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Abstract
Lysosomal storage disorders are a heterogeneous group of genetic diseases characterized by defective function in one of the lysosomal enzymes. In this review paper, we describe neuroradiological findings and clinical characteristics of neuronopathic lysosomal disorders with a focus on differential diagnosis. New insights regarding pathogenesis and therapeutic perspectives are also briefly discussed.
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Mohammad SA, Abdelkhalek HS. Nonketotic hyperglycinemia: spectrum of imaging findings with emphasis on diffusion-weighted imaging. Neuroradiology 2017; 59:1155-1163. [PMID: 28864914 DOI: 10.1007/s00234-017-1913-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/22/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to explore brain abnormalities in nonketotic hyperglycinemia (NKH) using diffusion-weighted imaging (DWI) and when feasible, diffusion tensor imaging (DTI) and tractography. METHODS Seven patients with confirmed diagnosis of NKH (8 days-2 years) underwent brain MRI. Conventional T1 and T2WI were acquired in all patients, DWI in six and DTI and tractography in two (4 months and 2 years). Measurements of fractional anisotropy (FA), radial diffusivity (RD), axial diffusivity (AD) and Trace from eight white matter regions were compared between the two patients and age-matched controls. Tractography of corpus callosum, superior longitudinal fasciculus and corticospinal tracts was performed with extraction of their FA and diffusivity indices. RESULTS MRI showed nonspecific brain atrophy in three children. Corpus callosum atrophy was found as a part of these atrophic changes. Cerebellar vermian hypoplasia and supratentorial hydrocephalus were seen in one patient. The topographic distribution of diffusion restriction was different among patients. The affected white matter regions were not predominantly following the expected areas of myelination according to patients' age. Deep grey matter nuclei were affected in one patient. DTI revealed lower FA with higher RD in most of the measured white matter regions and tracts. These changes were more appreciated in the 2-year-old patient. However, Trace was higher in the 2-year-old patient and lower in the 4-month-old one. The extracted tracts were decreased in volume. CONCLUSION DWI, DTI and tractography with FA and diffusivity measurements can give insights into white matter microstructural alterations that can occur in NKH.
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Affiliation(s)
- Shaimaa Abdelsattar Mohammad
- Radiodiagnosis Department, Faculty of Medicine, Ain-Shams University, 9 Lotfi Elsayed St. Ain-Shams University Staff Buildings, Cairo, 11657, Egypt.
| | - Heba Salah Abdelkhalek
- Medical Genetics Unit, Pediatric Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
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Pediatric brain MRI, Part 2: Advanced techniques. Pediatr Radiol 2017; 47:544-555. [PMID: 28409252 DOI: 10.1007/s00247-017-3792-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 11/13/2016] [Accepted: 01/26/2017] [Indexed: 10/19/2022]
Abstract
Pediatric neuroimaging is a complex and specialized field that uses magnetic resonance (MR) imaging as the workhorse for diagnosis. MR protocols should be tailored to the specific indication and reviewed by the supervising radiologist in real time. Targeted advanced imaging sequences can be added to provide information regarding tissue microstructure, perfusion, metabolism and function. In part 2 of this review, we highlight the utility of advanced imaging techniques for superior evaluation of pediatric neurologic disease. We focus on the following techniques, with clinical examples: phase-contrast imaging, perfusion-weighted imaging, vessel wall imaging, diffusion tensor imaging, task-based functional MRI and MR spectroscopy.
