1
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Pohlmann JE, Kim ISY, Brush B, Sambhu KM, Conti L, Saglam H, Milos K, Yu L, Cronin MFM, Balogun O, Chatzidakis S, Zhang Y, Trinquart L, Huang Q, Smirnakis SM, Benjamin EJ, Dupuis J, Greer DM, Ong CJ. Association of large core middle cerebral artery stroke and hemorrhagic transformation with hospitalization outcomes. Sci Rep 2024; 14:10008. [PMID: 38693282 PMCID: PMC11063151 DOI: 10.1038/s41598-024-60635-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 04/25/2024] [Indexed: 05/03/2024] Open
Abstract
Historically, investigators have not differentiated between patients with and without hemorrhagic transformation (HT) in large core ischemic stroke at risk for life-threatening mass effect (LTME) from cerebral edema. Our objective was to determine whether LTME occurs faster in those with HT compared to those without. We conducted a two-center retrospective study of patients with ≥ 1/2 MCA territory infarct between 2006 and 2021. We tested the association of time-to-LTME and HT subtype (parenchymal, petechial) using Cox regression, controlling for age, mean arterial pressure, glucose, tissue plasminogen activator, mechanical thrombectomy, National Institute of Health Stroke Scale, antiplatelets, anticoagulation, temperature, and stroke side. Secondary and exploratory outcomes included mass effect-related death, all-cause death, disposition, and decompressive hemicraniectomy. Of 840 patients, 358 (42.6%) had no HT, 403 (48.0%) patients had petechial HT, and 79 (9.4%) patients had parenchymal HT. LTME occurred in 317 (37.7%) and 100 (11.9%) had mass effect-related deaths. Parenchymal (HR 8.24, 95% CI 5.46-12.42, p < 0.01) and petechial HT (HR 2.47, 95% CI 1.92-3.17, p < 0.01) were significantly associated with time-to-LTME and mass effect-related death. Understanding different risk factors and sequelae of mass effect with and without HT is critical for informed clinical decisions.
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Affiliation(s)
- Jack E Pohlmann
- Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA
- Department of Epidemiology, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA
| | - Ivy So Yeon Kim
- Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA
| | - Benjamin Brush
- Department of Neurology, NYU Langone Medical Center, 550 1st Ave, New York, NY, 10016, USA
| | - Krishna M Sambhu
- Department of Neurology, Boston University School of Medicine, Chobanian and Avedisian School of Medicine, 85 E Concord St., Suite 1116, Boston, MA, 02118, USA
| | - Lucas Conti
- Department of Neurology, Boston University School of Medicine, Chobanian and Avedisian School of Medicine, 85 E Concord St., Suite 1116, Boston, MA, 02118, USA
| | - Hanife Saglam
- Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Katie Milos
- Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA
| | - Lillian Yu
- Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA
| | - Michael F M Cronin
- Department of Neurology, Boston University School of Medicine, Chobanian and Avedisian School of Medicine, 85 E Concord St., Suite 1116, Boston, MA, 02118, USA
| | - Oluwafemi Balogun
- Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA
| | - Stefanos Chatzidakis
- Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Yihan Zhang
- Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA
| | - Ludovic Trinquart
- Department of Epidemiology, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA
- Tufts Clinical and Translational Science Institute, Tufts University, 419 Boston, Ave, Medford, MA, 02155, USA
| | - Qiuxi Huang
- Department of Epidemiology, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA
| | - Stelios M Smirnakis
- Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
- Department of Neurology, Jamaica Plain Veterans Administration Medical Center, 150 S Huntington Ave, Boston, MA, 02130, USA
| | - Emelia J Benjamin
- Department of Epidemiology, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA
- Department of Cardiology, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, 85 E Concord St, Boston, MA, 02118, USA
| | - Josée Dupuis
- Department of Epidemiology, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 2001 McGill College, Montreal, QC, Canada
| | - David M Greer
- Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA
- Department of Neurology, Boston University School of Medicine, Chobanian and Avedisian School of Medicine, 85 E Concord St., Suite 1116, Boston, MA, 02118, USA
| | - Charlene J Ong
- Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA.
- Department of Neurology, Boston University School of Medicine, Chobanian and Avedisian School of Medicine, 85 E Concord St., Suite 1116, Boston, MA, 02118, USA.
- Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
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Song JJ, Stafford RA, Pohlmann JE, Kim ISY, Cheekati M, Dennison S, Brush B, Chatzidakis S, Huang Q, Smirnakis SM, Gilmore EJ, Mohammed S, Abdalkader M, Benjamin EJ, Dupuis J, Greer DM, Ong CJ. Later Midline Shift Is Associated with Better Outcomes after Large Middle Cerebral Artery Stroke. Res Sq 2024:rs.3.rs-4189278. [PMID: 38699310 PMCID: PMC11065061 DOI: 10.21203/rs.3.rs-4189278/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background/Objective Space occupying cerebral edema is the most feared early complication after large ischemic stroke, occurring in up to 30% of patients with middle cerebral artery (MCA) occlusion, and is reported to peak 2-4 days after injury. Little is known about the factors and outcomes associated with peak edema timing, especially when it occurs after 96 hours. We aimed to characterize differences between patients who experienced maximum midline shift (MLS) or decompressive hemicraniectomy (DHC) in the acute (<48 hours), average (48-96 hours), and subacute (>96 hours) groups and determine whether patients with subacute peak edema timing have improved discharge dispositions. Methods We performed a two-center, retrospective study of patients with ≥1/2 MCA territory infarct and MLS. We constructed a multivariable model to test the association of subacute peak edema and favorable discharge disposition, adjusting for age, admission Alberta Stroke Program Early CT Score (ASPECTS), National Institute of Health Stroke Scale (NIHSS), acute thrombolytic intervention, cerebral atrophy, maximum MLS, parenchymal hemorrhagic transformation, DHC, and osmotic therapy receipt. Results Of 321 eligible patients with MLS, 32%, 36%, and 32% experienced acute, average, and subacute peak edema. Subacute peak edema was significantly associated with higher odds of favorable discharge than non-subacute swelling, adjusting for confounders (aOR, 1.85; 95% CI, 1.05-3.31). Conclusions Subacute peak edema after large MCA stroke is associated with better discharge disposition compared to earlier peak edema courses. Understanding how the timing of cerebral edema affects risk of unfavorable discharge has important implications for treatment decisions and prognostication.
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Affiliation(s)
| | | | | | | | | | - Sydney Dennison
- Department of Epidemiology, Boston University School of Public Health
| | | | | | - Qiuxi Huang
- Department of Neurology, Jamaica Plain Veterans Administration Medical Center
| | | | | | - Shariq Mohammed
- Department of Biostatistics, Boston University School of Public Health
| | | | - Emelia J Benjamin
- Department of Epidemiology, Boston University School of Public Health
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health
| | - David M Greer
- Boston University Chobanian & Avedisian School of Medicine
| | - Charlene J Ong
- Boston University Chobanian & Avedisian School of Medicine
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3
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Stafford R, Chatzidakis S, Kim ISY, Zhang Y, Rina A, Brush B, Mian A, Abdalkader M, Greer DM, Smirnakis SM, Feske SK, Dupuis J, Ong CJ. Follow-up ASPECTS improves prediction of potentially lethal malignant edema in patients with large middle cerebral artery stroke. J Neurointerv Surg 2023:jnis-2023-021145. [PMID: 38160055 DOI: 10.1136/jnis-2023-021145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Recent studies have shown that follow-up head CT is a strong predictor of functional outcomes in patients with middle cerebral artery stroke and mechanical thrombectomy. We sought to determine whether total and/or regional follow-up Alberta Stroke Program Early CT Score (ASPECTSfu) are associated with important clinical outcomes during hospitalization and improve the performance of clinical prediction models of potentially lethal malignant edema (PLME). METHODS We conducted a retrospective study of patients at three medical centers in a major North American metropolitan area with baseline and follow-up head CTs after large middle cerebral artery stroke between 2006 and 2022. We used multivariable logistic regression to test the association of total and regional ASPECTSfu with PLME (cerebral edema related death or surgery), adjusting for total baseline ASPECTS, age, sex, admission glucose, tissue plasminogen activator, and mechanical thrombectomy. We compared existing clinical risk models with and without total or regional ASPECTSfu using area under the curve. RESULTS In our 560 patient cohort, lower total ASPECTSfu was significantly associated with higher odds of PLME when adjusting for confounders (OR 1.69, 95% CI 1.49 to 2.0), and improved model discrimination compared with existing models and models using baseline ASPECTS. Deep territory involvement (OR 2.46, 95% CI 1.53 to 4.01) and anterior territory involvement (OR 3.23, 95% CI 1.88 to 5.71) were significantly associated with PLME. CONCLUSIONS Lower ASPECTSfu and certain locations on regional ASPECTSfu, including deep and anterior areas, were significantly associated with PLME. Including ASPECTSfu information improved discrimination of established edema prediction models and could be used immediately to help facilitate clinical management decisions and prognostication.
