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Ma SY, Liu YT, Cun YS, Wang Q, Fu MC, Wu KD, Cai XY, Cheng ST, Patel N, Da M, Hu L, Deqin Z, Kang XJ, Yang M, Mo XM. Preoperative serum cortisone levels are associated with cognition in preschool-aged children with tetralogy of Fallot after corrective surgery: new evidence from human populations and mice. World J Pediatr 2024; 20:173-184. [PMID: 37737505 PMCID: PMC10884142 DOI: 10.1007/s12519-023-00754-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 08/06/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Children with TOF would be confronted with neurological impairment across their lifetime. Our study aimed to identify the risk factors for cerebral morphology changes and cognition in postoperative preschool-aged children with TOF. METHODS We used mass spectrometry (MS) technology to assess the levels of serum metabolites, Wechsler preschool and primary scale of intelligence-Fourth edition (WPPSI-IV) index scores to evaluate neurodevelopmental levels and multimodal magnetic resonance imaging (MRI) to detect cortical morphological changes. RESULTS Multiple linear regression showed that preoperative levels of serum cortisone were positively correlated with the gyrification index of the left inferior parietal gyrus in children with TOF and negatively related to their lower visual spaces index and nonverbal index. Meanwhile, preoperative SpO2 was negatively correlated with levels of serum cortisone after adjusting for all covariates. Furthermore, after intervening levels of cortisone in chronic hypoxic model mice, total brain volumes were reduced at both postnatal (P) 11.5 and P30 days. CONCLUSIONS Our results suggest that preoperative serum cortisone levels could be used as a biomarker of neurodevelopmental impairment in children with TOF. Our study findings emphasized that preoperative levels of cortisone could influence cerebral development and cognition abilities in children with TOF.
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Affiliation(s)
- Si-Yu Ma
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Yu-Ting Liu
- Department of Radiology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Yue-Shuang Cun
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Qiang Wang
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Ming-Cui Fu
- Department of Radiology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Ke-De Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Xin-Yu Cai
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Shu-Ting Cheng
- Department of Radiology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Nishant Patel
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Min Da
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Liang Hu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Zhuoga Deqin
- Medical School of Nanjing University, Nanjing, 210093, China
| | - Xue-Jun Kang
- Key Laboratory of Child Development and Learning Science, Research Center For Learning Science, School of Biological Sciences & Medical Engineering, Ministry of Education, Southeast University, Nanjing, 210096, China.
| | - Ming Yang
- Department of Radiology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China.
| | - Xu-Ming Mo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China.
- Medical School of Nanjing University, Nanjing, 210093, China.
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Asiedu K, Krishnan AV, Kwai N, Poynten A, Markoulli M. Conjunctival microcirculation in ocular and systemic microvascular disease. Clin Exp Optom 2023; 106:694-702. [PMID: 36641840 DOI: 10.1080/08164622.2022.2151872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/09/2022] [Accepted: 11/21/2022] [Indexed: 01/16/2023] Open
Abstract
The conjunctival microcirculation is an accessible complex network of micro vessels whose quantitative assessment can reveal microvascular haemodynamic properties. Currently, algorithms for the measurement of conjunctival haemodynamics use either manual or semi-automated systems, which may provide insight into overall conjunctival health, as well as in ocular and systemic disease. These algorithms include functional slit-lamp biomicroscopy, laser doppler flowmetry, optical coherence tomography angiography, orthogonal polarized spectral imaging, computer-assisted intravitral microscopy, diffuse reflectance spectroscopy and corneal confocal microscopy. Furthermore, several studies have demonstrated a relationship between conjunctival microcirculatory haemodynamics and many diseases such as dry eye disease, Alzheimer's disease, diabetes, hypertension, sepsis, coronary microvascular disease, and sickle cell anaemia. This review aims to describe conjunctival microcirculation, its characteristics, and techniques for its measurement, as well as the association between conjunctival microcirculation and microvascular abnormalities in disease states.
