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Zhou X, Yang Y, Zhu F, Chen X, Zhu Y, Gui T, Li Y, Xue Q. Neurometabolic and Brain Functional Alterations Associated with Cognitive Impairment in Patients with Myasthenia Gravis: A Combined 1H-MRS and fMRI Study. Neuroscience 2024; 544:12-27. [PMID: 38423165 DOI: 10.1016/j.neuroscience.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/04/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
Whether patients with myasthenia gravis (MG) exhibit cognitive impairment is controversial. Also the underlying mechanisms are unknown. We aimed to investigate alterations in cognitive function, neurometabolite levels, and brain function in patients with MG and to explore the associations between abnormal regional brain functional activity, neurometabolite concentrations in the MPFC and left thalamus, and cognitive activity in patients with MG. Neuropsychological tests, proton magnetic resonance spectroscopy, and resting-state functional magnetic resonance imaging were performed on 41 patients with MG and 45 race-, sex-, age-, and education-matched healthy controls (HCs). The results suggest that MG is accompanied by cognitive decline, as indicated by global cognitive function, visual-spatial function, language, memory, abnormalities in regional brain functional activity, and neurometabolite alterations (including GABA, NAA, and Cho) in the medial prefrontal cortex (MPFC) and left thalamus. Cognitive impairment in patients with MG may be related to abnormal regional brain functional activity and changes in neurometabolites, and regional brain functional activity may be modulated by specific neurometabolites.
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Affiliation(s)
- Xiaoling Zhou
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China; Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215000, China
| | - Yang Yang
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214000, China
| | - Feng Zhu
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Xiang Chen
- Department of Radiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Yunfei Zhu
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Tiantian Gui
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Yonggang Li
- Department of Radiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China.
| | - Qun Xue
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China.
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Zhao T, Grist JT, Auer DP, Avula S, Bailey S, Davies NP, Grundy RG, Khan O, MacPherson L, Morgan PS, Pizer B, Rose HEL, Sun Y, Wilson M, Worthington L, Arvanitis TN, Peet AC. Noise suppression of proton magnetic resonance spectroscopy improves paediatric brain tumour classification. NMR Biomed 2024:e5129. [PMID: 38494431 DOI: 10.1002/nbm.5129] [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] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 01/07/2024] [Accepted: 02/03/2024] [Indexed: 03/19/2024]
Abstract
Proton magnetic resonance spectroscopy (1 H-MRS) is increasingly used for clinical brain tumour diagnosis, but suffers from limited spectral quality. This retrospective and comparative study aims at improving paediatric brain tumour classification by performing noise suppression on clinical 1 H-MRS. Eighty-three/forty-two children with either an ependymoma (ages 4.6± $$ \pm $$ 5.3/9.3± $$ \pm $$ 5.4), a medulloblastoma (ages 6.9± $$ \pm $$ 3.5/6.5± $$ \pm $$ 4.4), or a pilocytic astrocytoma (8.0± $$ \pm $$ 3.6/6.3± $$ \pm $$ 5.0), recruited from four centres across England, were scanned with 1.5T/3T short-echo-time point-resolved spectroscopy. The acquired raw 1 H-MRS was quantified by using Totally Automatic Robust Quantitation in NMR (TARQUIN), assessed by experienced spectroscopists, and processed with adaptive wavelet noise suppression (AWNS). Metabolite concentrations were extracted as features, selected based on multiclass receiver operating characteristics, and finally used for identifying brain tumour types with supervised machine learning. The minority class was oversampled through the synthetic minority oversampling technique for comparison purposes. Post-noise-suppression 1 H-MRS showed significantly elevated signal-to-noise ratios (P < .05, Wilcoxon signed-rank test), stable full width at half-maximum (P > .05, Wilcoxon signed-rank test), and significantly higher classification accuracy (P < .05, Wilcoxon signed-rank test). Specifically, the cross-validated overall and balanced classification accuracies can be improved from 81% to 88% overall and 76% to 86% balanced for the 1.5T cohort, whilst for the 3T cohort they can be improved from 62% to 76% overall and 46% to 56%, by applying Naïve Bayes on the oversampled 1 H-MRS. The study shows that fitting-based signal-to-noise ratios of clinical 1 H-MRS can be significantly improved by using AWNS with insignificantly altered line width, and the post-noise-suppression 1 H-MRS may have better diagnostic performance for paediatric brain tumours.
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Affiliation(s)
- Teddy Zhao
- Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - James T Grist
- Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Dorothee P Auer
- Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Shivaram Avula
- Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Simon Bailey
- Paediatric Oncology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Nigel P Davies
- Imaging and Medical Physics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Omar Khan
- Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | | | - Paul S Morgan
- Clinical Neuroscience, University of Nottingham, Nottingham, UK
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
- Medical Physics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Heather E L Rose
- Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Yu Sun
- Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Martin Wilson
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Lara Worthington
- Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Oncology, Birmingham Children's Hospital, Birmingham, UK
- RRPPS, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Theodoros N Arvanitis
- Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Oncology, Birmingham Children's Hospital, Birmingham, UK
- Digital Healthcare, WMG, University of Warwick, Coventry, UK
- Engineering, University of Birmingham, Birmingham, UK
| | - Andrew C Peet
- Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Oncology, Birmingham Children's Hospital, Birmingham, UK
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Nguyen DH, Nguyen DH, Le TD, Nguyen HK, Nguyen-Thi VA, Nguyen MD. Diagnostic algorithm for glioma grading using dynamic susceptibility contrast‑enhanced magnetic resonance perfusion and proton magnetic resonance spectroscopy. Biomed Rep 2024; 20:56. [PMID: 38357240 PMCID: PMC10865167 DOI: 10.3892/br.2024.1741] [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: 07/17/2023] [Accepted: 12/14/2023] [Indexed: 02/16/2024] Open
Abstract
The present retrospective study aimed to investigate the diagnostic capacity of and design a diagnostic algorithm for dynamic susceptibility contrast-enhanced MRI (DSCE-MRI) and proton magnetic resonance spectroscopy (1H-MRS) in grading low-grade glioma (LGG) and high-grade glioma (HGG). This retrospective study enrolled 57 patients, of which 14 had LGG and 43 had HGG, five had World Health Organization grade 1, nine had grade 2, 20 had grade 3 and 23 had grade 4 glioma. All subjects underwent a standard 3T MRI brain tumor protocol with conventional MRI (cMRI) and advanced techniques, including DSCE-MRI and 1H-MRS. The associations of grade categorization with parameters in tumor and peritumor regions in the DSCE-MRI were examined, including tumor relative cerebral blood volume (TrCBV) and peripheral relative (Pr)CBV, as well as Tr and Pr cerebral blood flow (CBF) and 1H-MRS, including the creatine (Cr) and N-acetyl aspartate (NAA) ratios of choline (Cho), i.e. the TCho/NAA, PCho/NAA, TCho/Cr and PCho/Cr metabolite ratios. The data were compared using the Mann-Whitney U-test, independent samples t-test, Chi-square test, Fisher's exact test and receiver operating characteristic curve analyses. Decision tree analysis established an algorithm based on cutoffs for specified significant parameters. The PrCBF had the highest performance in the preoperative prediction of histological glioma grading, followed by the TrCBV, PrCBF, TrCBV, PCho/NAA, PCho/Cr, TCho/NAA and TCho/Cr. An algorithm based on TrCBV, PrCBF and TCho/Cr had a diagnostic accuracy of 100% for LGG and 90.7% for HGG and a misclassification risk of 7%. The cutoffs (sensitivity and specificity) were 2.48 (86 and 100%) for TrCBV, 1.26 (83.7 and 100%) for PrCBF and 3.18 (69.8 and 78.6%) for TCho/Cr. In conclusion, the diagnostic algorithm using TrCBV, PrCBF and TCho/Cr values, which were obtained from DSCE-MRI and 1H-MRS, increased diagnostic accuracy to 100% for LGGs and 90.7% for HGGs compared to previous studies using conventional MRI. This non-invasive advanced MRI diagnostic algorithm is recommended for clinical application for constructing preoperative strategies and prognosis of patients with glioma.
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Affiliation(s)
- Dinh Hieu Nguyen
- Department of Radiology, Hanoi Medical University, Hanoi 100000, Vietnam
- Department of Radiology, Ha Dong General Hospital, Hanoi 100000, Vietnam
| | - Duy Hung Nguyen
- Department of Radiology, Hanoi Medical University, Hanoi 100000, Vietnam
- Department of Radiology, Viet Duc Hospital, Hanoi 100000, Vietnam
| | - Thanh Dung Le
- Department of Radiology, Viet Duc Hospital, Hanoi 100000, Vietnam
- Department of Radiology, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi 100000, Vietnam
| | - Ha Khuong Nguyen
- Department of Radiology, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Van Anh Nguyen-Thi
- Department of Radiology, Hanoi Medical University Hospital, Hanoi 100000, Vietnam
| | - Minh Duc Nguyen
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 700000, Vietnam
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Kanagasabai K, Palaniyappan L, Théberge J. Precision of metabolite-selective MRS measurements of glutamate, GABA and glutathione: A review of human brain studies. NMR Biomed 2024; 37:e5071. [PMID: 38050448 DOI: 10.1002/nbm.5071] [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] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 09/27/2023] [Accepted: 10/10/2023] [Indexed: 12/06/2023]
Abstract
Single-voxel proton magnetic resonance spectroscopy (SV 1 H-MRS) is an in vivo noninvasive imaging technique used to detect neurotransmitters and metabolites. It enables repeated measurements in living participants to build explanatory neurochemical models of psychiatric symptoms and testing of therapeutic approaches. Given the tight link among glutamate, gamma-amino butyric acid (GABA), glutathione and glutamine within the cellular machinery, MRS investigations of neurocognitive and psychiatric disorders must quantify a network of metabolites simultaneously to capture the pathophysiological states of interest. Metabolite-selective sequences typically provide improved metabolite isolation and spectral modelling simplification for a single metabolite at a time. Non-metabolite-selective sequences provide information on all detectable human brain metabolites, but feature many signal overlaps and require complicated spectral modelling. Although there are short-echo time (TE) MRS sequences that do not use spectral editing and are optimised to target either glutamate, GABA or glutathione, these approaches usually imply a precision tradeoff for the remaining two metabolites. Given the interest in assessing psychiatric and neurocognitive diseases that involve excitation-inhibition imbalances along with oxidative stress, there is a need to survey the literature on the quantification precision of current metabolite-selective MRS techniques. In this review, we locate and describe 17 studies that report on the quality of simultaneously acquired MRS metabolite data in the human brain. We note several factors that influence the data quality for single-shot acquisition of multiple metabolites of interest using metabolite-selective MRS: (1) internal in vivo references; (2) brain regions of interests; (3) field strength of scanner; and/or (4) optimised acquisition parameters. We also highlight the strengths and weaknesses of various SV spectroscopy techniques that were able to quantify in vivo glutamate, GABA and glutathione simultaneously. The insights from this review will assist in the development of new MRS pulse sequences for simultaneous, selective measurements of these metabolites and simplified spectral modelling.
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Affiliation(s)
- Kesavi Kanagasabai
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Imaging Program, Lawson Health Research Institute, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Lena Palaniyappan
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Imaging Program, Lawson Health Research Institute, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jean Théberge
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Imaging Program, Lawson Health Research Institute, London, Ontario, Canada
- Department of Medical Imaging, St. Joseph's Health Care Centre, London, Ontario, Canada
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Javor D, Bennani-Baiti BI, Clauser P, Kifjak D, Baltzer PAT. Automated analysis of the total choline resonance peak in breast proton magnetic resonance spectroscopy. NMR Biomed 2024; 37:e5054. [PMID: 37794648 DOI: 10.1002/nbm.5054] [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] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023]
Abstract
The aim of the current study was to compare the performance of fully automated software with human expert interpretation of single-voxel proton magnetic resonance spectroscopy (1H-MRS) spectra in the assessment of breast lesions. Breast magnetic resonance imaging (MRI) (including contrast-enhanced T1-weighted, T2-weighted, and diffusion-weighted imaging) and 1H-MRS images of 74 consecutive patients were acquired on a 3-T positron emission tomography-MRI scanner then automatically imported into and analyzed by SpecTec-ULR 1.1 software (LifeTec Solutions GmbH). All ensuing 117 spectra were additionally independently analyzed and interpreted by two blinded radiologists. Histopathology of at least 24 months of imaging follow-up served as the reference standard. Nonparametric Spearman's correlation coefficients for all measured parameters (signal-to-noise ratio [SNR] and integral of total choline [tCho]), Passing and Bablok regression, and receiver operating characteristic analysis, were calculated to assess test diagnostic performance, as well as to compare automated with manual reading. Based on 117 spectra of 74 patients, the area under the curve for tCho SNR and integrals ranged from 0.768 to 0.814 and from 0.721 to 0.784 to distinguish benign from malignant tissue, respectively. Neither method displayed significant differences between measurements (automated vs. human expert readers, p > 0.05), in line with the results from the univariate Spearman's rank correlation coefficients, as well as the Passing and Bablok regression analysis. It was concluded that this pilot study demonstrates that 1H-MRS data from breast MRI can be automatically exported and interpreted by SpecTec-ULR 1.1 software. The diagnostic performance of this software was not inferior to human expert readers.
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Affiliation(s)
- Domagoj Javor
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Radiology, University Hospital Krems, Krems, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Barbara I Bennani-Baiti
- Department of Radiology, University Hospital Krems, Krems, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Paola Clauser
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Daria Kifjak
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Radiology, UMass Memorial Medical Center and University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Pascal A T Baltzer
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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Zhang T, Guo B, Zuo Z, Long X, Hu S, Li S, Su X, Wang Y, Liu C. Excitatory-inhibitory modulation of transcranial focus ultrasound stimulation on human motor cortex. CNS Neurosci Ther 2023; 29:3829-3841. [PMID: 37309308 PMCID: PMC10651987 DOI: 10.1111/cns.14303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/10/2023] [Accepted: 05/27/2023] [Indexed: 06/14/2023] Open
Abstract
AIMS Transcranial focus ultrasound stimulation (tFUS) is a promising non-invasive neuromodulation technology. This study aimed to evaluate the modulatory effects of tFUS on human motor cortex (M1) excitability and explore the mechanism of neurotransmitter-related intracortical circuitry and plasticity. METHODS Single pulse transcranial magnetic stimulation (TMS)-eliciting motor-evoked potentials (MEPs) were used to assessed M1 excitability in 10 subjects. Paired-pulse TMS was used to measure the effects of tFUS on GABA- and glutamate-related intracortical excitability and 1 H-MRS was used to assess the effects of repetitive tFUS on GABA and Glx (glutamine + glutamate) neurometabolic concentrations in the targeting region in nine subjects. RESULTS The etFUS significantly increased M1 excitability, decreased short interval intracortical inhibition (SICI) and long interval intracortical inhibition (LICI). The itFUS significantly suppressed M1 excitability, increased SICI, LICI, and decreased intracortical facilitation (ICF). Seven times of etFUS decreased the GABA concentration (6.32%), increased the Glx concentration (12.40%), and decreased the GABA/Glx ratio measured by MRS, while itFUS increased the GABA concentration (18.59%), decreased Glx concentration (0.35%), and significantly increased GABA/Glx ratio. CONCLUSION The findings support that tFUS with different parameters can exert excitatory and inhibitory neuromodulatory effects on the human motor cortex. We provide novel insights that tFUS change cortical excitability and plasticity by regulating excitatory-inhibition balance related to the GABAergic and glutamatergic receptor function and neurotransmitter metabolic level.
