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Chanana V, Zafer D, Kintner DB, Chandrashekhar JH, Eickhoff J, Ferrazzano PA, Levine JE, Cengiz P. TrkB-mediated neuroprotection in female hippocampal neurons is autonomous, estrogen receptor alpha-dependent, and eliminated by testosterone: a proposed model for sex differences in neonatal hippocampal neuronal injury. Biol Sex Differ 2024; 15:30. [PMID: 38566248 PMCID: PMC10988865 DOI: 10.1186/s13293-024-00596-1] [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: 09/19/2023] [Accepted: 02/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Neonatal hypoxia ischemia (HI) related brain injury is one of the major causes of learning disabilities and memory deficits in children. In both human and animal studies, female neonate brains are less susceptible to HI than male brains. Phosphorylation of the nerve growth factor receptor TrkB has been shown to provide sex-specific neuroprotection following in vivo HI in female mice in an estrogen receptor alpha (ERα)-dependent manner. However, the molecular and cellular mechanisms conferring sex-specific neonatal neuroprotection remain incompletely understood. Here, we test whether female neonatal hippocampal neurons express autonomous neuroprotective properties and assess the ability of testosterone (T) to alter this phenotype. METHODS We cultured sexed hippocampal neurons from ERα+/+ and ERα-/- mice and subjected them to 4 h oxygen glucose deprivation and 24 h reoxygenation (4-OGD/24-REOX). Sexed hippocampal neurons were treated either with vehicle control (VC) or the TrkB agonist 7,8-dihydroxyflavone (7,8-DHF) following in vitro ischemia. End points at 24 h REOX were TrkB phosphorylation (p-TrkB) and neuronal survival assessed by immunohistochemistry. In addition, in vitro ischemia-mediated ERα gene expression in hippocampal neurons were investigated following testosterone (T) pre-treatment and TrkB antagonist therapy via q-RTPCR. Multifactorial analysis of variance was conducted to test for significant differences between experimental conditions. RESULTS Under normoxic conditions, administration of 3 µM 7,8-DHF resulted an ERα-dependent increase in p-TrkB immunoexpression that was higher in female, as compared to male neurons. Following 4-OGD/24-REOX, p-TrkB expression increased 20% in both male and female ERα+/+ neurons. However, with 3 µM 7,8-DHF treatment p-TrkB expression increased further in female neurons by 2.81 ± 0.79-fold and was ERα dependent. 4-OGD/24-REOX resulted in a 56% increase in cell death, but only female cells were rescued with 3 µM 7,8-DHF, again in an ERα dependent manner. Following 4-OGD/3-REOX, ERα mRNA increased ~ 3 fold in female neurons. This increase was blocked with either the TrkB antagonist ANA-12 or pre-treatment with T. Pre-treatment with T also blocked the 7,8-DHF- dependent sex-specific neuronal survival in female neurons following 4-OGD/24-REOX. CONCLUSIONS OGD/REOX results in sex-dependent TrkB phosphorylation in female neurons that increases further with 7,8-DHF treatment. TrkB phosphorylation by 7,8-DHF increased ERα mRNA expression and promoted cell survival preferentially in female hippocampal neurons. The sex-dependent neuroprotective actions of 7,8-DHF were blocked by either ANA-12 or by T pre-treatment. These results are consistent with a model for a female-specific neuroprotective pathway in hippocampal neurons in response to hypoxia. The pathway is activated by 7,8-DHF, mediated by TrkB phosphorylation, dependent on ERα and blocked by pre-exposure to T.
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Affiliation(s)
- Vishal Chanana
- Waisman Center, University of Wisconsin, Madison, WI, USA
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Wisconsin, 1500 Highland Ave - T505, Madison, WI, 53705-9345, USA
| | - Dila Zafer
- Waisman Center, University of Wisconsin, Madison, WI, USA
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Wisconsin, 1500 Highland Ave - T505, Madison, WI, 53705-9345, USA
| | - Douglas B Kintner
- Waisman Center, University of Wisconsin, Madison, WI, USA
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Wisconsin, 1500 Highland Ave - T505, Madison, WI, 53705-9345, USA
| | - Jayadevi H Chandrashekhar
- Waisman Center, University of Wisconsin, Madison, WI, USA
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Jens Eickhoff
- Department of Statistics and Bioinformatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Peter A Ferrazzano
- Waisman Center, University of Wisconsin, Madison, WI, USA
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Wisconsin, 1500 Highland Ave - T505, Madison, WI, 53705-9345, USA
| | - Jon E Levine
- Department of Neuroscience, University of Wisconsin, Madison, WI, USA
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Pelin Cengiz
- Waisman Center, University of Wisconsin, Madison, WI, USA.
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Wisconsin, 1500 Highland Ave - T505, Madison, WI, 53705-9345, USA.
