1
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Schäfer A, Gralinski LE, Leist SR, Hampton BK, Mooney MA, Jensen KL, Graham RL, Agnihothram S, Jeng S, Chamberlin S, Bell TA, Scobey DT, Linnertz CL, VanBlargan LA, Thackray LB, Hock P, Miller DR, Shaw GD, Diamond MS, de Villena FPM, McWeeney SK, Heise MT, Menachery VD, Ferris MT, Baric RS. Genetic loci regulate Sarbecovirus pathogenesis: A comparison across mice and humans. Virus Res 2024; 344:199357. [PMID: 38508400 PMCID: PMC10981091 DOI: 10.1016/j.virusres.2024.199357] [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: 09/28/2023] [Revised: 02/15/2024] [Accepted: 03/16/2024] [Indexed: 03/22/2024]
Abstract
Coronavirus (CoV) cause considerable morbidity and mortality in humans and other mammals, as evidenced by the emergence of Severe Acute Respiratory CoV (SARS-CoV) in 2003, Middle East Respiratory CoV (MERS-CoV) in 2012, and SARS-CoV-2 in 2019. Although poorly characterized, natural genetic variation in human and other mammals modulate virus pathogenesis, as reflected by the spectrum of clinical outcomes ranging from asymptomatic infections to lethal disease. Using multiple human epidemic and zoonotic Sarbecoviruses, coupled with murine Collaborative Cross genetic reference populations, we identify several dozen quantitative trait loci that regulate SARS-like group-2B CoV pathogenesis and replication. Under a Chr4 QTL, we deleted a candidate interferon stimulated gene, Trim14 which resulted in enhanced SARS-CoV titers and clinical disease, suggesting an antiviral role during infection. Importantly, about 60 % of the murine QTL encode susceptibility genes identified as priority candidates from human genome-wide association studies (GWAS) studies after SARS-CoV-2 infection, suggesting that similar selective forces have targeted analogous genes and pathways to regulate Sarbecovirus disease across diverse mammalian hosts. These studies provide an experimental platform in rodents to investigate the molecular-genetic mechanisms by which potential cross mammalian susceptibility loci and genes regulate type-specific and cross-SARS-like group 2B CoV replication, immunity, and pathogenesis in rodent models. Our study also provides a paradigm for identifying susceptibility loci for other highly heterogeneous and virulent viruses that sporadically emerge from zoonotic reservoirs to plague human and animal populations.
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Affiliation(s)
- Alexandra Schäfer
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Lisa E Gralinski
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Sarah R Leist
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brea K Hampton
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Curriculum in Genetics and Molecular Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael A Mooney
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; Division of Bioinformatics and Computational Biology, Oregon Health & Science University, Portland, OR, USA; Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Kara L Jensen
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rachel L Graham
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sudhakar Agnihothram
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sophia Jeng
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Steven Chamberlin
- Division of Bioinformatics and Computational Biology, Oregon Health & Science University, Portland, OR, USA; Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Timothy A Bell
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - D Trevor Scobey
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Colton L Linnertz
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura A VanBlargan
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Larissa B Thackray
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Pablo Hock
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Darla R Miller
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ginger D Shaw
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael S Diamond
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA; Department of Pathology & Immunology2, Washington University School of Medicine, St. Louis, MO, USA; Department of Molecular Microbiology3, Washington University School of Medicine, St. Louis, MO, USA
| | - Fernando Pardo Manuel de Villena
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shannon K McWeeney
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; Division of Bioinformatics and Computational Biology, Oregon Health & Science University, Portland, OR, USA; Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA; Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Mark T Heise
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Rapidly Emerging Antiviral Drug Discovery Initiative, University of North Carolina, Chapel Hill NC, USA
| | - Vineet D Menachery
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA; Institute for Human Infection and Immunity, University of Texas Medical Branch, Galveston TX, USA; Department of Pathology and Center for Biodefense & Emerging Infectious Diseases, University of Texas Medical Branch, Galveston, TX, USA
| | - Martin T Ferris
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Ralph S Baric
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Rapidly Emerging Antiviral Drug Discovery Initiative, University of North Carolina, Chapel Hill NC, USA.
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2
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Hermosillo RJM, Moore LA, Feczko E, Miranda-Domínguez Ó, Pines A, Dworetsky A, Conan G, Mooney MA, Randolph A, Graham A, Adeyemo B, Earl E, Perrone A, Carrasco CM, Uriarte-Lopez J, Snider K, Doyle O, Cordova M, Koirala S, Grimsrud GJ, Byington N, Nelson SM, Gratton C, Petersen S, Feldstein Ewing SW, Nagel BJ, Dosenbach NUF, Satterthwaite TD, Fair DA. A precision functional atlas of personalized network topography and probabilities. Nat Neurosci 2024; 27:1000-1013. [PMID: 38532024 PMCID: PMC11089006 DOI: 10.1038/s41593-024-01596-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/08/2024] [Indexed: 03/28/2024]
Abstract
Although the general location of functional neural networks is similar across individuals, there is vast person-to-person topographic variability. To capture this, we implemented precision brain mapping functional magnetic resonance imaging methods to establish an open-source, method-flexible set of precision functional network atlases-the Masonic Institute for the Developing Brain (MIDB) Precision Brain Atlas. This atlas is an evolving resource comprising 53,273 individual-specific network maps, from more than 9,900 individuals, across ages and cohorts, including the Adolescent Brain Cognitive Development study, the Developmental Human Connectome Project and others. We also generated probabilistic network maps across multiple ages and integration zones (using a new overlapping mapping technique, Overlapping MultiNetwork Imaging). Using regions of high network invariance improved the reproducibility of executive function statistical maps in brain-wide associations compared to group average-based parcellations. Finally, we provide a potential use case for probabilistic maps for targeted neuromodulation. The atlas is expandable to alternative datasets with an online interface encouraging the scientific community to explore and contribute to understanding the human brain function more precisely.
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Affiliation(s)
- Robert J M Hermosillo
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA.
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Lucille A Moore
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Eric Feczko
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Óscar Miranda-Domínguez
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Adam Pines
- Department of Neuroscience, University of Pennsylvania, Philadelphia, PA, USA
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Ally Dworetsky
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Gregory Conan
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Michael A Mooney
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Center for Mental Health Innovation, Oregon Health and Science University, Portland, OR, USA
| | - Anita Randolph
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Alice Graham
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Babatunde Adeyemo
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric Earl
- Data Science and Sharing Team, National Institute of Mental Health, Bethesda, MD, USA
| | - Anders Perrone
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Cristian Morales Carrasco
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | | | - Kathy Snider
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Olivia Doyle
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Michaela Cordova
- Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, CA, USA
- Joint Doctoral Program in Clinical Psychology, University of California San Diego, San Diego, CA, USA
| | - Sanju Koirala
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Gracie J Grimsrud
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Nora Byington
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Steven M Nelson
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Caterina Gratton
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Department of Psychology, Florida State University, Tallahassee, FL, USA
- Department of Psychological and Brain Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Steven Petersen
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Psychological and Brain Sciences, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Bonnie J Nagel
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Nico U F Dosenbach
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Theodore D Satterthwaite
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Damien A Fair
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
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Tobochnik S, Regan MS, Dorotan MKC, Reich D, Lapinskas E, Hossain MA, Stopka SA, Santagata S, Murphy MM, Arnaout O, Bi WL, Chiocca EA, Golby AJ, Mooney MA, Smith TR, Ligon KL, Wen PY, Agar NYR, Lee JW. Pilot trial of perampanel on peritumoral hyperexcitability and clinical outcomes in newly diagnosed high-grade glioma. medRxiv 2024:2024.04.11.24305666. [PMID: 38645003 PMCID: PMC11030478 DOI: 10.1101/2024.04.11.24305666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background Glutamatergic neuron-glioma synaptogenesis and peritumoral hyperexcitability promote glioma growth in a positive feedback loop. The objective of this study was to evaluate the feasibility and estimated effect sizes of the AMPA-R antagonist, perampanel, on intraoperative electrophysiologic hyperexcitability and clinical outcomes. Methods An open-label trial was performed comparing perampanel to standard of care (SOC) in patients undergoing resection of newly-diagnosed radiologic high-grade glioma. Perampanel was administered as a pre-operative loading dose followed by maintenance therapy until progressive disease or up to 12-months. SOC treatment involved levetiracetam for 7-days or as clinically indicated. The primary outcome of hyperexcitability was defined by intra-operative electrocorticography high frequency oscillation (HFO) rates. Seizure-freedom and overall survival (OS) were estimated by the Kaplan-Meier method. Tissue concentrations of perampanel, levetiracetam, and metabolites were measured by mass spectrometry. Results HFO rates were similar between perampanel-treated and SOC cohorts. The trial was terminated early after interim analysis for futility, and outcomes assessed in 11 patients (7 perampanel-treated, 4 SOC). Over a median 281 days of post-enrollment follow-up, 27% of patients had seizures, including 14% treated with perampanel and 50% treated with SOC. OS in perampanel-treated patients was similar to a glioblastoma reference cohort (p=0.81). Glutamate concentrations in surface biopsies were positively correlated with HFO rates in adjacent electrode contacts and were not significantly associated with treatment assignment or drug concentrations. Conclusions A peri-operative loading regimen of perampanel was safe and well-tolerated, with similar peritumoral hyperexcitability as in levetiracetam-treated patients. Maintenance anti-glutamatergic therapy was not observed to impact survival outcomes.
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4
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Mooney MA, Hermosillo RJM, Feczko E, Miranda-Dominguez O, Moore LA, Perrone A, Byington N, Grimsrud G, Rueter A, Nousen E, Antovich D, Feldstein Ewing SW, Nagel BJ, Nigg JT, Fair DA. Cumulative Effects of Resting-State Connectivity Across All Brain Networks Significantly Correlate with Attention-Deficit Hyperactivity Disorder Symptoms. J Neurosci 2024; 44:e1202232023. [PMID: 38286629 PMCID: PMC10919250 DOI: 10.1523/jneurosci.1202-23.2023] [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: 04/19/2023] [Revised: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 01/31/2024] Open
Abstract
Identification of replicable neuroimaging correlates of attention-deficit hyperactivity disorder (ADHD) has been hindered by small sample sizes, small effects, and heterogeneity of methods. Given evidence that ADHD is associated with alterations in widely distributed brain networks and the small effects of individual brain features, a whole-brain perspective focusing on cumulative effects is warranted. The use of large, multisite samples is crucial for improving reproducibility and clinical utility of brain-wide MRI association studies. To address this, a polyneuro risk score (PNRS) representing cumulative, brain-wide, ADHD-associated resting-state functional connectivity was constructed and validated using data from the Adolescent Brain Cognitive Development (ABCD, N = 5,543, 51.5% female) study, and was further tested in the independent Oregon-ADHD-1000 case-control cohort (N = 553, 37.4% female). The ADHD PNRS was significantly associated with ADHD symptoms in both cohorts after accounting for relevant covariates (p < 0.001). The most predictive PNRS involved all brain networks, though the strongest effects were concentrated among the default mode and cingulo-opercular networks. In the longitudinal Oregon-ADHD-1000, non-ADHD youth had significantly lower PNRS (Cohen's d = -0.318, robust p = 5.5 × 10-4) than those with persistent ADHD (age 7-19). The PNRS, however, did not mediate polygenic risk for ADHD. Brain-wide connectivity was robustly associated with ADHD symptoms in two independent cohorts, providing further evidence of widespread dysconnectivity in ADHD. Evaluation in enriched samples demonstrates the promise of the PNRS approach for improving reproducibility in neuroimaging studies and unraveling the complex relationships between brain connectivity and behavioral disorders.
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Affiliation(s)
- Michael A Mooney
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon 97239
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon 97239
- Center for Mental Health Innovation, Oregon Health & Science University, Portland, Oregon 97239
| | - Robert J M Hermosillo
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55454
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, Minnesota 55414
| | - Eric Feczko
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55454
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, Minnesota 55414
| | - Oscar Miranda-Dominguez
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55454
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, Minnesota 55414
- Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, Minnesota 55455
| | - Lucille A Moore
- Department of Neurology, Oregon Health & Science University, Portland, Oregon 97239
| | - Anders Perrone
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, Minnesota 55414
| | - Nora Byington
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, Minnesota 55414
| | - Gracie Grimsrud
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, Minnesota 55414
| | - Amanda Rueter
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, Minnesota 55414
| | - Elizabeth Nousen
- Center for Mental Health Innovation, Oregon Health & Science University, Portland, Oregon 97239
- Division of Psychology, Department of Psychiatry, Oregon Health & Science University, Portland, Oregon 97239
| | - Dylan Antovich
- Division of Psychology, Department of Psychiatry, Oregon Health & Science University, Portland, Oregon 97239
| | | | - Bonnie J Nagel
- Center for Mental Health Innovation, Oregon Health & Science University, Portland, Oregon 97239
- Division of Psychology, Department of Psychiatry, Oregon Health & Science University, Portland, Oregon 97239
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon 97239
| | - Joel T Nigg
- Center for Mental Health Innovation, Oregon Health & Science University, Portland, Oregon 97239
- Division of Psychology, Department of Psychiatry, Oregon Health & Science University, Portland, Oregon 97239
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon 97239
| | - Damien A Fair
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55454
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, Minnesota 55414
- Institute of Child Development, College of Education and Human Development, University of Minnesota, Minneapolis, Minnesota 55455
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5
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Chen JA, Mooney MA, Rachlin JR. Landmine Injury Resulting in Comminuted Lumbar Facet Fracture as a Cause of Lumbar Stenosis and Spondylolisthesis. Mil Med 2024; 189:e902-e906. [PMID: 37675860 DOI: 10.1093/milmed/usad358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023] Open
Abstract
Lumbar facet fractures are rarely reported and have been linked to sports and spine surgery. We describe the case of a 77-year-old patient who sustained an injury from multiple landmine blasts during the Vietnam War. He had low back pain since that time, which was initially managed conservatively. However, the pain progressed over decades to severe neurogenic claudication that greatly restricted his quality of life. Neuroimaging revealed the presence of bone fragments impinging on the spinal canal at the L5/6 level (transitional anatomy) that resulted from a comminuted fracture of the lumbar facet at the inferior articular process. We performed an L5/6 decompressive laminectomy, with removal of these fragments, and posterior instrumented fusion, with substantial improvement in symptoms. This case illustrates a unique mechanism of lumbar facet fracture and the biomechanic origination, natural history, and optimal treatment of this entity. We expand on the spectrum of lumbosacral injuries associated with the combat blast injury that have only increased in prevalence in recent conflicts.