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Affiliation(s)
- Kofi Asiedu
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Arun V Krishnan
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Department of Neurology, Prince of Wales Hospital, Sydney, Australia
| | - Natalie Kwai
- School of Medical Sciences, University of sydney, Sydney, Australia
| | - Ann Poynten
- Department of Endocrinology, Prince of Wales Hospital, Sydney, Australia
| | - Maria Markoulli
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Koutsiaris AG, Riri K, Boutlas S, Daniil Z, Tsironi EE. A normative blood velocity model in the exchange microvessels for discriminating health from disease: Healthy controls versus COVID-19 cases. Clin Hemorheol Microcirc 2023:CH231780. [PMID: 37182862 DOI: 10.3233/ch-231780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
A usual practice in medicine is to search for "biomarkers" which are measurable quantities of a normal or abnormal biological process. Biomarkers can be biochemical or physical quantities of the body and although commonly used statistically in clinical settings, it is not usual for them to be connected to basic physiological models or equations. In this work, a normative blood velocity model framework for the exchange microvessels was introduced, combining the velocity-diffusion (V-J) equation and statistics, in order to define the normative range (NR) and normative area (NA) diagrams for discriminating normal (normemic) from abnormal (hyperemic or underemic) states, taking into account the microvessel diameter D. This is different from the usual statistical processing since there is a basis on the well-known physiological principle of the flow diffusion equation. The discriminative power of the average axial velocity model was successfully tested using a group of healthy individuals (Control Group) and a group of post COVID-19 patients (COVID-19 Group).
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Affiliation(s)
- Aristotle G Koutsiaris
- Medical Informatics and Biomedical Imaging (MIBI) Laboratory, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis Campus, Larissa, Greece
| | - Konstantina Riri
- Department of Ophthalmology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Stylianos Boutlas
- Department of Respiratory Medicine, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Zoe Daniil
- Department of Respiratory Medicine, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Evangelia E Tsironi
- Department of Ophthalmology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Mailey JA, Moore JS, Brennan PF, Jing M, Awuah A, McLaughlin JAD, Nesbit MA, Moore TCB, Spence MS. Assessment of hemodynamic indices of conjunctival microvascular function in patients with coronary microvascular dysfunction. Microvasc Res 2023; 147:104480. [PMID: 36690270 DOI: 10.1016/j.mvr.2023.104480] [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: 10/21/2022] [Revised: 01/07/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Coronary microvascular dysfunction (CMD) is a cause of ischaemia with non-obstructive coronary arteries (INOCA). It is notoriously underdiagnosed due to the need for invasive microvascular function testing. We hypothesized that systemic microvascular dysfunction could be demonstrated non-invasively in the microcirculation of the bulbar conjunctiva in patients with CMD. METHODS Patients undergoing coronary angiography for the investigation of chest pain or dyspnoea, with physiologically insignificant epicardial disease (fractional flow reserve ≥0.80) were recruited. All patients underwent invasive coronary microvascular function testing. We compared a cohort of patients with evidence of CMD (IMR ≥25 or CFR <2.0); to a group of controls (IMR <25 and CFR ≥2.0). Conjunctival imaging was performed using a previously validated combination of a smartphone and slit-lamp biomicroscope. This technique allows measurement of vessel diameter and other indices of microvascular function by tracking erythrocyte motion. RESULTS A total of 111 patients were included (43 CMD and 68 controls). There were no differences in baseline demographics, co-morbidities or epicardial coronary disease severity. The mean number of vessel segments analysed per patient was 21.0 ± 12.8 (3.2 ± 3.5 arterioles and 14.8 ± 10.8 venules). In the CMD cohort, significant reductions were observed in axial/cross-sectional velocity, blood flow, wall shear rate and stress. CONCLUSION The changes in microvascular function linked to CMD can be observed non-invasively in the bulbar conjunctiva. Conjunctival vascular imaging may have utility as a non-invasive tool to both diagnose CMD and augment conventional cardiovascular risk assessment.
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Affiliation(s)
- Jonathan A Mailey
- Department of Cardiology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom; Biomedical Sciences Research Institute, Ulster University, Coleraine, United Kingdom.
