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Tchalova K, Lydon JE, Atkinson L, Fleming AS, Kennedy J, Lecompte V, Meaney MJ, Moss E, O'Donnell KA, O'Donnell KJ, Silveira PP, Sokolowski MB, Steiner M, Bartz JA. Variation in the mu-opioid receptor gene (OPRM1) moderates the influence of maternal sensitivity on child attachment. Transl Psychiatry 2024; 14:181. [PMID: 38580654 PMCID: PMC10997775 DOI: 10.1038/s41398-024-02888-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/07/2024] Open
Abstract
The endogenous opioid system is thought to play an important role in mother-infant attachment. In infant rhesus macaques, variation in the μ-opioid receptor gene (OPRM1) is related to differences in attachment behavior that emerges following repeated separation from the mother; specifically, infants carrying at least one copy of the minor G allele of the OPRM1 C77G polymorphism show heightened and more persistent separation distress, as well as a pattern of increased contact-seeking behavior directed towards the mother during reunions (at the expense of affiliation with other group members). Research in adult humans has also linked the minor G allele of the analogous OPRM1 A118G polymorphism with greater interpersonal sensitivity. Adopting an interactionist approach, we examined whether OPRM1 A118G genotype and maternal (in)sensitivity are associated with child attachment style, predicting that children carrying the G allele may be more likely to develop an ambivalent attachment pattern in response to less sensitive maternal care. The sample consisted of 191 mothers participating with their children (n = 223) in the Maternal Adversity, Vulnerability and Neurodevelopment (MAVAN) project, a community-based, birth cohort study of Canadian mothers and their children assessed longitudinally across the child's development. Maternal sensitivity was coded from at-home mother-child interactions videotaped when the child was 18 months of age. Child attachment was assessed at 36 months using the Strange Situation paradigm. As predicted, G allele carriers, but not AA homozygotes, showed increasing odds of being classified as ambivalently attached with decreasing levels of maternal sensitivity. Paralleling earlier non-human animal research, this work provides support for the theory that endogenous opioids contribute to the expression of attachment behaviors in humans.
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Affiliation(s)
- K Tchalova
- Department of Psychology, McGill University, Montréal, QC, Canada
| | - J E Lydon
- Department of Psychology, McGill University, Montréal, QC, Canada
| | - L Atkinson
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - A S Fleming
- Department of Psychology, University of Toronto Mississauga, Toronto, ON, Canada
| | - J Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - V Lecompte
- L'Université du Québec à Montréal, Montréal, QC, Canada
| | - M J Meaney
- Department of Psychology, McGill University, Montréal, QC, Canada
- Douglas Research Centre, Montréal, QC, Canada
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - E Moss
- L'Université du Québec à Montréal, Montréal, QC, Canada
| | - K A O'Donnell
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - K J O'Donnell
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - P P Silveira
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - M B Sokolowski
- Department of Ecology and Evolutionary Biology, University of Toronto, Toronto, ON, Canada
| | - M Steiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - J A Bartz
- Department of Psychology, McGill University, Montréal, QC, Canada.