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Affiliation(s)
- Tingting Zhang
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
- Beijing Key Laboratory of NeuromodulationBeijingChina
| | - Bingqi Guo
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
- Beijing Key Laboratory of NeuromodulationBeijingChina
| | - Zhentao Zuo
- State Key Laboratory of Brain and Cognitive Science, Beijing MR Center for Brain Research, Institute of BiophysicsChinese Academy of SciencesBeijingChina
- Hefei Comprehensive National Science CenterInstitute of Artificial IntelligenceHefeiChina
- Sino‐Danish CollegeUniversity of Chinese Academy of SciencesBeijingChina
| | - Xiaojing Long
- Shenzhen Institutes of Advanced TechnologyChinese Academy of SciencesShenzhenChina
| | - Shimin Hu
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
- Beijing Key Laboratory of NeuromodulationBeijingChina
| | - Siran Li
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xin Su
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Yuping Wang
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
- Beijing Key Laboratory of NeuromodulationBeijingChina
- Institute of Sleep and Consciousness Disorders, Center of Epilepsy, Beijing Institute for Brain DisordersCapital Medical UniversityBeijingChina
- Hebei Hospital of Xuanwu HospitalCapital Medical UniversityShijiazhuangChina
- Neuromedical Technology Innovation Center of Hebei ProvinceShijiazhuangChina
| | - Chunyan Liu
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
- Beijing Key Laboratory of NeuromodulationBeijingChina
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Ernst T, Ryan MC, Liang HJ, Wang JP, Cunningham E, Saleh MG, Kottilil S, Chang L. Neuronal and Glial Metabolite Abnormalities in Participants With Persistent Neuropsychiatric Symptoms After COVID-19: A Brain Proton Magnetic Resonance Spectroscopy Study. J Infect Dis 2023; 228:1559-1570. [PMID: 37540098 PMCID: PMC10681871 DOI: 10.1093/infdis/jiad309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 06/01/2023] [Accepted: 08/02/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND The aim of this study was to determine whether neurometabolite abnormalities indicating neuroinflammation and neuronal injury are detectable in individuals post-coronavirus disease 2019 (COVID-19) with persistent neuropsychiatric symptoms. METHODS All participants were studied with proton magnetic resonance spectroscopy at 3 T to assess neurometabolite concentrations (point-resolved spectroscopy, relaxation time/echo time = 3000/30 ms) in frontal white matter (FWM) and anterior cingulate cortex-gray matter (ACC-GM). Participants also completed the National Institutes of Health Toolbox cognition and motor batteries and selected modules from the Patient-Reported Outcomes Measurement Information System. RESULTS Fifty-four participants were evaluated: 29 post-COVID-19 (mean ± SD age, 42.4 ± 12.3 years; approximately 8 months from COVID-19 diagnosis; 19 women) and 25 controls (age, 44.1 ± 12.3 years; 14 women). When compared with controls, the post-COVID-19 group had lower total N-acetyl compounds (tNAA; ACC-GM: -5.0%, P = .015; FWM: -4.4%, P = .13), FWM glutamate + glutamine (-9.5%, P = .001), and ACC-GM myo-inositol (-6.2%, P = .024). Additionally, only hospitalized patients post-COVID-19 showed age-related increases in myo-inositol, choline compounds, and total creatine (interaction P = .029 to <.001). Across all participants, lower FWM tNAA and higher ACC-GM myo-inositol predicted poorer performance on several cognitive measures (P = .001-.009), while lower ACC-GM tNAA predicted lower endurance on the 2-minute walk (P = .005). CONCLUSIONS In participants post-COVID-19 with persistent neuropsychiatric symptoms, the lower-than-normal tNAA and glutamate + glutamine indicate neuronal injury, while the lower-than-normal myo-inositol reflects glial dysfunction, possibly related to mitochondrial dysfunction and oxidative stress in Post-COVID participants with persistent neuropsychiatric symptoms.
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Affiliation(s)
- Thomas Ernst
- Department of Diagnostic Radiology and Nuclear Medicine, School of Medicine, University of Maryland
- Department of Neurology, School of Medicine, Johns Hopkins University
| | - Meghann C Ryan
- Department of Diagnostic Radiology and Nuclear Medicine, School of Medicine, University of Maryland
- Program in Neuroscience, School of Medicine, University of Maryland
| | - Hua-Jun Liang
- Department of Diagnostic Radiology and Nuclear Medicine, School of Medicine, University of Maryland
| | - Justin P Wang
- Department of Diagnostic Radiology and Nuclear Medicine, School of Medicine, University of Maryland
| | - Eric Cunningham
- Department of Diagnostic Radiology and Nuclear Medicine, School of Medicine, University of Maryland
| | - Muhammad G Saleh
- Department of Diagnostic Radiology and Nuclear Medicine, School of Medicine, University of Maryland
| | - Shyamasundaran Kottilil
- Institute of Human Virology, Division of Infectious Disease, Department of Medicine, School of Medicine, University of Maryland
| | - Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, School of Medicine, University of Maryland
- Department of Neurology, School of Medicine, Johns Hopkins University
- Department of Neurology, School of Medicine, University of Maryland, Baltimore
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Batista ANR, Garcia T, Prudente R, Barbosa MF, Modesto P, Franco E, de Godoy I, Paiva S, Azevedo P, Tanni SE. Cardiac function, myocardial fat deposition, and lipid profile in young smokers: a cross-sectional study. Front Cardiovasc Med 2023; 10:1225621. [PMID: 38034384 PMCID: PMC10682099 DOI: 10.3389/fcvm.2023.1225621] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023] Open
Abstract
Background There is a possibility that cardiac morphometric characteristics are associated with the lipid profile, that is, the composition and concentration of triglycerides, total cholesterol, HDL, LDL, and others lipoproteins in young smokers without comorbidities. Thus, this study aimed to evaluate the association of cardiac morphometric characteristics, myocardial fat deposition, and smoking cessation with the lipid profile of young smokers. Methods A clinical and laboratory evaluation of lipids and the smoking status was performed on 57 individuals, including both a smoker group and a control group. Cardiac magnetic resonance imaging (MRI) with proton spectroscopy was performed to identify cardiac changes and triglyceride (TG) deposition in myocardial tissue. Results No differences were observed between the groups (control vs. smokers) in relation to the amount of myocardial TG deposition (p = 0.47); however, when TG deposition was correlated with cardiac MRI variables, a positive correlation was identified between smoking history and myocardial TG deposition [hazard ratio (95% CI), 0.07 (0.03-0.12); p = 0.002]. Furthermore, it was observed that the smoking group had lower high-density lipoprotein cholesterol [51 (45.5-59.5) mg/dl vs. 43 (36-49.5) mg/dl, p = 0.003] and higher TG [73 (58-110) mg/dl vs. 122 (73.5-133) mg/dl, p = 0.01] and very-low-density lipoprotein cholesterol [14.6 (11.6-22.2) mg/dl vs. 24.4 (14.7-26.6) mg/dl, p = 0.01] values. In the control and smoking groups, a negative correlation between TGs and the diameter of the aortic root lumen and positive correlation with the thickness of the interventricular septum and end-diastolic volume (EDV) of both the right ventricle (RV) and left ventricle (LV) were noted. Moreover, in the RV, positive correlations with the end-systolic volume (ESV) index (ESVI), stroke volume (SV), ESV, and EDV were observed. Regarding serum free fatty acids, we found a negative correlation between their values and the diameter of the lumen of the ascending aortic vessel. Lipoprotein lipase showed a positive correlation with the SV index of the RV and negative correlation with the diameter of the lumen of the ascending aortic vessel. Conclusion Several associations were observed regarding cardiac morphometric characteristics, myocardial fat deposition, and smoking cessation with the lipid profile of young smokers.
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Affiliation(s)
- Ana Natália Ribeiro Batista
- Pneumology Area, Department of Internal Medicine, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Thaís Garcia
- Pneumology Area, Department of Internal Medicine, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Robson Prudente
- Pulmonary Function Laboratory, Clinical Hospital of Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil
| | - Maurício F. Barbosa
- Department of Tropical Diseases and Diagnostic Imaging, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Pamela Modesto
- Pneumology Area, Department of Internal Medicine, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Estefânia Franco
- Pulmonary Function Laboratory, Clinical Hospital of Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil
| | - Irma de Godoy
- Pneumology Area, Department of Internal Medicine, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Sergio Paiva
- Pneumology Area, Department of Internal Medicine, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Paula Azevedo
- Pneumology Area, Department of Internal Medicine, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Suzana Erico Tanni
- Pneumology Area, Department of Internal Medicine, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
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Andescavage NN, Pradhan S, Gimovsky AC, Kapse K, Donofrio MT, Cheng JJ, Sharker Y, Wessel D, du Plessis AJ, Limperopoulos C. Magnetic Resonance Spectroscopy of Brain Metabolism in Fetuses With Congenital Heart Disease. J Am Coll Cardiol 2023; 82:1614-1623. [PMID: 37821172 DOI: 10.1016/j.jacc.2023.08.013] [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: 05/10/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Congenital heart disease (CHD) remains a significant risk factor for neurologic injury because altered fetal hemodynamics may be unable to support typical brain development during critical periods of growth and maturation. OBJECTIVES The primary objective was to assess differences in the cerebral biochemical profile between healthy fetuses and fetuses with complex CHD and to relate these with infant outcomes. METHODS Pregnant participants underwent fetal magnetic resonance imaging with cerebral proton magnetic resonance spectroscopy acquisitions as part of a prospective observational study. Cerebral metabolites of N-acetyl aspartate, creatine, choline, myo-inositol, scyllo-inositol, lactate, and relevant ratios were quantified using LCModel. RESULTS We acquired 503 proton magnetic resonance spectroscopy images (controls = 333; CHD = 170) from 333 participants (controls = 221; CHD = 112). Mean choline levels were higher in CHD compared with controls (CHD 2.47 IU [Institutional Units] ± 0.44 and Controls 2.35 IU ± 0.45; P = 0.02), whereas N-acetyl aspartate:choline ratios were lower among CHD fetuses compared with controls (CHD 1.34 ± 0.40 IU vs controls 1.44 ± 0.48 IU; P = 0.001). Cerebral lactate was detected in all cohorts but increased in fetuses with transposition of the great arteries and single-ventricle CHD (median: 1.63 [IQR: 0.56-3.27] in transposition of the great arteries and median: 1.28 [IQR: 0-2.42] in single-ventricle CHD) compared with 2-ventricle CHD (median: 0.79 [IQR: 0-1.45]). Cerebral lactate also was associated with increased odds of death before discharge (OR: 1.75; P = 0.04). CONCLUSIONS CHD is associated with altered cerebral metabolites in utero, particularly in the third trimester period of pregnancy, which is characterized by exponential brain growth and maturation, and is associated with survival to hospital discharge. The long-term neurodevelopmental consequences of these findings warrant further study.
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Affiliation(s)
- Nickie N Andescavage
- Department of Neonatology, Children's National Hospital, Washington, DC, USA; Developing Brain Institute, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Subechhya Pradhan
- Developing Brain Institute, Children's National Hospital, Washington, DC, USA
| | - Alexis C Gimovsky
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Kushal Kapse
- Developing Brain Institute, Children's National Hospital, Washington, DC, USA
| | - Mary T Donofrio
- Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Department of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Jenhao Jacob Cheng
- Department of Biostatistics, Children's National Hospital, Washington, DC, USA
| | - Yushuf Sharker
- Developing Brain Institute, Children's National Hospital, Washington, DC, USA
| | - David Wessel
- Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Department of Critical Care Medicine, Children's National Hospital, Washington, DC, USA
| | - Adre J du Plessis
- Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Prenatal Pediatric Institute, Children's National Hospital, Washington, DC, USA
| | - Catherine Limperopoulos
- Developing Brain Institute, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Department of Radiology, Children's National Hospital, Washington, DC, USA; Department of Radiology, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
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Resende LL, Leite CDC, Pastorello BF, Solla DJF, Martins PN, da BFP, Aranha MR, Ferraciolli SF, Otaduy MCG. Brain Spectroscopy Analysis in Retired Soccer Players With Chronic Exposure to Mild Traumatic Brain Injuries. Neurotrauma Rep 2023; 4:551-559. [PMID: 37636333 PMCID: PMC10457626 DOI: 10.1089/neur.2023.0020] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
Soccer players are at risk of suffering cranial injuries in the short and long term. There is growing concern that this may lead to traumatic brain injury in soccer players. Magnetic resonance spectroscopy (MRS) is an analytical method that enables the measurement of changes in brain metabolites that usually occur before significant structural changes. This study aimed to use MRS to compare variations in brain metabolite levels between retired soccer players and a control group. Twenty retired professional soccer players and 22 controls underwent magnetic resonance imaging, including MRS sequences and Mini-Mental State Examination (MMSE). Metabolite analysis was conducted based on absolute concentration and relative ratios. N-acetyl-aspartate, choline, glutamate, glutamine, and myoinositol were the metabolites of interest for the statistical analysis. Retired soccer players had an average age of 57.8 years, whereas the control group had an average age of 63.2 years. Median cognitive evaluation score, assessed using the MMSE, was 28 [26-29] for athletes and 29 [28-30] for controls (p = 0.01). Uni- and multi-variate analyses of the absolute concentration of metabolites (mM) between former athletes and controls did not yield any statistically significant results. Comparison of metabolites to creatine ratio concentrations did not yield any statistically significant results. There were no changes in concentrations of brain metabolites that indicated brain metabolic changes in retired soccer players compared with controls.
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Affiliation(s)
- Lucas Lopes Resende
- Laboratorio de Ressonancia Magnetica em Neurorradiologia (LIM-44), Instituto e Departamento de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Claudia da Costa Leite
- Laboratorio de Ressonancia Magnetica em Neurorradiologia (LIM-44), Instituto e Departamento de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruno Fraccini Pastorello
- Laboratorio de Ressonancia Magnetica em Neurorradiologia (LIM-44), Instituto e Departamento de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Davi Jorge Fontoura Solla
- Divisao de Neurocirurgia, Departamento de Neurologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Bernardo Fernandes Pelinca da
- Laboratorio de Ressonancia Magnetica em Neurorradiologia (LIM-44), Instituto e Departamento de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mateus Rozalem Aranha
- Laboratorio de Ressonancia Magnetica em Neurorradiologia (LIM-44), Instituto e Departamento de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Suely Fazio Ferraciolli
- Laboratorio de Ressonancia Magnetica em Neurorradiologia (LIM-44), Instituto e Departamento de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria Concepción García Otaduy
- Laboratorio de Ressonancia Magnetica em Neurorradiologia (LIM-44), Instituto e Departamento de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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11
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Grigoryants NF, Sass S, Alexander J. Novel Technologies in Breast Imaging: A Scoping Review. Cureus 2023; 15:e44061. [PMID: 37746370 PMCID: PMC10517733 DOI: 10.7759/cureus.44061] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Breast cancer is one of the leading causes of death in the United States and can cause considerable suffering for not only the patient but their families as well. The current mainstay of screening is mammography, although this screening modality has its drawbacks. Multiple technologies have been recently explored in hopes of increasing breast cancer detection rates and decreasing false positive rates. Overall, improving breast cancer screening techniques has the potential to decrease cost, patient anxiety, and the use of unnecessary procedures. This review discusses multiple modalities including digital breast tomosynthesis, contrast-enhanced dual-energy digital mammography (CE DE DM), MRI with diffusion-weighted sequences and proton magnetic resonance spectroscopy. This paper was written with the objective of synthesizing information across several databases to provide clinicians with a more accessible tool to understand the underlying concepts behind these imaging modalities, as well as present reviewed data which highlights the benefits and drawbacks of these breast cancer-detecting techniques.
