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Guadix SW, Pandey A, Gundlach C, Walsh M, Moss NS, Souweidane MM. Laser interstitial thermal therapy as a radiation-sparing approach for central nervous system tumors in children with cancer predisposition syndromes: report of a child with Li-Fraumeni syndrome. Illustrative case. J Neurosurg Case Lessons 2024; 7:CASE23595. [PMID: 38315990 PMCID: PMC10849145 DOI: 10.3171/case23595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Ionizing radiation and alkylating chemotherapies increase secondary malignancy risk in patients with cancer predisposition syndromes (CPSs), such as Li-Fraumeni syndrome. Laser interstitial thermal therapy (LITT) is a minimally invasive ablation technique that has not been associated with mutagenic risks. We describe the case of a child with LFS and a history of treated choroid plexus carcinoma (CPC) who developed a second primary glial tumor that was safely treated with magnetic resonance imaging (MRI)-guided LITT. OBSERVATIONS A 4-year-old male with left parietal World Health Organization grade III CPC associated with a TP53 germline mutation was evaluated. The patient underwent neoadjuvant platinum-based chemotherapy before near-total resection, followed by 131I-8H9 immunotherapy and 30 fractions of 54-Gy proton radiotherapy. He remained without evidence of disease for 2 years before developing a slow-growing mass adjacent to the left frontal ventricular horn. Stereotactic biopsy revealed a glial neoplasm. Given the nonsuperficial location and focality of the lesion, MRI-guided LITT was performed for ablative therapy. There were no complications, and 2 years of surveillance revealed continued retraction of the ablated tumor focus and no subsequent disease. LESSONS Alternatives to mutagenic therapies for brain tumors should be explored for patients with CPS. LITT paired with imaging surveillance is a logical strategy to ensure durable outcomes and mitigate treatment-related secondary neoplasms.
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Affiliation(s)
- Sergio W Guadix
- 1Department of Neurological Surgery, Weill Cornell Medicine, New York, New York; and
| | - Abhinav Pandey
- 1Department of Neurological Surgery, Weill Cornell Medicine, New York, New York; and
| | - Carson Gundlach
- 1Department of Neurological Surgery, Weill Cornell Medicine, New York, New York; and
| | - Michael Walsh
- 2Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nelson S Moss
- 2Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark M Souweidane
- 1Department of Neurological Surgery, Weill Cornell Medicine, New York, New York; and
- 2Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
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2
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Schraegle WA, Hsu DA, Almane DN, Gundlach C, Stafstrom CE, Seidenberg M, Jones JE, Hermann BP. Neighborhood disadvantage and intellectual development in youth with epilepsy. Epilepsy Behav 2023; 149:109492. [PMID: 37951133 DOI: 10.1016/j.yebeh.2023.109492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/13/2023]
Abstract
RATIONALE Recent cross-sectional investigations have demonstrated an adverse impact of socioeconomic disadvantage on cognition and behavior in youth and adults with epilepsy. The goal of this study is to investigate the impact of disadvantage on prospective intellectual development in youth with epilepsy. METHOD Participants were youth, aged 8-18 years, with recent onset epilepsy (n = 182) and healthy first-degree cousin controls (n = 106). The Wechsler Abbreviated Scale of Intelligence (WASI) was administered at baseline and 2 years later. The Neighborhood Atlas identified each family's Area Deprivation Index via state deciles and national percentiles. WASI data were analyzed by mixed group by time ANOVAs followed by regression analysis to identify other baseline predictors of time 2 outcomes. RESULTS Youth with epilepsy demonstrated significant interactions between group and time for both verbal (F = 4.02, df = 1,215, p =.05) and nonverbal (F = 4.57, df = 1,215, p =.04) reasoning, demonstrating that disadvantage was associated with slower cognitive development compared to advantaged youth with epilepsy. Similar interactions were not observed for controls. CONCLUSIONS In youth with new and recent onset epilepsies, neighborhood-level disadvantage is associated with a negative impact on the development of verbal and nonverbal reasoning skills.
