1
|
Velasquez MA, Winston JL, Sur S, Yurgil K, Upman AE, Wroblewski SR, Huddle A, Colombo PJ. Music training is related to late ERP modulation and enhanced performance during Simon task but not Stroop task. Front Hum Neurosci 2024; 18:1384179. [PMID: 38711801 PMCID: PMC11070544 DOI: 10.3389/fnhum.2024.1384179] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Increasing evidence suggests that music training correlates with better performance in tasks measuring executive function components including inhibitory control, working memory and selective attention. The Stroop and Simon tasks measure responses to congruent and incongruent information reflecting cognitive conflict resolution. However, there are more reports of a music-training advantage in the Simon than the Stroop task. Reports indicate that these tasks may differ in the timing of conflict resolution: the Stroop task might involve early sensory stage conflict resolution, while the Simon task may do so at a later motor output planning stage. We hypothesize that musical experience relates to conflict resolution at the late motor output stage rather than the early sensory stage. Behavioral responses, and event-related potentials (ERP) were measured in participants with varying musical experience during these tasks. It was hypothesized that musical experience correlates with better performance in the Simon but not the Stroop task, reflected in ERP components in the later stage of motor output processing in the Simon task. Participants were classified into high- and low-music training groups based on the Goldsmith Musical Sophistication Index. Electrical brain activity was recorded while they completed visual Stroop and Simon tasks. The high-music training group outperformed the low-music training group on the Simon, but not the Stroop task. Mean amplitude difference (incongruent-congruent trials) was greater for the high-music training group at N100 for midline central (Cz) and posterior (Pz) sites in the Simon task and midline central (Cz) and frontal (Fz) sites in the Stroop task, and at N450 at Cz and Pz in the Simon task. N450 difference peaks occurred earlier in the high-music training group at Pz. Differences between the groups at N100 indicate that music training may be related to better sensory discrimination. These differences were not related to better behavioral performance. Differences in N450 responses between the groups, particularly in regions encompassing the motor and parietal cortices, suggest a role of music training in action selection during response conflict situations. Overall, this supports the hypothesis that music training selectively enhances cognitive conflict resolution during late motor output planning stages.
Collapse
Affiliation(s)
| | - Jenna L. Winston
- Department of Psychological Sciences, Loyola University New Orleans, New Orleans, LA, United States
| | - Sandeepa Sur
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Kate Yurgil
- Department of Psychological Sciences, Loyola University New Orleans, New Orleans, LA, United States
| | - Anna E. Upman
- Department of Psychological Sciences, Loyola University New Orleans, New Orleans, LA, United States
| | | | - Annabelle Huddle
- Department of Psychology, Tulane University, New Orleans, LA, United States
| | - Paul J. Colombo
- Department of Psychology, Tulane University, New Orleans, LA, United States
- Brain Institute, Tulane University, New Orleans, LA, United States
| |
Collapse
|
2
|
Sur S, Lin Z, Li Y, Yasar S, Rosenberg PB, Moghekar A, Hou X, Jiang D, Kalyani RR, Hazel K, Pottanat G, Xu C, Pillai JJ, Liu P, Albert M, Lu H. CO 2 cerebrovascular reactivity measured with CBF-MRI in older individuals: Association with cognition, physical function, amyloid, and tau proteins. J Cereb Blood Flow Metab 2024:271678X241240582. [PMID: 38489769 DOI: 10.1177/0271678x241240582] [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] [Indexed: 03/17/2024]
Abstract
Vascular pathology is the second leading cause of cognitive impairment and represents a major contributing factor in mixed dementia. However, biomarkers for vascular cognitive impairment and dementia (VCID) are under-developed. Here we aimed to investigate the potential role of CO2 Cerebrovascular Reactivity (CVR) measured with phase-contrast quantitative flow MRI in cognitive impairment and dementia. Forty-five (69 ± 7 years) impaired (37 mild-cognitive-impairment and 8 mild-dementia by syndromic diagnosis) and 22 cognitively-healthy-control (HC) participants were recruited and scanned on a 3 T MRI. Biomarkers of AD pathology were measured in cerebrospinal fluid. We found that CBF-CVR was lower (p = 0.027) in the impaired (mean±SE, 3.70 ± 0.15%/mmHg) relative to HC (4.28 ± 0.21%/mmHg). After adjusting for AD pathological markers (Aβ42/40, total tau, and Aβ42/p-tau181), higher CBF-CVR was associated with better cognitive performance, including Montreal Cognitive Assessment, MoCA (p = 0.001), composite cognitive score (p = 0.047), and language (p = 0.004). Higher CBF-CVR was also associated with better physical function, including gait-speed (p = 0.006) and time for five chair-stands (p = 0.049). CBF-CVR was additionally related to the Clinical-Dementia-Rating, CDR, including global CDR (p = 0.026) and CDR Sum-of-Boxes (p = 0.015). CBF-CVR was inversely associated with hemoglobin A1C level (p = 0.017). In summary, CBF-CVR measured with phase-contrast MRI shows associations with cognitive performance, physical function, and disease-severity, independent of AD pathological markers.
Collapse
Affiliation(s)
- Sandeepa Sur
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Zixuan Lin
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Yang Li
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Sevil Yasar
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Paul B Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Xirui Hou
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Dengrong Jiang
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Rita R Kalyani
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Kaisha Hazel
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - George Pottanat
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Cuimei Xu
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Jay J Pillai
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Division of Neuroradiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Peiying Liu
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center, Kennedy Krieger Institute, Baltimore, MD, USA
| |
Collapse
|
3
|
Sur S, Chen L, Yu D, Rubin LH, Xu YH, Lin Z, Yasar S, Rosenberg PB, Kalyani R, Van Zijl P, Albert MS, Lu H, Li X. Brain iron deposits are associated with apathy in cognitively normal and impaired adults. Alzheimers Dement 2021. [DOI: 10.1002/alz.055853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Lin Chen
- Johns Hopkins University Baltimore MD USA
| | - Danyang Yu
- Johns Hopkins University Baltimore MD USA
| | | | | | | | | | | | | | - Peter Van Zijl
- Johns Hopkins University School of Medicine Baltimore MD USA
| | | | - Hanzhang Lu
- Johns Hopkins University School of Medicine Baltimore MD USA
| | - Xu Li
- Kennedy Krieger Institute Baltimore MD USA
| |
Collapse
|
4
|
Kyriacou C, Cooper N, Robinson E, Parker N, Barcroft J, Kundu S, Letchworth P, Sur S, Gould D, Stalder C, Bourne T. Ultrasound characteristics, serum biochemistry and outcome of ectopic pregnancies presenting during COVID-19 pandemic. Ultrasound Obstet Gynecol 2021; 58:909-915. [PMID: 34605083 PMCID: PMC8661840 DOI: 10.1002/uog.24793] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/14/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To describe and compare the characteristics of ectopic pregnancies (EPs) in the year prior to vs during the coronavirus disease 2019 (COVID-19) pandemic. METHODS This was a retrospective analysis of women diagnosed with an EP on transvaginal sonography conducted at a center in London, UK, providing early-pregnancy assessment, between 1 January 2019 and 31 December 2020. Women were identified via the Astraia ultrasound reporting system using coded and non-coded outcomes of EP or pregnancy outside the uterine cavity. Data related to predefined outcomes were collected using Astraia and Cerner electronic reporting systems. Main outcome measures included clinical, ultrasound and biochemical features of EP, in addition to reported complications and management. RESULTS There were 22 683 consultations over the 2-year period. Following consultation, a similar number and proportion of EPs were diagnosed in 2019 (141/12 657 (1%)) and 2020 (134/10 026 (1%)). Both cohorts were comparable in age, ethnicity, weight and method of conception. Gestational age at the first transvaginal sonography scan and at diagnosis were similar, and no difference in location, size or morphology of EP was found between the two cohorts. Serum human chorionic gonadotropin (hCG) levels at the time of EP diagnosis were higher in 2020 than in 2019 (1005 IU/L vs 665 IU/L; P = 0.03). The proportions of women according to type of final EP management were similar, but the rate of failed first-line management was higher during vs before the pandemic (16% vs 6%; P = 0.01). The rates of blood detected in the pelvis (hemoperitoneum) on ultrasound (23% vs 26%; P = 0.58) and of ruptured EP confirmed surgically (9% vs 3%; P = 0.07) were similar in 2019 vs 2020. CONCLUSIONS No difference was observed in the location, size, morphology or gestational age at the first ultrasound examination or at diagnosis of EP between women diagnosed before vs during the COVID-19 pandemic. Complication rates and final management strategy were also unchanged. However, hCG levels and the failure rate of first-line conservative management measures were higher during the pandemic. Our findings suggest that women continued to access appropriate care for EP during the COVID-19 pandemic, with no evidence of diagnostic delay or an increase in adverse outcome in our population. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- C. Kyriacou
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - N. Cooper
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
| | - E. Robinson
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
| | - N. Parker
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
| | - J. Barcroft
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
| | - S. Kundu
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - P. Letchworth
- St Mary's Hospital, Department of Obstetrics and GynaecologyImperial College LondonLondonUK
| | - S. Sur
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
| | - D. Gould
- St Mary's Hospital, Department of Obstetrics and GynaecologyImperial College LondonLondonUK
| | - C. Stalder
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
| | - T. Bourne
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- Department of Obstetrics and GynaecologyUniversity Hospitals LeuvenLeuvenBelgium
| |
Collapse
|
5
|
Myers JC, Chinn LK, Sur S, Golob EJ. Widespread theta coherence during spatial cognitive control. Neuropsychologia 2021; 160:107979. [PMID: 34339719 DOI: 10.1016/j.neuropsychologia.2021.107979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/06/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022]
Abstract
Cognitive control allows humans to process relevant sensory information while minimizing distractions from irrelevant stimuli. The neural basis of cognitive control is known to involve frontal regions of the brain such as the medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC), but the temporal dynamics of larger scale networks is unclear. Here we used EEG with source localization to identify how the neural oscillations localized to the mPFC and ACC coordinate with parietal, sensory, and motor areas during spatial cognitive control. Theta coherence (3-8 Hz) between the mPFC and ACC increased with task difficulty and predicted individual differences in reaction time. Individual differences in accuracy were predicted by earlier activation of ACC-motor coherence, highlighting the relationship between processing speed and task performance. Our results provide evidence that successful cognitive control requires dynamic coordination between a widespread network of brain regions. Long range theta coherence may be a key mechanism for efficient cognitive control across the neocortex.