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Affiliation(s)
| | - Sarah Sass
- Medicine, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Julia Alexander
- Diagnostic Radiology, Alabama College of Osteopathic Medicine, Dothan, USA
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Tzanetakos D, Kyrozis A, Karavasilis E, Velonakis G, Tzartos JS, Toulas P, Sotirli SA, Evdokimidis I, Tsivgoulis G, Potagas C, Kilidireas C, Andreadou E. Early metabolic alterations in the normal‑appearing grey and white matter of patients with clinically isolated syndrome suggestive of multiple sclerosis: A proton MR spectroscopic study. Exp Ther Med 2023; 26:349. [PMID: 37324507 PMCID: PMC10265702 DOI: 10.3892/etm.2023.12048] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/18/2023] [Indexed: 06/17/2023] Open
Abstract
Proton magnetic resonance spectroscopy (1H-MRS) is an advanced method of examining metabolic profiles. The present study aimed to assess in vivo metabolite levels in areas of normal-appearing grey (thalamus) and white matter (centrum semiovale) using 1H-MRS in patients with clinically isolated syndrome (CIS) suggestive of multiple sclerosis and compare them to healthy controls (HCs). Data from 35 patients with CIS (CIS group), of which 23 were untreated (CIS-untreated group) and 12 were treated (CIS-treated group) with disease-modifying-therapies (DMTs) at the time of 1H-MRS, and from 28 age- and sex-matched HCs were collected using a 3.0 T MRI and single-voxel 1H-MRS (point resolved spectroscopy sequence; repetition time, 2,000 msec; time to echo, 35 msec). Concentrations and ratios of total N-acetyl aspartate (tNAA), total creatine (tCr), total choline (tCho), myoinositol, glutamate (Glu), glutamine (Gln), Glu + Gln (Glx) and glutathione (Glth) were estimated in the thalamic-voxel (th) and centrum semiovale-voxel (cs). For the CIS group, the median duration from the first clinical attack to 1H-MRS was 102 days (interquartile range, 89.5.-131.5). Compared with HCs, significantly lower Glx(cs) (P=0.014) and ratios of tCho/tCr(th) (P=0.026), Glu/tCr(cs) (P=0.040), Glx/tCr(cs) (P=0.004), Glx/tNAA(th) (P=0.043) and Glx/tNAA(cs) (P=0.015) were observed in the CIS group. No differences in tNAA levels were observed between the CIS and the HC groups; however, tNAA(cs) was higher in the CIS-treated than in the CIS-untreated group (P=0.028). Compared with those in HC group, decreased Glu(cs) (P=0.019) and Glx(cs) levels (P=0.014) and lower ratios for tCho/tCr(th) (P=0.015), Gln/tCr(th) (P=0.004), Glu/tCr(cs) (P=0.021), Glx/tCr(th) (P=0.041), Glx/tCr(cs) (P=0.003), Glx/tNAA(th) (P=0.030) and Glx/tNAA(cs) (P=0.015) were found in the CIS-untreated group. The present findings showed alterations in the normal-appearing grey and white matter of patients with CIS; moreover, the present results suggested an early indirect treatment effect of DMTs on the brain metabolic profile of these patients.
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Affiliation(s)
- Dimitrios Tzanetakos
- Second Department of Neurology, ‘Attikon’ University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Andreas Kyrozis
- First Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Efstratios Karavasilis
- Research Unit of Radiology, Second Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Medical Physics Laboratory, School of Medicine, Democritus University of Thrace, 68100 Alexandroupoli, Greece
| | - Georgios Velonakis
- Research Unit of Radiology, Second Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - John S. Tzartos
- Second Department of Neurology, ‘Attikon’ University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Panagiotis Toulas
- Research Unit of Radiology, Second Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Stefania Alexia Sotirli
- MS Center and Other Neurodegenerative diseases, Metropolitan General Hospital, 15562 Holargos, Athens, Greece
| | - Ioannis Evdokimidis
- First Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, ‘Attikon’ University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Constantin Potagas
- First Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Costantinos Kilidireas
- First Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Elisabeth Andreadou
- First Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
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Allen J, Pham L, Bond ST, O’Brien WT, Spitz G, Shultz SR, Drew BG, Wright DK, McDonald SJ. Acute effects of single and repeated mild traumatic brain injury on levels of neurometabolites, lipids, and mitochondrial function in male rats. Front Mol Neurosci 2023; 16:1208697. [PMID: 37456524 PMCID: PMC10338885 DOI: 10.3389/fnmol.2023.1208697] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Mild traumatic brain injuries (mTBIs) are the most common form of acquired brain injury. Symptoms of mTBI are thought to be associated with a neuropathological cascade, potentially involving the dysregulation of neurometabolites, lipids, and mitochondrial bioenergetics. Such alterations may play a role in the period of enhanced vulnerability that occurs after mTBI, such that a second mTBI will exacerbate neuropathology. However, it is unclear whether mTBI-induced alterations in neurometabolites and lipids that are involved in energy metabolism and other important cellular functions are exacerbated by repeat mTBI, and if such alterations are associated with mitochondrial dysfunction. Methods In this experiment, using a well-established awake-closed head injury (ACHI) paradigm to model mTBI, male rats were subjected to a single injury, or five injuries delivered 1 day apart, and injuries were confirmed with a beam-walk task and a video observation protocol. Abundance of several neurometabolites was evaluated 24 h post-final injury in the ipsilateral and contralateral hippocampus using in vivo proton magnetic resonance spectroscopy (1H-MRS), and mitochondrial bioenergetics were evaluated 30 h post-final injury, or at 24 h in place of 1H-MRS, in the rostral half of the ipsilateral hippocampus. Lipidomic evaluations were conducted in the ipsilateral hippocampus and cortex. Results We found that behavioral deficits in the beam task persisted 1- and 4 h after the final injury in rats that received repetitive mTBIs, and this was paralleled by an increase and decrease in hippocampal glutamine and glucose, respectively, whereas a single mTBI had no effect on sensorimotor and metabolic measurements. No group differences were observed in lipid levels and mitochondrial bioenergetics in the hippocampus, although some lipids were altered in the cortex after repeated mTBI. Discussion The decrease in performance in sensorimotor tests and the presence of more neurometabolic and lipidomic abnormalities, after repeated but not singular mTBI, indicates that multiple concussions in short succession can have cumulative effects. Further preclinical research efforts are required to understand the underlying mechanisms that drive these alterations to establish biomarkers and inform treatment strategies to improve patient outcomes.
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Affiliation(s)
- Josh Allen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Louise Pham
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Simon T. Bond
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Baker Heart & Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia
| | - William T. O’Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Gershon Spitz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Sandy R. Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Health Sciences, Vancouver Island University, Nanaimo, BC, Canada
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Brian G. Drew
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Baker Heart & Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia
| | - David K. Wright
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Stuart J. McDonald
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
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Nanga RPR, Elliott MA, Swain A, Wilson NE, Swago S, Witschey WR, Reddy R. Identification of new resonances in downfield 1 H MRS of human calf muscle in vivo: Potentially metabolite precursors for skeletal muscle NAD . Magn Reson Med 2023. [PMID: 37125620 DOI: 10.1002/mrm.29687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/20/2023] [Accepted: 04/14/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE The purpose of this study was to identify and characterize newly discovered resonances appearing in the downfield proton MR spectrum (DF 1 H MRS) of the human calf muscle in vivo at 7T. METHODS Downfield 1 H MRS was performed on the calf muscle of five healthy volunteers at 7T. A spectrally selective 90° E-BURP RF pulse with an excitation center frequency at 10.3 ppm and an excitation bandwidth of 2 ppm was used for DF 1 H MRS acquisition. RESULTS In all participants, we observed new resonances at 9.7, 10.1, 10.3, and 10.9 ppm in the DF 1 H MRS. Phantom experiments at 37°C strongly suggest the new resonance at 9.7 ppm could be from H2-proton of the nicotinamide rings in nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN) while the resonance at 10.1 ppm could be attributed to the indole -NH proton of L-tryptophan. We observed that the resonances at 10.1 and 10.9 ppm are significantly suppressed when the water resonance is saturated, indicating that these peaks have either 1 H chemical exchange or cross-relaxation with water. Conversely, the resonances at 9.7 and 10.3 ppm exhibit moderate signal reduction in the presence of water saturation. CONCLUSION We have identified new proton resonances in vivo in human calf muscle occurring at chemical shifts of 9.7, 10.1, 10.3, and 10.9 ppm. These preliminary results are promising for investigating the role of NR/NMN and L-tryptophan metabolism in understanding the de novo and salvage pathways of NAD+ synthesis in skeletal muscle.
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Affiliation(s)
- Ravi Prakash Reddy Nanga
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark A Elliott
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anshuman Swain
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neil E Wilson
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sophia Swago
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Walter R Witschey
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ravinder Reddy
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Brinker EJ, Towns TJ, Watanabe R, Ma X, Bashir A, Cole RC, Wang X, Graff EC. Direct activation of the fibroblast growth factor-21 pathway in overweight and obese cats. Front Vet Sci 2023; 10:1072680. [PMID: 36756310 PMCID: PMC9900002 DOI: 10.3389/fvets.2023.1072680] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023] Open
Abstract
Introduction Feline obesity is common, afflicting ~25-40% of domestic cats. Obese cats are predisposed to many metabolic dyscrasias, such as insulin resistance, altered blood lipids, and feline hepatic lipidosis. Fibroblast Growth Factor-21 (FGF21) is an endocrine hormone that mediates the fat-liver axis, and in humans and animals, FGF21 can ameliorate insulin resistance, non-alcoholic fatty liver disease, and obesity. Activation of the FGF21 pathway may have therapeutic benefits for obese cats. Methods In this preliminary cross-sectional study, ad libitum fed, purpose-bred, male-neutered, 6-year-old, obese and overweight cats were administered either 10 mg/kg/day of an FGF21 mimetic (FGF21; n = 4) or saline (control; n = 3) for 14 days. Body weight, food, and water intake were quantified daily during and 2 weeks following treatment. Changes in metabolic and liver parameters, intrahepatic triglyceride content, liver elasticity, and gut microbiota were evaluated. Results Treatment with FGF21 resulted in significant weight loss (~5.93%) compared to control and a trend toward decreased intrahepatic triglyceride content. Cats treated with FGF21 had decreased serum alkaline phosphatase. No significant changes were noted in liver elasticity, serum, liver, or metabolic parameters, or gut microbiome composition. Discussion In obese and overweight cats, activation of the FGF21 pathway can safely induce weight loss with trends to improve liver lipid content. This exploratory study is the first to evaluate the FGF21 pathway in cats. Manipulation of the FGF21 pathway has promising potential as a therapeutic for feline obesity. Further studies are needed to see if FGF21-pathway manipulation can be therapeutic for feline hepatic lipidosis.
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Affiliation(s)
- Emily J. Brinker
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, United States,Scott Ritchey Research Center, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
| | - T. Jordan Towns
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, United States,Scott Ritchey Research Center, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
| | - Rie Watanabe
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
| | - Xiaolei Ma
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, United States,School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Adil Bashir
- Department of Electrical and Computer Engineering, Samuel Ginn College of Engineering, Auburn University, Auburn, AL, United States
| | - Robert C. Cole
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
| | - Xu Wang
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, United States,Scott Ritchey Research Center, College of Veterinary Medicine, Auburn University, Auburn, AL, United States,Center for Advanced Science, Innovation and Commerce, Alabama Agricultural Experiment Station, Auburn, AL, United States,HudsonAlpha Institute for Biotechnology, Huntsville, AL, United States
| | - Emily C. Graff
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, United States,Scott Ritchey Research Center, College of Veterinary Medicine, Auburn University, Auburn, AL, United States,*Correspondence: Emily C. Graff ✉
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Prisciandaro JJ, Zöllner HJ, Murali-Manohar S, Oeltzschner G, Edden RAE. More than one-half of the variance in in vivo proton MR spectroscopy metabolite estimates is common to all metabolites. NMR Biomed 2023:e4907. [PMID: 36651918 DOI: 10.1002/nbm.4907] [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] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 05/12/2023]
Abstract
The present study characterized associations among brain metabolite levels, applying bivariate and multivariate (i.e., factor analysis) statistical methods to total creatine (tCr)-referenced estimates of the major Point RESolved Spectroscopy (PRESS) proton MR spectroscopy (1 H-MRS) metabolites (i.e., total NAA/tCr, total choline/tCr, myo-inositol/tCr, glutamate + glutamine/tCr) acquired at 3 T from medial parietal lobe in a large (n = 299), well-characterized international cohort of healthy volunteers. Results supported the hypothesis that 1 H-MRS-measured metabolite estimates are moderately intercorrelated (Mr = 0.42, SDr = 0.11, ps < 0.001), with more than one-half (i.e., 57%) of the total variability in metabolite estimates explained by a single common factor. Older age was significantly associated with lower levels of the identified common metabolite variance (CMV) factor (β = -0.09, p = 0.048), despite not being associated with levels of any individual metabolite. Holding CMV factor levels constant, females had significantly lower levels of total choline (i.e., unique metabolite variance; β = -0.19, p < 0.001), mirroring significant bivariate correlations between sex and total choline reported previously. Supplementary analysis of water-referenced metabolite estimates (i.e., including tCr/water) demonstrated lower, although still substantial, intercorrelations among metabolites, with 37% of total metabolite variance explained by a single common factor. If replicated, these results would suggest that applied 1 H-MRS researchers shift their analytical framework from examining bivariate associations between individual metabolites and specialty-dependent (e.g., clinical, research) variables of interest (e.g., using t-tests) to examining multivariable (i.e., covariate) associations between multiple metabolites and specialty-dependent variables of interest (e.g., using multiple regression).
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Affiliation(s)
- James J Prisciandaro
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Helge J Zöllner
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Saipavitra Murali-Manohar
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Georg Oeltzschner
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Richard A E Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
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17
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Ziegs T, Dorst J, Ruhm L, Avdievitch N, Henning A. Measurement of glucose metabolism in the occipital lobe and frontal cortex after oral administration of [1-13C]glucose at 9.4 T. J Cereb Blood Flow Metab 2022; 42:1890-1904. [PMID: 35632989 PMCID: PMC9536126 DOI: 10.1177/0271678x221104540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
For the first time, labeling effects after oral intake of [1-13C]glucose are observed in the human brain with pure 1H detection at 9.4 T. Spectral time series were acquired using a short-TE 1H MRS MC-semiLASER (Metabolite Cycling semi Localization by Adiabatic SElective Refocusing) sequence in two voxels of 5.4 mL in the frontal cortex and the occipital lobe. High-quality time-courses of [4-13C]glutamate, [4-13C]glutamine, [3-13C]glutamate + glutamine, [2-13C] glutamate+glutamine and [3-13C]aspartate for individual volunteers and additionally, group-averaged time-courses of labeled and non-labeled brain glucose could be obtained. Using a one-compartment model, mean metabolic rates were calculated for each voxel position: The mean rate of the TCA-cycle (Vtca) value was determined to be 1.36 and 0.93 μmol min-1 g-1, the mean rate of glutamine synthesis (Vgln) was calculated to be 0.23 and 0.45 μmol min-1 g-1, the mean exchange rate between cytosolic amino acids and mitochondrial Krebs cycle intermediates (Vx) rate was found to be 0.57 and 1.21 μmol min-1 g-1 for the occipital lobe and the frontal cortex, respectively. These values were in agreement with previously reported data. Altogether, it can be shown that this most simple technique combining oral administration of [1-13C]Glc with pure 1H MRS acquisition is suitable to measure metabolic rates.
