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Messica S, Presil D, Hoch Y, Lev T, Hadad A, Katz O, Owens DR. Enhancing stroke risk and prognostic timeframe assessment with deep learning and a broad range of retinal biomarkers. Artif Intell Med 2024; 154:102927. [PMID: 38991398 DOI: 10.1016/j.artmed.2024.102927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/15/2024] [Accepted: 06/25/2024] [Indexed: 07/13/2024]
Abstract
Stroke stands as a major global health issue, causing high death and disability rates and significant social and economic burdens. The effectiveness of existing stroke risk assessment methods is questionable due to their use of inconsistent and varying biomarkers, which may lead to unpredictable risk evaluations. This study introduces an automatic deep learning-based system for predicting stroke risk (both ischemic and hemorrhagic) and estimating the time frame of its occurrence, utilizing a comprehensive set of known retinal biomarkers from fundus images. Our system, tested on the UK Biobank and DRSSW datasets, achieved AUROC scores of 0.83 (95% CI: 0.79-0.85) and 0.93 (95% CI: 0.9-0.95), respectively. These results not only highlight our system's advantage over established benchmarks but also underscore the predictive power of retinal biomarkers in assessing stroke risk and the unique effectiveness of each biomarker. Additionally, the correlation between retinal biomarkers and cardiovascular diseases broadens the potential application of our system, making it a versatile tool for predicting a wide range of cardiovascular conditions.
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Affiliation(s)
| | - Dan Presil
- NEC Israeli Research Center, Herzliya, Israel
| | - Yaacov Hoch
- NEC Israeli Research Center, Herzliya, Israel
| | - Tsvi Lev
- NEC Israeli Research Center, Herzliya, Israel
| | - Aviel Hadad
- Ophthalmology Department, Soroka University Medical Center, Be'er Sheva, South District, Israel
| | - Or Katz
- NEC Israeli Research Center, Herzliya, Israel
| | - David R Owens
- Swansea University Medical School, Swansea, Wales, UK
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2
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Xu X, Fu Y, Luo D, Zhang L, Huang X, Chen Y, Lei C, Liu J, Li S, Yu Z, Lin Y, Zhang M. Therapeutic effects of tetrahedral framework nucleic acids and tFNAs-miR22 on retinal ischemia/reperfusion injury. Cell Prolif 2024:e13695. [PMID: 39086110 DOI: 10.1111/cpr.13695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/29/2024] [Accepted: 06/06/2024] [Indexed: 08/02/2024] Open
Abstract
Retinal ischemia/reperfusion injury (RI/R) is a common pathological process in ophthalmic diseases, which can cause severe visual impairment. The mechanisms underlying RI/R damage and repair are still unclear. Scholars are actively exploring effective intervention strategies to restore impaired visual function. With the development of nucleic acid nanomaterials, tetrahedral framework nucleic acids (tFNAs) have shown promising therapeutic potential in various fields such as stem cells, biosensors, and tumour treatment due to their excellent biological properties. Besides, miRNA-22-3p (miR-22), as an important regulatory factor in neural tissue, has been proven to have positive effects in various neurodegenerative diseases. By stably constructing a complex of tetrahedral framework nucleic acids miR22 (tFNAs-miR22), we observed that tFNAs-miR22 had a positive effect on the repair of RI/R injury in retinal neural tissue. Previous studies have shown that tFNAs can effectively deliver miR-22 into damaged retinal neurons, subsequently exerting neuroprotective effects. Interestingly, we found that there was a certain synergistic effect between tFNAs and miR-22. tFNAs-miR22 can selectively activated the ERK1/2 signalling pathway to reduce neuronal apoptosis, accelerate cell proliferation, and restore synaptic functional activity. In this study, we established a simple yet effective small molecule drug for RI/R treatment which may become a promising neuroprotectant for treating this type of vision impairment disease in the future.
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Affiliation(s)
- Xiaoxiao Xu
- Department of Ophthalmology, and Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
- Innovative Institute of Chinese Medicine and Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yanyan Fu
- Department of Ophthalmology, and Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Delun Luo
- Innovative Institute of Chinese Medicine and Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lina Zhang
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu, China
| | - Xi Huang
- Department of Ophthalmology, and Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yingying Chen
- Department of Ophthalmology, and Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Chunyan Lei
- Department of Ophthalmology, and Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Jinnan Liu
- Innovative Institute of Chinese Medicine and Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shiqi Li
- Innovative Institute of Chinese Medicine and Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhouyuan Yu
- Innovative Institute of Chinese Medicine and Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yunfeng Lin
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Department of Maxillofacial Surgery, West China Stomatological Hospital, Sichuan University, Chengdu, China
| | - Meixia Zhang
- Department of Ophthalmology, and Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
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Dumitrascu OM, Doustar J, Fuchs DT, Koronyo Y, Sherman DS, Miller MS, Johnson KO, Carare RO, Verdooner SR, Lyden PD, Schneider JA, Black KL, Koronyo-Hamaoui M. Retinal peri-arteriolar versus peri-venular amyloidosis, hippocampal atrophy, and cognitive impairment: exploratory trial. Acta Neuropathol Commun 2024; 12:109. [PMID: 38943220 PMCID: PMC11212356 DOI: 10.1186/s40478-024-01810-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/02/2024] [Indexed: 07/01/2024] Open
Abstract
The relationship between amyloidosis and vasculature in cognitive impairment and Alzheimer's disease (AD) pathogenesis is increasingly acknowledged. We conducted a quantitative and topographic assessment of retinal perivascular amyloid plaque (AP) distribution in individuals with both normal and impaired cognition. Using a retrospective dataset of scanning laser ophthalmoscopy fluorescence images from twenty-eight subjects with varying cognitive states, we developed a novel image processing method to examine retinal peri-arteriolar and peri-venular curcumin-positive AP burden. We further correlated retinal perivascular amyloidosis with neuroimaging measures and neurocognitive scores. Our study unveiled that peri-arteriolar AP counts surpassed peri-venular counts throughout the entire cohort (P < 0.0001), irrespective of the primary, secondary, or tertiary vascular branch location, with a notable increase among cognitively impaired individuals. Moreover, secondary branch peri-venular AP count was elevated in the cognitively impaired (P < 0.01). Significantly, peri-venular AP count, particularly in secondary and tertiary venules, exhibited a strong correlation with clinical dementia rating, Montreal cognitive assessment score, hippocampal volume, and white matter hyperintensity count. In conclusion, our exploratory analysis detected greater peri-arteriolar versus peri-venular amyloidosis and a marked elevation of amyloid deposition in secondary branch peri-venular regions among cognitively impaired subjects. These findings underscore the potential feasibility of retinal perivascular amyloid imaging in predicting cognitive decline and AD progression. Larger longitudinal studies encompassing diverse populations and AD-biomarker confirmation are warranted to delineate the temporal-spatial dynamics of retinal perivascular amyloid deposition in cognitive impairment and the AD continuum.
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Affiliation(s)
- Oana M Dumitrascu
- Departments of Neurology, Mayo Clinic, AZ, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA.
| | - Jonah Doustar
- Department of Neurosurgery, Cedars-Sinai Medical Center, Maxine Dunitz Neurosurgical Institute, 127 S. San Vicente Blvd., Los Angeles, CA, 90048, USA
| | - Dieu-Trang Fuchs
- Department of Neurosurgery, Cedars-Sinai Medical Center, Maxine Dunitz Neurosurgical Institute, 127 S. San Vicente Blvd., Los Angeles, CA, 90048, USA
| | - Yosef Koronyo
- Department of Neurosurgery, Cedars-Sinai Medical Center, Maxine Dunitz Neurosurgical Institute, 127 S. San Vicente Blvd., Los Angeles, CA, 90048, USA
| | - Dale S Sherman
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Los Angeles, CA, 90048, USA
| | - Michelle Shizu Miller
- Department of Neurosurgery, Cedars-Sinai Medical Center, Maxine Dunitz Neurosurgical Institute, 127 S. San Vicente Blvd., Los Angeles, CA, 90048, USA
- Department of Neurosurgery, Tulane University School of Medicine, 1415 Tulane Ave, New Orleans, LA, 70112, USA
| | - Kenneth O Johnson
- NeuroVision Imaging LLC, 1395 Garden Hwy, Sacramento, CA, 95833, USA
| | - Roxana O Carare
- Department of Clinical Neuroanatomy, University of Southampton, University Road Southampton, Southampton, SO17 1BJ, UK
| | | | - Patrick D Lyden
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, 1501 San Pablo St, Los Angeles, CA, 90033, USA
| | - Julie A Schneider
- Department of Pathology, Department of Neurological Sciences, Alzheimer's Disease Research Center, Rush Medical College, Rush University, 600 S. Paulina St., Chicago, IL, 60612, USA
| | - Keith L Black
- Department of Neurosurgery, Cedars-Sinai Medical Center, Maxine Dunitz Neurosurgical Institute, 127 S. San Vicente Blvd., Los Angeles, CA, 90048, USA
| | - Maya Koronyo-Hamaoui
- Department of Neurosurgery, Cedars-Sinai Medical Center, Maxine Dunitz Neurosurgical Institute, 127 S. San Vicente Blvd., Los Angeles, CA, 90048, USA.
- Department of Neurology, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Los Angeles, CA, 90048, USA.
- Division of Applied Cell Biology and Physiology, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Los Angeles, CA, 90048, USA.
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Dumitrascu OM, Doustar J, Fuchs DT, Koronyo Y, Sherman DS, Miller MS, Johnson KO, Carare RO, Verdooner SR, Lyden PD, Schneider JA, Black KL, Koronyo-Hamaoui M. Distinctive retinal peri-arteriolar versus peri-venular amyloid plaque distribution correlates with the cognitive performance. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.27.580733. [PMID: 38464292 PMCID: PMC10925252 DOI: 10.1101/2024.02.27.580733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Introduction The vascular contribution to Alzheimer's disease (AD) is tightly connected to cognitive performance across the AD continuum. We topographically describe retinal perivascular amyloid plaque (AP) burden in subjects with normal or impaired cognition. Methods Using scanning laser ophthalmoscopy, we quantified retinal peri-arteriolar and peri-venular curcumin-positive APs in the first, secondary and tertiary branches in twenty-eight subjects. Perivascular AP burden among cognitive states was correlated with neuroimaging and cognitive measures. Results Peri-arteriolar exceeded peri-venular AP count (p<0.0001). Secondary branch AP count was significantly higher in cognitively impaired (p<0.01). Secondary small and tertiary peri-venular AP count strongly correlated with clinical dementia rating, hippocampal volumes, and white matter hyperintensity count. Discussion Our topographic analysis indicates greater retinal amyloid accumulation in the retinal peri-arteriolar regions overall, and distal peri-venular regions in cognitively impaired individuals. Larger longitudinal studies are warranted to understand the temporal-spatial relationship between vascular dysfunction and perivascular amyloid deposition in AD. Highlights Retinal peri-arteriolar region exhibits more amyloid compared with peri-venular regions.Secondary retinal vascular branches have significantly higher perivascular amyloid burden in subjects with impaired cognition, consistent across sexes.Cognitively impaired individuals have significantly greater retinal peri-venular amyloid deposits in the distal small branches, that correlate with CDR and hippocampal volumes.
