1
|
Patel KS, Tessema KK, Kawaguchi R, Dudley L, Alvarado AG, Muthukrishnan SD, Perryman T, Hagiwara A, Swarup V, Liau LM, Wang AC, Yong W, Geschwind DH, Nakano I, Goldman SA, Everson RG, Ellingson BM, Kornblum HI. Single-nucleus expression characterization of non-enhancing region of recurrent high-grade glioma. Neurooncol Adv 2024; 6:vdae005. [PMID: 38616896 PMCID: PMC11012612 DOI: 10.1093/noajnl/vdae005] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
Background Non-enhancing (NE) infiltrating tumor cells beyond the contrast-enhancing (CE) bulk of tumor are potential propagators of recurrence after gross total resection of high-grade glioma. Methods We leveraged single-nucleus RNA sequencing on 15 specimens from recurrent high-grade gliomas (n = 5) to compare prospectively identified biopsy specimens acquired from CE and NE regions. Additionally, 24 CE and 22 NE biopsies had immunohistochemical staining to validate RNA findings. Results Tumor cells in NE regions are enriched in neural progenitor cell-like cellular states, while CE regions are enriched in mesenchymal-like states. NE glioma cells have similar proportions of proliferative and putative glioma stem cells relative to CE regions, without significant differences in % Ki-67 staining. Tumor cells in NE regions exhibit upregulation of genes previously associated with lower grade gliomas. Our findings in recurrent GBM paralleled some of the findings in a re-analysis of a dataset from primary GBM. Cell-, gene-, and pathway-level analyses of the tumor microenvironment in the NE region reveal relative downregulation of tumor-mediated neovascularization and cell-mediated immune response, but increased glioma-to-nonpathological cell interactions. Conclusions This comprehensive analysis illustrates differing tumor and nontumor landscapes of CE and NE regions in high-grade gliomas, highlighting the NE region as an area harboring likely initiators of recurrence in a pro-tumor microenvironment and identifying possible targets for future design of NE-specific adjuvant therapy. These findings also support the aggressive approach to resection of tumor-bearing NE regions.
Collapse
Affiliation(s)
- Kunal S Patel
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kaleab K Tessema
- The Intellectual and Developmental Disabilities Research Center and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Riki Kawaguchi
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Lindsey Dudley
- The Intellectual and Developmental Disabilities Research Center and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Alvaro G Alvarado
- The Intellectual and Developmental Disabilities Research Center and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sree Deepthi Muthukrishnan
- The Intellectual and Developmental Disabilities Research Center and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Travis Perryman
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Akifumi Hagiwara
- UCLA Brain Tumor Imaging Laboratory (BTIL), Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Vivek Swarup
- Department of Neurobiology and Behavior, UCI School of Biological Sciences, Irvine, California, USA
| | - Linda M Liau
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Anthony C Wang
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - William Yong
- Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Daniel H Geschwind
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ichiro Nakano
- Department of Neurosurgery, Hokuto Social Medical Corporation, Hokuto Hospital, Hokuto, Japan
| | - Steven A Goldman
- Center for Translational Neuromedicine, University of Rochester Medical Center, Rochester, New York, USA
- Faculty of Health and Medical Sciences, Center for Translational Neuromedicine, University of Copenhagen, Copenhagen, Denmark
| | - Richard G Everson
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Benjamin M Ellingson
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Harley I Kornblum
- The Intellectual and Developmental Disabilities Research Center and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Departments of Pediatrics, Psychiatry, and Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| |
Collapse
|
2
|
Sargent B, Havens KL, Kubo M, Wisnowski JL, Wu TW, Fetters L. Motivating Selective Motor Control of Infants at High Risk of Cerebral Palsy Using an In-Home Kicking-Activated Mobile Task: A Pilot Study. Phys Ther 2022; 102:pzab265. [PMID: 34935956 PMCID: PMC8869361 DOI: 10.1093/ptj/pzab265] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 07/05/2021] [Accepted: 09/28/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Decreased selective motor control limits gait function of children with spastic cerebral palsy (CP). Infants at high risk of CP demonstrate decreased selective motor control by 1 month of age. To motivate more selective hip-knee control, infants at high risk of CP participated in an in-home kicking-activated mobile task. The purpose of this study was to determine whether infants at high risk of CP and infants with typical development (TD) demonstrated increased selective hip-knee control during 2-minute intervals of the mobile task when they demonstrated learning of the association between their leg movement and mobile activation vs during 2-minute intervals when they did not demonstrate learning. METHODS Participants in this cohort study included 10 infants at high risk of CP based on neuroimaging and 11 infants with TD at 3.5 to 4.5 months of age. Each infant participated in the in-home kicking-activated mobile task for 8 to 10 min/d, 5 d/wk, for 6 weeks. Over 80,000 kicks were extracted and classified for each infant as occurring during 2-minute intervals of the task when the infant demonstrated learning vs not learning based on mobile activation time above baseline. RESULTS Infants demonstrated kicks with more selective hip-knee control during 2-minute intervals of the mobile task when they demonstrated learning compared with when they did not demonstrate learning for 4 of 6 weeks in the cohort at high risk of CP and for 2 of 6 weeks in the cohort with TD. CONCLUSION Participation in the in-home kicking-activated mobile task may motivate more selective hip-knee control of infants at high risk of CP. IMPACT This study is a first step toward developing an intervention to promote selective hip-knee control of infants at high risk of CP, with the ultimate goal of optimizing future walking function. LAY SUMMARY This study showed that playing with an in-home infant kicking-activated mobile may motivate infants at high risk of CP to produce more age-appropriate leg movements.