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Henry M, Harvey R, Chen LM, Meaney M, Nguyen TTT, Kao HT, Rosberger Z, Frenkiel S, Hier M, Zeitouni A, Kost K, Mlynarek A, Richardson K, Greenwood CMT, Melnychuk D, Gold P, Chartier G, Black M, Mascarella M, MacDonald C, Sadeghi N, Sultanem K, Shenouda G, Cury F, O'Donnell KJ. Genetic predisposition to depression and inflammation impacts symptom burden and survival in patients with head and neck cancer: A longitudinal study. J Affect Disord 2023; 331:149-157. [PMID: 36948466 DOI: 10.1016/j.jad.2023.03.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 02/13/2023] [Accepted: 03/06/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE The primary purpose of this study was to investigate the contribution of genetic predispositions to depression and inflammation, as measured through polygenic risk scores, on symptom burden (physical and psychological) in patients with head and neck cancer in the immediate post-treatment period (i.e., at three months post-diagnosis), as well as on 3-, 6-, 12-, 24- and 36-month survival. METHODS Prospective longitudinal study of 223 adults (72 % participation) newly diagnosed with a first occurrence of primary head and neck cancer, paired with genetic data (Illumina PsychArray), validated psychometric measures, Structured Clinical Interviews for DSM Disorders (SCID-I), and medical chart reviews. RESULTS Symptom burden at 3 months was predicted by (R2 adj. = 0.38, p < 0.001): a baseline SCID-I Anxiety Disorder (b = 1.69, B = 0.23, 95%CI = 0.43-2.94; p = 0.009), baseline levels of HADS anxiety (b = 0.20, B = 0.29, 95%CI = 0.07-0.34; p = 0.003), the polygenic risk score (PRS) for depression (b = 0.66, B = 0.18, 95%CI = 0.003-1.32; p = 0.049), and cumulated dose of radiotherapy (b = 0.002, B = 0.46, 95%CI = 0.001-0.003; p < 0.001). When controlling for factors known to be associated with cancer survival, patients with a higher PRS associated with depression and inflammation, respectively, presented higher risk of death within 36 months (b = 1.75, Exp(B) = 5.75, 95%CI = 1.55-21.27, p = 0.009 and b = 0.14, Exp(B) = 1.15, 95%CI = 1.01-1.30, p = 0.03). CONCLUSIONS Our results outline three potential pathways of symptom burden in patients with head and neck cancer: a genetic predisposition towards depression; an initial anxiety disorder upon being diagnosed with cancer or high levels of anxiety upon diagnosis; and a dose-related response to radiotherapy. One may want to investigate early interventions in these areas to alleviate symptom burden in patients faced with a life-threatening disease, as well as consider targeting genetic predisposition towards depression and inflammation implicated in survival. The high prevalence of distress in patients with head and neck cancer is an opportunity to study genetic predispositions, which could potentially be broadly generalized to other cancers and diseases.
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Affiliation(s)
- Melissa Henry
- McGill University, Canada; Jewish General Hospital, Canada; Lady-Davis Institute for Medical Research, Canada.
| | | | | | | | | | - Han-Tin Kao
- McGill University, Canada; Douglas Hospital, Canada
| | - Zeev Rosberger
- McGill University, Canada; Jewish General Hospital, Canada; Lady-Davis Institute for Medical Research, Canada
| | - Saul Frenkiel
- McGill University, Canada; Jewish General Hospital, Canada; Douglas Hospital, Canada
| | - Michael Hier
- McGill University, Canada; Jewish General Hospital, Canada; Lady-Davis Institute for Medical Research, Canada
| | - Anthony Zeitouni
- McGill University, Canada; McGill University Health Centre, Canada
| | - Karen Kost
- McGill University, Canada; McGill University Health Centre, Canada
| | - Alex Mlynarek
- McGill University, Canada; Jewish General Hospital, Canada; McGill University Health Centre, Canada
| | - Keith Richardson
- McGill University, Canada; McGill University Health Centre, Canada
| | - Celia M T Greenwood
- McGill University, Canada; Lady-Davis Institute for Medical Research, Canada
| | | | - Phil Gold
- McGill University, Canada; Jewish General Hospital, Canada
| | | | - Martin Black
- McGill University, Canada; Jewish General Hospital, Canada
| | - Marco Mascarella
- McGill University, Canada; McGill University Health Centre, Canada
| | | | - Nader Sadeghi
- McGill University, Canada; McGill University Health Centre, Canada
| | - Khalil Sultanem
- McGill University, Canada; McGill University Health Centre, Canada
| | - Georges Shenouda
- McGill University, Canada; McGill University Health Centre, Canada
| | - Fabio Cury
- McGill University, Canada; McGill University Health Centre, Canada
| | - Kieran John O'Donnell
