Jan Deprest

Universitair Psychiatrisch Centrum KU Leuven, Cortenberg, Flanders, Belgium

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Publications (667)2077.09 Total impact

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    ABSTRACT: Objective: To report the results of fetal cystoscopic laser ablation of posterior urethral valves (PUV) in a consecutive series in two referral centers. Methods: Twenty pregnant women with a presumptive isolated PUV were treated with fetal cystoscopy under local anesthesia. Identification and fulguration of the PUV by one or several firing-contacts with diode laser were attempted. Perinatal and long-term outcomes were prospectively recorded. Results: The median gestational age at procedure was 18.1 weeks (range 15.0-25.6), and median operation time was 24 min (range 15-40). Access to the urethra was achieved in 19/20 (95%) cases, and postoperative, normalization of bladder size and amniotic fluid was observed in 16/20 (80%). Overall, there were 9 (45%) terminations of pregnancy and 11 women (55%) delivered a liveborn baby at a mean gestational age of 37.3 (29.1-40.2) weeks. No infants developed pulmonary hypoplasia and all were alive at 15-110 months. Eight (40% of all fetuses, 72.7% of newborns) had normal renal function and 3 (27.3%) had renal failure awaiting renal transplantation. Conclusion: Fetoscopic laser ablation for PUV can achieve bladder decompression and amniotic fluid normalization with a single procedure in selected cases with anyhydramnios. There is still a significant risk of progression to renal failure pre or postnatally. © 2015 S. Karger AG, Basel.
    Fetal Diagnosis and Therapy 01/2015; · 2.30 Impact Factor
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    ABSTRACT: Objectives Stem cells (SC) can be isolated from amniotic fluid (AF) for a variety of perinatal applications. In view of this we compared different cryopreservation protocols for these AFSCs.Methods We screened seven freezing & thawing protocols using two well-established human AFSC lines: Freezing protocol 1 (FP1): 10% DMSO, FP2: 2.5% DMSO, caspase-inhibitor and catalase, FP3: 5% glycerol, caspase-inhibitor and catalase, FP4: sperm freezing medium, FP5: slow freezing solution, FP6: ethylene glycol, sucrose and ficoll 70 and FP7: vitrification solution. Outcome measures were post-thawing cell viability, recovery, doubling time and mesenchymal stem cell markers. The three best performing protocols were subsequently tested on cells isolated from clinical consecutive freshly harvested amniotic fluid samples from two fetal medicine units.ResultsProtocols 1, 5 and 6 performed significantly better on well characterized cell lines. They performed equally well on cell pellets from freshly harvested amniotic fluid (n=28).Conclusions We identified 3 suitable cryopreservation protocols because of high cell recovery and unchanged stem cell characteristics. Given one of these, the slow freezing solution, is compatible with current Good Manufacturing Practice (GMP)-legislation, it may be ultimately clinically used. This article is protected by copyright. All rights reserved.
    Prenatal Diagnosis 01/2015; · 2.68 Impact Factor
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    ABSTRACT: Our objective was to determine the fetal in vivo microRNA signature in hypoplastic lungs of human fetuses with severe isolated congenital diaphragmatic hernia (CDH) and changes in tracheal and amniotic fluid of fetuses undergoing fetoscopic endoluminal tracheal occlusion (FETO) to reverse severe lung hypoplasia due to CDH. We profiled microRNA expression in prenatal human lungs by microarray analysis. We then validated this signature with real-time quantitative polymerase chain reaction in tracheal and amniotic fluid of CDH patients undergoing FETO. We further explored the role of miR-200b using semiquantitative in situ hybridization and immunohistochemistry for TGF-β2 in postnatal lung sections. We investigated miR-200b effects on TGF-β signaling using a SMAD-luciferase reporter assay and Western blotting for phospho-SMAD2/3 and ZEB-2 in cultures of human bronchial epithelial cells. CDH lungs display an increased expression of 2 microRNAs: miR-200b and miR-10a as compared to control lungs. Fetuses undergoing FETO display increased miR-200 expression in their tracheal fluid at the time of balloon removal. Future survivors of FETO display significantly higher miR-200 expression than those with a limited response. miR-200b was expressed in bronchial epithelial cells and vascular endothelial cells. TGF-β2 expression was lower in CDH lungs. miR-200b inhibited TGF-β-induced SMAD signaling in cultures of human bronchial epithelial cells. Human fetal hypoplastic CDH lungs have a specific miR-200/miR-10a signature. Survival after FETO is associated with increased miR-200 family expression. miR-200b overexpression in CDH lungs results in decreased TGF-β/SMAD signaling.