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Fink EL, Alcamo AM, Lovett M, Hartman M, Williams C, Garcia A, Rasmussen L, Pal R, Drury K, MackDiaz E, Ferrazzano PA, Dervan L, Appavu B, Snooks K, Stulce C, Rubin P, Pate B, Toney N, Robertson CL, Wainwright MS, Roa JD, Schober ME, Slomine BS. Post-discharge outcomes of hospitalized children diagnosed with acute SARS-CoV-2 or MIS-C. Front Pediatr 2024; 12:1340385. [PMID: 38410766 PMCID: PMC10895015 DOI: 10.3389/fped.2024.1340385] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/18/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction Hospitalized children diagnosed with SARS-CoV-2-related conditions are at risk for new or persistent symptoms and functional impairments. Our objective was to analyze post-hospital symptoms, healthcare utilization, and outcomes of children previously hospitalized and diagnosed with acute SARS-CoV-2 infection or Multisystem Inflammatory Syndrome in Children (MIS-C). Methods Prospective, multicenter electronic survey of parents of children <18 years of age surviving hospitalization from 12 U.S. centers between January 2020 and July 2021. The primary outcome was a parent report of child recovery status at the time of the survey (recovered vs. not recovered). Secondary outcomes included new or persistent symptoms, readmissions, and health-related quality of life. Multivariable backward stepwise logistic regression was performed for the association of patient, disease, laboratory, and treatment variables with recovered status. Results The children [n = 79; 30 (38.0%) female] with acute SARS-CoV-2 (75.7%) or MIS-C (24.3%) had a median age of 6.5 years (interquartile range 2.0-13.0) and 51 (64.6%) had a preexisting condition. Fifty children (63.3%) required critical care. One-third [23/79 (29.1%)] were not recovered at follow-up [43 (31, 54) months post-discharge]. Admission C-reactive protein levels were higher in children not recovered vs. recovered [5.7 (1.3, 25.1) vs. 1.3 (0.4, 6.3) mg/dl, p = 0.02]. At follow-up, 67% overall had new or persistent symptoms. The most common symptoms were fatigue (37%), weakness (25%), and headache (24%), all with frequencies higher in children not recovered. Forty percent had at least one return emergency visit and 24% had a hospital readmission. Recovered status was associated with better total HRQOL [87 (77, 95) vs. 77 (51, 83), p = 0.01]. In multivariable analysis, lower admission C-reactive protein [odds ratio 0.90 (95% confidence interval 0.82, 0.99)] and higher admission lymphocyte count [1.001 (1.0002, 1.002)] were associated with recovered status. Conclusions Children considered recovered by their parents following hospitalization with SARS-CoV-2-related conditions had less symptom frequency and better HRQOL than those reported as not recovered. Increased inflammation and lower lymphocyte count on hospital admission may help to identify children needing longitudinal, multidisciplinary care. Clinical Trial Registration ClinicalTrials.gov (NCT04379089).
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Affiliation(s)
- Ericka L. Fink
- Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States
- Safar Center for Resuscitation Research, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Alicia M. Alcamo
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Marlina Lovett
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Mary Hartman
- Division of Pediatric Critical Care Medicine, Seattle Children’s Hospital, University of Washington, Seattle, WA, United States
| | - Cydni Williams
- Department of Pediatrics, Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR, United States
| | - Angela Garcia
- Division of Pediatric Physical Medicine and Rehabilitation, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Lindsey Rasmussen
- Division of Pediatric Critical Care Medicine, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA, United States
| | - Ria Pal
- Department of Neurology, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA, United States
| | - Kurt Drury
- Department of Pediatrics, Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR, United States
- Division of Pediatrics, Comer Children’s Hospital, University of Chicago, Chicago, IL, United States
| | - Elizabeth MackDiaz
- Division of Pediatric Critical Care Medicine, MUSC Shawn Jenkins Children’s Hospital, Charleston, SC, United States
| | - Peter A. Ferrazzano
- Department of Pediatrics, University of Wisconsin, Madison, WI, United States
| | - Leslie Dervan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Brain Appavu
- Division of Neurology, Barrow Neurological Institute at Phoenix Children’s Hospital, College of Medicine, University of Arizona, Phoenix, AZ, United States
| | - Kellie Snooks
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Casey Stulce
- Department of Pediatrics, University of Chicago, Chicago, IL, United States
| | - Pamela Rubin
- Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Bianca Pate
- Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Nicole Toney
- Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Courtney L. Robertson
- Departments of Anesthesiology and Critical Care Medicine, and Pediatrics, Johns Hopkins Children’s Center, Baltimore, MD, United States
| | - Mark S. Wainwright
- Division of Pediatric Neurology, Seattle Children’s Hospital, University of Washington, Seattle, WA, United States
| | - Juan D. Roa
- Department of Pediatrics, Universidad Nacional de Colombia and Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - Michelle E. Schober
- Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Beth S. Slomine
- Department of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Guerrero-Gonzalez JM, Kirk GR, Birn R, Bigler ED, Bowen K, Broman AT, Rosario BL, Butt W, Beers SR, Bell MJ, Alexander AL, Ferrazzano PA. Multi-modal MRI of hippocampal morphometry and connectivity after pediatric severe TBI. Brain Imaging Behav 2024; 18:159-170. [PMID: 37955810 PMCID: PMC10844146 DOI: 10.1007/s11682-023-00818-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 11/14/2023]
Abstract
This investigation explores memory performance using the California Verbal Learning Test in relation to morphometric and connectivity measures of the memory network in severe traumatic brain injury. Twenty-two adolescents with severe traumatic brain injury were recruited for multimodal MRI scanning 1-2 years post-injury at 13 participating sites. Analyses included hippocampal volume derived from anatomical T1-weighted imaging, fornix white matter microstructure from diffusion tensor imaging, and hippocampal resting-state functional magnetic resonance imaging connectivity as well as diffusion-based structural connectivity. A typically developing control cohort of forty-nine age-matched children also underwent scanning and neurocognitive assessment. Results showed hippocampus volume was decreased in traumatic brain injury with respect to controls. Further, hippocampal volume loss was associated with worse performance on memory and learning in traumatic brain injury subjects. Similarly, hippocampal fornix fractional anisotropy was reduced in traumatic brain injury with respect to controls, while decreased fractional anisotropy in the hippocampal fornix also was associated with worse performance on memory and learning in traumatic brain injury subjects. Additionally, reduced structural connectivity of left hippocampus to thalamus and calcarine sulcus was associated with memory and learning in traumatic brain injury subjects. Functional connectivity in the left hippocampal network was also associated with memory and learning in traumatic brain injury subjects. These regional findings from a multi-modal neuroimaging approach should not only be useful for gaining valuable insight into traumatic brain injury induced memory and learning disfunction, but may also be informative for monitoring injury progression, recovery, and for developing rehabilitation as well as therapy strategies.
