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Robinson JL, Richardson H, Xie SX, Alfaro B, Loh N, Lee VMY, Lee EB, Trojanowski JQ. Cerebrovascular disease lesions are additive and tied to vascular risk factors and cognitive impairment. Free Neuropathol 2022; 3:7. [PMID: 37250748 PMCID: PMC10209856 DOI: 10.17879/freeneuropathology-2022-3792] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Cerebrovascular lesions are prevalent in late life and frequently co-occur but the relationship to cognitive impairment is complicated by the lack of consensus around which lesions represent hallmark pathologies for vascular impairment, particularly in the presence of Alzheimer's disease (AD). We developed an easily applicable model of cerebrovascular disease (CVD), defined as the presence of two or more lesions: moderate to severe cerebral amyloid angiopathy, moderate to severe arteriolosclerosis, infarcts (large, lacunar, or micro), and/or hemorrhages. AD was defined as intermediate or high AD neuropathologic change. The contribution of vascular risk factors such as atherosclerosis and/or a health history of heart disease, hyperlipidemia, stroke events, diabetes, or hypertension was also assessed. Logistic regression analysis reported the association of CVD with increasing age, vascular risk factors, AD, and cognitive impairment in this study of 1,485 autopsied individuals. Cerebrovascular lesions were present in 48% and 16% had CVD. Increasing age associated with all lesions (p<0.001), except hemorrhages (p=0.41). CVD was more likely in individuals with vascular risk factors or AD (p<0.01). CVD, but not individual cerebrovascular lesions, associated with impairment in cases without AD (p<0.01), but not in cases with AD (p>0.61). From this, we conclude that a simple, additive model of CVD is 1) age and AD-associated, 2) is associated with vascular risk factors, and 3) clinically correlates with cognitive decline independent of AD.
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Affiliation(s)
- John L Robinson
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging (JLR, SXX, BA, NL, VMYL), Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine (EBL), Department of Biostatistics, Epidemiology and Informatics (HR, SXX), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Hayley Richardson
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging (JLR, SXX, BA, NL, VMYL), Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine (EBL), Department of Biostatistics, Epidemiology and Informatics (HR, SXX), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sharon X Xie
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging (JLR, SXX, BA, NL, VMYL), Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine (EBL), Department of Biostatistics, Epidemiology and Informatics (HR, SXX), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Brian Alfaro
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging (JLR, SXX, BA, NL, VMYL), Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine (EBL), Department of Biostatistics, Epidemiology and Informatics (HR, SXX), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nicholas Loh
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging (JLR, SXX, BA, NL, VMYL), Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine (EBL), Department of Biostatistics, Epidemiology and Informatics (HR, SXX), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Virginia M-Y Lee
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging (JLR, SXX, BA, NL, VMYL), Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine (EBL), Department of Biostatistics, Epidemiology and Informatics (HR, SXX), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Edward B Lee
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging (JLR, SXX, BA, NL, VMYL), Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine (EBL), Department of Biostatistics, Epidemiology and Informatics (HR, SXX), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John Q Trojanowski
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging (JLR, SXX, BA, NL, VMYL), Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine (EBL), Department of Biostatistics, Epidemiology and Informatics (HR, SXX), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Robinson JL, Richardson H, Xie SX, Suh E, Van Deerlin VM, Alfaro B, Loh N, Porras-Paniagua M, Nirschl JJ, Wolk D, Lee VMY, Lee EB, Trojanowski JQ. The development and convergence of co-pathologies in Alzheimer's disease. Brain 2021; 144:953-962. [PMID: 33449993 PMCID: PMC8041349 DOI: 10.1093/brain/awaa438] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [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: 07/13/2020] [Revised: 09/15/2020] [Accepted: 10/02/2020] [Indexed: 12/14/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA), limbic-predominant