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Affiliation(s)
- William A Schraegle
- Departments of Neurology and Pediatrics, Dell Medical School, The University of Texas, Austin, TX, USA; Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, TX, USA
| | - David A Hsu
- Department of Neurology, University of Wisconsin, School of Medicine and Public Health, USA
| | - Dace N Almane
- Department of Neurology, University of Wisconsin, School of Medicine and Public Health, USA
| | - Carson Gundlach
- Department of Neurology, University of Wisconsin, School of Medicine and Public Health, USA
| | | | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin University of Medicine and Science, USA
| | - Jana E Jones
- Department of Neurology, University of Wisconsin, School of Medicine and Public Health, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin, School of Medicine and Public Health, USA.
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3
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Park N, Gundlach C, Judge T, Batavia AS, Charney P. Expanding Access to Psychiatric Care Through Universal Depression Screening: Lessons from an Urban Student-Run Free Clinic. J Community Health 2023; 48:932-936. [PMID: 37400658 DOI: 10.1007/s10900-023-01250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/05/2023]
Abstract
The purpose of this study is to report the utility of a universal depression screening in a student-run free clinic (SRFC) to improve bridging to psychiatric care. Patients (n = 224) seen by an SRFC between April 2017 and November 2022 were screened for depression in the patient's primary language using the standardized Patient Health Questionnaire (PHQ-9). A PHQ-9 score greater or equal to 5 prompted psychiatry referral. Retrospective chart review was conducted to determine clinical characteristics and length of psychiatry follow-up. Out of 224 patients screened, 77 patients had positive depression screens and were referred to the SRFC's adjacent psychiatry clinic. Of these 77 patients, 56 patients (73%) were female, the average age was 43.7 (SD = 14.5), and the mean PHQ score was 10 (SD = 5.13). Thirty-seven patients (48%) accepted referral, while 40 (52%) declined or were lost to follow-up. There were no statistical differences in age or number of medical comorbidities between the two groups. Patients who accepted referrals were more likely to be female, as well as to have psychiatric histories, higher PHQ-9 scores, and a history of trauma. Reasons for declining and being lost to follow-up included transition to insurance, geographic relocation and deferral due to hesitancy in seeking psychiatric care. Implementation of a standardized depression screening reveals a significant rate of depressive symptoms among an urban uninsured primary care population. Universal screening may serve as a tool to improve the delivery of psychiatric care to underserved patients.
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Affiliation(s)
- Nana Park
- Weill Cornell Medical College, New York, NY, USA.
| | | | - Tyler Judge
- Weill Cornell Medical College, New York, NY, USA
| | - Ashita S Batavia
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Pamela Charney
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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4
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Chu DY, Adluru N, Nair VA, Choi T, Adluru A, Garcia-Ramos C, Dabbs K, Mathis J, Nencka AS, Gundlach C, Conant L, Binder JR, Meyerand ME, Alexander AL, Struck AF, Hermann B, Prabhakaran V. Association of neighborhood deprivation with white matter connectome abnormalities in temporal lobe epilepsy. Epilepsia 2023; 64:2484-2498. [PMID: 37376741 PMCID: PMC10530287 DOI: 10.1111/epi.17702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE Social determinants of health, including the effects of neighborhood disadvantage, impact epilepsy prevalence, treatment, and outcomes. This study characterized the association between aberrant white matter connectivity in temporal lobe epilepsy (TLE) and disadvantage using a US census-based neighborhood disadvantage metric, the Area Deprivation Index (ADI), derived from measures of income, education, employment, and housing quality. METHODS Participants including 74 TLE patients (47 male, mean age = 39.2 years) and 45 healthy controls (27 male, mean age = 31.9 years) from the Epilepsy Connectome Project were classified into ADI-defined low and high disadvantage groups. Graph theoretic metrics were applied to multishell connectome diffusion-weighted imaging (DWI) measurements to derive 162 × 162 structural connectivity matrices (SCMs). The SCMs were harmonized using neuroCombat to account for interscanner differences. Threshold-free network-based statistics were used for analysis, and findings were correlated with ADI quintile metrics. A decrease in cross-sectional area (CSA) indicates reduced white matter integrity. RESULTS