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Affiliation(s)
- Theresia Ziegs
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,IMPRS for Cognitive and Systems Neuroscience, Tübingen, Germany
| | - Johanna Dorst
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,IMPRS for Cognitive and Systems Neuroscience, Tübingen, Germany
| | - Loreen Ruhm
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,IMPRS for Cognitive and Systems Neuroscience, Tübingen, Germany
| | - Nikolai Avdievitch
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Anke Henning
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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18
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Bonanno L, Ciurleo R, Marino S, Ruvolo C, Morabito R, Bramanti A, Corallo F. Effect of MAO-B Inhibitors on Neurometabolic Profile of Patients Affected by Parkinson Disease: A Proton Magnetic Resonance Spectroscopy Study. J Clin Med 2022; 11:1931. [PMID: 35407539 DOI: 10.3390/jcm11071931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/18/2022] [Accepted: 03/27/2022] [Indexed: 12/10/2022] Open
Abstract
Parkinson’s Disease (PD) is the most common neurodegenerative movement disorder whose treatment is symptomatic. No suitable methods for assessing the effects of dopaminergic drugs on disease progression in clinical trials have yet been provided. The aim of this longitudinal study is to evaluate the influence of rasagiline and selegiline on neurometabolic profile in de novo PD patients by using Proton Magnetic Resonance Spectroscopy (1H-MRS). We enrolled de novo PD patients who were divided into two groups of 20 patients each, according to the dopaminergic treatment prescribed at the baseline visit (rasagiline or selegiline). At the baseline visit and after 12 months, all patients underwent neurological evaluation as well as 1H-MRS. Forty healthy controls (HC) underwent 1H-MRS at baseline and after 12 months. PD patients, compared to HC, showed significantly lower concentrations of NAA in the motor cortex, while the Cho levels showed a decreasing trend. After 12 months of therapy, the 1H-MRS study revealed that rasagiline and selegiline in a similar way were able to restore the NAA levels to values similar to those of HC. In addition, this neurometabolic change showed a correlation with UPDRS-III scores. This is the first longitudinal study that provides preliminary evidence that 1H-MRS may be a suitable method to evaluate objectively the influence of MAO-B inhibitors on the neurometabolic profile of PD patients. These results could open a new scenario on the hypothesis of a drug-induced slowing effect of PD progression.
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19
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Guan JT, Zheng X, Lai L, Sun S, Geng Y, Zhang X, Zhou T, Wu HZ, Chen JQ, Yang ZX, zheng XH, Wang JX, Chen W, Zhang YQ. Proton Magnetic Resonance Spectroscopy for Diagnosis of Non-Motor Symptoms in Parkinson's Disease. Front Neurol 2022; 13:594711. [PMID: 35295827 PMCID: PMC8918562 DOI: 10.3389/fneur.2022.594711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/04/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The current diagnosis of Parkinson's disease (PD) is mainly based on the typical clinical manifestations. However, 60% dopaminergic neurons have died when the typical clinical manifestations occur. Predictive neurobiomarkers may help identify those PD patients having non-motor disorders or in different stage and achieving the aim of early diagnosis. Up to date, few if any neuroimaging techniques have been described useful for non-movement disorders diagnosis in PD patients. Here, we investigated the alteration of metabolites in PD patients in different stage of PD and non-motor symptoms including sleep, gastrointestinal and cognitive dysfunction, by using the 1H-MRS. METHODS A total of 48 subjects were included between 2017 and 2019: 37 PD (15 men, age 47-82 years) and 11 healthy people (8 men, age 49-74 years). All participants underwent MRI and multi-voxel 1H-MRS examination within 3 days in admission. Six kinds of metabolites, such as creatine (Cr), N-acetyl aspartate/creatine (NAA/Cr), N-acetyl aspartate/choline (NAA/Cho), choline/creatine (Cho/Cr), lipid/creatine (LL/Cr), and myo-Inositol/creatine ratio (mI/Cr) were tested among the PD group and the control groups. Statistical analyses and correlation analyses were performed by using SPSS. The p < 0.05 was considered statistically significant. RESULTS Compared late PD group with a control group or early group, higher Cr ratio and lower NAA/Cr ratio were observed in the late PD group (p < 0.05). The mI/Cr in the late PD group was also lower than that in the early PD group (p < 0.05). Regarding the relationship between metabolites and NMS, Cho/Cr was higher in the sleep disorder group, whereas mI/Cr was lower in the gastrointestinal dysfunction group in comparison with the non-symptom groups. Moreover, Cr, Cho/Cr, mI/Cr, and LL/Cr were identified to have higher concentrations in the cognitive group in thalamus. CONCLUSIONS Proton magnetic resonance spectroscopy is an advanced tool to quantify the metabolic changes in PD. Three biomarkers (Cr, NAA/Cr, and mI/Cr) were detected in the late stage of PD, suggesting that these markers might be potential to imply the progression of PD. In addition, subgroups analysis showed that MRS of thalamus is a sensitive region for the detection of cognitive decline in PD, and the alteration of neurochemicals (involving Cr, Cho, mI, and LL) may be promising biomarkers to predict cognitive decline in PD.
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Affiliation(s)
- Ji-tian Guan
- Department of Radiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xin Zheng
- Cell Therapy Center, Beijing Institute of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases and Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China
| | - Lingfeng Lai
- Department of Radiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shuyi Sun
- Department of Radiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yiqun Geng
- Laboratory of Molecular Pathology, Shantou University Medical College, Shantou, China
| | - Xiaolei Zhang
- Department of Radiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Teng Zhou
- Department of Computer Science, Shantou University, Shantou, China
| | - Huan-ze Wu
- Department of Neurology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jia-qing Chen
- Department of Neurology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zhong-xian Yang
- Department of Radiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xiao-hong zheng
- Department of Neurology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jia-xu Wang
- Department of Neurology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Wei Chen
- Department of Neurology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - You-qiao Zhang
- Department of Neurology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
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20
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McGlade EC, Han DH, Kim SM, Shi X, Cline K, Yurgelun-Todd D, Renshaw PF. Proton magnetic resonance spectroscopy (MRS) in individuals with internet gaming. Front Psychiatry 2022; 13:1031947. [PMID: 36620656 PMCID: PMC9813490 DOI: 10.3389/fpsyt.2022.1031947] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Various comorbid psychiatric diagnoses, including attention deficit hyperactivity disorder (ADHD), have been reported in individuals with internet gaming disorder (IGD). Prior research has shown alterations in brain metabolites, including N-acetylaspartate (NAA), and combined glutamate and glutamine in patients with ADHD that were similar to those observed in patients with IGD. We hypothesized that the decreased NAA levels in the IGD group would be associated with a history of ADHD. METHODS Forty adults participated in this study. Participants were classified as having a high risk for IGD if they had a total score higher than 21 on the IGD Scale-short form. Proton magnetic resonance spectroscopy (1H-MRS) and high-resolution structural magnetic resonance imaging (MRI) data were acquired using a 3 Tesla Siemens Prisma scanner system. RESULTS Levels of NAA within the right prefrontal cortex were lower in the IGD group than those observed in the control group. In a multiple linear regression analysis, internet addiction test scores and history of ADHD were shown to predict increased game play. In addition, history of ADHD predicted lower levels of NAA within the right prefrontal cortex. CONCLUSION The preliminary results of current study suggest a mediating effect of ADHD on the severity of internet game play as well as the levels of NAA within the dorsolateral prefrontal cortex (DLPFC). The inclusion of ADHD in IGD research is important and deserving of further consideration.
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Affiliation(s)
- Erin C McGlade
- Huntsman Mental Health Institute, The University of Utah, Salt Lake City, UT, United States.,VA Salt Lake City MIRECC, Salt Lake City, UT, United States
| | - Doug Hyun Han
- Department of Psychiatry, Chung Ang University Hospital, Seoul, Republic of Korea
| | - Sun Mi Kim
- Department of Psychiatry, Chung Ang University Hospital, Seoul, Republic of Korea
| | - Xianfeng Shi
- Huntsman Mental Health Institute, The University of Utah, Salt Lake City, UT, United States
| | - Kirsten Cline
- Huntsman Mental Health Institute, The University of Utah, Salt Lake City, UT, United States.,VA Salt Lake City MIRECC, Salt Lake City, UT, United States
| | - Deborah Yurgelun-Todd
- Huntsman Mental Health Institute, The University of Utah, Salt Lake City, UT, United States.,VA Salt Lake City MIRECC, Salt Lake City, UT, United States
| | - Perry F Renshaw
- Huntsman Mental Health Institute, The University of Utah, Salt Lake City, UT, United States.,VA Salt Lake City MIRECC, Salt Lake City, UT, United States
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21
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Wolf P, Marty B, Bouazizi K, Kachenoura N, Piedvache C, Blanchard A, Salenave S, Prigent M, Jublanc C, Ajzenberg C, Droumaguet C, Young J, Lecoq AL, Kuhn E, Agostini H, Trabado S, Carlier PG, Fève B, Redheuil A, Chanson P, Kamenický P. Epicardial and Pericardial Adiposity Without Myocardial Steatosis in Cushing Syndrome. J Clin Endocrinol Metab 2021; 106:3505-3514. [PMID: 34333603 DOI: 10.1210/clinem/dgab556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Cardiovascular disease is the leading cause of death in patients with Cushing syndrome. Cortisol excess and adverse metabolic profile could increase cardiac fat, which can subsequently impair cardiac structure and function. OBJECTIVE We aimed to evaluate cardiac fat mass and distribution in patients with Cushing syndrome. METHODS In this prospective, cross-sectional study, 23 patients with Cushing syndrome and 27 control individuals of comparable age, sex, and body mass index were investigated by cardiac magnetic resonance imaging and proton spectroscopy. Patients were explored before and after biochemical disease remission. Myocardial fat measured by the Dixon method was the main outcome measure. The intramyocardial triglyceride/water ratio measured by spectroscopy and epicardial and pericardial fat volumes were secondary outcome measures. RESULTS No difference was found between patients and controls in intramyocardial lipid content. Epicardial fat mass was increased in patients compared to controls (30.8 g/m2 [20.4-34.8] vs 17.2 g/m2 [13.1-23.5], P < .001). Similarly, pericardial fat mass was increased in patients compared to controls (28.3 g/m2 [17.9-38.0] vs 11.4 g/m2 [7.5-19.4], P = .003). Sex, glycated hemoglobin A1c, and the presence of hypercortisolism were independent determinants of epicardial fat. Pericardial fat was associated with sex, impaired glucose homeostasis and left ventricular wall thickness. Disease remission decreased epicardial fat mass without affecting pericardial fat. CONCLUSION Intramyocardial fat stores are not increased in patients with Cushing syndrome, despite highly prevalent metabolic syndrome, suggesting increased cortisol-mediated lipid consumption. Cushing syndrome is associated with marked accumulation of epicardial and pericardial fat. Epicardial adiposity may exert paracrine proinflammatory effects promoting cardiomyopathy.
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Affiliation(s)
- Peter Wolf
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, 1090 Vienna, Austria
| | - Benjamin Marty
- Institut de Myologie, CEA, Laboratoire de Résonance Magnétique Nucléaire, 75013 Paris, France
| | - Khaoula Bouazizi
- Institut de Cardiométabolisme et Nutrition (ICAN), 75013 Paris, France
- Sorbonne Université, CNRS, Inserm, Laboratoire d'Imagerie Biomédicale, LIB, 75006 Paris, France
| | - Nadjia Kachenoura
- Institut de Cardiométabolisme et Nutrition (ICAN), 75013 Paris, France
- Sorbonne Université, CNRS, Inserm, Laboratoire d'Imagerie Biomédicale, LIB, 75006 Paris, France
| | - Céline Piedvache
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Unité de Recherche Clinique, 94275 Le Kremlin-Bicêtre, France
| | - Anne Blanchard
- Université de Paris, Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Centre d'Investigations Cliniques, Inserm CIC1318 et UMR 1138, 75015 Paris, France
| | - Sylvie Salenave
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Mikaël Prigent
- Institut de Cardiométabolisme et Nutrition (ICAN), 75013 Paris, France
| | - Christel Jublanc
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Service d'Endocrinologie-Métabolisme, 75013 Paris, France
| | - Christiane Ajzenberg
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Service de Médecine Interne, 94000 Créteil, France
| | - Céline Droumaguet
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Service de Médecine Interne, 94000 Créteil, France
| | - Jacques Young
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Anne-Lise Lecoq
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Emmanuelle Kuhn
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Helene Agostini
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Unité de Recherche Clinique, 94275 Le Kremlin-Bicêtre, France
| | - Severine Trabado
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, 94275 Le Kremlin-Bicêtre, France
| | - Pierre G Carlier
- Institut de Myologie, CEA, Laboratoire de Résonance Magnétique Nucléaire, 75013 Paris, France
| | - Bruno Fève
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Service d'Endocrinologie et Métabolisme, Centre de Référence des Maladies Rares de l'Insulino-Sécrétion et de l'Insulino-Sensibilité (PRISIS), Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, UMR-S938, IHU ICAN, 75012 Paris, France
| | - Alban Redheuil
- Sorbonne Université, CNRS, Inserm, Laboratoire d'Imagerie Biomédicale, LIB, 75006 Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Unité d'Imagerie Cardiovasculaire et Thoracique, APHP.SU, 75013 Paris, France
| | - Philippe Chanson
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Peter Kamenický
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
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22
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Lievens E, Derave W. Reply to da Eira Silva et al. J Appl Physiol (1985) 2021; 131:1615-1616. [PMID: 34766843 DOI: 10.1152/japplphysiol.00681.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Eline Lievens
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Wim Derave
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
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23
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Liu DY, Ju X, Gao Y, Han JF, Li Z, Hu XW, Tan ZL, Northoff G, Song XM. From Molecular to Behavior: Higher Order Occipital Cortex in Major Depressive Disorder. Cereb Cortex 2021; 32:2129-2139. [PMID: 34613359 DOI: 10.1093/cercor/bhab343] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/14/2022] Open
Abstract
Medial prefrontal cortex (MPFC) and other regions like the occipital cortex (OC) exhibit abnormal neural activity in major depressive disorder (MDD). Their relationship to specific biochemical, psychophysical, and psychopathological changes remains unclear, though. For that purpose, we focus on a particular subregion in OC, namely middle temporal (MT) visual area that is known to mediate the perception of visual motion. Using high-field 7 T magnetic resonance imaging (MRI), including resting state functional MRI and proton magnetic resonance spectroscopy, the amplitude of low-frequency fluctuations (ALFF) of the blood oxygen level-dependent signal in MT, MT-seeded functional connectivity (FC), and gamma-aminobutyric acid (GABA) in MT were investigated. Applying the vision motion psychophysical task, the motion suppression index of subjects was also examined. We demonstrate significantly elevated neural variability (as measured by ALFF) in MT together with decreases in both MT GABA and motion suppression in our MDD sample. Unlike in healthy subjects, MT neural variability no longer modulates the relationship of MT GABA and motion suppression in MDD. MT also exhibits reduction in global inter-regional FC to MPFC in MDD. Finally, elevated MT ALFF relates to specifically retardation in behavior as measured by the Hamilton subscore. Together, MT provides a strong candidate for biomarker in MDD.