Collapse
Affiliation(s)
- John C Myers
- Department of Psychology, Tulane University, New Orleans, LA, 70118, USA; Department of Psychology, University of Texas, San Antonio, TX, 78249, USA; Department of Neurosurgery, Baylor College of Medicine, Houston, TX, 77030, USA.
| | - Lisa K Chinn
- Department of Psychology, Tulane University, New Orleans, LA, 70118, USA; Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, 77004, USA
| | - Sandeepa Sur
- Department of Radiology, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Edward J Golob
- Department of Psychology, Tulane University, New Orleans, LA, 70118, USA; Department of Psychology, University of Texas, San Antonio, TX, 78249, USA
| |
Collapse
|
6
|
Lin Z, Sur S, Liu P, Li Y, Jiang D, Hou X, Darrow J, Pillai JJ, Yasar S, Rosenberg P, Albert M, Moghekar A, Lu H. Blood-Brain Barrier Breakdown in Relationship to Alzheimer and Vascular Disease. Ann Neurol 2021; 90:227-238. [PMID: 34041783 PMCID: PMC8805295 DOI: 10.1002/ana.26134] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/04/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023]
Abstract
Objective: Blood–brain barrier (BBB) breakdown has been suggested to be an early biomarker in human cognitive impairment. However, the relationship between BBB breakdown and brain pathology, most commonly Alzheimer disease (AD) and vascular disease, is still poorly understood. The present study measured human BBB function in mild cognitive impairment (MCI) patients on 2 molecular scales, specifically BBB’s permeability to water and albumin molecules. Methods: Fifty-five elderly participants were enrolled, including 33 MCI patients and 22 controls. BBB permeability to water was measured with a new magnetic resonance imaging technique, water extraction with phase contrast arterial spin tagging. BBB permeability to albumin was determined using cerebrospinal fluid (CSF)/serum albumin ratio. Cognitive performance was assessed by domain-specific composite scores. AD pathology (including CSF Aβ and ptau) and vascular risk factors were examined. Results: Compared to cognitively normal subjects, BBB in MCI patients manifested an increased permeability to small molecules such as water but was no more permeable to large molecules such as albumin. BBB permeability to water was found to be related to AD markers of CSF Aβ and ptau. On the other hand, BBB permeability to albumin was found to be related to vascular risk factors, especially hypercholesterolemia, but was not related to AD pathology. BBB permeability to small molecules, but not to large molecules, was found to be predictive of cognitive function. Interpretation: These findings provide early evidence that BBB breakdown is related to both AD and vascular risks, but their effects can be differentiated by spatial scales. BBB permeability to small molecules has a greater impact on cognitive performance.
Collapse
Affiliation(s)
- Zixuan Lin
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD.,Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sandeepa Sur
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Peiying Liu
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yang Li
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dengrong Jiang
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Xirui Hou
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD.,Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jacqueline Darrow
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jay J Pillai
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sevil Yasar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Paul Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hanzhang Lu
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD.,Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD.,F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD
| |
Collapse
|
7
|
Wilcock D, Jicha G, Blacker D, Albert MS, D’Orazio LM, Elahi FM, Fornage M, Hinman JD, Knoefel J, Kramer J, Kryscio RJ, Lamar M, Moghekar A, Prestopnik J, Ringman JM, Rosenberg G, Sagare A, Satizabal CL, Schneider J, Seshadri S, Sur S, Tracy RP, Yasar S, Williams V, Singh H, Mazina L, Helmer KG, Corriveau RA, Schwab K, Kivisäkk P, Greenberg SM. MarkVCID cerebral small vessel consortium: I. Enrollment, clinical, fluid protocols. Alzheimers Dement 2021; 17:704-715. [PMID: 33480172 PMCID: PMC8122220 DOI: 10.1002/alz.12215] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [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: 05/26/2020] [Accepted: 09/22/2020] [Indexed: 01/04/2023]
Abstract
The concept of vascular contributions to cognitive impairment and dementia (VCID) derives from more than two decades of research indicating that (1) most older individuals with cognitive impairment have post mortem evidence of multiple contributing pathologies and (2) along with the preeminent role of Alzheimer's disease (AD) pathology, cerebrovascular disease accounts for a substantial proportion of this contribution. Contributing cerebrovascular processes include both overt strokes caused by etiologies such as large vessel occlusion, cardioembolism, and embolic infarcts of unknown source, and frequently asymptomatic brain injuries caused by diseases of the small cerebral vessels. Cerebral small vessel diseases such as arteriolosclerosis and cerebral amyloid angiopathy, when present at moderate or greater pathologic severity, are independently associated with worse cognitive performance and greater likelihood of dementia, particularly in combination with AD and other neurodegenerative pathologies. Based on this evidence, the US National Alzheimer's Project Act explicitly authorized accelerated research in vascular and mixed dementia along with frontotemporal and Lewy body dementia and AD itself. Biomarker development has been consistently identified as a key step toward translating scientific advances in VCID into effective prevention and treatment strategies. Validated biomarkers can serve a range of purposes in trials of candidate interventions, including (1) identifying individuals at increased VCID risk, (2) diagnosing the presence of cerebral small vessel disease or specific small vessel pathologies, (3) stratifying study participants according to their prognosis for VCID progression or treatment response, (4) demonstrating an intervention's target engagement or pharmacodynamic mechanism of action, and (5) monitoring disease progression during treatment. Effective biomarkers allow academic and industry investigators to advance promising interventions at early stages of development and discard interventions with low success likelihood. The MarkVCID consortium was formed in 2016 with the goal of developing and validating fluid- and imaging-based biomarkers for the cerebral small vessel diseases associated with VCID. MarkVCID consists of seven project sites and a central coordinating center, working with the National Institute of Neurologic Diseases and Stroke and National Institute on Aging under cooperative agreements. Through an internal selection process, MarkVCID has identified a panel of 11 candidate biomarker "kits" (consisting of the biomarker measure and the clinical and cognitive data used to validate it) and established a range of harmonized procedures and protocols for participant enrollment, clinical and cognitive evaluation, collection and handling of fluid samples, acquisition of neuroimaging studies, and biomarker validation. The overarching goal of these protocols is to generate rigorous validating data that could be used by investigators throughout the research community in selecting and applying biomarkers to multi-site VCID trials. Key features of MarkVCID participant enrollment, clinical/cognitive testing, and fluid biomarker procedures are summarized here, with full details in the following text, tables, and supplemental material, and a description of the MarkVCID imaging biomarker procedures in a companion paper, "MarkVCID Cerebral small vessel consortium: II. Neuroimaging protocols." The procedures described here address a range of challenges in MarkVCID's design, notably: (1) acquiring all data under informed consent and enrollment procedures that allow unlimited sharing and open-ended analyses without compromising participant privacy rights; (2) acquiring the data in a sufficiently wide range of study participants to allow assessment of candidate biomarkers across the various patient groups who might ultimately be targeted in VCID clinical trials; (3) defining a common dataset of clinical and cognitive elements that contains all the key outcome markers and covariates for VCID studies and is realistically obtainable during a practical study visit; (4) instituting best fluid-handling practices for minimizing avoidable sources of variability; and (5) establishing rigorous procedures for testing the reliability of candidate fluid-based biomarkers across replicates, assay runs, sites, and time intervals (collectively defined as the biomarker's instrumental validity). Participant Enrollment Project sites enroll diverse study cohorts using site-specific inclusion and exclusion criteria so as to provide generalizable validation data across a range of cognitive statuses, risk factor profiles, small vessel disease severities, and racial/ethnic characteristics representative of the diverse patient groups that might be enrolled in a future VCID trial. MarkVCID project sites include both prospectively enrolling centers and centers providing extant data and samples from preexisting