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Rao D, Yang L, Enxi X, Siyuan L, Yu Q, Zheng L, Zhou Z, Yerong C, Bo C, Xiuhong S, Eryi S. A predictive model in patients with chronic hydrocephalus following aneurysmal subarachnoid hemorrhage: a retrospective cohort study. Front Neurol 2024; 15:1366306. [PMID: 38817542 PMCID: PMC11137279 DOI: 10.3389/fneur.2024.1366306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/07/2024] [Indexed: 06/01/2024] Open
Abstract
Objective Our aim was to develop a nomogram that integrates clinical and radiological data obtained from computed tomography (CT) scans, enabling the prediction of chronic hydrocephalus in patients with aneurysmal subarachnoid hemorrhage (aSAH). Method A total of 318 patients diagnosed with subarachnoid hemorrhage (SAH) and admitted to the Department of Neurosurgery at the Affiliated People's Hospital of Jiangsu University between January 2020 and December 2022 were enrolled in our study. We collected clinical characteristics from the hospital's medical record system. To identify risk factors associated with chronic hydrocephalus, we conducted both univariate and LASSO regression models on these clinical characteristics and radiological features, accompanied with penalty parameter adjustments conducted through tenfold cross-validation. All features were then incorporated into multivariate logistic regression analyses. Based on these findings, we developed a clinical-radiological nomogram. To evaluate its discrimination performance, we conducted Receiver Operating Characteristic (ROC) curve analysis and calculated the Area Under the Curve (AUC). Additionally, we employed calibration curves, and utilized Brier scores as an indicator of concordance. Additionally, Decision Curve Analysis (DCA) was performed to determine the clinical utility of our models by estimating net benefits at various threshold probabilities for both training and testing groups. Results The study included 181 patients, with a determined chronic hydrocephalus prevalence of 17.7%. Univariate logistic regression analysis identified 11 potential risk factors, while LASSO regression identified 7 significant risk factors associated with chronic hydrocephalus. Multivariate logistic regression analysis revealed three independent predictors for chronic hydrocephalus following aSAH: Periventricular white matter changes, External lumbar drainage, and Modified Fisher Grade. A nomogram incorporating these factors accurately predicted the risk of chronic hydrocephalus in both the training and testing cohorts. The AUC values were calculated as 0.810 and 0.811 for each cohort respectively, indicating good discriminative ability of the nomogram model. Calibration curves along with Hosmer-Lemeshow tests demonstrated excellent agreement between predicted probabilities and observed outcomes in both cohorts. Furthermore, Brier scores (0.127 for the training and 0.09 for testing groups) further validated the predictive performance of our nomogram model. The DCA confirmed that this nomogram provides superior net benefit across various risk thresholds when predicting chronic hydrocephalus. The decision curve demonstrated that when an individual's threshold probability ranged from 5 to 62%, this model is more effective in predicting the occurrence of chronic hydrocephalus after aSAH. Conclusion A clinical-radiological nomogram was developed to combine clinical characteristics and radiological features from CT scans, aiming to enhance the accuracy of predicting chronic hydrocephalus in patients with aSAH. This innovative nomogram shows promising potential in assisting clinicians to create personalized and optimal treatment plans by providing precise predictions of chronic hydrocephalus among aSAH patients.
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Affiliation(s)
- Dai Rao
- Department of Radiology, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Li Yang
- Department of Radiology, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Xu Enxi
- Department of Neurosurgery, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Lu Siyuan
- Department of Radiology, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Qian Yu
- Department of Neurosurgery, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Li Zheng
- Department of Neurosurgery, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Zhou Zhou
- Department of Neurosurgery, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Chen Yerong
- Department of Radiology, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Chen Bo
- Department of Neurosurgery, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Shan Xiuhong
- Department of Radiology, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Sun Eryi
- Department of Neurosurgery, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
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White H, Webb R, McKnight I, Legg K, Lee C, Lee PH, Spicer OS, Shim JW. TRPV4 mRNA is elevated in the caudate nucleus with NPH but not in Alzheimer's disease. Front Genet 2022; 13:936151. [PMID: 36406122 PMCID: PMC9670164 DOI: 10.3389/fgene.2022.936151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/17/2022] [Indexed: 01/04/2023] Open
Abstract
Symptoms of normal pressure hydrocephalus (NPH) and Alzheimer's disease (AD) are somewhat similar, and it is common to misdiagnose these two conditions. Although there are fluid markers detectable in humans with NPH and AD, determining which biomarker is optimal in representing genetic characteristics consistent throughout species is poorly understood. Here, we hypothesize that NPH can be differentiated from AD with mRNA biomarkers of unvaried proximity to telomeres. We examined human caudate nucleus tissue samples for the expression of transient receptor potential cation channel subfamily V member 4 (TRPV4) and amyloid precursor protein (APP). Using the genome data viewer, we analyzed the mutability of TRPV4 and other genes in mice, rats, and humans through matching nucleotides of six genes of interest and one house keeping gene with two factors associated with high mutation rate: 1) proximity to telomeres or 2) high adenine and thymine (A + T) content. We found that TRPV4 and microtubule associated protein tau (MAPT) mRNA were elevated in NPH. In AD, mRNA expression of TRPV4 was unaltered unlike APP and other genes. In mice, rats, and humans, the nucleotide size of TRPV4 did not vary, while in other genes, the sizes were inconsistent. Proximity to telomeres in TRPV4 was <50 Mb across species. Our analyses reveal that TRPV4 gene size and mutability are conserved across three species, suggesting that TRPV4 can be a potential link in the pathophysiology of chronic hydrocephalus in aged humans (>65 years) and laboratory rodents at comparable ages.