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Affiliation(s)
- Rebecca Stafford
- Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Stefanos Chatzidakis
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ivy So Yeon Kim
- Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Yihan Zhang
- Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andriani Rina
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin Brush
- Department of Neurology, New York University Langone Medical Center, New York, New York, USA
| | - Asim Mian
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Mohamad Abdalkader
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - David M Greer
- Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Stelios M Smirnakis
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Jamaica Plain Veterans Administration Hospital, Boston, Massachusetts, USA
| | - Steven K Feske
- Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Charlene J Ong
- Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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4
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Ong C, Huang Q, Kim I, Pohlmann J, Chatzidakis S, Brush B, Zhang Y, Du Y, Mallinger LA, Benjamin EJ, Dupuis J, Greer D, Smirnakis S, Trinquart L. Dynamic trajectories of life-threatening mass effect in patients with large middle cerebral artery stroke. Res Sq 2023:rs.3.rs-3594179. [PMID: 38045289 PMCID: PMC10690305 DOI: 10.21203/rs.3.rs-3594179/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background Life-threatening, space-occupying mass effect due to cerebral edema and/or hemorrhagic transformation is an early complication of patients with middle cerebral artery ( MCA ) stroke. Little is known about longitudinal trajectories of laboratory and vital signs leading up to radiographic and clinical deterioration related to this mass effect. Methods We curated a granular retrospective dataset of 635 patients with large middle cerebral artery ( MCA ) stroke totaling 108,547 data points for repeated measurements of 10 covariates, and 40 time-independent covariates. We assessed longitudinal trajectories of the 10 longitudinal variables during the 72 hours preceding three outcomes representative of life-threatening mass effect: midline shift ( MLS ) \(\ge\)5mm, pineal gland shift ( PGS ) \(>\)4mm, and decompressive hemicraniectomy ( DHC ). We used a "backward looking" trajectory approach. Patients were aligned according to the time of outcome occurrence and the trajectory of each variable was assessed prior to that outcome by accounting for both cases and non-cases. Results Of 635 patients, 49% were female, and mean age was 69 years. Thirty five percent of patients had MLS \(\ge\)5mm, 24.1% had PGS \(>\)4mm, and DHC occurred in 10.7%. For the three outcomes of interest, backward-looking trajectories showed mild increases in white blood cell count (10 up to 11 K/UL within 72 hours), temperature (up to half a degree within 24 hours), and sodium (1-3 mEq/L within 24 hours) leading up to outcomes. We also observed a decrease in heart rate (75 - 65 beats per minute) 24 hours prior to DHC. Conclusions Univariable longitudinal profiling showed that temperature, white blood cell count, and sodium increase prior to radiographic and clinical indicators of space-occupying mass effect. These findings will inform development of multivariable dynamic risk models to aid prediction of life-threatening space-occupying mass effect.