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Li R, Hui Y, Zhang X, Zhang S, Lv B, Ni Y, Li X, Liang X, Yang L, Lv H, Yin Z, Li H, Yang Y, Liu G, Li J, Xie G, Wu S, Wang Z. Ocular biomarkers of cognitive decline based on deep-learning retinal vessel segmentation. BMC Geriatr 2024; 24:28. [PMID: 38184539 PMCID: PMC10770952 DOI: 10.1186/s12877-023-04593-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 12/13/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND The current literature shows a strong relationship between retinal neuronal and vascular alterations in dementia. The purpose of the study was to use NFN+ deep learning models to analyze retinal vessel characteristics for cognitive impairment (CI) recognition. METHODS We included 908 participants from a community-based cohort followed for over 15 years (the prospective KaiLuan Study) who underwent brain magnetic resonance imaging (MRI) and fundus photography between 2021 and 2022. The cohort consisted of both cognitively healthy individuals (N = 417) and those with cognitive impairment (N = 491). We employed the NFN+ deep learning framework for retinal vessel segmentation and measurement. Associations between Retinal microvascular parameters (RMPs: central retinal arteriolar / venular equivalents, arteriole to venular ratio, fractal dimension) and CI were assessed by Pearson correlation. P < 0.05 was considered statistically significant. The correlation between the CI and RMPs were explored, then the correlation coefficients between CI and RMPs were analyzed. Random Forest nonlinear classification model was used to predict whether one having cognitive decline or not. The assessment criterion was the AUC value derived from the working characteristic curve. RESULTS The fractal dimension (FD) and global vein width were significantly correlated with the CI (P < 0.05). Age (0.193), BMI (0.154), global vein width (0.106), retinal vessel FD (0.099), and CRAE (0.098) were the variables in this model that were ranked in order of feature importance. The AUC values of the model were 0.799. CONCLUSIONS Establishment of a predictive model based on the extraction of vascular features from fundus images has a high recognizability and predictive power for cognitive function and can be used as a screening method for CI.
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Affiliation(s)
- Rui Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ying Hui
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | | | - Shun Zhang
- Department of Psychiatry, Kailuan Mental Health Centre, Hebei province, Tangshan, China
| | - Bin Lv
- Ping An Healthcare Technology, Beijing, China
| | - Yuan Ni
- Ping An Healthcare Technology, Beijing, China
| | - Xiaoshuai Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaoliang Liang
- Department of Psychiatry, Kailuan Mental Health Centre, Hebei province, Tangshan, China
| | - Ling Yang
- School of Public Health, North China University of Science and Technology, Hebei province, Tangshan, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhiyu Yin
- Longzhen Senior Care, Beijing, China
| | - Hongyang Li
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yingping Yang
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guangfeng Liu
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Jing Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Guotong Xie
- Ping An Healthcare Technology, Beijing, China.
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, 57 Xinhua E Rd, Tangshan, China.
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Danielescu C, Dabija MG, Nedelcu AH, Lupu VV, Lupu A, Ioniuc I, Gîlcă-Blanariu GE, Donica VC, Anton ML, Musat O. Automated Retinal Vessel Analysis Based on Fundus Photographs as a Predictor for Non-Ophthalmic Diseases-Evolution and Perspectives. J Pers Med 2023; 14:45. [PMID: 38248746 PMCID: PMC10817503 DOI: 10.3390/jpm14010045] [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: 11/28/2023] [Revised: 12/27/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
The study of retinal vessels in relation to cardiovascular risk has a long history. The advent of a dedicated tool based on digital imaging, i.e., the retinal vessel analyzer, and also other software such as Integrative Vessel Analysis (IVAN), Singapore I Vessel Assessment (SIVA), and Vascular Assessment and Measurement Platform for Images of the Retina (VAMPIRE), has led to the accumulation of a formidable body of evidence regarding the prognostic value of retinal vessel analysis (RVA) for cardiovascular and cerebrovascular disease (including arterial hypertension in children). There is also the potential to monitor the response of retinal vessels to therapies such as physical activity or bariatric surgery. The dynamic vessel analyzer (DVA) remains a unique way of studying neurovascular coupling, helping to understand the pathogenesis of cerebrovascular and neurodegenerative conditions and also being complementary to techniques that measure macrovascular dysfunction. Beyond cardiovascular disease, retinal vessel analysis has shown associations with and prognostic value for neurological conditions, inflammation, kidney function, and respiratory disease. Artificial intelligence (AI) (represented by algorithms such as QUantitative Analysis of Retinal vessel Topology and siZe (QUARTZ), SIVA-DLS (SIVA-deep learning system), and many others) seems efficient in extracting information from fundus photographs, providing prognoses of various general conditions with unprecedented predictive value. The future challenges will be integrating RVA and other qualitative and quantitative risk factors in a unique, comprehensive prediction tool, certainly powered by AI, while building the much-needed acceptance for such an approach inside the medical community and reducing the "black box" effect, possibly by means of saliency maps.
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Affiliation(s)
- Ciprian Danielescu
- Department of Ophthalmology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Marius Gabriel Dabija
- Department of Surgery II, Discipline of Neurosurgery, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Alin Horatiu Nedelcu
- Department of Morpho-Functional Sciences I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Vasile Valeriu Lupu
- Department of Pediatrics, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (V.V.L.); (I.I.)
| | - Ancuta Lupu
- Department of Pediatrics, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (V.V.L.); (I.I.)
| | - Ileana Ioniuc
- Department of Pediatrics, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (V.V.L.); (I.I.)
| | | | - Vlad-Constantin Donica
- Doctoral School, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (V.-C.D.); (M.-L.A.)
| | - Maria-Luciana Anton
- Doctoral School, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (V.-C.D.); (M.-L.A.)
| | - Ovidiu Musat
- Department of Ophthalmology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucuresti, Romania;
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Rebouças SCL, Cougnard‐Gregoire A, Arnould L, Delyfer M, Schweitzer C, Korobelnik J, Foubert‐Samier A, Cheung CY, Wong TY, Delcourt C, Helmer C. Retinal microvasculature and incident dementia over 10 years: The Three-City-Alienor cohort. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12480. [PMID: 37915467 PMCID: PMC10617985 DOI: 10.1002/dad2.12480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 11/03/2023]
Abstract
Introduction We explored the longitudinal relationship between retinal vascular features and dementia incidence over 10 years. Methods Among 584 participants from the Three-City-Alienor (3C-Alienor) population-based cohort, quantitative retinal vascular features (caliber, tortuosity, fractal dimension) were measured using semi-automated software. Dementia was actively diagnosed over the follow-up period. Results One hundred twenty-eight participants (21.9%) developed dementia over a median of 7.1 years. In Cox proportional hazards models adjusted for sociodemographic characteristics, apolipoprotein E (APOE) ε4, and vascular factors, increased retinal arteriolar tortuosity was associated with all-cause dementia (hazard ratio per standard deviation increase, 1.21; 95% confidence interval: 1.02-1.44). Wider retinal calibers and a higher venular tortuosity were associated with mixed/vascular dementia, but not Alzheimer's disease. Fractal dimensions were not associated with dementia. Discussion Changes in the retinal microvasculature were associated with dementia risk. More studies are needed to replicate these findings and determine which features might help identify persons at risk at an early stage. HIGHLIGHTS The retinal microvasculature might reflect the brain microvasculatureWe explored the association between retinal vascular features and incident dementia584 participants from the Three-City-Alienor cohort were followed-up over 10 yearsIncreased arteriolar tortuosity and venular calibers were associated with dementia riskRetinal imaging might help identify persons at risk of future dementia.
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Affiliation(s)
| | | | - Louis Arnould
- University of BordeauxINSERM, BPH, U1219BordeauxFrance
- Department of OphthalmologyDijon University HospitalDijonFrance
| | - Marie‐Noëlle Delyfer
- University of BordeauxINSERM, BPH, U1219BordeauxFrance
- Department of OphthalmologyBordeaux University HospitalBordeauxFrance
| | - Cédric Schweitzer
- University of BordeauxINSERM, BPH, U1219BordeauxFrance
- Department of OphthalmologyBordeaux University HospitalBordeauxFrance
| | - Jean‐François Korobelnik
- University of BordeauxINSERM, BPH, U1219BordeauxFrance
- Department of OphthalmologyBordeaux University HospitalBordeauxFrance
| | - Alexandra Foubert‐Samier
- University of BordeauxINSERM, BPH, U1219BordeauxFrance
- Institut des Maladies NeurodégénérativesBordeaux University HospitalBordeauxFrance
| | - Carol Y. Cheung
- Department of Ophthalmology and Visual SciencesThe Chinese University of Hong KongHong KongChina
| | - Tien Y. Wong
- Singapore Eye Research InstituteSingapore National Eye CenterSingaporeSingapore
- Tsinghua MedicineBeijing Tsinghua Changgung HospitalTsinghua UniversityBeijingChina
| | | | - Catherine Helmer
- University of BordeauxINSERM, BPH, U1219BordeauxFrance
- Clinical Investigation Center – Clinical EpidemiologyINSERMBordeauxFrance
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Dong Y, Liu C, Wang J, Li H, Wang Q, Feng A, Tang Z. Association between total bilirubin and gender-specific incidence of fundus arteriosclerosis in a Chinese population: a retrospective cohort study. Sci Rep 2023; 13:11244. [PMID: 37433836 DOI: 10.1038/s41598-023-38378-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/07/2023] [Indexed: 07/13/2023] Open
Abstract
To investigate the gender-specific relationship between total bilirubin (TBIL) and fundus arteriosclerosis in the general population, and to explore whether there is a dose-response relationship between them. In a retrospective cohort study, 27,477 participants were enrolled from 2006 to 2019. The TBIL was divided into four groups according to the quartile. The Cox proportional hazards model was used to estimate the HRs with 95% CIs of different TBIL level and fundus arteriosclerosis in men and women. The dose-response relationship between TBIL and fundus arteriosclerosis was estimated using restricted cubic splines method. In males, after adjusting for potential confounders, the Q2 to Q4 level of TBIL were significantly associated with the risk of fundus arteriosclerosis. The HRs with 95% CIs were 1.217 (1.095-1.354), 1.255 (1.128-1.396) and 1.396 (1.254-1.555), respectively. For females, TBIL level was not associated with the incidence of fundus arteriosclerosis. In addition, a linear relationship between TBIL and fundus arteriosclerosis in both genders (P < 0.0001 and P = 0.0047, respectively). In conclusion, the incidence of fundus arteriosclerosis is positively correlated with serum TBIL level in males, but not in females. In addition, there was a linear dose-response relationship between TBIL and incidence of fundus arteriosclerosis.
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Affiliation(s)
- Yongfei Dong
- Department of Biostatistics, School of Public Health, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, 215123, Jiangsu Province, P.R. China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, 215123, Jiangsu Province, China
| | - Chunxing Liu
- Department of Laboratory, Hua Dong Sanatorium, Wuxi, 214065, Jiangsu Province, China
| | - Jieli Wang
- Department of Laboratory, Hua Dong Sanatorium, Wuxi, 214065, Jiangsu Province, China
| | - Huijun Li
- Department of Biostatistics, School of Public Health, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, 215123, Jiangsu Province, P.R. China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, 215123, Jiangsu Province, China
| | - Qi Wang
- Department of Biostatistics, School of Public Health, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, 215123, Jiangsu Province, P.R. China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, 215123, Jiangsu Province, China
| | - Aicheng Feng
- Department of Otorhinolaryngology, Hua Dong Sanatorium, Wuxi, 214065, Jiangsu Province, China.
| | - Zaixiang Tang
- Department of Biostatistics, School of Public Health, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, 215123, Jiangsu Province, P.R. China.
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, 215123, Jiangsu Province, China.