Sex- and age-adjusted CSA in TLE groups was significantly reduced compared to controls regardless of disadvantage status, revealing discrete aberrant white matter tract connectivity abnormalities in addition to apparent differences in graph measures of connectivity and network-based statistics. When comparing broadly defined disadvantaged TLE groups, differences were at trend level. Sensitivity analyses of ADI quintile extremes revealed significantly lower CSA in the most compared to least disadvantaged TLE group. SIGNIFICANCE Our findings demonstrate (1) the general impact of TLE on DWI connectome status is larger than the association with neighborhood disadvantage; however, (2) neighborhood disadvantage, indexed by ADI, revealed modest relationships with white matter structure and integrity on sensitivity analysis in TLE. Further studies are needed to explore this relationship and determine whether the white matter relationship with ADI is driven by social drift or environmental influences on brain development. Understanding the etiology and course of the disadvantage-brain integrity relationship may serve to inform care, management, and policy for patients.
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Affiliation(s)
- Daniel Y Chu
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Nagesh Adluru
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Veena A Nair
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Timothy Choi
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Anusha Adluru
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Camille Garcia-Ramos
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kevin Dabbs
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jedidiah Mathis
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew S Nencka
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Carson Gundlach
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lisa Conant
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jeffrey R Binder
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mary E Meyerand
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Andrew L Alexander
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Aaron F Struck
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- William S. Middleton Veterans Hospital, Madison, Wisconsin, USA
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Vivek Prabhakaran
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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5
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Schraegle WA, Slomowitz RF, Gundlach C, Hsu DA, Almane DN, Stafstrom CE, Seidenberg M, Jones JE, Hermann BP. Disadvantage and Neurocognitive Comorbidities in Childhood Idiopathic Epilepsies. Epilepsia 2023. [PMID: 36965077 DOI: 10.1111/epi.17581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE To characterize the relationship between neighborhood disadvantage on cognitive function as well as clinical, sociodemographic, and family factors in children with new onset idiopathic epilepsy and healthy controls. METHODS Research participants were 288 children aged 8-18 years with recent onset epilepsy (CWE, n = 182; mean age = 12.2 ± 3.2 years), healthy first-degree cousin controls (HC, n = 106; mean age = 12.5 ± 3.0), and one biological or adopted parent per child (n=279). All participants were administered a comprehensive neuropsychological battery (reasoning, language, memory, executive function, motor function, and academic achievement). Family residential addresses were entered into the Neighborhood Atlas to determine each family's Area Deprivation Index (ADI), a metric used to quantify income, education, employment, and housing quality. A combination of parametric (ANOVA) and non-parametric (χ2 ) tests examined the effect of ADI by group (epilepsy and controls) across cognitive, academic, clinical, and family factors. RESULTS Disadvantage (ADI) was equally distributed between groups (p = .63). For CWE, high disadvantage was associated with lower overall intellectual quotient (p =.04), visual naming/expressive language (p = .03), phonemic (letter) fluency (p <.01), passive inattention (omission errors) (p = .03), delayed verbal recall (p = .04) and dominant fine motor dexterity and speed (p < .01). Cognitive status of the HC group did not differ by level of disadvantage (p = .40). CWE exhibited greater academic difficulties in comparison to HC (p < .001), which were exacerbated by disadvantage in CWE (p = .02), but not HC (p < .05). High disadvantage was associated with a threefold risk for academic challenges prior to epilepsy onset (odds ratio = 3.31, p = .024). SIGNIFICANCE Socioeconomic hardship (increased neighborhood disadvantage) exerts a significant adverse impact on the cognitive and academic status of youth with new and recent onset epilepsies, an impact that needs to be incorporated into etiological models of the neurobehavioral comorbidities of epilepsy.
