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1.
Sci Adv ; 10(8): eadk2904, 2024 Feb 23.
Artículo en Inglés | MEDLINE | ID: mdl-38381818

RESUMEN

We present a robust radiocarbon (14C) chronology for burials at Sakhtysh, in European Russia, where nearly 180 inhumations of Lyalovo and Volosovo pottery-using hunter-gatherer-fishers represent the largest known populations of both groups. Past dating attempts were restricted by poor understanding of dietary 14C reservoir effects (DREs). We developed a DRE correction approach that uses multiple linear regression of differences in 14C, δ13C, and δ15N between bones and teeth of the same individuals to predict DREs of up to approximately 900 years. Our chronological model dates Lyalovo burials to the early fifth millennium BCE, and Volosovo burials to the mid-fourth to early third millennium. It reveals a change in the subsistence economy at approximately 3300 BCE, coinciding with a reorientation of trade networks, and dates the final burial to the early Fatyanovo period, the regional expression of the Yamnaya/Corded Ware expansion. Our approach is applicable when freshwater 14C reservoir effects are poorly constrained and grave goods cannot be dated directly.


Asunto(s)
Entierro , Diente , Humanos , Federación de Rusia , Dieta , Huesos
2.
Proc Natl Acad Sci U S A ; 120(43): e2310138120, 2023 10 24.
Artículo en Inglés | MEDLINE | ID: mdl-37844237

RESUMEN

To investigate changes in culinary practices associated with the arrival of farming, we analysed the organic residues of over 1,000 pottery vessels from hunter-gatherer-fisher and early agricultural sites across Northern Europe from the Lower Rhine Basin to the Northeastern Baltic. Here, pottery was widely used by hunter-gatherer-fishers prior to the introduction of domesticated animals and plants. Overall, there was surprising continuity in the way that hunter-gatherer-fishers and farmers used pottery. Both aquatic products and wild plants remained prevalent, a pattern repeated consistently across the study area. We argue that the rapid adaptation of farming communities to exploit coastal and lagoonal resources facilitated their northerly expansion, and in some cases, hunting, gathering, and fishing became the most dominant subsistence strategy. Nevertheless, dairy products frequently appear in pottery associated with the earliest farming groups often mixed with wild plants and fish. Interestingly, we also find compelling evidence of dairy products in hunter-gatherer-fisher Ertebølle pottery, which predates the arrival of domesticated animals. We propose that Ertebølle hunter-gatherer-fishers frequently acquired dairy products through exchange with adjacent farming communities prior to the transition. The continuity observed in pottery use across the transition to farming contrasts with the analysis of human remains which shows substantial demographic change through ancient DNA and, in some cases, a reduction in marine consumption through stable isotope analysis. We postulate that farmers acquired the knowledge and skills they needed to succeed from local hunter-gatherer-fishers but without substantial admixture.


Asunto(s)
Agricultura , Arqueología , Animales , Humanos , Europa (Continente) , Granjas , Agricultores
3.
Biomed Eng Online ; 22(1): 79, 2023 Aug 12.
Artículo en Inglés | MEDLINE | ID: mdl-37573331

RESUMEN

In order to study the local interactions between facial soft-tissues and a Silhouette Soft® suspension suture, a CE marked medical device designed for the repositioning of soft tissues in the face and the neck, Finite element simulations were run, in which a model of the suture was embedded in a three-layer Finite Element structure that accounts for the local mechanical organization of human facial soft tissues. A 2D axisymmetric model of the local interactions was designed in ANSYS, in which the geometry of the tissue, the boundary conditions and the applied loadings were considered to locally mimic those of human face soft tissue constrained by the suture in facial tissue repositioning. The Silhouette Soft suture is composed of a knotted thread and sliding cones that are anchored in the tissue. Hence, simulating these interactions requires special attention for an accurate modelling of contact mechanics. As tissue is modelled as a hyper-elastic material, the displacement of the facial soft tissue changes in a nonlinear way with the intensity of stress induced by the suture and the number of the cones. Our simulations show that for a 4-cone suture a displacement of 4.35 mm for a 2.0 N external loading and of 7.6 mm for 4.0 N. Increasing the number of cones led to the decrease in the equivalent local strain (around 20%) and stress (around 60%) applied to the tissue. The simulated displacements are in general agreement with experimental observations.


