用和其他妊娠暴露的信息。对5例或更多暴露病例的出生缺陷进行校正优势比(ORs)和95%置信区间(ci)估计;粗略的ORs和精确的95% ci估计有三到四个暴露病例的出生缺陷。结果373例产妇报告自身免疫性疾病(279例,对照组94例)。大多数被评估的出生缺陷与自身免疫性疾病无关;然而,母体自身免疫性疾病与脑膨出之间存在统计学上显著的关联(OR, 4.64;95% ci, 1.95-11.04)。82名患有自身免疫性疾病的母亲在怀孕期间使用了免疫修饰/抑制药物;这与脑膨出相关(OR, 7.26;95% CI, 1.37-24.61)和房间隔缺损(OR, 3.01;95% ci, 1.16-7.80)。结论母体自身免疫性疾病及其治疗与大多数出生缺陷无关,但可能与某些缺陷有关,特别是脑膨出。鉴于个体自身免疫性疾病的低患病率和罕见的特定药物的使用,我们无法检查特定自身免疫性疾病和药物与出生缺陷的关联。需要其他研究来证实这些发现。出生缺陷研究(A辑)(06):950-962,2016。©2016 Wiley期刊公司
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引用次数: 7
Using state and provincial surveillance programs to reduce risk of recurrence of neural tube defects in the United States and Canada: A missed opportunity? 在美国和加拿大,使用州和省监测项目来降低神经管缺陷复发的风险:一个错失的机会?
Q Medicine Pub Date : 2016-11-01 DOI: 10.1002/bdra.23576
T. Flood, Chelsea M Rienks, A. Flores, Cara T Mai, Barbara Frohnert, Rachel E. Rutkowski, J. Evans, R. Kirby
BACKGROUNDOnce a woman has had a fetus or infant affected with a neural tube defect (NTD), the risk of recurrence is approximately 3%. This risk can be significantly reduced by folic acid supplement consumption during the periconceptional period; however, this requires women at risk to be adequately informed about the appropriate dosage and timing of supplement intake before planning another pregnancy. As birth defects surveillance programs are tasked with identifying and documenting NTD-affected pregnancies and births, they are in a unique position to support recurrence prevention activities.METHODSIn 2015, we surveyed state and provincial birth defects surveillance programs to assess their NTD recurrence prevention activities. The online survey was sent to programs in 52 United States (U.S.) jurisdictions and all 13 provinces and territories in Canada. Findings were compared with a similar survey conducted in 2005 among U.S. programs.RESULTSIn 2015, of the 44 U.S. and Canadian surveillance programs that responded, only 9 programs (7 U.S. and 2 Canadian) reported currently having activities specifically directed toward preventing NTD recurrence. Compared with a 2005 survey of U.S. programs, the number of U.S. programs working on NTD recurrence prevention decreased by almost 50% (from 13 to 7 programs).CONCLUSIONThe number of birth defects surveillance programs with NTD recurrence prevention activities has decreased over the past decade due to a range of barriers, most notably a lack of resources. However, while some recurrence prevention activities require part-time staff, other activities could be accomplished using minimal resources. Birth Defects Research (Part A) 106:875-880, 2016.© 2016 Wiley Periodicals, Inc.
背景:一旦女性的胎儿或婴儿患有神经管缺陷(NTD),其复发的风险约为3%。在妊娠期补充叶酸可以显著降低这种风险;然而,这要求有风险的妇女在计划下一次怀孕前充分了解适当的剂量和摄入补充剂的时间。由于出生缺陷监测项目的任务是确定和记录受ntd影响的妊娠和分娩,它们在支持预防复发活动方面处于独特地位。方法2015年,我们对国家和省级出生缺陷监测项目进行调查,评估其预防新生儿td复发的活动。这项在线调查被发送到美国52个司法管辖区和加拿大所有13个省和地区的项目中。研究结果与2005年在美国各项目中进行的一项类似调查进行了比较。结果2015年,在美国和加拿大的44个监测项目中,只有9个项目(7个美国项目和2个加拿大项目)报告目前有专门针对预防NTD复发的活动。与2005年对美国项目的调查相比,美国致力于NTD复发预防的项目数量减少了近50%(从13个减少到7个)。结论在过去的十年中,由于一系列障碍,尤其是资源的缺乏,具有NTD复发预防活动的出生缺陷监测项目的数量有所减少。然而,虽然有些预防复发活动需要非全时工作人员,但其他活动可以用最少的资源完成。出生缺陷研究(A部分),2016。©2016 Wiley期刊公司
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引用次数: 1
Population-based microcephaly surveillance in the United States, 2009 to 2013: An analysis of potential sources of variation. 2009年至2013年美国基于人群的小头畸形监测:潜在变异来源分析
Q Medicine Pub Date : 2016-11-01 DOI: 10.1002/bdra.23587
J. Cragan, Jennifer L Isenburg, S. E. Parker, C. Alverson, R. Meyer, Erin B Stallings, R. Kirby, P. Lupo, Jennifer S. Liu, Amanda Seagroves, M. Ethen, Sook Ja Cho, M. Evans, R. Liberman, J. Fornoff, M. Browne, Rachel E. Rutkowski, A. Nance, M. Anderka, D. Fox, A. Steele, G. Copeland, P. Romitti, Cara T Mai