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Affiliation(s)
- Jason A Chen
- Department of Neurosurgery, Veterans Affairs Boston Healthcare System, West Roxbury, MA 02132, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Michael A Mooney
- Department of Neurosurgery, Veterans Affairs Boston Healthcare System, West Roxbury, MA 02132, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jacob R Rachlin
- Department of Neurosurgery, Veterans Affairs Boston Healthcare System, West Roxbury, MA 02132, USA
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6
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Bihn JR, Cioffi G, Waite KA, Kruchko C, Neff C, Price M, Ostrom QT, Swinnerton KN, Elbers DC, Mooney MA, Rachlin J, Stein TD, Brophy MT, Do NV, Ferguson RE, Priemer DS, Perl DP, Hickman RA, Nabors B, Rusiecki J, Barnholtz-Sloan JS, Fillmore NR. Brain tumors in United States military veterans. Neuro Oncol 2024; 26:387-396. [PMID: 37738677 PMCID: PMC10836768 DOI: 10.1093/neuonc/noad182] [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: 06/15/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Comprehensive analysis of brain tumor incidence and survival in the Veteran population has been lacking. METHODS Veteran data were obtained from the Veterans Health Administration (VHA) Medical Centers via VHA Corporate Data Warehouse. Brain tumor statistics on the overall US population were generated from the Central Brain Tumor Registry of the US data. Cases were individuals (≥18 years) with a primary brain tumor, diagnosed between 2004 and 2018. The average annual age-adjusted incidence rates (AAIR) and 95% confidence intervals were estimated per 100 000 population and Kaplan-Meier survival curves evaluated overall survival outcomes among Veterans. RESULTS The Veteran population was primarily white (78%), male (93%), and between 60 and 64 years old (18%). Individuals with a primary brain tumor in the general US population were mainly female (59%) and between 18 and 49 years old (28%). The overall AAIR of primary brain tumors from 2004 to 2018 within the Veterans Affairs cancer registry was 11.6. Nonmalignant tumors were more common than malignant tumors (AAIR:7.19 vs 4.42). The most diagnosed tumors in Veterans were nonmalignant pituitary tumors (AAIR:2.96), nonmalignant meningioma (AAIR:2.62), and glioblastoma (AAIR:1.96). In the Veteran population, survival outcomes became worse with age and were lowest among individuals diagnosed with glioblastoma. CONCLUSIONS Differences between Veteran and US populations can be broadly attributed to demographic composition differences of these groups. Prior to this, there have been no reports on national-level incidence rates and survival outcomes for Veterans. These data provide vital information that can drive efforts to understand disease burden and improve outcomes for individuals with primary brain tumors.
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Affiliation(s)
- John R Bihn
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Gino Cioffi
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Kristin A Waite
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Corey Neff
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mackenzie Price
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Danne C Elbers
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Michael A Mooney
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob Rachlin
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Thor D Stein
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University, Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Mary T Brophy
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University, Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Nhan V Do
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University, Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Ryan E Ferguson
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University, Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - David S Priemer
- Department of Pathology, Uniformed Services University School of Medicine, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for The Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Daniel P Perl
- Department of Pathology, Uniformed Services University School of Medicine, Bethesda, Maryland, USA
| | - Richard A Hickman
- Henry M. Jackson Foundation for The Advancement of Military Medicine, Bethesda, Maryland, USA
- Human Oncology and Pathogenesis Program, Sloan Kettering Institute, New York, New York, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Burt Nabors
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer Rusiecki
- Department of Preventive Medicine and Biostatistics, Uniformed Services University School of Medicine, Bethesda, Maryland, USA
| | - Jill S Barnholtz-Sloan
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, Maryland, USA
| | - Nathanael R Fillmore
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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7
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Vaz N, Dietsche E, Mooney MA, Choudhury AD, Jacene HA. Late Subacute Cerebral Hematoma Mimicking a Metastasis on PSMA PET/CT. Clin Nucl Med 2024; 49:e70-e72. [PMID: 38108822 DOI: 10.1097/rlu.0000000000005011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
ABSTRACT A 64-year-old man with history of prostate cancer was found to have rising prostate-specific antigen after radical prostatectomy. 18 F-DCFPyL PET/CT demonstrated a prostate-specific membrane antigen-avid brain lesion in the left frontal lobe and no other findings to account for rising prostate-specific antigen. Brain MRI demonstrated a small intraparenchymal hematoma with late subacute features in this location. The patient reported a seizure 3 weeks before but was otherwise asymptomatic, and neurologic examination was normal. Follow-up MRI demonstrated gradual decrease in size of the hematoma without treatment.
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Yoon JS, Ng PR, Hoffman SE, Gupta S, Mooney MA. Price Transparency for Cervical Spinal Fusion Among High-Performing Spine Centers in the United States. Neurosurgery 2023:00006123-990000000-00966. [PMID: 37982614 DOI: 10.1227/neu.0000000000002770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/06/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES As of January 1, 2021, all US hospitals are required by the Hospital Price Transparency Final Rule (HPTFR) to publish standard charges for all items and services, yet the state of price transparency for cervical spinal fusion is unknown. Here, we assess the nationwide price transparency landscape for cervical spinal fusion among high-performing spine centers in the United States. METHODS In this cross-sectional economic evaluation, we queried publicly available price transparency websites of 332 "high-performing" spine centers, as defined by the US News and World Report. We extracted variables including gross charges for cervical spinal fusion, payor options, price reporting methodology, and prices relevant to consumers including listed cash prices and minimum and maximum negotiated charges. RESULTS While nearly all 332 high-performing spine surgery centers (99.4%) had an online cost estimation tool, the HPTFR compliance rate was only 8.4%. Gross charges for cervical spinal fusion were accessible for 68.1% of hospitals, discounted cash prices for 46.4% of hospitals, and minimum and maximum charges for 10.8% of hospitals. There were large IQRs for gross charges ($48 491.98-$99 293.37), discounted cash prices ($26 952.25-$66 806.63), minimum charges ($10 766.11-$21 248.36), and maximum charges ($39 280.49-$89 035.35). There was geographic variability in the gross charges of cervical spinal fusion among high-performing spine centers within and between states. There was a significant association between "excellent" discharge to home status and lower mean gross charges. CONCLUSION Although online cost reporting has drastically increased since implementation of the HPTFR, data reported for cervical spinal fusion remain inadequate and difficult to interpret by both providers and patients.
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Affiliation(s)
- James S Yoon
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Patrick R Ng
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Samantha E Hoffman
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Saksham Gupta
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Michael A Mooney
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Yearley AG, Patel RV, Mooney MA. In Reply: Integration of Veterans Affairs Medical Centers into Neurosurgical Residency Programs. Neurosurgery 2023; 92:e137. [PMID: 36995089 DOI: 10.1227/neu.0000000000002471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 03/31/2023] Open
Affiliation(s)
| | | | - Michael A Mooney
- Harvard Medical School, Boston , Massachusetts , USA
- Department of Neurosurgery , VA Boston Healthcare System , Boston,Massachusetts,USA
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10
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Mooney MA, Ryabinin P, Morton H, Selah K, Gonoud R, Kozlowski M, Nousen E, Tipsord J, Antovich D, Schwartz J, Herting MM, Faraone SV, Nigg JT. Joint polygenic and environmental risks for childhood attention-deficit/hyperactivity disorder (ADHD) and ADHD symptom dimensions. JCPP Adv 2023; 3:e12152. [PMID: 37753156 PMCID: PMC10519744 DOI: 10.1002/jcv2.12152] [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: 09/14/2022] [Accepted: 02/10/2023] [Indexed: 03/18/2023] Open
Abstract
Background attention-deficit/hyperactivity disorder (ADHD) is associated with both polygenic liability and environmental exposures, both intrinsic to the family, such as family conflict, and extrinsic, such as air pollution. However, much less is known about the interplay between environmental and genetic risks relevant to ADHD-a better understanding of which could inform both mechanistic models and clinical prediction algorithms. Methods Two independent data sets, the population-based Adolescent Brain Cognitive Development Study (ABCD) (N = 11,876) and the case-control Oregon-ADHD-1000 (N = 1449), were used to examine additive (G + E) and interactive (GxE) effects of selected polygenic risk scores (PRS) and environmental factors in a cross-sectional design. Genetic risk was measured using PRS for nine mental health disorders/traits. Exposures included family income, family conflict/negative sentiment, and geocoded measures of area deprivation, lead exposure risk, and air pollution exposure (nitrogen dioxide and fine particulate matter). Results ADHD PRS and family conflict jointly predicted concurrent ADHD symptoms in both cohorts. Additive-effects models, including both genetic and environmental factors, explained significantly more variation in symptoms than any individual factor alone (joint R 2 = .091 for total symptoms in ABCD; joint R 2 = .173 in Oregon-ADHD-1000; all delta-R 2 p-values <2e-7). Significant effect size heterogeneity across ancestry groups was observed for genetic and environmental factors (e.g., Q = 9.01, p = .011 for major depressive disorder PRS; Q = 13.34, p = .001 for area deprivation). GxE interactions observed in the full ABCD cohort suggested stronger environmental effects when genetic risk is low, though they did not replicate. Conclusions Reproducible additive effects of PRS and family environment on ADHD symptoms were found, but GxE interaction effects were not replicated and appeared confounded by ancestry. Results highlight the potential value of combining exposures and PRS in clinical prediction algorithms. The observed differences in risks across ancestry groups warrant further study to avoid health care disparities.
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Affiliation(s)
- Michael A. Mooney
- Division of Bioinformatics and Computational BiologyDepartment of Medical Informatics and Clinical EpidemiologyOregon Health & Science UniversityPortlandOregonUSA
- Knight Cancer InstituteOregon Health & Science UniversityPortlandOregonUSA
| | - Peter Ryabinin
- Knight Cancer InstituteOregon Health & Science UniversityPortlandOregonUSA
| | - Hannah Morton
- Department of PsychiatryCenter for ADHD ResearchOregon Health & Science UniversityPortlandOregonUSA
| | - Katharine Selah
- Department of PsychiatryCenter for ADHD ResearchOregon Health & Science UniversityPortlandOregonUSA
| | - Rose Gonoud
- Department of PsychiatryCenter for ADHD ResearchOregon Health & Science UniversityPortlandOregonUSA
| | - Michael Kozlowski
- Department of PsychiatryCenter for ADHD ResearchOregon Health & Science UniversityPortlandOregonUSA
| | - Elizabeth Nousen
- Department of PsychiatryCenter for ADHD ResearchOregon Health & Science UniversityPortlandOregonUSA
| | - Jessica Tipsord
- Department of PsychiatryCenter for ADHD ResearchOregon Health & Science UniversityPortlandOregonUSA
| | - Dylan Antovich
- Department of PsychiatryCenter for ADHD ResearchOregon Health & Science UniversityPortlandOregonUSA
| | - Joel Schwartz
- Department of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Megan M. Herting
- Department of Population and Public Health SciencesKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of PediatricsChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Stephen V. Faraone
- Department of PsychiatrySUNY Upstate Medical UniversitySyracuseNew YorkUSA
| | - Joel T. Nigg
- Department of PsychiatryCenter for ADHD ResearchOregon Health & Science UniversityPortlandOregonUSA
- Department of Behavioral NeuroscienceOregon Health & Science UniversityPortlandOregonUSA
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11
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Yearley AG, Patel RV, Rachlin JR, Gupta S, King JT, Cosgrove GR, Mooney MA. Integration of Veterans Affairs Medical Centers Into Neurosurgical Residency Programs. Neurosurgery 2023; 92:e120-e125. [PMID: 36728276 DOI: 10.1227/neu.0000000000002362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/14/2022] [Indexed: 02/03/2023] Open
Abstract
Veterans Affairs (VA) medical centers serve as a unique training environment for US residency programs. In this study, we aim to explore the scope and details of VA integration into neurosurgery resident training. We used data from the Accreditation Council for Graduate Medical Education database to provide an overview of neurosurgery training programs with an active VA affiliation and developed a multi-institutional survey to gather information related to rotation design, operative volume, expectations, and core training values. Of the 116 neurosurgery residency programs, 40 have an active affiliation with a VA medical center (34%). Residents most frequently rotated at the VA during their third postgraduate year, with an average rotation length of 7.5 months (range 2-21). Nearly all programs reported a weekly mix of clinic and operative days (96%), with residents longitudinally following patients throughout their rotations. Attending neurosurgeons from VA-affiliated programs reported operative experience (100%), independent decision-making (89%), and continuity of care (81%) as core values of VA neurosurgery rotations. Surgical volume varied between programs with an average of 13.4 ± 6.4 (SD) cases per month per rotating resident. A significant portion of neurosurgery residency programs in the United States incorporate VA rotations into resident training. Although rotation details vary from program-to-program, shared values include a strong operative experience, independent decision-making, and continuity of care. This analysis provides a comprehensive assessment of VA rotation structure across the country, which is valuable for programs considering implementing a VA rotation into their training program or modifying an existing rotation.