- McGill University, Canada; Douglas Hospital, Canada; Yale Child Study Center, Yale School of Medicine, Yale University, United States of America; Department of Obstetrics Gynecology & Reproductive Sciences, Yale School of Medicine, Yale University, United States of America
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Miguel PM, Pereira LO, Barth B, de Mendonça Filho EJ, Pokhvisneva I, Nguyen TTT, Garg E, Razzolini BR, Koh DXP, Gallant H, Sassi RB, Hall GBC, O'Donnell KJ, Meaney MJ, Silveira PP. Prefrontal Cortex Dopamine Transporter Gene Network Moderates the Effect of Perinatal Hypoxic-Ischemic Conditions on Cognitive Flexibility and Brain Gray Matter Density in Children. Biol Psychiatry 2019; 86:621-630. [PMID: 31142432 DOI: 10.1016/j.biopsych.2019.03.983] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/23/2019] [Accepted: 03/25/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Genetic polymorphisms of the dopamine transporter gene (DAT1) and perinatal complications associated with poor oxygenation are risk factors for attentional problems in childhood and may show interactive effects. METHODS We created a novel expression-based polygenic risk score (ePRS) reflecting variations in the function of the DAT1 gene network (ePRS-DAT1) in the prefrontal cortex and explored the effects of its interaction with perinatal hypoxic-ischemic-associated conditions on cognitive flexibility and brain gray matter density in healthy children from two birth cohorts-MAVAN from Canada (n = 139 boys and girls) and GUSTO from Singapore (n = 312 boys and girls). RESULTS A history of exposure to several perinatal hypoxic-ischemic-associated conditions was associated with impaired cognitive flexibility only in the high-ePRS group, suggesting that variation in the prefrontal cortex expression of genes involved in dopamine reuptake is associated with differences in this behavior. Interestingly, this result was observed in both ethnically distinct birth cohorts. Additionally, parallel independent component analysis (MAVAN cohort, n = 40 children) demonstrated relationships between single nucleotide polymorphism-based ePRS and gray matter density in areas involved in executive (cortical regions) and integrative (bilateral thalamus and putamen) functions, and these relationships differ in children from high and low exposure to hypoxic-ischemic-associated conditions. CONCLUSIONS These findings reveal that the impact of conditions associated with hypoxia-ischemia on brain development and executive functions is moderated by genotypes associated with dopamine signaling in the prefrontal cortex. We discuss the potential impact of innovative genomic and environmental measures for the identification of children at high risk for impaired executive functions.
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Affiliation(s)
- Patrícia Maidana Miguel
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lenir Orlandi Pereira
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Barbara Barth
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montréal, Quebec, Canada; Integrated Program in Neuroscience, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | - Euclides José de Mendonça Filho
- Programa de Pós-Graduação em Psicologia, Instituto de Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Irina Pokhvisneva
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Thao T T Nguyen
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Elika Garg
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Bruna Regis Razzolini
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montréal, Quebec, Canada; Integrated Program in Neuroscience, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | - Dawn Xin Ping Koh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Heather Gallant
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Roberto Britto Sassi
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Geoffrey B C Hall
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Kieran John O'Donnell
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montréal, Quebec, Canada; Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | - Michael J Meaney
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montréal, Quebec, Canada; Integrated Program in Neuroscience, Faculty of Medicine, McGill University, Montréal, Quebec, Canada; Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada; Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Patrícia Pelufo Silveira
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montréal, Quebec, Canada; Integrated Program in Neuroscience, Faculty of Medicine, McGill University, Montréal, Quebec, Canada; Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada.