community- and population-based studies. With approval of local institutional review boards, all sites incorporate MarkVCID consensus language into their study documents and informed consent agreements. The consensus language asks prospectively enrolled participants to consent to unrestricted access to their data and samples for research analysis within and outside MarkVCID. The data are transferred and stored as a de-identified dataset as defined by the Health Insurance Portability and Accountability Act Privacy Rule. Similar human subject protection and informed consent language serve as the basis for MarkVCID Research Agreements that act as contracts and data/biospecimen sharing agreements across the consortium. Clinical and Cognitive Data Clinical and cognitive data are collected across prospectively enrolling project sites using common MarkVCID instruments. The clinical data elements are modified from study protocols already in use such as the Alzheimer's Disease Center program Uniform Data Set Version 3 (UDS3), with additional focus on VCID-related items such as prior stroke and cardiovascular disease, vascular risk factors, focal neurologic findings, and blood testing for vascular risk markers and kidney function including hemoglobin A1c, cholesterol subtypes, triglycerides, and creatinine. Cognitive assessments and rating instruments include the Clinical Dementia Rating Scale, Geriatric Depression Scale, and most of the UDS3 neuropsychological battery. The cognitive testing requires ≈60 to 90 minutes. Study staff at the prospectively recruiting sites undergo formalized training in all measures and review of their first three UDS3 administrations by the coordinating center. Collection and Handling of Fluid Samples Fluid sample types collected for MarkVCID biomarker kits are serum, ethylenediaminetetraacetic acid-plasma, platelet-poor plasma, and cerebrospinal fluid (CSF) with additional collection of packed cells to allow future DNA extraction and analyses. MarkVCID fluid guidelines to minimize variability include fasting morning fluid collections, rapid processing, standardized handling and storage, and avoidance of CSF contact with polystyrene. Instrumental Validation for Fluid-Based Biomarkers Instrumental validation of MarkVCID fluid-based biomarkers is operationally defined as determination of intra-plate and inter-plate repeatability, inter-site reproducibility, and test-retest repeatability. MarkVCID study participants both with and without advanced small vessel disease are selected for these determinations to assess instrumental validity across the full biomarker assay range. Intra- and inter-plate repeatability is determined by repeat assays of single split fluid samples performed at individual sites. Inter-site reproducibility is determined by assays of split samples distributed to multiple sites. Test-retest repeatability is determined by assay of three samples acquired from the same individual, collected at least 5 days apart over a 30-day period and assayed on a single plate. The MarkVCID protocols are designed to allow direct translation of the biomarker validation results to multicenter trials. They also provide a template for outside groups to perform analyses using identical methods and therefore allow direct comparison of results across studies and centers. All MarkVCID protocols are available to the biomedical community and intended to be shared. In addition to the instrumental validation procedures described here, each of the MarkVCID kits will undergo biological validation to determine whether the candidate biomarker measures important aspects of VCID such as cognitive function. Analytic methods and results of these validation studies for the 11 MarkVCID biomarker kits will be published separately. The results of this rigorous validation process will ultimately determine each kit's potential usefulness for multicenter interventional trials aimed at preventing or treating small vessel disease related VCID.
Collapse
Affiliation(s)
- Donna Wilcock
- Sanders-Brown Center on Aging, University of Kentucky College of Medicine, Lexington, KY 40504, USA
| | - Gregory Jicha
- Sanders-Brown Center on Aging, University of Kentucky College of Medicine, Lexington, KY 40504, USA
| | - Deborah Blacker
- Department of Epidemiology, Harvard T.H Chan School of Public Health and Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Marilyn S. Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Lina M. D’Orazio
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Fanny M. Elahi
- Center for Memory and Aging, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, USA
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School and Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Jason D. Hinman
- David Geffen School of Medicine, Department of Neurology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Janice Knoefel
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Joel Kramer
- David Geffen School of Medicine, Department of Neurology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Richard J. Kryscio
- Sanders-Brown Center on Aging, University of Kentucky College of Medicine, Lexington, KY 40504, USA
| | - Melissa Lamar
- Rush Alzheimer’s Disease Center, Rush University, Chicago, IL, USA
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Jillian Prestopnik
- Center for Memory and Aging, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - John M. Ringman
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Gary Rosenberg
- Center for Memory and Aging, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Abhay Sagare
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Claudia L. Satizabal
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Julie Schneider
- Rush Alzheimer’s Disease Center, Rush University, Chicago, IL, USA
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Sandeepa Sur
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Russell P. Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, VT 05405, USA
| | - Sevil Yasar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Victoria Williams
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Herpreet Singh
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Lidiya Mazina
- Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Karl G. Helmer
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Kristin Schwab
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Pia Kivisäkk
- Alzheimer’s Clinical and Translational Research Unit, Massachusetts General Hospital, Boston, MA 02129, USA
| | - Steven M. Greenberg
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | | |
Collapse
|
8
|
Jiang D, Lin Z, Liu P, Sur S, Xu C, Hazel K, Pottanat G, Darrow J, Pillai JJ, Yasar S, Rosenberg P, Moghekar A, Albert M, Lu H. Brain Oxygen Extraction Is Differentially Altered by Alzheimer's and Vascular Diseases. J Magn Reson Imaging 2020; 52:1829-1837. [PMID: 32567195 PMCID: PMC9973301 DOI: 10.1002/jmri.27264] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 04/06/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Alzheimer's disease and vascular cognitive impairment (VCI), as well as their concurrence, represent the most common types of cognitive dysfunction. Treatment strategies for these two conditions are quite different; however, there exists a considerable overlap in their clinical manifestations, and most biomarkers reveal similar abnormalities between these two conditions. PURPOSE To evaluate the potential of cerebral oxygen extraction fraction (OEF) as a biomarker for differential diagnosis of Alzheimer's disease and VCI. We hypothesized that in Alzheimer's disease OEF will be reduced (decreased oxygen consumption due to decreased neural activity), while in vascular diseases OEF will be elevated (increased oxygen extraction due to abnormally decreased blood flow). STUDY TYPE Prospective cross-sectional. POPULATION Sixty-five subjects aged 52-89 years, including 33 mild cognitive impairment (MCI), 7 dementia, and 25 cognitively normal subjects. FIELD STRENGTH/SEQUENCE 3T T2 -relaxation-under-spin-tagging (TRUST) and fluid-attenuated inversion recovery imaging (FLAIR). ASSESSMENT OEF, consensus diagnoses of cognitive impairment, vascular risk factors (such as hypertension, hypercholesterolemia, diabetes, smoking, and obesity), cognitive assessments, and cerebrospinal fluid concentration of amyloid and tau were assessed. STATISTICAL TESTS Multiple linear regression analyses of OEF with diagnostic category (normal, MCI, or dementia), vascular risks, cognitive performance, amyloid and tau pathology. RESULTS When evaluating the entire group, OEF was found to be lower with more severe cognitive impairment (β = -2.70 ± 1.15, T = -2.34, P = 0.02), but was higher with greater vascular risk factors (β = 1.36 ± 0.55, T = 2.48, P = 0.02). Further investigation of the subgroup of participants with low vascular risks (N = 44) revealed that lower OEF was associated with worse cognitive performance (β = 0.04 ± 0.01, T = 3.27, P = 0.002) and greater amyloid burden (β = 92.12 ± 41.23, T = 2.23, P = 0.03). Among cognitively impaired individuals (N = 40), higher OEF was associated with greater vascular risk factors (β = 2.19 ± 0.71, T = 3.08, P = 0.004). DATA CONCLUSION These findings suggest that OEF is differentially affected by Alzheimer's disease and VCI pathology and may be useful in etiology-based diagnosis of cognitive impairment. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 3 J. MAGN. RESON. IMAGING 2020;52:1829-1837.