age-related TDP-43 encephalopathy neuropathological change (LATE-NC) and Lewy bodies occur in the absence of clinical and neuropathological Alzheimer's disease, but their prevalence and severity dramatically increase in Alzheimer's disease. To investigate how plaques, tangles, age and apolipoprotein E ε4 (APOE ε4) interact with co-pathologies in Alzheimer's disease, we analysed 522 participants ≥50 years of age with and without dementia from the Center for Neurodegenerative Disease Research (CNDR) autopsy program and 1340 participants in the National Alzheimer's Coordinating Center (NACC) database. Consensus criteria were applied for Alzheimer's disease using amyloid phase and Braak stage. Co-pathology was staged for CAA (neocortical, allocortical, and subcortical), LATE-NC (amygdala, hippocampal, and cortical), and Lewy bodies (brainstem, limbic, neocortical, and amygdala predominant). APOE genotype was determined for all CNDR participants. Ordinal logistic regression was performed to quantify the effect of independent variables on the odds of having a higher stage after checking the proportional odds assumption. We found that without dementia, increasing age associated with all pathologies including CAA (odds ratio 1.63, 95% confidence interval 1.38-1.94, P < 0.01), LATE-NC (1.48, 1.16-1.88, P < 0.01), and Lewy bodies (1.45, 1.15-1.83, P < 0.01), but APOE ε4 only associated with CAA (4.80, 2.16-10.68, P < 0.01). With dementia, increasing age associated with LATE-NC (1.30, 1.15-1.46, P < 0.01), while Lewy bodies associated with younger ages (0.90, 0.81-1.00, P = 0.04), and APOE ε4 only associated with CAA (2.36, 1.52-3.65, P < 0.01). A longer disease course only associated with LATE-NC (1.06, 1.01-1.11, P = 0.01). Dementia in the NACC cohort associated with the second and third stages of CAA (2.23, 1.50-3.30, P < 0.01), LATE-NC (5.24, 3.11-8.83, P < 0.01), and Lewy bodies (2.41, 1.51-3.84, P < 0.01). Pathologically, increased Braak stage associated with CAA (5.07, 2.77-9.28, P < 0.01), LATE-NC (5.54, 2.33-13.15, P < 0.01), and Lewy bodies (4.76, 2.07-10.95, P < 0.01). Increased amyloid phase associated with CAA (2.27, 1.07-4.80, P = 0.03) and Lewy bodies (6.09, 1.66-22.33, P = 0.01). In summary, we describe widespread distributions of CAA, LATE-NC and Lewy bodies that progressively accumulate alongside plaques and tangles in Alzheimer's disease dementia. CAA interacted with plaques and tangles especially in APOE ε4 positive individuals; LATE-NC associated with tangles later in the disease course; most Lewy bodies associated with moderate to severe plaques and tangles.
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Affiliation(s)
- John L Robinson
- Center for Neurodegenerative Disease Research, Department of Pathology and
Laboratory Medicine, Institute on Aging, University of Pennsylvannia,
Philadelphia, PA, USA
| | - Hayley Richardson
- Department of Biostatistics, Epidemiology and Informatics, University of
Pennsylvannia, Philadelphia, PA, USA
| | - Sharon X Xie
- Center for Neurodegenerative Disease Research, Department of Pathology and
Laboratory Medicine, Institute on Aging, University of Pennsylvannia,
Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, University of
Pennsylvannia, Philadelphia, PA, USA
| | - EunRan Suh
- Center for Neurodegenerative Disease Research, Department of Pathology and
Laboratory Medicine, Institute on Aging, University of Pennsylvannia,
Philadelphia, PA, USA
| | - Vivianna M Van Deerlin
- Center for Neurodegenerative Disease Research, Department of Pathology and
Laboratory Medicine, Institute on Aging, University of Pennsylvannia,
Philadelphia, PA, USA
| | - Brian Alfaro
- Center for Neurodegenerative Disease Research, Department of Pathology and
Laboratory Medicine, Institute on Aging, University of Pennsylvannia,
Philadelphia, PA, USA
| | - Nicholas Loh
- Center for Neurodegenerative Disease Research, Department of Pathology and
Laboratory Medicine, Institute on Aging, University of Pennsylvannia,
Philadelphia, PA, USA
| | - Matias Porras-Paniagua
- Center for Neurodegenerative Disease Research, Department of Pathology and
Laboratory Medicine, Institute on Aging, University of Pennsylvannia,
Philadelphia, PA, USA
| | - Jeffrey J Nirschl
- Center for Neurodegenerative Disease Research, Department of Pathology and
Laboratory Medicine, Institute on Aging, University of Pennsylvannia,
Philadelphia, PA, USA
| | - David Wolk
- Department of Neurology, University of Pennsylvania Perelman School of
Medicine, Philadelphia, PA, USA
| | - Virginia M -Y Lee
- Center for Neurodegenerative Disease Research, Department of Pathology and
Laboratory Medicine, Institute on Aging, University of Pennsylvannia,
Philadelphia, PA, USA
| | - Edward B Lee
- Department of Neurology, University of Pennsylvania Perelman School of
