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Palermo F, Chen Y, Capstick A, Fletcher-Loyd N, Walsh C, Kouchaki S, True J, Balazikova O, Soreq E, Scott G, Rostill H, Nilforooshan R, Barnaghi P. TIHM: An open dataset for remote healthcare monitoring in dementia. Sci Data 2023; 10:606. [PMID: 37689815 PMCID: PMC10492790 DOI: 10.1038/s41597-023-02519-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023] Open
Abstract
Dementia is a progressive condition that affects cognitive and functional abilities. There is a need for reliable and continuous health monitoring of People Living with Dementia (PLWD) to improve their quality of life and support their independent living. Healthcare services often focus on addressing and treating already established health conditions that affect PLWD. Managing these conditions continuously can inform better decision-making earlier for higher-quality care management for PLWD. The Technology Integrated Health Management (TIHM) project developed a new digital platform to routinely collect longitudinal, observational, and measurement data, within the home and apply machine learning and analytical models for the detection and prediction of adverse health events affecting the well-being of PLWD. This work describes the TIHM dataset collected during the second phase (i.e., feasibility study) of the TIHM project. The data was collected from homes of 56 PLWD and associated with events and clinical observations (daily activity, physiological monitoring, and labels for health-related conditions). The study recorded an average of 50 days of data per participant, totalling 2803 days.
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Affiliation(s)
- Francesca Palermo
- Imperial College London, Department of Brain Sciences, London, W12 0NN, UK
- The UK Dementia Research Institute, Care Research and Technology Centre, London, W1T 7NF, UK
| | - Yu Chen
- Imperial College London, Department of Brain Sciences, London, W12 0NN, UK
- The UK Dementia Research Institute, Care Research and Technology Centre, London, W1T 7NF, UK
| | - Alexander Capstick
- Imperial College London, Department of Brain Sciences, London, W12 0NN, UK
- The UK Dementia Research Institute, Care Research and Technology Centre, London, W1T 7NF, UK
| | - Nan Fletcher-Loyd
- Imperial College London, Department of Brain Sciences, London, W12 0NN, UK
- The UK Dementia Research Institute, Care Research and Technology Centre, London, W1T 7NF, UK
| | - Chloe Walsh
- Imperial College London, Department of Brain Sciences, London, W12 0NN, UK
- The UK Dementia Research Institute, Care Research and Technology Centre, London, W1T 7NF, UK
- Surrey and Borders Partnership NHS Trust, Leatherhead, KT22 7AD, UK
| | - Samaneh Kouchaki
- The UK Dementia Research Institute, Care Research and Technology Centre, London, W1T 7NF, UK
- University of Surrey, Guildford, GU2 7XH, UK
| | - Jessica True
- Surrey and Borders Partnership NHS Trust, Leatherhead, KT22 7AD, UK
| | - Olga Balazikova
- Surrey and Borders Partnership NHS Trust, Leatherhead, KT22 7AD, UK
| | - Eyal Soreq
- Imperial College London, Department of Brain Sciences, London, W12 0NN, UK
- The UK Dementia Research Institute, Care Research and Technology Centre, London, W1T 7NF, UK
| | - Gregory Scott
- Imperial College London, Department of Brain Sciences, London, W12 0NN, UK
- The UK Dementia Research Institute, Care Research and Technology Centre, London, W1T 7NF, UK
| | - Helen Rostill
- Imperial College London, Department of Brain Sciences, London, W12 0NN, UK
- The UK Dementia Research Institute, Care Research and Technology Centre, London, W1T 7NF, UK
- Surrey and Borders Partnership NHS Trust, Leatherhead, KT22 7AD, UK
| | - Ramin Nilforooshan
- Imperial College London, Department of Brain Sciences, London, W12 0NN, UK
- The UK Dementia Research Institute, Care Research and Technology Centre, London, W1T 7NF, UK
- Surrey and Borders Partnership NHS Trust, Leatherhead, KT22 7AD, UK
| | - Payam Barnaghi
- Imperial College London, Department of Brain Sciences, London, W12 0NN, UK.
- The UK Dementia Research Institute, Care Research and Technology Centre, London, W1T 7NF, UK.
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Scott G. A transformational 'weird feeling': dysembryoplastic neuroepithelial tumour. Pract Neurol 2023; 23:170-172. [PMID: 36517222 DOI: 10.1136/pn-2022-003618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Gregory Scott
- Department of Brain Sciences, Imperial College London, London, UK
- UK Dementia Research Institute Care Research & Technology Centre, Imperial College London, London, UK
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3
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Vonberg FW, Dawson A, Scott G, Davies N. Aciclovir-induced neurotoxicity. Pract Neurol 2023; 23:157-159. [PMID: 36601749 DOI: 10.1136/pn-2022-003597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 12/13/2022]
Abstract
Aciclovir-induced neurotoxicity results from the accumulation of aciclovir and its metabolite 9-carboxymethoxymethylguanine (CMMG). It occurs predominantly in older patients with impaired renal function and is characterised by a combination of confusion and psychiatric changes. Seizures, myoclonus and dysarthria may also occur. Critically, peritoneal dialysis has little effect on reversing the toxic effects of aciclovir. We describe a woman in her 70s with renal failure who developed confusion and seizures after receiving aciclovir. She was ultimately diagnosed with aciclovir-induced neurotoxicity, confirmed by an elevated serum CMMG concentration. This condition is likely to be underdiagnosed and the neurologist's primary challenge is differentiating aciclovir-induced neurotoxicity from viral encephalitis.
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Affiliation(s)
- Frederick William Vonberg
- Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
- Department of Neurology, Chelsea and Westminster Healthcare NHS Trust, London, UK
| | - Angelo Dawson
- Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
| | - Gregory Scott
- Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | - Nicholas Davies
- Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
- Department of Neurology, Chelsea and Westminster Healthcare NHS Trust, London, UK
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David MCB, Kolanko M, Del Giovane M, Lai H, True J, Beal E, Li LM, Nilforooshan R, Barnaghi P, Malhotra PA, Rostill H, Wingfield D, Wilson D, Daniels S, Sharp DJ, Scott G. Remote Monitoring of Physiology in People Living With Dementia: An Observational Cohort Study. JMIR Aging 2023; 6:e43777. [PMID: 36892931 PMCID: PMC10037178 DOI: 10.2196/43777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/09/2023] [Accepted: 01/31/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Internet of Things (IoT) technology enables physiological measurements to be recorded at home from people living with dementia and monitored remotely. However, measurements from people with dementia in this context have not been previously studied. We report on the distribution of physiological measurements from 82 people with dementia over approximately 2 years. OBJECTIVE Our objective was to characterize the physiology of people with dementia when measured in the context of their own homes. We also wanted to explore the possible use of an alerts-based system for detecting health deterioration and discuss the potential applications and limitations of this kind of system. METHODS We performed a longitudinal community-based cohort study of people with dementia using "Minder," our IoT remote monitoring platform. All people with dementia received a blood pressure machine for systolic and diastolic blood pressure, a pulse oximeter measuring oxygen saturation and heart rate, body weight scales, and a thermometer, and were asked to use each device once a day at any time. Timings, distributions, and abnormalities in measurements were examined, including the rate of significant abnormalities ("alerts") defined by various standardized criteria. We used our own study criteria for alerts and compared them with the National Early Warning Score 2 criteria. RESULTS A total of 82 people with dementia, with a mean age of 80.4 (SD 7.8) years, recorded 147,203 measurements over 958,000 participant-hours. The median percentage of days when any participant took any measurements (ie, any device) was 56.2% (IQR 33.2%-83.7%, range 2.3%-100%). Reassuringly, engagement of people with dementia with the system did not wane with time, reflected in there being no change in the weekly number of measurements with respect to time (1-sample t-test on slopes of linear fit, P=.45). A total of 45% of people with dementia met criteria for hypertension. People with dementia with α-synuclein-related dementia had lower systolic blood pressure; 30% had clinically significant weight loss. Depending on the criteria used, 3.03%-9.46% of measurements generated alerts, at 0.066-0.233 per day per person with dementia. We also report 4 case studies, highlighting the potential benefits and challenges of remote physiological monitoring in people with dementia. These include case studies of people with dementia developing acute infections and one of a person with dementia developing symptomatic bradycardia while taking donepezil. CONCLUSIONS We present findings from a study of the physiology of people with dementia recorded remotely on a large scale. People with dementia and their carers showed acceptable compliance throughout, supporting the feasibility of the system. Our findings inform the development of technologies, care pathways, and policies for IoT-based remote monitoring. We show how IoT-based monitoring could improve the management of acute and chronic comorbidities in this clinically vulnerable group. Future randomized trials are required to establish if a system like this has measurable long-term benefits on health and quality of life outcomes.
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Affiliation(s)
- Michael C B David
- UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London, United Kingdom
| | - Magdalena Kolanko
- UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London, United Kingdom
| | - Martina Del Giovane
- UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London, United Kingdom
| | - Helen Lai
- UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London, United Kingdom
| | - Jessica True
- UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London, United Kingdom
| | - Emily Beal
- UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London, United Kingdom
| | - Lucia M Li
- UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London, United Kingdom
| | - Ramin Nilforooshan
- UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London, United Kingdom
| | - Payam Barnaghi
- UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London, United Kingdom
| | - Paresh A Malhotra
- UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London, United Kingdom
- Imperial College London, Brain Sciences, South Kensington, London, United Kingdom
| | - Helen Rostill
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, Surrey, United Kingdom
| | - David Wingfield
- UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London, United Kingdom
| | - Danielle Wilson
- UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London, United Kingdom
| | - Sarah Daniels
- UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London, United Kingdom
| | - David J Sharp
- UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London, United Kingdom
| | - Gregory Scott
- UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London, United Kingdom
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Loreto F, Gontsarova A, Scott G, Patel N, Win Z, Carswell C, Perry R, Malhotra P. Visual atrophy rating scales and amyloid PET status in an Alzheimer's disease clinical cohort. Ann Clin Transl Neurol 2023; 10:619-631. [PMID: 36872523 PMCID: PMC10109315 DOI: 10.1002/acn3.51749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 03/07/2023] Open
Abstract
OBJECTIVES Visual rating scales (VRS) are the quantification method closest to the approach used in routine clinical practice to assess brain atrophy. Previous studies have suggested that the medial temporal atrophy (MTA) rating scale is a reliable diagnostic marker for AD, equivalent to volumetric quantification, while others propose a higher diagnostic utility for the Posterior Atrophy (PA) scale in early-onset AD. METHODS Here, we reviewed 14 studies that assessed the diagnostic accuracy of PA and MTA, we explored the issue of cut-off heterogeneity, and assessed 9 rating scales in a group of patients with biomarker-confirmed diagnosis. A neuroradiologist blinded to all clinical information rated the MR images of 39 amyloid-positive and 38 amyloid-negative patients using 9 validated VRS assessing multiple brain regions. Automated volumetric analyses were performed on a subset of patients (n = 48) and on a group of cognitively normal individuals (n = 28). RESULTS No single VRS could differentiate amyloid-positive from amyloid-negative patients with other neurodegenerative conditions. 44% of amyloid-positive patients were deemed to have age-appropriate levels of MTA. In the amyloid-positive group, 18% had no abnormal MTA or PA scores. These findings were substantially affected by cut-off selection. Amyloid-positive and amyloid-negative patients had comparable hippocampal and parietal volumes, and MTA but not PA scores correlated with the respective volumetric measures. INTERPRETATION Consensus guidelines are needed before VRS can be recommended for use in the diagnostic workup of AD. Our data are suggestive of high intragroup variability and non-superiority of volumetric quantification of atrophy over visual assessment.