Collapse
Affiliation(s)
- Dengrong Jiang
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zixuan Lin
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peiying Liu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sandeepa Sur
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Cuimei Xu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kaisha Hazel
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - George Pottanat
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jacqueline Darrow
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jay J. Pillai
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sevil Yasar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hanzhang Lu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Maryland, USA
| |
Collapse
|
9
|
Sur S, Lin Z, Li Y, Yasar S, Rosenberg PB, Moghekar A, Agarwal S, Hou X, Jiang D, Kalyani R, Hazel K, Pottanat G, Xu C, Van Zijl P, Pillai J, Liu P, Albert MS, Lu H. CO2 cerebrovascular reactivity measured with phase‐contrast MRI: A potential biomarker of cognition and physical function in older adults. Alzheimers Dement 2020. [DOI: 10.1002/alz.042215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Yang Li
- Johns Hopkins University Baltimore MD USA
| | | | | | | | | | - Xirui Hou
- Johns Hopkins University Baltimore MD USA
| | | | | | | | | | - Cuimei Xu
- Johns Hopkins University Baltimore MD USA
| | - Peter Van Zijl
- Johns Hopkins University School of Medicine Baltimore MD USA
| | - Jay Pillai
- Johns Hopkins University Baltimore MD USA
| | | | | | | |
Collapse
|
10
|
Sur S, Rubin LH. Neural dynamics of attention in HIV: A cognitive aging phenotype? EBioMedicine 2020; 62:103114. [PMID: 33181460 PMCID: PMC7658472 DOI: 10.1016/j.ebiom.2020.103114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 12/05/2022] Open
Affiliation(s)
- Sandeepa Sur
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Leah H Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA.
| |
Collapse
|
11
|
Sur S, Lin Z, Li Y, Yasar S, Rosenberg P, Moghekar A, Hou X, Kalyani R, Hazel K, Pottanat G, Xu C, van Zijl P, Pillai J, Liu P, Albert M, Lu H. Association of cerebrovascular reactivity and Alzheimer pathologic markers with cognitive performance. Neurology 2020; 95:e962-e972. [PMID: 32661101 DOI: 10.1212/wnl.0000000000010133] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/17/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To determine whether MRI-based cerebrovascular reactivity (CVR) can predict cognitive performance independently of Alzheimer pathologic markers, we studied the relationship between cognition, CVR, and CSF-derived β-amyloid42 (Aβ42) and tau in a group of elderly individuals with mixed Alzheimer and vascular cognitive impairment and dementia. METHODS This was a cross-sectional study of 72 participants 69 ± 8 years of age consisting of individuals with normal cognition (n = 28) and cognitive impairment (n = 44) (including 36 with mild cognitive impairment [MCI] and 8 with mild dementia). CVR was measured with hypercapnia-MRI. Whole-brain CVR (percent blood oxygen level-dependent per 1 mm Hg Etco2) was used to estimate vasodilatory capacity. Montreal Cognitive Assessment (MoCA) scores, cognitive domains scores, and a global composite cognitive score were obtained. AD biomarkers included CSF assays of Aβ42 and tau. RESULTS Whole-brain CVR was lower in the impaired (mean ± SE, 0.132 ± 0.006%/mm Hg) compared to the normal (0.151 ± 0.007%/mm Hg) group (β = -0.02%/mm Hg; 95% confidence interval [CI] -0.038 to -0.001). After adjustment for CSF Aβ42 and tau, higher whole-brain CVR was associated with better performance on the MoCA (β = 29.64, 95% CI 9.94-49.34) and with a global composite cognitive score (β = 4.32, 95% CI 0.05-8.58). When the CVR marker was compared with the Fazekas score based on white matter hyperintensities and vascular risk-score in a single regression model predicting the MoCA score, only CVR revealed a significant effect (β = 28.09, 95% CI 6.14-50.04), while the other 2 measures were not significant. CONCLUSIONS CVR was significantly associated with cognitive performance independently of AD pathology. Whole-brain CVR may be a useful biomarker for evaluating cognitive impairment related to vascular disease in older individuals. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that CVR was significantly associated with cognitive performance independent of AD pathology.
Collapse
Affiliation(s)
- Sandeepa Sur
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Zixuan Lin
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Yang Li
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Sevil Yasar
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Paul Rosenberg
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Abhay Moghekar
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Xirui Hou
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Rita Kalyani
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Kaisha Hazel
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - George Pottanat
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Cuimei Xu
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Peter van Zijl
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Jay Pillai
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Peiying Liu
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Marilyn Albert
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Hanzhang Lu
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD.
| |
Collapse
|
12
|
Jiang D, Lin Z, Liu P, Sur S, Xu C, Hazel K, Pottanat G, Yasar S, Rosenberg P, Albert M, Lu H. Normal variations in brain oxygen extraction fraction are partly attributed to differences in end-tidal CO 2. J Cereb Blood Flow Metab 2020; 40:1492-1500. [PMID: 31382788 PMCID: PMC7308520 DOI: 10.1177/0271678x19867154] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Indexed: 12/24/2022]
Abstract
Cerebral oxygen extraction fraction is an important physiological index of the brain's oxygen consumption and supply and has been suggested to be a potential biomarker for a number of diseases such as stroke, Alzheimer's disease, multiple sclerosis, sickle cell disease, and metabolic disorders. However, in order for oxygen extraction fraction to be a sensitive biomarker for personalized disease diagnosis, inter-subject variations in normal subjects must be minimized or accounted for, which will otherwise obscure its interpretation. Therefore, it is essential to investigate the physiological underpinnings of normal differences in oxygen extraction fraction. This work used two studies, one discovery study and one verification study, to examine the extent to which an individual's end-tidal CO2 can explain variations in oxygen extraction fraction. It was found that, across normal subjects, oxygen extraction fraction is inversely correlated with end-tidal CO2. Approximately 50% of the inter-subject variations in oxygen extraction fraction can be attributed to end-tidal CO2 differences. In addition, oxygen extraction fraction was found to be positively associated with age and systolic blood pressure. By accounting for end-tidal CO2, age, and systolic blood pressure of the subjects, normal variations in oxygen extraction fraction can be reduced by 73%, which is expected to substantially enhance the utility of oxygen extraction fraction as a disease biomarker.
Collapse
Affiliation(s)
- Dengrong Jiang
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zixuan Lin
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peiying Liu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sandeepa Sur
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cuimei Xu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kaisha Hazel
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - George Pottanat
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sevil Yasar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hanzhang Lu
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA
| |
Collapse
|
13
|
Liu P, Xu C, Lin Z, Sur S, Li Y, Yasar S, Rosenberg P, Albert M, Lu H. Cerebrovascular reactivity mapping using intermittent breath modulation. Neuroimage 2020; 215:116787. [PMID: 32278094 DOI: 10.1016/j.neuroimage.2020.116787] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 09/17/2019] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 01/28/2023] Open
Abstract
Cerebrovascular reactivity (CVR), an index of brain vessel's dilatory capacity, is typically measured using hypercapnic gas inhalation or breath-holding as a vasoactive challenge. However, these methods require considerable subject cooperation and could be challenging in clinical studies. More recently, there have been attempts to use resting-state BOLD data to map CVR by utilizing spontaneous changes in breathing pattern. However, in subjects who have small fluctuations in their spontaneous breathing pattern, the CVR results could be noisy and unreliable. In this study, we aim to develop a new method for CVR mapping that does not require gas-inhalation yet provides substantially higher sensitivity than resting-state CVR mapping. This new method is largely based on resting-state scan, but introduces intermittent modulation of breathing pattern in the subject to enhance fluctuations in their end-tidal CO2 (EtCO2) level. Here we examined the comfort level, sensitivity, and accuracy of this method in two studies. First, in 8 healthy young subjects, we developed the intermittent breath-modulation method using two different modulation frequencies, 6 s per breath and 12 s per breath, respectively, and compared the results to three existing CVR methods, specifically hypercapnic gas inhalation, breath-holding, and resting-state. Our results showed that the comfort level of the 6-s breath-modulation method was significantly higher than breath-holding (p = 0.007) and CO2-inhalation (p = 0.015) methods, while not different from the resting-state, i.e. free breathing method (p = 0.52). When comparing the sensitivity of CVR methods, the breath-modulation methods revealed higher Z-statistics compared to the resting-state scan (p < 0.008) and was comparable to breath-holding results. Next, we tested the feasibility of breath-modulation CVR mapping (6 s per breath) in 21 cognitively normal elderly participants and compared quantitative CVR values to that obtained with the CO2-inhalation method. Whole-brain CVR was found to be 0.150 ± 0.055 and 0.154 ± 0.032 %ΔBOLD/mmHg for the breath-modulation and CO2-inhalation method, respectively, with a significant correlation between them (y = 0.97x, p = 0.007). CVR mapping with intermittent breath modulation may be a useful method that combines the advantages of resting-state and CO2-inhalation based approaches.