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Gao Y, Xu L, He N, Ding Y, Zhao W, Meng T, Li M, Wu J, Haddad Y, Zhang X, Ji X. A narrative review of retinal vascular parameters and the applications (Part II): Diagnosis in stroke. Brain Circ 2023; 9:129-134. [PMID: 38020952 PMCID: PMC10679631 DOI: 10.4103/bc.bc_9_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/27/2023] [Accepted: 04/12/2023] [Indexed: 12/01/2023] Open
Abstract
The retina, as an external extension of the diencephalon, can be directly, noninvasively observed by ocular fundus photography. Therefore, it offers a convenient and feasible mode to study nervous system diseases. Caliber, tortuosity, and fractal dimension, as three commonly used retinal vascular parameters, are not only the reflection of structural changes in the retinal microcirculation but also capture the branching pattern or density changes of the retinal microvascular network. Therefore, it contributes to better reflecting the subclinical pathological changes (e.g., lacunar stroke and small cerebral vascular disease) and predicting the risk of incident stroke and recurrent stroke.
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Affiliation(s)
- Yuan Gao
- Department of Biomedical Engineering, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Department of Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lijun Xu
- Department of School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China
| | - Ning He
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Wenbo Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tingting Meng
- Department of Ophthalmology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiaqi Wu
- Department of Biomedical Engineering, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yazeed Haddad
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Xuxiang Zhang
- Department of Ophthalmology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Biomedical Engineering, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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10
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Malan L, van Wyk R, von Känel R, Ziemssen T, Vilser W, Nilsson PM, Magnusson M, Jujic A, Mak D, Steyn F, Malan NT. The chronic stress risk phenotype mirrored in the human retina as a neurodegenerative condition. Stress 2023:1-43. [PMID: 37154816 DOI: 10.1080/10253890.2023.2210687] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
The brain is the key organ that orchestrates the stress response which translates to the retina. The retina is an extension of the brain and retinal symptoms in subjects with neurodegenerative diseases substantiated the eye as a window to the brain. The retina is used in this study to determine whether chronic stress reflects neurodegenerative signs indicative of neurodegenerative conditions. A 3-year prospective cohort (n = 333; aged 46 ± 9 years) was stratified into stress-phenotype cases (n = 212) and controls (n = 121) by applying the Malan stress-phenotype index. Neurodegenerative risk markers included ischemia (astrocytic S100 calcium-binding protein B/S100B); 24h blood pressure, proteomics; inflammation (tumor-necrosis-factor-α/TNF-α); neuronal damage (neuron-specific-enolase); anti-apoptosis of retinal-ganglion-cells (beta-nerve-growth-factor), astrocytic activity (glial-fibrillary-acidic-protein); hematocrit (viscosity) and retinal follow-up data [vessels; stress-optic-neuropathy]. Stress-optic-neuropathy risk was calculated from two indices: a newly derived diastolic-ocular-perfusion-pressure cut-point ≥68 mmHg relating to the stress-phenotype; combined with an established cup-to-disc ratio cut-point ≥0.3. Higher stress-optic-neuropathy (39% vs. 17%) and hypertension (73% vs. 16%) prevalence was observed in the stress-phenotype cases vs. controls. Elevated diastolic-ocular-perfusion-pressure, indicating hypoperfusion, was related to arterial narrowing and trend for ischemia increases in the stress-phenotype. Ischemia in the stress-phenotype at baseline, follow-up and 3-yr changes was related to consistent inflammation (TNF-α and cytokine-interleukin-17-receptor-A), neuron-specific-enolase increases, consistent apoptosis (chitinase 3-like-1, low beta-nerve-growth-factor), glial-fibrillary-acidic-protein decreases, elevated viscosity, vein widening as risk marker of endothelial dysfunction in the blood-retinal-barrier, lower vein count, and elevated stress-optic-neuropathy. The stress-phenotype and related neurodegenerative signs of ongoing brain ischemia, apoptosis and endothelial dysfunction compromised blood-retinal-barrier permeability and optic nerve integrity. In fact, the stress-phenotype could identify persons at high risk of neurodegeneration to indicate a neurodegenerative condition.
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Affiliation(s)
- Leoné Malan
- Technology Transfer and Innovation-Support Office; Private Bag X1290, North-West University, Potchefstroom 2520, South Africa
| | - Roelof van Wyk
- Surgical Ophthalmologist; 85 Peter Mokaba Street, Potchefstroom, South Africa
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich; University of Zurich; Zurich Switzerland
| | - Tjalf Ziemssen
- Autonomic and Neuroendocrinological Laboratory Dresden, University Hospital Carl Gustav Carus; Technische Universität Dresden, Germany
| | - Walthard Vilser
- Institute of Biomedical Engineering and informatics; Technical University Ilmenau, Germany
- Department of Pediatrics and Adolescent Medicine, Section Neonatalogy; University Hospital, Jena, Germany
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University; Malmö, Sweden
| | - Martin Magnusson
- Department of Clinical Sciences, Lund University; Malmö, Sweden
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa
- Department of Cardiology; Skåne University Hospital, Malmö, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University; Malmö Sweden
| | - Amra Jujic
- Department of Clinical Sciences, Lund University; Malmö, Sweden
| | - Daniel Mak
- Centre for Regenerative Medicine and Health; Hong Kong Institute of Science & Innovation, Chinese Academy of Sciences, Hong Kong, SAR, People's Republic of China
| | - Faans Steyn
- Statistical Consultation Services; North-West University, Potchefstroom, South Africa
| | - Nico T Malan
- Technology Transfer and Innovation-Support Office; Private Bag X1290, North-West University, Potchefstroom 2520, South Africa
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11
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Choroidal structural analysis in ultra-high risk and first-episode psychosis. Eur Neuropsychopharmacol 2023; 70:72-80. [PMID: 36931136 DOI: 10.1016/j.euroneuro.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/02/2023] [Accepted: 02/22/2023] [Indexed: 03/19/2023]
Abstract
Both structural and functional alterations in the retina and the choroid of the eye, as parts of the central nervous system, have been shown in psychotic disorders, especially in schizophrenia. In addition, genetic and imaging studies indicate vascular and angiogenesis anomalies in the psychosis spectrum disorders. In this ocular imaging study, choroidal structure and vascularity were investigated using enhanced depth imaging (EDI) optical coherence tomography (OCT) in first-episode psychosis (FEP), ultra-high risk for psychosis (UHR-P), and age- and gender- matched healthy controls (HCs). There were no significant differences between groups in central choroidal thickness, stromal choroidal area (SCA), luminal choroidal area (LCA) and total subfoveal choroidal area. The LCA/SCA ratio (p<0.001) and the choroidal vascularity index (CVI) (p<0.001) were significantly different between FEP, UHR-P and HCs. CVI and LCA/SCA ratio were significantly higher in patients with FEP compared to help-seeking youth at UHR-P. CVI and LCA/SCA ratio were not different between UHR-P and HCs. However, CVI was higher in UHR-P compared to HCs after excluding the outliers for the sensitivity analysis (p = 0.002). Current findings suggest that choroidal thickness is normal, but there are abnormalities in choroidal microvasculature in prodromal and first-episode psychosis. Further longitudinal studies are needed to investigate oculomics, especially CVI, as a promising biomarker for the prediction of conversion to psychosis in individuals at clinical high-risk.
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12
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Lee YC, Cha J, Shim I, Park WY, Kang SW, Lim DH, Won HH. Multimodal deep learning of fundus abnormalities and traditional risk factors for cardiovascular risk prediction. NPJ Digit Med 2023; 6:14. [PMID: 36732671 PMCID: PMC9894867 DOI: 10.1038/s41746-023-00748-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023] Open
Abstract
Cardiovascular disease (CVD), the leading cause of death globally, is associated with complicated underlying risk factors. We develop an artificial intelligence model to identify CVD using multimodal data, including clinical risk factors and fundus photographs from the Samsung Medical Center (SMC) for development and internal validation and from the UK Biobank for external validation. The multimodal model achieves an area under the receiver operating characteristic curve (AUROC) of 0.781 (95% confidence interval [CI] 0.766-0.798) in the SMC and 0.872 (95% CI 0.857-0.886) in the UK Biobank. We further observe a significant association between the incidence of CVD and the predicted risk from at-risk patients in the UK Biobank (hazard ratio [HR] 6.28, 95% CI 4.72-8.34). We visualize the importance of individual features in photography and traditional risk factors. The results highlight that non-invasive fundus photography can be a possible predictive marker for CVD.
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Affiliation(s)
- Yeong Chan Lee
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
- Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jiho Cha
- Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Injeong Shim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
| | - Woong-Yang Park
- Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Hui Lim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea.
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Hong-Hee Won
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea.
- Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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13
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Lu K, Kwapong WR, Jiang S, Zhang X, Xie J, Ye C, Yan Y, Cao L, Zhao Y, Wu B. Differences in retinal microvasculature between large artery atherosclerosis and small artery disease: an optical coherence tomography angiography study. Front Aging Neurosci 2022; 14:1053638. [PMID: 36620764 PMCID: PMC9816383 DOI: 10.3389/fnagi.2022.1053638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose: Recent reports suggest retinal microvasculature mirror cerebral microcirculation. Using optical coherence tomography angiography (OCTA), we investigated the retinal microvasculature differences between ischemic stroke patients with large artery atherosclerosis (LAA) and small artery disease (SAD). Methods: All patients underwent MR imaging and were classified as SAD and LAA; LAA was subdivided into anterior LAS and posterior LAS depending on the location. Swept-source OCTA (SS-OCTA) was used to image and segment the retina into the superficial vascular complex (SVC) and deep vascular complex (DVC) in a 6 × 6 mm area around the fovea. A deep learning algorithm was used to assess the vessel area density (VAD, %) in the retinal microvasculature. Results: Fifty-eight (mean age = 60.26 ± 10.88 years; 81.03% males) were LAA while 64 (mean age = 55.58 ± 10.34 years; 85.94% males) were SAD. LAS patients had significantly reduced VAD in the DVC (P = 0.022) compared to SAD patients; the VAD in the SVC did not show any significant difference between the two groups (P = 0.580). Anterior LAA ischemic stroke showed significantly lower VAD (P = 0.002) in the SVC compared with posterior LAS patients. There was no significant difference in the DVC between the two groups (P = 0.376). Conclusions: We found LAA patients had significantly reduced DVC density compared with SAD; we also showed anterior LAA patients had significantly reduced SVC density compared with posterior LAA. These findings suggest retinal imaging has the potential to be used to detect microvasculature changes in subtypes of ischemic stroke.
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Affiliation(s)
- Kun Lu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Shuai Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xuening Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianyang Xie
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Chen Ye
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuying Yan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Le Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yitian Zhao
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China,The Affiliated People’s Hospital of Ningbo University, Ningbo, China,*Correspondence: Bo Wu Yitian Zhao
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Bo Wu Yitian Zhao
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14
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Sinclair SH, Miller E, Talekar KS, Schwartz SS. Diabetes mellitus associated neurovascular lesions in the retina and brain: A review. FRONTIERS IN OPHTHALMOLOGY 2022; 2:1012804. [PMID: 38983558 PMCID: PMC11182219 DOI: 10.3389/fopht.2022.1012804] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/14/2022] [Indexed: 07/11/2024]
Abstract
Diabetes mellitus (DM) is now recognized as a system-wide, autoimmune, inflammatory, microvascular disorder, which, in the retina and brain results in severe multifocal injury now recognized as a leading cause, world-wide, of progressive vision loss and dementia. To address this problem, resulting primarily from variations in glycemia in the prediabetic and overt diabetic states, it must be realized that, although some of the injury processes associated with diabetes may be system wide, there are varying responses, effector, and repair mechanisms that differ from organ to organ or within varying cell structures. Specifically, within the retina, and similarly within the brain cortex, lesions occur of the "neurovascular unit", comprised of focal microvascular occlusions, inflammatory endothelial and pericyte injury, with small vessel leakage resulting in injury to astrocytes, Müller cells, and microglia, all of which occur with progressive neuronal apoptosis. Such lesions are now recognized to occur before the first microaneurysms are visible to imaging by fundus cameras or before they result in detectable symptoms or signs recognizable to the patient or clinician. Treatments, therefore, which currently are not initiated within the retina until edema develops or there is progression of vascular lesions that define the current staging of retinopathy, and in the brain only after severe signs of cognitive failure. Treatments, therefore are applied relatively late with some reduction in progressive cellular injury but with resultant minimal vision or cognitive improvement. This review article will summarize the multiple inflammatory and remediation processes currently understood to occur in patients with diabetes as well as pre-diabetes and summarize as well the current limitations of methods for assessing the structural and functional alterations within the retina and brain. The goal is to attempt to define future screening, monitoring, and treatment directions that hopefully will prevent progressive injury as well as enable improved repair and attendant function.