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Affiliation(s)
- Alexander G Yearley
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ruchit V Patel
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob R Rachlin
- Department of Neurosurgery, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Saksham Gupta
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph T King
- Department of Neurosurgery, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael A Mooney
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurosurgery, VA Boston Healthcare System, Boston, Massachusetts, USA
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12
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de la Paz L, Mooney MA, Ryabinin P, Neighbor C, Antovich D, Nigg JT, Nikolas MA. Youth Polygenic Scores, Youth ADHD Symptoms, and Parenting Dimensions: An Evocative Gene-Environment Correlation Study. Res Child Adolesc Psychopathol 2023; 51:665-677. [PMID: 36645612 PMCID: PMC10560546 DOI: 10.1007/s10802-023-01024-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Accepted: 01/05/2023] [Indexed: 01/17/2023]
Abstract
Parenting practices and parental symptoms of attention-deficit/hyperactivity disorder (ADHD) have been linked to severity and course of youth ADHD. However, genetically influenced behaviors related to ADHD in youth may also influence parenting behaviors. Polygenic scores (PGS) have been widely used to quantify genetic vulnerability for ADHD but has rarely been used to examine gene-environment correlation effects. The current study examined the direct effects of youth ADHD PGS and its evocative effects on parenting behaviors via youth ADHD symptoms. 803 youth aged 6-18 years (58.5% male) completed a multistage, multi-informant assessment that included measures of parenting practices and youth and parental ADHD symptoms. A mediation model was used to evaluate direct and evocative effects. Furthermore, we examined if these evocative effects remain after controlling for parental ADHD symptoms. Sensitivity analyses across age, sex, and socioeconomic status (SES) as well as restricting ancestry groups to European only ancestry were also conducted. Results indicated that youth ADHD PGS reliably predicted youth ADHD symptoms across all models (βs ranging from 0.18 to 0.26), including across age, sex, and SES and held even with ancestry restricted to the largest group (northern European). Evocative effects emerged such that higher youth PGS significantly predicted more youth ADHD symptoms, which in turn, significantly predicted lower levels of parental involvement and higher levels of poor supervision/monitoring and inconsistent discipline. These effects remained after controlling for parent ADHD symptoms.
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Affiliation(s)
- Leiana de la Paz
- Department of Psychological and Brain Sciences, G60 Psychological and Brain Sciences Bldg., 340 Iowa Ave, Iowa City, IA, 52242, USA.
| | - Michael A Mooney
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Peter Ryabinin
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | | | - Dylan Antovich
- Division of Psychology, Department of Psychiatry, Portland, OR, USA
| | - Joel T Nigg
- Division of Psychology, Department of Psychiatry, Portland, OR, USA
| | - Molly A Nikolas
- Department of Psychological and Brain Sciences, G60 Psychological and Brain Sciences Bldg., 340 Iowa Ave, Iowa City, IA, 52242, USA
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13
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Dash GF, Karalunas SL, Kenyon EA, Carter EK, Mooney MA, Nigg JT, Feldstein Ewing SW. Gene-by-Environment Interaction Effects of Social Adversity on Externalizing Behavior in ABCD Youth. Behav Genet 2023; 53:219-231. [PMID: 36795263 PMCID: PMC9933005 DOI: 10.1007/s10519-023-10136-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/01/2023] [Indexed: 02/17/2023]
Abstract
This study tested whether multiple domains of social adversity, including neighborhood opportunity/deprivation and life stress, moderate genetic (A), common environmental (C), and unique environmental (E) influences on externalizing behaviors in 760 same-sex twin pairs (332 monozygotic; 428 dizygotic) ages 10-11 from the ABCD Study. Proportion of C influences on externalizing behavior increased at higher neighborhood adversity (lower overall opportunity). A decreased and C and E increased at lower levels of educational opportunity. A increased at lower health-environment and social-economic opportunity levels. For life stress, A decreased and E increased with number of experienced events. Results for educational opportunity and stressful life experiences suggest a bioecological gene-environment interaction pattern such that environmental influences predominate at higher levels of adversity, whereas limited access to healthcare, housing, and employment stability may potentiate genetic liability for externalizing behavior via a diathesis-stress mechanism. More detailed operationalization of social adversity in gene-environment interaction studies is needed.
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Affiliation(s)
- Genevieve F Dash
- Department of Psychological Sciences, University of Missouri, 210 McAlester Hall, 320 S. 6th St. Columbia, 65211, Columbia, MO, USA.
| | - Sarah L Karalunas
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| | - Emily A Kenyon
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Emily K Carter
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Michael A Mooney
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Joel T Nigg
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Sarah W Feldstein Ewing
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
- MPI ABCD - Oregon Health & Science University (OHSU) Site, Portland, USA
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14
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Byington N, Grimsrud G, Mooney MA, Cordova M, Doyle O, Hermosillo RJM, Earl E, Houghton A, Conan G, Hendrickson TJ, Ragothaman A, Carrasco CM, Rueter A, Perrone A, Moore LA, Graham A, Nigg JT, Thompson WK, Nelson SM, Feczko E, Fair DA, Miranda-Dominguez O. Polyneuro risk scores capture widely distributed connectivity patterns of cognition. Dev Cogn Neurosci 2023; 60:101231. [PMID: 36934605 PMCID: PMC10031023 DOI: 10.1016/j.dcn.2023.101231] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/02/2022] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Resting-state functional connectivity (RSFC) is a powerful tool for characterizing brain changes, but it has yet to reliably predict higher-order cognition. This may be attributed to small effect sizes of such brain-behavior relationships, which can lead to underpowered, variable results when utilizing typical sample sizes (N∼25). Inspired by techniques in genomics, we implement the polyneuro risk score (PNRS) framework - the application of multivariate techniques to RSFC data and validation in an independent sample. Utilizing the Adolescent Brain Cognitive Development® cohort split into two datasets, we explore the framework's ability to reliably capture brain-behavior relationships across 3 cognitive scores - general ability, executive function, learning & memory. The weight and significance of each connection is assessed in the first dataset, and a PNRS is calculated for each participant in the second. Results support the PNRS framework as a suitable methodology to inspect the distribution of connections contributing towards behavior, with explained variance ranging from 1.0 % to 21.4 %. For the outcomes assessed, the framework reveals globally distributed, rather than localized, patterns of predictive connections. Larger samples are likely necessary to systematically identify the specific connections contributing towards complex outcomes. The PNRS framework could be applied translationally to identify neurologically distinct subtypes of neurodevelopmental disorders.
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Affiliation(s)
- Nora Byington
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, United States; Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN 55414, United States.
| | - Gracie Grimsrud
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, United States; Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN 55414, United States
| | - Michael A Mooney
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR 97239, United States; Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, United States
| | - Michaela Cordova
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, CA 92120, United States
| | - Olivia Doyle
- Department of Psychiatry, Oregon Health & Science University, Portland, OR 97239, United States
| | - Robert J M Hermosillo
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, United States; Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN 55414, United States
| | - Eric Earl
- Data Science and Sharing Team, National Institute of Mental Health, Bethesda, MD 20892, United States
| | - Audrey Houghton
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, United States; Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN 55414, United States
| | - Gregory Conan
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, United States; Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN 55414, United States
| | - Timothy J Hendrickson
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, United States; Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN 55414, United States
| | | | - Cristian Morales Carrasco
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, United States; Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN 55414, United States
| | - Amanda Rueter
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, United States; Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN 55414, United States
| | - Anders Perrone
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, United States; Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN 55414, United States
| | - Lucille A Moore
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, United States; Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN 55414, United States
| | - Alice Graham
- Department of Psychiatry, Oregon Health & Science University, Portland, OR 97239, United States
| | - Joel T Nigg
- Department of Psychiatry, Oregon Health & Science University, Portland, OR 97239, United States; Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, United States
| | - Wesley K Thompson
- Center for Population Neuroscience and Genetics, Laureate Institute for Brain Research, Tulsa, OK 74136, United States
| | - Steven M Nelson
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, United States; Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN 55414, United States; Department of Pediatrics, University of Minnesota, Minneapolis, MN 55414, United States
| | - Eric Feczko
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, United States; Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN 55414, United States; Department of Pediatrics, University of Minnesota, Minneapolis, MN 55414, United States
| | - Damien A Fair
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, United States; Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN 55414, United States; Department of Pediatrics, University of Minnesota, Minneapolis, MN 55414, United States; Institute of Child Development, University of Minnesota, Minneapolis, MN 55414, United States
| | - Oscar Miranda-Dominguez
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, United States; Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN 55414, United States; Department of Pediatrics, University of Minnesota, Minneapolis, MN 55414, United States
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15
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Nigg JT, Karalunas SL, Mooney MA, Wilmot B, Nikolas MA, Martel MM, Tipsord J, Nousen EK, Schmitt C, Ryabinin P, Musser ED, Nagel BJ, Fair DA. The Oregon ADHD-1000: A new longitudinal data resource enriched for clinical cases and multiple levels of analysis. Dev Cogn Neurosci 2023; 60:101222. [PMID: 36848718 PMCID: PMC9984785 DOI: 10.1016/j.dcn.2023.101222] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/31/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023] Open
Abstract
The fields of developmental psychopathology, developmental neuroscience, and behavioral genetics are increasingly moving toward a data sharing model to improve reproducibility, robustness, and generalizability of findings. This approach is particularly critical for understanding attention-deficit/hyperactivity disorder (ADHD), which has unique public health importance given its early onset, high prevalence, individual variability, and causal association with co-occurring and later developing problems. A further priority concerns multi-disciplinary/multi-method datasets that can span different units of analysis. Here, we describe a public dataset using a case-control design for ADHD that includes: multi-method, multi-measure, multi-informant, multi-trait data, and multi-clinician evaluation and phenotyping. It spans > 12 years of annual follow-up with a lag longitudinal design allowing age-based analyses spanning age 7-19 + years with a full age range from 7 to 21. Measures span genetic and epigenetic (DNA methylation) array data; EEG, functional and structural MRI neuroimaging; and psychophysiological, psychosocial, clinical and functional outcomes data. The resource also benefits from an autism spectrum disorder add-on cohort and a cross sectional case-control ADHD cohort from a different geographical region for replication and generalizability. Datasets allowing for integration from genes to nervous system to behavior represent the "next generation" of researchable cohorts for ADHD and developmental psychopathology.
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Affiliation(s)
- Joel T Nigg
- Department of Psychiatry & Behavioral Neuroscience, Oregon Health & Science University, USA.
| | | | - Michael A Mooney
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, USA
| | - Beth Wilmot
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, USA
| | - Molly A Nikolas
- Department of Psychological and Brain Sciences, University of Iowa, USA
| | | | - Jessica Tipsord
- Department of Psychiatry & Behavioral Neuroscience, Oregon Health & Science University, USA
| | - Elizabeth K Nousen
- Department of Psychiatry & Behavioral Neuroscience, Oregon Health & Science University, USA
| | - Colleen Schmitt
- Department of Psychiatry & Behavioral Neuroscience, Oregon Health & Science University, USA
| | - Peter Ryabinin
- Knight Cancer Institute, Oregon Health & Science University, USA
| | - Erica D Musser
- Department of Psychology, Florida International University, USA
| | - Bonnie J Nagel
- Department of Psychiatry & Behavioral Neuroscience, Oregon Health & Science University, USA
| | - Damien A Fair
- Department of Pediatrics, Masonic Institute for the Developing Brain, Institute of Child Development, College of Education and Human Development, University of Minnesota, USA.
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16
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Abo KM, Kane J, Druckenbrod RC, Mooney MA, Rachlin J. Intraoperative hypovolemia as a possible precipitating factor for pituitary apoplexy: a case report. J Med Case Rep 2023; 17:53. [PMID: 36759850 PMCID: PMC9912690 DOI: 10.1186/s13256-022-03738-4] [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: 06/20/2022] [Accepted: 12/23/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Pituitary apoplexy is acute infarction with or without hemorrhage of the pituitary gland. It is a rare but potentially life-threatening emergency that most commonly occurs in the setting of pituitary adenoma. The mechanisms underlying pituitary apoplexy are not well understood, but are proposed to include factors of both hemodynamic supply and adenoma demand. In the case of patients with known pituitary macroadenomas undergoing major surgery for other indications, there is a theoretically increased risk of apoplexy in the setting of "surgical stress." However, risk stratification of patients with nonfunctioning pituitary adenomas prior to major surgery is challenging because the precipitating factors for pituitary apoplexy are not completely understood. Here we present a case in which intraoperative hypovolemia is a possible mechanistic precipitating factor for pituitary apoplexy. CASE PRESENTATION A 76-year-old patient with a known hypofunctioning pituitary macroadenoma underwent nephrectomy for renal cell carcinoma, during which there was significant intraoperative blood loss. He became symptomatic with ophthalmoplegia on the second postoperative day, and was diagnosed with pituitary apoplexy. He was managed conservatively with cortisol replacement therapy, and underwent therapeutic anticoagulation 2 months after pituitary apoplexy for deep vein thrombosis. His ophthalmoplegia slowly resolved over months of follow-up. Pituitary apoplexy did not recur with therapeutic anticoagulation. CONCLUSIONS When considering the risk of surgery in patients with a known pituitary macroadenoma, an operation with possible high-volume intraoperative blood loss may have increased risk of pituitary apoplexy because intraoperative hypovolemia may precipitate ischemia, infarction, and subsequent hemorrhage. This may be particularly relevant in the cases of elective surgery. Additionally, we found that we were able to therapeutically anticoagulate a patient 2 months after pituitary apoplexy for the management of deep vein thrombosis without recurrence of pituitary apoplexy.
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Affiliation(s)
- Kristine M. Abo
- grid.189504.10000 0004 1936 7558Boston University School of Medicine, Boston, MA USA
| | - Joseph Kane
- grid.410370.10000 0004 4657 1992Department of Optometry, VA Boston Healthcare System, Jamaica Plain, Boston, MA USA
| | - Rachel C. Druckenbrod
- grid.410370.10000 0004 4657 1992Department of Optometry, VA Boston Healthcare System, Jamaica Plain, Boston, MA USA
| | - Michael A. Mooney
- grid.410370.10000 0004 4657 1992Neurosurgery Division, Department of Surgery, VA Boston Healthcare System, Jamaica Plain, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Jacob Rachlin
- Neurosurgery Division, Department of Surgery, VA Boston Healthcare System, Jamaica Plain, Boston, MA, USA.
