The Management of Acardiac Twinning: Twin Reverse Arterial Perfusion Sequence - An International Survey.

INTRODUCTION: The optimal approach and therapy method for the acardiac twin with a reverse arterial perfusion sequence has not yet been established. The aim of this study was to determine the clinical practice patterns among international fetal therapy units in their management of these cases. METHODS: A survey was sent to fetal centers across the world via email between December 2020 and December 2021. RESULTS: Responses were obtained from 77% contacted centers. The most frequent ultrasound variables used in the evaluation of twin reverse arterial perfusion sequence include echocardiographic assessment of the pump twin and umbilical artery Doppler waveforms in the acardiac and pump twins, in 90% and 80% of the centers, respectively. Most centers in Europe and Latin America propose an in utero intervention in all cases. Most centers in Europe and Latin America prefer interstitial laser ablation, whereas radiofrequency ablation (RFA) is preferred in North America. The earliest gestational age for an intervention is on mean 13 weeks in Europe, which is earlier than the other geographic areas (p = 0.001). CONCLUSIONS: Most centers agreed that antenatal evaluation should include echocardiography along with the UA Doppler waveform measurements, and the most frequently used interventions were interstitial laser ablation or RFA at a median between 14 and 26 weeks.

Position statement on fetal myelomeningocele repair.

Following the promising multicenter randomized trial results of in utero fetal myelomeningocele repair; we anticipate that an increasing number of tertiary care centers may want to offer this therapy. It is essential to establish minimum criteria for centers providing open fetal myelomeningocele repair to ensure optimal maternal and fetal/pediatric outcomes, as well as patient safety both short- and long-term; and to advance our knowledge of the role and benefit of fetal surgery in the management of fetal myelomeningocele. The fetal myelomeningocele Maternal-Fetal Management Task Force was initially convened by the Eunice Kennedy Shriver National Institute of Child Health and Human Development to discuss the implementation of maternal fetal surgery for myelomeningocele. The decision was made to develop the optimal practice criteria presented in this document for the purpose of medical and surgical leadership. These criteria are not intended to be used for legal or regulatory purposes.

In vitro osteogenesis on fluorcanasite glass-ceramic with three different chemical compositions.

This study aimed at investigating in vitro osteogenesis on three fluorcanasite glass-ceramic compositions with different solubilities (K3, K5, and K8). Osteoblastic cells were obtained from human alveolar bone fragments and cultured under standard osteogenic condition until subconfluence. First passage cells were cultured on K3, K5, and K8 and on Bioglass((R)) 45S5 (45S5-control). Cell adhesion was evaluated at 24 h. For proliferation and viability, cells were cultured for 1, 4, and 10 days. Total protein content and alkaline phosphatase (ALP) activity were measured at 7, 14, and 21 days. Cultures were stained with Alizarin red at 21 days, for detection of mineralized matrix. Data were compared by ANOVA followed by Duncan's test. Cell adhesion, cell proliferation, viability, total protein content, and ALP activity were not affected by fluorcanasite glass-ceramic composition and solubility. Bone-like formation was similar on all fluorcanasite glass-ceramics and was reduced compared to 45S5. The changes in the chemical composition and consequently solubility of the fluorcanasite glass-ceramics tested here did not significantly alter the in vitro osteogenesis. Further modifications of the chemical composition of the fluorcanasite glass-ceramic would be required to improve bone response, making this biomaterial a good candidate to be employed as a bone substitute.

Bone response to three different chemical compositions of fluorcanasite glass-ceramic.

The aim of this study was to evaluate the bone response to three fluorcanasite glass-ceramic compositions with different solubilities (K3, K5, and K8) after implantation in a femur rabbit model. Fluorcanasite glass-ceramic rods were implanted bilaterally in the mid-shafts rabbit femurs. Implants were harvested at 8 and 12 weeks and prepared for histological and histomorphometric analyses at the light microscope level. Bioglass 45S5 rods were used as a control material. At 8 weeks, all fluorcanasite glass-ceramics were entirely surrounded by a nonmineralized connective tissue. At 12 weeks, reduced areas of bone tissue were observed in the cortical area in direct contact with the K3 and K5 fluorcanasite glass-ceramics compared to Bioglass 45S5, whereas no bone tissue was observed in direct contact with the K8 surface. Bone-to-implant contact in the cortical area was affected by the material chemical composition and ranked as follows: Bioglass 45S5>K3>K5>K8 (p=0.001). In the bone marrow, a layer of fibrous connective tissue formed in direct contact with the fluorcanasite glass-ceramics and Bioglass 45S5, and only rarely exhibited contact osteogenesis. All the fluorcanasite glass-ceramics appeared to degrade in the biological environment. The solubility ratio did not alter significantly the biological reply of the fluorcanasite glass-ceramics in vivo. Further modifications of the chemical composition of the fluorcanasite glass-ceramic are required to increase the stability of the material in vivo.