| | - Julie S Moore
- Biomedical Sciences Research Institute, Ulster University, Coleraine, United Kingdom; Integrated Diagnostic Laboratory, Northland House, Ulster University, Belfast, United Kingdom
| | - Paul F Brennan
- Department of Cardiology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Min Jing
- Nanotechnology and Integrated Bioengineering Centre (NIBEC), Ulster University, Jordanstown, United Kingdom
| | - Agnes Awuah
- Biomedical Sciences Research Institute, Ulster University, Coleraine, United Kingdom; Integrated Diagnostic Laboratory, Northland House, Ulster University, Belfast, United Kingdom
| | - James A D McLaughlin
- Integrated Diagnostic Laboratory, Northland House, Ulster University, Belfast, United Kingdom; Nanotechnology and Integrated Bioengineering Centre (NIBEC), Ulster University, Jordanstown, United Kingdom
| | - M Andrew Nesbit
- Biomedical Sciences Research Institute, Ulster University, Coleraine, United Kingdom; Integrated Diagnostic Laboratory, Northland House, Ulster University, Belfast, United Kingdom
| | - Tara C B Moore
- Biomedical Sciences Research Institute, Ulster University, Coleraine, United Kingdom; Integrated Diagnostic Laboratory, Northland House, Ulster University, Belfast, United Kingdom
| | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom; Integrated Diagnostic Laboratory, Northland House, Ulster University, Belfast, United Kingdom
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Assessment of indices of conjunctival microvascular function in patients with and without obstructive coronary artery disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 50:26-33. [PMID: 36707373 DOI: 10.1016/j.carrev.2023.01.007] [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: 11/16/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Atherosclerotic heart disease often remains asymptomatic until presentation with a major adverse cardiovascular event. Primary preventive therapies improve outcomes, but conventional screening often misattributes risk. Vascular imaging can be utilised to detect atherosclerosis, but often involves ionising radiation. The conjunctiva is a readily accessible vascular network allowing non-invasive hemodynamic evaluation. AIM To compare conjunctival microcirculatory function in patients with and without obstructive coronary artery disease. METHODS We compared the conjunctival microcirculation of myocardial infarction patients (MI-cohort) to controls with no obstructive coronary artery disease (NO-CAD cohort). Conjunctival imaging was performed using a smartphone and slit-lamp biomicroscope combination. Microvascular indices of axial (Va) and cross-sectional (Vcs) velocity; blood flow rate (Q); and wall shear rate (WSR) were compared in all conjunctival vessels between 5 and 45 μm in diameter. RESULTS A total of 127 patients were recruited (66 MI vs 61 NO-CAD) and 3602 conjunctival vessels analysed (2414 MI vs 1188 NO-CAD). Mean Va, Vcs and Q were significantly lower in the MI vs NO-CAD cohort (Va 0.50 ± 0.17 mm/s vs 0.55 ± 0.15 mm/s, p < 0.001; Vcs 0.35 ± 0.12 mm/s vs 0.38 ± 0.10 mm/s, p < 0.001; Q 154 ± 116 pl/s vs 198 ± 130 pl/s, p < 0.001). To correct for differences in mean vessel diameter, WSR was compared in 10-36 μm vessels (3268/3602 vessels) and was lower in the MI-cohort (134 ± 64 s-1 vs 140 ± 63 s-1, p = 0.002). CONCLUSIONS Conjunctival microcirculatory alterations can be observed in patients with obstructive coronary artery disease. The conjunctival microvasculature merits further evaluation in cardiovascular risk screening.
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Moore JS, Nesbit MA, Moore T. Appraisal of Cardiovascular Risk Factors, Biomarkers, and Ocular Imaging in Cardiovascular Risk Prediction. Curr Cardiol Rev 2023; 19:72-81. [PMID: 37497700 PMCID: PMC10636798 DOI: 10.2174/1573403x19666230727101926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 05/12/2023] [Accepted: 06/15/2023] [Indexed: 07/28/2023] Open
Abstract
Cardiovascular disease remains a leading cause of death worldwide despite the use of available cardiovascular disease risk prediction tools. Identification of high-risk individuals via risk stratification and screening at sub-clinical stages, which may be offered by ocular screening, is important to prevent major adverse cardiac events. Retinal microvasculature has been widely researched for potential application in both diabetes and cardiovascular disease risk prediction. However, the conjunctival microvasculature as a tool for cardiovascular disease risk prediction remains largely unexplored. The purpose of this review is to evaluate the current cardiovascular risk assessment methods, identifying gaps in the literature that imaging of the ocular microcirculation may have the potential to fill. This review also explores the themes of machine learning, risk scores, biomarkers, medical imaging, and clinical risk factors. Cardiovascular risk classification varies based on the population assessed, the risk factors included, and the assessment methods. A more tailored, standardised and feasible approach to cardiovascular risk prediction that utilises technological and medical imaging advances, which may be offered by ocular imaging, is required to support cardiovascular disease prevention strategies and clinical guidelines.