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McKinney RE, Johnson GM, Stanley K, Yong FH, Keller A, O'Donnell KJ, Brouwers P, Mitchell WG, Yogev R, Wara DW, Wiznia A, Mofenson L, McNamara J, Spector SA. A randomized study of combined zidovudine-lamivudine versus didanosine monotherapy in children with symptomatic therapy-naive HIV-1 infection. The Pediatric AIDS Clinical Trials Group Protocol 300 Study Team. J Pediatr 1998; 133:500-8. [PMID: 9787687 DOI: 10.1016/s0022-3476(98)70057-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The Pediatric AIDS Clinical Trials Group (PACTG) Protocol 300 assessed the clinical efficacy and safety of combination zidovudine/lamivudine (ZDV/3TC) compared with either didanosine (ddI) alone or combination ZDV/ddI. STUDY DESIGN Children with symptomatic human immunodeficiency virus (HIV) infection, 6 weeks through 15 years of age, were stratified according to age and randomly assigned to receive ddI, ZDV/3TC, or ZDV/ddI. The primary endpoint was time to first progression of HIV disease or death. Enrollment in the ZDV/ddI arm stopped after 11 months on the basis of results of PACTG Protocol 152, but blinded follow-up continued. RESULTS For the 471 children who could be evaluated, the median age was 2.7 years, median CD4 cell count was 699 cells/mm3, and median log10 HIV RNA was 5.1/mL. Median follow-up was 9.4 months. Patients receiving ZDV/3TC had a lower risk of HIV disease progression or death than those receiving ddI alone (15 vs 38 failures, P = .0006) and a lower risk of death (3 vs 15 deaths, P = .0039). Weight and height growth rates, CD4+ cell counts, and RNA concentrations showed results favoring ZDV/3TC. For patients concurrently randomized to all 3 treatment arms, both ZDV/3TC and ZDV/ddI recipients had lower risk of HIV disease progression than those who received ddI alone (P = .0026 and P = .0045). CONCLUSIONS Combination therapy with either ZDV/3TC or ZDV/ddI was superior, as determined by clinical and laboratory measures, to monotherapy with ddI.
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Affiliation(s)
- R E McKinney
- Department of Pediatrics and Psychiatry, Duke University Medical Center, Durham, North Carolina 27710, USA
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Gingras JL, O'Donnell KJ. State control in the substance-exposed fetus. I. The fetal neurobehavioral profile: an assessment of fetal state, arousal, and regulation competency. Ann N Y Acad Sci 1998; 846:262-76. [PMID: 9668413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Behavioral states are stable structures of behaviors that become more definable and coordinated with increasing age. With ultrasound we can see the fetus move, breathe, and react to changes in its environment. Ultrasound used in conjunction with Doppler fetal heart rate recording provides behavioral and neurophysiologic data useful in state determination. The Fetal Neurobehavioral Profile (FNP) was developed by our group as an assessment of fetal behaviors reflecting CNS integrity in the drug-exposed fetus. The FNP was designed to parallel methods of examining the newborn infant, especially in state-related behaviors. The FNP measures: fetal responsiveness and arousal after environmental perturbation with vibroacoustic stimulation (VAS); habituation to VAS; state recovery; and self-regulation post-VAS. From the behavioral and physiologic recordings, the constructs of state differentiation, organization, and regulation as well as fetal arousal and regulation competency can be measured. Previous work using the FNP showed that those fetuses with abnormal or suspect fetal state regulation demonstrated impaired performance on the NBAS (Am. J. Obstet. Gynecol. 161: 685, 1989). To expand these observations, three populations are currently being studied: prenatal nicotine-exposed, prenatal cocaine-exposed, and controls. Data are from 97 women/fetus dyads and a total of 236 FNP at ages 28-30 weeks gestational age, 31-34 weeks gestational age, and > 36 weeks gestational age. Although there are no group differences in the ability to achieve state by 36 weeks, interesting trends emerge: fetuses prenatally cocaine-exposed spend less time in 1F, more time in 4F and have fewer transitions. At FNP, fewer cocaine-exposed fetuses had an initial reaction to VAS, whereas fewer nicotine-exposed fetuses habituated. Although the ability to habituate to VAS did not discriminate the cocaine group from the control or nicotine groups, the number of stimuli required for habituation differed between groups: 7 for the cocaine-exposed, 3 for the nicotine, and 5 for the control groups. Thus latency, a measure of arousal, differs among the groups Preliminary data also suggest a correlation of prenatal data with postnatal outcome.