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Affiliation(s)
- William A Schraegle
- Departments of Neurology and Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
- Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, Texas, USA
| | - Rebecca F Slomowitz
- Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, Texas, USA
| | - Carson Gundlach
- Department of Neurology, University of Wisconsin School of Medicine and Public Health
| | - David A Hsu
- Department of Neurology, University of Wisconsin School of Medicine and Public Health
| | - Dace N Almane
- Department of Neurology, University of Wisconsin School of Medicine and Public Health
| | | | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin University of Medicine and Science
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health
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6
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Guadix SW, Garman TS, Gundlach C, Pisapia DJ, Souweidane MM. Durability of an endoscopic management strategy for recurrent choroid plexus carcinoma with a comprehensive molecular characterization: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE22508. [PMID: 36880511 PMCID: PMC10550668 DOI: 10.3171/case22508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/14/2022] [Indexed: 03/08/2023]
Abstract
OBJECTIVE Choroid plexus carcinoma (CPC) is a rare, primarily intraventricular neoplasm. Extent of resection correlates with improved outcomes but is limited due to tumor vascularity and size. Evidence on optimal surgical management and molecular drivers of recurrence remains limited. Here the authors characterize a case of multiply recurrent CPC treated with sequential endoscopic removals over 10 years and highlight its genomic properties. OBSERVATIONS Five years after standard treatment, a 16-year-old female presented with a distant intraventricular recurrence of CPC. Whole exome sequencing revealed NF1, PER1, and SLC12A2 mutations, FGFR3 gain, and no TP53 alterations. Repeat sequencing on recurrences 4 and 5 years later showed persistent NF1 and FGFR3 alterations. Methylation profiling was consistent with plexus tumor, subclass pediatric B. Short-term magnetic resonance imaging detected four total isolated recurrences, all treated with complete endoscopic resections at 5, 6.5, 9, and 10 years after initial diagnosis. Mean hospital stay for all recurrences was 1 day with no complications. LESSONS The authors describe a patient with four isolated recurrences of CPC over a decade, each treated with complete endoscopic removal, and identify unique molecular alterations that persisted without TP53 alterations. These outcomes support frequent neuroimaging to facilitate endoscopic surgical removal following early detection of CPC recurrence.
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Affiliation(s)
| | - Tyler S. Garman
- Brady Urological Institute & Department of Urology, Johns Hopkins University, Baltimore, Maryland; and
| | | | - David J. Pisapia
- Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Mark M. Souweidane
- Departments of Neurological Surgery, and
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
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7
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Hermann BP, Struck AF, Stafstrom CE, Hsu DA, Dabbs K, Gundlach C, Almane D, Seidenberg M, Jones JE. Behavioral phenotypes of childhood idiopathic epilepsies. Epilepsia 2020; 61:1427-1437. [PMID: 32557544 DOI: 10.1111/epi.16569] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To characterize the presence and nature of discrete behavioral phenotypes and their correlates in a cohort of youth with new and recent onset focal and generalized epilepsies. METHODS The parents of 290 youth (age = 8-18 years) with epilepsy (n = 183) and typically developing participants (n = 107) completed the Child Behavior Checklist for children aged 6-18 from the Achenbach System of Empirically Based Assessment. The eight behavior problem scales were subjected to hierarchical clustering analytics to identify behavioral subgroups. To characterize the external validity and co-occurring comorbidities of the identified subgroups, we examined demographic features (age, gender, handedness), cognition (language, perception, attention, executive function, speed), academic problems (present/absent), clinical epilepsy characteristics (epilepsy syndrome, medications), familial factors (parental intelligence quotient, education, employment), neuroimaging features (cortical thickness), parent-observed day-to-day executive function, and number of lifetime-to-date Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses. RESULTS Hierarchical clustering identified three behavioral phenotypes, which included no behavioral complications (Cluster 1, 67% of epilepsy cohort [n = 122]), nonexternalizing problems (Cluster 2, 11% of cohort [n = 21]), and combined internalizing and externalizing problems (Cluster 3, 22% of cohort [n = 40]). These behavioral phenotypes were characterized by orderly differences in personal characteristics, neuropsychological status, history of academic problems, parental status, cortical thickness, daily executive function, and number of lifetime-to-date DSM-IV diagnoses. Cluster 1 was most similar to controls across most metrics, whereas Cluster 3 was the most abnormal compared to controls. Epilepsy syndrome was not a predictor of cluster membership. SIGNIFICANCE Youth with new and recent onset epilepsy fall into three distinct behavioral phenotypes associated with a variety of co-occurring features and comorbidities. This approach identifies important phenotypes of behavior problem presentations and their accompanying factors that serve to advance clinical and theoretical understanding of the behavioral complications of children with epilepsy and the complex conditions with which they co-occur.