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Affiliation(s)
- Stephen H Sinclair
- Pennsylvania College of Optometry, Salus University, Philadelphia, PA, United States
| | - Elan Miller
- Division of Vascular Neurology, Vickie & Jack Farber Institute for Institute for Neuroscience, Sidney Kimmel Medical College (SKMC) Thomas Jefferson University, Philadelphia, PA, United States
| | - Kiran S Talekar
- Department of Radiology, Section of Neuroradiology and ENT Radiology, Clinical Functional Magnetic Resonance Imaging and Diffusion Tensor Imaging at Thomas Jefferson University Hospital and The Jefferson Integrated Magnetic Resonance Imaging Center (JIMRIC) Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | - Stanley S Schwartz
- Department of Endocrinology and Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Main Line Health System, Philadelphia, PA, United States
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15
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Lv X, Teng Z, Jia Z, Dong Y, Xu J, Lv P. Retinal thickness changes in different subfields reflect the volume change of cerebral white matter hyperintensity. Front Neurol 2022; 13:1014359. [PMID: 36324380 PMCID: PMC9618613 DOI: 10.3389/fneur.2022.1014359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate the relationship between the retinal thickness in different subfields and the volume of white matter hyperintensity (WMH), with the hope to provide new evidence for the potential association between the retina and the brain. Methods A total of 185 participants aged over 40 years were included in our study. Magnetic resonance imaging (MRI) was used to image the WMH, and WMH volume was quantitatively measured by a specific toolbox. The thickness of the total retina, the retinal nerve fiber layer (RNFL), and the ganglion cell and inner plexiform layer (GCIP) was measured by optical coherence tomography (OCT) in nine subfields. The association between retinal thickness and WMH volume was demonstrated using binary logistic regression and Pearson correlation analysis. Results Participants were divided into two groups by the WMH volume (‰, standardized WMH volume) median. In the quartile-stratified binary logistic regression analysis, we found that the risk of higher WMH volume showed a positive linear trend correlation with the thickness of total retina (95% CI: 0.848 to 7.034; P for trend = 0.044)/ GCIP (95% CI: 1.263 to 10.549; P for trend = 0.038) at the central fovea, and a negative linear trend correlation with the thickness of nasal inner RNFL (95% CI: 0.086 to 0.787; P for trend = 0.012), nasal outer RNFL (95% CI: 0.058 to 0.561; P for trend = 0.004), and inferior outer RNFL (95% CI: 0.081 to 0.667; P for trend = 0.004), after adjusting for possible confounders. Correlation analysis results showed that WMH volume had a significant negative correlation with superior outer RNFL thickness (r = −0.171, P = 0.02) and nasal outer RNFL thickness (r = −0.208, P = 0.004). Conclusion It is suggested that central fovea and outer retina thickness are respectively associated with WMH volume. OCT may be a biological marker for early detection and longitudinal monitoring of WMH.
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Affiliation(s)
- Xiaohan Lv
- Department of Neurology, Hebei Medical University, Shijiazhuang, China
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China
- Department of Neurology, Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, China
| | - Zhenjie Teng
- Department of Neurology, Hebei Medical University, Shijiazhuang, China
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China
- Department of Neurology, Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, China
| | - Zhiyang Jia
- Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, China
| | - Yanhong Dong
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China
| | - Jing Xu
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China
| | - Peiyuan Lv
- Department of Neurology, Hebei Medical University, Shijiazhuang, China
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China
- Department of Neurology, Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, China
- *Correspondence: Peiyuan Lv
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16
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Association between retinal vessel density and neuroimaging features and cognitive impairment in cerebral small vessel disease. Clin Neurol Neurosurg 2022; 221:107407. [PMID: 35933965 DOI: 10.1016/j.clineuro.2022.107407] [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: 06/15/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 11/20/2022]
Abstract
AIMS This study aimed to investigate the associations among retinal vessel density (RVD), neuroimaging features and cognitive impairment in patients with sporadic cerebral small vessel disease (CSVD). METHODS This was a prospective observational study. A total of forty-nine patients with CSVD were recruited. The CSVD imaging burden was calculated by using a scoring system with a total score of 4 that assigns one point each for severe white matter hyperintensities (WMH), lacune, microbleeds (MBs), and basal-ganglia perivascular space (BG-PVS). Patients with a burden score ≥ 2 were classified as having a moderate/severe burden, and those with a score ≤ 1 were classified as the having a none/mild burden. The RVD in the superficial retinal capillary plexus (SRCP) and deep retinal capillary plexus (DRCP) was evaluated by using optical coherence tomography angiography (OCTA). The associations among the RVD values, CSVD imaging features, and cognitive impairment were evaluated. RESULTS Patients with a moderate/severe CSVD burden showed lower RVD values in the para-fovea and peri-fovea areas of the left DRCP than patients with none/mild burden (para-fovea, β coefficient= -0.185 [-0.351~-0.015], P = 0.003; peri-fovea, β coefficient= -0.113 [-0.208~-0.018], P = 0.021). The RVD values in the para-fovea and peri-fovea areas of the left DRCP were significantly associated with the CSVD burden score after adjusting for age and vascular risk factors (P = 0.030 and P = 0.021, respectively) and with severe WMH (para-fovea, R = -0.398, P = 0.005; peri-fovea, R= -0.443, P = 0.001) and BG-PVS (para-fovea, R = -0.445, P = 0.001; peri-fovea, R= -0.396, P = 0.005). Neither para-fovea nor peri-fovea RVD values had a marked association with cognition. CONCLUSION The RVD in the left DRCP may reflect the presence of cerebral small vessel lesions and might be a useful tool for predicting the neuroimaging-based burden of CSVD.
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Huang Y, Zhou H, Zhang S, Zhong X, Lin Y, Xiong Z, Liu M, Yimamu A, Christopher O, Zhou Z, Zhuang X, Liao X. Mid- to Late-Life Time-Averaged Cumulative Blood Pressure and Late-Life Retinal Microvasculature: The ARIC Study. J Am Heart Assoc 2022; 11:e25226. [PMID: 35876422 PMCID: PMC9375499 DOI: 10.1161/jaha.122.025226] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The associations of time-averaged cumulative blood pressure (BP) from midlife to late life with microvasculature expressed as retinal vessel diameters is not well studied. The aim of this study was to evaluate the association of cumulative systolic BP and diastolic BP (DBP) with retinal vessel calibers, focusing on race differences. Methods and Results The analysis included 1818 adults from the ARIC (Atherosclerosis Risk in Communities) study attending the fifth visit (2011-2013; age 77±5 years, 17.1% Black participants). Time-averaged cumulative BPs were calculated as the sum of averaged BPs from adjacent consecutive visits (visits 1-5) indexed to total observation time (24±1 years). Summarized estimates for central retinal arteriolar equivalent and central retinal venular equivalent at the fifth visit represent average retinal vessel diameters. The arteriole:venule ratio was calculated. We tested for effect modification by race. Results from multiple linear regression models suggested that higher time-averaged cumulative DBP (β [95% CI] per 1-SD increase: -1.78 [-2.53, -1.02], P<0.001 and -0.005 [-0.009, -0.002], P=0.004, respectively) but not systolic BP (-0.52 [-1.30, 0.26], P=0.189 and 0.001 [-0.002, 0.005], P=0.485, respectively) was associated with smaller central retinal arteriolar equivalent and arteriole:venule ratio. The association between time-averaged cumulative DBP and arteriole:venule ratio was strongest in White participants (interaction P=0.007). The association of cumulative systolic BP and DBP with central retinal venular equivalent was strongest in Black participants (interaction P=0.015 and 0.011, respectively). Conclusions Exposure to higher BP levels, particularly DBP, from midlife to late life is associated with narrower retinal vessel diameters in late life. Furthermore, race moderated the association of cumulative BP exposure with retinal microvasculature.
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Affiliation(s)
- Yiquan Huang
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Huimin Zhou
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Shaozhao Zhang
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Xiangbin Zhong
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Yifen Lin
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Zhenyu Xiong
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Menghui Liu
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Aili Yimamu
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Odong Christopher
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Ziwei Zhou
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Xiaodong Zhuang
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Xinxue Liao
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
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18
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Study on the Interaction between the Characteristics of Retinal Microangiopathy and Risk Factors for Cerebral Small Vessel Disease. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:9505945. [PMID: 35800241 PMCID: PMC9203197 DOI: 10.1155/2022/9505945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/18/2022] [Accepted: 05/03/2022] [Indexed: 11/24/2022]
Abstract
Objective This study was designed to explore the characteristics of retinal microangiopathy in patients with cerebral small vessel disease (CSVD) and clarify its interaction with the risk factors for CSVD. Methods Sixty patients with CSVD and 15 healthy individuals were enrolled. Demographic data, risk factors, and medical history were recorded, and magnetic resonance imaging was performed to detect and analyze the characteristics of retinal microangiopathy in the two groups. The interaction among retinal microangiopathy, vascular risk factors, and total imaging load of CSVD was compared. Results (1) Hypertension, standard deviation of systolic blood pressure (SBPSD), standard deviation of blood glucose (SDBG), and atherogenic index of plasma (AIP) were independent vascular risk factors for CSVD. (2) Statistically significant differences in hypertension, SBPSD, SDBG, and AIP were observed between the two groups in terms of the total imaging burden of CSVD (p < 0.05). (3) Multivariate logistic linear regression showed that CSVD was associated with a wider central retinal vein equivalent (CRVE) (p = 0.015), a smaller arteriole-to-venule ratio (AVR) (p = 0.001), and a higher incidence of vessel tortuosity (p = 0.027). (4) When the total imaging burden of CSVD ranges from 0 to 4 points, the CRVE is larger, the AVR is smaller, and the incidence of vascular tortuosity is higher, with a statistically significant difference (p < 0.05). (5) The characteristics of retinal microangiopathy were correlated with hypertension, SBPSD, SDBG, and AIP (p < 0.05). (6) An association was observed between the characteristics of retinal microangiopathy and vascular risk factors and the total imaging burden of CSVD (p < 0.05). Conclusions (1) Hypertension, SBP variability, BG fluctuation, and AIP are independent vascular risk factors for CSVD. (2) Retinal microvessels are changed in patients with CSVD, and venous dilatation, decreased arteriovenous ratio, and vascular tortuosity are the main characteristics of the disease. (3) The characteristics of retinal microangiopathy are interactively correlated with the total imaging load and risk factors for CSVD and can be used as indicators of the severity of CSVD.