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Miller MI, Orfanoudaki A, Cronin M, Saglam H, So Yeon Kim I, Balogun O, Tzalidi M, Vasilopoulos K, Fanaropoulou G, Fanaropoulou NM, Kalin J, Hutch M, Prescott BR, Brush B, Benjamin EJ, Shin M, Mian A, Greer DM, Smirnakis SM, Ong CJ. Natural Language Processing of Radiology Reports to Detect Complications of Ischemic Stroke. Neurocrit Care 2022; 37:291-302. [PMID: 35534660 PMCID: PMC9986939 DOI: 10.1007/s12028-022-01513-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/02/2021] [Accepted: 04/05/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Abstraction of critical data from unstructured radiologic reports using natural language processing (NLP) is a powerful tool to automate the detection of important clinical features and enhance research efforts. We present a set of NLP approaches to identify critical findings in patients with acute ischemic stroke from radiology reports of computed tomography (CT) and magnetic resonance imaging (MRI). METHODS We trained machine learning classifiers to identify categorical outcomes of edema, midline shift (MLS), hemorrhagic transformation, and parenchymal hematoma, as well as rule-based systems (RBS) to identify intraventricular hemorrhage (IVH) and continuous MLS measurements within CT/MRI reports. Using a derivation cohort of 2289 reports from 550 individuals with acute middle cerebral artery territory ischemic strokes, we externally validated our models on reports from a separate institution as well as from patients with ischemic strokes in any vascular territory. RESULTS In all data sets, a deep neural network with pretrained biomedical word embeddings (BioClinicalBERT) achieved the highest discrimination performance for binary prediction of edema (area under precision recall curve [AUPRC] > 0.94), MLS (AUPRC > 0.98), hemorrhagic conversion (AUPRC > 0.89), and parenchymal hematoma (AUPRC > 0.76). BioClinicalBERT outperformed lasso regression (p < 0.001) for all outcomes except parenchymal hematoma (p = 0.755). Tailored RBS for IVH and continuous MLS outperformed BioClinicalBERT (p < 0.001) and linear regression, respectively (p < 0.001). CONCLUSIONS Our study demonstrates robust performance and external validity of a core NLP tool kit for identifying both categorical and continuous outcomes of ischemic stroke from unstructured radiographic text data. Medically tailored NLP methods have multiple important big data applications, including scalable electronic phenotyping, augmentation of clinical risk prediction models, and facilitation of automatic alert systems in the hospital setting.
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Affiliation(s)
- Matthew I Miller
- Department of Neurology, Boston University School of Medicine, 85 E. Concord St., Suite 1116, Boston, MA, 02118, USA
| | | | - Michael Cronin
- Department of Neurology, Boston University School of Medicine, 85 E. Concord St., Suite 1116, Boston, MA, 02118, USA
| | - Hanife Saglam
- Department of Neurology, West Virginia University School of Medicine, Morgantown, WV, USA
| | | | - Oluwafemi Balogun
- Boston Medical Center, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA
| | - Maria Tzalidi
- School of Medicine, University of Crete, Heraklion, Greece
| | | | | | - Nina M Fanaropoulou
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jack Kalin
- Department of Neurology, Boston University School of Medicine, 85 E. Concord St., Suite 1116, Boston, MA, 02118, USA
| | - Meghan Hutch
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Benjamin Brush
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Emelia J Benjamin
- Department of Neurology, Boston University School of Medicine, 85 E. Concord St., Suite 1116, Boston, MA, 02118, USA.,Boston University School of Public Health, Boston, MA, USA
| | - Min Shin
- Department of Computer Science, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Asim Mian
- Department of Radiology, Boston Medical Center, Boston, MA, USA
| | - David M Greer
- Department of Neurology, Boston University School of Medicine, 85 E. Concord St., Suite 1116, Boston, MA, 02118, USA.,Boston Medical Center, Boston, MA, USA
| | - Stelios M Smirnakis
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Jamaica Plain Veterans Administration Hospital, Boston, MA, USA
| | - Charlene J Ong
- Department of Neurology, Boston University School of Medicine, 85 E. Concord St., Suite 1116, Boston, MA, 02118, USA. .,Boston Medical Center, Boston, MA, USA. .,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA. .,Department of Neurology, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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Reynolds AS, Brush B, Schiano TD, Reilly KJ, Dangayach NS. Neurological Monitoring in Acute Liver Failure. Hepatology 2019; 70:1830-1835. [PMID: 31077591 DOI: 10.1002/hep.30760] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 05/08/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Alexandra S Reynolds
- Department of Neurosurgery, The Mount Sinai Hospital, New York, NY.,Department of Neurology, The Mount Sinai Hospital, New York, NY
| | - Benjamin Brush
- Department of Neurology, The Mount Sinai Hospital, New York, NY
| | | | - Kaitlin J Reilly
- Department of Neurosurgery, The Mount Sinai Hospital, New York, NY.,Department of Neurology, The Mount Sinai Hospital, New York, NY
| | - Neha S Dangayach
- Department of Neurosurgery, The Mount Sinai Hospital, New York, NY.,Department of Neurology, The Mount Sinai Hospital, New York, NY