Medicine, Philadelphia, PA, USA
| | - John Q Trojanowski
- Department of Neurology, University of Pennsylvania Perelman School of
Medicine, Philadelphia, PA, USA
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Abstract
COVID-19 (coronavirus disease 2019) is a disease caused by the coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). COVID-19 has yielded many reported complications and unusual observations. In this article, we have reviewed one such observation: an association between malaria endemicity and reduced reported COVID-19 fatality. Malaria-endemic regions have a significantly lower reported COVID-19 fatality rate as compared to regions where malaria is non-endemic. Statistical analyses show that there is a strong negative correlation between the reported SARS-CoV-2 fatality and endemicity of malaria. In this review, we have discussed the potential role of CD-147, and potential malaria-induced immunity and polymorphisms in COVID-19 patients. Noteworthy, the results may also be due to underreported cases or due to the economic, political, and environmental differences between the malaria endemic and non-endemic countries. The study of this potential relationship might be of great help in COVID-19 therapy and prevention.
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Affiliation(s)
- Abdul Rehman Arshad
- CMH Lahore Medical College and Institute of Dentistry (NUMS), Lahore, Pakistan
| | - Imtiaz Bashir
- CMH Lahore Medical College and Institute of Dentistry (NUMS), Lahore, Pakistan
| | - Farhat Ijaz
- CMH Lahore Medical College and Institute of Dentistry (NUMS), Lahore, Pakistan
| | - Nicholas Loh
- Flinders University, College of Medicine and Public Health. Adelaide, SA, Australia
| | - Suraj Shukla
- Flinders University, College of Medicine and Public Health. Adelaide, SA, Australia
| | - Ubaid Ur Rehman
- Flinders University, College of Medicine and Public Health. Adelaide, SA, Australia
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Dixon P, Loh N, Barakzai S. Swellings of the angle of the mandible in 32 horses (1997–2011). Vet J 2014; 199:97-102. [DOI: 10.1016/j.tvjl.2013.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 10/11/2013] [Accepted: 10/12/2013] [Indexed: 11/16/2022]
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Saerbeck T, Loh N, Lott D, Toperverg BP, Mulders AM, Fraile Rodríguez A, Freeland JW, Ali M, Hickey BJ, Stampfl APJ, Klose F, Stamps RL. Spatial fluctuations of loose spin coupling in CuMn/Co multilayers. Phys Rev Lett 2011; 107:127201. [PMID: 22026792 DOI: 10.1103/physrevlett.107.127201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Indexed: 05/31/2023]
Abstract
A detailed investigation of magnetic impurity-mediated interlayer exchange coupling observed in Cu(0.94)Mn(0.06)/Co multilayers using polarized neutron reflectometry and magnetic x-ray techniques is reported. Excellent descriptions of temperature and magnetic field dependent biquadratic coupling are obtained using a variant of the loose spin model that takes into account the distribution of the impurity Mn ions in three dimensions. Positional disorder of the magnetic impurities is shown to enhance biquadratic coupling via a new contribution J(2)(fluct), leading to a temperature dependent canting of magnetic domains in the multilayer. These results provide measurable effects on RKKY coupling associated with the distribution of impurities within planes parallel to the interfaces.
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Affiliation(s)
- T Saerbeck
- School of Physics, University of Western Australia, Crawley, WA6009, Australia.
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Abstract
Proponents of cannabis law reform argue that many people who are convicted for minor cannabis offences have no prior criminal conviction and are otherwise law-abiding citizens. This study of criminal justice system data in a strict prohibition jurisdiction (Western Australia) found that over 10% of all charges and 85% of all drug charges were for cannabis. Approximately 90% of these were for minor offences. Over 40% of those charged with cannabis possession/use as their most serious offence had never been arrested for any prior offence. Almost half of those first arrested for cannabis possession/use had not been arrested up to 10 years later. Younger first-time arrested cannabis users were more likely to be re-arrested than older offenders. Almost all adult cannabis offenders who went to court were convicted and fined. Nearly 95% of those imprisoned for possession/use of cannabis were gaoled for fine default. The findings accord with earlier research showing that the vast majority of these offenders are, in all respects apart from their cannabis use, a non-criminal section of the community.