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Affiliation(s)
- Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Aaron F Struck
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Carl E Stafstrom
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - David A Hsu
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kevin Dabbs
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Carson Gundlach
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Dace Almane
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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8
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Gundlach C, Moratti S, Forschack N, Müller MM. Spatial Attentional Selection Modulates Early Visual Stimulus Processing Independently of Visual Alpha Modulations. Cereb Cortex 2020; 30:3686-3703. [PMID: 31907512 DOI: 10.1093/cercor/bhz335] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 11/18/2019] [Accepted: 12/17/2019] [Indexed: 01/06/2023] Open
Abstract
The capacity-limited human brain is constantly confronted with a huge amount of sensory information. Selective attention is needed for biasing neural processing towards relevant information and consequently allows meaningful interaction with the environment. Activity in the alpha-band has been proposed to be related to top-down modulation of neural inhibition and could thus represent a viable candidate to control the priority of stimulus processing. It is, however, unknown whether modulations in the alpha-band directly relate to changes in the sensory gain control of the early visual cortex. Here, we used a spatial cueing paradigm while simultaneously measuring ongoing alpha-band oscillations and steady-state visual evoked potentials (SSVEPs) as a marker of continuous early sensory processing in the human visual cortex. Thereby, the effects of spatial attention for both of these signals and their potential interactions were assessed. As expected, spatial attention modulated both alpha-band and SSVEP responses. However, their modulations were independent of each other and the corresponding activity profiles differed across task demands. Thus, our results challenge the view that modulations of alpha-band activity represent a mechanism that directly alters or controls sensory gain. The potential role of alpha-band oscillations beyond sensory processing will be discussed in light of the present results.
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Affiliation(s)
- C Gundlach
- Experimental Psychology and Methods, Universität Leipzig, Leipzig, Germany.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - S Moratti
- Department of Experimental Psychology, Complutense University of Madrid, Madrid, Spain.,Laboratory for Clinical Neuroscience, Centre for Biomedical Technology, Universidad Politécnica de Madrid, Spain
| | - N Forschack
- Experimental Psychology and Methods, Universität Leipzig, Leipzig, Germany.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - M M Müller
- Experimental Psychology and Methods, Universität Leipzig, Leipzig, Germany
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Diller GP, Helm P, Gundlach C, Baumgartner H, Bauer UMM. P2574Sexual activity and dysfunction in adult patients with congenital heart disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Although the number of adults with congenital heart disease (CHD) is increasing, there is little research into the impact of CHD on sexual activity and -dysfunction. Whether and to what extent sexual function is discussed with patients in clinical practice is also unknown.
Purpose
To study the current knowledge level, problems, wishes and fears of adult CHD patients regarding sexual activity.