    Annals of surgery. 01/2015;
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    ABSTRACT: The properties of meshes used in reconstructive surgery affect the host response and biomechanical characteristics of the grafted tissue. Whereas durable synthetics induce a chronic inflammation, biological grafts are usually considered as more biocompatible. The location of implantation is another determinant of the host response: the vagina is a different environment with specific function and anatomy. Herein, we evaluated a cross-linked acellular collagen matrix (ACM), pretreated by the anti-calcification procedure ADAPT® in a sheep model for vaginal surgery. Ten sheep were implanted with a cross-linked ACM, and six controls were implanted with a polypropylene (PP; 56 g/m2) control. One implant was inserted in the lower rectovaginal septum, and one was used for abdominal wall defect reconstruction. Grafts were removed after 180 days; all graft-related complications were recorded, and explants underwent bi-axial tensiometry and contractility testing. Half of ACM-implanted animals had palpable induration in the vaginal implantation area, two of these also on the abdominal implant. One animal had a vaginal exposure. Vaginal ACMs were 63 % less stiff compared to abdominal ACM explants (p = 0.01) but comparable to vaginal PP explants. Seven anterior vaginal ACM explants showed areas of graft degradation on histology. There was no overall difference in vaginal contractility. Considering histologic degradation in the anterior vaginal implant as representative for the host, posterior ACM explants of animals with degradation had a 60 % reduced contractility as compared to PP (p = 0.048). Three abdominal implants showed histologic degradation; those were more compliant than non-degraded implants. Vaginal implantation with ACM was associated with graft-related complications (GRCs) and biomechanical properties comparable to PP. Partially degraded ACM had a decreased vaginal contractility.
    Gynecological Surgery 01/2015;
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    ABSTRACT: Objective To determine expert consensus on substeps of fetoscopic laser surgery (FLS) for twin-to-twin transfusion syndrome (TTTS) required for an authority-based curriculum for fetal medicine specialists in training for this procedure.MethodsA Delphi survey was conducted among an international panel of experts (n = 98) in fetoscopic laser surgery. Experts rated the substeps of laser surgery on a 5-point Likert-type scale and were able to comment on each substep using a dedicated online platform, accessed by invited tertiary care facilities specialized in fetal therapy. Responses were returned to the panel until consensus was reached. (Crohnbach's α ≥ .80). All substeps that 80% of experts rated as ≥4 were included in the evaluation instrument.ResultsAfter the first iteration of the Delphi procedure, a response rate of 74% (73/98) was reached, in the second and the third iteration response rates of respectively 90% (66/73) and 81% (59/73) were reached. Of the total of 81 substeps rated in the first round, 20 substeps had to be rerated in the second round. Finally, the initial list of substeps was reduced to 55 on which experts agreed to be essential. In the third round the substeps were ranked in order of importance; with ‘coagulation of all anastomoses that cross equator’ and ‘determine fetoscope insertion site’ as most important.ConclusionsA list of 55 essential substeps of FLS for TTTS was defined. This list is the first authority-based evidence to be used for a final training model for future fetal surgeons.