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Ng PR, Yearley AG, Mooney MA. In Reply to the Letter to the Editor Regarding "Utility of a Pilot Neurosurgical Operative Skills Boot Camp in Medical Student Training". World Neurosurg 2022; 167:251. [PMID: 36793176 DOI: 10.1016/j.wneu.2022.09.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 10/31/2022]
Affiliation(s)
- Patrick R Ng
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Michael A Mooney
- Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Yearley AG, Ng PR, Gupta S, Cosgrove GR, Mooney MA. Utility of a Pilot Neurosurgical Operative Skills Boot Camp in Medical Student Training. World Neurosurg 2022; 166:e551-e560. [PMID: 35870784 DOI: 10.1016/j.wneu.2022.07.065] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The neurosurgical sub-internship is a crucial step for prospective neurosurgeons. However, the expectations for sub-interns, particularly the technical skills required by residents and attendings, often are unclear. We present survey data on what medical students, residents, and attendings believe are important procedural proficiencies for neurosurgical sub-internships. We incorporated these tasks into a pilot skills-based craniotomy workshop, and here we report on the impact of the session on the neurosurgical training of medical students. METHODS A 1-day craniotomy lab using cadaveric cranial specimens was conducted for medical students. Surveys querying important competencies for sub-internships were answered by residents and attendings at affiliated hospitals. Pre- and postlab surveys querying interest in and perceptions of neurosurgery, self-assessment of skills, and important competencies for sub-internship preparation were answered by attendees. RESULTS Medical students, residents, and attendings agreed that burr-hole placement, bone replating, and galea and skin closure were of high importance for sub-interns. There was significant disagreement on the importance of dural opening and closure, establishing a craniotomy, and neuronavigation. The workshop altered perceptions of neurosurgery, with significant changes in recognizing the value of peer mentorship. Students also expressed increased confidence in technical skills, with significant improvements shown in understanding of neurosurgical high-speed drill use (P < 0.001). CONCLUSIONS Although the expectations for sub-interns may be heterogeneous, there is general agreement that proficiency in the initial and final steps of craniotomies, as well as minor procedures, is recommended. Cadaveric labs can improve student engagement in neurosurgery, facilitate interactions with neurosurgical departments, and enhance technical skills.
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Affiliation(s)
| | - Patrick R Ng
- Harvard Medical School, Boston, Massachusetts, USA
| | - Saksham Gupta
- Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - G Rees Cosgrove
- Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael A Mooney
- Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Cordova MM, Antovich DM, Ryabinin P, Neighbor C, Mooney MA, Dieckmann NF, Miranda-Dominguez O, Nagel BJ, Fair DA, Nigg JT. Attention-Deficit/Hyperactivity Disorder: Restricted Phenotypes Prevalence, Comorbidity, and Polygenic Risk Sensitivity in the ABCD Baseline Cohort. J Am Acad Child Adolesc Psychiatry 2022; 61:1273-1284. [PMID: 35427730 PMCID: PMC9677584 DOI: 10.1016/j.jaac.2022.03.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 08/05/2021] [Revised: 02/15/2022] [Accepted: 03/25/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the prevalence and major comorbidities of ADHD using different operational definitions in a newly available national dataset and to test the utility of operational definitions against genetic and cognitive correlates. METHOD The US Adolescent Brain Cognitive Development (ABCD) Study enrolled 11,878 children aged 9-10 years at baseline. ADHD prevalence, comorbidity, and association with polygenic risk score and laboratory-assessed executive functions were calculated at 4 thresholds of ADHD phenotype restrictiveness. Bias from missingness, sampling, and nesting were addressed statistically. RESULTS Prevalence of current ADHD for 9- to 10-year old children was 3.53% (95% CI 3.14%-3.92%) when Computerized Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-COMP) score and parent and teacher ratings were required to converge. Of ADHD cases so defined, 70% had a comorbid psychiatric disorder. After control for overlapping comorbidity and ruling out for psychosis or low IQ, 30.9% (95% CI 25.7%-36.7%) had a comorbid disruptive behavior disorder, 27.4% (95% CI 22.3%-33.1%) had an anxiety or fear disorder, and 2.1% (95% CI 1.2%-3.8%) had a mood disorder. Children in the top decile of polygenic load incurred a 63% increased chance of having ADHD vs the bottom half of polygenic load (p < .01)-an effect detected only with a stringent phenotype definition. Dimensional latent variables for irritability, externalizing, and ADHD yielded convergent results for cognitive correlates. CONCLUSION This fresh estimate of national prevalence of ADHD in the United States suggests that the DSM-5 definition requiring multiple informants yields a prevalence of about 3.5%. Results may inform further ADHD studies in the ABCD sample.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Joel T Nigg
- Oregon Health & Science University, Portland.
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20
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Almefty KK, Mooney MA, Al-Mefty O, Essayed WI, Bi WL, Cai L, Kadri PA. "Intracranial Facial Schwannomas: multiple distinct entities necessitating tailored management". World Neurosurg 2022; 168:e187-e195. [PMID: 36150600 DOI: 10.1016/j.wneu.2022.09.082] [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: 07/17/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Facial nerve (FN) schwannomas are extremely rare. According to their origin and involved segment(s), they constitute distinct subtypes. Intact FN function presents a management challenge, particularly in the CPA Cisternal subtype that masquerades as a vestibular schwannoma. Fascicular sparing technique with subtotal resection can maintain a good facial nerve function. This study focuses on management to maintain good FN function. METHODS A retrospective analysis of a cohort of thirteen patients harboring FN schwannoma. Patients' demographics, clinical findings, imaging, surgical intervention, and outcomes were analyzed. RESULTS Five women and 8 men, with an average age of 55.3 years (39-75years), harbored 6 Cisternal, 2 Ganglion and 5 Combined tumors. Average tumor size was 28.3 mm (16-50mm). Eleven patients underwent surgery. Seven patients had fascicle sparing technique. Five of whom maintained their preoperative FN function, while 2 patients with near-total removal had a deterioration in FN function. Two patients with pre-operative complete facial paralysis had gross total removal with interposition nerve graft. CONCLUSIONS Facial nerve schwannomas management is individualized according to the subtype and the facial nerve function at presentation. When facial nerve function is normal, observation can be applied for prolonged period of time. At the early sign of deterioration, sub or near total resection with fascicle sparing technique can be performed. The Cisternal subtype masquerade as vestibular schwannoma and should be recognized at the initial exposure by the appearance of finely splayed nerve fascicles at the perimetry of the tumor which elicits a motor response at low threshold stimulation.
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Affiliation(s)
- Kaith K Almefty
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix. Arizona, United States
| | - Michael A Mooney
- Department of Neurosurgery, Brigham and Women`s Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women`s Hospital, Harvard Medical School, Boston, Massachusetts, United States.
| | - Walid Ibn Essayed
- Department of Neurosurgery, Brigham and Women`s Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women`s Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Li Cai
- Arkansas Neurosciences Institute, Little Rock, Arkansas, United States
| | - Paulo As Kadri
- Department of Neurosurgery, Brigham and Women`s Hospital, Harvard Medical School, Boston, Massachusetts, United States; Medical School, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
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21
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Wu KC, Cantalino JM, Dee EC, Hsu L, Harris TC, Rawal B, Juvekar PR, Mooney MA, Dunn IF, Aizer AA, Devlin PM, Bi WL. Salvage brachytherapy for multiply recurrent metastatic brain tumors: a matched-case analysis. Neurooncol Adv 2022; 4:vdac039. [PMID: 35571989 PMCID: PMC9092639 DOI: 10.1093/noajnl/vdac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Patients with recurrent brain metastases who have exhausted external radiation options pose a treatment challenge in the setting of advances in systemic disease control which have improved quality of life and survival. Brachytherapy holds promise as salvage therapy given its ability to enforce surgical cytoreduction and minimize regional toxicity. This study investigates the role of salvage brachytherapy in maintaining local control for recurrent metastatic lesions. Methods We retrospectively reviewed our institution’s experience with brachytherapy in patients with multiply recurrent cerebral metastases who have exhausted external radiation treatment options (14 cases). The primary outcome of the study was freedom from local recurrence (FFLR). To capture the nuances of tumor biology, we compared FFLR achieved by brachytherapy to the preceding treatment for each patient. We further compared the response to brachytherapy in patients with lung cancer (8 cases) against a matched cohort of maximally radiated lung brain metastases (10 cases). Results Brachytherapy treatment conferred significantly longer FFLR compared to prior treatments (median 7.39 vs 5.51 months, P = .011) for multiply recurrent brain metastases. Compared to an independent matched cohort, brachytherapy demonstrated superior FFLR (median 8.49 vs 1.61 months, P = .004) and longer median overall survival (11.07 vs 5.93 months, P = .055), with comparable side effects. Conclusion Brachytherapy used as salvage treatment for select patients with a multiply recurrent oligometastatic brain metastasis in the setting of well-controlled systemic disease holds promise for improving local control in this challenging patient population.
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Affiliation(s)
- Kyle C Wu
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School
| | - Jonathan M Cantalino
- Department of Radiation Oncology, Brigham and Women’s Hospital, Harvard Medical School
| | - Edward C Dee
- Department of Radiation Oncology, Brigham and Women’s Hospital, Harvard Medical School
| | - Liangge Hsu
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School
| | - Thomas C Harris
- Department of Radiation Oncology, Brigham and Women’s Hospital, Harvard Medical School
| | - Bhupendra Rawal
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Harvard Medical School
| | - Parikshit R Juvekar
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School
| | - Michael A Mooney
- Department of Neurosurgery, Barrow Neurologic Institute, Phoenix, Arizona
| | - Ian F Dunn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, University of Oklahoma College of Medicine
| | - Ayal A Aizer
- Department of Radiation Oncology, Brigham and Women’s Hospital, Harvard Medical School
| | - Phillip M Devlin
- Department of Radiation Oncology, Brigham and Women’s Hospital, Harvard Medical School
| | - Wenya Linda Bi
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School
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22
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Tam EK, Laver NV, Thakore-James M, Mooney MA, Daly MK, Lefebvre DR. ARHGEF-10 gene mutation presenting as orbital inflammatory syndrome. BMJ Case Rep 2022; 15:e245475. [PMID: 35260397 PMCID: PMC8905991 DOI: 10.1136/bcr-2021-245475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/03/2022] Open
Abstract
Rho guanine nucleotide exchange factor 10 (ARHGEF-10) is a RHO GTPase that has a role for neural morphogenesis, however its effect on the eyes remains unknown. Here, we report a 44-year-old man who presented with eyelid swelling along with a history of bilateral hand contractures, high-arched feet and muscle wasting, who was found to have an ARHGEF-10 mutation. Neuroimaging was significant for numerous nerve-based cystic abnormalities in the bilateral orbits and throughout the neuraxis, and an orbital biopsy revealed S-100 and SOX-10 positive lesion consistent with pseudocysts. While the role of ARHGEF-10 remains unclear, further research is warranted to further describe its clinical manifestations.
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Affiliation(s)
- Emily K Tam
- Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts, USA
- Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA
| | - Nora V Laver
- Department of Pathology and Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Manisha Thakore-James
- Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Michael A Mooney
- Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurosurgery, Harvard Medical School, Boston, MA, USA
| | - Mary K Daly
- Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts, USA
- Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Daniel R Lefebvre
- Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Mooney MA, Essayed WI, Patel V, Devlin PM, Al-Mefty O. Brachytherapy as Salvage Treatment for Meningioma With Malignant Progression After Exhausting Other Treatment Options: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 22:e215. [DOI: 10.1227/ons.0000000000000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/27/2021] [Indexed: 11/19/2022] Open
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Mooney MA, Aboud E, Essayed WI, Al-Mefty O. “Grade Zero” Removal of a Falcine Meningioma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 22:e158. [DOI: 10.1227/ons.0000000000000093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022] Open
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25
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Martel MM, Elkins AR, Eng AG, Goh PK, Bansal PS, Smith-Thomas TE, Thaxton MH, Ryabinin P, Mooney MA, Gustafsson HC, Karalunas SL, Nigg JT. Longitudinal Temperament Pathways to ADHD Between Childhood and Adolescence. Res Child Adolesc Psychopathol 2022; 50:1055-1066. [PMID: 35102487 PMCID: PMC9680910 DOI: 10.1007/s10802-022-00902-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
The current investigation extended prior cross-sectional mapping of etiological factors, transdiagnostic effortful and affective traits, and ADHD symptoms to longitudinal pathways extending from two etiological domains: polygenic and prenatal risk. Hypotheses were (1) genetic risk for ADHD would be related to inattentive ADHD symptoms in adolescence and mediated by childhood effortful control; (2) prenatal smoking would be related to hyperactive-impulsive ADHD symptoms during childhood and mediated by childhood surgency; and (3) there would be age-related variation, such that mediation of genetic risk would be larger for older than younger ages, whereas mediation of prenatal risk would be larger in earlier childhood than at later ages. Participants were 849 children drawn from the Oregon ADHD-1000 Cohort, which used a case control sample and an accelerated longitudinal design to track development from childhood (at year 1 ages 7-13) through adolescence (at year 6 ages 13-19). Results showed the mediational pathway from prenatal smoking through surgency to hyperactivity-impulsivity at Year 1 was significant (indirect effect estimate = .053, p < .01). The mediational pathway from polygenic risk through effortful control to inattention at Year 6 was also significant (indirect effect estimate = .084, p < .01). Both results were independent of the association between inattention and hyperactivity-impulsivity and control for the alternative etiological input and held across parent- and teacher-report of ADHD symptoms. In line with dual pathway models of ADHD, early prenatal risk for hyperactivity-impulsivity appears to operate through surgency, while polygenic genetic risk for inattention appears mediated by effortful control.
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26
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Yearley AG, Iorgulescu JB, Chiocca EA, Peruzzi PP, Smith TR, Reardon DA, Mooney MA. The current state of glioma data registries. Neurooncol Adv 2022; 4:vdac099. [DOI: 10.1093/noajnl/vdac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The landscape of glioma research has evolved in the past 20 years to include numerous large, multi-institutional, database efforts compiling either clinical data on glioma patients, molecular data on glioma specimens, or a combination of both. While these strategies can provide a wealth of information for glioma research, obtaining information regarding data availability and access specifications can be challenging.