Asunto(s)
Suturas , Humanos , Análisis de Elementos Finitos , Cadáver , Fenómenos Biomecánicos , Estrés Mecánico
4.
Nat Hum Behav ; 7(2): 171-183, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-36550220

RESUMEN

Human history has been shaped by global dispersals of technologies, although understanding of what enabled these processes is limited. Here, we explore the behavioural mechanisms that led to the emergence of pottery among hunter-gatherer communities in Europe during the mid-Holocene. Through radiocarbon dating, we propose this dispersal occurred at a far faster rate than previously thought. Chemical characterization of organic residues shows that European hunter-gatherer pottery had a function structured around regional culinary practices rather than environmental factors. Analysis of the forms, decoration and technological choices suggests that knowledge of pottery spread through a process of cultural transmission. We demonstrate a correlation between the physical properties of pots and how they were used, reflecting social traditions inherited by successive generations of hunter-gatherers. Taken together the evidence supports kinship-driven, super-regional communication networks that existed long before other major innovations such as agriculture, writing, urbanism or metallurgy.


Asunto(s)
Agricultura , Tecnología , Humanos , Datación Radiométrica , Europa (Continente)
5.
Archaeol Anthropol Sci ; 13(8): 141, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34777611

RESUMEN

The emergence of pottery in Europe is associated with two distinct traditions: hunter-gatherers in the east of the continent during the early 6th millennium BC and early agricultural communities in the south-west in the late 7th millennium BC. Here we investigate the function of pottery from the site of Rakushechny Yar, located at the Southern fringe of Eastern Europe, in this putative contact zone between these two economic 'worlds'. To investigate, organic residue analysis was conducted on 120 samples from the Early Neolithic phase (ca. mid-6th millennium BC) along with microscopic and SEM analysis of associated foodcrusts. The results showed that the earliest phase of pottery use was predominantly used to process riverine resources. Many of the vessels have molecular and isotopic characteristics consistent with migratory fish, such as sturgeon, confirmed by the identification of sturgeon bony structures embedded in the charred surface deposits. There was no evidence of dairy products in any of the vessels, despite the fact these have been routinely identified in coeval sites to the south. Further analysis of some of the mammalian bones using ZooMS failed to demonstrate that domesticated animals were present in the Early Neolithic. Nevertheless, we argue that intensive exploitation of seasonally migratory fish, accompanied by large-scale pottery production, created storable surpluses that led to similar socio-economic outcomes as documented in early agricultural societies. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12520-021-01412-2.

6.
J Environ Manage ; 294: 113014, 2021 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-34144319

RESUMEN

Bauxite mining operations are increasingly sited on Indigenous-owned land, particularly in tropical areas, including northern Australia. The environmental impacts of bauxite mining are significant. Native vegetation, including commercially valuable forests, is cleared and typically windrowed and burnt. For many Indigenous Australians, mining of their land creates much concern about biocultural, community health and livelihood impacts from the loss of access to traditional lands and resources, and the ability to 'care for country'. Improved pre-mining utilisation of forest resources and effective mine rehabilitation can mitigate some of these impacts and it is important to Indigenous communities that they are engaged in these processes. But Indigenous peoples' expectations are rarely considered or adequately addressed in site clearing activities or mine completion criteria, and there is limited guidance on how their expected outcomes can be monitored and evaluated for mine closure and relinquishment. This paper reports on a case-study of the Western Cape York Peninsula bauxite mining region in northern Australia. The paper reviews mine rehabilitation in the case-study region, including related Indigenous forest livelihoods initiatives, presents local Indigenous peoples' expectations for pre- and post-mining forest and landscape management as an integrated mining-community forestry 'vision', and discusses implications for mine completion criteria, mine closure and relinquishment. The findings highlight the need for Indigenous peoples' full and transparent free, prior and informed consent participation in all aspects of mine closure planning, and for further research to trial the development and assessment of mine completion criteria linked to local biocultural landscape restoration and Indigenous livelihoods. The findings can inform mining policymakers, regulators and industry professionals on the design, implementation and monitoring of mine completion criteria and associated pre- and post-mining management that will improve environmental outcomes and socio-cultural benefits for Indigenous communities impacted by mining.