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Affiliation(s)
- Flavia Loreto
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | | | - Gregory Scott
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.,UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, London, UK
| | - Neva Patel
- Department of Nuclear Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Zarni Win
- Department of Nuclear Medicine, Imperial College Healthcare NHS Trust, London, UK
| | | | - Richard Perry
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.,Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
| | - Paresh Malhotra
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.,UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, London, UK.,Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
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6
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Kurtin DL, Scott G, Hebron H, Skeldon AC, Violante IR. Task-based differences in brain state dynamics and their relation to cognitive ability. Neuroimage 2023; 271:119945. [PMID: 36870433 DOI: 10.1016/j.neuroimage.2023.119945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/06/2023] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Transient patterns of interregional connectivity form and dissipate in response to varying cognitive demands. Yet, it is not clear how different cognitive demands influence brain state dynamics, and whether these dynamics relate to general cognitive ability. Here, using functional magnetic resonance imaging (fMRI) data, we characterised shared, recurrent, global brain states in 187 participants across the working memory, emotion, language, and relation tasks from the Human Connectome Project. Brain states were determined using Leading Eigenvector Dynamics Analysis (LEiDA). In addition to the LEiDA-based metrics of brain state lifetimes and probabilities, we also computed information-theoretic measures of Block Decomposition Method of complexity, Lempel-Ziv complexity and transition entropy. Information theoretic metrics are notable in their ability to compute relationships amongst sequences of states over time, compared to lifetime and probability, which capture the behaviour of each state in isolation. We then related task-based brain state metrics to fluid intelligence. We observed that brain states exhibited stable topology across a range of numbers of clusters (K = 2:15). Most metrics of brain state dynamics, including state lifetime, probability, and all information theoretic metrics, reliably differed between tasks. However, relationships between state dynamic metrics and cognitive abilities varied according to the task, the metric, and the value of K, indicating that there are contextual relationships between task-dependant state dynamics and trait cognitive ability. This study provides evidence that the brain reconfigures across time in response to cognitive demands, and that there are contextual, rather than generalisable, relationships amongst task, state dynamics, and cognitive ability.
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Affiliation(s)
- Danielle L Kurtin
- NeuroModulation Lab, Department of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK; Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.
| | - Gregory Scott
- UK Dementia Research Institute, Care Research and Technology Centre at Imperial College, London and the University of Surrey, Guildford, UK; Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Henry Hebron
- NeuroModulation Lab, Department of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK; UK Dementia Research Institute, Care Research and Technology Centre at Imperial College, London and the University of Surrey, Guildford, UK
| | - Anne C Skeldon
- UK Dementia Research Institute, Care Research and Technology Centre at Imperial College, London and the University of Surrey, Guildford, UK; Department of Mathematics, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, UK
| | - Ines R Violante
- NeuroModulation Lab, Department of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
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Kent T, Scott G, Seifert R. A case of clinically aggressive EBV-negative ENKTL in a non-Asian female patient. J Hematop 2023; 16:33-38. [PMID: 38175370 DOI: 10.1007/s12308-023-00529-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The patient was a 65-year-old White woman who presented to dermatology with a painless, rapidly growing exophytic nodule on her left upper cheek. AIMS/PURPOSE In this case report, we aim to demonstrate the difficulty of diagnosing Epstein-Barr virus-negative extranodal NK cell lymphomas given the broad differential of NK cell lymphomas and the rarity of EBV-negative extranodal NK cell lymphoma. METHODS Immunohistochemical studies confirmed the diagnosis of cutaneous, extranodal NK cell lymphoma. Interestingly, Epstein-Barr virus in situ hybridization was negative, which is unusual for most NK cell lymphomas. RESULTS/CONCLUSIONS In our view, a combination of immunohistochemistry, clonality assessment, sequencing, and flow cytometric studies is required.
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Affiliation(s)
- Thomas Kent
- University of Florida College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Gregory Scott
- Department of Pathology, Immunology & Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Robert Seifert
- Department of Pathology, Immunology & Laboratory Medicine, University of Florida, Gainesville, FL, USA
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8
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Vonberg F, Dawson A, Scott G. Cryptic confusion. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Neurotoxicity is often a late consideration, particularly if the neurotoxic agent is given with therapeutic intent, because the poisoning occurs without the diagnostic clues typical of an intentional attack. We present the case of a 76 year old woman with renal failure, who was admitted with confusion and hal- lucinations. Several days previously, she had started Aciclovir because of a vesicular rash. Her condition was attributed to varicella zoster encephalitis and she was switched from oral to intravenous Aciclovir. Two days later, and after peritoneal dialysis, she had deteriorated further, becoming completely unre- sponsive with upper limb myoclonus.The 9-Carboxymethoxymethylguanine (CMMG) level was elevated at 21.2 mg/L (normal <2mg/L). A diagnosis of Aciclovir-induced neurotoxicity (AIN) was made. Aciclovir was stopped, the patient received haemodialysis, and she made a significant recovery.AIN occurs almost exclusively in patients with renal failure. Reduced excretion of Aciclovir, or its prodrug Valaciclovir, results in the toxic accumulation of CMMG. Critically, peritoneal dialysis has little effect on removing Aciclovir. AIN is characterised by triad of hallucinations, involuntary movements, and delusions of death, including Cotard’s syndrome. Diagnosis is challenging as AIN can resemble viral encephalitis. AIN should be considered in encephalopathic patients with renal failure who are taking Aciclovir.
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Jones B, Cammidge J, Evan C, Scott G, Sherriffs P, Breen F, Andersen P, Popov K, O'Hara J. Degradation of polymer banknotes through handling, and effect on fingermark visualisation. Sci Justice 2022; 62:644-656. [DOI: 10.1016/j.scijus.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/12/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022]
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Alim-Marvasti A, Romagnoli G, Pérez-García F, Geranmayeh F, Scott G, Shahrbaf S, Chowdhury FA, Diehl B, Clarkson M, Duncan J. 006 Seizure focus prediction from seizure semiology: data-driven cortical probabilis- tic heatmaps from 4643 patients. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Seizure semiology is important in the evaluation of patients with drug resistant focal epilepsy to help later- alise and localise the seizure onset zone for curative resection. The localising values of initial semiology are widely variable. We created the Semiology-to-Brain Database and 3D Visualisation Tool (SVT) to objectively localise the seizure focus, from an individual-participant systematic review, as per PRISMA guidelines. This yielded 11230 localising and 2391 lateralising semiology datapoints from 4643 patients across 309 studies.We integrated SVT into the freely available 3D-Slicer software with a graphical user interface, enabling visualisations of semiologies as probabilistic cortical heatmaps.We used SVT to predict the seizure-focus for a random retrospective patient: a 28-year-old right-handed gentleman. He had nocturnal generalised seizures from age 12yrs and subsequently developed stereo- typed head and eye versions to the right, tonic left leg extension and raising of the left arm with speech arrest. Ictal scalp EEG was non lateralising and interictal EEG showed bitemporal sharp waves. MRI showed cortical dysplasia in the left superior frontal gyrus and ictal SPECT highlighted the superior more than middle frontal gyrus. After intracranial EEG, a limited resection including the supplementary motor area resulted in complete seizure-freedom (ILAE 1) for four years of follow up.We demonstrate that the SVT prediction, blinded to MRI and EEG data, is congruent with the actual resection.alijesusalim-marvasti@nhs.net28
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Simeone CA, Andrews JP, Johnson SP, Casalia M, Kochanski R, Chang EF, Cameron D, Dennison S, Inglis B, Scott G, Kruse-Elliott K, Okonski FF, Calvo E, Goulet K, Robles D, Griffin-Stence A, Kuiper E, Krasovec L, Field CL, Hoard VF, Baraban SC. Xenotransplantation of porcine progenitor cells in an epileptic California sea lion (Zalophus californianus): illustrative case. J Neurosurg Case Lessons 2022; 3:CASE21417. [PMID: 36273868 PMCID: PMC9379678 DOI: 10.3171/case21417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/06/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Domoic acid (DA) is a naturally occurring neurotoxin harmful to marine animals and humans. California sea lions exposed to DA in prey during algal blooms along the Pacific coast exhibit significant neurological symptoms, including epilepsy with hippocampal atrophy. OBSERVATIONS Here the authors describe a xenotransplantation procedure to deliver interneuron progenitor cells into the damaged hippocampus of an epileptic sea lion with suspected DA toxicosis. The sea lion has had no evidence of seizures after the procedure, and clinical measures of well-being, including weight and feeding habits, have stabilized. LESSONS These preliminary results suggest xenotransplantation has improved the quality of life for this animal and holds tremendous therapeutic promise.
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Affiliation(s)
- Claire A. Simeone
- Sea Change Health, Kentfield, California
- Six Flags Discovery Kingdom, Vallejo, California
| | - John P. Andrews
- Department of Neurological Surgery & Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, California
| | | | - Mariana Casalia
- Department of Neurological Surgery & Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, California
| | - Ryan Kochanski
- Department of Neurological Surgery & Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, California
| | - Edward F. Chang
- Department of Neurological Surgery & Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, California
| | | | | | - Ben Inglis
- Henry H. Wheeler, Jr. Brain Imaging Center, University of California, Berkeley, Berkeley, California
| | | | | | - F. Fabian Okonski
- Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children’s Hospital at Stanford, Stanford School of Medicine, Stanford, California
| | - Eric Calvo
- Six Flags Discovery Kingdom, Vallejo, California
| | - Kelly Goulet
- Six Flags Discovery Kingdom, Vallejo, California
| | - Dawn Robles
- Six Flags Discovery Kingdom, Vallejo, California
| | | | - Erin Kuiper
- Six Flags Discovery Kingdom, Vallejo, California
| | | | - Cara L. Field
- The Marine Mammal Center, Sausalito, California; and
| | | | - Scott C. Baraban
- Department of Neurological Surgery & Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, California
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Saeed M, Scott G, Murphy S. Teaching Video NeuroImage: Tongue Tremor as a Presenting Feature of Progressive Supranuclear Palsy. Neurology 2022; 98:642. [PMID: 35145003 DOI: 10.1212/wnl.0000000000200147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mamoun Saeed
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Chelsea and Westminster Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Gregory Scott
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Chelsea and Westminster Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Stephen Murphy
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK .,Chelsea and Westminster Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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13
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Britton Z, Scott G. Ocular Ipsipulsion Caused by Posterior Inferior Cerebellar Artery Stroke. Stroke 2022; 53:e122-e125. [PMID: 35135321 DOI: 10.1161/strokeaha.121.037510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Zelie Britton
- National Hospital for Neurology and Neurosurgery, London, United Kingdom (Z.B., G.S.)
| | - Gregory Scott
- National Hospital for Neurology and Neurosurgery, London, United Kingdom (Z.B., G.S.).,Department of Brain Sciences, Imperial College London, United Kingdom (G.S.)