Methods
We reviewed the literature for ongoing clinical, molecular, and combined database efforts related to glioma research to provide researchers with a curated overview of the current state of glioma database resources.
Results
We identified and reviewed a total of 20 databases with data collection spanning from 1975 to 2022. Surveyed databases included both low- and high-grade gliomas, and data elements included over 100 clinical variables and 12 molecular data types. Select database strengths included large sample sizes and a wide variety of variables available, while limitations of some databases included complex data access requirements and a lack of glioma-specific variables.
Conclusions
This review highlights current databases and registries and their potential utility in clinical and genomic glioma research. While many high-quality resources exist, the fluid nature of glioma taxonomy makes it difficult to isolate a large cohort of patients with a pathologically confirmed diagnosis. Large, well-defined, and publicly available glioma datasets have the potential to expand the reach of glioma research and drive the field forward.
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Affiliation(s)
- Alexander G Yearley
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts , USA
| | - Julian Bryan Iorgulescu
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts , USA
- Department of Medical Oncology, Dana-Farber Cancer Institute , Boston, Massachusetts , USA
| | - Ennio Antonio Chiocca
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts , USA
| | - Pier Paolo Peruzzi
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts , USA
| | - Timothy R Smith
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts , USA
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute , Boston, Massachusetts , USA
| | - Michael A Mooney
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts , USA
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Adams HP, Adeoye O, Albers GW, Alexandrov AV, Amin-Hanjani S, An H, Anderson CS, Anrather J, Aparicio HJ, Arai K, Aronowski J, Atchaneeyasakul K, Audebert H, Auer RN, Awad IA, Ay H, Baltan S, Balu R, Behbahani M, Benavente OR, Bershad EM, Berthaud JV, Blackburn SL, Bonati LH, Bösel J, Bousser MG, Broderick JP, Brown MM, Brown W, Brust JC, Bushnell C, Canhão P, Caplan LR, Carrión-Penagos J, Castellanos M, Caunca MR, Chabriat H, Chamorro A, Chen J, Chen J, Chopp M, Christorforids G, Connolly ES, Cramer SC, Cucchiara BL, Czap AL, Dannenbaum MJ, Davis PH, Dawson TM, Dawson VL, Day AL, De Silva TM, de Sousa DA, Del Brutto VJ, del Zoppo GJ, Derdeyn CP, Di Tullio MR, Diener HC, Diringer MN, Dobkin BH, Dzialowski I, Elkind MS, Elm J, Feigin VL, Ferro JM, Field TS, Fischer M, Fornage M, Furie KL, Garcia-Bonilla L, Giannotta SL, Gobin YP, Goldberg MP, Goldstein LB, Gonzales NR, Greer DM, Grotta JC, Guo R, Gutierrez J, Harmel P, Howard G, Howard VJ, Hwang JY, Iadecola C, Jahan R, Jickling GC, Joutel A, Kasner SE, Katan M, Kellner CP, Khan M, Kidwell CS, Kim H, Kim JS, Kircher CE, Krings T, Krishnamurthi RV, Kurth T, Lansberg MG, Levy EI, Liebeskind DS, Liew SL, Lin DJ, Lisle B, Lo EH, Lyden PD, Maki T, Maragkos GA, Marosfoi M, McCullough LD, Meckler JM, Meschia JF, Messé SR, Mocco J, Mokin M, Mooney MA, Morgenstern LB, Moskowitz MA, Mullen MT, Nägel S, Nedergaard M, Neira JA, Newman S, Nicholson PJ, Norrving B, O’Donnell M, Ofengeim D, Ogata J, Ogilvy CS, Orrù E, Ortega-Gutiérrez S, Padrick MM, Parsha K, Parsons M, Patel NV, Patel VI, Pawlikowska L, Pérez A, Perez-Pinzon MA, Picard JM, Polster SP, Powers WJ, Puetz V, Putaala J, Rabinovich M, Ransom BR, Roa JA, Rosenberg GA, Rossitto CP, Rundek T, Russin JJ, Sacco RL, Safouris A, Samaniego EA, Sansing LH, Satani N, Sattenberg RJ, Saver JL, Savitz SI, Schmidt C, Seshadri S, Sharma VK, Sharp FR, Sheth KN, Siddiqi OK, Singhal AB, Sobey CG, Sommer CJ, Spetzler RF, Stapleton CJ, Strickland BA, Su H, Suarez JI, Takayama H, Tarsia J, Tatlisumak T, Thomas AJ, Thompson JW, Tsivgoulis G, Tournier-Lasserve E, Vidal G, Wakhloo AK, Weksler BB, Willey JZ, Wintermark M, Wong LK, Xi G, Xu J, Yaghi S, Yamaguchi T, Yang T, Yasaka M, Zahuranec DB, Zhang F, Zhang JH, Zheng Z, Zukin RS, Zweifler RM. Contributors. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.01002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mooney MA, Al-Mefty O. Syringomyelia From Extramedullary Compression: Resolution After Microsurgical Resection of a High-Cervical Spine Schwannoma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 22:e39. [PMID: 34982911 DOI: 10.1227/ons.0000000000000003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/31/2021] [Indexed: 11/19/2022] Open
Abstract
Syringomyelia with compression at the foramen magnum is a well-studied subject with a pathophysiological hypothesis explaining syrinx development and treatment.1,2 However, compression of the cervical cord, as in cervical spondylosis, can also lead to cavitation in the spinal cord.3,4 Although the association of intramedullary spinal cord tumors with syringomyelia is well known,5 the association of extramedullary tumors with syringomyelia is scarcely reported, and it is of unknown mechanism and uncertain outcomes regarding syrinx resolution. Syringomyelia is reported to be associated with intramedullary spinal schwannoma.6 However, spinal schwannomas are by and large extramedullary tumors that produce deficits through compressive radiculopathy or myelopathy. The association of extramedullary schwannomas with syringomyelia is extremely rare. In this article, we present a patient with an extramedullary high-cervical schwannoma causing significant syringomyelia who underwent microsurgical resection of the schwannoma, with subsequent total resolution of the syringomyelia. The patient consented for surgery. Images from Lancet 1969 at 6:36 in video Reprinted from The Lancet, Vol. 294, Bernard Williams, The Distending Force in the Production of "Communicating Syringomyelia," Pages 189-193, Copyright 1969, with permission from Elsevier.
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Affiliation(s)
- Michael A Mooney
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Mooney MA, Al-Mefty O. Sugita-Kobayashi Maneuver for Preservation of Large Bridging Veins in the Interhemispheric Approach: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 22:e46. [PMID: 34982916 DOI: 10.1227/ons.0000000000000022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/13/2021] [Indexed: 11/19/2022] Open
Abstract
Giants of neurosurgery have made contributions that might at times seem to be minor maneuvers but have a major impact on safe surgery, such as Sugita and Kobayashi's description of the preservation of the bridging sagittal veins.1 The interhemispheric approach is haunted by risk to the bridging veins and resultant venous infarction. At the midsegment, this could produce devastating neurological deficits.2 This is an especially critical factor in falcine meningiomas in which the location of the tumor narrows the options for the surgical corridor, particularly if an additional falcine margin, "Grade Zero" resection, is to be performed.3 Detailed preoperative neuroimaging workup is required to plan the appropriate surgical strategy and minimize risk for venous complications. This may include magnetic resonance or computed tomography venogram, dynamic computed tomography angiography,4 or in some cases formal angiography to assess the relationship with the superior sagittal sinus, the anatomy of parasagittal bridging veins in relation to the lesion, and the patterns of collateral venous drainage. While bridging veins may be displaced, compressed, or obscured by tumor involvement,5 microsurgical technique can facilitate the safe identification and preservation of this crucial anatomy. Bridging veins are separated from the underlying cortex to a distance from the sinus, allowing for improved relaxation of the ipsilateral cortex, without venous compromise.1,6 Herein, we demonstrate a case of a large falcine meningioma with a "Grade Zero" resection, with mobilization of the parasagittal bridging veins to develop the interhemispheric surgical corridor. The patient consented for surgery.
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Affiliation(s)
- Michael A Mooney
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Belykh E, Giovani A, Abramov I, Ngo B, Bardonova L, Zhao X, Loymak T, Mooney MA, Sheehy JP, McBryan S, Tanikawa R, Lawton MT, Preul MC. Novel System of Simulation Models for Aneurysm Clipping Training: Description of Models and Assessment of Face, Content, and Construct Validity. Oper Neurosurg (Hagerstown) 2021; 21:558-569. [PMID: 34662910 DOI: 10.1093/ons/opab357] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/04/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Aneurysm clipping simulation models are needed to provide tactile feedback of biological vessels in a nonhazardous but surgically relevant environment. OBJECTIVE To describe a novel system of simulation models for aneurysm clipping training and assess its validity. METHODS Craniotomy models were fabricated to mimic actual tissues and movement restrictions experienced during actual surgery. Turkey wing vessels were used to create aneurysm models with patient-specific geometry. Three simulation models (middle cerebral artery aneurysm clipping via a pterional approach, anterior cerebral artery aneurysm clipping via an interhemispheric approach, and basilar artery aneurysm clipping via an orbitozygomatic pretemporal approach) were subjected to face, content, and construct validity assessments by experienced neurosurgeons (n = 8) and neurosurgery trainees (n = 8). RESULTS Most participants scored the model as replicating actual aneurysm clipping well and scored the difficulty of clipping as being comparable to that of real surgery, confirming face validity. Most participants responded that the model could improve clip-applier-handling skills when working with patients, which confirms content validity. Experienced neurosurgeons performed significantly better than trainees on all 3 models based on subjective (P = .003) and objective (P < .01) ratings and on time to complete the task (P = .04), which confirms construct validity. Simulations were used to discuss clip application strategies and compare them to prototype clinical cases. CONCLUSION This novel aneurysm clipping model can be used safely outside the wet laboratory; it has high face, content, and construct validity; and it can be an effective training tool for microneurosurgery training during aneurysm surgery courses.
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Affiliation(s)
- Evgenii Belykh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.,Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Andrei Giovani
- Department of Neurosurgery, Emergency Clinical Hospital Bagdasar-Arseni, Bucharest, Romania
| | - Irakliy Abramov
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Brandon Ngo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Liudmila Bardonova
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Xiaochun Zhao
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Thanapong Loymak
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - John P Sheehy
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Sarah McBryan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mark C Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Hoffman C, Siddiqui NY, Fields I, Gregory WT, Simon HM, Mooney MA, Wolfe AJ, Karstens L. Species-Level Resolution of Female Bladder Microbiota from 16S rRNA Amplicon Sequencing. mSystems 2021; 6:e0051821. [PMID: 34519534 PMCID: PMC8547459 DOI: 10.1128/msystems.00518-21] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/18/2021] [Indexed: 01/04/2023] Open
Abstract
The human bladder contains bacteria, even in the absence of infection. Interest in studying these bacteria and their association with bladder conditions is increasing. However, the chosen experimental method can limit the resolution of the taxonomy that can be assigned to the bacteria found in the bladder. 16S rRNA amplicon sequencing is commonly used to identify bacteria in urinary specimens, but it is typically restricted to genus-level identification. Our primary aim here was to determine if accurate species-level identification of bladder bacteria is possible using 16S rRNA amplicon sequencing. We evaluated the ability of different classification schemes, each consisting of combinations of a reference database, a 16S rRNA gene variable region, and a taxonomic classification algorithm to correctly classify bladder bacteria. We show that species-level identification is possible and that the reference database chosen is the most important component, followed by the 16S variable region sequenced. IMPORTANCE Accurate species-level identification from culture-independent techniques is of importance for microbial niches that are less well characterized, such as that of the bladder. 16S rRNA amplicon sequencing, a common culture-independent way to identify bacteria, is often critiqued for lacking species-level resolution. Here, we extensively evaluate classification schemes for species-level bacterial annotation of 16S amplicon data from bladder bacteria. Our results show that the proper choice of taxonomic database and variable region of the 16S rRNA gene sequence makes species level identification possible. We also show that this improvement can be achieved through the more careful application of existing methods and resources. Species-level information may deepen our understanding of associations between bacteria in the bladder and bladder conditions such as lower urinary tract symptoms and urinary tract infections.