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Affiliation(s)
- J L Gingras
- Department of Pediatrics, Carolinas Medical Center, SIDS C.A.R.E. Center, Charlotte, North Carolina 28232, USA
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Gingras JL, Muelenaer A, Dalley LB, O'Donnell KJ. Prenatal cocaine exposure alters postnatal hypoxic arousal responses and hypercarbic ventilatory responses but not pneumocardiograms in prenatally cocaine-exposed term infants. Pediatr Pulmonol 1994; 18:13-20. [PMID: 7970902 DOI: 10.1002/ppul.1950180106] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To test the hypothesis that respiratory control is altered in cocaine-exposed infants, we evaluated the hypoxic arousal response and the ventilatory response to carbon dioxide (CO2) in 18 term newborn infants prenatally exposed to cocaine and in 10 healthy, term newborn infants within the first week of life. Three infants could not be tested for the hypoxic arousal response because of low baseline oxygen saturation, and data from these infants were excluded from analysis. Twelve hour overnight pneumocardiograms were performed on all infants. Results show that 60% (9/15) of the prenatally cocaine-exposed infants had an abnormal hypoxic arousal response and 87% (13/15) had abnormal hypercarbic ventilatory response. Only 6% (1/15) of the prenatally cocaine-exposed infants demonstrated any abnormality on pneumocardiogram. In contrast, all control infants (10/10) were aroused by the hypoxic challenge and 80% (8/10) had normal ventilatory response to CO2. No abnormalities were found in the assessment of the overnight pneumocardiogram in the control infants. For the cocaine-exposed infants, test abnormalities were not correlated with a concurrent positive urine toxicology for cocaine, suggesting that the injury occurs early in development. These findings support the hypothesis that infants prenatally exposed to cocaine demonstrate abnormalities of respiratory control.
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Affiliation(s)
- J L Gingras
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710
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Abstract
As cocaine use during pregnancy has become increasingly recognized, there also has been increased concern about the toxic and teratogenic properties of cocaine on the fetus. A significant literature exists describing the adverse fetal and neonatal outcomes associated with in utero cocaine exposure. However, specific causality by cocaine on outcome in the human is difficult to ascertain because of multiple confounding variables associated with substance abuse including social factors and polydrug use as well as difficulty in confirming timing, dose and frequency of cocaine exposure. Most literature suggests that prenatal cocaine exposure is associated with developmental risk to the fetus. What is currently unknown is the extent of risk, the additive and/or synergistic factors contributing to cocaine's toxicity and the reversibility of the injury. In this paper we review the pharmacologic properties of cocaine as related to a model of mechanisms for developmental injury secondary to cocaine exposure and the published literature on the adverse fetal and neonatal outcomes associated with cocaine use during pregnancy. Specific attention has been focused on the structural, neurobehavioral and respiratory control teratogenesis.
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Affiliation(s)
- J L Gingras
- Department of Pediatrics, Duke University Medical Center, Durham, NC 27710
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Abstract
Pseudomonas fluorescens MT15 is the host of the large (250 kbp) TOL plasmid pWW15. We have shown by a combination of hybridization, molecular cloning and enzyme assay that pWW15 carries two distinct regions which share homology with the upper pathway operons (xylCMABN) of other TOL plasmids and two distinct regions which are homologous to the meta pathway operons (xylXYZLTEGFJQKIH) of other TOL plasmids. Both the areas of homology to the upper pathway operons appear to carry all of the structural genes for the three catabolic enzymes of the operon. One of the regions of meta pathway operon homology encodes a complete functional pathway, but the second is incomplete and appears to carry only the genes from xylF downstream.