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Affiliation(s)
- S Lenton
- National Centre for Research into the Prevention of Drug Abuse, Curtin University of Technology, GPO Box U1987, Perth, Western Australia, Australia
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Loh N, Mahmood K. G.P.12.09 Audit of Duchenne muscular dystrophy in Southwest England. Neuromuscul Disord 2008. [DOI: 10.1016/j.nmd.2008.06.281] [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: 11/15/2022]
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Loh N, Porter W, Webb M. The obvious "non-accidental injury". Ir Med J 2005; 98:217-8. [PMID: 16185021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Nicchia GP, Nico B, Camassa LMA, Mola MG, Loh N, Dermietzel R, Spray DC, Svelto M, Frigeri A. The role of aquaporin-4 in the blood-brain barrier development and integrity: studies in animal and cell culture models. Neuroscience 2005; 129:935-45. [PMID: 15561409 DOI: 10.1016/j.neuroscience.2004.07.055] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2004] [Indexed: 02/09/2023]
Abstract
Aquaporin-4 (AQP4) is the major water channel expressed in brain perivascular astrocyte processes. Although the role of AQP4 in brain edema has been extensively investigated, little information exists regarding its functional role at the blood-brain barrier (BBB). The purpose of this work is to integrate previous and recent data regarding AQP4 expression during BBB formation and depending on BBB integrity, using several experimental models. Results from studies on the chick optic tectum, a well-established model of BBB development, and the effect of lipopolysaccharide on the BBB integrity and on perivascular AQP4 expression have been analyzed and discussed. Moreover, data on the BBB structure and AQP4 expression in murine models of Duchenne muscular dystrophy are reviewed. In particular, published results obtained from mdx(3cv) mice have been analyzed together with new data obtained from mdx mice in which all the dystrophin isoforms including DP71 are strongly reduced. Finally, the role of the endothelial component on AQP4 cellular expression and distribution has been investigated using rat primary astrocytes and brain capillary endothelial cell co-cultures as an in vitro model of BBB.
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Affiliation(s)
- G P Nicchia
- Department of General and Environmental Physiology and Centre of Excellence in Comparative Genomics (CEGBA), University of Bari, via Amendola 165/A, I-70126 Bari, Italy
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Loh N, Ch'en IY, Olcott E, Jeffrey RB, Hui KC, Persons B, Lineaweaver WC. Power Doppler imaging in preoperative planning and postoperative monitoring of muscle flaps. J Clin Ultrasound 1997; 25:465-471. [PMID: 9350564 DOI: 10.1002/(sici)1097-0096(199711/12)25:9<465::aid-jcu1>3.0.co;2-l] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
PURPOSE We assessed the utility of power Doppler imaging (PDI) in preoperative planning and postoperative evaluation of microvascular tissue transfers. METHODS Twenty-five PDI studies were performed on 23 patients using a 5-10-MHz linear-array transducer. Thirteen patients were assessed preoperatively for patency of the desired donor vessel; 8 of them had surgical scars overlying the desired vascular territory. Twelve patients (including 2 from the first group) were evaluated postoperatively for patency of the vascular anastomoses and adequacy of the blood supply to the transferred tissue. RESULTS Twelve of the 13 patients assessed preoperatively had successful flap transfers. Four of the 8 patients with scars over the desired vascular territories had absent or aberrant arteries, necessitating a change in the operative plan. None of these patients had operative complications. Eight of the 12 patients scanned postoperatively had patent anastomoses. In 2 of these patients, impending surgery was averted when the adequacy of the tissue blood supply was established with PDI. In 4 patients, PDI showed arterial or venous compromise, which was confirmed at surgery. CONCLUSIONS PDI is a useful technique in microsurgical tissue transfer for assessing the patency of desired donor vessels preoperatively and for postoperative evaluation of blood supply.
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Affiliation(s)
- N Loh
- Department of Radiology, Stanford University Medical Center, California 94305, USA
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