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Affiliation(s)
- Carter Hoffman
- Division of Bioinformatics and Computational Biomedicine, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Nazema Y. Siddiqui
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| | - Ian Fields
- Division of Urogynecology, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - W. Thomas Gregory
- Division of Urogynecology, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Michael A. Mooney
- Division of Bioinformatics and Computational Biomedicine, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Alan J. Wolfe
- Department of Microbiology & Immunology, Loyola University Chicago, Maywood, Illinois, USA
| | - Lisa Karstens
- Division of Bioinformatics and Computational Biomedicine, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
- Division of Urogynecology, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
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Srinivasan VM, Catapano JS, Frisoli FA, Mooney MA, Lawton MT. Microsurgical Management of a Marginal Sinus Dural Arteriovenous Fistula: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E447-E448. [PMID: 34423838 DOI: 10.1093/ons/opab287] [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: 03/18/2021] [Accepted: 06/28/2021] [Indexed: 11/14/2022] Open
Abstract
Dural arteriovenous fistulas (DAVFs) are benign but may present with life-threatening hemorrhage or symptoms of venous hypertension (eg, progressive myelopathy).1-3 DAVFs follow well-described anatomic patterns.4 The marginal sinus is located between the layers of the dura, circumferentially around the foramen magnum. It communicates with the basal venous plexus of the clivus anteriorly and the occipital sinus posteriorly.5,6 Arterial supply to the dura in this region that fistulizes into the sinus arises from meningeal branches from the V3 or V4 segments. A man in his early 70s presented with chronic neck pain and new onset of left arm and face paresthesias. He had brisk patellar reflexes bilaterally and a marginal sinus DAVF, with numerous dilated veins around the cisterna magna, causing dorsal cervicomedullary compression. Angiography confirmed the diagnosis of DAVF rather than arteriovenous malformation. Endovascular embolization was considered, but surgery was preferable because of poor transarterial access. The patient underwent left far lateral craniotomy and C1 laminectomy with exposure of the condylar fossa. The dura was carefully elevated laterally, revealing a network of dilated tortuous veins, with multiple points of fistulous connection within the dura emanating in a large venous varix. Indocyanine green videoangiography showed the aberrant flow dynamics. The fistulous point was occluded with aneurysm clips on the venous side, then cauterized and interrupted. The patient was discharged within 3 d of surgery and had full resolution of symptoms at 6 wk. Angiography confirmed complete obliteration of the DAVF. The patient provided written informed consent for treatment. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
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Affiliation(s)
- Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Fabio A Frisoli
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Mooney MA, Ibn Essayed W, Aziz-Sultan MA, Al-Mefty O. Concomitant Embolization and Microsurgical Resection of a Giant, Hypervascular Skull Base Meningioma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E97-E98. [PMID: 33930164 DOI: 10.1093/ons/opab128] [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: 11/19/2020] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Abstract
Some skull base tumors can be extremely hypervascular, incorporating multiple vascular territories and demonstrating arteriovenous shunting. Devascularization is a critical step undertaken early in meningioma surgery, necessary before the debulking that is required in skull base tumors. While devascularization can often be achieved with appropriate approach selection, bony drilling, and microsurgical cautery, preoperative embolization of meningiomas has an invaluable role in selected cases.1,2 Embolization, however, does have added risk, magnified in large tumors by the potential infarction with subsequent edema that can potentially lead to acute deterioration and neurosurgical emergency. Hence, to achieve devascularization of an extremely vascular tumor, embolization and surgical resection should be performed concomitantly, as one operation, in which embolization might be the first stage, or might be performed after the craniotomy flap is raised, if necessary.3 Naturally, this requires the multifaceted neurosurgical expertise of embolization and microsurgical resection, and the facility to perform such. We present a case of a giant, hypervascular, radiation-induced, skull base meningioma with internal and external carotid artery supply in a young patient with deteriorating vision in his only eye. Selective embolization of the internal maxillary, middle meningeal, and middle cerebral artery blood supplies was performed. Microsurgical interruption of the ethmoidal artery blood supply was then performed. This hybrid approach safely and effectively devascularized the tumor and allowed for a complete resection of this high-risk tumor4 while minimizing risk to the ophthalmic artery and optic nerve. The patient was consented for surgery.
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Affiliation(s)
- Michael A Mooney
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Walid Ibn Essayed
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohammad Ali Aziz-Sultan
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Mooney MA, Ibn Essayed W, Al-Mefty O. Simpson Grade I Removal of Tuberculum Sella Meningioma Through the Supraorbital Approach: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E103-E104. [PMID: 33989424 DOI: 10.1093/ons/opab133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/23/2021] [Indexed: 11/14/2022] Open
Abstract
As described by Cushing1 in the chiasmatic syndrome, tuberculum sellae meningiomas induce progressive asymmetrical, incongruous visual loss, which would lead to blindness. The surgical removal of these lesions has been rewarding in regard to visual preservation, or recovery, and has passed the test of time. Optic canal extension, in one or both canals, is a consistent feature of these tumors, and removing the tumor from the optic canals is paramount in the treatment of these lesions.2 Despite the small target volume, radiosurgery is not applicable because of the lack of safe distance from the optic pathways. Tuberculum sella meningioma has been distinguished with good surgical outcomes and low recurrence rates; thus, Simpson grade I removal (tumor, dura, and bone invasion) confers a prospect of cure. Safe and successful resection of tuberculum meningiomas is achieved through the skull base supraorbital approach3 with several critical objectives: (1) visualization of the tumor without brain retraction; (2) 270° opening of the optic canal proximally and distally for safe tumor removal; (3) preservation of the vascular supply to the optic pathways and pituitary; (4) microsurgical dissection under high magnification on a short working distance to the encased carotid and anterior cerebral arteries; (5) complete resection of involved dura and bone at the skull base, particularly laterally; and (6) a robust skull base reconstruction with a vascularized pericranial flap.4 We present the case of a 45-yr-old female with a tuberculum sella meningioma who underwent Simpson grade I removal with an uneventful outcome. The patient consented for surgery. Image at 2:59 reprinted with permission from Al-Mefty O, Operative Atlas of Meningiomas. Vol 1, © LWW, 1998; Image at 9:33 public domain.4.
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Affiliation(s)
- Michael A Mooney
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Walid Ibn Essayed
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Frisoli FA, Catapano JS, Farber SH, Baranoski JF, Singh R, Benet A, Cole TS, Mooney MA, Lawton MT. Thrombectomy and Clip Occlusion of a Giant, Stent-Coiled Basilar Bifurcation Aneurysm: 3-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E117-E118. [PMID: 33929027 DOI: 10.1093/ons/opab108] [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: 08/26/2020] [Accepted: 02/08/2021] [Indexed: 11/12/2022] Open
Abstract
Giant basilar apex aneurysms are associated with significant therapeutic challenges.1-6 Multiple techniques exist to treat giant basilar apex aneurysms, including direct clipping, stent-assisted coil embolization, and proximal occlusion with bypass revascularization.7-9 Hypothermic circulatory arrest was a useful adjunct for surgical repair of these aneurysms but has been abandoned because of associated risks.10,11 Rapid ventricular pacing can achieve similar aneurysm softening with minimal risks and assist in clip occlusion. This case illustrates clip occlusion of a giant, partially thrombosed, previously stent-coiled basilar apex aneurysm in a 15-yr-old boy with progressive cranial neuropathies and sensorimotor impairment. Although a wire was placed preoperatively for ventricular pacing, it was not needed during the procedure. Patient consent was obtained. A right-sided orbitozygomatic craniotomy transcavernous approach with anterior and posterior clinoidectomies was performed. The basilar quadrification was dissected, and proximal control was obtained. After aneurysm trapping, the aneurysm was incised and thrombectomized using an ultrasonic aspirator. Back-bleeding from the aneurysm was anticipated, and ventricular pacing was ready, but back-bleeding was minimal. With the coil mass left in place, stacked, fenestrated clips were applied in a tandem fashion to occlude the aneurysm neck. Indocyanine green videoangiography confirmed occlusion of the aneurysm and patency of parent and branch arteries. The patient was at a neurological baseline after the operation, with improvement in motor skills and cognition at 3-mo follow-up. This case demonstrates the use of trans-sylvian-transcavernous exposure, rapid ventricular pacing, and thrombectomy amid previous coils and stents to clip a giant, thrombotic basilar apex aneurysm. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
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Affiliation(s)
- Fabio A Frisoli
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - S Harrison Farber
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jacob F Baranoski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Rohin Singh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Arnau Benet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Tyler S Cole
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Mooney MA, Ibn Essayed W, Al-Mefty O. Nuances of Olfactory Groove Meningioma Surgery: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E338-E339. [PMID: 34195839 DOI: 10.1093/ons/opab233] [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: 02/22/2021] [Accepted: 05/03/2021] [Indexed: 11/14/2022] Open
Abstract
Olfactory groove meningiomas frequently present as large or giant-size tumors associated with marked frontal lobe edema and significant frontal lobe dysfunction. Simpson grade I removal was rare in early reports due to their invasion of the ethmoid sinuses and skull base bone,1 which resulted in high recurrence rates.2,3 Indeed, recurrence occurred in the most celebrated case of olfactory groove meningioma.4,5 To achieve Simpson grade I removal (tumor, dura, bone), protect the frontal lobes from additional injury, and provide the best chance for recovery, we demonstrate a few nuances for olfactory groove meningioma surgery: Utilizing a skull base approach with a low dural opening, the frontal veins are preserved, and the frontal lobe is protected from retraction, manipulation, and venous injury. By the time of diagnosis, although the patient's olfaction is often absent, there still remains a role to preserve at least 1 olfactory tract, which might yield some preservation in a limited number of patients. Emphasis has been rightly made on the preservation of the A2 segments, which can be dissected using microsurgical technique. Lastly, multilayer reconstruction of the skull base is required, using an inlay graft, resting on a vascularized pericranial flap, and occlusion of the sinuses with a fat graft. The endonasal endoscopic approach has fallen out of favor due to limitations for complete tumor resection and higher complication rates.6 We present a case of a relatively small olfactory groove meningioma in a 36-yr-old male with partial olfactory loss. The patient consented for surgery. Images at 2:07, 2:29, and 2:54 from Al-Mefty O, Operative Atlas of Meningiomas, © LWW, 1997, with permission. Image at 8:31 public domain by age.
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Affiliation(s)
- Michael A Mooney
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Walid Ibn Essayed
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Essayed WI, Mooney MA, Al-Mefty O. Transcavernous Resection of an Upper Clival Chondrosarcoma: "Cavernous Sinus as a Route": 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 20:E422-E423. [PMID: 33940624 DOI: 10.1093/ons/opab043] [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: 11/19/2020] [Accepted: 12/25/2020] [Indexed: 11/13/2022] Open
Abstract
Complete resection of skull base chondrosarcomas offers the potential for a durable, or even lifelong, cure and is best achieved at the first surgery.1,2 When a skull base chondrosarcoma is located at the upper clivus and in the interpeduncular cistern and invading laterally toward the petrous apex and cavernous sinus, the traditional approaches, ie, endonasal endoscopic or middle fossa approaches, are not adequate for the exposure and resection. The transcavernous sinus approach has been utilized to remove tumor from the cavernous sinus and as a corridor to the interpeduncular cistern and upper clivus, originally described for the clipping of basilar apex aneurysms. We present a case of a chondrosarcoma centered in the upper clivus and eroding the right posterior clinoid, analogous to the location of a giant basilar apex aneurysm. Detailed study of the tumor extension, bony invasion, and relationship with neuroanatomy dictated the most effective surgical approach.3,4 Neuronavigation and intraoperative magnetic resonance imaging (MRI) facilitated the gross total resection of the tumor in the Advanced Multimodality Image-Guided Operating (AMIGO) suite. Achieving a gross total tumor removal of this World Health Organization (WHO) grade I chondrosarcoma, adjuvant irradiation can be withheld1 and the patient monitored with serial imaging. The patient did well after the surgery. The patient consented for surgery and the use of photography.
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Affiliation(s)
- Walid Ibn Essayed
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael A Mooney
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Essayed WIBN, Mooney MA, Al-Mefty O. Venous Anatomy Influence on the Approach Selection of a Petroclival Clear Cell Meningioma With Associated Multiple Spinal Meningiomas: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 20:E426-E427. [PMID: 33928378 DOI: 10.1093/ons/opab072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/24/2021] [Indexed: 02/05/2023] Open
Abstract
Preoperative careful evaluation of the sigmoid transverse sinus and its tributary veins is paramount for the safe surgical planning of petroclival lesions.1,2 When the vein of Labbé is running within the tentorium, classic petrosal approach involving transection of the tentorium is modified to avoid the risk of postoperative morbid temporal lobe venous infarcts.1-3 Thus, the surgical plan should be tailored to the specific patient anatomy as demonstrated in the presented case during which a transmastoid approach was followed, in the same surgical setting, by a middle fossa approach to resect a large petroclival clear cell meningioma with extension into Meckel cave. These meningiomas are WHO grade II tumors with a propensity to local recurrence and cerebrospinal fluid seeding.4 SMARCE1 mutations define this subtype of meningioma, with frequent familial inheritance, and predispose patients to both skull base and spinal clear cell meningiomas.5,6 Maximal surgical resection is the best initial treatment option allowing to withhold or delay the use of radiation in tumors frequently encountered in young patients.7 In this report, we demonstrate the microsurgical techniques deployed to achieve maximal resection of a petroclival clear cell meningioma and associated lumbar and sacral spinal meningiomas in a 20-yr-old patient with a familial SMARCE1 mutation. The patient agreed to the surgical intervention and to the use of her image.
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Mooney MA, Bhatt P, Hermosillo RJM, Ryabinin P, Nikolas M, Faraone SV, Fair DA, Wilmot B, Nigg JT. Smaller total brain volume but not subcortical structure volume related to common genetic risk for ADHD. Psychol Med 2021; 51:1279-1288. [PMID: 31973781 PMCID: PMC7461955 DOI: 10.1017/s0033291719004148] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Mechanistic endophenotypes can inform process models of psychopathology and aid interpretation of genetic risk factors. Smaller total brain and subcortical volumes are associated with attention-deficit hyperactivity disorder (ADHD) and provide clues to its development. This study evaluates whether common genetic risk for ADHD is associated with total brain volume (TBV) and hypothesized subcortical structures in children. METHODS Children 7-15 years old were recruited for a case-control study (N = 312, N = 199 ADHD). Children were assessed with a multi-informant, best-estimate diagnostic procedure and motion-corrected MRI measured brain volumes. Polygenic scores were computed based on discovery data from the Psychiatric Genomics Consortium (N = 19 099 ADHD, N = 34 194 controls) and the ENIGMA + CHARGE consortium (N = 26 577). RESULTS ADHD was associated with smaller TBV, and altered volumes of caudate, cerebellum, putamen, and thalamus after adjustment for TBV; however, effects were larger and statistically reliable only in boys. TBV was associated with an ADHD polygenic score [β = -0.147 (-0.27 to -0.03)], and mediated a small proportion of the effect of polygenic risk on ADHD diagnosis (average ACME = 0.0087, p = 0.012). This finding was stronger in boys (average ACME = 0.019, p = 0.008). In addition, we confirm genetic variation associated with whole brain volume, via an intracranial volume polygenic score. CONCLUSION Common genetic risk for ADHD is not expressed primarily as developmental alterations in subcortical brain volumes, but appears to alter brain development in other ways, as evidenced by TBV differences. This is among the first demonstrations of this effect using molecular genetic data. Potential sex differences in these effects warrant further examination.