Methods
Patients recruited via the German National Register for Congenital Heart Defects were invited to an online survey about sexual function. Overall, 4,484 patients (2,264 female) were invited to the survey and 873 patients (502 female) participated (19.5%). Patients were divided into four groups based on the underlying CHD severity classification: simple CHD (136 patients), moderate CHD (354 patients), complex CHD (340 patients).
Results
301 (35.6%) patients reported that they had very rarely or no sex at all in the six months preceding the survey (simple CHD: 25.7%, moderate CHD: 33.6%, complex CHD: 38.2%, other CHD: 39.5%). Based on the last six months, 71.2% of the surveyed male patients estimated the probability of having and maintaining an erection as high or very high (simple CHD: 85%, moderate CHD: 71.4%, complex CHD: 69.7%). In addition, 60.6% of the interviewed male patients reported to be almost always or always able to get a full erection sufficient for sexual intercourse. In contrast, 14.6% of the male patients already had erectile dysfunction, but did not discuss this issue with their physician. Overall, only 3.5% of the male patients stated that they were offered a consultation regarding erectile dysfunction by their treating physician. In contrast, 29.6% of the male patients would like to receive such counseling during routine medical examinations. In the last six months, 56.4% of the interviewed female patients, reported no difficulties with lubrication. 44% of the female patients already received advice from their physician on sexuality, contraception and pregnancy and 64.5% of the female patients would like to receive additional medical advice and information on sexuality, contraception and pregnancy in the context of routine medical check-ups.
Conclusions
This study reveals important issues regarding sexual function in male and female adult patients with CHD. The study reveals important gaps in counselling patients regarding sexual issues beyond contraception and pregnancy.
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Affiliation(s)
- G P Diller
- University Medical Center, Center for Adults with Congenital Heart Defects (EMAH-Center), Münster, Germany
| | - P Helm
- National Register for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - C Gundlach
- University Medical Center, Center for Adults with Congenital Heart Defects (EMAH-Center), Münster, Germany
| | - H Baumgartner
- University Medical Center, Center for Adults with Congenital Heart Defects (EMAH-Center), Münster, Germany
| | - U M M Bauer
- National Register for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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10
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Gundlach C, Nierhaus T, Müller M, Villringer A, Sehm B. P 52 Amplitude modulation of the somatosensory alpha rhythm by transcranial alternating current stimulation applied at the individual endogenous frequency. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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Christiansen BC, Dideriksen K, Katz A, Nedel S, Bovet N, Sørensen HO, Frandsen C, Gundlach C, Andersson MP, Stipp SLS. Incorporation of monovalent cations in sulfate green rust. Inorg Chem 2014; 53:8887-94. [PMID: 25144528 DOI: 10.1021/ic500495a] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Green rust is a naturally occurring layered mixed-valent ferrous-ferric hydroxide, which can react with a range of redox-active compounds. Sulfate-bearing green rust is generally thought to have interlayers composed of sulfate and water. Here, we provide evidence that the interlayers also contain monovalent cations, using X-ray photoelectron spectroscopy and synchrotron X-ray scattering. For material synthesized with Na(+), K(+), Rb(+), or Cs(+), interlayer thickness derived from basal plane spacings correlates with the radius of the monovalent cation. In addition, sequential washing of the materials with water showed that Na(+) and K(+) were structurally fixed in the interlayer, whereas Rb(+) and Cs(+) could be removed, resulting in a decrease in the basal layer spacing. The incorporation of cations in the interlayer opens up new possibilities for the use of sulfate green rust for exchange reactions with both anions and cations: e.g., radioactive Cs.