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Affiliation(s)
- Dong-Yu Liu
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Interdisciplinary Institute of Neuroscience and Technology, Zhejiang University School of Medicine, Hangzhou, 310013, China.,Key Laboratory of Biomedical Engineering of Ministry of Education, Qiushi Academy for Advanced Studies, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Xuan Ju
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Interdisciplinary Institute of Neuroscience and Technology, Zhejiang University School of Medicine, Hangzhou, 310013, China
| | - Yuan Gao
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Interdisciplinary Institute of Neuroscience and Technology, Zhejiang University School of Medicine, Hangzhou, 310013, China
| | - Jin-Fang Han
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Interdisciplinary Institute of Neuroscience and Technology, Zhejiang University School of Medicine, Hangzhou, 310013, China
| | - Zhe Li
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Interdisciplinary Institute of Neuroscience and Technology, Zhejiang University School of Medicine, Hangzhou, 310013, China.,Key Laboratory of Biomedical Engineering of Ministry of Education, Qiushi Academy for Advanced Studies, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Xi-Wen Hu
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Interdisciplinary Institute of Neuroscience and Technology, Zhejiang University School of Medicine, Hangzhou, 310013, China
| | - Zhong-Lin Tan
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Interdisciplinary Institute of Neuroscience and Technology, Zhejiang University School of Medicine, Hangzhou, 310013, China
| | - Georg Northoff
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Interdisciplinary Institute of Neuroscience and Technology, Zhejiang University School of Medicine, Hangzhou, 310013, China.,University of Ottawa Institute of Mental Health Research, University of Ottawa; Ottawa, ON, K1Z 7K4, Canada
| | - Xue Mei Song
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Interdisciplinary Institute of Neuroscience and Technology, Zhejiang University School of Medicine, Hangzhou, 310013, China.,Key Laboratory of Biomedical Engineering of Ministry of Education, Qiushi Academy for Advanced Studies, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou 310027, China
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24
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Lievens E, Van Vossel K, Van de Casteele F, Baguet A, Derave W. Sex-specific maturation of muscle metabolites carnosine, creatine, and carnitine over puberty: a longitudinal follow-up study. J Appl Physiol (1985) 2021; 131:1241-1250. [PMID: 34473575 DOI: 10.1152/japplphysiol.00380.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Due to the invasiveness of a muscle biopsy, there is fragmentary information on the existence and possible origin of a sexual dimorphism in the skeletal muscle concentrations of the energy delivery-related metabolites carnosine, creatine, and carnitine. As these metabolites can be noninvasively monitored by proton magnetic resonance spectroscopy, this technique offers the possibility to investigate if sexual dimorphisms are present in an adult reference population and if these dimorphisms originated during puberty using a longitudinal design. Concentrations of carnosine, creatine, and carnitine were examined using proton magnetic resonance spectroscopy in the soleus and gastrocnemius muscles of an adult reference population of female (n = 50) and male adults (n = 50). For the longitudinal follow-up over puberty, 29 boys and 28 girls were scanned prepuberty. Six years later, 24 boys and 24 girls were rescanned postpuberty. A sexual dimorphism was present in carnosine and creatine, but not carnitine, in the adult reference population. Carnosine was 28.5% higher in the gastrocnemius (P < 0.001) and carnosine and creatine were respectively 19.9% (P < 0.001) and 18.2% (P < 0.001) higher in the soleus of male when compared with female adults. Through puberty, carnosine increased more in male subjects compared with female subjects, both in the gastrocnemius (+10.43% and -10.83%, respectively; interaction effect: P = 0.002) and in the soleus (+24.30% and +5.49%, respectively; interaction effect: P = 0.012). No significant effect of puberty was found in either creatine (interaction effect: P = 0.307) or carnitine (interaction effect: P = 0.066). A sexual dimorphism in the adult human muscle is present in carnosine and creatine, but not in carnitine.NEW & NOTEWORTHY This is the first study to investigate sexual dimorphisms in skeletal muscle carnosine, creatine, and carnitine concentrations in a substantial adult reference population (n = 100). A sexual dimorphism is present in both carnosine and creatine at adult age. The origin of the sexual dimorphisms is investigated using a longitudinal design over puberty in 24 males and 24 females. The sexual dimorphism in carnosine originated partly during puberty for carnosine, but not for creatine.
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Affiliation(s)
- Eline Lievens
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Kim Van Vossel
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | | | - Audrey Baguet
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Wim Derave
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
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25
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Selitsky GV, Pertsov SS, Sorokina ND, Titova NA, Zherdeva AS. [Neurophysiological and functional neuroimaging methods in the assessment of migraines and epilepsy with vertigo]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:106-111. [PMID: 34481445 DOI: 10.17116/jnevro2021121081106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A review of the current literature shows that the combined use of neurophysiological and structural-functional neuroimaging methods has significantly expanded the understanding of the mechanisms of migraine with vestibular dysfunction: functional and structural disorders were found in brain regions involved in multisensory vestibular control and Central vestibular processing. Analysis of numerous studies shows that epilepsy can also cause vestibular symptoms, they can occur both without epileptic markers, and in combination with epileptic paroxysms. In isolated epileptic vertigo, according to studies widely presented in the literature, epileptic activity was most often detected by EEG data in the temporal regions, to a lesser extent in the parietal regions. In these studies, neuroimaging findings of foci of reduced substance density were found, which could be a consequence of deafferentation, as well as violations of connections with the focus of neuronal activity. In the absence of structural abnormalities, numerous studies have shown using magnetic resonance spectroscopy, diffusion MRI, and PET that the physiological basis for impaired neuronal metabolism was a decrease in synaptic activity, a violation of maintaining the difference in membrane potentials on the surface of the hippocampus, or changes in neighboring tracts of the white matter of the brain.
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Affiliation(s)
- G V Selitsky
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - S S Pertsov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.,Anokhin Research Institute of Normal Physiology, Moscow, Russia
| | - N D Sorokina
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - N A Titova
- Clinical hospital No. 85 of the FMBA of Russia, Moscow, Russia
| | - A S Zherdeva
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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26
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Cai XL, Li GY, Wang LL, Zhao WW, Wang Y, Yan C, Lui SSY, Li JQ, Chan RCK. Striatal GABA level is associated with sensory integration ability in individuals with low levels of negative schizotypy. Psych J 2021; 11:205-213. [PMID: 34414691 DOI: 10.1002/pchj.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/24/2021] [Accepted: 07/13/2021] [Indexed: 11/08/2022]
Abstract
Recent studies suggest that altered gamma-aminobutyric acidergic (GABAergic) function may result in multisensory integration deficits in schizophrenia. However, it is unclear whether the GABA level is abnormal in individuals with high levels of schizotypal traits and how it would correlate with sensory integration ability in these individuals. This study aimed to compare the GABA level between individuals with high and low levels of negative schizotypy, and examine the relationship between GABA levels and sensory integration ability in each group. In vivo GABA+ and N-acetylaspartate (NAA) levels in the striatum were measured using proton magnetic resonance imaging in 19 participants with high levels of negative schizotypy and 21 participants with low levels of negative schizotypy. The Sensory Integration subscale of the abridged version of the Cambridge Neurological Inventory was used. We examined the group differences in GABA+/NAA levels, and the correlation between striatal GABA+/NAA levels and sensory integration ability in each group. The two groups showed comparable levels of in-vivo GABA+/NAA. In-vivo GABA+/NAA levels were negatively correlated with sensory integration score in participants with low levels of negative schizotypy, but not in participants with high levels of negative schizotypy. Our findings indicate that the increased GABA level is correlated with better sensory integration ability in individuals with low levels of negative schizotypy, implicating the role of GABAergic function in multisensory integration. Unlike schizophrenia patients, individuals with high levels of schizotypy do not exhibit any abnormality in their GABAergic system and sensory integration ability.
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Affiliation(s)
- Xin-Lu Cai
- Sino-Danish College, University of Chinese Academy of Sciences, Beijing, China.,Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Sino-Danish Center for Education and Research, Beijing, China
| | - Gai-Ying Li
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Ling-Ling Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Wei-Wei Zhao
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Chao Yan
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Shanghai Changning-ECNU Mental Health Center, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Simon S Y Lui
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Jian-Qi Li
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Raymond C K Chan
- Sino-Danish College, University of Chinese Academy of Sciences, Beijing, China.,Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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27
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Liao R, Zhang D, Li X, Ma J, Yu J, Yang C, Xiong H, Zhou B, Huang X, Tang Z. A Preliminary Study on the Diagnostic Efficacy of Proton Magnetic Resonance Spectroscopy at 3.0T in Rabbit With VX2 Liver Tumor. Technol Cancer Res Treat 2021; 20:15330338211036852. [PMID: 34372732 PMCID: PMC8361547 DOI: 10.1177/15330338211036852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/29/2022] Open
Abstract
Background: To investigate the diagnostic efficacy of choline (Cho) value of magnetic resonance spectroscopy (MRS) in rabbit with VX2 liver tumor via comparative and quantitative analysis with the choline compounds concentration measured by enzyme linked immunosorbent assay (ELISA). Methods: MRS was performed on normal liver and VX2 tumor. The Cho value of VX2 tumor was compared with that of normal liver. Tissues were harvested for ELISA to detect the concentrations of acetylcholine (ACh), glycophorophosphygholine (GPC) and phosphochorine (PC). The diagnostic performance of Cho value and concentrations of choline compounds were assessed by receiver operating characteristic (ROC) curve and area under ROC curve (AUC). The specificity and sensitivity were discussed by the maximum Youden’s index. Results: The concentration of ACh was obviously higher than that of GPC and PC both in VX2 tumor and normal liver (P < 0.01). Furthermore, the concentration differences among ACh, GPC and PG were the third power of 10. Both the ACh concentration and Cho value of MRS in VX2 tumor were significantly higher than those in normal liver (P < 0.01). The AUC of ACh in VX2 tumor was 0.883, when the cutoff value was 7259000, the sensitivity and specificity of the diagnosis of liver cancer were 94.4% and 77.8%, respectively. The AUC of Cho in VX2 tumor was 0.807, when the cutoff value was 28.35, the sensitivity and specificity of the diagnosis of liver cancer were 83.3% and 77.8%, respectively. Conclusion: The change of Cho value in MRS between liver cancer and normal liver was consistent with the changes of concentrations of choline compounds measured by ELISA, especially the change of ACh concentration. The diagnostic efficiency of Cho value and that of choline compounds concentration in liver cancer were extremely similar, with the AUC more than 0.8. We conclude that MRS may be applied as an important, non-invasive biomarker for the diagnosis of liver cancer.
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Affiliation(s)
- Ruikun Liao
- Department of Radiology, Chongqing General Hospital, 74519University of Chinese Academy of Sciences, Chongqing, China.,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, 74519University of Chinese Academy of Sciences, Chongqing, China
| | - Dan Zhang
- Department of Radiology, Chongqing General Hospital, 74519University of Chinese Academy of Sciences, Chongqing, China.,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, 74519University of Chinese Academy of Sciences, Chongqing, China
| | - Xiaojiao Li
- Department of Radiology, Chongqing General Hospital, 74519University of Chinese Academy of Sciences, Chongqing, China.,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, 74519University of Chinese Academy of Sciences, Chongqing, China
| | - Jiang Ma
- Department of Radiology, Chongqing General Hospital, 74519University of Chinese Academy of Sciences, Chongqing, China
| | - Jiayi Yu
- Department of Radiology, Chongqing General Hospital, 74519University of Chinese Academy of Sciences, Chongqing, China.,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, 74519University of Chinese Academy of Sciences, Chongqing, China
| | - Chao Yang
- Department of Radiology, Chongqing General Hospital, 74519University of Chinese Academy of Sciences, Chongqing, China.,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, 74519University of Chinese Academy of Sciences, Chongqing, China
| | - Hua Xiong
- Department of Radiology, Chongqing General Hospital, 74519University of Chinese Academy of Sciences, Chongqing, China.,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, 74519University of Chinese Academy of Sciences, Chongqing, China
| | - Bi Zhou
- Department of Radiology, Chongqing General Hospital, 74519University of Chinese Academy of Sciences, Chongqing, China.,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, 74519University of Chinese Academy of Sciences, Chongqing, China
| | - Xianlong Huang
- Department of Radiology, Chongqing General Hospital, 74519University of Chinese Academy of Sciences, Chongqing, China
| | - Zhuoyue Tang
- Department of Radiology, Chongqing General Hospital, 74519University of Chinese Academy of Sciences, Chongqing, China.,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, 74519University of Chinese Academy of Sciences, Chongqing, China
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Abstract
BACKGROUND Emerging evidence supports the antipsychotic effect of cannabidiol, a non-intoxicating component of cannabis, in people with psychosis. Preclinical findings suggest that this antipsychotic effect may be related to cannabidiol modulating glutamatergic signalling in the brain. AIM The purpose of this study was to investigate the effects of cannabidiol on the neurochemical mechanisms underlying psychosis. METHODS We investigated the effects of a single oral dose of cannabidiol (600 mg) in patients with psychosis, using a double-blind, randomised, placebo-controlled, repeated-measures, within-subject cross-over design. After drug administration, 13 patients were scanned using proton magnetic resonance spectroscopy to measure left hippocampal glutamate levels. Symptom severity was rated using the Positive and Negative Syndrome Scale 60 min before drug administration (pre-scan), and 270 min after drug administration (post-scan). Effects of cannabidiol on hippocampal glutamate levels, symptom severity, and correlations between hippocampal glutamate and symptoms were investigated. RESULTS Compared to placebo, there was a significant increase in hippocampal glutamate (p=0.035), and a significantly greater decrease in symptom severity (p=0.032) in the psychosis patients under cannabidiol treatment. There was also a significant negative relationship between post-treatment total Positive and Negative Syndrome Scale score and hippocampal glutamate (p=0.047), when baseline Positive and Negative Syndrome Scale score, treatment (cannabidiol vs placebo), and interaction between treatment and glutamate levels were controlled for. CONCLUSIONS These findings may suggest a link between the increase in glutamate levels and concomitant decrease in symptom severity under cannabidiol treatment observed in psychosis patients. Furthermore, the findings provide novel insight into the potential neurochemical mechanisms underlying the antipsychotic effects of cannabidiol.
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Affiliation(s)
- Aisling O’Neill
- Department of Psychosis Studies, King’s College London, London, UK,Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Luciano Annibale
- Department of Psychosis Studies, King’s College London, London, UK
| | | | - Robin Wilson
- Department of Psychosis Studies, King’s College London, London, UK
| | | | - Sagnik Bhattacharyya
- Department of Psychosis Studies, King’s College London, London, UK,Sagnik Bhattacharyya, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, M6.01.04, 16 De Crespigny Park, London, SE5 8AF, UK.
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29
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Abstract
Research examining bone marrow adipose tissue (BMAT) has rapidly expanded during the last two decades, leading to advances in knowledge on the role of BMAT in the pathogenesis of bone loss and endocrine disorders. Clinical imaging has played a crucial role for the in vivo assessment of BMAT, allowing non-invasive quantification and evaluation of BMAT composition. In the present work, we review different imaging methods for assessing properties of BMAT. Our aim is to review conventional magnetic resonance imaging (MRI), water-fat imaging, and single-voxel proton magnetic resonance spectroscopy (1H-MRS), as well as computed tomography (CT)-based techniques, including single energy and dual energy CT. We will also discuss the clinical applications of these methods in type 2 diabetes mellitus, obesity and anorexia nervosa.
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Affiliation(s)
- Mohamed Jarraya
- Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Boston, MA, USA.
| | - Miriam A Bredella
- Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Boston, MA, USA
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30
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Brennan NA, Fishbein KW, Reiter DA, Ferrucci L, Spencer RG. Contribution of Intramyocellular Lipids to Decreased Computed Tomography Muscle Density With Age. Front Physiol 2021; 12:632642. [PMID: 34276390 PMCID: PMC8279780 DOI: 10.3389/fphys.2021.632642] [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: 11/23/2020] [Accepted: 04/21/2021] [Indexed: 12/03/2022] Open
Abstract
Skeletal muscle density, as determined by computed tomography (CT), has been shown to decline with age, resulting in increased frailty and morbidity. However, the mechanism underlying this decrease in muscle density remains elusive. We sought to investigate the role of intramyocellular lipid (IMCL) accumulation in the age-related decline in muscle density. Muscle density was measured using computerized tomography (CT), and IMCL content was quantified using in vivo proton magnetic resonance spectroscopy (1H-MRS). The study population consisted of 314 healthy participants (142 men, 32–98 years) of the Baltimore Longitudinal Study of Aging (BLSA). In addition to IMCL quantification, obesity-related covariates were measured, including body mass index (BMI), waist circumference, and circulating triglyceride concentration. Higher IMCL concentrations were significantly correlated with lower muscle density in older individuals, independent of age, sex, race, and the obesity-associated covariates (p < 0.01). Lower muscle density was also significantly associated with greater age-adjusted IMCL, a variable we constructed using LOESS regression (p < 0.05). Our results suggest that the accumulation of IMCL may be associated with a decrease in muscle density. This may serve to define a potential therapeutic target for treatment of age-associated decreased muscle function.