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14
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David M, Barnaghi P, Nilforooshan R, Rostill H, Soreq E, Sharp DJ, Scott G. Home monitoring of vital signs and generation of alerts in a cohort of people living with dementia. Alzheimers Dement 2021. [DOI: 10.1002/alz.055151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Michael David
- UK Dementia Research Institute Centre for Care Research and Technology London United Kingdom
| | - Payam Barnaghi
- UK Dementia Research Institute Centre for Care Research and Technology London United Kingdom
| | | | - Helen Rostill
- Surrey and Borders Partnership NHS Trust Leatherhead United Kingdom
| | - Eyal Soreq
- UK Dementia Research Institute Centre for Care Research and Technology London United Kingdom
| | - David J Sharp
- UK Dementia Research Institute Centre for Care Research and Technology London United Kingdom
- Imperial College London London United Kingdom
| | - Gregory Scott
- UK Dementia Research Institute Centre for Care Research and Technology London United Kingdom
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15
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Kaur H, Reyes-Barron C, Scott G. Immunohistochemistry Aids in the Diagnosis of Blastic Plasmacytoid Dendritic Cell Neoplasm in a Patient with Multiple Cutaneous Plaques and Nodules. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN) is a rare hematologic malignancy of plasmacytoid dendritic cell precursors with an estimated incidence of 0.04 cases per 100,000 in the US. Given the cutaneous tropism of BPDCN, it should be differentiated from other CD56+ hematopoietic neoplasms with skin involvement such as CD56+ AML, extranodal NK/T-cell lymphoma, and other T-cell lymphomas.
Methods/Case Report
A 71-year-old male presented to the emergency department with asymptomatic, pink- violaceous plaques/nodules on the trunk for 3 months. One month prior, a dermatologist diagnosed epidermal inclusion cysts that were left untreated. The nodules progressed and a course of steroids prescribed by a primary care physician provided short term improvement before the lesions flared again. Review of systems and vitals were normal. Biopsies of representative lesions sent for histologic examination showed a diffuse dermal infiltrate of small to medium atypical cells with irregular nuclear contours, fine chromatin, one to several nucleoli and scant cytoplasm. Immunohistochemistry showed these cells were positive for CD2, CD4, CD56 and CD45 with strong expression of BCL2 and focal CD123. The cells were negative for CD3, CD20, CD79a, CD8, CD30, ALK-1, MUM-1, CD10, Cyclin- D1, C-MYC, EBER, BCL6, Langerin, Granzyme, TIA1, CD68, CD163, MPO, and Lysozyme. The histology and immunoprofile were consistent with BPDCN. A bone marrow biopsy showed cells with similar morphology and staining pattern, including expression of CD123.Treatment with chemotherapy and Tagraxofusp, was initiated. Within a week, the patient showed near resolution of cutaneous lesions. Repeat bone marrow aspirate and flow cytometry a month later showed no malignant cells.
Results (if a Case Study enter NA)
NA
Conclusion
We present this case as a rare hematologic malignancy with a challenging clinical and histopathologic diagnosis. The histologic findings suggested either a high grade myeloid or lymphoid malignancy. The combination of CD3-/CD56+/CD4+/CD123+ in the lesional cells helped establish the diagnosis of BPDCN, allowing for prompt treatment.
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Affiliation(s)
- H Kaur
- Pathology, URMC, Rochester, New York, UNITED STATES
| | | | - G Scott
- Pathology, URMC, Rochester, New York, UNITED STATES
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16
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Waheed A, Presswood E, Scott G. Organisational values of National Health Service trusts in England: semantic analysis and relation to performance indicators. leader 2021; 6:192-198. [DOI: 10.1136/leader-2021-000512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/20/2021] [Indexed: 11/04/2022]
Abstract
BackgroundOrganisational values are widely assumed to have positive effects on performance and staff. National Health Service (NHS) trusts in England have accordingly chosen their own organisational values. However, there has been no survey of the values adopted, and there is little evidence that the choice of values per se has consequences for outcomes. We comprehensively described trusts’ organisational values, using natural language processing to identify common themes. We tested whether the choice of themes was associated with outcomes for patients and staff.MethodsWe collected data on trusts’ values (from their websites), performance (Summary Hospital-level Mortality Indicator (SHMI) statistics, Care Quality Commission (CQC) ratings), sickness absence rates (SAR) and staff opinions (NHS Staff Survey responses). We first characterised values based on lexical properties then progressed to semantic analysis, using Google’s Universal Sentence Encoder, to transform values to high-dimensional embeddings, and k-means clustering of embeddings to semantically cluster values into 12 common themes. We tested for associations between trusts’ use of these themes and outcomes.ResultsOrganisational values were obtained for 221 of 228 NHS trusts, with 985 values in total (480 unique). Semantic clustering identified themes including ‘care’, ‘value respect’ and ‘togetherness’. There was no significant association between themes and SHMI or CQC ratings. However, themes predicted trusts’ SAR (p=0.001, R2=0.159), with use of ‘care’, ‘value respect’, ‘aspirational’ and ‘people’ all significant predictors of increased sickness absence; themes also predicted staff opinions on ‘Equality, diversity and inclusion’ (p=0.011, R2=0.116), but with ‘supportive’ and ‘openness’ predicting more negative responses.ConclusionA trust’s adoption of individualised organisational values does not seem to make a positive difference to its patients or staff. These findings should give NHS managers pause for thought, challenging them to reconsider their reliance on value-defining initiatives, and to seek evidence that a focus on values has measurable benefits on outcomes.
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17
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Scott G, Waffa BJ, DeVoe RS, Harms CA, Lewbart GA. Successful and unsuccessful nonsurgical removal of ingested golf balls and an artificial egg in four rat snakes ( Pantherophis alleghaniensis). J Am Vet Med Assoc 2021; 258:1135-1141. [PMID: 33944601 DOI: 10.2460/javma.258.10.1135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION 4 wild adult rat snakes (Pantherophis alleghaniensis) were evaluated after ingesting spherical or ovoid foreign bodies. CLINICAL FINDINGS Physical examination revealed a large, firm mass at the level of the stomach in each snake. Radiographic findings were consistent with ingestion of a golf ball (3 snakes) or an artificial egg (1 snake). Signs consistent with prolonged impaction included scale loss, dermal abrasions, and apparent loss of body condition in one snake and regional skin ulceration, dehydration, and generalized muscle atrophy in another. TREATMENT AND OUTCOME Nonsurgical removal of the foreign body was attempted in anesthetized or heavily sedated snakes by external manipulation in the orad direction. A golf ball was removed through the oral cavity without complications in 1 snake. In the other 3 snakes, tension caused by the advancing foreign body resulted in full-thickness skin rupture in the cervical region. The procedure was completed with the use of a balloon catheter to aid foreign body advancement for 1 of the 3 snakes, and the skin defect was closed. The procedure was converted to esophagotomy for the other 2 snakes. Three snakes recovered and were released; 1 died of complications from prolonged impaction and esophageal perforation. CLINICAL RELEVANCE The described nonsurgical techniques for removal of ingested round or ovoid foreign bodies were associated with substantial complications in 3 of 4 treated rat snakes. Although a nonsurgical method for removal of ingested objects such as golf balls could benefit snakes, the methods used for these patients did not appear to be more beneficial than traditional gastrotomy.
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18
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Mallas EJ, De Simoni S, Scott G, Jolly AE, Hampshire A, Li LM, Bourke NJ, Roberts SAG, Gorgoraptis N, Sharp DJ. Abnormal dorsal attention network activation in memory impairment after traumatic brain injury. Brain 2021; 144:114-127. [PMID: 33367761 DOI: 10.1093/brain/awaa380] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/17/2020] [Accepted: 08/19/2020] [Indexed: 11/14/2022] Open
Abstract
Memory impairment is a common, disabling effect of traumatic brain injury. In healthy individuals, successful memory encoding is associated with activation of the dorsal attention network as well as suppression of the default mode network. Here, in traumatic brain injury patients we examined whether: (i) impairments in memory encoding are associated with abnormal brain activation in these networks; (ii) whether changes in this brain activity predict subsequent memory retrieval; and (iii) whether abnormal white matter integrity underpinning functional networks is associated with impaired subsequent memory. Thirty-five patients with moderate-severe traumatic brain injury aged 23-65 years (74% males) in the post-acute/chronic phase after injury and 16 healthy control subjects underwent functional MRI during performance of an abstract image memory encoding task. Diffusion tensor imaging was used to assess structural abnormalities across patient groups compared to 28 age-matched healthy controls. Successful memory encoding across all participants was associated with activation of the dorsal attention network, the ventral visual stream and medial temporal lobes. Decreased activation was seen in the default mode network. Patients with preserved episodic memory demonstrated increased activation in areas of the dorsal attention network. Patients with impaired memory showed increased left anterior prefrontal activity. White matter microstructure underpinning connectivity between core nodes of the encoding networks was significantly reduced in patients with memory impairment. Our results show for the first time that patients with impaired episodic memory show abnormal activation of key nodes within the dorsal attention network and regions regulating default mode network activity during encoding. Successful encoding was associated with an opposite direction of signal change between patients with and without memory impairment, suggesting that memory encoding mechanisms could be fundamentally altered in this population. We demonstrate a clear relationship between functional networks activated during encoding and underlying abnormalities within the structural connectome in patients with memory impairment. We suggest that encoding failures in this group are likely due to failed control of goal-directed attentional resources.
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Affiliation(s)
- Emma-Jane Mallas
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, London, UK
| | - Sara De Simoni
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, London, UK
| | - Gregory Scott
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, London, UK
| | - Amy E Jolly
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, London, UK
| | - Adam Hampshire
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, London, UK.,UK Dementia Research Institute, Care Research and Technology Centre, Imperial College London, London, UK
| | - Lucia M Li
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, London, UK.,UK Dementia Research Institute, Care Research and Technology Centre, Imperial College London, London, UK
| | - Niall J Bourke
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, London, UK
| | - Stuart A G Roberts
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, London, UK.,Academic Department of Military Surgery and Trauma (ADMST), Royal Centre for Defence Medicine (RCDM), Birmingham, UK
| | - Nikos Gorgoraptis
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, London, UK
| | - David J Sharp
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, London, UK.,UK Dementia Research Institute, Care Research and Technology Centre, Imperial College London, London, UK.,Royal British Legion Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, UK
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19
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Abstract
The COVID-19 global pandemic has forced the higher education sector to transition to an uncharted remote-learning format. This offers an opportunity to adopt active learning, which increases students’ performance compared to lectures, narrows achievement gaps for underrepresented students, and promotes equity and inclusivity, as the basis of STEM education.
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Affiliation(s)
- Stefano Sandrone
- The Computational, Cognitive and Clinical Neuroimaging Laboratory (C(3)NL), Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom.
| | - Gregory Scott
- The Computational, Cognitive and Clinical Neuroimaging Laboratory (C(3)NL), Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom.
| | - William J Anderson
- Department of Stem Cell and Regenerative Biology, Harvard University, and Harvard Stem Cell Institute, Cambridge, USA.
| | - Kiran Musunuru
- Cardiovascular Institute, Department of Medicine, and Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA.