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Affiliation(s)
- Jose M Guerrero-Gonzalez
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI, 53705, USA.
| | - Gregory R Kirk
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI, 53705, USA
| | - Rasmus Birn
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Erin D Bigler
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT, USA
- Department of Neurology & Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | | | - Aimee T Broman
- Department of Biostatistics, University of Wisconsin-Madison, Madison, WI, USA
| | - Bedda L Rosario
- Department of Epidemiology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Warwick Butt
- Department of Critical Care, Faculty of Medicine, Melbourne University, Melbourne, Australia
| | - Sue R Beers
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael J Bell
- Department of Pediatrics, Children's National Medical Center, Washington, DC, USA
| | - Andrew L Alexander
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI, 53705, USA
| | - Peter A Ferrazzano
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI, 53705, USA
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Al-Subu AM, Long MT, Nelson KL, Amond KL, Lasarev MR, Ferrazzano PA, Lushaj EB, Anagnostopoulos PV. Risk of Hypovitaminosis and Vitamin C Deficiency in Pediatric Patients Undergoing Cardiopulmonary Bypass. Pediatr Cardiol 2023; 44:1487-1494. [PMID: 37498330 DOI: 10.1007/s00246-023-03243-5] [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: 05/12/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
Vitamin C levels are known rapidly decrease in adult critical illness. Vitamin C scavenges free radicals, provides critical protection of the endothelial barrier, and improves endothelial responsiveness to catecholamines. Children with congenital heart disease and undergoing cardiac surgery might be at increased risk for low circulating vitamin C levels. A prospective single-center observational study investigated perioperative changes in vitamin C levels in critically ill Children who underwent congenital heart surgery using CPB. Vitamin C serum levels were collected preoperatively and postoperatively (upon admission to the ICU, 24 and 72 h). Linear mixed-effect model was used to estimate mean circulating concentration of vitamin C and to estimate changes in concentration over time. Primary outcome was change in circulating levels of vitamin C before and after CPB. Secondary outcomes were hospital length of stay (LOS), acute kidney injury (AKI), and illness severity. Forty-one patients with a median age of 4.5 [interquartile range (IQR) 2.6-65.6] months at the time of surgery were consented and enrolled. Median CPB duration was 130 [90-175] minutes, and hospital LOS was 9.1 [5.2-19] days. Mean vitamin C levels (μmol/L) before CPB, at PICU admission, 24 h, and 72 h were 82.0 (95% CI 73.4-90.7), 53.4 (95% CI 44.6,62.0), 55.1 (95% CI 46.3,63.8), and 59.2 (95% CI 50.3,68.1), respectively. Upon postoperative admission to the PICU, vitamin C levels decreased by 28.7 (95% CI 20.6-36.8; p < 0.001) μmol/L, whereas levels at 24 and 72 h recovered and did not differ substantially from concentrations reported upon PICU admission (p > 0.15). Changes in vitamin C concentration were not associated with CPB time, STAT mortality category, age, or PIM3. Three patients had post-CPB hypovitaminosis C or vitamin C deficiency. Reduction in vitamin C levels was not associated with hospital LOS (p = 0.673). A 25 μmol/L decrease in vitamin C levels upon PICU admission was associated with developing AKI (aOR = 3.65; 95% CI 1.01-18.0, p = 0.049). Pediatric patients undergoing cardiac surgery with CPB showed decreased vitamin C levels during the immediate postoperative period. Effects of hypovitaminosis C and vitamin C deficiency in this population remain unclear.