Collapse
Affiliation(s)
- Peiying Liu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Cuimei Xu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zixuan Lin
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sandeepa Sur
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yang Li
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sevil Yasar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA
| |
Collapse
|
14
|
Al-Memar M, Vaulet T, Fourie H, Bobdiwala S, Farren J, Saso S, Bracewell-Milnes T, Moor BD, Sur S, Stalder C, Bennett P, Timmerman D, Bourne T. First-trimester intrauterine hematoma and pregnancy complications. Ultrasound Obstet Gynecol 2020; 55:536-545. [PMID: 31483898 DOI: 10.1002/uog.20861] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/14/2019] [Accepted: 08/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess whether sonographic diagnosis of intrauterine hematoma (IUH) in the first trimester of pregnancy is associated with first-trimester miscarriage and antenatal, delivery and neonatal complications. METHODS This was a prospective observational cohort study of women with an intrauterine singleton pregnancy between 5 and 14 weeks' gestation recruited at Queen Charlotte's and Chelsea Hospital, London, UK, between March 2014 and March 2016. Participants underwent serial ultrasound examinations in the first trimester, and the presence, location, size and persistence of any IUH was evaluated. First-trimester miscarriage was defined as pregnancy loss before 14 weeks' gestation. Clinical symptoms, including pelvic pain and vaginal bleeding, were recorded at each visit using validated symptom scores. Antenatal, delivery and neonatal outcomes were obtained from hospital records. Logistic regression analysis and the chi-square test were used to assess the association between the presence and features of IUH and the incidence of adverse pregnancy outcome. Odds ratios (OR) were first adjusted for maternal age (aOR) and then further adjusted for the presence of vaginal bleeding or pelvic pain in the first trimester. RESULTS Of 1003 women recruited to the study, 946 were included in the final analysis and of these, 268 (28.3%) were diagnosed with an IUH in the first trimester. The presence of IUH was associated with the incidence of preterm birth (aOR, 1.94 (95% CI, 1.07-3.52)), but no other individual or overall antenatal, delivery or neonatal complications. No association was found between the presence of IUH in the first trimester and first-trimester miscarriage (aOR, 0.81 (95% CI, 0.44-1.50)). These findings were independent of the absolute size of the hematoma and the presence of vaginal bleeding or pelvic pain in the first trimester. When IUH was present in the first trimester, there was no association between its size, content or position in relation to the gestational sac and overall antenatal, delivery and neonatal complications. Diagnosis of a retroplacental IUH was associated with an increased risk of overall antenatal complications (P = 0.04). CONCLUSIONS Our findings demonstrate that there is no association between the presence of IUH in the first trimester and first-trimester miscarriage. However, an association with preterm birth, independently of the presence of symptoms of pelvic pain and/or vaginal bleeding, is evident. Women diagnosed with IUH in the first trimester should be counseled about their increased risk of preterm birth and possibly be offered increased surveillance during the course of their pregnancy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- M Al-Memar
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
- Division of Surgery and Cancer, Institute of Developmental Reproductive and Developmental Biology, Imperial College London, London, UK
| | - T Vaulet
- ESAT-STADIUS, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- imec, Leuven, Belgium
| | - H Fourie
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
- Division of Surgery and Cancer, Institute of Developmental Reproductive and Developmental Biology, Imperial College London, London, UK
| | - S Bobdiwala
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
- Division of Surgery and Cancer, Institute of Developmental Reproductive and Developmental Biology, Imperial College London, London, UK
| | - J Farren
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
- Division of Surgery and Cancer, Institute of Developmental Reproductive and Developmental Biology, Imperial College London, London, UK
| | - S Saso
- Division of Surgery and Cancer, Institute of Developmental Reproductive and Developmental Biology, Imperial College London, London, UK
| | - T Bracewell-Milnes
- Division of Surgery and Cancer, Institute of Developmental Reproductive and Developmental Biology, Imperial College London, London, UK
| | - B De Moor
- ESAT-STADIUS, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- imec, Leuven, Belgium
| | - S Sur
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - C Stalder
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - P Bennett
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
- Division of Surgery and Cancer, Institute of Developmental Reproductive and Developmental Biology, Imperial College London, London, UK
| | - D Timmerman
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - T Bourne
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
- Division of Surgery and Cancer, Institute of Developmental Reproductive and Developmental Biology, Imperial College London, London, UK
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
15
|
Sur S, Lin Z, Li Y, Yasar S, Rosenberg PB, Moghekar A, Wang Z, Hazel K, Pottanat G, Taneja K, Xu C, Van Zijl P, Pillai J, Liu P, Albert MS, Lu H. P1-363: CEREBRAL SMALL VESSEL REACTIVITY IS ASSOCIATED WITH COGNITIVE PERFORMANCE INDEPENDENT OF ALZHEIMER PATHOLOGY IN ELDERLY INDIVIDUALS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | - Yang Li
- Johns Hopkins University; Baltimore MD USA
| | | | | | - Abhay Moghekar
- Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Zheyu Wang
- Johns Hopkins University; Baltimore MD USA
| | | | | | | | - Cuimei Xu
- Johns Hopkins University; Baltimore MD USA
| | - Peter Van Zijl
- Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Jay Pillai
- Johns Hopkins University; Baltimore MD USA
| | | | | | | |
Collapse
|
16
|
Lin Z, Sur S, Soldan A, Pettigrew C, Miller M, Oishi K, Bilgel M, Moghekar A, Pillai JJ, Albert M, Lu H. Brain Oxygen Extraction by Using MRI in Older Individuals: Relationship to Apolipoprotein E Genotype and Amyloid Burden. Radiology 2019; 292:140-148. [PMID: 31012816 DOI: 10.1148/radiol.2019182726] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Apolipoprotein E4 (APOE4) is a major genetic risk factor for late-onset Alzheimer disease. However, the mechanisms by which APOE4 affects the brain, underpinning this risk, have not been fully elucidated. Purpose To investigate the influence of APOE4 on global cerebral oxygen extraction fraction (OEF) and possible mediation through amyloid burden by using MRI-based brain oxygen extraction technique. Materials and Methods Participants were enrolled from a longitudinal prospective study, the Biomarkers for Older Controls at Risk for Dementia study (data collected from January 2015 to December 2017), of whom 35% (50 of 143 participants) were APOE4 carriers. OEF was measured by using a T2-relaxation-under-spin-tagging MRI technique with a 3.0-T MRI system. PET acquired with carbon 11-labeled Pittsburgh compound B tracer was available in 119 participants to measure amyloid burden. Cognitive performance was assessed by using domain-specific composite scores including executive function, episodic memory, visual-spatial processing, and language. Linear regression analysis was performed to investigate the relationship between APOE4, OEF, and amyloid burden. The association between OEF and cognitive function was studied for the entire study cohort and separately for the APOE4 carriers and noncarriers. Results A total of 143 cognitively healthy individuals (mean age 6 standard deviation, 69.1 years 6 8.2; 57 men and 86 women) were studied. APOE4 genetic status was associated with lower OEF (noncarriers, 41.1% 6 5.8; one E4 allele, 40.1% 6 4.9; two E4 alleles, 36.7% 6 4.5; P = .03). Furthermore, among APOE4 carriers, lower OEF correlated with lower executive function scores (b = 0.079 z score for each percent change in OEF; P = .03). Amyloid burden and OEF were independently associated with APOE4 but were not associated with one another, suggesting that the effect of APOE4 on OEF is not mediated by amyloid. Conclusion MRI-based brain oxygen extraction shows that cognitively healthy carriers of the apolipoprotein E4 gene manifest diminished brain oxygen extraction capacity independent of amyloid burden. ©RSNA, 2019 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Zixuan Lin
- From the Department of Biomedical Engineering (Z.L., M.M., H.L.), The Russell H. Morgan Department of Radiology and Radiological Science (Z.L., S.S., K.O., J.J.P., H.L.), and Department of Neurology (A.S., C.P., A.M., M.A.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Park 322, Baltimore, Md; Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Md (M.B.); and F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Md (H.L.)
| | - Sandeepa Sur
- From the Department of Biomedical Engineering (Z.L., M.M., H.L.), The Russell H. Morgan Department of Radiology and Radiological Science (Z.L., S.S., K.O., J.J.P., H.L.), and Department of Neurology (A.S., C.P., A.M., M.A.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Park 322, Baltimore, Md; Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Md (M.B.); and F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Md (H.L.)
