Resting-State Functional Magnetic Resonance Imaging Network Association With Mortality, Epilepsy, Cognition, and Motor Two-Year Outcomes in Suspected Severe Neonatal Acute Brain Injury

BACKGROUND AND OBJECTIVES

In acute brain injury of neonates, resting-state functional magnetic resonance imaging (MRI) (RS) showed incremental association with consciousness, mortality, cognitive and motor development, and epilepsy, with correction for multiple comparisons, at six months postgestation in neonates with suspected acute brain injury (ABI). However, there are relatively few developmental milestones at six months to benchmark against, thus, we extended this cohort study to evaluate two-year outcomes.

METHODS

In 40 consecutive neonates with ABI and RS, ordinal scores of resting-state networks; MRI, magnetic resonance spectroscopy, and electroencephalography; and up to 42-month outcomes of mortality, general and motor development, Pediatric Cerebral Performance Category Scale (PCPC), and epilepsy informed associations between tests and outcomes.

RESULTS

Mean gestational age was 37.8 weeks, 68% were male, and 60% had hypoxic-ischemic encephalopathy. Three died in-hospital, four at six to 42 months, and five were lost to follow-up. Associations included basal ganglia network with PCPC (P = 0.0003), all-mortality (P = 0.005), and motor (P = 0.0004); language/frontoparietal network with developmental delay (P = 0.009), PCPC (P = 0.006), and all-mortality (P = 0.01); default mode network with developmental delay (P = 0.003), PCPC (P = 0.004), neonatal intensive care unit mortality (P = 0.01), and motor (P = 0.009); RS seizure onset zone with epilepsy (P = 0.01); and anatomic MRI with epilepsy (P = 0.01).

CONCLUSION

For the first time, at any age, resting state functional MRI in ABI is associated with long-term epilepsy and RSNs predicted mortality in neonates. Severity of RSN abnormality was associated with incrementally worsened neurodevelopment including cognition, language, and motor function over two years.

Backyard aerosol pollution monitors: foliar surfaces, dust enrichment, and factors influencing foliar retention

Air pollution is one of the leading causes of death from noncommunicable diseases globally, and in Arizona, both mining activities and abandoned agriculture can generate erodible dust. This dust is transported via wind and can carry high amounts of toxic pollutants. Industry-adjacent communities, or "fenceline communities," are generally closer to the pollution sources and are disproportionally impacted by pollution, or in this case, dust. The dust transported from the mine settles into nearby rivers, gardens, and homes, and increases the concentrations of elements beyond their naturally occurring amounts (i.e., enriched). This study was built upon previous community science work in which plant leaves were observed to collect similar concentrations to an accepted dust collection method and illustrated promise for their use as low-cost air quality monitors in these communities. This work investigated the concentration of Na, Mg, Al, K, Ca, Mn, Co, Cu, Zn, Mo, and Ba in dust from the leaves of community-collected backyard and garden plants (foliar dust), as well as if certain variables affected collection efficacy. This assessment evaluated (1) foliar concentration versus surface area for 11 elements, (2) enrichment factor (EF) values and ratios, (3) comparisons of foliar, garden, and yard samples to US Geological Survey data, and (4) what variable significantly affected dust collection efficacy. The EF results indicate that many of the samples were enriched (anthropogenically contaminated) and that the foliar samples were generally more contaminated than the yard and garden soil samples. Leaf surface area was the most influential factor for leaf collection efficiency (p < 0.05) compared to plant family or sampling location. Further studies are needed that standardize the plant species and age and include multiple replicates of the same plant species across partnering communities. This study has demonstrated that foliar dust is enriched in the participating partnering communities and that plant leaf samples can serve as backyard aerosol pollution monitors. Therefore, foliar dust is a viable indicator of outdoor settled dust and aerosol contamination and this is an adoptable monitoring technique for "fenceline communities."