    Ultrasound in Obstetrics and Gynecology 12/2014; · 3.56 Impact Factor
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    ABSTRACT: Congenital diaphragmatic hernia (CDH) may be isolated or associated with other structural anomalies, the latter with poor prognosis. The defect allows viscera to herniate through the defect into the chest, competing for space with the developing lungs. At birth, pulmonary hypoplasia leads to respiratory insufficiency and persistent pulmonary hypertension that is lethal in up to 30% of patients. When isolated, survival chances can be predicted by antenatal measurement of lung size and liver herniation. Chromosomal microarrays and exome sequencing contribute to understanding genetic factors underlying isolated CDH. Prenatal intervention aims at stimulating lung development, clinically achieved by percutaneous fetal endoscopic tracheal occlusion (FETO) under local anesthesia. The Tracheal Occlusion To Accelerate Lung growth trial (www.totaltrial.eu) is an international randomized trial investigating the role of fetal therapy for severe and moderate pulmonary hypoplasia. Despite an apparent increase in survival following FETO, the search for lesser invasive and more potent prenatal interventions must continue. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Seminars in Fetal and Neonatal Medicine 11/2014; · 3.13 Impact Factor
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    ABSTRACT: Objective: To correlate prenatal indicators of pulmonary hypoplasia with neonatal lung function and pulmonary hypertension (PHT) in isolated congenital diaphragmatic hernia (iCDH). Materials and Methods: Prospective single-center study on 40 fetuses with iCDH either expectantly managed (n = 13) or undergoing tracheal occlusion (n = 27). Prenatal predictors included observed/expected lung-head ratio (O/E LHR), observed/expected total fetal lung volume, fetal pulmonary reactivity to maternal O2 administration (Δpulsatility index, ΔPI) and liver-to-thorax ratio (LiTR) as measured in the second and third trimesters. Postnatal outcome measures included survival until discharge, best oxygenation index (OI) and alveolar-arterial oxygen gradient [D(A-a)O2] in the first 24 h of life and the occurrence of PHT in the first 28 days of life. Results: Median gestational age (GA) at evaluations was 27.2 and 34.3 weeks. GA at delivery was 36.0 weeks, and overall survival was 55%. In the second trimester, measurement of lung size, LiTR and pulmonary reactivity were significantly related to survival and the best OI and D(A-a)O2.The occurrence of PHT was better predicted by ΔPI and LiTR. Conclusions: O/E LHR, LiTR and vascular reactivity correlate with ventilatory parameters in the first 24 h of life. Occurrence of PHT at ≥28 days was best predicted by LiTR and ΔPI, but not by lung size. © 2014 S. Karger AG, Basel.
    Fetal Diagnosis and Therapy 11/2014; · 2.30 Impact Factor
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    ABSTRACT: We aimed to characterize the effect of vaginal or abdominal mesh insertion, and of different collagen augmentation of polypropylene mesh in a sheep model. Outcome measures were passive and active biomechanical properties and semi-quantitative morphometry.
    American Journal of Obstetrics and Gynecology 11/2014; · 3.97 Impact Factor
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    ABSTRACT: Introduction: We review the characteristics and prenatal choices of patients recently evaluated for neural tube defects (NTD) at two tertiary units. The prenatal diagnosis of NTD allows parents to consider all prenatal options. In selected cases of spina bifida aperta this also includes fetal surgery, which we started offering after combined 'in-house' and 'exported' training. Material and Methods: This is a retrospective review of prospectively collected data on NTD diagnosed over the last 8 years and recent fetal surgery referrals. Results: A total of 167 patients were referred for assessment at a median of 19 weeks. Cranial lesions were diagnosed significantly earlier than spinal lesions. Of the open spinal lesions, 77% were isolated. Of these, 22% were managed expectantly and 1 (1%) had fetal surgery. There was no correlation between parental decisions on prenatal management with disease-specific severity markers. We had 14 fetal surgery referrals, all but 1 from beyond our typical referral area; 6 of the assessed patients were operated on, 4 were expectantly managed and 4 requested termination of pregnancy (TOP). These pregnancy outcomes were in the expected range. Discussion: Open spina bifida is mainly diagnosed in the second trimester and 76% of subjects request TOP, irrespective of the severity indicators. The number of local patients considering fetal surgery is low. © 2014 S. Karger AG, Basel.