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Affiliation(s)
- Awni M Al-Subu
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave Rm H6/535, Madison, WI, 53792, USA.
| | - Micah T Long
- Division of Critical Care, Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kari L Nelson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kate L Amond
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michael R Lasarev
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Peter A Ferrazzano
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave Rm H6/535, Madison, WI, 53792, USA
| | - Entela B Lushaj
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Petros V Anagnostopoulos
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Abstract
OBJECTIVES To define the prevalence of neurologic diagnoses and evaluate the utilization of critical care and neurocritical care (NCC) resources among children admitted to the PICU. DESIGN Retrospective cohort analysis. SETTING Data submitted to the Virtual Pediatric Systems (VPS) database. PATIENTS All children entered in VPS during 2016 (January 1, 2016, to December 31, 2016). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There were 128,688 patients entered into VPS and were comprised of 24.3% NCC admissions and 75.7% general PICU admissions. The NCC cohort was older, represented more scheduled admissions, and was more frequently admitted from the operating room. The NCC cohort also experienced a greater decline in prehospitalization to posthospitalization functional status and required more frequent use of endotracheal intubation, arterial lines, and foley catheters but had an overall shorter duration of PICU and hospital length of stay with a higher mortality rate. One thousand seven hundred fifteen patients at 12 participating institutions were entered into a novel, pilot NCC module evaluating sources of secondary neurologic injury. Four hundred forty-eight patients were manually excluded by the data entrant, leaving 1,267 patients in the module. Of the patients in the module, 75.8% of patients had a NCC diagnosis as their primary diagnosis; they experienced a high prevalence of pathophysiologic events associated with secondary neurologic insult (ranging from hyperglycemia at 10.5% to hyperthermia at 36.8%). CONCLUSIONS In children admitted to a VPS-contributing PICU, a diagnosis of acute neurologic disease was associated with greater use of resources. We have identified the most common etiologies of acute neurologic disease in the 2016 VPS cohort, and such admissions were associated with significant decrease in functional status, as well as an increase in mortality.
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Affiliation(s)
- Ryan L DeSanti
- Department of Pediatrics, Drexel University College of Medicine, St Christopher's Hospital for Children, Philadelphia, PA
| | - Binod Balakrishnan
- Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Tom B Rice
- Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Jose A Pineda
- Department of Anesthesiology and Critical Care Medicine, Keck School of Medicine of the University of Southern California, Children's Hospital of Los Angeles, Los Angeles, CA
| | - Peter A Ferrazzano
- Department of Pediatrics, University of Wisconsin School of Medicine, American Family Children's Hospital, Madison, WI
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Ferguson NM, Rebsamen S, Field AS, Guerrero JM, Rosario BL, Broman AT, Rathouz PJ, Bell MJ, Alexander AL, Ferrazzano PA. Magnetic Resonance Imaging Findings in Infants with Severe Traumatic Brain Injury and Associations with Abusive Head Trauma. Children (Basel) 2022; 9:children9071092. [PMID: 35884076 PMCID: PMC9322188 DOI: 10.3390/children9071092] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022]
Abstract
Young children with severe traumatic brain injury (TBI) have frequently been excluded from studies due to age and/or mechanism of injury. Magnetic resonance imaging (MRI) is now frequently being utilized to detect parenchymal injuries and early cerebral edema. We sought to assess MRI findings in infants with severe TBI, and to determine the association between specific MRI findings and mechanisms of injury, including abusive head trauma (AHT). MRI scans performed within the first 30 days after injury were collected and coded according to NIH/NINDS Common Data Elements (CDEs) for Neuroimaging in subjects age < 2 years old with severe TBI enrolled in the Approaches and Decisions in Acute Pediatric Traumatic Brain Injury Trial. Demographics and injury characteristics were analyzed. A total of 81 children were included from ADAPT sites with MRI scans. Median age was 0.77 years and 57% were male. Most common MRI finding was ischemia, present in 57/81 subjects (70%), in a median of 7 brain regions per subject. Contusion 46/81 (57%) and diffuse axonal injury (DAI) 36/81 (44.4%) subjects followed. Children were dichotomized based on likelihood of AHT with 43/81 subjects classified as AHT. Ischemia was found to be significantly associated with AHT (p = 0.001) and “inflicted” injury mechanism (p = 0.0003). In conclusion, the most common intracerebral injury seen on MRI of infants with severe TBI was ischemia, followed by contusion and DAI. Ischemia was associated with AHT, and ischemia affecting > 4 brain regions was predictive of AHT.
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Affiliation(s)
- Nikki Miller Ferguson
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA 23298, USA;
| | - Susan Rebsamen
- Department of Radiology, University of Wisconsin, Madison, WI 53792, USA; (S.R.); (A.S.F.)
| | - Aaron S. Field
- Department of Radiology, University of Wisconsin, Madison, WI 53792, USA; (S.R.); (A.S.F.)
| | - Jose M. Guerrero
- Waisman Center, University of Wisconsin, Madison, WI 53705, USA; (J.M.G.); (A.L.A.)
- Department of Medical Physics, University of Wisconsin, Madison, WI 53705, USA
- Waisman Brain Imaging Laboratory, University of Wisconsin, Madison, WI 53705, USA
| | - Bedda L. Rosario
- Department of Epidemiology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | - Aimee T. Broman
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI 53705, USA;
| | - Paul J. Rathouz
- Department of Population Health, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA;
| | - Michael J. Bell
- Department of Pediatrics, Children’s National Medical Center, Washington, DC 20010, USA;
| | - Andrew L. Alexander
- Waisman Center, University of Wisconsin, Madison, WI 53705, USA; (J.M.G.); (A.L.A.)
- Department of Medical Physics, University of Wisconsin, Madison, WI 53705, USA
- Waisman Brain Imaging Laboratory, University of Wisconsin, Madison, WI 53705, USA
- Department of Psychiatry, University of Wisconsin, Madison, WI 53705, USA
| | - Peter A. Ferrazzano
- Waisman Center, University of Wisconsin, Madison, WI 53705, USA; (J.M.G.); (A.L.A.)