BACKGROUNDCongenital microcephaly has been linked to maternal Zika virus infection. However, ascertaining infants diagnosed with microcephaly can be challenging.METHODSThirty birth defects surveillance programs provided data on infants diagnosed with microcephaly born 2009 to 2013. The pooled prevalence of microcephaly per 10,000 live births was estimated overall and by maternal/infant characteristics. Variation in prevalence was examined across case finding methods. Nine programs provided data on head circumference and conditions potentially contributing to microcephaly.RESULTSThe pooled prevalence of microcephaly was 8.7 per 10,000 live births. Median prevalence (per 10,000 live births) was similar among programs using active (6.7) and passive (6.6) methods; the interdecile range of prevalence estimates was wider among programs using passive methods for all race/ethnicity categories except Hispanic. Prevalence (per 10,000 live births) was lowest among non-Hispanic Whites (6.5) and highest among non-Hispanic Blacks and Hispanics (11.2 and 11.9, respectively); estimates followed a U-shaped distribution by maternal age with the highest prevalence among mothers <20 years (11.5) and ≥40 years (13.2). For gestational age and birth weight, the highest prevalence was among infants <32 weeks gestation and infants <1500 gm. Case definitions varied; 41.8% of cases had an HC ≥ the 10th percentile for sex and gestational age.CONCLUSIONDifferences in methods, population distribution of maternal/infant characteristics, and case definitions for microcephaly can contribute to the wide range of observed prevalence estimates across individual birth defects surveillance programs. Addressing these factors in the setting of Zika virus infection can improve the quality of prevalence estimates. Birth Defects Research (Part A) 106:972-982, 2016. © 2016 Wiley Periodicals, Inc.
背景先天性小头症与母体感染寨卡病毒有关。然而,确定诊断为小头畸形的婴儿可能具有挑战性。方法30个出生缺陷监测项目提供了2009 - 2013年出生的小头畸形患儿的数据。根据总体和母婴特征估计每10,000活产婴儿中小头畸形的总患病率。不同的病例发现方法检查了患病率的差异。9个项目提供了有关头围和可能导致小头畸形的条件的数据。结果小头畸形的总患病率为8.7 / 10000。在使用主动(6.7)和被动(6.6)方法的项目中,中位患病率(每10,000例活产)相似;除西班牙裔外,在所有种族/族裔类别中使用被动方法的项目中,患病率估计的十分位数范围更大。患病率(每1万例活产)在非西班牙裔白人中最低(6.5例),在非西班牙裔黑人和西班牙裔人中最高(分别为11.2和11.9例);根据产妇年龄,估计呈u型分布,年龄<20岁(11.5)和≥40岁(13.2)的产妇患病率最高。就胎龄和出生体重而言,患病率最高的是妊娠<32周和<1500克的婴儿。41.8%的病例HC≥性别和胎龄的第10百分位。结论:小头畸形的方法、母婴特征的人群分布和病例定义的差异可能导致个体出生缺陷监测项目中观察到的患病率估计范围很大。在寨卡病毒感染的背景下处理这些因素可以提高流行率估计的质量。出生缺陷研究(A部分)106:972-982,2016。©2016 Wiley期刊公司
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引用次数: 55
Characterizing facial features in individuals with craniofacial microsomia: A systematic approach for clinical research. 颅面短小症患者的面部特征表征:临床研究的系统方法。
Q Medicine Pub Date : 2016-11-01 DOI: 10.1002/bdra.23560
C. Heike, Erin R. Wallace, M. Speltz, B. Siebold, M. Werler, A. Hing, C. Birgfeld, B. Collett, B. Leroux, D. Luquetti
BACKGROUNDCraniofacial microsomia (CFM) is a congenital condition with wide phenotypic variability, including hypoplasia of the mandible and external ear. We assembled a cohort of children with facial features within the CFM spectrum and children without known craniofacial anomalies. We sought to develop a standardized approach to assess and describe the facial characteristics of the study cohort, using multiple sources of information gathered over the course of this longitudinal study and to create case subgroups with shared phenotypic features.METHODSParticipants were enrolled between 1996 and 2002. We classified the facial phenotype from photographs, ratings using a modified version