1
|
Hadaya L, Dimitrakopoulou K, Vanes LD, Kanel D, Fenn-Moltu S, Gale-Grant O, Counsell SJ, Edwards AD, Saqi M, Batalle D, Nosarti C. Parsing brain-behavior heterogeneity in very preterm born children using integrated similarity networks. Transl Psychiatry 2023; 13:108. [PMID: 37012252 PMCID: PMC10070645 DOI: 10.1038/s41398-023-02401-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 04/05/2023] Open
Abstract
Very preterm birth (VPT; ≤32 weeks' gestation) is associated with altered brain development and cognitive and behavioral difficulties across the lifespan. However, heterogeneity in outcomes among individuals born VPT makes it challenging to identify those most vulnerable to neurodevelopmental sequelae. Here, we aimed to stratify VPT children into distinct behavioral subgroups and explore between-subgroup differences in neonatal brain structure and function. 198 VPT children (98 females) previously enrolled in the Evaluation of Preterm Imaging Study (EudraCT 2009-011602-42) underwent Magnetic Resonance Imaging at term-equivalent age and neuropsychological assessments at 4-7 years. Using an integrative clustering approach, we combined neonatal socio-demographic, clinical factors and childhood socio-emotional and executive function outcomes, to identify distinct subgroups of children based on their similarity profiles in a multidimensional space. We characterized resultant subgroups using domain-specific outcomes (temperament, psychopathology, IQ and cognitively stimulating home environment) and explored between-subgroup differences in neonatal brain volumes (voxel-wise Tensor-Based-Morphometry), functional connectivity (voxel-wise degree centrality) and structural connectivity (Tract-Based-Spatial-Statistics). Results showed two- and three-cluster data-driven solutions. The two-cluster solution comprised a 'resilient' subgroup (lower psychopathology and higher IQ, executive function and socio-emotional scores) and an 'at-risk' subgroup (poorer behavioral and cognitive outcomes). No neuroimaging differences between the resilient and at-risk subgroups were found. The three-cluster solution showed an additional third 'intermediate' subgroup, displaying behavioral and cognitive outcomes intermediate between the resilient and at-risk subgroups. The resilient subgroup had the most cognitively stimulating home environment and the at-risk subgroup showed the highest neonatal clinical risk, while the intermediate subgroup showed the lowest clinical, but the highest socio-demographic risk. Compared to the intermediate subgroup, the resilient subgroup displayed larger neonatal insular and orbitofrontal volumes and stronger orbitofrontal functional connectivity, while the at-risk group showed widespread white matter microstructural alterations. These findings suggest that risk stratification following VPT birth is feasible and could be used translationally to guide personalized interventions aimed at promoting children's resilience.
Collapse
Affiliation(s)
- Laila Hadaya
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Konstantina Dimitrakopoulou
- Translational Bioinformatics Platform, NIHR Biomedical Research Centre, Guy's and St. Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Lucy D Vanes
- Centre for Neuroimaging Sciences, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Dana Kanel
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Sunniva Fenn-Moltu
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Oliver Gale-Grant
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - A David Edwards
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Mansoor Saqi
- Translational Bioinformatics Platform, NIHR Biomedical Research Centre, Guy's and St. Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Dafnis Batalle
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Chiara Nosarti
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, Faculty of Life Sciences & Medicine, King's College London, London, UK.
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.
| |
Collapse
|
2
|
Sheridan MA, Mukerji CE, Wade M, Humphreys KL, Garrisi K, Goel S, Patel K, Fox NA, Zeanah CH, Nelson CA, McLaughlin KA. Early deprivation alters structural brain development from middle childhood to adolescence. SCIENCE ADVANCES 2022; 8:eabn4316. [PMID: 36206331 PMCID: PMC9544316 DOI: 10.1126/sciadv.abn4316] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 08/24/2022] [Indexed: 05/21/2023]
Abstract
Hypotheses concerning the biologic embedding of early adversity via developmental neuroplasticity mechanisms have been proposed on the basis of experimental studies in animals. However, no studies have demonstrated a causal link between early adversity and neural development in humans. Here, we present evidence from a randomized controlled trial linking psychosocial deprivation in early childhood to changes in cortical development from childhood to adolescence using longitudinal data from the Bucharest Early Intervention Project. Changes in cortical structure due to randomization to foster care were most pronounced in the lateral and medial prefrontal cortex and in white matter tracts connecting the prefrontal and parietal cortex. Demonstrating the causal impact of exposure to deprivation on the development of neural structure highlights the importance of early placement into family-based care to mitigate lasting neurodevelopmental consequences associated with early-life deprivation.