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20
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Graham NSN, Jolly A, Zimmerman K, Bourke NJ, Scott G, Cole JH, Schott JM, Sharp DJ. Diffuse axonal injury predicts neurodegeneration after moderate-severe traumatic brain injury. Brain 2021; 143:3685-3698. [PMID: 33099608 DOI: 10.1093/brain/awaa316] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/16/2020] [Accepted: 08/03/2020] [Indexed: 11/14/2022] Open
Abstract
Traumatic brain injury is associated with elevated rates of neurodegenerative diseases such as Alzheimer's disease and chronic traumatic encephalopathy. In experimental models, diffuse axonal injury triggers post-traumatic neurodegeneration, with axonal damage leading to Wallerian degeneration and toxic proteinopathies of amyloid and hyperphosphorylated tau. However, in humans the link between diffuse axonal injury and subsequent neurodegeneration has yet to be established. Here we test the hypothesis that the severity and location of diffuse axonal injury predicts the degree of progressive post-traumatic neurodegeneration. We investigated longitudinal changes in 55 patients in the chronic phase after moderate-severe traumatic brain injury and 19 healthy control subjects. Fractional anisotropy was calculated from diffusion tensor imaging as a measure of diffuse axonal injury. Jacobian determinant atrophy rates were calculated from serial volumetric T1 scans as a measure of measure post-traumatic neurodegeneration. We explored a range of potential predictors of longitudinal post-traumatic neurodegeneration and compared the variance in brain atrophy that they explained. Patients showed widespread evidence of diffuse axonal injury, with reductions of fractional anisotropy at baseline and follow-up in large parts of the white matter. No significant changes in fractional anisotropy over time were observed. In contrast, abnormally high rates of brain atrophy were seen in both the grey and white matter. The location and extent of diffuse axonal injury predicted the degree of brain atrophy: fractional anisotropy predicted progressive atrophy in both whole-brain and voxelwise analyses. The strongest relationships were seen in central white matter tracts, including the body of the corpus callosum, which are most commonly affected by diffuse axonal injury. Diffuse axonal injury predicted substantially more variability in white matter atrophy than other putative clinical or imaging measures, including baseline brain volume, age, clinical measures of injury severity and microbleeds (>50% for fractional anisotropy versus <5% for other measures). Grey matter atrophy was not predicted by diffuse axonal injury at baseline. In summary, diffusion MRI measures of diffuse axonal injury are a strong predictor of post-traumatic neurodegeneration. This supports a causal link between axonal injury and the progressive neurodegeneration that is commonly seen after moderate/severe traumatic brain injury but has been of uncertain aetiology. The assessment of diffuse axonal injury with diffusion MRI is likely to improve prognostic accuracy and help identify those at greatest neurodegenerative risk for inclusion in clinical treatment trials.
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Affiliation(s)
- Neil S N Graham
- Department of Brain Sciences, Division of Medicine, Imperial College London, London, UK.,UK Dementia Research Institute, Centre for Care, Research and Technology, London, UK
| | - Amy Jolly
- Department of Brain Sciences, Division of Medicine, Imperial College London, London, UK.,UK Dementia Research Institute, Centre for Care, Research and Technology, London, UK
| | - Karl Zimmerman
- Department of Brain Sciences, Division of Medicine, Imperial College London, London, UK.,UK Dementia Research Institute, Centre for Care, Research and Technology, London, UK
| | - Niall J Bourke
- Department of Brain Sciences, Division of Medicine, Imperial College London, London, UK.,UK Dementia Research Institute, Centre for Care, Research and Technology, London, UK
| | - Gregory Scott
- Department of Brain Sciences, Division of Medicine, Imperial College London, London, UK.,UK Dementia Research Institute, Centre for Care, Research and Technology, London, UK
| | - James H Cole
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK.,Centre for Medical Image Computing, University College London, London, UK
| | - Jonathan M Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - David J Sharp
- Department of Brain Sciences, Division of Medicine, Imperial College London, London, UK.,UK Dementia Research Institute, Centre for Care, Research and Technology, London, UK.,Centre for Blast Injury Studies, Imperial College London, London, UK
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21
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Biggs A, Scott G, Solan MC, Williamson M. Achilles tendon rupture: what you need to know. Br J Hosp Med (Lond) 2021; 82:1-7. [PMID: 33646025 DOI: 10.12968/hmed.2020.0593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Heel pain and a history of a 'pop' or feeling 'something go' are the buzz phrases classically associated with Achilles tendon rupture. However, the diagnosis is often missed in clinical practice because of the assumption that this is a sporting injury suffered only by the young or middle-aged. In a sedentary older patient, the injury may be dismissed as an ankle sprain. If swelling is present but no injury is recalled then deep vein thrombosis is suspected, but Achilles rupture is not. The diagnosis of Achilles tendon rupture is clinical, based on history and examination. Radiological imaging (ultrasound scan) is useful to plan orthopaedic management and exclude concomitant deep vein thrombosis. In most cases, non-operative management with the ankle held plantar flexed in a boot is the current best practice.
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Affiliation(s)
- A Biggs
- Department of Trauma and Orthopaedics, Royal Surrey Hospital, Guildford, Surrey, UK
| | - G Scott
- Department of Trauma and Orthopaedics, Royal Surrey Hospital, Guildford, Surrey, UK
| | - M C Solan
- Department of Trauma and Orthopaedics, Royal Surrey Hospital, Guildford, Surrey, UK
| | - M Williamson
- Department of Trauma and Orthopaedics, Royal Surrey Hospital, Guildford, Surrey, UK
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22
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Farber ON, Weingarden A, Lee C, Braxton DR, Bingham D, Scott G, Fernandez-Becker N, Goff D, Shelton A, Kin C. Not in the Same Vein: Inflammatory Bowel Disease, Malignancy, and Enterocolic Lymphocytic Phlebitis. Dig Dis Sci 2021; 66:413-418. [PMID: 32594463 DOI: 10.1007/s10620-020-06425-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Orly N Farber
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3690, Stanford, CA, 94305, USA
| | - Alexa Weingarden
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway, Pavilion C, 3rd Floor, Redwood City, CA, 94063, USA
| | - Christopher Lee
- Department of Gastroenterology and Hepatology, Hoag Memorial Hospital Presbyterian, 520 Superior Ave. Suite 290, Newport Beach, CA, 92663, USA
| | - David R Braxton
- Department of Pathology, Hoag Memorial Hospital Presbyterian, 1 Hoag Drive, Newport Beach, CA, 92663, USA
| | - David Bingham
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2210, Stanford, CA, 94305, USA
| | - Gregory Scott
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2210, Stanford, CA, 94305, USA
| | - Nielsen Fernandez-Becker
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway, Pavilion C, 3rd Floor, Redwood City, CA, 94063, USA
| | - Daniel Goff
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Andrew Shelton
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3690, Stanford, CA, 94305, USA
| | - Cindy Kin
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3690, Stanford, CA, 94305, USA.
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23
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Beppi C, Ribeiro Violante I, Scott G, Sandrone S. EEG, MEG and neuromodulatory approaches to explore cognition: Current status and future directions. Brain Cogn 2021; 148:105677. [PMID: 33486194 DOI: 10.1016/j.bandc.2020.105677] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/26/2020] [Accepted: 12/27/2020] [Indexed: 01/04/2023]
Abstract
Neural oscillations and their association with brain states and cognitive functions have been object of extensive investigation over the last decades. Several electroencephalography (EEG) and magnetoencephalography (MEG) analysis approaches have been explored and oscillatory properties have been identified, in parallel with the technical and computational advancement. This review provides an up-to-date account of how EEG/MEG oscillations have contributed to the understanding of cognition. Methodological challenges, recent developments and translational potential, along with future research avenues, are discussed.
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Affiliation(s)
- Carolina Beppi
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland; Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
| | - Inês Ribeiro Violante
- Computational, Cognitive and Clinical Neuroscience Laboratory (C3NL), Department of Brain Sciences, Imperial College London, London, United Kingdom; School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.
| | - Gregory Scott
- Computational, Cognitive and Clinical Neuroscience Laboratory (C3NL), Department of Brain Sciences, Imperial College London, London, United Kingdom.
| | - Stefano Sandrone
- Computational, Cognitive and Clinical Neuroscience Laboratory (C3NL), Department of Brain Sciences, Imperial College London, London, United Kingdom.
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24
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Huang AC, Montiel-Esparza R, Scott G, Martin B, Bruzoni M, Kadapakkam M, Namjoshi SS. A Novel Case of Carcinoid Tumor in a Pediatric Patient With Short Bowel Syndrome Secondary to Gastroschisis. JPGN Rep 2020; 1:e023. [PMID: 37206611 PMCID: PMC10191495 DOI: 10.1097/pg9.0000000000000023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/13/2020] [Indexed: 05/21/2023]
Affiliation(s)
- Alice C. Huang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Lucile Packard Children’s Hospital, Palo Alto, California
| | - Raul Montiel-Esparza
- Department of Pediatric Hematology and Oncology, Lucile Packard Children’s Hospital, Palo Alto, California
| | - Gregory Scott
- Department of Pathology, Lucile Packard Children’s Hospital, Palo Alto, California
| | - Brock Martin
- Department of Pathology, Lucile Packard Children’s Hospital, Palo Alto, California
| | - Matias Bruzoni
- Department of Pediatric Surgery, Lucile Packard Children’s Hospital, Palo Alto, California
| | - Meena Kadapakkam
- Department of Pediatric Hematology and Oncology, Lucile Packard Children’s Hospital, Palo Alto, California
| | - Shweta S. Namjoshi
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Lucile Packard Children’s Hospital, Palo Alto, California
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25
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Joshi RP, Pejaver V, Hammarlund NE, Sung H, Lee SK, Furmanchuk A, Lee HY, Scott G, Gombar S, Shah N, Shen S, Nassiri A, Schneider D, Ahmad FS, Liebovitz D, Kho A, Mooney S, Pinsky BA, Banaei N. A predictive tool for identification of SARS-CoV-2 PCR-negative emergency department patients using routine test results. J Clin Virol 2020; 129:104502. [PMID: 32544861 PMCID: PMC7286235 DOI: 10.1016/j.jcv.2020.104502] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 01/08/2023]
Abstract
Background Testing for COVID-19 remains limited in the United States and across the world. Poor allocation of limited testing resources leads to misutilization of health system resources, which complementary rapid testing tools could ameliorate. Objective To predict SARS-CoV-2 PCR positivity based on complete blood count components and patient sex. Study design A retrospective case-control design for collection of data and a logistic regression prediction model was used. Participants were emergency department patients > 18 years old who had concurrent complete blood counts and SARS-CoV-2 PCR testing. 33 confirmed SARS-CoV-2 PCR positive and 357 negative patients at Stanford Health Care were used for model training. Validation cohorts consisted of emergency department patients > 18 years old who had concurrent complete blood counts and SARS-CoV-2 PCR testing in Northern California (41 PCR positive, 495 PCR negative), Seattle, Washington (40 PCR positive, 306 PCR negative), Chicago, Illinois (245 PCR positive, 1015 PCR negative), and South Korea (9 PCR positive, 236 PCR negative). Results A decision support tool that utilizes components of complete blood count and patient sex for prediction of SARS-CoV-2 PCR positivity demonstrated a C-statistic of 78 %, an optimized sensitivity of 93 %, and generalizability to other emergency department populations. By restricting PCR testing to predicted positive patients in a hypothetical scenario of 1000 patients requiring testing but testing resources limited to 60 % of patients, this tool would allow a 33 % increase in properly allocated resources. Conclusions A prediction tool based on complete blood count results can better allocate SARS-CoV-2 testing and other health care resources such as personal protective equipment during a pandemic surge.