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Affiliation(s)
- Nicholas A Brennan
- Laboratory of Clinical Investigation, NIA, NIH, Baltimore, MD, United States
| | - Kenneth W Fishbein
- Laboratory of Clinical Investigation, NIA, NIH, Baltimore, MD, United States
| | - David A Reiter
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Luigi Ferrucci
- Longitudinal Studies Section, NIA, NIH, Baltimore, MD, United States
| | - Richard G Spencer
- Laboratory of Clinical Investigation, NIA, NIH, Baltimore, MD, United States
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31
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Lievens E, Van Vossel K, Van de Casteele F, Krššák M, Murdoch JB, Befroy DE, Derave W. CORP: quantification of human skeletal muscle carnosine concentration by proton magnetic resonance spectroscopy. J Appl Physiol (1985) 2021; 131:250-264. [PMID: 33982593 DOI: 10.1152/japplphysiol.00056.2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Noninvasive techniques to quantify metabolites in skeletal muscle provide unique insight into human physiology and enable the translation of research into practice. Proton magnetic resonance spectroscopy (1H-MRS) permits the assessment of several abundant muscle metabolites in vivo, including carnosine, a dipeptide composed of the amino acids histidine and beta-alanine. Muscle carnosine loading, accomplished by chronic oral beta-alanine supplementation, improves muscle function and exercise capacity and has pathophysiological relevance in multiple diseases. Moreover, the marked difference in carnosine content between fast-twitch and slow-twitch muscle fibers has rendered carnosine an attractive candidate to estimate human muscle fiber type composition. However, the quantification of carnosine with 1H-MRS requires technical expertise to obtain accurate and reproducible data. In this review, we describe the technical and physiological factors that impact the detection, analysis, and quantification of carnosine in muscle with 1H-MRS. We discuss potential sources of error during the acquisition and preprocessing of the 1H-MRS spectra and present best practices to enable the accurate, reliable, and reproducible application of this technique.
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Affiliation(s)
- E Lievens
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - K Van Vossel
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - F Van de Casteele
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - M Krššák
- Division of Endocrinology and Metabolism, Department of Internal Medicine III and High Field MR Centre, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | | | - W Derave
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
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32
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Abstract
This study aimed to investigate the levels of creatine (Cr) metabolites in the
anterior cingulate cortex (ACC), thalamus, and insula of patients with
fibromyalgia (FM) using proton magnetic resonance spectroscopy (MRS). The levels
of Cr and phosphocreatine (PCr) relative to total Cr (tCr), which includes Cr
and PCr, in the ACC, thalamus, and insula were determined using MRS in 12
patients with FM and in 13 healthy controls. The FM group had lower levels of
PCr/tCr in the ACC and right insula compared to healthy controls. There was a
negative correlation between Cr/tCr in the ACC and total pain levels (McGill
Pain Questionnaire-Total; r = −0.579, p = 0.049) and between Cr/tCr in the left
insula and affective pain levels (McGill Pain Questionnaire-Affective;
r = −0.638, p = 0.047) in patients with FM. In addition, there were negative
correlations between stress levels (Stress Response Inventory) and Cr/tCr in the
right (r = −0.780, p = 0.005) and left thalamus (r = −0.740, p = 0.006), as well
as in the right insula (r = −0.631, p = 0.028) in patients with FM. There were
negative correlations between symptom levels of post-traumatic stress disorder
(PTSD; PTSD checklist) and Cr/tCr in the right (r = −0.783, p = 0.004) and left
thalamus (r = −0.642, p = 0.024) of patients with FM. These findings are
paramount to understanding the decisive pathologies related to brain energy
metabolism in patients with FM.
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Affiliation(s)
- Ye-Ha Jung
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeonjin Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Dasom Lee
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Yeon Lee
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine and Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea
| | - Do-Hyung Kang
- Seoul Chung Psychiatry Clinic, Seoul, Republic of Korea
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33
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Cudalbu C, Behar KL, Bhattacharyya PK, Bogner W, Borbath T, de Graaf RA, Gruetter R, Henning A, Juchem C, Kreis R, Lee P, Lei H, Marjańska M, Mekle R, Murali-Manohar S, Považan M, Rackayová V, Simicic D, Slotboom J, Soher BJ, Starčuk Z, Starčuková J, Tkáč I, Williams S, Wilson M, Wright AM, Xin L, Mlynárik V. Contribution of macromolecules to brain 1 H MR spectra: Experts' consensus recommendations. NMR Biomed 2021; 34:e4393. [PMID: 33236818 PMCID: PMC10072289 DOI: 10.1002/nbm.4393] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 05/08/2023]
Abstract
Proton MR spectra of the brain, especially those measured at short and intermediate echo times, contain signals from mobile macromolecules (MM). A description of the main MM is provided in this consensus paper. These broad peaks of MM underlie the narrower peaks of metabolites and often complicate their quantification but they also may have potential importance as biomarkers in specific diseases. Thus, separation of broad MM signals from low molecular weight metabolites enables accurate determination of metabolite concentrations and is of primary interest in many studies. Other studies attempt to understand the origin of the MM spectrum, to decompose it into individual spectral regions or peaks and to use the components of the MM spectrum as markers of various physiological or pathological conditions in biomedical research or clinical practice. The aim of this consensus paper is to provide an overview and some recommendations on how to handle the MM signals in different types of studies together with a list of open issues in the field, which are all summarized at the end of the paper.
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Affiliation(s)
- Cristina Cudalbu
- Center for Biomedical Imaging, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Vaud, Switzerland
| | - Kevin L Behar
- Magnetic Resonance Research Center and Department of Psychiatry, Yale University, New Haven, Connecticut, USA
| | | | - Wolfgang Bogner
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Clinical Molecular MR Imaging, Vienna, Austria
| | - Tamas Borbath
- High-Field Magnetic Resonance, Max-Planck-Institute for Biological Cybernetics, Tübingen, Germany
- Faculty of Science, Eberhard-Karls Universität Tübingen, Tübingen, Germany
| | - Robin A de Graaf
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
| | - Rolf Gruetter
- Laboratory for Functional and Metabolic Imaging, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Anke Henning
- High-Field Magnetic Resonance, Max-Planck-Institute for Biological Cybernetics, Tübingen, Germany
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, Germany
| | - Christoph Juchem
- Departments of Biomedical Engineering and Radiology, Columbia University, New York, USA
| | - Roland Kreis
- Departments of Radiology and Biomedical Research, University of Bern, Bern, Switzerland
| | - Phil Lee
- Department of Radiology, Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Hongxia Lei
- Center for Biomedical Imaging, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Vaud, Switzerland
| | - Małgorzata Marjańska
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ralf Mekle
- Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Saipavitra Murali-Manohar
- High-Field Magnetic Resonance, Max-Planck-Institute for Biological Cybernetics, Tübingen, Germany
- Faculty of Science, Eberhard-Karls Universität Tübingen, Tübingen, Germany
| | - Michal Považan
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Veronika Rackayová
- Center for Biomedical Imaging, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Vaud, Switzerland
- Laboratory for Functional and Metabolic Imaging, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Dunja Simicic
- Center for Biomedical Imaging, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Vaud, Switzerland
- Laboratory for Functional and Metabolic Imaging, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Johannes Slotboom
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern and Inselspital, Bern, Switzerland
| | - Brian J Soher
- Center for Advanced MR Development, Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Zenon Starčuk
- Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czech Republic
| | - Jana Starčuková
- Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czech Republic
| | - Ivan Tkáč
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Stephen Williams
- Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Martin Wilson
- Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham, UK
| | - Andrew Martin Wright
- High-Field Magnetic Resonance, Max-Planck-Institute for Biological Cybernetics, Tübingen, Germany
- IMPRS for Cognitive and Systems Neuroscience, Eberhard-Karls Universität Tübingen, Tübingen, Germany
| | - Lijing Xin
- Center for Biomedical Imaging, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Vaud, Switzerland
| | - Vladimír Mlynárik
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Clinical Molecular MR Imaging, Vienna, Austria
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34
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Sai E, Shimada K, Aikawa T, Aoshima C, Takamura K, Hiki M, Yokoyama T, Miyazaki T, Fujmoto S, Konishi H, Hirano KI, Daida H, Minamino T. Triglyceride Deposit Cardiomyovasculopathy with Massive Myocardial Triglyceride which Was Proven Using Proton-magnetic Resonance Spectroscopy. Intern Med 2021; 60:1217-1220. [PMID: 33162485 PMCID: PMC8112966 DOI: 10.2169/internalmedicine.6126-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/22/2020] [Indexed: 12/04/2022] Open
Abstract
The patient was a 73-year-old man with a history of hypertension, diabetes mellitus, dyslipidemia, rheumatoid arthritis, repeated percutaneous coronary intervention and percutaneous peripheral intervention procedures. He was frequently admitted to our hospital for congestive heart failure with orthopnea. The myocardial washout rate of iodine-123-β-methyl iodophenyl-pentadecanoic acid was defective on scintigraphy. He was diagnosed with triglyceride deposit cardiomyovasculopathy (TGCV). Proton magnetic resonance spectroscopy (1H-MRS) indicated the level of myocardial triglyceride (TG) content to be extremely high (4.92%). This is the first report to confirm a massive accumulation of TG in the myocardium of a patient with TGCV using 1H-MRS noninvasively.
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Affiliation(s)
- Eiryu Sai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Kazunori Shimada
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
- Sportology Center, Juntendo University Graduate School of Medicine, Japan
| | - Tatsuro Aikawa
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Chihiro Aoshima
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Makoto Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Takayuki Yokoyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Tetsuro Miyazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Cardiovascular Medicine, Juntendo Urayasu Hospital, Japan
| | - Shinichiro Fujmoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Hakuoh Konishi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Ken-Ichi Hirano
- Laboratory of Cardiovascular Disease, Novel, Non-invasive, and Nutritional Therapeutics and Triglyceride Research Center (TGRC), Graduate School of Medicine, Osaka University, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
- Sportology Center, Juntendo University Graduate School of Medicine, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
- Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Japan
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Bitencourt A, Sevilimedu V, Morris EA, Pinker K, Thakur SB. Fat Composition Measured by Proton Spectroscopy: A Breast Cancer Tumor Marker? Diagnostics (Basel) 2021; 11:564. [PMID: 33801022 DOI: 10.3390/diagnostics11030564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 01/05/2023] Open
Abstract
Altered metabolism including lipids is an emerging hallmark of breast cancer. The purpose of this study was to investigate if breast cancers exhibit different magnetic resonance spectroscopy (MRS)-based lipid composition than normal fibroglandular tissue (FGT). MRS spectra, using the stimulated echo acquisition mode sequence, were collected with a 3T scanner from patients with suspicious lesions and contralateral normal tissue. Fat peaks at 1.3 + 1.6 ppm (L13 + L16), 2.1 + 2.3 ppm (L21 + L23), 2.8 ppm (L28), 4.1 + 4.3 ppm (L41 + L43), and 5.2 + 5.3 ppm (L52 + L53) were quantified using LCModel software. The saturation index (SI), number of double bods (NBD), mono and polyunsaturated fatty acids (MUFA and PUFA), and mean chain length (MCL) were also computed. Results showed that mean concentrations of all lipid metabolites and PUFA were significantly lower in tumors compared with that of normal FGT (p ≤ 0.002 and 0.04, respectively). The measure best separating normal and tumor tissues after adjusting with multivariable analysis was L21 + L23, which yielded an area under the curve of 0.87 (95% CI: 0.75–0.98). Similar results were obtained between HER2 positive versus HER2 negative tumors. Hence, MRS-based lipid measurements may serve as independent variables in a multivariate approach to increase the specificity of breast cancer characterization.
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Liao X, Lai S, Zhong S, Wang Y, Zhang Y, Shen S, Huang H, Chen G, Chen F, Jia Y. Interaction of Serum Copper and Neurometabolites on Executive Dysfunction in Unmedicated Patients With Major Depressive Disorder. Front Psychiatry 2021; 12:564375. [PMID: 33746789 PMCID: PMC7965952 DOI: 10.3389/fpsyt.2021.564375] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 01/19/2021] [Indexed: 12/28/2022] Open
Abstract
Objective: The mechanism of executive function (EF) impairment in major depressive disorder (MDD) remains unclear. Previous studies have demonstrated that altered serum copper levels and neurometabolic alterations may be associated with the psychopathology and cognitive impairment of MDD. While, their inter-relationships in MDD remain uncertain. The present study aims to assess whether the interaction between serum copper levels and neurometabolic alterations is involved in the deficit of executive function (EF) in patients with unmedicated MDD. Methods: Serum copper levels and EFs were measured in 41 MDD patients and 50 control subjects. EFs were evaluated by Trail Making Test, Part-B (TMT-B), Digit Symbol Substitution Test (DSST), Wisconsin Card Sorting Task (WCST), and Semantic Verbal Fluency testing (SVFT). Additionally, 41 patients and 41 healthy controls underwent proton magnetic resonance spectroscopy (1H-MRS) to obtain ratios of N-acetyl aspartate to creatine (NAA/Cr) and choline-containing compounds to creatine (Cho/Cr) in the lenticular nucleus (LN) of basal ganglia (BG). Finally, association and interaction analysis were conducted to investigate their inter-relationships. Results: The results showed that patients performed worse in the DSST, WCST, TMT-B time and SVFT. Moreover, patients had higher serum copper levels, but lower NAA/Cr ratios in left LN of BG than healthy controls. In patients, serum copper levels were found to significantly negative associated with Categories Completed (CC) number of WCST (r = -0.408, p = 0.008), and positive associated with the Total Errors (TE) and Nonperseverative Errors (PE) number of WCST (r = 0.356, p = 0.023; r = -0.356, p = 0.022). In addition, the NAA/Cr ratios of left LN were found to significantly negative associated with VFS (r = -0.401, p = 0.009), as well as negative associated with serum copper levels (r = -0.365, p = 0.019). Finally, the interaction between copper and NAA may as influencing factors for SVFT and CC number of WCST in patients. Conclusion: Our results indicated that the interaction of abnormal copper levels and NAA/Cr neurometabolic disruption of the LN may impact executive dysfunction, and this may relevant to the pathophysiology of executive impairment in MDD patients.