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Affiliation(s)
- Hunter White
- Department of Biomedical Engineering, Marshall University, Huntington, WV, United States
| | - Ryan Webb
- Department of Biomedical Engineering, Marshall University, Huntington, WV, United States
| | - Ian McKnight
- Department of Biomedical Engineering, Marshall University, Huntington, WV, United States
| | - Kaitlyn Legg
- Department of Biomedical Engineering, Marshall University, Huntington, WV, United States
| | - Chan Lee
- Department of Anesthesia, Indiana University Health Arnett Hospital, Lafayette, IN, United States
| | - Peter H.U. Lee
- Department of Cardiothoracic Surgery, Southcoast Health, Fall River, MA, United States,Department of Pathology and Laboratory Medicine, Brown University, Providence, RI, United States
| | - Olivia Smith Spicer
- National Institute of Mental Health, National Institute of Health, Bethesda, MD, United States
| | - Joon W. Shim
- Department of Biomedical Engineering, Marshall University, Huntington, WV, United States,*Correspondence: Joon W. Shim,
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Meinicke A, Härtig W, Winter K, Puchta J, Mages B, Michalski D, Emmer A, Otto M, Hoffmann KT, Reimann W, Krause M, Schob S. Surfactant Protein-G in Wildtype and 3xTg-AD Mice: Localization in the Forebrain, Age-Dependent Hippocampal Dot-like Deposits and Brain Content. Biomolecules 2022; 12:biom12010096. [PMID: 35053244 PMCID: PMC8773979 DOI: 10.3390/biom12010096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 11/16/2022] Open
Abstract
The classic surfactant proteins (SPs) A, B, C, and D were discovered in the lungs, where they contribute to host defense and regulate the alveolar surface tension during breathing. Their additional importance for brain physiology was discovered decades later. SP-G, a novel amphiphilic SP, was then identified in the lungs and is mostly linked to inflammation. In the brain, it is also present and significantly elevated after hemorrhage in premature infants and in distinct conditions affecting the cerebrospinal fluid circulation of adults. However, current knowledge on SP-G-expression is limited to ependymal cells and some neurons in the subventricular and superficial cortex. Therefore, we primarily focused on the distribution of SP-G-immunoreactivity (ir) and its spatial relationships with components of the neurovascular unit in murine forebrains. Triple fluorescence labeling elucidated SP-G-co-expressing neurons in the habenula, infundibulum, and hypothalamus. Exploring whether SP-G might play a role in Alzheimer’s disease (AD), 3xTg-AD mice were investigated and displayed age-dependent hippocampal deposits of β-amyloid and hyperphosphorylated tau separately from clustered, SP-G-containing dots with additional Reelin-ir—which was used as established marker for disease progression in this specific context. Semi-quantification of those dots, together with immunoassay-based quantification of intra- and extracellular SP-G, revealed a significant elevation in old 3xTg mice when compared to age-matched wildtype animals. This suggests a role of SP-G for the pathophysiology of AD, but a confirmation with human samples is required.
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Affiliation(s)
- Anton Meinicke
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr. 19, 04103 Leipzig, Germany; (A.M.); (W.H.); (J.P.); (W.R.)
- Institute of Neuroradiology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany;
| | - Wolfgang Härtig
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr. 19, 04103 Leipzig, Germany; (A.M.); (W.H.); (J.P.); (W.R.)
| | - Karsten Winter
- Institute of Anatomy, University of Leipzig, Liebigstr. 13, 04103 Leipzig, Germany; (K.W.); (B.M.)
| | - Joana Puchta
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr. 19, 04103 Leipzig, Germany; (A.M.); (W.H.); (J.P.); (W.R.)