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Affiliation(s)
- Rohan P Joshi
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Vikas Pejaver
- Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, WA, USA
| | - Noah E Hammarlund
- Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, WA, USA
| | - Heungsup Sung
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Seong Kyu Lee
- Department of Laboratory Medicine, Bundang Jesaeng General Hospital, Seongnam, Republic of Korea
| | - Al'ona Furmanchuk
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hye-Young Lee
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea; Department of Laboratory Medicine, U2Bio Laboratories, Seoul, Republic of Korea
| | - Gregory Scott
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Saurabh Gombar
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Nigam Shah
- Department of Medicine, Division of Stanford University School of Medicine, Stanford, CA, USA
| | - Sam Shen
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Daniel Schneider
- Research Analytics at Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Faraz S Ahmad
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David Liebovitz
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Abel Kho
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sean Mooney
- Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, WA, USA
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA; Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA; Clinical Virology Laboratory, Stanford University Medical Center, Palo Alto, CA, USA
| | - Niaz Banaei
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA; Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA; Clinical Microbiology Laboratory, Stanford University Medical Center, Palo Alto, CA, USA.
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26
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Jenkins PO, De Simoni S, Bourke NJ, Fleminger J, Scott G, Towey DJ, Svensson W, Khan S, Patel MC, Greenwood R, Friedland D, Hampshire A, Cole JH, Sharp DJ. Stratifying drug treatment of cognitive impairments after traumatic brain injury using neuroimaging. Brain 2020; 142:2367-2379. [PMID: 31199462 DOI: 10.1093/brain/awz149] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/26/2019] [Accepted: 04/09/2019] [Indexed: 01/12/2023] Open
Abstract
Cognitive impairment is common following traumatic brain injury. Dopaminergic drugs can enhance cognition after traumatic brain injury, but individual responses are highly variable. This may be due to variability in dopaminergic damage between patients. We investigate whether measuring dopamine transporter levels using 123I-ioflupane single-photon emission computed tomography (SPECT) predicts response to methylphenidate, a stimulant with dopaminergic effects. Forty patients with moderate-severe traumatic brain injury and cognitive impairments completed a randomized, double-blind, placebo-controlled, crossover study. 123I-ioflupane SPECT, MRI and neuropsychological testing were performed. Patients received 0.3 mg/kg of methylphenidate or placebo twice a day in 2-week blocks. Subjects received neuropsychological assessment after each block and completed daily home cognitive testing during the trial. The primary outcome measure was change in choice reaction time produced by methylphenidate and its relationship to stratification of patients into groups with normal and low dopamine transporter binding in the caudate. Overall, traumatic brain injury patients showed slow information processing speed. Patients with low caudate dopamine transporter binding showed improvement in response times with methylphenidate compared to placebo [median change = -16 ms; 95% confidence interval (CI): -28 to -3 ms; P = 0.02]. This represents a 27% improvement in the slowing produced by traumatic brain injury. Patients with normal dopamine transporter binding did not improve. Daily home-based choice reaction time results supported this: the low dopamine transporter group improved (median change -19 ms; 95% CI: -23 to -7 ms; P = 0.002) with no change in the normal dopamine transporter group (P = 0.50). The low dopamine transporter group also improved on self-reported and caregiver apathy assessments (P = 0.03 and P = 0.02, respectively). Both groups reported improvements in fatigue (P = 0.03 and P = 0.007). The cognitive effects of methylphenidate after traumatic brain injury were only seen in patients with low caudate dopamine transporter levels. This shows that identifying patients with a hypodopaminergic state after traumatic brain injury can help stratify the choice of cognitive enhancing therapy.
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Affiliation(s)
- Peter O Jenkins
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Sara De Simoni
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Niall J Bourke
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Jessica Fleminger
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Gregory Scott
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - David J Towey
- Department of Nuclear Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - William Svensson
- Department of Nuclear Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sameer Khan
- Department of Nuclear Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Maneesh C Patel
- Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Richard Greenwood
- Institute of Neurology, Division of Clinical Neurology, University College London, London, UK
| | - Daniel Friedland
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Adam Hampshire
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - James H Cole
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - David J Sharp
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK.,United Kingdom (UK) Dementia Research Institute, 6th Floor, UCL Maple House Tottenham Court Road, London, W1T 7NF, UK
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Affiliation(s)
- Apostolos A Alexandridis
- Apostolos A. Alexandridis is with the US Food and Drug Administration, Silver Spring, MD. Maya Doe-Simkins and Gregory Scott are with the Chicago Recovery Alliance, Chicago, IL. Gregory Scott is also with the Department of Sociology, DePaul University, Chicago
| | - Maya Doe-Simkins
- Apostolos A. Alexandridis is with the US Food and Drug Administration, Silver Spring, MD. Maya Doe-Simkins and Gregory Scott are with the Chicago Recovery Alliance, Chicago, IL. Gregory Scott is also with the Department of Sociology, DePaul University, Chicago
| | - Gregory Scott
- Apostolos A. Alexandridis is with the US Food and Drug Administration, Silver Spring, MD. Maya Doe-Simkins and Gregory Scott are with the Chicago Recovery Alliance, Chicago, IL. Gregory Scott is also with the Department of Sociology, DePaul University, Chicago
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Scott G, Field CL, Papich MG, Harms CA. Plasma concentrations of itraconazole following a single oral dose in juvenile California sea lions (Zalophus californianus). J Vet Pharmacol Ther 2020; 43:377-380. [PMID: 32286696 DOI: 10.1111/jvp.12865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/25/2020] [Accepted: 03/19/2020] [Indexed: 11/26/2022]
Abstract
The objective of this study was to establish a single-dose pharmacokinetic profile for orally administered itraconazole in California sea lions (Zalophus californianus). Twenty healthy rehabilitated juvenile California sea lions were included in this study. Itraconazole capsules were administered orally with food at a target dose of 5-10 mg/kg. Blood samples were collected from each animal at 0 hr and at two of the following timepoints: 0.5, 1, 2, 4, 6, 8, 12, 24, 48, and 72 hr. Quantitative analysis of itraconazole in plasma samples was performed by high-performance liquid chromatography. An average maximum concentration of 0.22 µg/ml ± 0.11 was detected 4 hr after administration. The average concentration fell to 0.12 µg/ml ± 0.11 by 6 hr and 0.02 µg/ml ± 0.02 at 12 hr. At no point did concentrations reach 0.5 µg/ml, the concentration commonly accepted for therapeutic efficacy. While this formulation was well tolerated by the sea lions, oral absorption was poor and highly variable among individuals. These data indicate that a single oral dose of itraconazole given as a capsule at 5-10 mg/kg, under the conditions used in this study, does not achieve therapeutic plasma concentrations in California sea lions.
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Affiliation(s)
- Gregory Scott
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.,Center for Marine Sciences and Technology, North Carolina State University, Morehead City, NC, USA
| | - Cara L Field
- Veterinary Science Department, The Marine Mammal Center, Sausalito, CA, USA
| | - Mark G Papich
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Craig A Harms
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.,Center for Marine Sciences and Technology, North Carolina State University, Morehead City, NC, USA
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29
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Romeo C, Chen SH, Goulding E, Van Gorder L, Schwartz M, Walker M, Scott G, Scappini E, Ray M, Martin NP. AAV diffuses across zona pellucida for effortless gene delivery to fertilized eggs. Biochem Biophys Res Commun 2020; 526:85-90. [PMID: 32197836 DOI: 10.1016/j.bbrc.2020.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 12/14/2022]
Abstract
Gene delivery to fertilized eggs is often the first step in creation of transgenic animals, CRISPR knock-out, or early developmental studies. The zona pellucida, a hardened glycoprotein matrix surrounding the mammalian fertilized eggs, often complicates gene delivery by forming a barrier against transfection reagents and viruses. High efficiency techniques to perforate or penetrate the zona allow for access and gene delivery to fertilized eggs. However, these techniques often rely on highly skilled technologists, are costly, and require specialized equipment for micromanipulation, laser perforation, or electroporation. Here, we report that adenoassociated viruses (AAVs) with serotypes 1 or DJ can efficiently diffuse across the zona to deliver genes without any manipulations to fertilized eggs. We observe lowered rates of embryo development after treatment of embryos with all AAV serotypes. However, we were able to reduce adverse effects on embryo development by exposing embryos to AAVs at later stages of in vitro development. AAVs have low immune response and do not incorporate into their host chromosomes to cause insertional mutations. Hence, AAVs can serve as a highly effective tool for transient delivery of genes to fertilized mammalian eggs.
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Affiliation(s)
- Charles Romeo
- Neurobiology Laboratory, Viral Vector Core, National Institute of Environmental Health Sciences, NIH/DHHS, 111 T.W. Alexander Drive, Research Triangle Park, N.C, 27709, USA
| | - Shih-Heng Chen
- Neurobiology Laboratory, Viral Vector Core, National Institute of Environmental Health Sciences, NIH/DHHS, 111 T.W. Alexander Drive, Research Triangle Park, N.C, 27709, USA
| | - Eugenia Goulding
- Neurobiology Laboratory, Viral Vector Core, National Institute of Environmental Health Sciences, NIH/DHHS, 111 T.W. Alexander Drive, Research Triangle Park, N.C, 27709, USA
| | - Lucas Van Gorder
- Neurobiology Laboratory, Viral Vector Core, National Institute of Environmental Health Sciences, NIH/DHHS, 111 T.W. Alexander Drive, Research Triangle Park, N.C, 27709, USA
| | - Maura Schwartz
- Neurobiology Laboratory, Viral Vector Core, National Institute of Environmental Health Sciences, NIH/DHHS, 111 T.W. Alexander Drive, Research Triangle Park, N.C, 27709, USA
| | - Mitzie Walker
- Neurobiology Laboratory, Viral Vector Core, National Institute of Environmental Health Sciences, NIH/DHHS, 111 T.W. Alexander Drive, Research Triangle Park, N.C, 27709, USA
| | - Gregory Scott
- Reproductive and Developmental Biology Laboratory, National Institute of Environmental Health Sciences, NIH/DHHS, 111 T.W. Alexander Drive, Research Triangle Park, N.C, 27709, USA
| | - Erica Scappini
- Signal Transduction Laboratory, National Institute of Environmental Health Sciences, NIH/DHHS, 111 T.W. Alexander Drive, Research Triangle Park, N.C, 27709, USA
| | - Manas Ray
- Reproductive and Developmental Biology Laboratory, National Institute of Environmental Health Sciences, NIH/DHHS, 111 T.W. Alexander Drive, Research Triangle Park, N.C, 27709, USA
| | - Negin P Martin
- Neurobiology Laboratory, Viral Vector Core, National Institute of Environmental Health Sciences, NIH/DHHS, 111 T.W. Alexander Drive, Research Triangle Park, N.C, 27709, USA.
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30
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Lim SY, Bodagh N, Scott G, Hill NE. Hyponatraemia: the importance of obtaining a detailed history and corroborating point-of-care analysis with laboratory testing. BMJ Case Rep 2019; 12:12/12/e229221. [PMID: 31822529 DOI: 10.1136/bcr-2019-229221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a 67-year-old man admitted from a mental health unit with an incidental finding of hyponatraemia on routine blood tests. Laboratory investigations were in keeping with syndrome of inappropriate antidiuretic hormone secretion (SIADH). He had been recently commenced on mirtazapine. During his inpatient stay, he became increasingly confused. Review of a previous admission with hyponatraemia raised the possibility of voltage-gated potassium channel antibody-associated limbic encephalitis, although subsequent investigations deemed this unlikely as a cause of hyponatraemia. Although his sodium levels improved with fluid restriction, serial point-of-care testing proved misleading in monitoring the efficacy of treatment as inconsistencies were seen in comparison with laboratory testing. The cause of hyponatraemia may have been medication-induced SIADH and/or polydipsia. This case highlights the importance of collating detailed histories and laboratory blood testing to guide management in cases of hyponatraemia of unknown aetiology.