Collapse
Affiliation(s)
- Margaret A. Sheridan
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, 235 E. Cameron Street, Chapel Hill, NC 27599, USA
- Corresponding author.
| | - Cora E. Mukerji
- Department of Psychology, Bryn Mawr College, 101 North Merion Ave, Bryn Mawr, PA 19010, USA
- Division of Developmental Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Mark Wade
- University of Toronto, Department of Applied Psychology and Human Development, 252 Bloor St. West, Toronto, ON M5S 1V6, Canada
| | - Kathryn L. Humphreys
- Department of Psychology and Human Development, Vanderbilt University, 230 Appleton Place, Nashville, TN 37203, USA
| | - Kathryn Garrisi
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, 235 E. Cameron Street, Chapel Hill, NC 27599, USA
| | - Srishti Goel
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, 235 E. Cameron Street, Chapel Hill, NC 27599, USA
- Department of Psychology, Yale University, Box 208205, New Haven, CT 06520-8205, USA
| | - Kinjal Patel
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, 235 E. Cameron Street, Chapel Hill, NC 27599, USA
| | - Nathan A. Fox
- Department of Human Development, University of Maryland, College Park, MD 20740, USA
| | - Charles H. Zeanah
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA
| | - Charles A. Nelson
- Division of Developmental Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Harvard Graduate School of Education, 13 Appian Way, Cambridge, MA 02138, USA
| | - Katie A. McLaughlin
- Department of Psychology, Harvard University, 33 Kirkland St, Cambridge, MA, 02138, USA
| |
Collapse
|
3
|
Bonthrone AF, Chew A, Bhroin MN, Rech FM, Kelly CJ, Christiaens D, Pietsch M, Tournier JD, Cordero-Grande L, Price A, Egloff A, Hajnal JV, Pushparajah K, Simpson J, David Edwards A, Rutherford MA, Nosarti C, Batalle D, Counsell SJ. Neonatal frontal-limbic connectivity is associated with externalizing behaviours in toddlers with Congenital Heart Disease. Neuroimage Clin 2022; 36:103153. [PMID: 35987179 PMCID: PMC9403726 DOI: 10.1016/j.nicl.2022.103153] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/02/2022] [Accepted: 08/12/2022] [Indexed: 12/14/2022]
Abstract
Children with Congenital Heart Disease (CHD) are at increased risk of neurodevelopmental impairments. The neonatal antecedents of impaired behavioural development are unknown. 43 infants with CHD underwent presurgical brain diffusion-weighted MRI [postmenstrual age at scan median (IQR) = 39.29 (38.71-39.71) weeks] and a follow-up assessment at median age of 22.1 (IQR 22.0-22.7) months in which parents reported internalizing and externalizing problem scores on the Child Behaviour Checklist. We constructed structural brain networks from diffusion-weighted MRI and calculated edge-wise structural connectivity as well as global and local brain network features. We also calculated presurgical cerebral oxygen delivery, and extracted perioperative variables, socioeconomic status at birth and a measure of cognitively stimulating parenting. Lower degree in the right inferior frontal gyrus (partial ρ = -0.687, p < 0.001) and reduced connectivity in a frontal-limbic sub-network including the right inferior frontal gyrus were associated with higher externalizing problem scores. Externalizing problem scores were unrelated to neonatal clinical course or home environment. However, higher internalizing problem scores were associated with earlier surgery in the neonatal period (partial ρ = -0.538, p = 0.014). Our results highlight the importance of frontal-limbic networks to the development of externalizing behaviours and provide new insights into early antecedents of behavioural impairments in CHD.
Collapse
Affiliation(s)
- Alexandra F Bonthrone
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Andrew Chew
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Megan Ní Bhroin
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Trinity College Institute of Neuroscience and Cognitive Systems Group, Discipline of Psychiatry, School of Medicine, Trinity College, Dublin, Ireland
| | - Francesca Morassutti Rech
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Christopher J Kelly
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Daan Christiaens
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department of Electrical Engineering (ESAT/PSI), KU Leuven, Leuven, Belgium
| | - Maximilian Pietsch
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J-Donald Tournier
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid & CIBER-BBN, Madrid, Spain
| | - Anthony Price
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Alexia Egloff
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Kuberan Pushparajah
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Paediatric Cardiology Department, Evelina London Children's Healthcare, London, UK
| | - John Simpson
- Paediatric Cardiology Department, Evelina London Children's Healthcare, London, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Chiara Nosarti
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
| |
Collapse
|
4
|
Teeuw J, Klein M, Mota NR, Brouwer RM, van ‘t Ent D, Al-Hassaan Z, Franke B, Boomsma DI, Hulshoff Pol HE. Multivariate Genetic Structure of Externalizing Behavior and Structural Brain Development in a Longitudinal Adolescent Twin Sample. Int J Mol Sci 2022; 23:ijms23063176. [PMID: 35328598 PMCID: PMC8949114 DOI: 10.3390/ijms23063176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 12/10/2022] Open
Abstract
Externalizing behavior in its more extreme form is often considered a problem to the individual, their families, teachers, and society as a whole. Several brain structures have been linked to externalizing behavior and such associations may arise if the (co)development of externalizing behavior and brain structures share the same genetic and/or environmental factor(s). We assessed externalizing behavior with the Child Behavior Checklist and Youth Self Report, and the brain volumes and white matter integrity (fractional anisotropy [FA] and mean diffusivity [MD]) with magnetic resonance imaging in the BrainSCALE cohort, which consisted of twins and their older siblings from 112 families measured longitudinally at ages 10, 13, and 18 years for the twins. Genetic covariance modeling based on the classical twin design, extended to also include siblings of twins, showed that genes influence externalizing behavior and changes therein (h2 up to 88%). More pronounced externalizing behavior was associated with higher FA (observed correlation rph up to +0.20) and lower MD (rph up to −0.20), with sizeable genetic correlations (FA ra up to +0.42; MD ra up to −0.33). The cortical gray matter (CGM; rph up to −0.20) and cerebral white matter (CWM; rph up to +0.20) volume were phenotypically but not genetically associated with externalizing behavior. These results suggest a potential mediating role for global brain structures in the display of externalizing behavior during adolescence that are both partially explained by the influence of the same genetic factor.