of the Orbital, Ear, Mandible, Nerve, Soft tissue (OMENS) pictorial system, data from medical record abstraction, and health history questionnaires.RESULTSThe participant sample included 142 cases and 290 controls. The average age was 13.5 years (standard deviation, 1.3 years; range, 11.1-17.1 years). Sixty-one percent of cases were male, 74% were white non-Hispanic. Among cases, the most common features were microtia (66%) and mandibular hypoplasia (50%). Case subgroups with meaningful group definitions included: (1) microtia without other CFM-related features (n = 24), (2) microtia with mandibular hypoplasia (n = 46), (3) other combinations of CFM- related facial features (n = 51), and (4) atypical features (n = 21).CONCLUSIONWe developed a standardized approach for integrating multiple data sources to phenotype individuals with CFM, and created subgroups based on clinically-meaningful, shared characteristics. We hope that this system can be used to explore associations between phenotype and clinical outcomes of children with CFM and to identify the etiology of CFM. Birth Defects Research (Part A) 106:915-926, 2016.© 2016 Wiley Periodicals, Inc.
颅面小畸形(CFM)是一种具有广泛表型变异的先天性疾病,包括下颌骨和外耳发育不全。我们收集了一组面部特征在CFM范围内的儿童和没有已知颅面异常的儿童。我们试图开发一种标准化的方法来评估和描述研究队列的面部特征,使用在这项纵向研究过程中收集的多种信息来源,并创建具有共同表型特征的病例亚组。方法研究对象于1996 - 2002年间入组。我们从照片中对面部表型进行分类,使用改进版本的眶、耳、下颌骨、神经、软组织(OMENS)图像系统进行评分,从医疗记录提取数据和健康史问卷中进行评分。结果纳入病例142例,对照组290例。平均年龄13.5岁(标准差1.3岁;范围:11.1-17.1年)。61%的病例为男性,74%为非西班牙裔白人。在病例中,最常见的特征是小畸形(66%)和下颌发育不全(50%)。具有有意义的组定义的病例亚组包括:(1)没有其他CFM相关特征的小个子畸形(n = 24),(2)伴有下颌发育不全的小个子畸形(n = 46),(3)其他CFM相关面部特征的组合(n = 51),(4)非典型特征(n = 21)。结论:我们开发了一种标准化的方法,将多个数据源整合到CFM个体的表型中,并基于有临床意义的共同特征创建了亚组。我们希望该系统可以用于探索儿童CFM的表型和临床结果之间的关系,并确定CFM的病因。出生缺陷研究(A辑)(06):915-926,2016。©2016 Wiley期刊公司
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引用次数: 29
Evaluation of the Western Australian Register of Developmental Anomalies: Thirty-five years of surveillance. 西澳大利亚发育异常登记册的评估:35年的监测。
Q Medicine Pub Date : 2016-11-01 DOI: 10.1002/bdra.23575
W. Nembhard, C. Bower
BACKGROUNDThe birth defects component of the Western Australian Register for Developmental Anomalies (WARDA-BD) was evaluated to assess its efficiency, effectiveness, and data quality.METHODSWARDA-BD was evaluated using the Centers for Disease Control and Prevention Guidelines for Evaluating Public Health Surveillance Systems and Data Quality Standards from the National Birth Defects Prevention Network. The evaluation included interviews with Register staff, local community organizations, parents, clinicians, and researchers; process observation; and secondary data analyses.RESULTSWARDA-BD is a statutory, statewide, population-based surveillance system established in 1980 that monitors approximately 30,000 births annually. Identification of eligible cases is for children up to age 6 years through active and passive ascertainment methods from multiple sources including birth, death, and hospitalization data; antenatal ultrasonography; hospital unit logs; medical records; fetal medicine departments; cytogenetic laboratories; specialty clinics; and pediatric surgery and pathology departments. Defect diagnoses are verified and coded using the 5-digit British Paediatric Association extension of the International Classification of Disease, Ninth Revision system. Register staff monitor Register data for completeness and accuracy resulting in high quality data with a low percentage of missing items.CONCLUSIONStrengths of WARDA-BD include high data quality, timeliness, representativeness, stable funding, active community engagement, and high staff retention. Its data were used in numerous epidemiologic investigations resulting in >325 peer-reviewed publications. Potential weaknesses include the limited number of variables collected and low visibility. Although WARDA-BD uses labor intensive case ascertainment and quality assurance and control processes, the Register provides accurate and essential data for stakeholders. Birth Defects Research (Part A) 106:894-904, 2016. © 2016 Wiley Periodicals, Inc.