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Affiliation(s)
- Michael A Mooney
- Division of Bioinformatics & Computational Biology, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
- OHSU Knight Cancer Institute, Portland, Oregon, USA
| | - Priya Bhatt
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Robert J M Hermosillo
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA
| | - Peter Ryabinin
- Oregon Clinical and Translational Research Institute, Portland, Oregon, USA
| | - Molly Nikolas
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, Iowa, USA
| | - Stephen V Faraone
- Departments of Psychiatry and Neuroscience & Physiology, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Damien A Fair
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA
- Advanced Imaging Research Center, OHSU, Portland, Oregon, USA
| | - Beth Wilmot
- Division of Bioinformatics & Computational Biology, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
- Oregon Clinical and Translational Research Institute, Portland, Oregon, USA
| | - Joel T Nigg
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA
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Schäfer A, Gralinski LE, Leist SR, Winkler ES, Hampton BK, Mooney MA, Jensen KL, Graham RL, Agnihothram S, Jeng S, Chamberlin S, Bell TA, Scobey DT, VanBlargan LA, Thackray LB, Hock P, Miller DR, Shaw GD, de Villena FPM, McWeeney SK, Montgomery SA, Diamond MS, Heise MT, Menachery VD, Ferris MT, Baric RS. Common Mechanism of SARS-CoV and SARS-CoV-2 Pathogenesis across Species. bioRxiv 2021:2021.05.14.444205. [PMID: 34013261 PMCID: PMC8132217 DOI: 10.1101/2021.05.14.444205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Sarbecovirus (CoV) infections, including Severe Acute Respiratory CoV (SARS-CoV) and SARS-CoV-2, are considerable human threats. Human GWAS studies have recently identified loci associated with variation in SARS-CoV-2 susceptibility. However, genetically tractable models that reproduce human CoV disease outcomes are needed to mechanistically evaluate genetic determinants of CoV susceptibility. We used the Collaborative Cross (CC) and human GWAS datasets to elucidate host susceptibility loci that regulate CoV infections and to identify host quantitative trait loci that modulate severe CoV and pan-CoV disease outcomes including a major disease regulating loci including CCR9. CCR9 ablation resulted in enhanced titer, weight loss, respiratory dysfunction, mortality, and inflammation, providing mechanistic support in mitigating protection from severe SARS-CoV-2 pathogenesis across species. This study represents a comprehensive analysis of susceptibility loci for an entire genus of human pathogens conducted, identifies a large collection of susceptibility loci and candidate genes that regulate multiple aspects type-specific and cross-CoV pathogenesis, and also validates the paradigm of using the CC platform to identify common cross-species susceptibility loci and genes for newly emerging and pre-epidemic viruses.
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Graham JB, Swarts JL, Edwards KR, Voss KM, Green R, Jeng S, Miller DR, Mooney MA, McWeeney SK, Ferris MT, Pardo-Manuel de Villena F, Gale M, Lund JM. Correlation of Regulatory T Cell Numbers with Disease Tolerance upon Virus Infection. Immunohorizons 2021; 5:157-169. [PMID: 33893179 PMCID: PMC8281504 DOI: 10.4049/immunohorizons.2100009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/19/2021] [Indexed: 11/19/2022] Open
Abstract
The goal of a successful immune response is to clear the pathogen while sparing host tissues from damage associated with pathogen replication and active immunity. Regulatory T cells (Treg) have been implicated in maintaining this balance as they contribute both to the organization of immune responses as well as restriction of inflammation and immune activation to limit immunopathology. To determine if Treg abundance prior to pathogen encounter can be used to predict the success of an antiviral immune response, we used genetically diverse mice from the collaborative cross infected with West Nile virus (WNV). We identified collaborative cross lines with extreme Treg abundance at steady state, either high or low, and used mice with these extreme phenotypes to demonstrate that baseline Treg quantity predicted the magnitude of the CD8 T cell response to WNV infection, although higher numbers of baseline Tregs were associated with reduced CD8 T cell functionality in terms of TNF and granzyme B expression. Finally, we found that abundance of CD44+ Tregs in the spleen at steady state was correlated with an increased early viral load within the spleen without an association with clinical disease. Thus, we propose that Tregs participate in disease tolerance in the context of WNV infection by tuning an appropriately focused and balanced immune response to control the virus while at the same time minimizing immunopathology and clinical disease. We hypothesize that Tregs limit the antiviral CD8 T cell function to curb immunopathology at the expense of early viral control as an overall host survival strategy.
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Affiliation(s)
- Jessica B Graham
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jessica L Swarts
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kristina R Edwards
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kathleen M Voss
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington School of Medicine, Seattle, WA
| | - Richard Green
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington School of Medicine, Seattle, WA
| | - Sophia Jeng
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR.,OHSU Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Darla R Miller
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael A Mooney
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR.,OHSU Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Shannon K McWeeney
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR.,OHSU Knight Cancer Institute, Oregon Health & Science University, Portland, OR.,Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR
| | - Martin T Ferris
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Fernando Pardo-Manuel de Villena
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; and
| | - Michael Gale
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR
| | - Jennifer M Lund
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; .,Department of Global Health, University of Washington, Seattle, WA
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Mooney MA, Abolfotoh M, Bi WL, Tavanaiepour D, Almefty RO, Bassiouni H, Pravdenkova S, Dunn IF, Al-Mefty O. Is Falcine Meningioma a Diffuse Disease of the Falx? Case Series and Analysis of a "Grade Zero" Resection. Neurosurgery 2021; 87:900-909. [PMID: 32294205 DOI: 10.1093/neuros/nyaa038] [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: 06/14/2019] [Accepted: 12/28/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Falcine meningiomas have unique characteristics including their high rates of recurrence, association with high grade pathology, increased male prevalence, and potential for diffuse involvement of the falx. OBJECTIVE To address these issues in a substantial series of falcine meningiomas and report on the impact of extent of resection for this distinct meningioma entity. METHODS Retrospective analysis of characteristics and outcomes of 59 falcine meningioma patients who underwent surgery with the senior author. A "Grade Zero" category was used when an additional resection margin of 2 to 3 cm from the tumor insertion was achieved. RESULTS For de novo falcine meningiomas, gross total resection (GTR) was associated with significantly decreased recurrence incidence compared with subtotal resection (P ≤ .0001). For recurrent falcine meningiomas, median progression-free survival (PFS) was significantly improved for GTR cases (37 mo vs 12 mo; P = .017, hazard ratio (HR) .243 (.077-.774)). "Grade Zero" resection demonstrated excellent durability for both de novo and recurrent cases, and PFS was significantly improved with "Grade Zero" resection for recurrent cases (P = .003, HR 1.544 (1.156-2.062)). The PFS benefit of "Grade Zero" resection did not achieve statistical significance over Simpson grade 1 during the limited follow-up period (mean 2.8 yr) for these groups. CONCLUSION The recurrence of falcine meningiomas is related to the diffuse presence of tumor between the leaflets of the falx. Increased extent of resection including, when possible, a clear margin of falx surrounding the tumor base was associated with the best long-term outcomes in our series, particularly for recurrent tumors.
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Affiliation(s)
- Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.,Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mohammad Abolfotoh
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky.,Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daryoush Tavanaiepour
- Department of Neurosurgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Rami O Almefty
- Department of Neurosurgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Hischam Bassiouni
- Department of Neurosurgery, Klinikum Amberg, Amberg, Germany.,Department of Neurosurgery, Klinikum Weiden, Weiden, Germany
| | - Svetlana Pravdenkova
- Department of Neurosurgery, Arkansas Neuroscience Institute, Little Rock, Arkansas
| | - Ian F Dunn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Hardesty DA, Mooney MA, Hendricks BK, Catapano JS, Brigeman ST, Bohl MA, Sheehy JP, Little AS. Postoperative 30-day emergency department utilization after 7294 cranial neurosurgery procedures at a tertiary neuroscience center. J Neurosurg 2021; 135:934-942. [PMID: 33513573 DOI: 10.3171/2020.8.jns202404] [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: 06/21/2020] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hospital readmission and the reduction thereof has become a major quality improvement initiative in organized medicine and neurosurgery. However, little research has been performed on why neurosurgical patients utilize hospital emergency rooms (ERs) with or without subsequent admission in the postoperative setting. METHODS This study was a retrospective, single-center review of data for all surgical cranial procedures performed from July 2013 to July 2016 in patients who survived to discharge. The study was approved by the institutional review board of the participating medical center. RESULTS The authors identified 7294 cranial procedures performed during 6596 hospital encounters in 5385 patients. The rate of postoperative ER utilization within 30 days after surgical hospitalization across all procedure types was 13.1 per 100 surgeries performed. The two most common chief complaints were pain (30.7%) and medical complication (18.2%). After identification of relevant surgical and patient factors with univariable analysis, a multivariable backward elimination logistic regression model was constructed in which Ommaya reservoir placement (OR 2.65, p = 0.0008) and cranial CSF shunt placement (OR 1.40, p = 0.0001) were associated with increased ER utilization. Deep brain stimulation electrode placement (OR 0.488, p = 0.0004), increasing hospital length of stay (OR 0.935, p < 0.0001), and increasing patient age (OR 0.988, p < 0.0001) were associated with lower rates of postoperative ER utilization. One-half (50%) of ER visit patients were readmitted to the hospital. New/worsening neurological deficit chief complaint (OR 1.99, p = 0.0088), fever chief complaint (OR 2.41, p = 0.0205), altered mentation chief complaint (OR 2.71, p = 0.0002), patient chronic kidney disease (OR 3.31, p = 0.0037), brain biopsy procedure type (OR 3.50, p = 0.0398), and wound infection chief complaint (OR 31.4, p = 0.0008) were associated with increased rates of readmission to the hospital from the ER in multivariable analysis. CONCLUSIONS The authors report the rates of and reasons for ER utilization in a large cohort of postoperative cranial neurosurgical patients. Factors identified were associated with both increased and decreased use of the ER after cranial surgery, as well as variables associated with readmission to the hospital after postoperative ER visitation. These findings may direct future quality improvement via prospective implementation of care pathways for high-risk procedures.
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Affiliation(s)
- Douglas A Hardesty
- 1Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
- 2Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael A Mooney
- 1Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Benjamin K Hendricks
- 1Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Joshua S Catapano
- 1Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Scott T Brigeman
- 1Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Michael A Bohl
- 1Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - John P Sheehy
- 1Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Andrew S Little
- 1Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
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Graham JB, Swarts JL, Leist SR, Schäfer A, Menachery VD, Gralinski LE, Jeng S, Miller DR, Mooney MA, McWeeney SK, Ferris MT, Pardo-Manuel de Villena F, Heise MT, Baric RS, Lund JM. Baseline T cell immune phenotypes predict virologic and disease control upon SARS-CoV infection in Collaborative Cross mice. PLoS Pathog 2021; 17:e1009287. [PMID: 33513210 PMCID: PMC7875398 DOI: 10.1371/journal.ppat.1009287] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/10/2021] [Accepted: 01/05/2021] [Indexed: 12/25/2022] Open
Abstract
The COVID-19 pandemic has revealed that infection with SARS-CoV-2 can result in a wide range of clinical outcomes in humans. An incomplete understanding of immune correlates of protection represents a major barrier to the design of vaccines and therapeutic approaches to prevent infection or limit disease. This deficit is largely due to the lack of prospectively collected, pre-infection samples from individuals that go on to become infected with SARS-CoV-2. Here, we utilized data from genetically diverse Collaborative Cross (CC) mice infected with SARS-CoV to determine whether baseline T cell signatures are associated with a lack of viral control and severe disease upon infection. SARS-CoV infection of CC mice results in a variety of viral load trajectories and disease outcomes. Overall, a dysregulated, pro-inflammatory signature of circulating T cells at baseline was associated with severe disease upon infection. Our study serves as proof of concept that circulating T cell signatures at baseline can predict clinical and virologic outcomes upon SARS-CoV infection. Identification of basal immune predictors in humans could allow for identification of individuals at highest risk of severe clinical and virologic outcomes upon infection, who may thus most benefit from available clinical interventions to restrict infection and disease.
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Affiliation(s)
- Jessica B. Graham
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, Unites States of America
| | - Jessica L. Swarts
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, Unites States of America
| | - Sarah R. Leist
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Unites States of America
| | - Alexandra Schäfer
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Unites States of America
| | - Vineet D. Menachery
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Unites States of America
- Department of Microbiology and Immunology, University of Texas Medical Center, Galveston, Texas, Unites States of America
| | - Lisa E. Gralinski
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Unites States of America
| | - Sophia Jeng
- OHSU Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, Unites States of America
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, Oregon, Unites States of America
| | - Darla R. Miller
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Unites States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Unites States of America
| | - Michael A. Mooney
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, Oregon, Unites States of America
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, Unites States of America
| | - Shannon K. McWeeney
- OHSU Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, Unites States of America
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, Oregon, Unites States of America
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, Unites States of America
| | - Martin T. Ferris
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Unites States of America
| | - Fernando Pardo-Manuel de Villena
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Unites States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Unites States of America
| | - Mark T. Heise
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Unites States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Unites States of America
| | - Ralph S. Baric
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Unites States of America
| | - Jennifer M. Lund
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, Unites States of America
- Department of Global Health, University of Washington, Seattle, Wasington, Unites States of America
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Zhang F, Xie G, Leung L, Mooney MA, Epprecht L, Norton I, Rathi Y, Kikinis R, Al-Mefty O, Makris N, Golby AJ, O'Donnell LJ. Creation of a novel trigeminal tractography atlas for automated trigeminal nerve identification. Neuroimage 2020; 220:117063. [PMID: 32574805 PMCID: PMC7572753 DOI: 10.1016/j.neuroimage.2020.117063] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/07/2020] [Accepted: 06/14/2020] [Indexed: 12/29/2022] Open
Abstract
Diffusion MRI (dMRI) tractography has been successfully used to study the trigeminal nerves (TGNs) in many clinical and research applications. Currently, identification of the TGN in tractography data requires expert nerve selection using manually drawn regions of interest (ROIs), which is prone to inter-observer variability, time-consuming and carries high clinical and labor costs. To overcome these issues, we propose to create a novel anatomically curated TGN tractography atlas that enables automated identification of the TGN from dMRI tractography. In this paper, we first illustrate the creation of a trigeminal tractography atlas. Leveraging a well-established computational pipeline and expert neuroanatomical knowledge, we generate a data-driven TGN fiber clustering atlas using tractography data from 50 subjects from the Human Connectome Project. Then, we demonstrate the application of the proposed atlas for automated TGN identification in new subjects, without relying on expert ROI placement. Quantitative and visual experiments are performed with comparison to expert TGN identification using dMRI data from two different acquisition sites. We show highly comparable results between the automatically and manually identified TGNs in terms of spatial overlap and visualization, while our proposed method has several advantages. First, our method performs automated TGN identification, and thus it provides an efficient tool to reduce expert labor costs and inter-operator bias relative to expert manual selection. Second, our method is robust to potential imaging artifacts and/or noise that can prevent successful manual ROI placement for TGN selection and hence yields a higher successful TGN identification rate.