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Poretti A, Meoded A, Fatemi A. Diffusion tensor imaging: A biomarker of outcome in Krabbe's disease. J Neurosci Res 2016; 94:1108-15. [PMID: 27638596 DOI: 10.1002/jnr.23769] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 03/22/2016] [Accepted: 04/29/2016] [Indexed: 01/16/2023]
Affiliation(s)
- Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Avner Meoded
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Ali Fatemi
- Moser Center for Leukodystrophies; Kennedy Krieger Institute; Baltimore Maryland
- Departments of Neurology and Pediatrics; The Johns Hopkins University School of Medicine; Baltimore Maryland
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Krishnan P, Muthusami P, Heyn C, Shroff M. Advances in pediatric neuroimaging. Indian J Pediatr 2015; 82:154-65. [PMID: 25557178 DOI: 10.1007/s12098-014-1657-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 12/03/2014] [Indexed: 12/19/2022]
Abstract
Conventional MRI protocols are an integral part of routine clinical imaging in pediatric patients. The advent of several newer MRI techniques provides crucial insight into the structural integrity and functional aspects of the developing brain, especially with the introduction of 3T MRI systems in clinical practice. The field of pediatric neuroimaging continues to evolve, with greater emphasis on high spatial resolution, faster scan time, as well as a quest for visualization of the functional aspects of the human brain. MR vendors are increasingly focusing on optimizing MR technology to make it suitable for children, in whom as compared to adults the head size is usually smaller and demonstrates inherent neuroanatomical differences relating to brain development. The eventual goal of these advances would be to evolve as potential biomarkers for predicting neurodevelopment outcomes and prognostication, in addition to their utility in routine diagnostic and therapeutic decision-making. Advanced MR techniques like diffusion tensor imaging, functional MRI, MR perfusion, spectroscopy, volumetric imaging and arterial spin labeling add to our understanding of normal brain development and pathophysiology of various neurological disease processes. This review is primarily focused on outlining advanced MR techniques and their current and potential pediatric neuroimaging applications as well as providing a brief overview of advances in hardware and machine design.
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Affiliation(s)
- Pradeep Krishnan
- Division of Pediatric Neuroradiology, Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada,
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BOSEMANI THANGAMADHAN, ORMAN GUNES, CARSON KATHRYNA, MEODED AVNER, HUISMAN THIERRYAGM, PORETTI ANDREA. Diffusion tensor imaging of the brainstem in children with achondroplasia. Dev Med Child Neurol 2014; 56:1085-92. [PMID: 24825324 PMCID: PMC4194128 DOI: 10.1111/dmcn.12492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2014] [Indexed: 11/28/2022]
Abstract
AIM The aims of this study were to compare, using diffusion tensor imaging (DTI) of the brainstem, microstructural integrity of the white matter in children with achondroplasia and age-matched participants and to correlate the severity of craniocervical junction (CCJ) narrowing and neurological findings with DTI scalars in children with achondroplasia. This study also aimed to assess the potential role of fibroblast growth factor receptor type 3 on white matter microstructure. METHOD Diffusion tensor imaging was performed using a 1.5T magnetic resonance scanner and balanced pairs of diffusion gradients along 20 non-collinear directions. Measurements were obtained from regions of interest, sampled in each pontine corticospinal tract (CST), medial lemniscus, and middle cerebellar peduncle, as well as in the lower brainstem and centrum semiovale, for fractional anisotropy and for mean, axial, and radial diffusivity. In addition, a severity score for achondroplasia was assessed by measuring CCJ narrowing. RESULT Eight patients with achondroplasia (seven males, one female; mean age 5y 6mo, range 1y 1mo-15y 1mo) and eight age- and sex-matched comparison participants (mean age 5y 2mo, range 1y 1mo-14y 11mo) were included in this study. Fractional anisotropy was lower and mean diffusivity and radial diffusivity were higher in the lower brainstem of patients with achondroplasia than in age-matched comparison participants. The CST and middle cerebellar peduncle of the participants showed increases in mean, axial, and radial diffusivity. Fractional anisotropy in the lower brainstem was negatively correlated with the degree of CCJ narrowing. No differences in the DTI metrics of the centrum semiovale were observed between the two groups. INTERPRETATION The reduction in fractional anisotropy and increase in diffusivities in the lower brainstem of participants with achondroplasia may reflect secondary encephalomalacic degeneration and cavitation of the affected white matter tracts as shown by histology. In children with achondroplasia, DTI may serve as a potential biomarker for brainstem white matter injury and aid in the care and management of these patients.