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Affiliation(s)
- K J O'Donnell
- School of Biological Sciences, University of Wales, Bangor, Gwynedd, UK
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O'Donnell KJ, Lanpher RP, Caliri RP, Connell RF, Marrinan GP, Day B. Payor/provider perspectives on EDI: achieving cost controls? Interview by Loran Walker. Healthc Inform 1991; 8:36-8, 40, 42. [PMID: 10120896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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O'Donnell KJ. Managed care goes electronic. AAPPO J 1991; 1:33-6. [PMID: 10149629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- K J O'Donnell
- National Electronic Information Corporation (NEIC), Secaucus, New Jersey
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Gingras JL, O'Donnell KJ, Hume RF. Maternal cocaine addiction and fetal behavioral state. I: A human model for the study of sudden infant death syndrome. Med Hypotheses 1990; 33:227-30. [PMID: 2090922 DOI: 10.1016/0306-9877(90)90131-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abnormalities of respiratory regulation, such as apnea and abnormal hypoxic arousal during sleep, are mechanistic in the pathophysiology of SIDS. In utero cocaine exposure is associated with poor head growth, abnormal neurodevelopment, and an increased incidence of sudden, unexplained death, suggesting that in utero cocaine exposure disrupts the central regulation of breathing. It is likely that this disruption is due to altered CNS maturation. Indeed, cocaine alters norepinephrine metabolism within the locus coeruleus, important in arousal from sleep, suggesting that the increased incidence of SIDS in cocaine exposed infants may be secondary to sleep-related deficits in arousal. Since components of fetal behavioural state organization reflect the successful integration of the Central Nervous System, have a specific developmental timetable, and can be studied by fetal ultrasound techniques, we developed a strategy for assessing the state organization of the fetus by ultrasound techniques. We hypothesize that fetal evaluation of state will be a marker of abnormal CNS maturation and a predictor of risk, i.e. abnormal neurodevelopment and/or state related arousal deficits predisposing the cocaine exposed neonate to SIDS. We propose that the study of in utero cocaine exposed fetuses will provide a human model for examining the pathophysiology of SIDS.
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Affiliation(s)
- J L Gingras
- Department of Pediatrics, Duke University Medical Center, Durham, NC 27707
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Hume RF, O'Donnell KJ, Stanger CL, Killam AP, Gingras JL. In utero cocaine exposure: Observations of fetal behavioral state may predict neonatal outcome. Int J Gynaecol Obstet 1990. [DOI: 10.1016/0020-7292(90)90500-k] [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: 10/26/2022]
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Hume RF, O'Donnell KJ, Stanger CL, Killam AP, Gingras JL. In utero cocaine exposure: observations of fetal behavioral state may predict neonatal outcome. Am J Obstet Gynecol 1989; 161:685-90. [PMID: 2675600 DOI: 10.1016/0002-9378(89)90380-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Components of fetal behavioral state organization reflect the successful integration of the central nervous system, have a specific developmental timetable, and can be studied with fetal ultrasonographic techniques. To test the hypothesis that evaluation of state organization is a marker of abnormal central nervous system maturation and a predictor of risk, we studied 20 fetuses and newborns exposed to cocaine in utero. Fetal assessments were accomplished by serial ultrasonographic examination, videotaped, and scored by a scheme developed by the authors to assess organization and regulation of behavioral states. Newborn neurobehavioral assessments also emphasized organization and regulation of behavioral state. Abnormal or delayed state behavior was identified in 13 of 20 fetuses. State organization was evaluated as suspect or abnormal for 16 of the 20 exposed newborns. Disorganized behavioral state in the fetus successfully predicted abnormal newborn behavior. These findings support the concepts that cocaine exposure disrupts central nervous system development and that fetal assessment of state is predictive of neonatal outcome.
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Affiliation(s)
- R F Hume
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710
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O'Donnell KJ. Electronic health claims--1988 and beyond. US Healthc 1988; 5:38-40. [PMID: 10290463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The board members of NEIC: Aetna Life and Casualty, CIGNA, EQUICOR-Equitable HCA Corp., John Hancock Mutual Life, Metropolitan Life, McDonnell Douglas Corp., and The Travelers, as well as the other owners and carrier members, are committed to electronic media claims. It is not a question of if, but when, all claims and attendant transactions will be submitted electronically. It will happen because it makes sound economic sense for the provider and for the carrier, and it will make life easier for the insured. It is no wonder EMC has become one of the hottest topics and growth areas in the healthcare information systems industry today.