| | - Anja Soldan
- From the Department of Biomedical Engineering (Z.L., M.M., H.L.), The Russell H. Morgan Department of Radiology and Radiological Science (Z.L., S.S., K.O., J.J.P., H.L.), and Department of Neurology (A.S., C.P., A.M., M.A.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Park 322, Baltimore, Md; Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Md (M.B.); and F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Md (H.L.)
| | - Corinne Pettigrew
- From the Department of Biomedical Engineering (Z.L., M.M., H.L.), The Russell H. Morgan Department of Radiology and Radiological Science (Z.L., S.S., K.O., J.J.P., H.L.), and Department of Neurology (A.S., C.P., A.M., M.A.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Park 322, Baltimore, Md; Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Md (M.B.); and F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Md (H.L.)
| | - Michael Miller
- From the Department of Biomedical Engineering (Z.L., M.M., H.L.), The Russell H. Morgan Department of Radiology and Radiological Science (Z.L., S.S., K.O., J.J.P., H.L.), and Department of Neurology (A.S., C.P., A.M., M.A.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Park 322, Baltimore, Md; Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Md (M.B.); and F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Md (H.L.)
| | - Kenichi Oishi
- From the Department of Biomedical Engineering (Z.L., M.M., H.L.), The Russell H. Morgan Department of Radiology and Radiological Science (Z.L., S.S., K.O., J.J.P., H.L.), and Department of Neurology (A.S., C.P., A.M., M.A.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Park 322, Baltimore, Md; Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Md (M.B.); and F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Md (H.L.)
| | - Murat Bilgel
- From the Department of Biomedical Engineering (Z.L., M.M., H.L.), The Russell H. Morgan Department of Radiology and Radiological Science (Z.L., S.S., K.O., J.J.P., H.L.), and Department of Neurology (A.S., C.P., A.M., M.A.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Park 322, Baltimore, Md; Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Md (M.B.); and F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Md (H.L.)
| | - Abhay Moghekar
- From the Department of Biomedical Engineering (Z.L., M.M., H.L.), The Russell H. Morgan Department of Radiology and Radiological Science (Z.L., S.S., K.O., J.J.P., H.L.), and Department of Neurology (A.S., C.P., A.M., M.A.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Park 322, Baltimore, Md; Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Md (M.B.); and F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Md (H.L.)
| | - Jay J Pillai
- From the Department of Biomedical Engineering (Z.L., M.M., H.L.), The Russell H. Morgan Department of Radiology and Radiological Science (Z.L., S.S., K.O., J.J.P., H.L.), and Department of Neurology (A.S., C.P., A.M., M.A.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Park 322, Baltimore, Md; Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Md (M.B.); and F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Md (H.L.)
| | - Marilyn Albert
- From the Department of Biomedical Engineering (Z.L., M.M., H.L.), The Russell H. Morgan Department of Radiology and Radiological Science (Z.L., S.S., K.O., J.J.P., H.L.), and Department of Neurology (A.S., C.P., A.M., M.A.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Park 322, Baltimore, Md; Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Md (M.B.); and F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Md (H.L.)
| | - Hanzhang Lu
- From the Department of Biomedical Engineering (Z.L., M.M., H.L.), The Russell H. Morgan Department of Radiology and Radiological Science (Z.L., S.S., K.O., J.J.P., H.L.), and Department of Neurology (A.S., C.P., A.M., M.A.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Park 322, Baltimore, Md; Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Md (M.B.); and F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Md (H.L.)
| |
Collapse
|
17
|
De Vis JB, Peng SL, Chen X, Li Y, Liu P, Sur S, Rodrigue KM, Park DC, Lu H. Arterial-spin-labeling (ASL) perfusion MRI predicts cognitive function in elderly individuals: A 4-year longitudinal study. J Magn Reson Imaging 2018; 48:449-458. [PMID: 29292540 DOI: 10.1002/jmri.25938] [Citation(s) in RCA: 57] [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: 09/13/2017] [Accepted: 12/12/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND With the disappointing outcomes of clinical trials on patients with Alzheimer's disease or mild cognitive impairment (MCI), there is increasing attention to understanding cognitive decline in normal elderly individuals, with the goal of identifying subjects who are most susceptible to imminent cognitive impairment. PURPOSE/HYPOTHESIS To evaluate the potential of cerebral blood flow (CBF) as a biomarker by investigating the relationship between CBF at baseline and cognition at follow-up. STUDY TYPE Prospective longitudinal study with a 4-year time interval. POPULATION 309 healthy subjects aged 20-89 years old. FIELD STRENGTH/SEQUENCE 3T pseudo-continuous-arterial-spin-labeling MRI. ASSESSMENT CBF at baseline and cognitive assessment at both baseline and follow-up. STATISTICAL TESTS Linear regression analyses with age, systolic blood pressure, physical activity, and baseline cognition as covariates. RESULTS Linear regression analyses revealed that whole-brain CBF at baseline was predictive of general fluid cognition at follow-up. This effect was observed in the older group (age ≥54 years, β = 0.221, P = 0.004), but not in younger or entire sample (β = 0.018, P = 0.867 and β = 0.089, P = 0.098, respectively). Among major brain lobes, frontal CBF had the highest sensitivity in predicting future cognition, with a significant effect observed for fluid cognition (β = 0.244 P = 0.001), episodic memory (β = 0.294, P = 0.001), and reasoning (β = 0.186, P = 0.027). These associations remained significant after accounting for baseline cognition. Voxelwise analysis revealed that medial frontal cortex and anterior cingulate cortex, part of the default mode network (DMN), are among the most important regions in predicting fluid cognition. DATA CONCLUSION In a healthy aging cohort, CBF can predict general cognitive ability as well as specific domains of cognitive function. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2018;48:449-458.
Collapse
Affiliation(s)
- Jill B De Vis
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shin-Lei Peng
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Xi Chen
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Texas, USA
| | - Yang Li
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peiying Liu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sandeepa Sur
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Karen M Rodrigue
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Texas, USA
| | - Denise C Park
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Texas, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
18
|
Sur S, Noack C, Christalla P, Tiburcy M, Nagata K, Mayr M, Zimmermann WH. 5044Heat shock protein 47 knockout in fibroblasts causes contractile dysfunction in engineered human myocardium. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5044] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
19
|
Soong P, Sur S, Fujita B, Grishina E, Kuzyakova M, Tiburcy M, Zimmermann W. P2545Inducible paracrine release of IGF-1 improves heart muscle thickness and function. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2545] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
20
|
Van Calster B, Bobdiwala S, Guha S, Van Hoorde K, Al-Memar M, Harvey R, Farren J, Kirk E, Condous G, Sur S, Stalder C, Timmerman D, Bourne T. Managing pregnancy of unknown location based on initial serum progesterone and serial serum hCG levels: development and validation of a two-step triage protocol. Ultrasound Obstet Gynecol 2016; 48:642-649. [PMID: 26776599 DOI: 10.1002/uog.15864] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 01/08/2016] [Accepted: 01/11/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES A uniform rationalized management protocol for pregnancies of unknown location (PUL) is lacking. We developed a two-step triage protocol to select PUL at high risk of ectopic pregnancy (EP), based on serum progesterone level at presentation (step 1) and the serum human chorionic gonadotropin (hCG) ratio, defined as the ratio of hCG at 48 h to hCG at presentation (step 2). METHODS This was a cohort study of 2753 PUL (301 EP), involving a secondary analysis of prospectively and consecutively collected PUL data from two London-based university teaching hospitals. Using a chronological split we used 1449 PUL for development and 1304 for validation. We aimed to assign PUL as low risk with high confidence (high negative predictive value (NPV)) while classifying most EP as high risk (high sensitivity). The first triage step assigned PUL as low risk using a threshold of serum progesterone at presentation. The remaining PUL were triaged using a novel logistic regression risk model based on hCG ratio and initial serum progesterone (second step), defining low risk as an estimated EP risk of < 5%. RESULTS On validation, initial serum progesterone ≤ 2 nmol/L (step 1) classified 16.1% PUL as low risk. Second-step classification with the risk model selected an additional 46.0% of all PUL as low risk. Overall, the two-step protocol classified 62.1% of PUL as low risk, with an NPV of 98.6% and a sensitivity of 92.0%. When the risk model was used in isolation (i.e. without the first step), 60.5% of PUL were classified as low risk with 99.1% NPV and 94.9% sensitivity. CONCLUSION PUL can be classified efficiently into being either high or low risk for complications using a two-step protocol involving initial progesterone and hCG levels and the hCG ratio. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- B Van Calster
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - S Bobdiwala
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
| | - S Guha
- West Middlesex Hospital, Isleworth, Middlesex, UK
| | | | - M Al-Memar
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
| | - R Harvey
- Charing Cross Oncology Laboratory and Trophoblastic Disease Center, Charing Cross Hospital, London, UK
| | - J Farren
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
| | - E Kirk
- North Middlesex Hospital, London, UK