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Khan A, De Boever P, Gerrits N, Akhtar N, Saqqur M, Ponirakis G, Gad H, Petropoulos IN, Shuaib A, Faber JE, Kamran S, Malik RA. Retinal vessel multifractals predict pial collateral status in patients with acute ischemic stroke. PLoS One 2022; 17:e0267837. [PMID: 35511879 PMCID: PMC9070887 DOI: 10.1371/journal.pone.0267837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 04/16/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Pial collateral blood flow is a major determinant of the outcomes of acute ischemic stroke. This study was undertaken to determine whether retinal vessel metrics can predict the pial collateral status and stroke outcomes in patients. METHODS Thirty-five patients with acute stroke secondary to middle cerebral artery (MCA) occlusion underwent grading of their pial collateral status from computed tomography angiography and retinal vessel analysis from retinal fundus images. RESULTS The NIHSS (14.7 ± 5.5 vs 10.1 ± 5.8, p = 0.026) and mRS (2.9 ± 1.6 vs 1.9 ± 1.3, p = 0.048) scores were higher at admission in patients with poor compared to good pial collaterals. Retinal vessel multifractals: D0 (1.673±0.028vs1.652±0.025, p = 0.028), D1 (1.609±0.027vs1.590±0.025, p = 0.044) and f(α)max (1.674±0.027vs1.652±0.024, p = 0.019) were higher in patients with poor compared to good pial collaterals. Furthermore, support vector machine learning achieved a fair sensitivity (0.743) and specificity (0.707) for differentiating patients with poor from good pial collaterals. Age (p = 0.702), BMI (p = 0.422), total cholesterol (p = 0.842), triglycerides (p = 0.673), LDL (p = 0.952), HDL (p = 0.366), systolic blood pressure (p = 0.727), HbA1c (p = 0.261) and standard retinal metrics including CRAE (p = 0.084), CRVE (p = 0.946), AVR (p = 0.148), tortuosity index (p = 0.790), monofractal Df (p = 0.576), lacunarity (p = 0.531), curve asymmetry (p = 0.679) and singularity length (p = 0.937) did not differ between patients with poor compared to good pial collaterals. CONCLUSIONS This is the first translational study to show increased retinal vessel multifractal dimensions in patients with acute ischemic stroke and poor pial collaterals. A retinal vessel classifier was developed to differentiate between patients with poor and good pial collaterals and may allow rapid non-invasive identification of patients with poor pial collaterals.
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Affiliation(s)
- Adnan Khan
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Patrick De Boever
- Department of Biology, University of Antwerp, Antwerp, Wilrijk, Belgium
- Center of Environmental Sciences, Hasselt University, Diepenbeek, Belgium
- VITO (Flemish Institute for Technological Research), Health Unit, Mol, Belgium
| | - Nele Gerrits
- VITO (Flemish Institute for Technological Research), Health Unit, Mol, Belgium
| | - Naveed Akhtar
- Institute of Neuroscience, Hamad Medical Corporation, Doha, Qatar
| | - Maher Saqqur
- Trillium Hospital, University of Toronto at Mississauga, Mississauga, ON, Canada
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Hoda Gad
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | - Ashfaq Shuaib
- Institute of Neuroscience, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - James E. Faber
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Saadat Kamran
- Institute of Neuroscience, Hamad Medical Corporation, Doha, Qatar
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20
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Appaji A, Harish V, Korann V, Devi P, Jacob A, Padmanabha A, Kumar V, Varambally S, Venkatasubramanian G, Rao SV, Suma HN, Webers CAB, Berendschot TTJM, Rao NP. Deep learning model using retinal vascular images for classifying schizophrenia. Schizophr Res 2022; 241:238-243. [PMID: 35176722 DOI: 10.1016/j.schres.2022.01.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 12/13/2022]
Abstract
Contemporary psychiatric diagnosis still relies on the subjective symptom report of the patient during a clinical interview by a psychiatrist. Given the significant variability in personal reporting and differences in the skill set of psychiatrists, it is desirable to have objective diagnostic markers that could help clinicians differentiate patients from healthy individuals. A few recent studies have reported retinal vascular abnormalities in patients with schizophrenia (SCZ) using retinal fundus images. The goal of this study was to use a trained convolution neural network (CNN) deep learning algorithm to detect SCZ using retinal fundus images. A total of 327 subjects [139 patients with Schizophrenia (SCZ) and 188 Healthy volunteers (HV)] were recruited, and retinal images were acquired using a fundus camera. The images were preprocessed and fed to a convolution neural network for the classification. The model performance was evaluated using the area under the receiver operating characteristic curve (AUC). The CNN achieved an accuracy of 95% for classifying SCZ and HV with an AUC of 0.98. Findings from the current study suggest the potential utility of deep learning to classify patients with SCZ and assist clinicians in clinical settings. Future studies need to examine the utility of the deep learning model with retinal vascular images as biomarkers in schizophrenia with larger sample sizes.
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Affiliation(s)
- Abhishek Appaji
- Department of Medical Electronics Engineering, B.M.S. College of Engineering, Bangalore, India
| | - Vaishak Harish
- Department of Medical Electronics Engineering, B.M.S. College of Engineering, Bangalore, India
| | - Vittal Korann
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Priyanka Devi
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Arpitha Jacob
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anantha Padmanabha
- Department of Medical Electronics Engineering, B.M.S. College of Engineering, Bangalore, India
| | - Vijay Kumar
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | | | - Shyam Vasudeva Rao
- University Eye Clinic Maastricht, Maastricht University, Maastricht, the Netherlands
| | - H N Suma
- Department of Medical Electronics Engineering, B.M.S. College of Engineering, Bangalore, India
| | - Caroll A B Webers
- University Eye Clinic Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Tos T J M Berendschot
- University Eye Clinic Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Naren P Rao
- National Institute of Mental Health and Neurosciences, Bangalore, India.
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21
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Zhang Y, Zhang Z, Zhang M, Cao Y, Yun W. Correlation Between Retinal Microvascular Abnormalities and Total Magnetic Resonance Imaging Burden of Cerebral Small Vessel Disease in Patients With Type 2 Diabetes. Front Neurosci 2022; 15:727998. [PMID: 34970109 PMCID: PMC8712683 DOI: 10.3389/fnins.2021.727998] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Purpose: Diabetic retinopathy (DR) is one of the common microvascular complications in diabetes. The total magnetic resonance imaging (MRI) burden of cerebral small vessel disease (CSVD) tends to be increased in diabetic patients and is a marker of microvascular disease; however, the relationship between DR and CSVD is unclear. This study aimed to explore the relationship between retinal microvascular abnormalities and the total MRI burden of CSVD in patients with type 2 diabetes. Methods: Data were collected from patients with type 2 diabetes who were hospitalized between December 2019 and November 2020 in Changzhou Second People’s Hospital affiliated to Nanjing Medical University. All patients underwent retinal photography and cerebral MRI. The central retinal artery equivalent (CRAE), the central retinal venous equivalent (CRVE), and arteriole-to-venule ratio (AVR) were calculated using Image J software to determine the retinal vascular calibers for each patient. The total MRI burden score for CSVD was determined, and the relationship between retinal microvascular abnormalities and the total MRI burden of CSVD was analyzed. Results: Of the 151 diabetic patients included in the study, 84 (55.6%) had no diabetic retinopathy (NDR), 27 (17.9%) had mild DR, and 40 (26.5%) had moderate, or severe non-proliferative DR (grouped together for this study as “more than mild DR”). In patients with more than mild DR, the proportion of moderate to severe burden of CSVD was 75%, which was higher than in patients with mild DR (48.1%) or NDR (26.2%). Patients with moderate to severe burden of CSVD were more likely than those with mild burden of CSVD to have narrowed retinal arterioles (105.24 ± 8.42 μm vs. 109.45 ± 7.93 μm), widened retinal venules (201.67 ± 16.25 μm vs. 193.95 ± 13.54 μm), and lower arteriole-to-venule ratio (0.52 ± 0.05 vs. 0.57 ± 0.04) (P < 0.05 for all). The degree of DR (r = 0.465, P < 0.001) and CRVE (r = 0.366, P < 0.001) were positively correlated with the total MRI burden of CSVD. Multivariate logistic regression analysis indicated that, after adjustments were made for age, smoking, alcohol consumption, hypertension, and other factors, more than mild DR (OR, 4.383; P = 0.028), CRAE (OR, 0.490; P = 0.031), and CRVE (OR, 1.475; P = 0.041) were independently associated with moderate to severe burden of CSVD. Conclusion: Retinal microvascular abnormalities in patients with type 2 diabetes are associated with the presence of cerebral small vessel lesions. The degree of DR and retinal vessel changes can be used as predictors of intracranial microcirculation lesions.
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Affiliation(s)
- Ying Zhang
- Department of Neurology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Zhixiang Zhang
- Department of Neurology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Min Zhang
- Department of Neurology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Yin Cao
- Department of Neurology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Wenwei Yun
- Department of Neurology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
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22
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Dumitrascu OM, Rosenberry R, Sherman DS, Khansari MM, Sheyn J, Torbati T, Sherzai A, Sherzai D, Johnson KO, Czeszynski AD, Verdooner S, Black KL, Frautschy S, Lyden PD, Shi Y, Cheng S, Koronyo Y, Koronyo-Hamaoui M. Retinal Venular Tortuosity Jointly with Retinal Amyloid Burden Correlates with Verbal Memory Loss: A Pilot Study. Cells 2021; 10:cells10112926. [PMID: 34831149 PMCID: PMC8616417 DOI: 10.3390/cells10112926] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/21/2021] [Accepted: 10/25/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction: Retinal imaging is a non-invasive tool to study both retinal vasculature and neurodegeneration. In this exploratory retinal curcumin-fluorescence imaging (RFI) study, we sought to determine whether retinal vascular features combined with retinal amyloid burden correlate with the neurocognitive status. Methods: We used quantitative RFI in a cohort of patients with cognitive impairment to automatically compute retinal amyloid burden. Retinal blood vessels were segmented, and the vessel tortuosity index (VTI), inflection index, and branching angle were quantified. We assessed the correlations between retinal vascular and amyloid parameters, and cognitive domain Z-scores using linear regression models. Results: Thirty-four subjects were enrolled and twenty-nine (55% female, mean age 64 ± 6 years) were included in the combined retinal amyloid and vascular analysis. Eleven subjects had normal cognition and 18 had impaired cognition. Retinal VTI was discriminated among cognitive scores. The combined proximal mid-periphery amyloid count and venous VTI index exhibited significant differences between cognitively impaired and cognitively normal subjects (0.49 ± 1.1 vs. 0.91 ± 1.4, p = 0.006), and correlated with both the Wechsler Memory Scale-IV and SF-36 mental component score Z-scores (p < 0.05). Conclusion: This pilot study showed that retinal venular VTI combined with the proximal mid-periphery amyloid count could predict verbal memory loss. Future research is needed to finesse the clinical application of this retinal imaging-based technology.
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Affiliation(s)
- Oana M. Dumitrascu
- Department of Neurology, Mayo Clinic, Scottsdale, AZ 85251, USA
- Correspondence: (O.M.D.); (M.K.-H.); Tel.: +480-301-8100 (O.M.D.); Fax: +480-301-9494 (O.M.D.)
| | - Ryan Rosenberry
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (R.R.); (S.C.)
| | - Dale S. Sherman
- Department of Neuropsychology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Maziyar M. Khansari
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA 90007, USA; (M.M.K.); (Y.S.)
| | - Julia Sheyn
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (J.S.); (T.T.); (K.L.B.); (Y.K.)
| | - Tania Torbati
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (J.S.); (T.T.); (K.L.B.); (Y.K.)
| | - Ayesha Sherzai
- Department of Neurology, Loma Linda University, Loma Linda, CA 92350, USA; (A.S.); (D.S.)
| | - Dean Sherzai
- Department of Neurology, Loma Linda University, Loma Linda, CA 92350, USA; (A.S.); (D.S.)
| | - Kenneth O. Johnson
- NeuroVision Imaging Inc., Sacramento, CA 95833, USA; (K.O.J.); (A.D.C.); (S.V.)
| | - Alan D. Czeszynski
- NeuroVision Imaging Inc., Sacramento, CA 95833, USA; (K.O.J.); (A.D.C.); (S.V.)
| | - Steven Verdooner
- NeuroVision Imaging Inc., Sacramento, CA 95833, USA; (K.O.J.); (A.D.C.); (S.V.)
| | - Keith L. Black
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (J.S.); (T.T.); (K.L.B.); (Y.K.)
| | - Sally Frautschy
- Department of Neurology, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Patrick D. Lyden
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Yonggang Shi
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA 90007, USA; (M.M.K.); (Y.S.)
| | - Susan Cheng
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (R.R.); (S.C.)
| | - Yosef Koronyo
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (J.S.); (T.T.); (K.L.B.); (Y.K.)
| | - Maya Koronyo-Hamaoui
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (J.S.); (T.T.); (K.L.B.); (Y.K.)