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Affiliation(s)
- Su Yin Lim
- Acute Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Neil Bodagh
- Acute Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Gregory Scott
- Neurology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Neil E Hill
- Endocrinology & Diabetes, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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31
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Affiliation(s)
- P R Shah
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - G Scott
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - L A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, U.S.A
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32
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Kumar J, Scott G, Oak J, Raess P, Gratzinger D. Flow Cytometry Signature for Kikuchi-Fujimoto/Lupus Lymphadenitis Derived From 975 Benign and Malignant Lymphadenopathies. Am J Clin Pathol 2019. [DOI: 10.1093/ajcp/aqz121.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Kikuchi lymphadenitis is a benign disease with histologic features that can be challenging to discern from malignant or infectious diagnoses. Furthermore, Kikuchi lymphadenitis and systemic lupus erythematosus–associated lymphadenitis (KD/SLE) show overlapping histologic features. We used flow cytometry to evaluate if KD/SLE has a distinct immunophenotype from other lymphadenopathies.
Methods and Materials
Sixteen cases of KD/SLE were compared to 959 control cases at Stanford by flow cytometry for three scenarios: KD/SLE versus T-cell lymphomas, all benign cases, and all benign and malignant cases. Select cases of KD/SLE and benign lymph nodes were analyzed by immunohistochemistry to evaluate the B-cell characteristics. A test set of five KD cases were compared to five normal controls from an independent institution to evaluate cross-platform reproducibility of the KD/SLE flow cytometry signature.
Results
The most discriminatory signature for KD/SLE versus all other benign cases comprised two surface antigen pairs (high CD38+ CD19+, low large-cell CD57+ CD3+), patient age, lymph node location, and four additional flow antigens (100% sensitivity, 99.6% specificity). The signature for KD/SLE versus T-cell lymphomas consisted of two flow antigens (high CD38+ CD19+ and high CD3) and patient age (100% sensitivity, 100% specificity). Based on the flow data, immunohistochemistry was performed to evaluate the B-cell characteristics. We observed clusters of IgD-positive B cells surrounding activated T-cell foci without IgM expression, suggesting that these cells represent either naive cells or memory IgD-positive B cells. Flow cytometry showed increased CD23 with minimal CD5 expression, supporting the hypothesis of naive functional anergic/autoreactive IgD+ IgM– B cells.
Conclusion
We have identified a signature that can distinguish Kikuchi disease and systemic lupus erythematosus from a large cohort of benign and malignant entities, likely reflecting a shared stable underlying etiology of KD/SLE. Our study provides a valuable tool to enhance the ability to accurately diagnose KD/SLE.
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33
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Jolly AE, Raymont V, Cole JH, Whittington A, Scott G, De Simoni S, Searle G, Gunn RN, Sharp DJ. Dopamine D2/D3 receptor abnormalities after traumatic brain injury and their relationship to post-traumatic depression. Neuroimage Clin 2019; 24:101950. [PMID: 31352218 PMCID: PMC6664227 DOI: 10.1016/j.nicl.2019.101950] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 06/20/2019] [Accepted: 07/19/2019] [Indexed: 11/18/2022]
Abstract
Objective To investigate dopamine D2/D3 receptor availability following traumatic brain injury (TBI) and their relationship to the presence of DSM-IV Major Depressive Disorder (MDD) and patterns of axonal injury. Methods Twelve moderate-severe TBI patients and 26 controls were imaged using [11C]PHNO positron emission tomography (PET) and structural magnetic resonance imaging (MRI). TBI patients and a second group of 32 controls also underwent diffusion tensor imaging (DTI) and neuropsychological assessment. Patients included six with post-injury MDD (TBI-MDD) and six without (TBI-NON). Non-displaceable binding potential (BPND) [11C]PHNO values were used to index D2/D3 receptor availability, and were calculated using a reference region procedure. Differences in BPND were examined using voxelwise and region-of-interest analyses. White matter microstructure integrity, quantified by fractional anisotropy (FA), was assessed and correlated with BPND. Results Lower [11C]PHNO BPND was found in the caudate across all TBI patients when compared to controls. Lower [11C]PHNO BPND was observed in the caudate of TBI-MDD patients and increased [11C]PHNO BPND in the Amygdala of TBI-NON patients compared to controls. There were no significant differences in [11C]PHNO BPND between TBI-MDD and TBI-NON patients. Furthermore, DTI provided evidence of axonal injury following TBI. The uncinate fasciculus and cingulum had abnormally low FA, with the uncinate particularly affected in TBI-MDD patients. Caudate [11C]PHNO BPND correlated with FA within the nigro-caudate tract. Conclusions [11C]PHNO BPND is abnormal following TBI, which indicates post-traumatic changes in D2/D3 receptors. Patterns of [11C]PHNO BPND seen in patients with and without MDD suggest that further research would be beneficial to determine whether the use of dopaminergic treatment might be effective in the treatment of post-traumatic depression. [11C]PHNO PET is used for the first time in traumatic brain injury (TBI) patients. Post-traumatic changes in dopamine D2/D3 receptors were observed. Patients with major depression showed more prominent reductions in [11C]PHNO BPND. Non-depressed TBI patients had greater [11C]PHNO BPND in the Amygdala. These findings suggest a potential role of D2/D3 changes in post-TBI depression.
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Affiliation(s)
- Amy E Jolly
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK.
| | - Vanessa Raymont
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK; Centre of Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, UK; Department of Psychiatry, University of Oxford, UK.
| | - James H Cole
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK.
| | - Alex Whittington
- Invicro, Centre for Imaging Sciences, Imperial College London, UK.
| | - Gregory Scott
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK.
| | - Sara De Simoni
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK.
| | - Graham Searle
- Invicro, Centre for Imaging Sciences, Imperial College London, UK.
| | - Roger N Gunn
- Invicro, Centre for Imaging Sciences, Imperial College London, UK.
| | - David J Sharp
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK.
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Lybrand DB, Naiman M, Laumann JM, Boardman M, Petshow S, Hansen K, Scott G, Wehrli M. Destruction complex dynamics: Wnt/β-catenin signaling alters Axin-GSK3β interactions in vivo. Development 2019; 146:dev164145. [PMID: 31189665 PMCID: PMC6633605 DOI: 10.1242/dev.164145] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/05/2019] [Indexed: 01/20/2023]
Abstract
The central regulator of the Wnt/β-catenin pathway is the Axin/APC/GSK3β destruction complex (DC), which, under unstimulated conditions, targets cytoplasmic β-catenin for degradation. How Wnt activation inhibits the DC to permit β-catenin-dependent signaling remains controversial, in part because the DC and its regulation have never been observed in vivo Using bimolecular fluorescence complementation (BiFC) methods, we have now analyzed the activity of the DC under near-physiological conditions in Drosophila By focusing on well-established patterns of Wnt/Wg signaling in the developing Drosophila wing, we have defined the sequence of events by which activated Wnt receptors induce a conformational change within the DC, resulting in modified Axin-GSK3β interactions that prevent β-catenin degradation. Surprisingly, the nucleus is surrounded by active DCs, which principally control the degradation of β-catenin and thereby nuclear access. These DCs are inactivated and removed upon Wnt signal transduction. These results suggest a novel mechanistic model for dynamic Wnt signal transduction in vivo.
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Affiliation(s)
- Daniel B Lybrand
- Dept. of Integrative Biosciences, School of Dentistry, Oregon Health and Science University, Portland, OR 97239, USA
- Reed College, Portland, OR 97202, USA
| | - Misha Naiman
- Dept. of Integrative Biosciences, School of Dentistry, Oregon Health and Science University, Portland, OR 97239, USA
- Reed College, Portland, OR 97202, USA
| | - Jessie May Laumann
- Dept. of Integrative Biosciences, School of Dentistry, Oregon Health and Science University, Portland, OR 97239, USA
| | - Mitzi Boardman
- Dept. of Integrative Biosciences, School of Dentistry, Oregon Health and Science University, Portland, OR 97239, USA
| | - Samuel Petshow
- Dept. of Integrative Biosciences, School of Dentistry, Oregon Health and Science University, Portland, OR 97239, USA
| | - Kevin Hansen
- Dept. of Integrative Biosciences, School of Dentistry, Oregon Health and Science University, Portland, OR 97239, USA
| | - Gregory Scott
- Dept. of Integrative Biosciences, School of Dentistry, Oregon Health and Science University, Portland, OR 97239, USA
| | - Marcel Wehrli
- Dept. of Integrative Biosciences, School of Dentistry, Oregon Health and Science University, Portland, OR 97239, USA
- Knight Cancer Institute, Portland, OR 97239, USA
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Cole JH, Jolly A, de Simoni S, Bourke N, Patel MC, Scott G, Sharp DJ. Spatial patterns of progressive brain volume loss after moderate-severe traumatic brain injury. Brain 2019; 141:822-836. [PMID: 29309542 PMCID: PMC5837530 DOI: 10.1093/brain/awx354] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/08/2017] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury leads to significant loss of brain volume, which continues into the chronic stage. This can be sensitively measured using volumetric analysis of MRI. Here we: (i) investigated longitudinal patterns of brain atrophy; (ii) tested whether atrophy is greatest in sulcal cortical regions; and (iii) showed how atrophy could be used to power intervention trials aimed at slowing neurodegeneration. In 61 patients with moderate-severe traumatic brain injury (mean age = 41.55 years ± 12.77) and 32 healthy controls (mean age = 34.22 years ± 10.29), cross-sectional and longitudinal (1-year follow-up) brain structure was assessed using voxel-based morphometry on T1-weighted scans. Longitudinal brain volume changes were characterized using a novel neuroimaging analysis pipeline that generates a Jacobian determinant metric, reflecting spatial warping between baseline and follow-up scans. Jacobian determinant values were summarized regionally and compared with clinical and neuropsychological measures. Patients with traumatic brain injury showed lower grey and white matter volume in multiple brain regions compared to controls at baseline. Atrophy over 1 year was pronounced following traumatic brain injury. Patients with traumatic brain injury lost a mean (± standard deviation) of 1.55% ± 2.19 of grey matter volume per year, 1.49% ± 2.20 of white matter volume or 1.51% ± 1.60 of whole brain volume. Healthy controls lost 0.55% ± 1.13 of grey matter volume and gained 0.26% ± 1.11 of white matter volume; equating to a 0.22% ± 0.83 reduction in whole brain volume. Atrophy was greatest in white matter, where the majority (84%) of regions were affected. This effect was independent of and substantially greater than that of ageing. Increased atrophy was also seen in cortical sulci compared to gyri. There was no relationship between atrophy and time since injury or age at baseline. Atrophy rates were related to memory performance at the end of the follow-up period, as well as to changes in memory performance, prior to multiple comparison correction. In conclusion, traumatic brain injury results in progressive loss of brain tissue volume, which continues for many years post-injury. Atrophy is most prominent in the white matter, but is also more pronounced in cortical sulci compared to gyri. These findings suggest the Jacobian determinant provides a method of quantifying brain atrophy following a traumatic brain injury and is informative in determining the long-term neurodegenerative effects after injury. Power calculations indicate that Jacobian determinant images are an efficient surrogate marker in clinical trials of neuroprotective therapeutics.