本研究对西澳大利亚发育异常登记处(WARDA-BD)的出生缺陷部分进行了评估,以评估其效率、有效性和数据质量。方法使用疾病控制和预防中心评估公共卫生监测系统指南和国家出生缺陷预防网络的数据质量标准对swarda - bd进行评估。评估包括与登记册工作人员、当地社区组织、家长、临床医生和研究人员的访谈;过程的观察;二手数据分析。结果:warda - bd是一个法定的、全州范围的、以人口为基础的监测系统,建立于1980年,每年监测大约3万名新生儿。通过包括出生、死亡和住院数据在内的多种来源的主动和被动确定方法,确定6岁以下儿童的合格病例;产前超声;医院单位日志;医疗记录;胎儿医学科;细胞遗传学实验室;专业诊所;还有儿科外科和病理科。缺陷诊断使用5位数字的英国儿科协会国际疾病分类第九次修订系统进行验证和编码。注册人员监控注册数据的完整性和准确性,从而获得高质量的数据,丢失项目的比例很低。结论WARDA-BD具有数据质量高、及时性好、代表性强、经费稳定、社区参与积极、人员留存率高等优势。它的数据被用于许多流行病学调查,产生了超过325篇同行评议的出版物。潜在的弱点包括收集的变量数量有限和低可见性。虽然WARDA-BD使用劳动密集型的病例确定和质量保证和控制过程,但登记册为利益相关者提供了准确和必要的数据。出生缺陷研究(A辑)106:894-904,2016。©2016 Wiley期刊公司
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引用次数: 5
Editorial advances in population-based birth defects surveillance, epidemiology, and public health practice. 基于人口的出生缺陷监测、流行病学和公共卫生实践的编辑进展。
Q Medicine Pub Date : 2016-11-01 DOI: 10.1002/bdra.23585
R. Kirby, M. Browne
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引用次数: 0
Editorial brain malformation surveillance in the Zika era 寨卡病毒时代的编辑性脑畸形监测
Q Medicine Pub Date : 2016-11-01 DOI: 10.1002/bdra.23582
E. Trevathan
The current surveillance systems for congenital microcephaly are necessary to monitor the impact of Zika virus (ZIKV) on the developing human brain, as well as the ZIKV prevention efforts. However, these congenital microcephaly surveillance systems are insufficient. Abnormalities of neuronal differentiation, development and migration may occur among infants with normal head circumference who have intrauterine exposure to ZIKV. Therefore, surveillance for congenital microcephaly does not ascertain many of the infants seriously impacted by congenital ZIKV infection. Furthermore, many infants with normal head circumference and with malformations of the brain cortex do not have clinical manifestations of their congenital malformations until several months to many years after birth, when they present with clinical manifestations such as seizures/epilepsy, developmental delays with or without developmental regression, and/or motor impairment. In response to the ZIKV threat, public health surveillance systems must be enhanced to ascertain a wide variety of congenital brain malformations, as well as their clinical manifestations that lead to diagnostic brain imaging. Birth Defects Research (Part A) 106:869–874, 2016. © 2016 The Authors Birth Defects Research Part A: Clinical and Molecular Teratology Published by Wiley Periodicals, Inc.
目前的先天性小头症监测系统对于监测寨卡病毒(ZIKV)对发育中的人脑的影响以及预防寨卡病毒的努力是必要的。然而,这些先天性小头症监测系统是不够的。在宫内暴露于寨卡病毒的正常头围婴儿中,可能出现神经元分化、发育和迁移的异常。因此,对先天性小头畸形的监测并不能确定许多受到先天性寨卡病毒感染严重影响的婴儿。此外,许多头围正常、脑皮质畸形的婴儿直到出生后几个月到许多年才出现先天性畸形的临床表现,这时他们会出现癫痫/癫痫、发育迟缓(伴或不伴发育倒退)和/或运动障碍等临床表现。为了应对寨卡病毒的威胁,必须加强公共卫生监测系统,以确定各种各样的先天性脑畸形及其临床表现,以便进行诊断性脑成像。出生缺陷研究(分册)(6):869 - 874,2016。©2016 The Authors Birth Defects Research Part A: Clinical and Molecular Teratology by Wiley journals, Inc.出版
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引用次数: 6
Diprosopus: Systematic review and report of two cases 双足虫:系统回顾并报告两例
Q Medicine Pub Date : 2016-10-05 DOI: 10.1002/bdra.23549
María Paz Bidondo, Boris Groisman, Agostina Tardivo, Fabián Tomasoni, Verónica Tejeiro, Inés Camacho, Mariana Vilas, Rosa Liascovich, Pablo Barbero