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Correspondence: (O.M.D.); (M.K.-H.); Tel.: +480-301-8100 (O.M.D.); Fax: +480-301-9494 (O.M.D.)
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23
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Wang X, Wei Q, Wu X, Cao S, Chen C, Zhang J, Yan Y, Geng Z, Tian Y, Wang K. The vessel density of the superficial retinal capillary plexus as a new biomarker in cerebral small vessel disease: an optical coherence tomography angiography study. Neurol Sci 2021; 42:3615-3624. [PMID: 33432462 DOI: 10.1007/s10072-021-05038-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/01/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Optical coherence tomography angiography (OCTA) is a novel and noninvasive technique for the quantitative assessment of retinal microvascular perfusion. Since the retinal and cerebral small vessels share similar embryological origins, anatomical features, and physiological properties, altered retinal microvasculature might provide a new perspective on the mechanisms of cerebral small vessel disease (CSVD). OBJECTIVE We aimed to evaluate retinal vessel density (VD) in patients with CSVD using OCTA and identify associations with cerebral magnetic resonance imaging (MRI) markers and cognitive function. METHODS We prospectively recruited 47 CSVD patients and 30 healthy controls (HCs) to participate in the study. All participants underwent OCTA to evaluate retinal microvascular perfusion. The VDs of the macular region in the superficial retinal capillary plexus (SRCP), deep retinal capillary plexus (DRCP), and foveal avascular zone (FAZ) were determined, along with the VD of the optic nerve head (ONH) in the radial peripapillary capillary (RPC) network. Additionally, cerebral MRI and cognitive function tests were performed. RESULTS In the macula area, the VD of the CSVD patients was significantly lower than HCs in the temporal quadrant of SRCP. In the ONH area, CSVD patients had lower VD than HCs in the peripapillary RPC network. According to multiple linear regression analysis, decreased VD of the macular SRCP was associated with white matter hyperintensity scores after adjustment for age, hypertension, diabetes, and hyperlipidemia. Furthermore, the VD of the macular SRCP was significantly correlated with CSVD patients' cognitive function, especially global cognition, memory function, attention function, information processing, and executive function. CONCLUSION OCTA revealed a significant decrease in retinal microvascular perfusion in CSVD patients, and retinal hypoperfusion was related to MRI markers and cognitive function, suggesting that these parameters could have potential utility as early disease biomarkers.
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Affiliation(s)
- Xiaojing Wang
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230032, China
| | - Qiang Wei
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230032, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, 230032, China
| | - Xingqi Wu
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230032, China
| | - Shanshan Cao
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230032, China
| | - Chen Chen
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230032, China
| | - Jun Zhang
- Department of Neurology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China
| | - Yibing Yan
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230032, China
| | - Zhi Geng
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230032, China
| | - Yanghua Tian
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230032, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, 230032, China
| | - Kai Wang
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230032, China.
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, 230032, China.
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24
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Zhao L, Jiang B, Li H, Yang X, Cheng X, Hong H, Wang Y. Risk Stratification Tool for Ischemic Stroke: A Risk Assessment Model Based on Traditional Risk Factors Combined With White Matter Lesions and Retinal Vascular Caliber. Front Neurol 2021; 12:696986. [PMID: 34421800 PMCID: PMC8373369 DOI: 10.3389/fneur.2021.696986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aims to establish a risk assessment model based on traditional risk factors combined with the Fazekas classification of white matter lesions and retinal vascular caliber for screening the patients at high risk of ischemic stroke. Methods: This study included 296 patients (128 cases of ischemic stroke and 168 cases in the normal control group). The basic data of the patients were collected. Color fundus photography was performed after pupil dilation, and the retinal vascular caliber was measured using semiautomated vascular measurement software (IVAN Software, Sydney, Australia). The severity of white matter lesions (WML) on cranial nuclear magnetic fluid-attenuated inversion recovery images were assessed using the Fazekas scale. Moreover, logistic regression analysis was used to establish different risk assessment models for ischemic stroke. The effects of models were evaluated through the receiver operating characteristic (ROC) curve and the Delong test compared area under the curve. Results: The sensitivity and specificity of models 1 (the traditional risk factor model), 2 (the retinal vascular caliber model), 3 (the WML model), and 4 (the combined the traditional risk factor, WML and central retinal artery equivalent (CRAE) model) were 71 and 55%, 48 and 71%, 49 and 67%, and 68 and 68.5% with areas under the curve of 0.658, 0.586, 0.601, and 0.708, respectively. The area under the receiver operating characteristic curve in models 1, 2, 3, and 4 showed statistically significant differences. Moreover, no statistical significance exists in the pairwise comparison of other models. Conclusion: The risk assessment model of ischemic stroke combined with Fazekas grade of WML and CRAE is superior to the traditional risk factor and the single-index model. This model is helpful for risk stratification of high-risk stroke patients.
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Affiliation(s)
- Lu Zhao
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Bin Jiang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongyang Li
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiufen Yang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaoyue Cheng
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Hong
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yanling Wang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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25
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Abstract
BACKGROUND Cerebrovascular disease (CeVD), including stroke, is a leading cause of death globally. The retina is an extension of the cerebrum, sharing embryological and vascular pathways. The association between different retinal signs and CeVD has been extensively evaluated. In this review, we summarize recent studies which have examined this association. EVIDENCE ACQUISITION We searched 6 databases through July 2019 for studies evaluating the link between retinal vascular signs and diseases with CeVD. CeVD was classified into 2 groups: clinical CeVD (including clinical stroke, silent cerebral infarction, cerebral hemorrhage, and stroke mortality), and sub-clinical CeVD (including MRI-defined lacunar infarct and white matter lesions [WMLs]). Retinal vascular signs were classified into 3 groups: classic hypertensive retinopathy (including retinal microaneurysms, retinal microhemorrhage, focal/generalized arteriolar narrowing, cotton-wool spots, and arteriovenous nicking), clinical retinal diseases (including diabetic retinopathy [DR], age-related macular degeneration [AMD], retinal vein occlusion, retinal artery occlusion [RAO], and retinal emboli), and retinal vascular imaging measures (including retinal vessel diameter and geometry). We also examined emerging retinal vascular imaging measures and the use of artificial intelligence (AI) deep learning (DL) techniques. RESULTS Hypertensive retinopathy signs were consistently associated with clinical CeVD and subclinical CeVD subtypes including subclinical cerebral large artery infarction, lacunar infarction, and WMLs. Some clinical retinal diseases such as DR, retinal arterial and venous occlusion, and transient monocular vision loss are consistently associated with clinical CeVD. There is an increased risk of recurrent stroke immediately after RAO. Less consistent associations are seen with AMD. Retinal vascular imaging using computer assisted, semi-automated software to measure retinal vascular caliber and other parameters (tortuosity, fractal dimension, and branching angle) has shown strong associations to clinical and subclinical CeVD. Other new retinal vascular imaging techniques (dynamic retinal vessel analysis, adaptive optics, and optical coherence tomography angiography) are emerging technologies in this field. Application of AI-DL is expected to detect subclinical retinal changes and discrete retinal features in predicting systemic conditions including CeVD. CONCLUSIONS There is extensive and increasing evidence that a range of retinal vascular signs and disease are closely linked to CeVD, including subclinical and clinical CeVD. New technology including AI-DL will allow further translation to clinical utilization.
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26
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Forés R, Manresa JM, López-Lifante VM, Heras A, Delgado P, Vázquez X, Ruiz S, Alzamora MT, Toran P. Relationship between Retinal Microvasculature, Cardiovascular Risk and Silent Brain Infarction in Hypertensive Patients. Diagnostics (Basel) 2021; 11:diagnostics11060937. [PMID: 34073652 PMCID: PMC8224683 DOI: 10.3390/diagnostics11060937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: The aims of this study are to analyze the role of artery-vein ratio AVR assessment using VesselMap 2 software (Imedos Systems) and cardiovascular risk evaluation by means of REGICOR in the prediction of silent brain infarction (SBI) in middle-age hypertensive patients from the ISSYS study. Material and Methods: A cross-sectional study with 695 patients with hypertension aged 50 to 70 years who participated in the project Investigating Silent Strokes in HYpertensives: a Magnetic Resonance Imaging Study (ISSYS), was conducted in two Primary Care Centres of Barcelona. Participants agreed to a retinography and an MRI to detect silent brain infarction (SBI). The IMEDOS software was used for the semiautomatic caliber measurement of retinal arteries and veins, and the AVR was considered abnormal when <0.66. The REGICOR score was calculated for all patients. Results: Multivariate logistic regression analysis was used to evaluate the impact of AVR and REGICOR scores on SBI. The OR (odds ratio) for a high REGICOR score and an abnormal AVR were 3.16 and 4.45, respectively. When analysing the interaction of both factors, the OR of an abnormal AVR and moderate REGICOR score was 3.27, whereas with a high REGICOR score it reached 13.07. Conclusions: The measurement of AVR in patients with hypertension and with a high REGICOR score can contribute to the detection of silent brain infarction.
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Affiliation(s)
- Rosa Forés
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.M.M.); (V.M.L.-L.); (A.H.); (M.T.A.); (P.T.)
- Riu Nord-Riu Sud Primary Healthcare Centre, Santa Coloma de Gramenet, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, 08921 Barcelona, Spain
- Correspondence: ; Tel.: +34-934662096
| | - Josep M. Manresa
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.M.M.); (V.M.L.-L.); (A.H.); (M.T.A.); (P.T.)
| | - Victor M. López-Lifante
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.M.M.); (V.M.L.-L.); (A.H.); (M.T.A.); (P.T.)
- Palau Healthcare Centre, Palau-Solità Plegamans, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, 08124 Barcelona, Spain
| | - Antonio Heras
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.M.M.); (V.M.L.-L.); (A.H.); (M.T.A.); (P.T.)
- Riu Nord-Riu Sud Primary Healthcare Centre, Santa Coloma de Gramenet, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, 08921 Barcelona, Spain
| | - Pilar Delgado
- Neurovascular Research Lab, Vall D’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
- Dementia Unit, Neurology Service, Vall D’Hebron University Hospital, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Xose Vázquez
- Hospital Municipal de Badalona, Badalona Serveis Assistencials, Secció d’Oftalmologia, Badalona, 08911 Barcelona, Spain;
| | - Susana Ruiz
- Germans Trias i Pujol University Hospital, Badalona, 08916 Barcelona, Spain;
| | - Maria Teresa Alzamora
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.M.M.); (V.M.L.-L.); (A.H.); (M.T.A.); (P.T.)
- Riu Nord-Riu Sud Primary Healthcare Centre, Santa Coloma de Gramenet, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, 08921 Barcelona, Spain
| | - Pere Toran
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.M.M.); (V.M.L.-L.); (A.H.); (M.T.A.); (P.T.)