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Affiliation(s)
- Xiaoxiao Liao
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, China.,Jiangmen Central Hospital, Jiangmen, China
| | - Shunkai Lai
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yiliang Zhang
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shiyi Shen
- School of Management, Jinan University, Guangzhou, China
| | - Hui Huang
- School of Management, Jinan University, Guangzhou, China
| | - Guanmao Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Feng Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, China
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Yue J, Zhong S, Luo A, Lai S, He T, Luo Y, Wang Y, Zhang Y, Shen S, Huang H, Wen S, Jia Y. Correlations Between Working Memory Impairment and Neurometabolites of the Prefrontal Cortex in Drug-Naive Obsessive-Compulsive Disorder. Neuropsychiatr Dis Treat 2021; 17:2647-2657. [PMID: 34421300 PMCID: PMC8373305 DOI: 10.2147/ndt.s296488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 07/12/2021] [Indexed: 01/06/2023] Open
Abstract
PURPOSE This study aimed to investigate the mechanism of working memory (WM) impairment in drug-naive obsessive-compulsive disorder (OCD) by using neuropsychological tests and proton magnetic resonance spectroscopy (1H-MRS). PATIENTS AND METHODS A total of 55 patients with drug-naive OCD and 55 healthy controls (HCs) were recruited for this study. The working memory (WM) was evaluated using the digit span test (DST), visual space memory test (VSMT), and the 2-back task and stroop color word test (SCWT). The bilateral metabolite levels of the prefrontal cortex (PFC) were evaluated by 1H-MRS, then determined the ratios of N-acetyl aspartate (NAA), choline-containing compounds (Cho), and myo-inositol (MI) to creatine (Cr). The independent sample t-test was used to analyse the differences in WM performance and neurometabolite ratios. Multivariate linear regression analysis was performed to screen the influential factors of WM, with an introduction level of 0.05 and a rejection level of 0.10. RESULTS 1) Patients with OCD performed significantly worse on DST (score), VSMT (score), 2-back task (accuracy rate), SCWT (execution time) when compared with HCs. 2) NAA/Cr and Cho/Cr in the left PFC (lPFC) and MI/Cr ratios in the bilateral PFC of OCD patients were significantly lower when compared to HCs. 3) For OCD patients, the NAA/Cr ratio in the lPFC was negatively correlated with the score of DST (forwards), the Cho/Cr ratio in the lPFC was positively correlated with the accuracy rate of 2-back task, and the MI/Cr ratio in the right PFC (rPFC) was positively correlated with the score of DST (forwards) and the accuracy rate of VSMT. We also found that the compulsive symptoms showed a positive correlation with MI/Cr ratio of the rPFC. CONCLUSION Drug-naive OCD patients have demonstrated WM impairments, including phonological loop, visual-spatial sketchpad and central executive system, and the WM impairments might be associated with hypometabolism in the PFC, especially the lPFC.
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Affiliation(s)
- Jihui Yue
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou, Guangdong Province, People's Republic of China.,Department of Psychiatry, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, People's Republic of China
| | - Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou, Guangdong Province, People's Republic of China
| | - Aimin Luo
- Department of Psychology, Guangdong Sanjiu Brain Hospital, Guangzhou, Guangdong Province, People's Republic of China
| | - Shunkai Lai
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou, Guangdong Province, People's Republic of China
| | - Tingting He
- School of Management, Jinan University, Guangzhou, Guangdong Province, People's Republic of China
| | - Yuchong Luo
- Department of Psychiatry, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, People's Republic of China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital, Jinan University, Guangzhou, Guangdong Province, People's Republic of China
| | - Yiliang Zhang
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou, Guangdong Province, People's Republic of China
| | - Shiyi Shen
- School of Management, Jinan University, Guangzhou, Guangdong Province, People's Republic of China
| | - Hui Huang
- School of Management, Jinan University, Guangzhou, Guangdong Province, People's Republic of China
| | - Shenglin Wen
- Department of Psychiatry, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, People's Republic of China
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou, Guangdong Province, People's Republic of China
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Wang X, Wang K, Wang H, Li X, Feng J, Chen Q. 1H NMR-based dynamic metabolomics delineates the therapeutic effects of Shenfu injection on laparoscopic hysterectomy. Medicine (Baltimore) 2020; 99:e23336. [PMID: 33350724 PMCID: PMC7769324 DOI: 10.1097/md.0000000000023336] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 10/19/2020] [Indexed: 11/26/2022] Open
Abstract
To explore the effect and mechanism of Shenfu Injection on serum metabolomics in laparoscopic hysterectomy.1.5 mL/kg Shenfu injection was added to inject 200 mL of normal saline after the patients who entered the standard were admitted to the operating room. NMR metabolomics were performed at each time point before anesthesia (T0), immediately after pneumoperitoneum (T1), and at the end of surgery (T2).Multivariate trajectory analysis showed that SFI treatment could make laparoscopic hysterectomy interfere with the recovery of plasma metabolites to normal metabolic state, with a time-dependent trend. In addition, the key metabolic changes of laparoscopic hysterectomy at different stages of SFI treatment involve energy metabolism, oxidative stress response, amino acid metabolism, and pyruvate metabolism. Especially, the important role of SFI in the treatment of laparoscopic hysterectomy is antioxidant capacity. The results show that SFI can be used as a potential drug for laparoscopic hysterectomy.The current findings provided, for the first time, sound evidence of the protective effects of SFI on laparoscopic hysterectomy from both biochemical and metabolomics perspectives. The mechanisms of SFI could be related to regulating amino acid metabolism, pyruvate metabolism, and energy metabolism. The present study lays an important foundation for further research and for the broad clinical application of SFI.
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Affiliation(s)
- Xue Wang
- Department of Anesthesiology, East Hospital of Sichuan Provincial People's Hospital
| | - Kai Wang
- Department of Acute Care Surgery, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences
| | - Huan Wang
- Department of Anesthesiology, East Hospital of Sichuan Provincial People's Hospital
| | - Xiangkui Li
- Department of Anesthesiology, East Hospital of Sichuan Provincial People's Hospital
| | - Jinzhou Feng
- Department of Neurosurgery, East Hospital of Sichuan Provincial People's Hospital, Chengdu, China
| | - Qian Chen
- Department of Anesthesiology, East Hospital of Sichuan Provincial People's Hospital
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Guenter W, Bieliński M, Bonek R, Borkowska A. Neurochemical Changes in the Brain and Neuropsychiatric Symptoms in Clinically Isolated Syndrome. J Clin Med 2020; 9:E3909. [PMID: 33276455 DOI: 10.3390/jcm9123909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/08/2020] [Accepted: 11/28/2020] [Indexed: 11/20/2022] Open
Abstract
To assess cognitive impairment and affective symptoms and their association with damage to normal-appearing white matter (NAWM) in patients with clinically isolated syndrome (CIS), we compared neuropsychological test scores between patients with CIS and healthy controls and examined correlations between these and proton magnetic resonance spectroscopy (1H-MRS) outcomes in patients with CIS. Forty patients with CIS and 40 healthy participants were tested with a set of neuropsychological tests, which included the Beck Depression Inventory (BDI) and the Hospital Anxiety and Depression Scale (HADS). Single-voxel 1H-MRS was performed on frontal and parietal NAWM of patients with CIS to assess ratios of N-acetyl-aspartate (NAA) to creatine (Cr), myo-inositol (mI), and choline (Cho), as well as mI/Cr and Cho/Cr ratios. Patients with CIS had lower cognitive performance and higher scores for the BDI and anxiety subscale of HADS than healthy controls. There were significant correlations between the following neuropsychological tests and metabolic ratios in the frontal NAWM: Stroop Color-Word Test and Cho/Cr, Symbol Digit Modalities Test and mI/Cr, as well as NAA/mI, Go/no-go reaction time, and NAA/Cho, as well as NAA/mI, Californian Verbal Learning Test, and NAA/Cr. BDI scores were related to frontal NAA/mI and parietal NAA/Cr and Cho/Cr ratios, whereas HADS-depression scores were associated with frontal NAA/Cr and NAA/mI and parietal NAA/Cr and Cho/Cr ratios. HADS-anxiety correlated with parietal NAA/Cr ratio. This study suggests that neurochemical changes in the NAWM assessed with single-voxel 1H-MRS are associated with cognitive performance and affective symptoms in patients with CIS.
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Tsili AC, Astrakas L, Sofikitis N, Argyropoulou MI. Proton MR Spectroscopy in Assessing the Biochemical Milieu of Human Testes. J Magn Reson Imaging 2020; 55:404-413. [PMID: 33128500 DOI: 10.1002/jmri.27416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 12/21/2022] Open
Abstract
Proton magnetic resonance spectroscopy (MRS), considered a connection between metabolism and anatomic and functional information provided by standard MRI, gives information on various tissue metabolites and their pathologic changes. Recently, proton MRS has been added as an adjunct tool to the multiparametric protocol of scrotal MRI, providing a new insight into the extremely complex biochemical milieu of normal and abnormal testes. This article reviews proton MR spectra of normal testes, showing age and bilateralism dependence. Disturbances of various metabolic pathways in testes of infertile men resulting in alterations of metabolite peaks are discussed. Preliminary data on proton MR spectra of testicular mass lesions are presented. LEVEL OF EVIDENCE: 5. TECHNICAL EFFICACY STAGE: 5.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, University Campus, Ioannina, Greece
| | - Loukas Astrakas
- Department of Medical Physics, School of Health Sciences, Faculty of Medicine, University of Ioannina, University Campus, Ioannina, Greece
| | - Nikolaos Sofikitis
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Ioannina, University Campus, Ioannina, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, University Campus, Ioannina, Greece
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Herrala M, Mikkonen JJW, Pesonen P, Lappalainen R, Tjäderhane L, Niemelä RK, Seitsalo H, Salo T, Myllymaa S, Kullaa AM. Variability of salivary metabolite levels in patients with Sjögren's syndrome. J Oral Sci 2020; 63:22-26. [PMID: 33116006 DOI: 10.2334/josnusd.19-0504] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE To investigate inter- and intra-individual variation in the levels and outputs (concentration multiplied by salivary flow rate) of salivary metabolites in patients with primary Sjögren's syndrome (pSS). METHODS A total of 56 samples of stimulated saliva were collected from 14 female pSS patients during four laboratory visits within 20 weeks and analyzed using proton nuclear magnetic resonance spectroscopy. Single saliva samples from each of 15 controls were also analyzed. RESULTS Among 21 quantified metabolites, choline was significantly elevated in the pSS patients at each time point (P ≤ 0.015), taurine at the last three time points (P ≤ 0.013), alanine at the last two time points (P ≤ 0.007) and glycine at the last time point (P = 0.005). Inter-individual variation in metabolite concentrations was generally larger among the patients than among the controls, and significantly large variations were observed for glycine (P ≤ 0.007, all time points), choline (P ≤ 0.033, three last time points) and alanine (P = 0.028, baseline). Metabolite output analysis showed that choline had the lowest intra-patient variation. CONCLUSION In spite of considerable intra- and inter-individual variation, levels and outputs of specific metabolites in patients with pSS differ from those in controls, and may be potentially applicable as new biological markers for monitoring of the response to treatment.
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Affiliation(s)
- Maria Herrala
- Research Group of Oral Health Sciences, Faculty of Medicine, University of Oulu and Oulu University Hospital.,Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital
| | - Jopi J W Mikkonen
- SIB Labs and Department of Applied Physics, Faculty of Science and Forestry, University of Eastern Finland
| | - Paula Pesonen
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu
| | - Reijo Lappalainen
- SIB Labs and Department of Applied Physics, Faculty of Science and Forestry, University of Eastern Finland
| | - Leo Tjäderhane
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital.,Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital
| | | | | | - Tuula Salo
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital.,Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital
| | - Sami Myllymaa
- SIB Labs and Department of Applied Physics, Faculty of Science and Forestry, University of Eastern Finland
| | - Arja M Kullaa
- Research Group of Oral Health Sciences, Faculty of Medicine, University of Oulu and Oulu University Hospital.,Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland.,Educational Dental Clinic, Kuopio University Hospital
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Frittoli RB, Pereira DR, Rittner L, Appenzeller S. Proton magnetic resonance spectroscopy ( 1H-MRS) in rheumatic autoimmune diseases: A systematic review. Lupus 2020; 29:1873-1884. [PMID: 33019878 DOI: 10.1177/0961203320961466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE Proton magnetic resonance spectroscopy (1H-MRS) has been shown to be an important non-invasive tool to quantify neuronal loss or damage in the investigation of central nervous system (CNS) disorders. The purpose of this article is to discuss the clinical utility of 1H-MRS in determining CNS involvement in individuals with rheumatic autoimmune diseases. METHODS This study is a systematic review of the literature, conducted during the month of November and December of 2019 of articles published in the last 16 years (2003-2019). The search for relevant references was done through the exploration of electronic databases (PubMed/Medline and Embase). We searched for studied including systemic lupus erythematosus (SLE), systemic sclerosis (SSc), juvenile idiopathic arthritis, rheumatoid arthritis (RA), psoriasis, Sjögren's syndrome (pSS), vasculitis and Behçet. Only studies published after 2003 and with more than 20 patients were included. RESULTS We included 26 articles. NAA/Cr ratios were significant lower and Cho/Cr ratios increased in several brain regions in SLE, SS, RA, SSc. Associations with disease activity, inflammatory markers, CNS manifestations and comorbidities was variable across studies and diseases. CONCLUSION The presence of neurometabolite abnormalities in patients without ouvert CNS manifestations, suggests that systemic inflammation, atherosclerosis or abnormal vascular reactivity may be associated with subclinical CNS manifestations. MRS may be a usefull non-invasive method for screening patients with risk for CNS manifestations.
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Affiliation(s)
| | | | - Leticia Rittner
- School of Electrical and Computer Engineering, University of Campinas
| | - Simone Appenzeller
- Rheumatology Lab, School of Medical Sciences, University of Campinas.,Pediatric Rheumatology Unit, School of Medical Sciences, University of Campinas.,Department of Medicine, Rheumatology Unit, School of Medical Sciences, University of Campinas
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Dehghan A, Saatchian E, Sobhani M, Montazerabadi A. Neurochemical metabolite alterations of the occipital lobe in migraine without aura by proton magnetic resonance spectroscopy. Neuroradiol J 2020; 33:410-415. [PMID: 32573358 PMCID: PMC7482038 DOI: 10.1177/1971400920932793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Migraine without aura is the most common type of migraine headache, accounting for about 80% of all migraines. The aim of the present investigation was to determine the neurochemical metabolite alterations in the occipital lobe of patients suffering from migraine without aura using proton magnetic resonance spectroscopy (1H-MRS). METHODS Fifteen patients suffering from migraine without aura with an occipital plaque and 16 healthy controls were included in this study. Changes in the neurochemical metabolites in the occipital lobe were assessed using 1H-MRS. The ratios of N-acetylaspartate (NAA) to creatine (Cr), choline (Cho) to Cr and myo-inositol (MI) to NAA were measured by voxel volume at 8 cm3. RESULTS The mean NAA/Cr ratio decreased significantly in patients compared to controls. Cho/Cr and MI/NAA ratios increased significantly in patients. In addition, the duration of the disease and the frequency of headache attacks were significantly associated with a decrease in the NAA/Cr ratio and an increase in the Cho/Cr ratio. CONCLUSIONS Migraine without aura shows a significant association with changes in neurochemical metabolites detectable by 1H-MRS in the occipital lobe of patients. In addition, changes in metabolic ratios showed a significant relationship with the duration of the disease and the frequency of headache attacks.