Asunto(s)
Óxido de Aluminio , Minería , Australia , Agricultura Forestal , Bosques
7.
Cell Rep ; 35(13): 109278, 2021 06 29.
Artículo en Inglés | MEDLINE | ID: mdl-34192537

RESUMEN

A 5,000-year-old Yersinia pestis genome (RV 2039) is reconstructed from a hunter-fisher-gatherer (5300-5050 cal BP) buried at Rinnukalns, Latvia. RV 2039 is the first in a series of ancient strains that evolved shortly after the split of Y. pestis from its antecessor Y. pseudotuberculosis ∼7,000 years ago. The genomic and phylogenetic characteristics of RV 2039 are consistent with the hypothesis that this very early Y. pestis form was most likely less transmissible and maybe even less virulent than later strains. Our data do not support the scenario of a prehistoric pneumonic plague pandemic, as suggested previously for the Neolithic decline. The geographical and temporal distribution of the few prehistoric Y. pestis cases reported so far is more in agreement with single zoonotic events.


Asunto(s)
Peste/microbiología , Yersinia pestis/fisiología , Humanos , Letonia , Funciones de Verosimilitud , Filogenia
8.
Commun Biol ; 4(1): 113, 2021 01 25.
Artículo en Inglés | MEDLINE | ID: mdl-33495542

RESUMEN

The Wartberg culture (WBC, 3500-2800 BCE) dates to the Late Neolithic period, a time of important demographic and cultural transformations in western Europe. We performed genome-wide analyses of 42 individuals who were interred in a WBC collective burial in Niedertiefenbach, Germany (3300-3200 cal. BCE). The results showed that the farming population of Niedertiefenbach carried a surprisingly large hunter-gatherer ancestry component (34-58%). This component was most likely introduced during the cultural transformation that led to the WBC. In addition, the Niedertiefenbach individuals exhibited a distinct human leukocyte antigen gene pool, possibly reflecting an immune response that was geared towards detecting viral infections.


Asunto(s)
Agricultura , Conducta Alimentaria/fisiología , Antígenos HLA/genética , Conducta Predatoria/fisiología , Animales , Arqueología , ADN Antiguo/análisis , Europa (Continente) , Evolución Molecular , Variación Genética , Genética de Población , Genoma Humano , Estudio de Asociación del Genoma Completo , Alemania , Historia Antigua , Migración Humana , Humanos , Polimorfismo de Nucleótido Simple , Grupos Raciales/genética , Características de la Residencia
10.
Sci Rep ; 10(1): 13698, 2020 08 13.
Artículo en Inglés | MEDLINE | ID: mdl-32792561

RESUMEN

Broomcorn millet (Panicum miliaceum L.) is not one of the founder crops domesticated in Southwest Asia in the early Holocene, but was domesticated in northeast China by 6000 BC. In Europe, millet was reported in Early Neolithic contexts formed by 6000 BC, but recent radiocarbon dating of a dozen 'early' grains cast doubt on these claims. Archaeobotanical evidence reveals that millet was common in Europe from the 2nd millennium BC, when major societal and economic transformations took place in the Bronze Age. We conducted an extensive programme of AMS-dating of charred broomcorn millet grains from 75 prehistoric sites in Europe. Our Bayesian model reveals that millet cultivation began in Europe at the earliest during the sixteenth century BC, and spread rapidly during the fifteenth/fourteenth centuries BC. Broomcorn millet succeeds in exceptionally wide range of growing conditions and completes its lifecycle in less than three summer months. Offering an additional harvest and thus surplus food/fodder, it likely was a transformative innovation in European prehistoric agriculture previously based mainly on (winter) cropping of wheat and barley. We provide a new, high-resolution chronological framework for this key agricultural development that likely contributed to far-reaching changes in lifestyle in late 2nd millennium BC Europe.


Asunto(s)
Agricultura/historia , Productos Agrícolas/historia , Panicum/crecimiento & desarrollo , Arqueología , Productos Agrícolas/crecimiento & desarrollo , Domesticación , Europa (Continente) , Historia Antigua , Datación Radiométrica
11.
R Soc Open Sci ; 7(4): 192016, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32431883

RESUMEN

The introduction of pottery vessels to Europe has long been seen as closely linked with the spread of agriculture and pastoralism from the Near East. The adoption of pottery technology by hunter-gatherers in Northern and Eastern Europe does not fit this paradigm, and its role within these communities is so far unresolved. To investigate the motivations for hunter-gatherer pottery use, here, we present the systematic analysis of the contents of 528 early vessels from the Baltic Sea region, mostly dating to the late 6th-5th millennium cal BC, using molecular and isotopic characterization techniques. The results demonstrate clear sub-regional trends in the use of ceramics by hunter-gatherers; aquatic resources in the Eastern Baltic, non-ruminant animal fats in the Southeastern Baltic, and a more variable use, including ruminant animal products, in the Western Baltic, potentially including dairy. We found surprisingly little evidence for the use of ceramics for non-culinary activities, such as the production of resins. We attribute the emergence of these sub-regional cuisines to the diffusion of new culinary ideas afforded by the adoption of pottery, e.g. cooking and combining foods, but culturally contextualized and influenced by traditional practices.