Collapse
Affiliation(s)
- Barbara Sargent
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | - Kathryn L Havens
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | - Masayoshi Kubo
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Jessica L Wisnowski
- Department of Radiology, Children’s Hospital Los Angeles, Los Angeles, California, USA
- Fetal and Neonatal Institute, Children’s Hospital Los Angeles Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Tai-Wei Wu
- Fetal and Neonatal Institute, Children’s Hospital Los Angeles Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Linda Fetters
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
3
|
Kelly CM, Vins H, Spicer JO, Mengistu BS, Wilson DR, Derbew M, Bekele A, Mariam DH, del Rio C, Kempker RR, Comeau DL, Blumberg HM. The rapid scale up of medical education in Ethiopia: Medical student experiences and the role of e-learning at Addis Ababa University. PLoS One 2019; 14:e0221989. [PMID: 31487332 PMCID: PMC6728036 DOI: 10.1371/journal.pone.0221989] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 08/20/2019] [Indexed: 11/18/2022] Open
Abstract
Background In response to a physician shortage in Ethiopia, the number of medical students admitted to public universities was rapidly increased through a “flooding” policy. Objectives To assess medical student perceptions on the impact of the “flooding” policy on medical education and e-learning initiatives, as well as plans for future emigration. Design A cross-sectional survey of medical students at AAU was implemented in 2014. Attitude and practice items were assessed using a Likert scale. Logistic regression analysis was performed to identify characteristics associated with an interest in future emigration. Results 673 (99.6%) of 676 students approached completed the survey, representing 39.5% of all 1705 medical students enrolled at AAU in 2014. Most students felt the “flooding” policy had a negative impact on their medical education and >90% felt there was not adequate infrastructure to support the increased student body. E-learning activities to accommodate increased class size included distribution of electronic tablets, but at the time of the survey only 34.8% of students still had a working tablet and 82.3% reported problems with internet connectivity. Most preclinical students (85.1%) who had attended live-streamed lectures preferred traditional classroom lectures. Half of the students (49.5%) intended to practice medicine in Ethiopia. Independent risk factors for planning to emigrate included age <21 years (aOR = 1.30, 95% CI 1.04, 1.97); having applied to medical school for reasons other than “wanting to be a physician” (aOR = 1.55, 95% CI 1.14, 2.20), and not believing that “flooding” policy would increase the number of physicians working in Ethiopia (aOR = 1.87, 95% CI 1.33, 2.58). Conclusions The “flooding” policy lead to significant educational challenges that were not fully alleviated by e-learning initiatives. Concomitant increases in resources for infrastructure development and faculty expansion are needed to maintain quality medical education. Additional research is needed on factors that influence medical graduates decision to emigrate.
Collapse
Affiliation(s)
- Caitrin M. Kelly
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
- * E-mail:
| | - Holly Vins
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health of Emory University, Atlanta, GA, United States of America
| | - Jennifer O. Spicer
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Brittney S. Mengistu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health of Emory University, Atlanta, GA, United States of America
| | - Daphne R. Wilson
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health of Emory University, Atlanta, GA, United States of America
- School of Law, Emory University, Atlanta, GA, United States of America
| | - Miliard Derbew
- Department of Surgery, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Abebe Bekele
- Department of Surgery, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Damen Haile Mariam
- Department of Community Health, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Carlos del Rio
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
- Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, GA, United States of America
| | - Russell R. Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Dawn L. Comeau
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health of Emory University, Atlanta, GA, United States of America
| | - Henry M. Blumberg
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
- Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, GA, United States of America
- Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, GA, United States of America
| |
Collapse
|