- Institute of Neuroradiology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany;
| | - Bianca Mages
- Institute of Anatomy, University of Leipzig, Liebigstr. 13, 04103 Leipzig, Germany; (K.W.); (B.M.)
| | - Dominik Michalski
- Department of Neurology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany;
| | - Alexander Emmer
- Department of Neurology, University Hospital Halle, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (A.E.); (M.O.)
| | - Markus Otto
- Department of Neurology, University Hospital Halle, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (A.E.); (M.O.)
| | - Karl-Titus Hoffmann
- Institute of Neuroradiology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany;
| | - Willi Reimann
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr. 19, 04103 Leipzig, Germany; (A.M.); (W.H.); (J.P.); (W.R.)
- Institute of Neuroradiology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany;
| | - Matthias Krause
- Department of Neurosurgery, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany;
| | - Stefan Schob
- Department of Neuroradiology, Clinic and Policlinic of Radiology, University Hospital Halle, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
- Correspondence: ; Tel.: +49-345-557-2432
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Schob S, Puchta J, Winter K, Michalski D, Mages B, Martens H, Emmer A, Hoffmann KT, Gaunitz F, Meinicke A, Krause M, Härtig W. Surfactant protein C is associated with perineuronal nets and shows age-dependent changes of brain content and hippocampal deposits in wildtype and 3xTg mice. J Chem Neuroanat 2021; 118:102036. [PMID: 34626771 DOI: 10.1016/j.jchemneu.2021.102036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 01/15/2023]
Abstract
Surfactant protein C (SP-C) modulates cerebrospinal fluid (CSF) rheology. During ageing, its declining levels are accompanied by an increased burden of white matter lesions. Pulmonary SP-C intermediates harbouring the BRICHOS-domain prevent protein misfolding in the lungs. Thus, cerebral SP-C intermediates may counteract cerebral β-amyloidosis, a hallmark of Alzheimer's disease (AD). However, data on the molecular neuroanatomy of SP-C and its alterations in wildtype and triple transgenic (3xTg) mice, featuring essential elements of AD-neuropathology, are lacking. Therefore, this study investigated SP-C-containing structures in murine forebrains and their spatial relationships with vascular, glial and neuronal components of the neurovascular unit. Fluorescence labelling demonstrated neuronal SP-C in the medial habenula, the indusium griseum and the hippocampus. Glial counterstaining elucidated astrocytes in the corpus callosum co-expressing SP-C and S100β. Notably, perineuronal nets were associated with SP-C in the nucleus reticularis thalami, the lateral hypothalamus and the retrosplenial cortex. In the hippocampus of aged 3xTg mice, an increased number of dot-like depositions containing SP-C and Reelin, but devoid of BRICHOS-immunoreactivity were observed apart from AD-like lesions. Wildtype and 3xTg mice revealed an age-dependent increase of such deposits markedly pronounced in about 24-month-old 3xTg mice. SP-C levels of the intracellular and extracellular compartments in each group revealed an inverse correlation of SP-C and Reelin, with reduced SP-C and increased Reelin in an age-dependent fashion especially in 3xTg mice. Taken together, extracellular SP-C, as modulator of glymphatic clearance and potential ligand of PNs, declines in 3xTg mice, which show an accumulation of extracellular Reelin depositions during ageing.
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Affiliation(s)
- Stefan Schob
- Department of Neuroradiology, Clinic and Policlinic of Radiology, University Hospital Halle, Ernst-Grube-Str. 40, 06120 Halle/Saale, Germany.
| | - Joana Puchta
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr.19, 04103 Leipzig, Germany; Institute of Neuroradiology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Karsten Winter
- Institute for Anatomy, University of Leipzig, Liebigstr. 13, 04103 Leipzig, Germany
| | - Dominik Michalski
- Department of Neurology, University of Leipzig, Liebigstr. 13, 04103 Leipzig, Germany
| | - Bianca Mages
- Institute for Anatomy, University of Leipzig, Liebigstr. 13, 04103 Leipzig, Germany
| | - Henrik Martens
- Synaptic Systems GmbH, Rudolf-Wissell-Str. 28a, 37079 Göttingen, Germany
| | - Alexander Emmer
- Department of Neurology, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle/Saale, Germany
| | - Karl-Titus Hoffmann
- Institute of Neuroradiology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Frank Gaunitz
- Department of Neurosurgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Anton Meinicke
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr.19, 04103 Leipzig, Germany; Institute of Neuroradiology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Matthias Krause
- Department of Neurosurgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Wolfgang Härtig
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr.19, 04103 Leipzig, Germany
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