12.
EMBO Rep ; 19(11)2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30206188

RESUMEN

In fission yeast, the lengths of interphase microtubule (iMT) arrays are adapted to cell length to maintain cell polarity and to help centre the nucleus and cell division ring. Here, we show that length regulation of iMTs is dictated by spatially regulated competition between MT-stabilising Tea2/Tip1/Mal3 (Kinesin-7) and MT-destabilising Klp5/Klp6/Mcp1 (Kinesin-8) complexes at iMT plus ends. During MT growth, the Tea2/Tip1/Mal3 complex remains bound to the plus ends of iMT bundles, thereby restricting access to the plus ends by Klp5/Klp6/Mcp1, which accumulate behind it. At cell ends, Klp5/Klp6/Mcp1 invades the space occupied by the Tea2/Tip1/Tea1 kinesin complex triggering its displacement from iMT plus ends and MT catastrophe. These data show that in vivo, whilst an iMT length-dependent model for catastrophe factor accumulation has validity, length control of iMTs is an emergent property reflecting spatially regulated competition between distinct kinesin complexes at the MT plus tip.


Asunto(s)
Cinesinas/metabolismo , Microtúbulos/metabolismo , Proteínas de Schizosaccharomyces pombe/metabolismo , Schizosaccharomyces/citología , Polaridad Celular , Interfase/fisiología , Cinesinas/genética , Microscopía Fluorescente , Proteínas Asociadas a Microtúbulos/genética , Proteínas Asociadas a Microtúbulos/metabolismo , Complejos Multiproteicos/genética , Complejos Multiproteicos/metabolismo , Schizosaccharomyces/metabolismo , Proteínas de Schizosaccharomyces pombe/genética
13.
Mol Cell Oncol ; 4(6): e1314238, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29209640

RESUMEN

The spindle assembly checkpoint (also known as the spindle or mitotic checkpoint) is a surveillance system that ensures fidelity of chromosome segregation. Here we suggest, in light of historical and more recent evidence, that this signaling system monitors kinetochore attachment and spindle assembly by two distinct, but functionally overlapping, pathways.

14.
Soft Matter ; 13(37): 6594-6605, 2017 Sep 27.
Artículo en Inglés | MEDLINE | ID: mdl-28905969

RESUMEN

The controlled complex coacervation of oppositely charged hyaluronic acid (Mw ≈ 800-1000 kg mol-1) and chitosan (Mw ≈ 160 kg mol-1, degree of acetylation = 15%) led to hydrogels with controllable properties in terms of elasticity and strength. In this work, we performed desalting by dialysis of high ionic strength solutions of mixed polyelectrolytes and showed that the control of the pH during the polyelectrolyte assembly greatly impacts the mechanical properties of the hydrogel. First, for pHs from 5.5 to 7.5, a slight coacervation was observed due to low chitosan protonation and poor polyelectrolyte associations. Then, for pHs from 3.0 to 5.5, coacervation and syneresis led to free-standing and easy to handle hydrogels. Finally, for pHs from 2.0 to 3.0 (close to the pKa of the hyaluronic acid), we observed the unusual stretchability of these hydrogels that could arise from the pre-folding of hyaluronic acid chains while physical crosslinking was achieved by hyaluronic acid/chitosan polyelectrolyte complexation.