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Affiliation(s)
- James H Cole
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Amy Jolly
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Sara de Simoni
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Niall Bourke
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Maneesh C Patel
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Gregory Scott
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - David J Sharp
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
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Jenkins PO, De Simoni S, Bourke NJ, Fleminger J, Scott G, Towey DJ, Svensson W, Khan S, Patel M, Greenwood R, Cole JH, Sharp DJ. Dopaminergic abnormalities following traumatic brain injury. Brain 2019; 141:797-810. [PMID: 29360949 DOI: 10.1093/brain/awx357] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/12/2017] [Indexed: 01/19/2023] Open
Abstract
Traumatic brain injury can reduce striatal dopamine levels. The cause of this is uncertain, but is likely to be related to damage to the nigrostriatal system. We investigated the pattern of striatal dopamine abnormalities using 123I-Ioflupane single-photon emission computed tomography (SPECT) scans and their relationship to nigrostriatal damage and clinical features. We studied 42 moderate-severe traumatic brain injury patients with cognitive impairments but no motor parkinsonism signs and 20 healthy controls. 123I-Ioflupane scanning was used to assess dopamine transporter levels. Clinical scan reports were compared to quantitative dopamine transporter results. Advanced MRI methods were used to assess the nigrostriatal system, including the area through which the nigrostriatal projections pass as defined from high-resolution Human Connectome data. Detailed clinical and neuropsychological assessments were performed. Around 20% of our moderate-severe patients had clear evidence of reduced specific binding ratios for the dopamine transporter in the striatum measured using 123I-Ioflupane SPECT. The caudate was affected more consistently than other striatal regions. Dopamine transporter abnormalities were associated with reduced substantia nigra volume. In addition, diffusion MRI provided evidence of damage to the regions through which the nigrostriatal tract passes, particularly the area traversed by dopaminergic projections to the caudate. Only a small percentage of patients had evidence of macroscopic lesions in the striatum and there was no relationship between presence of lesions and dopamine transporter specific binding ratio abnormalities. There was also no relationship between reduced volume in the striatal subregions and reduced dopamine transporter specific binding ratios. Patients with low caudate dopamine transporter specific binding ratios show impaired processing speed and executive dysfunction compared to patients with normal levels. Taken together, our results suggest that the dopaminergic system is affected by a moderate-severe traumatic brain injury in a significant proportion of patients, even in the absence of clinical motor parkinsonism. Reduced dopamine transporter levels are most commonly seen in the caudate and this is likely to reflect the pattern of nigrostriatal tract damage produced by axonal injury and associated midbrain damage.
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Affiliation(s)
- Peter O Jenkins
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Sara De Simoni
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Niall J Bourke
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Jessica Fleminger
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Gregory Scott
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - David J Towey
- Department of Nuclear Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - William Svensson
- Department of Nuclear Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sameer Khan
- Department of Nuclear Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Maneesh Patel
- Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Richard Greenwood
- Institute of Neurology, Division of Clinical Neurology, University College London, London, UK
| | - James H Cole
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - David J Sharp
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
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Key S, Scott G, Stammers JG, Freeman MAR, Pinskerova V, Field RE, Skinner J, Banks SA. Does lateral lift-off occur in static and dynamic activity in a medially spherical total knee arthroplasty? A pulsed-fluoroscopic investigation. Bone Joint Res 2019; 8:207-215. [PMID: 31214333 PMCID: PMC6548977 DOI: 10.1302/2046-3758.85.bjr-2018-0237.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objectives The medially spherical GMK Sphere (Medacta International AG, Castel San Pietro, Switzerland) total knee arthroplasty (TKA) was previously shown to accommodate lateral rollback while pivoting around a stable medial compartment, aiming to replicate native knee kinematics in which some coronal laxity, especially laterally, is also present. We assess coronal plane kinematics of the GMK Sphere and explore the occurrence and pattern of articular separation during static and dynamic activities. Methods Using pulsed fluoroscopy and image matching, the coronal kinematics and articular surface separation of 16 well-functioning TKAs were studied during weight-bearing and non-weight-bearing, static, and dynamic activities. The closest distances between the modelled articular surfaces were examined with respect to knee position, and proportions of joint poses exhibiting separation were computed. Results Overall, 1717 joint poses were analyzed. At a 1.0 mm detection threshold, 37 instances of surface separation were observed in the lateral compartment and four medially (p < 0.001). Separation was activity-dependent, both laterally and medially (p < 0.001), occurring more commonly during static deep flexion in the lateral compartment, and during static rotation in the medial compartment. Lateral separation occurred more frequently than medial during kneeling (7/14 lateral vs 1/14 medial; p = 0.031) and stepping (20/1022 lateral vs 0/1022 medial; p < 0.001). Separation varied significantly between individuals during dynamic activities. Conclusion No consistent association between closest distances of the articular surfaces and knee position was found during any activity. Lift-off was infrequent and depended on the activity performed and the individual knee. Lateral separation was consistent with the design rationale. Medial lift-off was rare and mostly in non-weight-bearing activities. Cite this article: S. Key, G. Scott, J.G. Stammers, M. A. R. Freeman†, V. Pinskerova, R. E. Field, J. Skinner, S. A. Banks. Does lateral lift-off occur in static and dynamic activity in a medially spherical total knee arthroplasty? A pulsed-fluoroscopic investigation. Bone Joint Res 2019;8:207–215. DOI: 10.1302/2046-3758.85.BJR-2018-0237.R1.
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Affiliation(s)
- S Key
- Royal London Hospital, London, UK
| | - G Scott
- Royal London Hospital, London, UK
| | | | - M A R Freeman
- †M.A.R Freeman has deceased since the submission of this manuscript
| | - V Pinskerova
- First Orthopaedic Clinic, Faculty of Medicine, Charles University, Prague, Czech Republic
| | - R E Field
- St George's, University of London, London, UK; Director of Research, South West London Elective Orthopaedic Centre, Epsom, UK
| | - J Skinner
- Royal National Orthopaedic Hospital, Stanmore, UK
| | - S A Banks
- University of Florida, Gainesville, Florida, USA
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Wong J, Ho C, Scott G, Machin JT, Briggs T. Getting It Right First Time: the national survey of surgical site infection rates in NHS trusts in England. Ann R Coll Surg Engl 2019; 101:463-471. [PMID: 31155919 DOI: 10.1308/rcsann.2019.0064] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Surgical site infections are associated with increased morbidity and mortality in patients. The Getting It Right First Time surgical site infection programme set up a national survey to review surgical site infection rates in surgical units in England. The objectives were for frontline clinicians to assess the rates of infection following selected procedures, to examine the risk of significant complications and to review current practice in the prevention of surgical site infection. METHODS A national survey was launched in April 2017 to assess surgical site infections within 13 specialties: breast surgery, cardiothoracic surgery, cranial neurosurgery, ear, nose and throat surgery, general surgery, obstetrics and gynaecology, ophthalmology, oral and maxillofacial surgery, orthopaedic surgery, paediatric surgery, spinal surgery, urology and vascular surgery. All participating trusts prospectively identified and collected supporting information on surgical site infections diagnosed within the six-month study period. RESULTS Data were received from 95 NHS trusts. A total of 1807 surgical site infection cases were reported. There were variations in rates reported by trusts across specialties and procedures. Reoperations were reported in 36.2% of all identified cases, and surgical site infections are associated with a delayed discharge rate of 34.1% in our survey. CONCLUSION The Getting It Right First Time surgical site infection programme has introduced a different approach to infection surveillance in England. Results of the survey has demonstrated variation in surgical site infection rates among surgical units, raised the importance in addressing these issues for better patient outcomes and to reduce the financial burden on the NHS. Much work remains to be done to improve surgical site infection surveillance across surgical units and trusts in England.
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Affiliation(s)
- Jlc Wong
- Getting It Right First Time, Royal National Orthopaedic Hospital NHS Trust and NHS Improvement, Brockley Hill, Stanmore, UK
| | - Cwy Ho
- Getting It Right First Time, Royal National Orthopaedic Hospital NHS Trust and NHS Improvement, Brockley Hill, Stanmore, UK
| | - G Scott
- Getting It Right First Time, Royal National Orthopaedic Hospital NHS Trust and NHS Improvement, Brockley Hill, Stanmore, UK
| | - J T Machin
- Getting It Right First Time, Royal National Orthopaedic Hospital NHS Trust and NHS Improvement, Brockley Hill, Stanmore, UK
| | - Twr Briggs
- Getting It Right First Time, Royal National Orthopaedic Hospital NHS Trust and NHS Improvement, Brockley Hill, Stanmore, UK
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Scott G, Zetterberg H, Jolly A, Cole JH, De Simoni S, Jenkins PO, Feeney C, Owen DR, Lingford-Hughes A, Howes O, Patel MC, Goldstone AP, Gunn RN, Blennow K, Matthews PM, Sharp DJ. Minocycline reduces chronic microglial activation after brain trauma but increases neurodegeneration. Brain 2019; 141:459-471. [PMID: 29272357 PMCID: PMC5837493 DOI: 10.1093/brain/awx339] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 10/19/2017] [Indexed: 12/12/2022] Open
Abstract
Survivors of a traumatic brain injury can deteriorate years later, developing brain atrophy and dementia. Traumatic brain injury triggers chronic microglial activation, but it is unclear whether this is harmful or beneficial. A successful chronic-phase treatment for traumatic brain injury might be to target microglia. In experimental models, the antibiotic minocycline inhibits microglial activation. We investigated the effect of minocycline on microglial activation and neurodegeneration using PET, MRI, and measurement of the axonal protein neurofilament light in plasma. Microglial activation was assessed using 11C-PBR28 PET. The relationships of microglial activation to measures of brain injury, and the effects of minocycline on disease progression, were assessed using structural and diffusion MRI, plasma neurofilament light, and cognitive assessment. Fifteen patients at least 6 months after a moderate-to-severe traumatic brain injury received either minocycline 100 mg orally twice daily or no drug, for 12 weeks. At baseline, 11C-PBR28 binding in patients was increased compared to controls in cerebral white matter and thalamus, and plasma neurofilament light levels were elevated. MRI measures of white matter damage were highest in areas of greater 11C-PBR28 binding. Minocycline reduced 11C-PBR28 binding (mean Δwhite matter binding = −23.30%, 95% confidence interval −40.9 to −5.64%, P = 0.018), but increased plasma neurofilament light levels. Faster rates of brain atrophy were found in patients with higher baseline neurofilament light levels. In this experimental medicine study, minocycline after traumatic brain injury reduced chronic microglial activation while increasing a marker of neurodegeneration. These findings suggest that microglial activation has a reparative effect in the chronic phase of traumatic brain injury.