- Department of Pediatrics, University of Wisconsin, Madison, WI 53705, USA
- Correspondence: ; Tel.: +1-608-265-4839
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7
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Erklauer JC, Thomas AX, Hong SJ, Appavu BL, Carpenter JL, Chiriboga-Salazar NR, Ferrazzano PA, Goldstein Z, Griffith JL, Guilliams KP, Kirschen MP, Lidsky K, Lovett ME, McLaughlin B, Munoz Pareja JC, Murphy S, O’Donnell W, Riviello JJ, Schober ME, Topjian AA, Wainwright MS, Simon DW. A Virtual Community of Practice: An International Educational Series in Pediatric Neurocritical Care. Children 2022; 9:children9071086. [PMID: 35884070 PMCID: PMC9316633 DOI: 10.3390/children9071086] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022]
Abstract
Pediatric neurocritical care (PNCC) is a rapidly growing field. Challenges posed by the COVID-19 pandemic on trainee exposure to educational opportunities involving direct patient care led to the creative solutions for virtual education supported by guiding organizations such as the Pediatric Neurocritical Care Research Group (PNCRG). Our objective is to describe the creation of an international, peer-reviewed, online PNCC educational series targeting medical trainees and faculty. More than 1600 members of departments such as pediatrics, pediatric critical care, and child neurology hailing from 75 countries across six continents have participated in this series over a 10-month period. We created an online educational channel in PNCC with over 2500 views to date and over 130 followers. This framework could serve as a roadmap for other institutions and specialties seeking to address the ongoing problems of textbook obsolescence relating to the rapid acceleration in knowledge acquisition, as well as those seeking to create new educational content that offers opportunities for an interactive, global audience. Through the creation of a virtual community of practice, we have created an international forum for pediatric healthcare providers to share and learn specialized expertise and best practices to advance global pediatric health.
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Affiliation(s)
- Jennifer C. Erklauer
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Neuroscience, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (A.X.T.); (J.J.R.J.)
- Correspondence:
| | - Ajay X. Thomas
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Neuroscience, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (A.X.T.); (J.J.R.J.)
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Sue J. Hong
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (S.J.H.); (N.R.C.-S.)
| | - Brian L. Appavu
- Division of Neurology, Barrow Neurological Institute at Phoenix Children’s Hospital, University of Arizona College of Medicine, Phoenix, AZ 85004, USA;
| | - Jessica L. Carpenter
- Department of Pediatrics, Division of Pediatric Neurology, University of Maryland Children’s Hospital, Baltimore, MD 21201, USA;
| | - Nicolas R. Chiriboga-Salazar
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (S.J.H.); (N.R.C.-S.)
| | | | - Zachary Goldstein
- Division of Critical Care, Barrow Neurological Institute at Phoenix Children’s Hospital, University of Arizona College of Medicine, Phoenix, AZ 85004, USA;
| | - Jennifer L. Griffith
- Department of Neurology, Washington University in St. Louis, St. Louis, MO 63130, USA; (J.L.G.); (K.P.G.)
| | - Kristin P. Guilliams
- Department of Neurology, Washington University in St. Louis, St. Louis, MO 63130, USA; (J.L.G.); (K.P.G.)
- Department of Pediatrics and Radiology, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Matthew P. Kirschen
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, School of Medicine, University of Pennsylvania Perelman, Philadelphia, PA 19104, USA; (M.P.K.); (A.A.T.)
| | - Karen Lidsky
- Department of Pediatric Critical Care, Division of Critical Care Medicine, University of Florida Jacksonville and Wolfson Children’s Hospital, Jacksonville, FL 322007, USA;
| | - Marlina E. Lovett
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH 43205, USA;
| | - Brandon McLaughlin
- Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA; (B.M.); (W.O.)
| | - Jennifer C. Munoz Pareja
- Department of Pediatric Critical Care Medicine, School of Medicine, University of Miami Miller, Miami, FL 33136, USA;
| | - Sarah Murphy
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA 02115, USA;
| | - Wendy O’Donnell
- Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA; (B.M.); (W.O.)
| | - James J. Riviello
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Neuroscience, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (A.X.T.); (J.J.R.J.)
| | - Michelle E. Schober
- Department of Pediatrics, Division of Critical Care of the University of Utah, Salt Lake City, UT 84112, USA;
| | - Alexis A. Topjian
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, School of Medicine, University of Pennsylvania Perelman, Philadelphia, PA 19104, USA; (M.P.K.); (A.A.T.)