Discerning Seizure-Onset v. Propagation Zone: Pre-and-Post-Operative Resting-State fMRI Directionality and Boerwinkle Neuroplasticity Index

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Directionality differentiates the SOZ and pZ with 88% accuracy, 73% specificity, and 95% sensitivity.

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The Boerwinkle Neuroplasticity Index >70% is predictive of good outcomes.

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Signal from seizure onset zone to propagation zone is excitatory and signal from propagation zone to seizure onset zone is inhibitory.

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Greater inhibition from propagation zone is associated with better surgical outcome.

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Pre to post-operative SOZ and pZ modulation was diminished as expected.

The goal of this study was to determine resting state fMRI (rs-fMRI) effective connectivity (RSEC) capacity, agnostic of epileptogenic events, in distinguishing seizure onset zones (SOZ) from propagation zones (pZ). Consecutive patients (2.1–18.2 years old), with epilepsy and hypothalamic hamartoma, pre-operative rs-fMRI-directed surgery, post-operative imaging, and Engel class I outcomes were collected. Cross-spectral dynamic causal modelling (DCM) was used to estimate RSEC between the ablated rs-fMRI-SOZ to its region of highest connectivity outside the HH, defined as the propagation zone (pZ). Pre-operatively, RSEC from the SOZ and PZ was expected to be positive (excitatory), and pZ to SOZ negative (inhibitory), and post-operatively to be either diminished or non-existent. Sensitivity, accuracy, positive predictive value were determined for node-to-node connections. A Parametric Empirical Bayes (PEB) group analysis on pre-operative data was performed to identify group effects and effects of Engel class outcome and age. Pre-operative RSEC strength was also evaluated for correlation with percent seizure frequency improvement, sex, and region of interest size. Of the SOZ’s RSEC, only 3.6% had no connection of significance to the pZ when patient models were individually reduced. Among remaining, 96% were in expected (excitatory signal found from SOZ → pZ and inhibitory signal found from pZ → SOZ) versus 3.6% reversed polarities. Both pre-operative polarity signals were equivalently as expected, with one false signal direction out of 26 each (3.7% total). Sensitivity of 95%, specificity 73%, accuracy of 88%, negative predictive value 88%, and positive predictive value of 88% in identifying and differentiating the SOZ and pZ. Groupwise PEB analysis confirmed SOZ → pZ EC was excitatory, and pZ → SOZ EC was inhibitory. Patients with better outcomes (Engel Ia vs. Ib) showed stronger inhibitory signal (pZ → SOZ). Age was negatively associated with absolute RSEC bidirectionally but had no relationship with Directionality SOZ identification performance. In an additional hierarchical PEB analysis identifying changes from pre-to-post surgery, SOZ → pZ modulation became less excitatory and pZ → SOZ modulation became less inhibitory. This study demonstrates the accuracy of Directionality to identify the origin of excitatory and inhibitory signal between the surgically confirmed SOZ and the region of hypothesized propagation zone in children with DRE due to a HH. Thus, this method validation study in a homogenous DRE population may have potential in narrowing the SOZ-candidates for epileptogenicity in other DRE populations and utility in other neurological disorders.

A dietary assessment tool to estimate arsenic and cadmium exposures from locally grown foods

Certain food products have been shown to accumulate arsenic (As) and cadmium (Cd) making it critical to monitor individual's intake, particularly when they live near sources of environmental contamination. After a literature review, a novel dietary assessment was conducted to estimate a child's potential exposure to these metal(loid)s via consumption of locally grown foods in communities impacted by active or legacy resource extraction activities. Mean ingestion rates of As- and Cd-translocating crops belonging to the Asteraceae, Brassicaceae, Caricaceae, Amaranthaceae, Cucurbitaceae, Liliaceae, Solanaceae, Apiaceae, and Fabaceae plant families were calculated for children: 1 to < 2 years, 2 to < 3 years, and 3 to < 6 years of age. These calculated ingestion rates ranged from 0 to 143,571 mg day^-1. Farmer-consumer relationship was the leading motivation for buying locally grown foods, while lack of experience/unfamiliarity was the most frequently reported reason for not buying locally. The median percentages of child's yearly consumption of fruits and vegetables originating from stores (conventionally grown) and from local sources (farmer's market) were 48% and 38%, respectively. Tomato was the crop with the highest intake rate among children 1 to < 2 years and 2 to < 3 years of age and broccoli for children 3 to < 6 years of age. It was concluded that families who are reliant on locally grown food products may be disproportionately exposed to As and Cd, which could cause detrimental health effects.