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Affiliation(s)
- Julie S. Moore
- School of Biomedical Sciences, Ulster University, York St, Belfast BT15 1ED, United Kingdom
- Integrated Diagnostics Laboratory, Ulster University, 3-5a Frederick St, Belfast, Northern Ireland, United Kingdom
| | - M. Andrew Nesbit
- School of Biomedical Sciences, Ulster University, York St, Belfast BT15 1ED, United Kingdom
- Integrated Diagnostics Laboratory, Ulster University, 3-5a Frederick St, Belfast, Northern Ireland, United Kingdom
| | - Tara Moore
- School of Biomedical Sciences, Ulster University, York St, Belfast BT15 1ED, United Kingdom
- Integrated Diagnostics Laboratory, Ulster University, 3-5a Frederick St, Belfast, Northern Ireland, United Kingdom
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7
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Awuah A, Moore JS, Nesbit MA, Ruddock MW, Brennan PF, Mailey JA, McNeil AJ, Jing M, Finlay DD, Trucco E, Kurth MJ, Watt J, Lamont JV, Fitzgerald P, Spence MS, McLaughlin JAD, Moore TCB. A novel algorithm for cardiovascular screening using conjunctival microcirculatory parameters and blood biomarkers. Sci Rep 2022; 12:6545. [PMID: 35449196 PMCID: PMC9023476 DOI: 10.1038/s41598-022-10491-7] [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: 10/07/2021] [Accepted: 03/15/2022] [Indexed: 11/30/2022] Open
Abstract
Microvascular haemodynamic alterations are associated with coronary artery disease (CAD). The conjunctival microcirculation can easily be assessed non-invasively. However, the microcirculation of the conjunctiva has not been previously explored in clinical algorithms aimed at identifying patients with CAD. This case–control study involved 66 patients with post-myocardial infarction and 66 gender-matched healthy controls. Haemodynamic properties of the conjunctival microcirculation were assessed with a validated iPhone and slit lamp-based imaging tool. Haemodynamic properties were extracted with semi-automated software and compared between groups. Biomarkers implicated in the development of CAD were assessed in combination with conjunctival microcirculatory parameters. The conjunctival blood vessel parameters and biomarkers were used to derive an algorithm to aid in the screening of patients for CAD. Conjunctival blood velocity measured in combination with the blood biomarkers (N-terminal pro-brain natriuretic peptide and adiponectin) had an area under receiver operator characteristic curve (AUROC) of 0.967, sensitivity 93.0%, specificity 91.5% for CAD. This study demonstrated that the novel algorithm which included a combination of conjunctival blood vessel haemodynamic properties, and blood-based biomarkers could be used as a potential screening tool for CAD and should be validated for potential utility in asymptomatic individuals.
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Affiliation(s)
- Agnes Awuah
- Biomedical Sciences Research Institute, Ulster University, Cromore Road, Coleraine, BT52 1SA, UK
| | - Julie S Moore
- Biomedical Sciences Research Institute, Ulster University, Cromore Road, Coleraine, BT52 1SA, UK
| | - M Andrew Nesbit
- Biomedical Sciences Research Institute, Ulster University, Cromore Road, Coleraine, BT52 1SA, UK
| | - Mark W Ruddock
- Clinical Studies Group, Randox Laboratories Ltd, 55 Diamond Road, Crumlin, BT29 4QY, UK
| | - Paul F Brennan
- Department of Cardiology, Royal Victoria Hospital, Belfast Health and Social Care Trust, 274 Grosvenor Road, Belfast, BT12 6BA, UK
| | - Jonathan A Mailey
- Department of Cardiology, Royal Victoria Hospital, Belfast Health and Social Care Trust, 274 Grosvenor Road, Belfast, BT12 6BA, UK
| | - Andrew J McNeil
- VAMPIRE Project, Computing (SSEN), University of Dundee, Dundee, DD1 4HN, UK
| | - Min Jing
- Nanotechnology and Integrated Bioengineering Centre (NIBEC), Ulster University, Jordanstown, BT37 0QB, UK
| | - Dewar D Finlay
- Nanotechnology and Integrated Bioengineering Centre (NIBEC), Ulster University, Jordanstown, BT37 0QB, UK
| | - Emanuele Trucco
- VAMPIRE Project, Computing (SSEN), University of Dundee, Dundee, DD1 4HN, UK
| | - Mary Jo Kurth
- Clinical Studies Group, Randox Laboratories Ltd, 55 Diamond Road, Crumlin, BT29 4QY, UK
| | - Joanne Watt
- Clinical Studies Group, Randox Laboratories Ltd, 55 Diamond Road, Crumlin, BT29 4QY, UK
| | - John V Lamont
- Clinical Studies Group, Randox Laboratories Ltd, 55 Diamond Road, Crumlin, BT29 4QY, UK
| | - Peter Fitzgerald
- Clinical Studies Group, Randox Laboratories Ltd, 55 Diamond Road, Crumlin, BT29 4QY, UK
| | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast Health and Social Care Trust, 274 Grosvenor Road, Belfast, BT12 6BA, UK
| | - James A D McLaughlin
- Nanotechnology and Integrated Bioengineering Centre (NIBEC), Ulster University, Jordanstown, BT37 0QB, UK
| | - Tara C B Moore
- Biomedical Sciences Research Institute, Ulster University, Cromore Road, Coleraine, BT52 1SA, UK.
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