| | - Mark S. Wainwright
- Division of Neurology, Seattle Children’s Hospital, University of Washington, Seattle, WA 98105, USA;
| | - Dennis W. Simon
- Department of Critical Care Medicine and Pediatrics, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA;
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8
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Guerrero-Gonzalez JM, Yeske B, Kirk GR, Bell MJ, Ferrazzano PA, Alexander AL. Mahalanobis distance tractometry (MaD-Tract) - a framework for personalized white matter anomaly detection applied to TBI. Neuroimage 2022; 260:119475. [PMID: 35840117 PMCID: PMC9531540 DOI: 10.1016/j.neuroimage.2022.119475] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/27/2022] [Accepted: 07/11/2022] [Indexed: 12/04/2022] Open
Abstract
Imaging-based quantitative measures from diffusion-weighted MRI (dMRI) offer the ability to non-invasively extract microscopic information from human brain tissues. Group-level comparisons of such measures represent an important approach to investigate abnormal brain conditions. These types of analyses are especially useful when the regions of abnormality spatially coincide across subjects. When this is not true, approaches for individualized analyses are necessary. Here we present a framework for single-subject multidimensional analysis based on the Mahalanobis distance. This is conducted along specific white matter pathways represented by tractography-derived streamline bundles. A definition for abnormality was constructed from Wilk’s criterion, which accounts for normative sample size, number of features used in the Mahalanobis distance, and multiple comparisons. One example of a condition exhibiting high heterogeneity across subjects is traumatic brain injury (TBI). Using the Mahalanobis distance computed from the three eigenvalues of the diffusion tensor along the cingulum, uncinate, and parcellated corpus callosum tractograms, 8 severe TBI patients were individually compared to a normative sample of 49 healthy controls. For all TBI patients, the analyses showed statistically significant deviations from the normative data at one or multiple locations along the analyzed bundles. The detected anomalies were widespread across the analyzed tracts, consistent with the expected heterogeneity that is hallmark of TBI. Each of the controls subjects was also compared to the remaining 48 subjects in the control group in a leave-one-out fashion. Only two segments were identified as abnormal out of the entire analysis in the control group, thus the method also demonstrated good specificity.
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Affiliation(s)
- Jose M Guerrero-Gonzalez
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Room T129, Madison, WI 53705, USA.
| | - Benjamin Yeske
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Room T129, Madison, WI 53705, USA
| | - Gregory R Kirk
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Room T129, Madison, WI 53705, USA
| | - Michael J Bell
- Critical Care Medicine, Children's National Medical Center, Washington, DC, USA
| | - Peter A Ferrazzano
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Room T129, Madison, WI 53705, USA
| | - Andrew L Alexander
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Room T129, Madison, WI 53705, USA
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9
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Ozaydin B, Bicki E, Taparli OE, Sheikh TZ, Schmidt DK, Yapici S, Hackett MB, Karahan-Keles N, Eickhoff JC, Corcoran K, Lagoa-Miguel C, Guerrero Gonzalez J, Dean Iii DC, Sousa AMM, Ferrazzano PA, Levine JE, Cengiz P. Novel injury scoring tool for assessing brain injury following neonatal hypoxia-ischemia in mice. Dev Neurosci 2022; 44:394-411. [PMID: 35613558 DOI: 10.1159/000525244] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/04/2022] [Indexed: 11/19/2022] Open
Abstract
The variability of severity in hypoxia ischemia (HI) induced brain injury among research subjects is a major challenge in developmental brain injury research. Our laboratory developed a novel injury scoring tool based on our gross pathological observations during hippocampal extraction. The hippocampi received scores of 0-6 with 0 being no injury and 6 being severe injury post-HI. The hippocampi exposed to sham surgery were grouped as having no injury. We have validated the injury scoring tool with T2-weighted MRI analysis of percent hippocampal/hemispheric tissue loss and cell survival/death markers after exposing the neonatal mice to Vannucci's rodent model of neonatal HI. In addition, we have isolated hippocampal nuclei and quantified the percent good quality nuclei to provide an example of utilization of our novel injury scoring tool. Our novel injury scores correlated significantly with percent hippocampal and hemispheric tissue loss, cell survival/death markers, and percent good quality nuclei. Caspase-3 and Poly (ADP-ribose) polymerase-1 (PARP1) have been implicated in different cell death pathways in response to neonatal HI. Another gene, sirtuin1 (SIRT1), has been demonstrated to have neuroprotective and anti-apoptotic properties. To assess the correlation between the severity of injury and genes involved in cell survival/death, we analyzed caspase-3, PARP1, and SIRT1 mRNA expressions in hippocampi 3 days post-HI and sham surgery, using RT-qPCR. The ipsilateral (IL) hippocampal caspase-3 and SIRT1 mRNA expressions post-HI were significantly higher than sham IL hippocampi, and positively correlated with the novel injury scores in both males and females. We detected a statistically significant sex difference in IL hippocampal caspase-3 mRNA expression with comparable injury scores between males and females with higher expression in females.