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Wagner L, Singleton B, Diaz M, Spetz J, Brush B. FOREIGN NURSES EXPERIENCES AND PERCEPTIONS OF GERIATRIC CARE IN NURSING HOMES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2861] [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: 11/12/2022] Open
Affiliation(s)
- L Wagner
- School of Nursing, San Francisco, California, United States
| | | | - M Diaz
- UCSF School of Nursing, San Francisco CA
| | - J Spetz
- UCSF School of Nursing, San Francisco, CA
| | - B Brush
- ANP-BC Univeristy of Michigan School of Nursing, Ann Arbor MI
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Dai J, Ozden I, Brooks DI, Wagner F, May T, Agha NS, Brush B, Borton D, Nurmikko AV, Sheinberg DL. Modified toolbox for optogenetics in the nonhuman primate. Neurophotonics 2015; 2:031202. [PMID: 26158011 PMCID: PMC4478720 DOI: 10.1117/1.nph.2.3.031202] [Citation(s) in RCA: 21] [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] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/09/2015] [Indexed: 05/04/2023]
Abstract
Attracted by the appealing advantages of optogenetics, many nonhuman primate labs are attempting to incorporate this technique in their experiments. Despite some reported successes by a few groups, many still find it difficult to develop a reliable way to transduce cells in the monkey brain and subsequently monitor light-induced neuronal activity. Here, we describe a methodology that we have developed and successfully deployed on a regular basis with multiple monkeys. All devices and accessories are easy to obtain and results using these have been proven to be highly replicable. We developed the "in-chair" viral injection system and used tapered and thinner fibers for optical stimulation, which significantly improved the efficacy and reduced tissue damage. With these methods, we have successfully transduced cells in multiple monkeys in both deep and shallow cortical areas. We could reliably obtain neural modulation for months after injection, and no light-induced artifacts were observed during recordings. Further experiments using these methods have shown that optogenetic stimulation can be used to bias spatial attention in a visual choice discrimination task in a way comparable to electrical microstimulation, which demonstrates the potential use of our methods in both fundamental research and clinical applications.
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Affiliation(s)
- Ji Dai
- Brown University, Department of Neuroscience, 185 Meeting Street, Box GL-N, Providence, Rhode Island 02912, United States
| | - Ilker Ozden
- Brown University, School of Engineering, 182 Hope Street, Box D, Providence, Rhode Island 02912, United States
| | - Daniel I. Brooks
- Brown University, Department of Neuroscience, 185 Meeting Street, Box GL-N, Providence, Rhode Island 02912, United States
| | - Fabien Wagner
- Brown University, Department of Neuroscience, 185 Meeting Street, Box GL-N, Providence, Rhode Island 02912, United States
| | - Travis May
- Brown University, School of Engineering, 182 Hope Street, Box D, Providence, Rhode Island 02912, United States
| | - Naubahar S. Agha
- Brown University, School of Engineering, 182 Hope Street, Box D, Providence, Rhode Island 02912, United States
| | - Benjamin Brush
- Brown University, School of Engineering, 182 Hope Street, Box D, Providence, Rhode Island 02912, United States
| | - David Borton
- Brown University, School of Engineering, 182 Hope Street, Box D, Providence, Rhode Island 02912, United States
| | - Arto V. Nurmikko
- Brown University, School of Engineering, 182 Hope Street, Box D, Providence, Rhode Island 02912, United States
- Brown University, Department of Physics, 182 Hope Street, Box D, Providence, Rhode Island 02912, United States
| | - David L. Sheinberg
- Brown University, Department of Neuroscience, 185 Meeting Street, Box GL-N, Providence, Rhode Island 02912, United States
- Address all correspondence to: David L. Sheinberg, E-mail:
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Wang J, Ozden I, Diagne M, Wagner F, Borton D, Brush B, Agha N, Burwell R, Sheinberg D, Diester I, Deisseroth K, Nurmikko A. Approaches to optical neuromodulation from rodents to non-human primates by integrated optoelectronic devices. Annu Int Conf IEEE Eng Med Biol Soc 2012; 2011:7525-8. [PMID: 22256079 DOI: 10.1109/iembs.2011.6091855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Methods on rendering neurons in the central nervous system to be light responsive has led to a boom in using optical neuromodulation as a new approach for controlling brain states and understanding neural circuits. In addition to the developing versatility to "optogenetically" labeling of neural cells and their subtypes by microbiological methods, parallel efforts are under way to design and implement optoelectronic devices to achieve simultaneous optical neuromodulation and electrophysiological recording with high spatial and temporal resolution. Such new device-based technologies need to be developed for full exploitation of the promise of optogenetics. In this paper we present single- and multi-element optoelectronic devices developed in our laboratories. The single-unit element, namely the coaxial optrode, was utilized to characterize the neural responses in optogenetically modified rodent and primate models. Furthermore, the multi-element device, integrating the optrode with a 6×6 microelectrode array, was used to characterize the spatiotemporal spread of neural activity in response to single-site optical stimulation in freely moving rats. We suggest that the particular approaches we employed can lead to the emergence of methods where spatio-temporal optical modulation is integrated with real-time read out from neural populations.