Ingestion and inhalation of metal(loid)s through preschool gardening: An exposure and risk assessment in legacy mining communities

Children residing in mining towns are potentially disproportionately exposed to metal(loid)s via ingestion and dust inhalation, thus, increasing their exposure when engaging in school or home gardening or playing outside. This citizen science study assessed preschool children's potential arsenic (As), cadmium (Cd), and lead (Pb) exposure via locally grown produce, water, incidental soil ingestion, and dust inhalation at four sites. Participants were trained to properly collect water, soil, and vegetable samples from their preschools in Nevada County, California. As, Cd, and Pb concentrations in irrigation sources did not exceed the U.S. EPA's maximum contaminant and action levels. In general, garden and playground As and Pb soil concentrations exceeded the U.S. EPA Regional Screening Level, CalEPA Human Health Screening Level, and California Department of Toxic Substances Control Screening Level. In contrast, all Cd concentrations were below these recommended screening levels. Dust samples (<10 μm diameter) were generated from surface garden and playground soil collected at the preschools by a technique that simulated windblown dust. Soil and dust samples were then analyzed by in-vitro bioaccessibility assays using synthetic lung and gastric fluids to estimate the bioaccessible fraction of As, Cd, and Pb in the body. Metal(loid) exposure via grown produce revealed that lettuce, carrot, and cabbage grown in the preschool gardens accumulated a higher concentration of metal(loid) than those store-bought nation-wide. None of the vegetables exceeded the respective recommendation maximum levels for Cd and Pb set by the World Health Organization Codex Alimentarius Commission. The results of this study indicate that consumption of preschool-grown produce and incidental soil ingestion were major contributors to preschool-aged children's exposure to As, Cd, and Pb. Traditionally, this level of site- and age-specific assessment and analyses does not occur at contaminated sites. The results of this holistic risk assessment can inform future risk assessment and public health interventions related to childhood metal(loid) exposures.

Environmental monitoring and exposure science dataset to calculate ingestion and inhalation of metal(loid)s through preschool gardening

Metal(loid) contamination may pose an increased risk of exposure to children residing near legacy and active resource extraction sites. Children may be exposed to arsenic, cadmium, and/or lead by ingestion and/or inhalation while engaging in school or home outdoor activities via environmental media including water, soil, dust, and locally grown produce. It is thus critical to collect site-specific data to best assess these risks. This data article provides gastric and lung in-vitro bioaccessibility assay (IVBA) data, as well as environmental monitoring data for water, soil, dust, and garden produce collected from preschools (N = 4) in mining communities throughout Nevada County, California in 2018. Arsenic, cadmium, and lead concentrations in the aforementioned media and synthetic gastric and lung fluids were measured by inductively coupled plasma-mass spectrometry (ICP-MS). This dataset provides useful metal(loid) concentrations for future risk assessments for similar settings.

Effects of physical exercise in pre-and postmenopausal women on lipid peroxidation and antioxidant systems

The effects of moderate physical activity were studied in 19 postmenopausal and 25 premenopausal women on the enzymatic (superoxide dismutase and catalase) and non-enzymatic (vitamins A and E) antioxidant systems and on the processes of lipid peroxidation (malondialdehyde), and to see whether there is any variation in oxidative stress indicators between the postmenopausal and non-menopausal women. The subjects were also studied anthropometrically. At the end of a training period, there was a decrease in body fat percentage and in various skin folds. Neither group presented a rise in lipid peroxidation levels, although there was a significant (p<0.05) rise in superoxide dismutase activity in the postmenopausal women.