Collapse
Affiliation(s)
- Jalmar Teeuw
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (R.M.B.); (Z.A.-H.); (H.E.H.P.)
- Correspondence: ; Tel.: +31-(088)-75-53-387
| | - Marieke Klein
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA;
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (N.R.M.); (B.F.)
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 XZ Nijmegen, The Netherlands
| | - Nina Roth Mota
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (N.R.M.); (B.F.)
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 XZ Nijmegen, The Netherlands
| | - Rachel M. Brouwer
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (R.M.B.); (Z.A.-H.); (H.E.H.P.)
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Dennis van ‘t Ent
- Department of Biological Psychology, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.v.‘t.E.); (D.I.B.)
| | - Zyneb Al-Hassaan
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (R.M.B.); (Z.A.-H.); (H.E.H.P.)
| | - Barbara Franke
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (N.R.M.); (B.F.)
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 XZ Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Dorret I. Boomsma
- Department of Biological Psychology, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.v.‘t.E.); (D.I.B.)
- Amsterdam Public Health (APH) Research Institute, 1081 BT Amsterdam, The Netherlands
| | - Hilleke E. Hulshoff Pol
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (R.M.B.); (Z.A.-H.); (H.E.H.P.)
- Department of Psychology, Utrecht University, 3584 CS Utrecht, The Netherlands
| |
Collapse
|
5
|
Wagels L, Habel U, Raine A, Clemens B. Neuroimaging, hormonal and genetic biomarkers for pathological aggression — success or failure? Curr Opin Behav Sci 2022. [DOI: 10.1016/j.cobeha.2021.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
6
|
Simonetti A, Kurian S, Saxena J, Verrico CD, Restaino A, Di Nicola M, Soares JC, Sani G, Saxena K. Cortical Correlates of Impulsive Aggressive Behavior in Pediatric Bipolar Disorder. Front Psychiatry 2021; 12:674707. [PMID: 34366914 PMCID: PMC8333699 DOI: 10.3389/fpsyt.2021.674707] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Impulsive aggression represents a frequent characteristic of pediatric bipolar disorder (PBD). Cortical alterations associated with impulsive aggression and its multiple facets have not been investigated yet in youth with bipolar disorder. Aim: To investigate the relationship between cortical thickness and facets of impulsive aggression in youth with PBD. Materials and Methods: Twenty-three youth with PBD and 23 healthy controls (HC) were administered the aggression questionnaire (AQ) and underwent 3T magnetic resonance imaging scan. Cortical thickness was assessed with FreeSurfer. Canonical correlation analyses were used to investigate the relationship between AQ total and subscale scores and cortical thickness in youth with PBD. Results: Youth with PBD had increased scores in the subscales of AQ-anger and AQ-hostility and cortical thinning in in areas belonging to the affective network (AN), frontoparietal network (FPN) and cingulo-opercular network (CON), i.e., right rostral anterior cingulate, right caudal anterior cingulate, right lateral orbitofrontal, right medial orbitofrontal, left and right inferior parietal, left posterior cingulate, left and right supramarginal left lingual cortices. Greater thickness in these networks positively correlated with the AQ-hostility subscale and negatively correlated with AQ-anger subscale. Conclusions: The opposite patterns observed between areas belonging to AN, FPN, CON, and the two facets of IA, namely anger and hostility, corroborate clinical findings supporting the different nature of these two constructs.
Collapse
Affiliation(s)
- Alessio Simonetti
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario “Agostino Gemelli” Istituto di Ricovero e Cura a Carattere Scientific (IRCCS), Rome, Italy
| | - Sherin Kurian
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
- Department of Psychiatry, Texas Children's Hospital, Houston, TX, United States
| | - Johanna Saxena
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
- Department of Psychiatry, Texas Children's Hospital, Houston, TX, United States
| | - Christopher D. Verrico
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Antonio Restaino
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Di Nicola
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario “Agostino Gemelli” Istituto di Ricovero e Cura a Carattere Scientific (IRCCS), Rome, Italy
| | - Jair C. Soares
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, United States
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario “Agostino Gemelli” Istituto di Ricovero e Cura a Carattere Scientific (IRCCS), Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Kirti Saxena
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
- Department of Psychiatry, Texas Children's Hospital, Houston, TX, United States
| |
Collapse
|