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Zhao L, Wang H, Yang X, Jiang B, Li H, Wang Y. Multimodal Retinal Imaging for Detection of Ischemic Stroke. Front Aging Neurosci 2021; 13:615813. [PMID: 33603658 PMCID: PMC7884475 DOI: 10.3389/fnagi.2021.615813] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study aims to evaluate ocular changes in patients with ischemic stroke using multimodal imaging and explore the predictive value of ocular abnormalities for ischemic stroke. Methods: A total of 203 patients (ischemic stroke group, 62; control group, 141) were enrolled in this study. Basic data from patients, including age; gender; height; weight; history of hypertension, hyperlipidemia, diabetes, alcohol use, and coronary heart disease; and smoking status, were collected. Consequently, Doppler color ultrasound, color fundus photography, and optical coherence tomography (OCT) examinations were conducted. Differences in traditional risk factors and ocular parameters between the two groups were compared, and binary logistic regression was used for multivariate analysis. Results: The central retinal artery equivalent (CRAE) in the ischemic stroke group was 150.72 ± 20.15 μm and that in the control group was 159.68 ± 20.05 μm. The difference was statistically significant (P = 0.004). Moreover, the subfoveal choroidal thickness (SFChT) in the ischemic stroke group was 199.90 ± 69.27 μm and that in the control group was 227.40 ± 62.20 μm. The difference was statistically significant (P = 0.006). Logistic regression results showed that smoking [odds ratio (OR) = 2.823; 95% confidence interval (95% CI) = 1.477–5.395], CRAE (OR = 0.980; 95% CI = 0.965–0.996), and SFChT (OR = 0.994; 95% CI = 0.989–0.999) are associated with increased risk of ischemic stroke when ocular parameters were combined with traditional risk factors. The area under the receiver operating characteristic (ROC) curve was 0.726, which shows good diagnostic accuracy. Conclusion: SFChT may be a diagnostic marker for early detection and monitoring of ischemic stroke. Combined with traditional risks, retinal artery diameter, and choroidal thickness, the prediction model can improve ischemic stroke prediction.
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Affiliation(s)
- Lu Zhao
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Wang
- Department of Ophthalmology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiufen Yang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Bin Jiang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongyang Li
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Multidisciplinary Team Center for Ocular Vascular Diseases, College of Ophthalmology, Capital Medical University, Beijing, China
| | - Yanling Wang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Abstract
PURPOSE OF REVIEW The retina is growingly recognized as a window into cerebrovascular and systemic vascular conditions. The utility of noninvasive retinal vessel biomarkers in cerebrovascular risk assessment has expanded due to advances in retinal imaging techniques and machine learning-based digital analysis. The purpose of this review is to underscore the latest evidence linking retinal vascular abnormalities with stroke and vascular-related cognitive disorders; to highlight modern developments in retinal vascular imaging modalities and software-based vasculopathy quantification. RECENT FINDINGS Longitudinal studies undertaken for extended periods indicate that retinal vascular changes can predict cerebrovascular disorders (CVD). Cerebrovascular ties to dementia provoked recent explorations of retinal vessel imaging tools for conceivable early cognitive decline detection. Innovative biomedical engineering technologies and advanced dynamic and functional retinal vascular imaging methods have recently been added to the armamentarium, allowing an unbiased and comprehensive analysis of the retinal vasculature. Improved artificial intelligence-based deep learning algorithms have boosted the application of retinal imaging as a clinical and research tool to screen, risk stratify, and monitor with precision CVD and vascular cognitive impairment. SUMMARY Mounting evidence supports the use of quantitative retinal vessel analysis in predicting CVD, from clinical stroke to neuroimaging markers of stroke and neurodegeneration.
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Cennamo G, Montorio D, Santoro C, Cocozza S, Spinelli L, Di Risi T, Riccio E, Russo C, Pontillo G, Esposito R, Imbriaco M, Pisani A. The Retinal Vessel Density as a New Vascular Biomarker in Multisystem Involvement in Fabry Disease: An Optical Coherence Tomography Angiography Study. J Clin Med 2020; 9:jcm9124087. [PMID: 33352849 PMCID: PMC7766384 DOI: 10.3390/jcm9124087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Abstract
In this study, we evaluated the possible relationship between the changes in retinal vessel density (VD) by optical coherence tomography angiography (OCTA) and the vascular alterations involving renal, cardiovascular and central nervous systems in patients affected by Fabry disease (FD). In 50 FD patients, the retinal superficial capillary plexus (SCP) and deep capillary plexus (DCP) in macular region were evaluated by OCTA examination. The patients also underwent a brain magnetic resonance imaging scan, renal and echocardiographic examinations with quantification of systolic pulmonary arterial pressure (PAPs) and left atrial volume index (LAVi). The VD of SCP and DCP was inversely related with E/e’ ratio, LAVi, interventricular septal thickness, global longitudinal strain (GLS) and PAPs (p < 0.05). No relationship was found, with a multivariate analysis, between OCTA parameters and kidney function and neuroradiological signs of central nervous system involvement. OCTA could be a new vascular biomarker in FD, revealing a strong correlation between retinal capillary damage and myocardial impairment, possibly preceding both renal dysfunction and cerebrovascular involvement.
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Affiliation(s)
- Gilda Cennamo
- Eye Clinic, Public Health Department, University of Naples “Federico II”, 80131 Naples, Italy
- Correspondence:
| | - Daniela Montorio
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
| | - Letizia Spinelli
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
| | - Teodolinda Di Risi
- CEINGE—Advanced Biotechnologies, 80145 Naples, Italy;
- Department of Public Medicine, University Federico II, 80131 Naples, Italy; (E.R.); (A.P.)
| | - Eleonora Riccio
- Department of Public Medicine, University Federico II, 80131 Naples, Italy; (E.R.); (A.P.)
| | - Camilla Russo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
- Department of Electrical Engineering and Information Technology, University of Naples “Federico II”, 80125 Naples, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
| | - Antonio Pisani
- Department of Public Medicine, University Federico II, 80131 Naples, Italy; (E.R.); (A.P.)
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Longitudinal effects of common carotid artery stenosis on ocular hemodynamics assessed using laser speckle flowgraphy in a rabbit model. Sci Rep 2020; 10:15829. [PMID: 32985560 PMCID: PMC7522272 DOI: 10.1038/s41598-020-72556-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
Real-time impairment of ocular blood flow (OBF) under common carotid artery stenosis (CCAS) has not been ascertained. We aimed to longitudinally assess the impact of CCAS on OBF using a rabbit model. About 75% stenosis was created by tying the common carotid artery with a plastic mandrel using a nylon suture. The plastic mandrel was gently removed, leaving a ligature. Neurological and behavioral assessments were recorded as the clinical indicator of stroke severity. With laser speckle flowgraphy, the pulse waveform parameters namely mean blur rate (MBR), blowout score (BOS), blowout time (BOT), rising rate, S1-area, falling rate (FR), S2-area, flow acceleration index (FAI), acceleration time index, resistive index (RI) and the difference between the maximum and minimum values of MBR (AC) were assessed in overall, vessel, and tissue regions of the optic nerve head (ONH). Longitudinally, BOS significantly increased until day 19 post-surgery, whereas FAI, RI, and AC significantly decreased. Beyond day 19, BOS, BOT, FR, FAI, RI, and AC significantly decreased. We defined two stages representing impaired vessel conditions, namely the vessel resistance phase, where BOS increases and FAI, RI, and AC decrease, and the vessel elasticity phase where BOS, BOT, FR, FAI, RI and AC decrease. These stages provide information about atherosclerosis, assessable non-invasively through the eye.
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Association Between Caliber of Retinal Vessels and Cardiovascular Disease: a Systematic Review and Meta-Analysis. Curr Atheroscler Rep 2020; 22:16. [PMID: 32440852 DOI: 10.1007/s11883-020-0834-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Pang Y, Zhu S, Pei H. Pachymic acid protects against cerebral ischemia/reperfusion injury by the PI3K/Akt signaling pathway. Metab Brain Dis 2020; 35:673-680. [PMID: 32140824 DOI: 10.1007/s11011-020-00540-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/23/2020] [Indexed: 12/26/2022]
Abstract
Pachymic acid (PA) from medicinal fungus Poria cocos has a variety of pharmacological potentials. However, there are no reports of the effects of PA on cerebral ischemia/reperfusion (I/R) injury. The purpose of this study was to investigate the mechanisms of PA on cerebral I/R injury in rats. The effects of PA on cerebral infarction size, brain water content, neurological symptoms and cerebral blood flow were evaluated. Nissl staining was used to observe the damage of ischemic brain neurons after I/R in rats. Apoptosis of ischemic brain neurons after I/R was observed by TUNEL staining. The effect of PA on the expression of some components of PI3K/Akt was detected by Western blotting. PA significantly increased cerebral blood flow after I/R in rats, reduced infarct volume and brain water content, and downgrade neurological function scores, significantly reduced neuronal damage after I/R in rats, and significantly decreased neuronal apoptosis. The effect of PA on rat I/R can be eliminated by LY294002. In addition, PA significantly up-regulated the protein expression of p-PTEN (Ser380), p-PDK1 (Ser241), p-Akt (Ser473), pc-Raf (Ser259) and p-BAD (Ser136), and down-regulated Cleaved caspase protein expression. LY294002 can reverse the effect of PA on the expression of PI3K / Akt signaling pathway related protein in rats after I/R. PA had obviously neuroprotective effects on brain I/R injury and neuronal apoptosis, and its mechanism may be related to activation of PI3K / Akt signaling pathway.
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Affiliation(s)
- Yingqiao Pang
- Medical School of Qingdao University, No. 38 Dengzhou Road, Qingdao City, Shandong Province, 266021, People's Republic of China
| | - Shaozhi Zhu
- Medical School of Qingdao University, No. 38 Dengzhou Road, Qingdao City, Shandong Province, 266021, People's Republic of China
| | - Haitao Pei
- Department of Neurology, The Affiliated Hospital of the Qingdao University, No.19 Jiangsu Road, Qingdao City, Shandong Province, 266011, People's Republic of China.
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Meyer ML, Klein BE, Klein R, Palta P, Sharrett AR, Heiss G, Nambi V, Wong TY, Tanaka H. Central arterial stiffness and retinal vessel calibers: the Atherosclerosis Risk in Communities Study-Neurocognitive Study. J Hypertens 2020; 38:266-273. [PMID: 31584520 PMCID: PMC6949400 DOI: 10.1097/hjh.0000000000002252] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The retinal microvasculature provides a window to the cerebral vasculature and enables examination of changes in retinal caliber that may mimic those occurring in cerebrovascular disease. The association of central arterial stiffness and retinal vessel caliber in a population sample is not fully understood. METHODS In 1706 older adults (mean age 76.3, 58.1% women) from the population-based Atherosclerosis Risk in Communities Study, we examined the cross-sectional association of central arterial stiffness [carotid-femoral pulse wave velocity (cfPWV)] with retinal vessel calibers [central retinal arteriolar equivalent (CRAE) and central retinal vein equivalent (CRVE)]. We estimated the association of cfPWV with CRAE narrowing (<25th percentile) and CRVE widening (>75th percentile) after adjustment for age, sex, race-field center, BMI, smoking, and type 2 diabetes. We tested for effect modification by sex, hypertension, and type 2 diabetes. RESULTS Carotid-femoral PWV (m/s) was not associated with the odds of CRAE narrowing [odds ratio (OR): 0.99; 95% CI: 0.95-1.03]. The association of cfPWV with CRVE widening was stronger in those without hypertension (OR: 1.10; 95% CI: 1.01-1.20) versus those with hypertension (OR: 1.01 95% CI: 0.96-1.05) and slightly stronger in those with type 2 diabetes (OR: 1.07; 95% CI: 1.00-1.14) versus without type 2 diabetes (OR: 1.01; 95% CI: 0.96-1.06). CONCLUSIONS In older adults, cfPWV was associated with wider retinal venular caliber, particularly in individuals without hypertension. Central arterial stiffening may be associated with cerebral microvascular changes, as exhibited in its retinal vasculature component.