    Fetal Diagnosis and Therapy 10/2014; · 2.30 Impact Factor
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    ABSTRACT: Background Large congenital diaphragmatic hernia may require prosthetic correction. Acellular collagen matrix were introduced to avoid complications due to the use of synthetic patches. We tested 3 different ACM for reconstruction of an abdominal wall defect in an animal model that mimics the fast growth during infancy. Methods Pelvisoft® and 2 investigational ACM were used for primary reconstruction of a full thickness abdominal wall defect. 3 months-old rats (n = 26) were allowed to survive for 90 days after implantation. Anatomical, tensiometric and histological analysis were performed. Based on good outcomes, we did the same with 1 month-old rats (n = 54). Unoperated rats were used for obtaining reference tensiometric values of selected native tissues. Results Major wound complications were exclusively observed in 1 month-old rats. All explants in both groups thinned significantly (p < 0.03) and had an elastic modulus increasing over time, far above that from native tissues at 90 days of life. Both investigational ACM induced a more vigorous foreign body reaction than Pelvisoft®. Conclusions The shift from 3 to 1 month-old rats was associated with wound complications. Pelvisoft® showed a better biocompatibility than the 2 investigational ACM. Passive biomechanical properties of all explants were still not comparable to that of native tissues.
    Journal of Pediatric Surgery 10/2014; · 1.31 Impact Factor
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    ABSTRACT: Objectives To assess the relationship between the position of the stomach and the volume of herniated organs into the thorax, and the observed-to-expected total fetal lung volume (o/e TFLV), which is a measure of pulmonary hypoplasia in fetuses with isolated left sided congenital diaphragmatic hernia (LCDH).Methods Single-center study on archived MR images of fetuses evaluated for isolated LCDH over an 11-year period. We retrieved the gestational age at MR examination, the o/e TFLV and liver position. Images were also reviewed to retrospectively determine the position of the stomach as well as the proportion of the volume of fetal liver, stomach and other viscera into the thorax, to the total thorax volume. The latter measurements were done by a single operator. Following confirmation of reproducibility, we correlated intra-thoracic organ volumes and stomach position to the o/e TFLV.Results205 fetuses underwent 259 MR examinations. The reproducibility of organ volume measurements was excellent (range of ICC: 0.928-0.997). The average time spent on each intra-thoracic organ volume ranged from 2.28-5.13 min. From all herniated organs, the liver-to-thoracic volume ratio (LiTR) correlated best to o/e TFLV (R = −0.429, p < 0.0001). Stomach volume did not correlate though as a categorical variable, the position of the stomach was inversely related to the o/e TFLV.Conclusions We observed an inverse relationship between lung volume and the amount of liver herniated as well as the position of the stomach into the chest.
    Ultrasound in Obstetrics and Gynecology 10/2014; · 3.56 Impact Factor
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    ABSTRACT: Pelvic organ prolapse is a common health problem: the lifetime risk of undergoing surgery for pelvic organ prolapse by the age of 85 years is 19%. Pelvic organ prolapse has significant negative effects on a woman's quality of life. Worldwide, vaginal hysterectomy is the leading treatment method for patients with symptomatic uterovaginal prolapse. Several studies have shown that vaginal sacrospinous hysteropexy and laparoscopic sacrohysteropexy are safe and effective alternatives in treating uterine descent. To date, it is unclear which of these techniques leads to the best operative result and the highest patient satisfaction. Therefore, we conducted the LAVA trial.