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Affiliation(s)
- Gregory Scott
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Amy Jolly
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK
| | - James H Cole
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK
| | - Sara De Simoni
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK
| | - Peter O Jenkins
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK
| | - Claire Feeney
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK
| | - David R Owen
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK
| | | | - Oliver Howes
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK
| | - Maneesh C Patel
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Anthony P Goldstone
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK
| | | | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Paul M Matthews
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK
| | - David J Sharp
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK
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Abstract
AIMS Short-stemmed femoral implants have been used for total hip arthroplasty (THA) in young and active patients to conserve bone, provide physiological loading, and reduce the incidence of thigh pain. Only short- to mid-term results have been presented and there have been concerns regarding component malalignment, incorrect sizing, and subsidence. This systematic review reports clinical and radiological outcomes, complications, revision rates, and implant survival in THA using short-stemmed femoral components. MATERIALS AND METHODS A literature review was performed using the EMBASE, Medline, and Cochrane databases. Strict inclusion and exclusion criteria were used to identify studies reporting clinical and radiological follow-up for short-stemmed hip arthroplasties. RESULTS A total of 28 studies were eligible for inclusion. This included 5322 hips in 4657 patients with a mean age of 59 years (13 to 94). The mean follow-up was 6.1 years (0.5 to 20). The mean Harris Hip Score improved from 46 (0 to 100) to 92 (39 to 100). The mean Oxford Hip Score improved from 25 (2 to 42.5) to 35 (12.4 to 48). The mean Western Ontario & McMaster Universities Osteoarthritis Index improved from 54 (2 to 95) to 22 (0 to 98). Components were aligned in a neutral coronal alignment in up to 90.9% of cases. A total of 15 studies reported component survivorship, which was 98.6% (92% to 100%) at a mean follow-up of 12.1 years. CONCLUSION Short-stemmed femoral implants show similar improvement in clinical and radiological outcomes compared with conventional length implants. Only mid-term survivorship, however, is known. An abundance of short components have been developed and used commercially without staged clinical trials. Long-term survival is still unknown for many of these components. There remains tension between innovation and the moral duty to ensure that the introduction of new implants is controlled until safety and patient benefit are demonstrated. Implant innovation and subsequent use should be driven by proven clinical outcomes, rather than market and financial forces, and ethical practice must be ensured. Cite this article: Bone Joint J 2019;101-B:502-511.
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Affiliation(s)
- S Lidder
- Department of Orthopaedics, Royal Melbourne Hospital, Parkville, Australia
| | - D J Epstein
- Department of Orthopaedics, Royal Melbourne Hospital, Parkville, Australia
| | - G Scott
- Bone and Joint Research Unit, The Royal London Hospital, London, UK
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41
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Scott G, Carhart-Harris RL. Psychedelics as a treatment for disorders of consciousness. Neurosci Conscious 2019; 2019:niz003. [PMID: 31024740 PMCID: PMC6475593 DOI: 10.1093/nc/niz003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 11/23/2022] Open
Abstract
Based on its ability to increase brain complexity, a seemingly reliable index of conscious level, we propose testing the capacity of the classic psychedelic, psilocybin, to increase conscious awareness in patients with disorders of consciousness. We also confront the considerable ethical and practical challenges this proposal must address, if this hypothesis is to be directly assessed.
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Affiliation(s)
- Gregory Scott
- Department of Medicine, The Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, 3rd Floor, Burlington Danes Building, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - Robin L Carhart-Harris
- Department of Medicine, The Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, 3rd Floor, Burlington Danes Building, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
- Department of Medicine, Centre for Psychedelic Research, Division of Brain Sciences, Imperial College London, 5th Floor, Burlington Danes Building, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
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42
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Scott G, Khan S, Asopa V, Ravikumar R, Gadikoppula S. Mid-term outcomes of neck of femur fractures treated with HA coated uncemented prosthesis. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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43
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Gars E, Purington N, Scott G, Chisholm K, Gratzinger D, Martin BA, Ohgami RS. Bone marrow histomorphological criteria can accurately diagnose hemophagocytic lymphohistiocytosis. Haematologica 2018; 103:1635-1641. [PMID: 29903767 PMCID: PMC6165820 DOI: 10.3324/haematol.2017.186627] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 06/13/2018] [Indexed: 01/15/2023] Open
Affiliation(s)
| | | | | | - Karen Chisholm
- Seattle Children's Hospital and University of Washington, WA, USA
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Scott G, Gratzinger D. 200 Defining Normal: Flow Cytometry Immunophenotyping of Benign Lymph Nodes Sampled by Fine Needle Aspiration or Surgical Biopsy. Am J Clin Pathol 2018. [DOI: 10.1093/ajcp/aqx121.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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45
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Scott G. Michael Alexander Reykers Freeman BA (Cantab) 1953, MB BCh (Cantab)1956, FRCS 1959, MD (Cantab) 1964, MD Hc (Swe) 1992 - (1931 to 2017). Bone Joint J 2017; 99-B:1552. [PMID: 29092998 DOI: 10.1302/0301-620x.99b11.bjj-2017-1156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 11/05/2022]
Affiliation(s)
- G Scott
- The British Editorial Society of Bone & Joint Surgery, 22 Buckingham Street, London WC2N 6ET, UK
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46
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Feeney C, Sharp DJ, Hellyer PJ, Jolly AE, Cole JH, Scott G, Baxter D, Jilka S, Ross E, Ham TE, Jenkins PO, Li LM, Gorgoraptis N, Midwinter M, Goldstone AP. Serum insulin-like growth factor-I levels are associated with improved white matter recovery after traumatic brain injury. Ann Neurol 2017; 82:30-43. [PMID: 28574152 PMCID: PMC5601275 DOI: 10.1002/ana.24971] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 02/06/2023]
Abstract
Objective Traumatic brain injury (TBI) is a common disabling condition with limited treatment options. Diffusion tensor imaging measures recovery of axonal injury in white matter (WM) tracts after TBI. Growth hormone deficiency (GHD) after TBI may impair axonal and neuropsychological recovery, and serum insulin‐like growth factor‐I (IGF‐I) may mediate this effect. We conducted a longitudinal study to determine the effects of baseline serum IGF‐I concentrations on WM tract and neuropsychological recovery after TBI. Methods Thirty‐nine adults after TBI (84.6% male, median age = 30.5 years, 87.2% moderate–severe, median time since TBI = 16.3 months, n = 4 with GHD) were scanned twice, 13.3 months (range = 12.1–14.9) apart, and 35 healthy controls were scanned once. Symptom and quality of life questionnaires and cognitive assessments were completed at both visits (n = 33). Our main outcome measure was fractional anisotropy (FA), a measure of WM tract integrity, in a priori regions of interest: splenium of corpus callosum (SPCC) and posterior limb of internal capsule (PLIC). Results At baseline, FA was reduced in many WM tracts including SPCC and PLIC following TBI compared to controls, indicating axonal injury, with longitudinal increases indicating axonal recovery. There was a significantly greater increase in SPCC FA over time in patients with serum IGF‐I above versus below the median for age. Only the higher IGF‐I group had significant improvements in immediate verbal memory recall over time. Interpretation WM recovery and memory improvements after TBI were greater in patients with higher serum IGF‐I at baseline. These findings suggest that the growth hormone/IGF‐I system may be a potential therapeutic target following TBI. Ann Neurol 2017;82:30–43
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Affiliation(s)
- Claire Feeney
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, United Kingdom.,Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, St Mary's and Charing Cross Hospitals, London, United Kingdom
| | - David J Sharp
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Peter J Hellyer
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Amy E Jolly
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - James H Cole
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Gregory Scott
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - David Baxter
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, United Kingdom.,Royal Centre for Defence Medicine, Academic Department of Military Surgery and Trauma, Birmingham, United Kingdom
| | - Sagar Jilka
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Ewan Ross
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Timothy E Ham
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Peter O Jenkins
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Lucia M Li
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Nikos Gorgoraptis
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Mark Midwinter
- Royal Centre for Defence Medicine, Academic Department of Military Surgery and Trauma, Birmingham, United Kingdom.,Academic Section for Musculoskeletal Disease, Chapel Allerton Hospital, University of Leeds, Leeds
| | - Anthony P Goldstone
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, United Kingdom.,Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, St Mary's and Charing Cross Hospitals, London, United Kingdom.,PsychoNeuroEndocrinology Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, United Kingdom
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Abstract
Microglia have a variety of functions in the brain, including synaptic pruning, CNS repair and mediating the immune response against peripheral infection. Microglia rapidly become activated in response to CNS damage. Depending on the nature of the stimulus, microglia can take a number of activation states, which correspond to altered microglia morphology, gene expression and function. It has been reported that early microglia activation following traumatic brain injury (TBI) may contribute to the restoration of homeostasis in the brain. On the other hand, if they remain chronically activated, such cells display a classically activated phenotype, releasing pro-inflammatory molecules, resulting in further tissue damage and contributing potentially to neurodegeneration. However, new evidence suggests that this classification is over-simplistic and the balance of activation states can vary at different points. In this article, we review the role of microglia in TBI, analyzing their distribution, morphology and functional phenotype over time in animal models and in humans. Animal studies have allowed genetic and pharmacological manipulations of microglia activation, in order to define their role. In addition, we describe investigations on the in vivo imaging of microglia using translocator protein (TSPO) PET and autoradiography, showing that microglial activation can occur in regions far remote from sites of focal injuries, in humans and animal models of TBI. Finally, we outline some novel potential therapeutic approaches that prime microglia/macrophages toward the beneficial restorative microglial phenotype after TBI.
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Affiliation(s)
| | | | | | - Magdalena Sastre
- Division of Brain Sciences, Department of Medicine, Imperial College LondonLondon, United Kingdom
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Datta G, Colasanti A, Kalk N, Owen D, Scott G, Rabiner EA, Gunn RN, Lingford-Hughes A, Malik O, Ciccarelli O, Nicholas R, Nei L, Battaglini M, Stefano ND, Matthews PM. 11C-PBR28 and 18F-PBR111 Detect White Matter Inflammatory Heterogeneity in Multiple Sclerosis. J Nucl Med 2017; 58:1477-1482. [DOI: 10.2967/jnumed.116.187161] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/28/2017] [Indexed: 11/16/2022] Open
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49
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Kwon C, Land A, Smoller B, Scott G, Beck L, Mercurio M. Bullous pemphigoid associated with nivolumab, a programmed cell death 1 protein inhibitor. J Eur Acad Dermatol Venereol 2017; 31:e349-e350. [DOI: 10.1111/jdv.14143] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- C.W. Kwon
- Department of Dermatology; University of Rochester Medical Center; Rochester NY USA
| | - A.S. Land
- Department of Dermatology; University of Rochester Medical Center; Rochester NY USA
| | - B.R. Smoller
- Department of Dermatology; University of Rochester Medical Center; Rochester NY USA
- Department of Pathology; University of Rochester Medical Center; Rochester NY USA
| | - G. Scott
- Department of Dermatology; University of Rochester Medical Center; Rochester NY USA
- Department of Pathology; University of Rochester Medical Center; Rochester NY USA
| | - L.A. Beck
- Department of Dermatology; University of Rochester Medical Center; Rochester NY USA
| | - M.G. Mercurio
- Department of Dermatology; University of Rochester Medical Center; Rochester NY USA
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50
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Benz C, Scott G, Chu D, Malato J, Hann B, Park B. Abstract P6-11-01: CDK2 inhibition prevents ERpS294 and restores the ability of tamoxifen to induce regression in breast tumors expressing mutant ESR1. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-11-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- C Benz
- Buck Institute for Research on Aging, Novato, CA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - G Scott
- Buck Institute for Research on Aging, Novato, CA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - D Chu
- Buck Institute for Research on Aging, Novato, CA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - J Malato
- Buck Institute for Research on Aging, Novato, CA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - B Hann
- Buck Institute for Research on Aging, Novato, CA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - B Park
- Buck Institute for Research on Aging, Novato, CA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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