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Affiliation(s)
- Fan Zhang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
| | - Guoqiang Xie
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Department of Neurosurgery, Nuclear Industry 215 Hospital of Shaanxi Province, Xianyang, China
| | - Laura Leung
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Michael A Mooney
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Lorenz Epprecht
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isaiah Norton
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Yogesh Rathi
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Ron Kikinis
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Nikos Makris
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Departments of Psychiatry, Neurology and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Alexandra J Golby
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Lauren J O'Donnell
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
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Zhao X, Cavallo C, Hlubek RJ, Mooney MA, Belykh E, Gandhi S, Moreira LB, Lei T, Albuquerque FC, Preul MC, Nakaji P. Styloidogenic Jugular Venous Compression Syndrome: Clinical Features and Case Series. Oper Neurosurg (Hagerstown) 2020; 17:554-561. [PMID: 31329946 DOI: 10.1093/ons/opz012] [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] [Received: 06/05/2018] [Accepted: 02/07/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Styloidogenic jugular venous compression syndrome (SJVCS) is a rare cause of idiopathic intracranial hypertension (IIH). OBJECTIVE To elucidate the pathophysiology and the hemodynamics of SJVCS. METHODS We conducted a retrospective review of medical records, clinical images, dynamic venography, and manometry for consecutive patients with SJVCS undergoing microsurgical decompression from April 2009 to October 2017. Patients with IIH with normal venography and manometry findings served as controls. RESULTS Data were analyzed for 10 patients with SJVCS who presented with headaches. Neck flexion exacerbated headaches in 7 patients. Eleven patients with IIH provided control data for normal intracranial venous pressure and styloid process anatomy. Patients with SJVCS had bilateral osseous compression of venous outflow. The styloid processes were significantly longer in patients with SJVCS than in those with IIH (mean [standard deviation (SD)] distance, 31.0 [10.6] vs 19.0 [14.1] mm; P < .01). The styloid process-C1 lateral tubercle distance was shorter in patients with SJVCS than in those with IIH (mean [SD] distance, 2.9 [1.0] vs 9.9 [2.8] mm; P < .01). Patients with SJVCS had significantly higher global venous pressure and a higher pressure gradient across the stenosis site than controls (mean [SD] pressure, 2.86 [2.61] vs 0.13 [1.09] cm H2O; P = .09). All 10 patients with SJVCS experienced venous pressure elevation during contralateral neck turning (mean [SD] pressure, 4.29 [2.50] cm H2O). All 10 patients with SJVCS underwent transcervical microsurgical decompression, and 9 experienced postoperative improvement or resolution of symptoms. One patient had transient postoperative dysphagia and facial drooping, and another patient reported jaw numbness. CONCLUSION SJVCS is a novel clinical entity causing IIH. Patients should be evaluated with dynamic venography with manometry. Surgical decompression with removal of osseous overgrowth is an effective treatment in select patients.
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Affiliation(s)
- Xiaochun Zhao
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Claudio Cavallo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Randall J Hlubek
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Evgenii Belykh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Sirin Gandhi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Leandro Borba Moreira
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Ting Lei
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark C Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Mooney MA, Sarris CE, Zhou JJ, Barkhoudarian G, Chicoine MR, Fernandez-Miranda JC, Gardner PA, Hardesty DA, Jahnke H, Kelly DF, Liebelt BD, Mayberg MR, Prevedello DM, Sfondouris J, Sheehy JP, Chandler JP, Yuen KCJ, White WL, Little AS. Proposal and Validation of a Simple Grading Scale (TRANSSPHER Grade) for Predicting Gross Total Resection of Nonfunctioning Pituitary Macroadenomas After Transsphenoidal Surgery. Oper Neurosurg (Hagerstown) 2020; 17:460-469. [PMID: 30649445 DOI: 10.1093/ons/opy401] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 05/17/2018] [Accepted: 12/31/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A simple, reliable grading scale to better characterize nonfunctioning pituitary adenomas (NFPAs) preoperatively has potential for research and clinical applications. OBJECTIVE To develop a grading scale from a prospective multicenter cohort of patients that accurately and reliably predicts the likelihood of gross total resection (GTR) after transsphenoidal NFPA surgery. METHODS Extent-of-resection (EOR) data from a prospective multicenter study in transsphenoidal NFPA surgery were analyzed (TRANSSPHER study; ClinicalTrials.gov NCT02357498). Sixteen preoperative radiographic magnetic resonance imaging (MRI) tumor characteristics (eg, tumor size, invasion measures, tumor signal characteristics, and parameters impacting surgical access) were evaluated to determine EOR predictors, to calculate receiver-operating characteristic curves, and to develop a grading scale. A separate validation cohort (n = 165) was examined to assess the scale's performance and inter-rater reliability. RESULTS Data for 222 patients from 7 centers treated by 15 surgeons were analyzed. Approximately one-fifth of patients (18.5%; 41 of 222) underwent subtotal resection (STR). Maximum tumor diameter > 40 mm; nodular tumor extension through the diaphragma into the frontal lobe, temporal lobe, posterior fossa, or ventricle; and Knosp grades 3 to 4 were identified as independent STR predictors. A grading scale (TRANSSPHER grade) based on a combination of these 3 features outperformed individual variables in predicting GTR (AUC, 0.732). In a validation cohort, the scale exhibited high sensitivity and specificity (AUC, 0.779) and strong inter-rater reliability (kappa coefficient, 0.617). CONCLUSION This simple, reliable grading scale based on preoperative MRI characteristics can be used to better characterize NFPAs for clinical and research purposes and to predict the likelihood of achieving GTR.
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Affiliation(s)
- Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Christina E Sarris
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - James J Zhou
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Garni Barkhoudarian
- Pacific Neuroscience Institute and Pituitary Disorders Center, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Michael R Chicoine
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Juan C Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Douglas A Hardesty
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Heidi Jahnke
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Daniel F Kelly
- Pacific Neuroscience Institute and Pituitary Disorders Center, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Brandon D Liebelt
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Marc R Mayberg
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Daniel M Prevedello
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John Sfondouris
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - John P Sheehy
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - James P Chandler
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kevin C J Yuen
- Department of Neurology and Barrow Neuroendocrinology Clinic, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - William L White
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Andrew S Little
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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48
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Belykh E, Ngo B, Farhadi DS, Zhao X, Mooney MA, White WL, Daniels JK, Little AS, Eschbacher JM, Preul MC. Confocal Laser Endomicroscopy Assessment of Pituitary Tumor Microstructure: A Feasibility Study. J Clin Med 2020; 9:jcm9103146. [PMID: 33003336 PMCID: PMC7600847 DOI: 10.3390/jcm9103146] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 08/11/2020] [Revised: 09/12/2020] [Accepted: 09/23/2020] [Indexed: 12/12/2022] Open
Abstract
This is the first study to assess confocal laser endomicroscopy (CLE) use within the transsphenoidal approach and show the feasibility of obtaining digital diagnostic biopsies of pituitary tumor tissue after intravenous fluorescein injection. We confirmed that the CLE probe reaches the tuberculum sellae through the transnasal transsphenoidal corridor in cadaveric heads. Next, we confirmed that CLE provides images with identifiable histological features of pituitary adenoma. Biopsies from nine patients who underwent pituitary adenoma surgery were imaged ex vivo at various times after fluorescein injection and were assessed by a blinded board-certified neuropathologist. With frozen sections used as the standard, pituitary adenoma was diagnosed as “definitively” for 13 and as “favoring” in 3 of 16 specimens. CLE digital biopsies were diagnostic for pituitary adenoma in 10 of 16 specimens. The reasons for nondiagnostic CLE images were biopsy acquisition <1 min or >10 min after fluorescein injection (n = 5) and blood artifacts (n = 1). In conclusion, fluorescein provided sufficient contrast for CLE at a dose of 2 mg/kg, optimally 1–10 min after injection. These results provide a basis for further in vivo studies using CLE in transsphenoidal surgery.
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Affiliation(s)
- Evgenii Belykh
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA; (E.B.); (B.N.); (D.S.F.); (X.Z.); (M.A.M.); (W.L.W.); (A.S.L.)
| | - Brandon Ngo
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA; (E.B.); (B.N.); (D.S.F.); (X.Z.); (M.A.M.); (W.L.W.); (A.S.L.)
| | - Dara S. Farhadi
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA; (E.B.); (B.N.); (D.S.F.); (X.Z.); (M.A.M.); (W.L.W.); (A.S.L.)
| | - Xiaochun Zhao
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA; (E.B.); (B.N.); (D.S.F.); (X.Z.); (M.A.M.); (W.L.W.); (A.S.L.)
| | - Michael A. Mooney
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA; (E.B.); (B.N.); (D.S.F.); (X.Z.); (M.A.M.); (W.L.W.); (A.S.L.)
| | - William L. White
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA; (E.B.); (B.N.); (D.S.F.); (X.Z.); (M.A.M.); (W.L.W.); (A.S.L.)
| | - Jessica K. Daniels
- Department of Neuropathology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA; (J.K.D.); (J.M.E.)
| | - Andrew S. Little
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA; (E.B.); (B.N.); (D.S.F.); (X.Z.); (M.A.M.); (W.L.W.); (A.S.L.)
| | - Jennifer M. Eschbacher
- Department of Neuropathology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA; (J.K.D.); (J.M.E.)
| | - Mark C. Preul
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA; (E.B.); (B.N.); (D.S.F.); (X.Z.); (M.A.M.); (W.L.W.); (A.S.L.)
- Correspondence: ; Tel.: +1-602-406-3593
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49
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Graham JB, Swarts JL, Leist SR, Schäfer A, Menachery VD, Gralinski LE, Jeng S, Miller DR, Mooney MA, McWeeney SK, Ferris MT, de Villena FPM, Heise MT, Baric RS, Lund JM. Baseline T cell immune phenotypes predict virologic and disease control upon SARS-CoV infection. bioRxiv 2020:2020.09.21.306837. [PMID: 32995791 PMCID: PMC7523117 DOI: 10.1101/2020.09.21.306837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The COVID-19 pandemic has revealed that infection with SARS-CoV-2 can result in a wide range of clinical outcomes in humans, from asymptomatic or mild disease to severe disease that can require mechanical ventilation. An incomplete understanding of immune correlates of protection represents a major barrier to the design of vaccines and therapeutic approaches to prevent infection or limit disease. This deficit is largely due to the lack of prospectively collected, pre-infection samples from indiviuals that go on to become infected with SARS-CoV-2. Here, we utilized data from a screen of genetically diverse mice from the Collaborative Cross (CC) infected with SARS-CoV to determine whether circulating baseline T cell signatures are associated with a lack of viral control and severe disease upon infection. SARS-CoV infection of CC mice results in a variety of viral load trajectories and disease outcomes. Further, early control of virus in the lung correlates with an increased abundance of activated CD4 and CD8 T cells and regulatory T cells prior to infections across strains. A basal propensity of T cells to express IFNg and IL17 over TNFa also correlated with early viral control. Overall, a dysregulated, pro-inflammatory signature of circulating T cells at baseline was associated with severe disease upon infection. While future studies of human samples prior to infection with SARS-CoV-2 are required, our studies in mice with SARS-CoV serve as proof of concept that circulating T cell signatures at baseline can predict clinical and virologic outcomes upon SARS-CoV infection. Identification of basal immune predictors in humans could allow for identification of individuals at highest risk of severe clinical and virologic outcomes upon infection, who may thus most benefit from available clinical interventions to restrict infection and disease. SUMMARY We used a screen of genetically diverse mice from the Collaborative Cross infected with mouse-adapted SARS-CoV in combination with comprehensive pre-infection immunophenotyping to identify baseline circulating immune correlates of severe virologic and clinical outcomes upon SARS-CoV infection.
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Affiliation(s)
- Jessica B. Graham
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jessica L. Swarts
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Sarah R. Leist
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alexandra Schäfer
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Vineet D. Menachery
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Microbiology and Immunology, University of Texas Medical Center, Galveston, TX
| | - Lisa E. Gralinski
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sophia Jeng
- OHSU Knight Cancer Institute, Oregon Health & Science University, Portland, OR
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR
| | - Darla R. Miller
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael A. Mooney
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR
| | - Shannon K. McWeeney
- OHSU Knight Cancer Institute, Oregon Health & Science University, Portland, OR
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR
| | - Martin T. Ferris
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Fernando Pardo-Manuel de Villena
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mark T. Heise
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ralph S. Baric
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer M. Lund
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
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50
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Catapano JS, Mezher AW, Wang DJ, Whiting AC, Mooney MA, Bohl MA, Sheehy JP, DiDomenico JD, Sarris CE, Smith KA, Lawton MT, Zabramski JM. In Reply to the Letter to the Editor Regarding "Laparoscopic-Assisted Ventriculoperitoneal Shunt Placement and Reduction in Operative Time and Total Hospital Charges". World Neurosurg 2020; 140:442. [PMID: 32797965 DOI: 10.1016/j.wneu.2020.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Andrew W Mezher
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Derrick J Wang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Alexander C Whiting
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - John P Sheehy
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joseph D DiDomenico
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Christina E Sarris
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kris A Smith
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joseph M Zabramski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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