    BMC Women's Health 09/2014; 14(1):112. · 1.66 Impact Factor
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    ABSTRACT: Objective To report a recent update on fetuses with right-sided congenital diaphragmatic hernia (RCDH) in the era of fetal surgery.DesignRetrospective review of prospectively collected data.SettingFetal treatment centres in Leuven and Barcelona.PopulationConsecutive cases of RCDH between 2002 and 2012.Methods Data on prenatal imaging, genetic testing, pregnancy and neonatal outcomes were extracted from our databases, including structural and genetic anomalies, candidate outcome predictors such as lung size, liver herniation ratio, polyhydramnios, cervical length, preterm prelabour rupture of membranes and gestational age at birth.Main outcome measuresSurvival and oxygen dependency at discharge.ResultsTen out of 86 fetuses with RCDH had associated abnormalities. Of 76 isolated pregnancies, eight women opted for termination of pregnancy, most with severe hypoplasia and one was lost to follow up. Nineteen pregnancies were expectantly managed and delivered at a mean gestational age of 36.0 ± 3.0 weeks. Survival at discharge was 53% (10/19), one being oxygen dependent. In the fetal surgery group (n = 48), mean gestational age at delivery was 34.5 ± 3.0 weeks. In our recent experience not previously published (n = 23) survival rate was 52 and 39% were oxygen dependent at discharge. Pooling these data with earlier reported observations by our group we observed a 42% survival rate in 57 fetuses. Lung size on magnetic resonance imaging and an interval of >24 hours between reversal of tracheal occlusion and delivery were predictors of outcome.Conclusions Right-sided CDH seems to have a poorer outcome than that reported for fetuses with left-sided CDH with similar lung size before birth. Survival rates after expectant management with observed/expected lung-to-head ratio values ≤45 and ≤30% were 17 and 0%, respectively. In those undergoing fetal surgery (observed/expected lung-to-head ratio ≤45%) there was an apparent increase (42%).
    BJOG An International Journal of Obstetrics & Gynaecology 09/2014; · 3.76 Impact Factor
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    ABSTRACT: This study is aimed at a comprehensive and extensive characterization of the mechanical biocompatibility of mesh prostheses. A robust and simple experimental protocol and a set of parameters is proposed, addressing stiffness under uniaxial and biaxial loading conditions, anisotropy, influence of prior deformation history, local mismatch of deformation mechanisms, and changes in mechanical properties when embedded in a homogeneous matrix. These parameters can form the basis for comparison of different mesh types and for evaluation of their mechanical biocompatibility. Measurements were performed on nine mesh types used for hernia and/or pelvic repair, including heavier as well as lighter implants and covering a wide range of mechanical responses. A total of 93 experiments were performed and all parameters are represented for each mesh in a single diagram to facilitate the quantitative assessment of implant characteristics and their comparison. The mechanics of implants is a critical factor determining clinical performance which should be accounted for in mesh selection and for development of future implants.
    Journal of the Mechanical Behavior of Biomedical Materials 08/2014; 40C:42-58. · 3.05 Impact Factor
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    ABSTRACT: Variants in PORCN are a cause of Goltz-Gorlin syndrome or Focal Dermal Hypoplasia, an X-linked dominant disorder affecting heterozygous females and until now considered to be embryonic lethal in males. Exome sequencing was performed in a family in which two male siblings were characterized by microphthalmia and additional congenital anomalies including diaphragmatic hernia, spina bifida and cardiac defects. Surprisingly, we identified a maternally inherited variant in PORCN present in both males as well as in two female siblings. This represents the first finding of a PORCN variant in non-mosaic males affected with Goltz-Gorlin syndrome. The apparently asymptomatic mother showed extreme skewing of X-inactivation (90%), an asymptomatic female sibling showed skewing of 88%, and the second female sibling affected with cutis aplasia of the scalp showed X-inactivation considered within the normal range.European Journal of Human Genetics advance online publication, 16 July 2014; doi:10.1038/ejhg.2014.135.
    European journal of human genetics: EJHG 07/2014; · 3.56 Impact Factor
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    ABSTRACT: Objective To evaluate cardiac function in fetuses with congenital diaphragmatic hernia (CDH) using speckle tracking.Method Case-control study assessing cardiac contractility in consecutive fetuses with CDH. Controls were anatomically normal fetuses, adjusted for gestational age. Speckle tracking software calculated ventricular peak longitudinal velocity, displacement and strain. Pulmonary hypoplasia was assessed using observed/expected lung-to-head ratio (O/E LHR).ResultsThirty-eight fetuses with CDH (29 left, 9 right) were evaluated at mean gestational age of 26.9±2.5w. In 6 fetuses the acquired images were of insufficient quality (feasibility 83%). Velocity and displacement showed regional differences, as well as significant differences between the ventricular walls, similar to control fetuses. Strain measurements also demonstrated regional differences, yet less uniformly arranged. In left CDH, we observed increased strain values in the left ventricle compared to controls (-18.7±7.2 vs. -15.1±4.9). There was no correlation between strain values in the left ventricle and O/E LHR. In fetuses with right CDH, deformation analysis was not different from controls.Conclusions In fetuses with CDH, no cardiac dysfunction could be detected despite the often concurrent hypoplasia of ipsilateral cardiac structures. In fetuses with left CDH, the decrease in ventricular size coincides with increased strain values in the free left ventricular wall. This article is protected by copyright. All rights reserved.