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Affiliation(s)
- THANGAMADHAN BOSEMANI
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore
| | - GUNES ORMAN
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore
| | - KATHRYN A CARSON
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore,Division of General Internal Medicine, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - AVNER MEODED
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore
| | - THIERRY A G M HUISMAN
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore
| | - ANDREA PORETTI
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore
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Menezes AH. Achondroplasia and brain stem dysfunction. Dev Med Child Neurol 2014; 56:1036. [PMID: 25040780 DOI: 10.1111/dmcn.12510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Arnold H Menezes
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Eshetu T, Meoded A, Jallo GI, Carson BS, Huisman TA, Poretti A. Diffusion tensor imaging in pediatric Chiari type I malformation. Dev Med Child Neurol 2014; 56:742-8. [PMID: 24825432 DOI: 10.1111/dmcn.12494] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2014] [Indexed: 11/29/2022]
Abstract
AIM Chiari type I malformation (C1M) may be symptomatic or asymptomatic as an incidental finding. In this retrospective study, we applied diffusion tensor imaging (DTI) to study the brainstem and cerebellar white matter tracts in C1M. METHOD Diffusion tensor imaging (DTI) data were acquired on a 1.5T MR-scanner using balanced pairs of diffusion gradients along 20 non-collinear directions. Measurements from regions of interest in each pontine corticospinal tract, medial leminscus, and middle cerebellar peduncle (MCP) and in the lower brainstem were obtained for fractional anisotropy and mean, axial, and radial diffusivity. Values in symptomatic and asymptomatic children, and children with and without hydromyelia were compared using analysis of variance. RESULTS Fifteen children with C1M (10 males, five females; six symptomatic [four with hydromyelia] and nine asymptomatic) were included. Median age was 6 years 5 months (range 2y 10mo-15y 4mo). No significant differences in DTI scalars were found in the lower brainstem. In both MCPs, axial diffusivity values were lower in symptomatic than in asymptomatic children (p=0.049 and p=0.035 respectively) and higher in children with hydromyelia versus without hydromyelia (p=0.018 and p=0.006 respectively). In the left MCP, mean diffusivity values were lower in symptomatic than in asymptomatic children (p=0.047). INTERPRETATION Our results show that microstructural tissue alterations may be present in C1M. Additionally, our study suggests a specific role for the MCPs in C1M. Further large-scale studies are warranted.
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Affiliation(s)
- Tadesse Eshetu
- Division of Neuroradiology, The Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA
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Rieger D, Auerbach S, Robinson P, Gropman A. Neuroimaging of lipid storage disorders. ACTA ACUST UNITED AC 2014; 17:269-82. [PMID: 23798015 DOI: 10.1002/ddrr.1120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2012] [Indexed: 01/09/2023]
Abstract
Lipid storage diseases, also known as the lipidoses, are a group of inherited metabolic disorders in which there is lipid accumulation in various cell types, including the central nervous system, because of the deficiency of a variety of enzymes. Over time, excessive storage can cause permanent cellular and tissue damage. The brain is particularly sensitive to lipid storage as the contents of the central nervous system must occupy uniform volume, and any increases in fluids or deposits will lead to pressure changes and interference with normal neurological function. In addition to primary lipid storage diseases, lysosomal storage diseases include the mucolipidoses (in which excessive amounts of lipids and carbohydrates are stored in the cells and tissues) and the mucopolysaccharidoses (in which abnormal glycosylated proteins cannot be broken down because of enzyme deficiency). Neurological dysfunction can be a manifestation of these conditions due to substrate deposition as well. This review will explore the modalities of neuroimaging that may have particular relevance to the study of the lipid storage disorder and their impact on elucidating aspects of brain function. First, the techniques will be reviewed. Next, the neuropathology of a few selected lipid storage disorders will be reviewed and the use of neuroimaging to define disease characteristics discussed in further detail. Examples of studies using these techniques will be discussed in the text.
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Affiliation(s)
- Deborah Rieger
- Department of Pediatrics, Children's National Medical Center and the George Washington University of the Health Sciences, Washington, District of Columbia, USA
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Poretti A, Meoded A, Bunge M, Fatemi A, Barrette P, Huisman TAGM, Salman MS. Novel diffusion tensor imaging findings in Krabbe disease. Eur J Paediatr Neurol 2014; 18:150-6. [PMID: 24149099 DOI: 10.1016/j.ejpn.2013.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 09/12/2013] [Accepted: 09/30/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Krabbe disease is a lysosomal disorder that primarily affects myelin. Diffusion tensor imaging (DTI) provides quantitative information about the white matter organization and integrity. Radial diffusivity (RD) reflects myelin injury selectively. PURPOSE To report on quantitative DTI findings (including axial diffusivity (AD) and RD, not previously reported) in two children with Krabbe disease compared to controls. METHODS A quantitative region of interest (ROI) based DTI analysis was performed for the patients and age- and gender-matched controls. Fractional anisotropy (FA), mean diffusivity, AD and RD values as well as variation ratios between the patients' and controls' values were calculated for nine brain regions. RESULTS Two boys with Krabbe disease were included in this study. DTI data were acquired at the ages of 6.25 years and 6.5 months. For all regions, FA ratios were negative, while RD and MD ratios positive. The most elevated variation ratios were found for RD. Variation ratios were greater in the centrum semiovale, corpus callosum, and middle cerebellar peduncles than in other anatomical regions, especially in the older patient in comparison with the younger patient. The AD ratios, however, were much lower and close to zero. CONCLUSIONS DTI allows a quantitative evaluation of white matter damage in Krabbe disease. RD seems to be the most sensitive DTI parameter in agreement with the histopathological findings in Krabbe disease, a primary myelin disorder. This may be important in the early detection of the onset of demyelination.