| | - G Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, NSW, Australia
| | - S Sur
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
| | - C Stalder
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
| | - D Timmerman
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - T Bourne
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
21
|
Zahiruddin A, Melethil S, McCracken J, Sur S. P032 What a contrast! a rare case of perflutren lipid microsphere-induced true anaphylaxis. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.040] [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: 10/20/2022]
|
22
|
Patel T, Sur S, McCracken J. P095 Transarterial chemoembolization (TACE) procedure-induced development of acquired angioedema. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.104] [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: 11/16/2022]
|
23
|
Dossumbekova A, Patel T, Gupta M, Goldblum R, Sur S, Grant J. P200 A case report of disseminated nocardia infection in an adult with moderate lymphopenia. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.211] [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: 10/20/2022]
|
24
|
Sur S, Snelling B, Peterson E. E-031 Superselective Intra-arterial Chemotherapy Infusion in an 8 Week-old Infant. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.103] [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: 11/03/2022]
|
25
|
Kortte KB, McWhorter JW, Pawlak MA, Slentz J, Sur S, Hillis AE. Anosognosia for hemiplegia: The contributory role of right inferior frontal gyrus. Neuropsychology 2014; 29:421-32. [PMID: 25133319 DOI: 10.1037/neu0000135] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Awareness of motor functioning is most likely a complex process that requires integration of sensory-motor feedback to constantly update the system on the functioning of the limb during motor behavior. Using lesion mapping procedures and behavioral measures, the current study aimed to evaluate neural correlates of anosognosia for hemiplegia (AHP) in the acute stage (first 48 hr) of right hemisphere stroke. METHOD Thirty-five individuals with right hemisphere stroke who presented to an urban medical center within 24 hr of symptom onset were included in the study. All 35 individuals had hemiplegia, and 8 of these individuals exhibited AHP. RESULTS Fisher's exact test statistical map of lesion-deficit association (range is between-log(p) 4 to 11) found maximal value of 10.9 located in pars orbitalis (Brodmann's Area 47; BA). In this selected location, 6 out of 8 patients with AHP had tissue abnormality, whereas none of the unaffected subjects had tissue abnormality in BA 47. Right BA 44/45 was also found to be lesioned more frequently in individuals with AHP (75%) than without AHP (11%). CONCLUSIONS The current study findings provide preliminary support for unique involvement of the right inferior frontal gyrus (IFG), pars orbitalis (BA 47) in AHP. The current data suggest that frontal operculum may play a key role in awareness of limb functioning.
Collapse
Affiliation(s)
- Kathleen B Kortte
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine
| | | | - Mikolaj A Pawlak
- Department of Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences
| | - Jamie Slentz
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine
| | - Sandeepa Sur
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine
| | - Argye E Hillis
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine
| |
Collapse
|
26
|
Schneider EB, Sur S, Raymont V, Duckworth J, Kowalski RG, Efron DT, Hui X, Selvarajah S, Hambridge HL, Stevens RD. Functional recovery after moderate/severe traumatic brain injury: a role for cognitive reserve? Neurology 2014; 82:1636-42. [PMID: 24759845 DOI: 10.1212/wnl.0000000000000379] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the hypothesis that educational attainment, a marker of cognitive reserve, is a predictor of disability-free recovery (DFR) after moderate to severe traumatic brain injury (TBI). METHODS Retrospective study of the TBI Model Systems Database, a prospective multicenter cohort funded by the National Institute on Disability and Rehabilitation Research. Patients were included if they were admitted for rehabilitation after moderate to severe TBI, were aged 23 years or older, and had at least 1 year of follow-up. The main outcome measure was DFR 1 year postinjury, defined as a Disability Rating Scale score of zero. RESULTS Of 769 patients included, 214 (27.8%) achieved DFR at 1 year. In total, 185 patients (24.1%) had <12 years of education, while 390 (50.7%) and 194 patients (25.2%) had 12 to 15 years and ≥16 years of education, respectively. DFR was achieved by 18 patients (9.7%) with <12 years, 120 (30.8%) with 12 to 15 years, and 76 (39.2%) with ≥16 years of education (p < 0.001). In a logistic regression model controlling for age, sex, and injury- and rehabilitation-specific factors, duration of education of ≥12 years was independently associated with DFR (odds ratio 4.74, 95% confidence interval 2.70-8.32 for 12-15 years; odds ratio 7.24, 95% confidence interval 3.96-13.23 for ≥16 years). CONCLUSION Educational attainment was a robust independent predictor of 1-year DFR even when adjusting for other prognostic factors. A dose-response relationship was noted, with longer educational exposure associated with increased odds of DFR. This suggests that cognitive reserve could be a factor driving neural adaptation during recovery from TBI.
Collapse
Affiliation(s)
- Eric B Schneider
- From the Center for Surgical Trials and Outcomes Research, Department of Surgery (E.B.S., D.T.E., X.H., S. Selvarajah, H.L.H.), Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine (R.G.K., R.D.S.), and Departments of Neurology (R.D.S.) and Neurosurgery (R.D.S.), Johns Hopkins School of Medicine, Baltimore, MD; Tulane Center for Aging (S. Sur), Tulane University School of Medicine, New Orleans, LA; Department of Radiology (V.R., J.D., R.D.S.), Johns Hopkins University, Baltimore, MD; and Centre for Mental Health (V.R.), Department of Medicine, Imperial College London, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Abdallah Y, Naji O, Saso S, Pexsters A, Stalder C, Sur S, Raine-Fenning N, Timmerman D, Brosens JJ, Bourne T. Ultrasound assessment of the peri-implantation uterus: a review. Ultrasound Obstet Gynecol 2012; 39:612-619. [PMID: 21910147 DOI: 10.1002/uog.10098] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Emerging evidence suggests that early embryo implantation is a more active maternal process than hitherto appreciated, involving active encapsulation of the implanting blastocyst by maternal decidual cells and coordinated changes in the underlying inner myometrium, known as the junctional zone. These concepts raise the possibility that early ultrasound markers predictive of adverse pregnancy outcome could be identified. In this review we assess the role of ultrasound in predicting the likelihood of different pregnancy outcomes and highlight potential novel markers that could be tested.
Collapse
Affiliation(s)
- Y Abdallah
- Institute of Development and Reproductive Biology (IRDB), Imperial College London, London, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Qi H, Redding D, Kurosky A, Singh B, Lane J, Bain M, Boldogh I, Hazra T, Sur S. Challenge With Ragweed Pollen Extract (RWPE) In Allergic Rhinitis Induces Rapid Increase In 8-hydroxydeoxyguanosine (8-OHdG), IL-10 and G-CSF. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.856] [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: 11/24/2022]
|
29
|
Sur S, Ying S, Corrigan C, Kurosky A, Boldogh I, Qi H. IL-8 And Neutrophils In Bronchoalveolar Lavage Fluids Distinguish Mild Asthma From Moderate To Severe Asthma. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.858] [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: 10/14/2022]
|
30
|
Jayaprakasan K, Chan YY, Sur S, Deb S, Clewes JS, Raine-Fenning NJ. Prevalence of uterine anomalies and their impact on early pregnancy in women conceiving after assisted reproduction treatment. Ultrasound Obstet Gynecol 2011; 37:727-732. [PMID: 21337662 DOI: 10.1002/uog.8968] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/12/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To estimate the prevalence of congenital uterine anomalies in subfertile women and to evaluate their influence on early pregnancy following assisted reproduction treatment (ART). METHODS We prospectively recruited 1402 subjects undergoing ART over a period of 5 years from 2005 to 2009. Three-dimensional transvaginal sonography was performed in the early follicular phase of the menstrual cycle (days 2-5) and repeated in the late follicular phase (days 10-14) if the shape of the uterine cavity could not be assessed at the first scan. All subjects who conceived following ART were followed up to 12 weeks' gestation. Chi-square test was used to compare the pregnancy rates and miscarriage rates between women shown to have uterine anomalies and those with a normal uterus. RESULTS One thousand three hundred and eighty-five subjects were included for final analysis after excluding 17 subjects in whom a definitive diagnosis could not be made. While 1201 (86.7%) subjects had a normal uterine cavity, uterine anomalies were demonstrated in 184 (13.3%) subjects. Arcuate uteri represented the commonest anomaly (n = 164 (11.8%)) followed by septate (n = 7 (0.5%)), unicornuate (n = 6 (0.4%)), subseptate (n = 5 (0.4%)), bicornuate (n = 1 (0.1%)) and T-shaped uteri (n = 1 (0.1%)). A total of 440 subjects who underwent ART were followed up. The pregnancy rates in women with arcuate uteri (36/66 (54.5%)) and major uterine anomalies (7/10 (70.0%)) were statistically similar (P = 0.09 and P = 0.11, respectively) to that of the matched controls with normal uteri (158/364 (43.4%)). While first-trimester miscarriage rates were similar (P = 0.81) between the control group (20/158 (12.7%)) and women with arcuate uteri (5/36 (13.9%)), women with major uterine anomalies experienced a higher miscarriage rate (3/7 (42.9%); P = 0.05). CONCLUSIONS Women who are referred for ART have a high prevalence of congenital uterine anomalies, the most common anomaly being an arcuate uterus. These anomalies are not associated with a reduction in pregnancy rates following ART. However, while the arcuate uterus was not associated with an increase in first-trimester miscarriage, major uterine anomalies seemed to increase the risk of first-trimester miscarriage.