    Prenatal Diagnosis 07/2014; · 2.68 Impact Factor
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    ABSTRACT: In the EU-27, 2,100 babies with congenital diaphragmatic hernia (CDH) are born annually. CDH is fatal in 30% of them. Experimental fetal surgery in severe cases results in a survival rate of 50 to 60% at its best. Failure is due to insufficient lung growth, persistent pulmonary hypertension or prematurity induced by the procedure. For nonsurvivors alternative strategies are required. Survivors undergo anatomical repair, but large diaphragmatic defects are closed using a patch. At present the used materials are less than ideal, mainly because of recurrence and chest deformation. To overcome the above limitations, alternative medical therapies (pharmacologic or cell therapy) that are more potent and less invasive are needed. Also a more functional postnatal repair may be possible when using novel scaffolds or engineered constructs. We see a prominent place for autologous amniotic fluid-derived stem cells for these novel strategies, which could be prenatally harvested following appropriate patient selection by noninvasive imaging.
    European Journal of Pediatric Surgery 06/2014; 24(03). · 0.98 Impact Factor
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    ABSTRACT: To evaluate whether assessment pulmonary vascular reactivity in response to maternal hyperoxygenation using fractional moving blood volume (FMBV) is associated with lesser variability between individual measurements than what is observed with direct Doppler measurements.
    Prenatal Diagnosis 05/2014; 34(10). · 2.51 Impact Factor
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    ABSTRACT: Vaginal-vault prolapse is effectively treated using sacrocolpopexy (SCP). A randomized trial demonstrated that it can be performed as effectively via laparoscopy (LSCP) as via laparotomy and with less morbidity. This evidence begs the question of how units offering abdominal sacrocolpopexy will implement LSCP. Several limitations need to be overcome. LSCP initially requires longer operating time; however, that decreases with surgeon experience. To decrease operation time, suture training can be implemented ahead. Following a 15-h suturing lab, trainees achieved comparable operation times after 30 cases. Dissection is another critical time-consuming step and is difficult to model. Proficiency is more dependent on patient characteristics, though this component is poorly studied. One experience showed it takes 60 procedures to effectively limit complications. The large number of patients required for surgeon training for this relative infrequent operation creates a problem, thus limiting the number of centers available for training surgeons within a reasonable period.
    International Urogynecology Journal 05/2014; · 2.17 Impact Factor
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    ABSTRACT: Using exome sequencing we identify a homozygous splice site mutation in the PIGN gene in a foetus with multiple congenital anomalies including bilateral diaphragmatic hernia, cardiovascular anomalies, segmental renal dysplasia, facial dysmorphism, cleft palate, and oligodactyly. This finding expands the phenotypic spectrum associated with homozygous loss of function mutations in PIGN, and adds further support for defective GPI anchor biosynthesis as a cause of developmental abnormalities. We demonstrate that exome sequencing is a valuable approach for the identification of a genetic cause in sporadic cases of MCA due to inherited mutations.
