Background/Objectives: The Management of Myelomeningocele (MMC) Study (MOMS) showed that prenatal repair of MMC resulted in improved neurological outcomes but was associated with high rates of obstetrical complications. This study compares outcomes of open and fetoscopic MMC repair. Data Sources: PubMed and Embase studies reporting outcomes of fetal MMC repair published since the completion of the MOMS. Results: We analyzed 11 studies and found no difference in mortality or the rate of shunt placement for hydrocephalus. Percutaneous fetoscopic repair was associated with higher rates of premature rupture of membranes (91 vs. 36%, p < 0.01) and preterm birth (96 vs. 81%, p = 0.04) compared to open repair, whereas fetoscopic repair via maternal laparotomy reduced preterm birth. The rate of dehiscence and leakage from the MMC repair site was higher after both types of fetoscopic surgery (30 vs. 7%, p < 0.01), while the rate of uterine dehiscence was higher after open repair (11 vs. 0%, p < 0.01). Discussion: Fetoscopic repair is a promising alternative to open fetal MMC repair with a lower risk of uterine dehiscence; however, fetoscopic techniques should be optimized to overcome the high rate of dehiscence and leakage at the MMC repair site. A fetoscopic approach via maternal laparotomy reduces the risk of preterm birth.

BackgroundOver one million asylum seekers were registered in Germany in 2016, most from Syria and Afghanistan. The Refugee Convention guarantees access to healthcare, however delivery mechanisms remain heterogeneous. There is an urgent need for more data describing the health conditions of asylum seekers to guide best practices for healthcare delivery. In this study, we describe the state of health of asylum seekers presenting to a multi-specialty primary care refugee clinic.MethodsDemographic and medical diagnosis data were extracted from the electronic medical records of patients seen at the ambulatory refugee clinic in Dresden, Germany between 15 September 2015 and 31 December 2016. Data were de-identified and analyzed using Stata version 14.0.ResultsTwo-thousand-seven-hundred and fifty-three individual patients were seen in the clinic. Of these, 2232 (81.1%) were insured by the state indicating arrival within the last 3 months. The median age was 25, interquartile range 16–34. Only 786 (28.6%) were female, while 1967 (71.5%) were male. The most frequent diagnoses were respiratory (17.4%), followed by miscellaneous symptoms and otherwise not classified ailments (R series, 14.1%), infection (10.8%), musculoskeletal or connective tissue (9.3%), gastrointestinal (6.8%), injury (5.9%), and mental or behavioral (5.1%) categories.ConclusionsThis study illustrates the diverse medical conditions that affect the asylum seeker population. Asylum seekers in our study group did not have a high burden of communicable diseases, however several warranted additional screening and treatment, including for tuberculosis and scabies. Respiratory illnesses were more common amongst newly arrived refugees. Trauma-related mental health disorders comprised half of mental health diagnoses.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0758-x) contains supplementary material, which is available to authorized users.

Purpose: The purpose of this study was to determine whether seeding density of placental mesenchymal stromal cells (PMSCs) on extracellular matrix (ECM) during in utero repair of myelomeningocele (MMC) affects motor function and neuronal preservation in the ovine model. Methods: MMC defects were surgically created in 33 fetuses and repaired following randomization into four treatment groups: ECM only (n=10), PMSC-ECM (42K cells/cm2) (n=8), PMSC-ECM (167K cells/cm2) (n=7), or PMSC-ECM (250–300K cells/cm2) (n=8). Motor function was evaluated using the Sheep Locomotor Rating Scale (SLR). Serial sections of the lumbar spinal cord were analyzed by measuring their cross-sectional area which were then normalized to normal lambs. Large neurons (LN, diameter 30–70μm) were counted manually and density calculated per mm2 gray matter. Results: Lambs treated with PMSCs at any density had a higher median SLR score (15 [IQR 13.5–15]) than ECM alone (6.5 [IQR 4–12.75], p=0.036). Cross-sectional areas of spinal cord and gray matter were highest in the PMSC-ECM (167K/cm2) group (p=0.002 and 0.006, respectively). LN density was highest in the greatest density PMSC-ECM (250–300K/cm2) group (p=0.045) which positively correlated with SLR score (r=0.807, p<0.0001). Conclusions: Fetal repair of myelomeningocele with high density PMSC-ECM resulted in increased large neuron density, which strongly correlated with improved motor function.

A number of observational studies of freeranging monkeys have indicated a strong attachment between the mother and the infant (Altmann, in press;Carpenter, 1934;Nolte, 1955). Mother-child closeness is prominent in the human and has been referred to as the mother-child tie (Bowlby, 1958). This tie is pre-eminent in the behavior determinants of man although it is not known if it serves comparable importance in subhuman primates. Harlow and Zimmerman (1959) have investigated certain aspects of the mother-child relationship in monkeys by the use of artificial mothers. This technique has yielded much information about the infant's attachment to the mother and has indicated some of the qualities of the effective mother.The study to be reported here is one of a series to delineate the characteristics of the mother-infant tie in the monkey. We have been especially interested in the maternal aspect of mother-infant pairs which have been allowed to remain together from birth. Three questions concerning older infants (5 to 7 months) have prompted this study: (a) What is the effect of brief separation, i.e., for any period less than 1 hr., on the established mother-infant tie? (b) Is the mother's maternal behavior infant-specific at this stage of development? (c) Is the infant's response to the mother at this age mother-specific? METHOD SubjectsTwo mother-infant pairs of pig-tailed macaques (Macaca nemistrind) were studied. These pairs were 1 This research was supported in part by a grant from the Boeing Airplane Company's Employees' Medical Research Fund. The authors are also indebted to Theodore C. Ruch and Orville A. Smith, Jr., of the Department of Physiology and Biophysics, for provision of laboratory space and subjects and to Donald M. Baer for critical comments on the manuscript.

The aim of this study was to assess the effectiveness of a spiritual-hypnosis assisted therapy (SHAT) for treatment of posttraumatic stress disorder (PTSD) in children. All children, age 6-12 years (N=226; 52.7% females), who experienced the terrorist bomb blasts in Bali in 2002, and subsequently were diagnosed with PTSD were studied, through a longitudinal, quasi-experimental (pre-post test), single-blind, randomized control design. Of them, 48 received group SHAT (treatment group), and 178 did not receive any therapy (control group). Statistically significant results showed that SHAT produced a 77.1% improvement rate, at a two-year follow up, compared to 24% in the control group, while at the same time, the mean PTSD symptom score differences were significantly lower in the former group. We conclude that the method of spiritual-hypnosis is highly effective, economic, and easily implemented, and has a potential for therapy of PTSD in other cultures or other catastrophic life-threatening events.