15.
J Hosp Palliat Nurs ; 19(1): 28-33, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28260997

RESUMEN

Over 42,000 children die each year in the United States, including those with intellectual disability (ID). Survival is often reduced when children with intellectual disability also suffer from significant motor dysfunction, progressive congenital conditions, and comorbidities. Yet, little is known about hospice care for children with intellectual disability. The purpose of this study was to explore the relationship between intellectual disability and hospice utilization. Additionally, we explored whether intellectual disability combined with motor dysfunction, progressive congenital conditions, and comorbidities influenced pediatric hospice utilization. Using a retrospective cohort design and data from the 2009 to 2010 California Medicaid claims files, we conducted a multivariate analysis of hospice utilization. This study shows that intellectual disability was negatively related to hospice enrollment and length of stay. We also found that when children had both intellectual disability and comorbidities, there was a positive association with enrolling in hospice care. A number of clinical implications can be drawn from the study findings that hospice and palliative care nurses use to improve their clinical practice of caring for children with ID and their families at end of life.

16.
Cell Rep ; 18(6): 1422-1433, 2017 02 07.
Artículo en Inglés | MEDLINE | ID: mdl-28178520

RESUMEN

The onset of anaphase is triggered by activation of the anaphase-promoting complex/cyclosome (APC/C) following silencing of the spindle assembly checkpoint (SAC). APC/C triggers ubiquitination of Securin and Cyclin B, which leads to loss of sister chromatid cohesion and inactivation of Cyclin B/Cdk1, respectively. This promotes relocalization of Aurora B kinase and other components of the chromosome passenger complex (CPC) from centromeres to the spindle midzone. In fission yeast, this is mediated by Clp1 phosphatase-dependent interaction of CPC with Klp9/MKLP2 (kinesin-6). When this interaction is disrupted, kinetochores bi-orient normally, but APC/C activation is delayed via a mechanism that requires Sgo2 and some (Bub1, Mph1/Mps1, and Mad3), but not all (Mad1 and Mad2), components of the SAC and the first, but not second, lysine, glutamic acid, glutamine (KEN) box in Mad3. These data indicate that interaction of CPC with Klp9 terminates a Sgo2-dependent, but Mad2-independent, APC/C-inhibitory pathway that is distinct from the canonical SAC.


Asunto(s)
Proteínas de Ciclo Celular/metabolismo , Proteínas de Schizosaccharomyces pombe/metabolismo , Schizosaccharomyces/metabolismo , Schizosaccharomyces/fisiología , Anafase , Ciclosoma-Complejo Promotor de la Anafase/metabolismo , Asparagina/metabolismo , Aurora Quinasa B/metabolismo , Ciclo Celular/fisiología , Centrómero/metabolismo , Centrómero/fisiología , Ciclina B/metabolismo , Ácido Glutámico/metabolismo , Cinetocoros/metabolismo , Cinetocoros/fisiología , Lisina/metabolismo , Proteínas Nucleares/metabolismo , Huso Acromático/metabolismo , Huso Acromático/fisiología
17.
J Pediatr Neurosci ; 12(4): 367-370, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29675080

RESUMEN

Mycotic cerebral aneurysms in neonates are extremely rare and can be difficult to diagnose without a high index of suspicion. We describe a 33-week gestation preterm neonate who developed a mycotic cerebral aneurysm leading to death before repair could be performed. We believe this to be the first literature reported case of a mycotic cerebral aneurysm in a preterm infant. This case revives the ongoing question of when to perform a lumbar puncture in a potentially septic or meningitic infant, while also casting light on maintaining a high index of suspicion for rare intracranial diagnoses that require cranial imaging.

18.
Curr Biol ; 26(19): 2642-2650, 2016 10 10.
Artículo en Inglés | MEDLINE | ID: mdl-27618268

RESUMEN

The spindle assembly checkpoint (SAC) ensures that sister chromatids do not separate until all chromosomes are attached to spindle microtubules and bi-oriented. Spindle checkpoint proteins, including Mad1, Mad2, Mad3 (BubR1), Bub1, Bub3, and Mph1 (Mps1), are recruited to unattached and/or tensionless kinetochores. SAC activation catalyzes the conversion of soluble Mad2 (O-Mad2) into a form (C-Mad2) that binds Cdc20, BubR1, and Bub3 to form the mitotic checkpoint complex (MCC), a potent inhibitor of the anaphase-promoting complex (APC/C). SAC silencing de-represses Cdc20-APC/C activity allowing poly-ubiquitination of Securin and Cyclin B, leading to the dissolution of sister chromatids and anaphase onset [1]. Understanding how microtubule interaction at kinetochores influences the timing of anaphase requires an understanding of how spindle checkpoint protein interaction with the kinetochore influences spindle checkpoint signaling. We, and others, recently showed that Mph1 (Mps1) phosphorylates multiple conserved MELT motifs in the Spc7 (Spc105/KNL1) protein to recruit Bub1, Bub3, and Mad3 (BubR1) to kinetochores [2-4]. In budding yeast, Mps1 phosphorylation of a central non-catalytic region of Bub1 promotes its association with the Mad1-Mad2 complex, although this association has not yet been detected in other organisms [5]. Here we report that multisite binding of Bub3 to the Spc7 MELT array toggles the spindle checkpoint switch by permitting Mph1 (Mps1)-dependent interaction of Bub1 with Mad1-Mad2.