    European Journal of Medical Genetics 05/2014; · 1.49 Impact Factor

Publication Stats

8k Citations
2,077.09 Total Impact Points

Institutions

  • 1995–2014
    • Universitair Psychiatrisch Centrum KU Leuven
      Cortenberg, Flanders, Belgium
  • 1993–2014
    • University of Leuven
      • • Faculty of Medicine
      • • Department of Human Genetics
      • • Department of Reproduction, Development and Regeneration
      • • Department of Cardiovascular Sciences
      Louvain, Flanders, Belgium
  • 1970–2014
    • Universitair Ziekenhuis Leuven
      • • Department of Gynaecology and obstetrics
      • • Department of Radiology
      Louvain, Flanders, Belgium
  • 2013
    • University of Toronto
      Toronto, Ontario, Canada
    • Université du Droit et de la Santé Lille 2
      Lille, Nord-Pas-de-Calais, France
    • Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
      • Obstetrics and Gynaecology 2
      Milano, Lombardy, Italy
    • Universidade Federal de Santa Maria
      Santa Maria da Boca do Monte, Rio Grande do Sul, Brazil
  • 2008–2013
    • IDIBAPS August Pi i Sunyer Biomedical Research Institute
      Barcino, Catalonia, Spain
    • St. Michael's Hospital
      Toronto, Ontario, Canada
    • The Fetal Medicine Foundation
      Londinium, England, United Kingdom
  • 2012
    • University of New South Wales
      Kensington, New South Wales, Australia
    • Great Ormond Street Hospital for Children NHS Foundation Trust
      • Department of Paediatric Psychology
      Londinium, England, United Kingdom
    • University of Sarajevo
      Bosna-Sarai, Federation of Bosnia and Herzegovina, Bosnia and Herzegovina
  • 2007–2011
    • University of Barcelona
      • Department of Obstetrics and Gynecology, Pediatrics, Radiology and Anatomy
      Barcelona, Catalonia, Spain
  • 2010
    • Mater Hospital
      Brisbane, Queensland, Australia
    • Centre Hospitalier Régional Universitaire de Lille
      Lille, Nord-Pas-de-Calais, France
    • University of Maryland, Baltimore
      • Department of Medicine
      Baltimore, MD, United States
    • Cliniques Universitaires Saint-Luc
      • Division of Obstetrics
      Bruxelles, Brussels Capital Region, Belgium
  • 2009–2010
    • Hospital Clínic de Barcelona
      • Servicio de Medicina Materno Fetal
      Barcino, Catalonia, Spain
    • University of Leipzig
      • Klinik und Poliklinik für Kinderchirurgie
      Leipzig, Saxony, Germany
    • Université René Descartes - Paris 5
      Lutetia Parisorum, Île-de-France, France
  • 2003–2009
    • Leiden University Medical Centre
      • • Department of Neonatology
      • • Department of Pediatrics
      • • Department of Obstetrics
      Leiden, South Holland, Netherlands
    • Harbor-UCLA Medical Center
      Torrance, California, United States
    • St. George's School
      Middletown, Rhode Island, United States
  • 2000–2009
    • Catholic University of Louvain
      • Department of Gynaecology, Obstetrics and Pediatrics - GYPE
      Лувен-ла-Нев, Walloon, Belgium
  • 2006–2008
    • King's College London
      • Division of Asthma, Allergy and Lung Biology
      Londinium, England, United Kingdom
    • Autonomous University of Barcelona
      • Departamento de Pediatría, Obstetricia, Ginecología y Medicina Preventiva
      Cerdanyola del Vallès, Catalonia, Spain
    • Tufts Medical Center
      • Department of Pediatrics
      Boston, MA, United States
    • University of Cincinnati
      Cincinnati, Ohio, United States
  • 2005–2007
    • University of Zurich
      Zürich, Zurich, Switzerland
    • Tufts University
      • Department of Obstetrics and Gynecology
      Boston, GA, United States
  • 2004–2005
    • Université de Versailles Saint-Quentin
      Versailles, Île-de-France, France
    • University Hospital Vall d'Hebron
      Barcino, Catalonia, Spain
    • Hannover Medical School
      Hanover, Lower Saxony, Germany
    • Wayne State University
      • Department of Obstetrics and Gynecology
      Detroit, Michigan, United States
  • 2002
    • University of Hamburg
      • Center for Experimental Medicine
      Hamburg, Hamburg, Germany
  • 1998
    • McGill University
      • Department of Surgery
      Montréal, Quebec, Canada
  • 1996–1997
    • Alpert Medical School - Brown University
      • Department of Surgery
      Providence, RI, United States