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Affiliation(s)
- Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Barbara E Klein
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Ronald Klein
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Priya Palta
- Department of Medicine, Columbia University, New York City, NY
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Vijay Nambi
- Michael E DeBakey Veterans Affairs Hospital and Baylor College of Medicine, Houston, TX
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, National University of Singapore, Singapore
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX
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Ballerini L, McGrory S, Valdés Hernández MDC, Lovreglio R, Pellegrini E, MacGillivray T, Muñoz Maniega S, Henderson R, Taylor A, Bastin ME, Doubal F, Trucco E, Deary IJ, Wardlaw J. Quantitative measurements of enlarged perivascular spaces in the brain are associated with retinal microvascular parameters in older community-dwelling subjects. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2020; 1:100002. [PMID: 33458712 PMCID: PMC7792660 DOI: 10.1016/j.cccb.2020.100002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/05/2020] [Accepted: 08/18/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Perivascular Spaces (PVS) become increasingly visible with advancing age on brain MRI, yet their relationship to morphological changes in the underlying microvessels remains poorly understood. Retinal and cerebral microvessels share morphological and physiological properties. We compared computationally-derived PVS morphologies with retinal vessel morphologies in older people. METHODS We analysed data from community-dwelling individuals who underwent multimodal brain MRI and retinal fundus camera imaging at mean age 72.55 years (SD=0.71). We assessed centrum semiovale PVS computationally to determine PVS total volume and count, and mean per-subject individual PVS length, width and size. We analysed retinal images using the VAMPIRE software suite, obtaining the Central Retinal Artery and Vein Equivalents (CRVE and CRAE), Arteriole-to-Venule ratio (AVR), and fractal dimension (FD) of both eyes. We investigated associations using general linear models, adjusted for age, gender, and major vascular risk factors. RESULTS In 381 subjects with all measures, increasing total PVS volume and count were associated with decreased CRAE in the left eye (volume β=-0.170, count β=-0.184, p<0.001). No associations of PVS with CRVE were found. The PVS total volume, individual width and size increased with decreasing FD of the arterioles (a) and venules (v) of the left eye (total volume: FDa β=-0.137, FDv β=-0.139, p<0.01; width: FDa β=-0.144, FDv β=-0.158, p<0.01; size: FDa β=-0.157, FDv β=-0.162, p<0.01). CONCLUSIONS Increase in PVS number and size visible on MRI reflect arteriolar narrowing and lower retinal arteriole and venule branching complexity, both markers of impaired microvascular health. Computationally-derived PVS metrics may be an early indicator of failing vascular health and should be tested in longitudinal studies.
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Affiliation(s)
- Lucia Ballerini
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, and VAMPIRE Project, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Sarah McGrory
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, and VAMPIRE Project, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Maria del C. Valdés Hernández
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, and VAMPIRE Project, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | | | - Enrico Pellegrini
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, and VAMPIRE Project, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Tom MacGillivray
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, and VAMPIRE Project, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Susana Muñoz Maniega
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, and VAMPIRE Project, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Ross Henderson
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Adele Taylor
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Mark E. Bastin
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, and VAMPIRE Project, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Fergus Doubal
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, and VAMPIRE Project, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Emanuele Trucco
- VAMPIRE Project, Computing (SSEN), University of Dundee, Dundee, UK
| | - Ian J. Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Joanna Wardlaw
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, and VAMPIRE Project, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
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Associations between dietary flavonoids and retinal microvasculature in older adults. Eur J Nutr 2019; 59:3093-3101. [PMID: 31768624 DOI: 10.1007/s00394-019-02148-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE In this study, we assessed whether there are independent associations between dietary total flavonoid intake and major flavonoid classes with retinal arteriolar and venular calibre. METHODS Blue Mountains Eye Study participants aged 49+ years who had complete data on diet and retinal vessel measures were analysed (n = 2821). Dietary intake was assessed using a semi-quantitative Food-Frequency Questionnaire (FFQ). Flavonoid content of foods in the FFQ was estimated using the US Department of Agriculture Flavonoid, Isoflavone and Proanthocyanidin databases. Fundus photographs were taken and retinal vascular calibre was measured using validated computer-assisted techniques. The associations of intake of dietary flavonoids with retinal vessel calibre were examined in linear regression models and general linear model. RESULTS The highest quartile of intake was compared with the lowest quartile using multivariable-adjustment models. Participants with the highest proanthocyanidin intake had narrower retinal venules (223.9 ± 0.62 versus 226.5 ± 0.63, respectively; Ptrend = 0.01); and the highest isoflavone intake was associated with wider retinal arterioles (188.1 ± 0.55 versus 186.3 ± 0.56, respectively; Ptrend = 0.01). The highest apple/pear consumption (a dietary source of catechin) was associated with narrower retinal venules (223.8 ± 0.57 versus 226.1 ± 0.52; Ptrend = 0.01) and wider retinal arterioles (187.9 ± 0.51 versus 186.2 ± 0.51; Ptrend = 0.02). Further, participants who were in the highest versus lowest quartile of chocolate consumption had ~ 2.1 μm narrower retinal venules (multivariable-adjusted P = 0.03). CONCLUSIONS This study shows that higher intakes of specific flavonoid subclasses are associated with a favourable retinal microvascular profile. Greater consumption of flavonoid-rich apples/pears and chocolate was also associated with beneficial variations in retinal vascular calibre.
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Wang J, Brown C, Shi C, Townsend J, Gameiro GR, Wang P, Jiang H. Improving diabetic and hypertensive retinopathy with a medical food containing L-methylfolate: a preliminary report. EYE AND VISION 2019; 6:21. [PMID: 31363484 PMCID: PMC6643316 DOI: 10.1186/s40662-019-0147-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/01/2019] [Indexed: 02/07/2023]
Abstract
Background Homocysteine and vitamin D may play a role in the development of diabetic and hypertensive retinopathy in patients with diabetes mellitus (DM) and hypertension. Supplementing food with L-methylfolate and vitamin D theoretically may improve diabetic and hypertensive retinopathy, however, the outcome of these nutritional approaches has not been fully examined. A retrospective case review was done of cases of retinopathy reversal in patients on Ocufolin™ and a similar nonprescription multivitamin, Eyefolate™. In this study, they were administered L-methylfolate (2.7 mg and 3.0 mg, respectively) and vitamin D3 (4500 IU each). These dosages are significantly above the RDA but well below levels associated with toxicity. Case presentation Seven patients had nonproliferative diabetic retinopathy (NPDR) and some of them had hypertension. One patient had only hypertensive retinopathy. All patients were instructed to take Ocufolin™ medical food as a food supplement. Baseline genetic testing for MTHFR polymorphisms was conducted. Fundus photography was used to document the fundus condition of the enrolled eyes in 8 NPDR patients at the initial and follow-up visits. Microaneurysms (MA) and exudates were observed to be improved in some trial patients. All subjects had one or more MTHFR polymorphisms. All had diabetic retinopathy, hypertensive retinopathy, or both. MAs were resolved, and exudates were decreased in 8/8 cases after taking the medical food. Retinal edema was found in 2/8 cases and improved or resolved in both cases after taking the medical food or the supplement. The best corrected visual activity was stable or improved in 8/8 cases. Conclusion We report a series of diabetic and hypertensive retinopathy cases with MTHFR polymorphisms and the improvement of retinal microvasculature (mainly MAs) in serial fundus photography after taking a medical food or supplement containing L-methylfolate and vitamin D. It appears that the use of nutritional supplements and medical foods containing L-methylfolate and vitamin D may be effective in facilitating the improvement of diabetic and hypertensive retinopathy.
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Affiliation(s)
- Jianhua Wang
- 1Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
| | - Craig Brown
- 2Department of Ophthalmology, College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR USA
| | - Ce Shi
- 1Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA.,3School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Justin Townsend
- 1Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
| | - Giovana Rosa Gameiro
- 1Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
| | - Peng Wang
- 1Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hong Jiang
- 1Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
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Association of dietary nitrate intake with retinal microvascular structure in older adults. Eur J Nutr 2019; 59:2057-2063. [PMID: 31309281 DOI: 10.1007/s00394-019-02055-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 07/09/2019] [Indexed: 01/17/2023]
Abstract
PURPOSE Existing research suggests that changes to retinal vascular caliber reflect nitric oxide (NO)-dependent endothelial dysfunction. Dietary nitrate is an important source of NO; however, studies on the link between dietary nitrate intake and retinal microvasculature are lacking. We aimed to assess the cross-sectional association between intake of dietary nitrate (from vegetable and non-vegetable sources) and retinal arteriolar and venular caliber among older adults. METHODS Participants from the Blue Mountains Eye Study aged 49+ years with complete data at baseline on diet and retinal vessel measures were analyzed (n = 2813). Dietary intake was assessed using a validated semi-quantitative food-frequency questionnaire. Nitrate intake from vegetable and non-vegetable sources was estimated using a validated comprehensive database and other published data where necessary. Fundus photographs were taken and retinal vascular caliber measured using validated computer-assisted techniques and summarized. RESULTS Participants in the lowest versus highest tertile of vegetable nitrate intake had significantly narrower retinal arterioles: 186.2 ± 0.48 versus 187.6 ± 0.48 µm (multivariable-adjusted p = 0.04). After multivariable adjustment, each 10-unit higher intake of total nitrate and vegetable nitrate was associated with 0.089 ± 0.004 and 0.090 ± 0.004 µm wider retinal arteriolar caliber, respectively, both p = 0.03. Each 10-unit higher vegetable nitrate intake was associated with 0.092 ± 0.005 µm narrower retinal venules (p = 0.05). CONCLUSION Intake of dietary nitrate, particularly from vegetable sources, was associated with beneficial variations in both retinal arteriolar and venular caliber among older adults. Further research into associations between dietary nitrate and the retinal microvasculature could allow for greater understanding and possible prevention of clinical cardiovascular events.
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Endes K, Köchli S, Zahner L, Hanssen H. Exercise and Arterial Modulation in Children: The EXAMIN YOUTH Study. Front Physiol 2019; 10:43. [PMID: 30774601 PMCID: PMC6367232 DOI: 10.3389/fphys.2019.00043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 01/16/2019] [Indexed: 12/26/2022] Open
Abstract
Background: Cardiovascular disease (CVD) remains to be one of the most frequent causes of death worldwide. Cardiovascular (CV) risk factors such as hypertension and obesity often manifest in childhood. The study examines the associations of blood pressure, body mass index and physical activity with cardiopulmonary, metabolic, and psychosocial health of children in a systems physiology approach. Methods/Design: This cross-sectional study will be performed in a cohort of 6 to 8 year old school children (n = 1000). As a measure of vascular health, retinal microvascular diameters and large artery pulse wave velocity will be examined. Anthropometric parameters, such as weight, height, body mass index, and blood pressure will be assessed according to standardized protocols for children. Physical fitness and activity will be measured by a 20 m shuttle run, a 20 m sprint and a proxy-reported questionnaire on lifestyle behavior. Spirometry, assessment of heart rate variability and skin advanced glycation end products as well as a flanker test will be performed to determine systemic end organ alterations. Discussion: The study offers a unique integrative primary prevention concept that aims to set the grounds for a healthy and active lifestyle approach during childhood. It will help optimize CV risk stratification to identify children at risk of disease progression later in life. The study will demonstrate the importance of specific CV screening programs in children to reduce the growing burden of CV disease in adulthood. Prospective follow-up studies will have to prove the efficacy of primary prevention programs in children to achieve healthier aging as a long-term goal.
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Affiliation(s)
| | | | | | - Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
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