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Affiliation(s)
- Burak Ozaydin
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ela Bicki
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Onur E Taparli
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Temour Z Sheikh
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Danielle K Schmidt
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sefer Yapici
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Nida Karahan-Keles
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jens C Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Karson Corcoran
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Jose Guerrero Gonzalez
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Douglas C Dean Iii
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Andre M M Sousa
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Neuroscience, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Peter A Ferrazzano
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jon E Levine
- Department of Neuroscience, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Pelin Cengiz
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
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10
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Liu Y, Nacewicz BM, Zhao G, Adluru N, Kirk GR, Ferrazzano PA, Styner MA, Alexander AL. A 3D Fully Convolutional Neural Network With Top-Down Attention-Guided Refinement for Accurate and Robust Automatic Segmentation of Amygdala and Its Subnuclei. Front Neurosci 2020; 14:260. [PMID: 32508558 PMCID: PMC7253589 DOI: 10.3389/fnins.2020.00260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 03/09/2020] [Indexed: 12/17/2022] Open
Abstract
Recent advances in deep learning have improved the segmentation accuracy of subcortical brain structures, which would be useful in neuroimaging studies of many neurological disorders. However, most existing deep learning based approaches in neuroimaging do not investigate the specific difficulties that exist in segmenting extremely small but important brain regions such as the subnuclei of the amygdala. To tackle this challenging task, we developed a dual-branch dilated residual 3D fully convolutional network with parallel convolutions to extract more global context and alleviate the class imbalance issue by maintaining a small receptive field that is just the size of the regions of interest (ROIs). We also conduct multi-scale feature fusion in both parallel and series to compensate the potential information loss during convolutions, which has been shown to be important for small objects. The serial feature fusion enabled by residual connections is further enhanced by a proposed top-down attention-guided refinement unit, where the high-resolution low-level spatial details are selectively integrated to complement the high-level but coarse semantic information, enriching the final feature representations. As a result, the segmentations resulting from our method are more accurate both volumetrically and morphologically, compared with other deep learning based approaches. To the best of our knowledge, this work is the first deep learning-based approach that targets the subregions of the amygdala. We also demonstrated the feasibility of using a cycle-consistent generative adversarial network (CycleGAN) to harmonize multi-site MRI data, and show that our method generalizes well to challenging traumatic brain injury (TBI) datasets collected from multiple centers. This appears to be a promising strategy for image segmentation for multiple site studies and increased morphological variability from significant brain pathology.
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Affiliation(s)
- Yilin Liu
- Waisman Brain Imaging Laboratory, University of Wisconsin-Madison, Madison, WI, United States
| | - Brendon M. Nacewicz
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Gengyan Zhao
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Nagesh Adluru
- Waisman Brain Imaging Laboratory, University of Wisconsin-Madison, Madison, WI, United States
| | - Gregory R. Kirk
- Waisman Brain Imaging Laboratory, University of Wisconsin-Madison, Madison, WI, United States
| | - Peter A. Ferrazzano
- Waisman Brain Imaging Laboratory, University of Wisconsin-Madison, Madison, WI, United States
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
| | - Martin A. Styner
- Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
- Department of Computer Science, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
| | - Andrew L. Alexander
- Waisman Brain Imaging Laboratory, University of Wisconsin-Madison, Madison, WI, United States
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
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11
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Ferrazzano PA, Rosario BL, Wisniewski SR, Shafi NI, Siefkes HM, Miles DK, Alexander AL, Bell MJ. Use of magnetic resonance imaging in severe pediatric traumatic brain injury: assessment of current practice. J Neurosurg Pediatr 2019; 23:471-479. [PMID: 30738383 PMCID: PMC6687576 DOI: 10.3171/2018.10.peds18374] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 07/20/2018] [Accepted: 10/24/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE There is no consensus on the optimal timing and specific brain MRI sequences in the evaluation and management of severe pediatric traumatic brain injury (TBI), and information on current practices is lacking. The authors performed a survey of MRI practices among sites participating in a multicenter study of severe pediatric TBI to provide information for designing future clinical trials using MRI to assess brain injury after severe pediatric TBI. METHODS Information on current imaging practices and resources was collected from 27 institutions participating in the Approaches and Decisions after Pediatric TBI Trial. Multiple-choice questions addressed the percentage of patients with TBI who have MRI studies, timing of MRI, MRI sequences used to investigate TBI, as well as the magnetic field strength of MR scanners used at the participating institutions and use of standardized MRI protocols for imaging after severe pediatric TBI. RESULTS Overall, the reported use of MRI in pediatric patients with severe TBI at participating sites was high, with 40% of sites indicating that they obtain MRI studies in > 95% of this patient population. Differences were observed in the frequency of MRI use between US and international sites, with the US sites obtaining MRI in a higher proportion of their pediatric patients with severe TBI (94% of US vs 44% of international sites reported MRI in at least 70% of patients with severe TBI). The reported timing and composition of MRI studies was highly variable across sites. Sixty percent of sites reported typically obtaining an MRI study within the first 7 days postinjury, with the remainder of responses distributed throughout the first 30-day postinjury period. Responses indicated that MRI sequences sensitive for diffuse axonal injury and ischemia are frequently obtained in patients with TBI, whereas perfusion imaging and spectroscopy techniques are less common. CONCLUSIONS Results from this survey suggest that despite the lack of consensus or guidelines, MRI is commonly obtained during the acute clinical setting after severe pediatric TBI. The variation in MRI practices highlights the need for additional studies to determine the utility, optimal timing, and composition of clinical MRI studies after TBI. The information in this survey describes current clinical MRI practices in children with severe TBI and identifies important challenges and objectives that should be considered when designing future studies.