Collapse
Affiliation(s)
- K Jayaprakasan
- Nottingham University Research and Treatment Unit in Reproduction, Division of Human Development, School of Clinical Sciences, University of Nottingham, Nottingham, UK.
| | | | | | | | | | | |
Collapse
|
31
|
Kalita A, Qi H, Murai H, Kurosky A, Boldogh I, Hazra T, Corry D, Sur S. NADPH Oxidase In Ragweed Pollen Promotes Th2 Differentiation Of Naïve T-cells And Induces IL-33 Secretion From BMDCs Via TLR4 And MYD88 Dependent Pathways. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.563] [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]
|
32
|
Qi H, Murai H, Kalita A, Sur S. In vivo Exposure of Mice to Alternaria Alternata Induces IL-18 Release into the Airways: A Cause of Allergic Asthma? J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.511] [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: 11/25/2022]
|
33
|
Sur S, Marsh A, Campbell B, Raine-Fenning N. Re: Gestational sac volume: comparison between SonoAVC and VOCAL measurements at 11 + 0 to 13 + 6 weeks of gestation. Ultrasound Obstet Gynecol 2010; 36:648-651. [PMID: 20981721 DOI: 10.1002/uog.8833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
|
34
|
Abstract
First Rank Symptoms (FRS) were first defined by Schneider as diagnostic of schizophrenia. Since then, there has been an immense debate on their diagnostic and prognostic utility. This review attempts to understand the concepts of FRS as depicted over the years and the diagnostic and prognostic implications of FRS in mental illnesses including schizophrenia. Review of relevant material showed that there are wide variations in the concepts of FRS which may be classified according to broad and narrow definitions. These variations have also led to the differences in the diagnostic systems currently being used. Although the diagnostic utility of FRS in schizophrenia remains, it is not clearly so with other mental illnesses in which these symptoms may also be observed. In addition there is controversy over the prognostic implications with evidence divided between poor and no influence on outcome.
Collapse
Affiliation(s)
- S Saddichha
- National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
| | | | | | | |
Collapse
|
35
|
|
36
|
Vaidya S, Murai H, Kalita A, Sur S. Ragweed Extract (RWE) Provides Danger Signal to Human Dendritic Cells That Facilitates a Th2 Response Against Bystander Antigens. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.418] [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]
|
37
|
Kalita A, Vaidya S, Murai H, Stafford S, Kurosky A, Boldogh I, Hazra T, Sur S. Ragweeds Extract (RWE) Proteins That Lack NADPH Oxidase Activity (RWENOX-) Promote Th1 Response By Upregulating CD40 Expression Independent of MAP Kinases. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.422] [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: 10/19/2022]
|
38
|
Singh B, Murai H, Vaidya S, Bain M, Redding D, Sur S. Ccl17 and Ccl22 Chemokine Levels in Nasal Fluids of Subjects With Allergic Rhinitis After Challenge With Ragweed Extract. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.440] [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: 10/19/2022]
|
39
|
Sur S, Murphy KW, Mackenzie IZ. Delivery after caesarean section: consultant obstetricians' professional advice and personal preferences. J OBSTET GYNAECOL 2009; 29:212-6. [PMID: 19358027 DOI: 10.1080/01443610902735785] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The objective of this study was to determine how obstetricians would wish to be managed in their own pregnancy and their advice to patients delivering after a caesarean section. A questionnaire was sent to 219 consultant obstetricians in two large UK medical deaneries investigating their personal preferences for delivery and management of spontaneous, augmented and induced labour after a caesarean section and how they advise their patients related to the indication for the previous caesarean section. Responses were analysed according to age and gender. The questionnaire yielded a 68% response rate. None would counsel against labour unless there were contraindications. The majority would recommend labour for all indications for the previous caesarean section, although personal preferences were lower (p<0.04): 56% would recommend labour to their patients after a failed instrumental delivery, but only 36% would personally choose that option (p<0.002). Female obstetricians would contemplate and recommend labour more readily than males. Labour augmentation and induction was more frequently recommended (66% and 57%, respectively) than opted for personally (57% and 52%). Reluctance for labour augmentation and induction was greatest among younger consultants. While the majority of consultants favour labour for themselves and recommend this for their patients, it was reassuring to note that patients are encouraged to make the final decision. Informed patient choice is paramount and it is therefore important that full information about risks and benefits is available.
Collapse
Affiliation(s)
- S Sur
- John Radcliffe Hospital, Oxford, UK.
| | | | | |
Collapse
|
40
|
Vaidya S, Singh B, Dharajiya N, Sinha M, Boldogh I, Sur S. Genes Involved in the Allergic Airway Inflammation Induced by Ragweed Extract (RWE) Associated NADPH Oxidase. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.762] [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: 10/21/2022]
|
41
|
Kalita A, stafford S, Soman K, Kurosky A, Sur S. Identification of Candidate Proteins in Ragweed Extract (RWE) serves as alarmins that produce ROS and Induce Th2 Cytokine Production. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.452] [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: 10/21/2022]
|
42
|
Murai H, Redding D, Gonzalez K, Singh B, Kalita A, Qi H, Cardenas Jr. V, Sur S. Pollen NADPH Oxidases Increase Intracellular ROS (iROS) And IL5 Production From PBMC Of Ragweed Allergic Patients With Late Phase Symptoms To Intranasal Ragweed Challenge. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.983] [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: 10/21/2022]
|
43
|
Aguilera-Aguirre L, Saavedra-Molina A, Bacsi A, Sur S, Boldogh I. Oxidative Damage to Mitochondrial Respiratory Chain Complexes Increases Allergic Airway Inflammation in Mice. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.448] [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]
|
44
|
Qi H, Redding D, Kurosky A, Singh B, Boldogh I, Soman K, Grant J, Cardenas V, Sur S. Identification of Biomarkers in Nasal Lavage Fluid (NLF) Associated with Early and Late Phase Symptoms Induced by Intranasal Challenge with Ragweed Extract (RWE). J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.450] [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: 11/16/2022]
|
45
|
Browne G, Sur S, Singh B, Dhara N. Identification of Genes of the Innate Immune System Induced by Oxidative Stress From Ragweed Extract (RWE) Challenge. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.449] [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: 11/28/2022]
|
46
|
Lane C, Redding D, Gonzalez K, Cardenas V, Boldogh I, Sur S. Topical N-acetyl cysteine (NAC) Reduces Late Phase Nasal Symptoms Following Ragweed Challenge. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.170] [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: 10/21/2022]
|
47
|
Sen A, Mondal UK, Sur S, Bothra AK. Comparative analysis of codon usage patterns and identification of predicted highly expressed genes in fiveSalmonellagenomes. Indian J Med Microbiol 2008; 26:313-21. [DOI: 10.4103/0255-0857.43558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
48
|
Patel J, Hotez P, Dharajiya N, Sur S. Hookworm Protein Necator Americanus-Ancyclostoma Secreted Protein 2 (Na-Asp-2) Inhibits Allergic Airway Inflammation. J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.11.649] [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]
|
49
|
Sur S, Chitranshi S, Ganesh S, Moona R, Sharma M, Bajpai S, Katiyar S. Living in Farming Communities (FC) Provides Children Greater Protection Against Asthma Attacks than Living in Poor Hygienic Conditions (PHC). J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.11.200] [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: 10/23/2022]
|
50
|
Saavedra M, Dharajiya N, Redding D, Boldogh I, Lee C, Sur S. Scavenging of Reactive Oxidative Species (ROS) Generated by Pollen NADPH Oxidases Inhibits Th2 and Th17 Cytokine Production from Johnson Grass (JG) Sensitized Human Peripheral Blood Mononuclear Cells (PBMCs). J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.12.507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|