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Affiliation(s)
- Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Avner Meoded
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Martin Bunge
- Department of Radiology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ali Fatemi
- Kennedy Krieger Institute, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Paul Barrette
- Department of Diagnostic Imaging, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Thierry A G M Huisman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael S Salman
- Section of Pediatric Neurology, Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Duncan AF, Caprihan A, Montague EQ, Lowe J, Schrader R, Phillips JP. Regional cerebral blood flow in children from 3 to 5 months of age. AJNR Am J Neuroradiol 2013; 35:593-8. [PMID: 24091444 DOI: 10.3174/ajnr.a3728] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Understanding the relationship between brain and behavior in early childhood requires a probe of functional brain development. We report the first large study of regional CBF by use of arterial spin-labeling in young children. MATERIALS AND METHODS Cerebral blood flow by use of arterial spin-labeling was measured in 61 healthy children between the ages of 3 and 5 months. Blood flow maps were parcellated into 8 broadly defined anatomic regions of each cerebral hemisphere. RESULTS There was no sex effect; however, group analysis demonstrated significantly greater CBF in the sensorimotor and occipital regions compared with dorsolateral prefrontal, subgenual, and orbitofrontal areas (P < .0001). A significant age effect was also identified, with the largest increase in blood flow between 3 and 5 months occurring in the following regions: orbitofrontal (P < .009), subgenual (P < .002), and inferior occipital lobe (P = .001). CONCLUSIONS These results are consistent with prior histologic studies demonstrating regional variation in brain maturation and suggest that arterial spin-labeling is sensitive to regional as well as age-related differences in CBF in young children.
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Affiliation(s)
- A F Duncan
- From the Department of Pediatrics, Division of Neonatology (A.F.D., J.L.)
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Abstract
Because pediatric intensive care units (PICUs) improve survival for a range of acute diseases, attention has turned toward ensuring the best possible functional outcomes after critical illness. The neurocritical care of children is of increasing interest. However, the pediatric population encompasses a heterogeneous set of neurologic conditions, with several possible models of how best to address them. This article reviews the special challenges faced by PICUs with regards to diseases, technologies, and skills and the progress that has been made in treatment, monitoring, and prognostication. Recent advances in translational research expected to modify the field in the near-term are described.
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Affiliation(s)
- Joshua Cappell
- Pediatric Critical Care Medicine, Department of Pediatrics, Morgan Stanley Children's Hospital, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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Oguz I, McMurray MS, Styner M, Johns JM. The translational role of diffusion tensor image analysis in animal models of developmental pathologies. Dev Neurosci 2012; 34:5-19. [PMID: 22627095 DOI: 10.1159/000336825] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 01/24/2012] [Indexed: 12/31/2022] Open
Abstract
Diffusion tensor magnetic resonance imaging (DTI) has proven itself a powerful technique for clinical investigation of the neurobiological targets and mechanisms underlying developmental pathologies. The success of DTI in clinical studies has demonstrated its great potential for understanding translational animal models of clinical disorders, and preclinical animal researchers are beginning to embrace this new technology to study developmental pathologies. In animal models, genetics can be effectively controlled, drugs consistently administered, subject compliance ensured, and image acquisition times dramatically increased to reduce between-subject variability and improve image quality. When pairing these strengths with the many positive attributes of DTI, such as the ability to investigate microstructural brain organization and connectivity, it becomes possible to delve deeper into the study of both normal and abnormal development. The purpose of this review is to provide new preclinical investigators with an introductory source of information about the analysis of data resulting from small animal DTI studies to facilitate the translation of these studies to clinical data. In addition to an in-depth review of translational analysis techniques, we present a number of relevant clinical and animal studies using DTI to investigate developmental insults in order to further illustrate techniques and to highlight where small animal DTI could potentially provide a wealth of translational data to inform clinical researchers.
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Affiliation(s)
- Ipek Oguz
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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