Background

Diprosopus is a subtype of symmetric conjoined twins with one head, facial duplication and a single trunk. Diprosopus is a very rare congenital anomaly.

Methods

This is a systematic review of published cases and the presentation of two new cases born in Argentina. We estimated the prevalence of conjoined twins and diprosopus using data from the National Network of Congenital Anomalies of Argentina (RENAC).

Results

The prevalence of conjoined twins in RENAC was 19 per 1,000,000 births (95% confidence interval, 12–29). Diprosopus prevalence was 2 per 1,000,000 births (95% confidence interval, 0.2–6.8). In the systematic review, we identified 31 diprosopus cases. The facial structures more frequently duplicated were nose and eyes. Most frequent associated anomalies were: anencephaly, duplication of cerebral hemispheres, craniorachischisis, oral clefts, spinal abnormalities, congenital heart defects, diaphragmatic hernia, thoracic and/or abdominal visceral laterality anomalies. One of the RENAC cases and three cases from the literature had another discordant nonmalformed twin.

Conclusion

The conjoined twins prevalence was similar to other studies. The prevalence of diprosopus was higher. The etiology is still unknown. The presence of visceral laterality anomalies may indicate the link between diprosopus and the alteration or duplication of the primitive node in the perigastrulation period (12–15 days postfertilization). Pregnancies of more than two embryos may be a risk factor for diprosopus. Given the low prevalence of this defect, it would be useful to perform studies involving several surveillance systems and international consortiums. Birth Defects Research (Part A), 2016. © 2016 Wiley Periodicals, Inc. Birth Defects Research (Part A) 106:993–1007, 2016. © 2016 Wiley Periodicals, Inc.

双头龙是对称连体双胞胎的一个亚型,有一个头,面部重复和一个躯干。双足畸形是一种非常罕见的先天性畸形。方法对已发表的病例进行系统回顾,并介绍两例在阿根廷出生的新病例。我们使用阿根廷国家先天性异常网络(RENAC)的数据估计了连体双胞胎和双胎的患病率。结果RENAC的连体双胞胎患病率为19 / 100万(95%可信区间为12-29)。双棘虫患病率为每100万新生儿2例(95%可信区间,0.2-6.8)。在系统综述中,我们发现了31例双足病例。面部结构的重复频率更高的是鼻子和眼睛。最常见的相关异常是:无脑畸形、大脑半球重复、颅裂、口裂、脊柱异常、先天性心脏缺陷、膈疝、胸廓和/或腹部内脏侧侧异常。一例RENAC病例和文献中的三例有另一个不一致的非畸形双胞胎。结论连体双胞胎患病率与其他研究相似。双足虫的患病率较高。病因尚不清楚。内脏侧性异常的存在可能表明双足畸形与孕周(受精后12-15天)原始淋巴结的改变或复制有关。超过两个胚胎的妊娠可能是双胎畸形的危险因素。鉴于这一缺陷的患病率较低,进行涉及几个监测系统和国际财团的研究将是有用的。出生缺陷研究(上),2016。©2016 Wiley期刊公司出生缺陷研究(A部分)106:993 - 1007,2016。©2016 Wiley期刊公司
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引用次数: 16
期刊
Birth defects research. Part A, Clinical and molecular teratology
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