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Affiliation(s)
| | - Bedda L. Rosario
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Nadeem I. Shafi
- Department of Pediatrics, University of Tennessee, Memphis, Tennessee
| | - Heather M. Siefkes
- Department of Pediatrics, University of California–Davis, Sacramento, California
| | - Darryl K. Miles
- Department of Pediatrics, University of Texas–Southwestern, Dallas, Texas
| | - Andrew L. Alexander
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin;,Department of Psychiatry, University of Wisconsin, Madison, Wisconsin
| | - Michael J. Bell
- Department of Pediatrics, Children’s National Medical Center, Washington, DC
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12
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Cengiz P, Zafer D, Chandrashekhar JH, Chanana V, Bogost J, Waldman A, Novak B, Kintner DB, Ferrazzano PA. Developmental differences in microglia morphology and gene expression during normal brain development and in response to hypoxia-ischemia. Neurochem Int 2019; 127:137-147. [PMID: 30639264 DOI: 10.1016/j.neuint.2018.12.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 09/24/2018] [Revised: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Neuroinflammation plays an important role in ischemic brain injury and recovery, however the interplay between brain development and the neuroinflammatory response is poorly understood. We previously described age-dependent differences in the microglial response and the effect of microglial inhibition. Here we investigate whether age-dependent microglial responses may be related to pre-injury developmental differences in microglial phenotype. METHODS Measures of microglia morphology were quantified using semi-automated software analysis of immunostained sections from postnatal day 2 (P2), P9, P30 and P60 mice using IMARIS. Microglia were isolated from P2, P9, P30 and P60 mice, and expression of markers of classical and alternative microglial activation was assessed, as well as transforming growth factor beta (TGF-β) receptor, Serpine1, Mer Tyrosine Kinase (MerTK), and the suppressor of cytokine signaling (SOCS3). Hypoxia-ischemia (HI) was induced in P9 and P30 mice using unilateral carotid artery ligation and exposure to 10% oxygen for 50 min. Microglia morphology and microglial expression of genes in the TGF-β and MerTK pathways were determined in ipsilateral and contralateral hippocampus. RESULTS A progressive and significant increase in microglia branching morphology was seen in all brain regions from P2 to P30. No consistent classical or alternative activation profile was seen in isolated microglia. A clear transition to increased expression of TGF-β and its downstream effector serpine1 was seen between P9 and P30. A similar increase in expression was seen in MerTK and its downstream effector SOCS3. HI resulted in a significant decrease in branching morphology only in the P9 mice, and expression of TGF-β receptor, Serpine1, MerTK, and SOCS3 were elevated in P30 mice compared to P9 post-HI. CONCLUSION Microglia maturation is associated with changes in morphology and gene expression, and microglial responses to ischemia in the developing brain differ based on the age at which injury occurs.
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Affiliation(s)
- Pelin Cengiz
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Waisman Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Dila Zafer
- Waisman Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jayadevi H Chandrashekhar
- Waisman Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; University of Illinois at Urbana-Champaign, IL, USA
| | - Vishal Chanana
- Waisman Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jacob Bogost
- Waisman Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alex Waldman
- Waisman Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Emory University School of Medicine, Atlanta, GA, USA
| | - Becca Novak
- Waisman Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Douglas B Kintner
- Waisman Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Peter A Ferrazzano
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Waisman Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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13
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Hsu DA, Rayer K, Jackson DC, Stafstrom CE, Hsu M, Ferrazzano PA, Dabbs K, Worrell GA, Jones JE, Hermann BP. Correlation of EEG with neuropsychological status in children with epilepsy. Clin Neurophysiol 2015; 127:1196-1205. [PMID: 26337841 DOI: 10.1016/j.clinph.2015.07.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 12/23/2014] [Revised: 07/10/2015] [Accepted: 07/20/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine correlations of the EEG frequency spectrum with neuropsychological status in children with idiopathic epilepsy. METHODS Forty-six children ages 8-18 years old with idiopathic epilepsy were retrospectively identified and analyzed for correlations between EEG spectra and neuropsychological status using multivariate linear regression. In addition, the theta/beta ratio, which has been suggested as a clinically useful EEG marker of attention-deficit hyperactivity disorder (ADHD), and an EEG spike count were calculated for each subject. RESULTS Neuropsychological status was highly correlated with posterior alpha (8-15 Hz) EEG activity in a complex way, with both positive and negative correlations at lower and higher alpha frequency sub-bands for each cognitive task in a pattern that depends on the specific cognitive task. In addition, the theta/beta ratio was a specific but insensitive indicator of ADHD status in children with epilepsy; most children both with and without epilepsy have normal theta/beta ratios. The spike count showed no correlations with neuropsychological status. CONCLUSIONS (1) The alpha rhythm may have at least two sub-bands which serve different purposes. (2) The theta/beta ratio is not a sensitive indicator of ADHD status in children with epilepsy. (3) The EEG frequency spectrum correlates more robustly with neuropsychological status than spike count analysis in children with idiopathic epilepsy. SIGNIFICANCE (1) The role of posterior alpha rhythms in cognition is complex and can be overlooked if EEG spectral resolution is too coarse or if neuropsychological status is assessed too narrowly. (2) ADHD in children with idiopathic epilepsy may involve different mechanisms from those in children without epilepsy. (3) Reliable correlations with neuropsychological status require longer EEG samples when using spike count analysis than when using frequency spectra.
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Affiliation(s)
- David A Hsu
- Department of Neurology, University of Wisconsin, Madison, WI, USA.
| | - Katherine Rayer
- Department of Neurology, University of Wisconsin, Madison, WI, USA
| | - Daren C Jackson
- Department of Neurology, University of Wisconsin, Madison, WI, USA
| | - Carl E Stafstrom
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Murielle Hsu
- Department of Neurology, University of Wisconsin, Madison, WI, USA
| | | | - Kevin Dabbs
- Department of Neurology, University of Wisconsin, Madison, WI, USA
| | | | - Jana E Jones
- Department of Neurology, University of Wisconsin, Madison, WI, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin, Madison, WI, USA
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