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Affiliation(s)
- Jing Wang
- Department of Physics, School of Engineering
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Abstract
The purpose of this study was to assess, in the early postoperative period of cardiac surgery, the efficacy of patient-controlled analgesia (PCA) versus nurse-administered intravenous morphine followed by oral acetaminophen with or without codeine. Patients undergoing coronary bypass and/or valvular surgery were recruited. All were under 75 years of age and were in stable angina with no ischaemic attacks within the last three months. Visual analog scores (VAS) were used for pain assessment. Pulmonary function tests were done preoperatively and measured every six hours after surgery until discharge from the intensive care unit. Patients allocated to the PCA group received morphine intravenously by a PCA Plus Micro Delivery Device for at least 48 hours. Patients entered into the nurse-administered intravenous morphine group received intravenous morphine followed by oral acetaminophen with or without codeine in 24 to 36 hours according to the clinical assessment of the critical care nurse. The data showed that the quality of pain control and pulmonary function were comparable in both groups. The equipotent morphine dosage requirements were also not statistically different. It was concluded that there was no significant advantage in using PCA routinely in the early postoperative period after cardiac surgery. Furthermore, repetition of PCA instructions was often required during the study period.
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Affiliation(s)
- J Tsang
- Intensive Care Unit, Vancouver General Hospital, Vancouver, B.C., Canada
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Abstract
Previous reports have shown that neutrophils are retained in the lung after acute embolization and that these neutrophils play an important role in the subsequent formation of permeability pulmonary edema. The present study was designed to test the hypothesis that acute embolic injury results in microvascular damage in lung regions with the greater retention of neutrophils. Seventeen pigs (20 +/- 2 kg) were embolized by injecting polystyrene beads (250 microns; labeled with 131I) into the right atrium over 5 min. Five pigs, which received no embolic beads, served as controls. Neutrophils (89 +/- 5% pure), isolated on Ficoll-Histopaque gradient, were radiolabeled with 111In-oxine. Twenty minutes after embolization, the radiolabeled neutrophils were injected into the right atrium along with 85Sr-labeled microspheres to mark the initial neutrophil distribution within the lung as well as the regional pulmonary blood flow at the time of their delivery. The animals were killed 50 min after embolization, and the lungs were removed, frozen over liquid nitrogen, and cut into 60 samples. The data show that after embolization regional neutrophil retention was inversely related to the regional blood flow but was not affected by the embolic load in the same region. Regional extravascular lung water was increased in regions of higher neutrophil retention, but the regions with increased edema did not receive a greater embolic load. These results show that microvascular injury occurs in the lung regions with the greatest neutrophil retention and that this increased retention of neutrophils is unrelated to the extent of embolization.
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Affiliation(s)
- J Tsang
- University of British Columbia Pulmonary Research Laboratory, St. Paul's Hospital, Vancouver, Canada
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Abstract
Current serological assays using whole rubella virus (RV) as a target antigen for detecting RV-specific antibodies fail to define specific RV proteins and antigenic determinants such as hemagglutinin (HA) and virus-neutralizing (VN) epitopes of rubella virus. A panel of E1 deletion mutants and a subset of E1-specific monoclonal antibodies (MAb) were used for the initial analysis of HA and VN epitopes of E1 glycoprotein. A peptide region (E1(193) to E1(269)) was found to contain HA and VN epitopes. Using both overlapping synthetic peptides and truncated fusion proteins within this region, the HA epitope defined by MAb 3D9F mapped to amino acid residues E1(214) to E1(240), while two VN epitopes defined by MAb 21B9H and MAb 16A10E mapped to amino acid residues E1(214) to E1(233) and E1(219) to E1(233), respectively. The epitopes defined in this study are recognized by antibody whether or not the epitopes are glycosylated.
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Affiliation(s)
- H Chaye
- Department of Pathology, University of British Columbia, Vancouver, Canada
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