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Affiliation(s)
- Alireza Dehghan
- Medical Physics Research Centre, Mashhad University of Medical Sciences, Iran
| | - Erfan Saatchian
- Medical Physics Research Centre, Mashhad University of Medical Sciences, Iran
| | - Mohammadreza Sobhani
- Neurology Department, Faculty of Medicine, Gonabad University of Medical Sciences, Iran
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Aengevaeren VL, Froeling M, van den Berg‐Faay S, Hooijmans MT, Monte JR, Strijkers GJ, Nederveen AJ, Eijsvogels TM, Bakermans AJ. Marathon running transiently depletes the myocardial lipid pool. Physiol Rep 2020; 8:e14543. [PMID: 32869950 PMCID: PMC7460059 DOI: 10.14814/phy2.14543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 01/05/2023] Open
Abstract
Lipids, stored as intracellular triacylglycerol droplets within the myocardium, serve as an important source of energy, particularly in times of prolonged increased energy expenditure. In only a few studies, the acute effects of exercise on such ectopic myocardial lipid storage were investigated. We studied the dynamic behavior of the myocardial lipid pool in response to completing the 2017 Amsterdam Marathon using proton magnetic resonance (MR) spectroscopy (1 H-MRS). We hypothesized that the prolonged increased myocardial energy demand of running a marathon could shift the balance of myocardial triacylglycerol turnover from triacylglycerol synthesis toward lipolysis and mitochondrial fatty acid β-oxidation, and decrease the myocardial lipid pool. We employed two 3 Tesla MR systems in parallel to noninvasively examine endurance-trained healthy men (n = 8; age 50.7 [50.1-52.7] y) at 1 week prior (baseline), <6 hr after finishing the marathon (post-marathon), and 2 weeks thereafter (recovery). Exercise intensity was 89 ± 6% of the age-predicted maximal heart rate, with a finish time of 3:56 [3:37-4:42] h:min. Myocardial lipid content was 0.66 [0.58-0.87]% of the total myocardial water signal at baseline, was lower post-marathon (0.47 [0.41-0.63]% of the total myocardial water signal), and had restored to 0.55 [0.49-0.83]% of the total myocardial water signal at recovery, representing a transient marathon running-induced depletion of 29 ± 24% (p = .04). The magnitude of this myocardial lipid pool depletion did not correlate with exercise intensity (r = -0.39; p = .39), nor with marathon finishing time (ρ = 0.57; p = .15). Our data show that prolonged high-intensity exercise can induce a transient depletion of the myocardial lipid pool, reinforcing the dynamic nature of ectopic triacylglycerol storage under real-life conditions of extreme endurance exercise.
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Affiliation(s)
- Vincent L. Aengevaeren
- Radboud Institute for Health Science, Department of PhysiologyRadboud University Medical CenterNijmegenThe Netherlands
- Radboud Institute for Health Sciences, Department of CardiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Martijn Froeling
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Sandra van den Berg‐Faay
- Department of Radiology and Nuclear MedicineAmsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Melissa T. Hooijmans
- Biomedical Engineering and PhysicsAmsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Jithsa R. Monte
- Department of Radiology and Nuclear MedicineAmsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Gustav J. Strijkers
- Biomedical Engineering and PhysicsAmsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Aart J. Nederveen
- Department of Radiology and Nuclear MedicineAmsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Thijs M.H. Eijsvogels
- Radboud Institute for Health Science, Department of PhysiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Adrianus J. Bakermans
- Department of Radiology and Nuclear MedicineAmsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
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Abstract
BACKGROUND Panic disorder (PD), defined by repeated and unexpected panic attacks, severely affects patients' living quality and social function. Perimenopausal women are high-risk group of PD and suffer greatly from it. Modern medicine therapies for this disorder have many side reactions and poor effects, so nonpharmacological modality is an urgent need. Although acupoint catgut embedding is widely used in clinical practice, there is no persuasive evidence of its effect for perimenopausal PD. The aim of this study is to investigate the effectiveness and safety of acupoint catgut embedding for perimenopausal PD and to elucidate the correlations among brain neural activation, bio-markers (amino acids) and clinical outcomes with radiographic evidence, thus to explore its neural mechanism. METHODS The parallel designed, exploratory randomized controlled trial will include 70 outpatients with perimenopausal PD recruited from two hospitals of Chinese Medicine. These subjects will be randomly allocated to an intervention group (Group Embedding) and a control group (Group Medication) in a 1:1 ratio. The subjects in the intervention group will receive acupoint catgut embedding treatment two weeks a time in the following predefined acupuncture points: Shenshu (BL23), Sanyinjiao (SP6), Guanyuan (RN4), Ganshu (BL18), Zusanli (ST36) and Pishu (BL20). The included women of the control group will take 0.4 mg Alprazolam tablet orally, 1 tablet a time, 3 times a day. There is a study period of 3 months and a follow-up period of 1 month for each group. The primary outcomes will be the following therapeutic indexes: the frequency of panic attack, Panic Disorder Severity Score (PDSS), and Panic-associated Symptoms Score (PASS) during the observation period and follow-up period. The changes in Hamilton Anxiety Scale (HAMA) Score and Symptom Checklist 90 (SCL-90) Score will also be compared between these two groups. Additionally, functional magnetic resonance imaging (fMRI) and proton magnetic resonance spectroscopy (1H-MRS) scans will be done before and after the observation period to show cranial neuroimaging changes. DISCUSSION We present a study design and rationale to explore the effectiveness and neural mechanism of acupoint catgut embedding for perimenopausal PD. There are still several factors restrict our research such as no unified standard of diagnostic criteria and curative effect evaluation. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-INR-16009724, registered in November 2016.
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Affiliation(s)
- Guizhen Chen
- The Bao’an District TCM Hospital, The Affiliated Hospital of Guangzhou University of Chinese Medicine, Shenzhen
| | - Xue Wang
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuo Zhang
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaokang Xu
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junquan Liang
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yunxiang Xu
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
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Khan AR, Geiger L, Wiborg O, Czéh B. Stress-Induced Morphological, Cellular and Molecular Changes in the Brain-Lessons Learned from the Chronic Mild Stress Model of Depression. Cells 2020; 9:cells9041026. [PMID: 32326205 PMCID: PMC7226496 DOI: 10.3390/cells9041026] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/14/2020] [Accepted: 04/19/2020] [Indexed: 02/07/2023] Open
Abstract
Major depressive disorder (MDD) is a severe illness imposing an increasing social and economic burden worldwide. Numerous rodent models have been developed to investigate the pathophysiology of MDD. One of the best characterized and most widely used models is the chronic mild stress (CMS) model which was developed more than 30 years ago by Paul Willner. More than 2000 published studies used this model, mainly to assess novel compounds with potential antidepressant efficacy. Most of these studies examined the behavioral consequences of stress and concomitant drug intervention. Much fewer studies focused on the CMS-induced neurobiological changes. However, the stress-induced cellular and molecular changes are important as they may serve as potential translational biomarkers and increase our understanding of the pathophysiology of MDD. Here, we summarize current knowledge on the structural and molecular alterations in the brain that have been described using the CMS model. We discuss the latest neuroimaging and postmortem histopathological data as well as molecular changes including recent findings on microRNA levels. Different chronic stress paradigms occasionally deliver dissimilar findings, but the available experimental data provide convincing evidence that the CMS model has a high translational value. Future studies examining the neurobiological changes in the CMS model in combination with clinically effective antidepressant drug intervention will likely deliver further valuable information on the pathophysiology of MDD.
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Affiliation(s)
- Ahmad Raza Khan
- Centre of Biomedical Research, Sanjay Gandhi Post Graduate Institute (SGPGI) Campus, Lucknow-226017, U.P, India;
| | - Lili Geiger
- Neurobiology of Stress Research Group, Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary;
- Department of Laboratory Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Ove Wiborg
- Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark;
| | - Boldizsár Czéh
- Neurobiology of Stress Research Group, Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary;
- Department of Laboratory Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
- Correspondence:
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47
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Tsili AC, Astrakas LG, Sofikitis N, Argyropoulou MI. Are there differences in the biochemical profile of bilateral normal testes? A 3.0 T 1H-MR spectroscopy study. Andrologia 2020; 52:e13569. [PMID: 32190931 DOI: 10.1111/and.13569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 01/12/2023] Open
Abstract
Bilateral normal testes asymmetry represents an interesting phenomenon. The aim was to assess possible differences in the biochemical profile of bilateral normal testes by 3.0 T proton magnetic resonance spectroscopy (1H-MRS). Twenty-one men were examined with scrotal 3.0 T MRI, including a single-voxel point-resolved spectroscopy sequence. MR spectra were obtained by placing a volume of interest in the middle of each normal testis. Normalised metabolite concentrations, defined as ratios of the calculated metabolite concentrations relative to creatine (Cr) concentration, were compared between bilateral normal testes using Mann-Whitney U test. 1H-MRS allowed the detection of certain testicular metabolites, including total choline, Cr, myo-inositol, Glx, total lipids and macromolecules resonating at 0.9, 1.3 and 2.0 ppm. Normal left testis had higher median normalised concentrations of Glx (p = .002) and lactate (p = .041) compared with the normal right testis. Differences in concentrations of Glx were attributed to differences in glutamate (p = .020). Normal testes asymmetry is confirmed in this study by differences in the biochemical testicular profile, as assessed by 3.0 T 1H-MRS. Increase in levels of glutamate and lactate in normal left testis should be correlated with changes in metabolic pathways, specifically glycometabolism and amino acid metabolism.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Loukas G Astrakas
- Department of Medical Physics, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Nikolaos Sofikitis
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
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Lee HH, Kim H. Deep learning-based target metabolite isolation and big data-driven measurement uncertainty estimation in proton magnetic resonance spectroscopy of the brain. Magn Reson Med 2020; 84:1689-1706. [PMID: 32141155 DOI: 10.1002/mrm.28234] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE The aim of this study was to develop a method for metabolite quantification with simultaneous measurement uncertainty estimation in deep learning-based proton magnetic resonance spectroscopy (1 H-MRS). METHODS The reliability of metabolite quantification depends on signal-to-noise ratio (SNR), linewidth, and degree of spectral overlap (DSO), and therefore knowledge about these factors may be utilized in measurement uncertainty estimation in deep learning-based 1 H-MRS. While SNR and linewidth are typically estimated from a representative singlet, DSO needs to be estimated metabolite-specifically. We developed convolutional neural networks (CNNs) capable of isolating target metabolite signal on simulated rat brain spectra at 9.4T, such that, in addition to metabolite content, the signal-to-background ratio (SBR) as a quantitative metric of DSO can be estimated directly from CNN-output for each metabolite. The CNN-predicted SBR was adjusted according to its pre-defined relationship to the ground-truth SBR by exploiting the big spectral data (N = 80 000), and used for measurement uncertainty estimation together with the SNR and linewidth from the CNN-input spectrum. The proposed method was tested first on the simulated spectra in comparison with LCModel and jMRUI and further on in vivo spectra. RESULTS The proposed method outperformed LCModel and jMRUI in both quantitative accuracy and measurement uncertainty estimation. Using in vivo data, the metabolite concentrations from the proposed method were close to the reported ranges with the measurement uncertainty of glutamine, glutamate, myo-inositol, N-acetylaspartate, and Tau less than 10%. CONCLUSION The proposed method may be used for metabolite quantification with measurement uncertainty estimation in rat brain at 9.4T by exploiting the spectral isolation capability of the CNNs and the availability of big spectral data.
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Affiliation(s)
- Hyeong Hun Lee
- Department of Biomedical Sciences, Seoul National University, Seoul, Korea
| | - Hyeonjin Kim
- Department of Biomedical Sciences, Seoul National University, Seoul, Korea.,Department of Radiology, Seoul National University Hospital, Seoul, Korea
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Maul S, Giegling I, Rujescu D. Proton Magnetic Resonance Spectroscopy in Common Dementias-Current Status and Perspectives. Front Psychiatry 2020; 11:769. [PMID: 32848938 PMCID: PMC7424040 DOI: 10.3389/fpsyt.2020.00769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022] Open
Abstract
Dementia occurs mainly in the elderly and is associated with cognitive decline and impairment of activities of daily living. The most common forms of dementia are Alzheimer's disease (AD), vascular dementia (VD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD). To date, there are no causal options for therapy, but drug and non-drug treatments can positively modulate the course of the disease. Valid biomarkers are needed for the earliest possible and reliable diagnosis, but so far, such biomarkers have only been established for AD and require invasive and expensive procedures. In this context, proton magnetic resonance spectroscopy (1H-MRS) provides a non-invasive and widely available technique for investigating the biochemical milieu of brain tissue in vivo. Numerous studies have been conducted for AD, but for VD, DLB, and FTD the number of studies is limited. Nevertheless, MRS can detect measurable metabolic alterations in common dementias. However, most of the studies conducted are too heterogeneous to assess the potential use of MRS technology in clinical applications. In the future, technological advances may increase the value of MRS in dementia diagnosis and treatment. This review summarizes the results of MRS studies conducted in common dementias and discusses the reasons for the lack of transfer into clinical routine.
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Affiliation(s)
- Stephan Maul
- University Clinic and Outpatient Clinic for Psychiatry, Psychotherapy and Psychosomatics, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Ina Giegling
- University Clinic and Outpatient Clinic for Psychiatry, Psychotherapy and Psychosomatics, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Dan Rujescu
- University Clinic and Outpatient Clinic for Psychiatry, Psychotherapy and Psychosomatics, Martin Luther University Halle-Wittenberg, Halle, Germany
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50
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Mellen EJ, Harper DG, Ravichandran C, Jensen E, Silveri M, Forester BP. Lamotrigine Therapy and Biomarkers of Cerebral Energy Metabolism in Older Age Bipolar Depression. Am J Geriatr Psychiatry 2019; 27:783-793. [PMID: 31000323 DOI: 10.1016/j.jagp.2019.02.017] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/25/2019] [Accepted: 02/27/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study compared brain energy metabolism, as measured by cerebral concentrations of glutamate (Glu), glutamine (Gln), and N-acetyl aspartate (NAA), in older age bipolar depression (OABD) to that of psychiatrically healthy comparison subjects using proton (1H) magnetic resonance spectroscopy imaging at 4-Tesla. Metabolite levels were assessed in OABD subjects before and after 8 weeks of lamotrigine therapy with the goal of determining relationships between cerebral energy metabolism, depression symptom severity, and changes in depression symptom response. METHODS Individuals (n = 21, mean age: 62.0 ± 5.9 years) with bipolar disorder, current episode depressed, and a healthy comparison group (n = 14, mean age: 67.5 ± 8.8 years) were selected. Participants with bipolar disorder, current episode depressed, were treated in open label fashion with lamotrigine monotherapy for 8 weeks. All subjects were scanned with 1H magnetic resonance spectroscopy at 4T at baseline and again after 8 weeks to assess levels of cerebral metabolites in the anterior cingulate cortex and parieto-occipital cortex. Metabolite levels were examined as ratios relative to creatine (Cr). Response to 8 weeks of lamotrigine treatment in the bipolar disorder, current episode depressed group, was assessed as a continuous measure on the Montgomery-Asberg Depression Rating Scale. RESULTS NAA/Cr ratio in OABD was significantly lower by 14% (95% confidence interval: [1%, 26%]) than in comparison subjects at baseline. However, there were no associations between NAA/Cr, Glu/Cr, or Gln/Cr and either depression severity or lamotrigine treatment. CONCLUSION Group differences in NAA suggest evidence for a deficit in cerebral energy metabolism in OABD.
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Affiliation(s)
- Emily J Mellen
- McLean Hospital Division of Geriatric Psychiatry (EJM, DGH, BPF), Belmont, MA
| | - David G Harper
- McLean Hospital Division of Geriatric Psychiatry (EJM, DGH, BPF), Belmont, MA; Department of Psychiatry (DGH, CR, EJ, MS, BPF), Harvard Medical School, Boston
| | - Caitlin Ravichandran
- Department of Psychiatry (DGH, CR, EJ, MS, BPF), Harvard Medical School, Boston; Program for Neuropsychiatric Research (CR), McLean Hospital, Belmont, MA; Lurie Center for Autism (CR), Massachusetts General Hospital, Lexington, MA
| | - Eric Jensen
- Department of Psychiatry (DGH, CR, EJ, MS, BPF), Harvard Medical School, Boston; Brain Imaging Center (EJ), McLean Hospital, Belmont, MA
| | - Marisa Silveri
- Department of Psychiatry (DGH, CR, EJ, MS, BPF), Harvard Medical School, Boston; Neurodevelopmental Laboratory on Addictions and Mental Health (MS), McLean Hospital, Belmont, MA
| | - Brent P Forester
- McLean Hospital Division of Geriatric Psychiatry (EJM, DGH, BPF), Belmont, MA; Department of Psychiatry (DGH, CR, EJ, MS, BPF), Harvard Medical School, Boston.
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