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Affiliation(s)
- B C Christiansen
- Nano-Science Center, Department of Chemistry, University of Copenhagen , Universitetsparken 5, 2100 Copenhagen, Denmark
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Gundlach C, Müller M, Nierhaus T, Villringer A, Sehm B. OP 10. Phasic modulation of somatosensory perception by means of transcranial alternating current stimulation. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.04.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Goltz D, Gundlach C, Nierhaus T, Villringer A, Müller M. P 186. Inter-and intra-individual differences in the attentional modulation of the somatosensory steady state signal. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.04.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hoff M, Kaminski E, Gundlach C, Sehm B, Villringer A, Ragert P. P 6. tDCS-induced effects on paired-pulse inhibition in the primary somatosensory cortex. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.04.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vaughan G, Wright J, Gundlach C, Schmidt S, Poulsen H, Soerensen H. Monocrystal-like structural, stochastic and microstructural information from polycrystalline samples. Acta Crystallogr A 2008. [DOI: 10.1107/s0108767308082500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Wright J, Vaughan G, Schmidt S, Poulsen H, Gundlach C. Center of mass grain maps in 3D. Acta Crystallogr A 2008. [DOI: 10.1107/s010876730809418x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Vaughan G, Wright J, Gundlach C, Margulies L, Schmidt S, Poulsen HF. Diffraction mapping of hierarchical systems. Acta Crystallogr A 2007. [DOI: 10.1107/s0108767307098297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Schmidt S, Nielsen SF, Gundlach C, Margulies L, Huang X, Jensen DJ. Watching the growth of bulk grains during recrystallization of deformed metals. Science 2004; 305:229-32. [PMID: 15247474 DOI: 10.1126/science.1098627] [Citation(s) in RCA: 202] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
We observed the in situ growth of a grain during recrystallization in the bulk of a deformed sample. We used the three-dimensional x-ray diffraction microscope located at the European Synchrotron Radiation Facility in Grenoble, France. The results showed a very heterogeneous growth pattern, contradicting the classical assumption of smooth and spherical growth of new grains during recrystallization. This type of in situ bulk measurement opens up the possibility of obtaining experimental data on scientific topics that before could only be analyzed theoretically on the basis of the statistical characterization of microstructures. For recrystallization, the in situ method includes direct measurements of nucleation and boundary migration through a deformed matrix.
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Affiliation(s)
- S Schmidt
- Center for Fundamental Research, Metal Structures in Four Dimensions, Risø National Laboratory, 4000 Roskilde, Denmark.
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Gundlach C, Price RH, Pullin J. Late-time behavior of stellar collapse and explosions. I. Linearized perturbations. Int J Clin Exp Med 1994; 49:883-889. [PMID: 10017045 DOI: 10.1103/physrevd.49.883] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Deruelle N, Gundlach C, Langlois D. Vacuum density fluctuations in extended chaotic inflation. Phys Rev D Part Fields 1992; 46:5337-5345. [PMID: 10014921 DOI: 10.1103/physrevd.46.5337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Fish SS, Mattea EJ, Thrasher KA, Cardoni AA, Cohen LG, Gundlach C, Labreche DG, Mutnick AH. Clinical pharmacy education in new England: a report of the Whispering Pines Conference. DICP 1989; 23:912-9. [PMID: 2596135 DOI: 10.1177/106002808902301114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Clinical pharmacy practice as it relates to the future of the pharmacy profession has been examined at Hilton Head in 1985 and at regional conferences throughout the U.S. between 1986 and 1988. However, clinical pharmacy education and its role in the future of the profession had not been the focus of this type of "futuristic" conference. In 1988, the clinical pharmacy faculties from the four colleges of pharmacy in New England met to discuss the "Directions for Clinical Pharmacy Education in New England." Through a series of workshops, and stimulated by challenges from keynote speakers, the participants focused on the current status of clinical pharmacy education in New England, the barriers to change, and the strategies required to accomplish these changes. Consensus on prioritization of changes and their strategies was reached, and those that could be implemented in the near future were identified. Since the conference, changes have occurred and the professional networking that began at the conference has continued. This paper is a summary of the proceedings of this conference.
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Affiliation(s)
- S S Fish
- Massachusetts College of Pharmacy and Allied Health Sciences, Boston
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