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Bozynski ME, Nelson MN, Matalon TA, O'Donnell KJ, Naughton PM, Vasan U, Meier WA, Ploughman L. Prolonged mechanical ventilation and intracranial hemorrhage: impact on developmental progress through 18 months in infants weighing 1,200 grams or less at birth. Pediatrics 1987; 79:670-6. [PMID: 3575020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
In this prospective, longitudinal study, the relative impact of intracranial hemorrhage and prolonged mechanical ventilation on developmental progress during the first 18 months of life of infants weighing 1,200 g or less at birth was examined. A total of 159 surviving infants were divided into two groups: infants with and those without intracranial hemorrhage. These groups were then subdivided into groups of infants receiving prolonged mechanical ventilation (greater than 21 days) and those mechanically ventilated for 21 days or less, thus creating four subgroups. Group 1 (intracranial hemorrhage and prolonged mechanical ventilation) and group 3 (intracranial hemorrhage and no prolonged mechanical ventilation) showed no statistically significant differences for severity of intracranial hemorrhage, persistence of ventriculomegaly, or presence of periventricular leukomalacia. A repeated-measures analysis of variance demonstrated a main effect for prolonged mechanical ventilation on outcome as measured by the Bayley Mental Development Index and Bayley Psychomotor Development Index at 4, 8, 12, and 18 months of age (corrected for prematurity). Forward stepwise regression revealed prolonged mechanical ventilation to the best predictor of Bayley indexes at all ages except 4 months of age, for which the Psychomotor Development Index was best predicted by length of hospitalization. No main effect for intracranial hemorrhage was demonstrated, but the motor performance of infants with intracranial hemorrhage declined significantly with age. By contrast prolonged mechanical ventilation was associated with uniformly poor performance at every age and serves as a powerful marker for poor developmental progress during the first 18 months of life in infants weighing 1,200 g or less at birth.
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Bozynski ME, Nelson MN, Genaze D, Rosati-Skertich C, Chilcote WS, Ramsey RG, O'Donnell KJ, Meier WA. Intracranial hemorrhage and neurodevelopmental outcome at one year in infants weighing 1200 grams or less. Prognostic significance of ventriculomegaly at term gestational age. Am J Perinatol 1984; 1:325-30. [PMID: 6394021 DOI: 10.1055/s-2007-1000032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Seventy-five surviving infants weighting 1200 g or less at birth were followed up longitudinally, employing real-time ultrasonographic examination of the brain from birth to term corrected gestational age. Evaluations using the Milani-Comparetti Motor Developmental Screening Test and developmental testing using the Bayley Scales of Infant Development were performed at 4, 8, and 12 months corrected age. Thirty-five (46.7%) of the infants were diagnosed to have intracranial hemorrhage (ICH). These infants were significantly smaller and lighter and were mechanically ventilated close to five times longer than infants without ICH. ICH was predictive of poorer developmental outcome through the first postnatal year. ICH infants had significantly lower Bayley motor scores at both 4 and 12 months. Sixteen of the 20 who scored less than 84 on one or both of the Bayley Scales at one year had a history of ICH. When infants with hemorrhage and normal ventricles at term (ICH-no VM) were compared to infants with hemorrhage and ventriculomegaly at term (ICH-VM), the poorest motor outcome was seen in the ICH-VM group. Only the ICH-VM group showed motor performance significantly poorer than the non-ICH group at 12 months of age. Regardless of severity of hemorrhage, the data suggested an added risk for poorer developmental outcome in ICH survivors who had ventriculomegaly or abnormal periventricular morphology at term. Thus, intracranial hemorrhage per se indicates significantly greater risk of short-term motor sequelae continuing through the first four postnatal months, but persistently abnormal ventricles serve as a more significant "marker" of risk for longer term neuromotor delays at one year corrected age.(ABSTRACT TRUNCATED AT 250 WORDS)
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