Asunto(s)
Puntos de Control del Ciclo Celular/fisiología , Proteínas de Schizosaccharomyces pombe/genética , Schizosaccharomyces/fisiología , Huso Acromático/metabolismo , Fosforilación , Schizosaccharomyces/genética , Proteínas de Schizosaccharomyces pombe/metabolismo , Transducción de Señal
19.
Biochem Soc Trans ; 43(1): 19-22, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25619242

RESUMEN

The segregation of sister chromatids during mitosis is one of the most easily visualized, yet most remarkable, events during the life cycle of a cell. The accuracy of this process is essential to maintain ploidy during cell duplication. Over the past 20 years, substantial progress has been made in identifying components of both the kinetochore and the mitotic spindle that generate the force to move mitotic chromosomes. Additionally, we now have a reasonable, albeit incomplete, understanding of the molecular and biochemical events that are involved in establishing and dissolving sister-chromatid cohesion. However, it is less well-understood how this dissolution of cohesion occurs synchronously on all chromosomes at the onset of anaphase. At the centre of the action is the anaphase-promoting complex/cyclosome (APC/C), an E3 ubiquitin ligase that, in association with its activator cell-division cycle protein 20 homologue (Cdc20), is responsible for the destruction of securin. This leads to the activation of separase, a specialized protease that cleaves the kleisin-subunit of the cohesin complex, to relieve cohesion between sister chromatids. APC/C-Cdc20 is also responsible for the destruction of cyclin B and therefore inactivation of the cyclin B-cyclin-dependent kinase 1 (Cdk1). This latter event induces a change in the microtubule dynamics that results in the movement of sister chromatids to spindle poles (anaphase A), spindle elongation (anaphase B) and the onset of cytokinesis. In the present paper, we review the emerging evidence that multiple, spatially and temporally regulated feedback loops ensure anaphase onset is rapid, co-ordinated and irreversible.


Asunto(s)
Anafase , Segregación Cromosómica , Animales , Proteína Quinasa CDC2 , Quinasas Ciclina-Dependientes/metabolismo , Humanos , Cinetocoros/fisiología , Metafase , Transducción de Señal , Cuerpos Polares del Huso/fisiología
20.
Pediatr Neurol ; 51(1): 123-5, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24814060

RESUMEN

BACKGROUND: Rachischisis totalis is a rare open neural tube defect often associated with lethal acrania. When acrania is not present, mortality remains high and morbidity for survivors is extreme. PATIENT: We describe is a term newborn with in-utero diagnosed rachischisis totalis without acrania and Chiari II malformation with subsequent hydrocephalus. RESULTS: At birth, clinical examination revealed rachischisis totalis without acrania. The spinal defect extended from the mid-cervical to the lower sacral vertebrae. Serial cranial ultrasonography and brain MRI revealed Chiari II malformation with severe hydrocephalus. The spinal defect was closed and a ventriculoperitoneal shunt placed to relieve the hydrocephalus. The clinical course was complicated by significant central apnea, often necessitating aggressive resuscitation and chest compressions. The infant has survived with expected severe developmental delay but has graduated from hospice care. CONCLUSION: This report demonstrates that survival with variable function and quality of life is possible with severe open neural tube defects. A multidisciplinary team approach including family-centered care must be used early to overcome the many ethical challenges that such patients present.


Asunto(s)
Hidrocefalia/etiología , Disrafia Espinal/complicaciones , Malformación de Arnold-Chiari/complicaciones , Encéfalo/patología , Humanos , Hidrocefalia/cirugía , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Defectos del Tubo Neural/diagnóstico , Defectos del Tubo Neural/cirugía , Médula Espinal/diagnóstico por imagen , Disrafia Espinal/diagnóstico , Disrafia Espinal/cirugía , Ultrasonografía , Derivación Ventriculoperitoneal
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