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Boardman JP, Ireland G, Sullivan G, Pataky R, Fleiss B, Gressens P, Miron V. The Cerebrospinal Fluid Inflammatory Response to Preterm Birth. Front Physiol 2018; 9:1299. [PMID: 30258368 PMCID: PMC6144928 DOI: 10.3389/fphys.2018.01299] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/29/2018] [Indexed: 12/21/2022] Open
Abstract
Background: Preterm birth is the leading risk factor for perinatal white matter injury, which can lead to motor and neuropsychiatric impairment across the life course. There is an unmet clinical need for therapeutics. White matter injury is associated with an altered inflammatory response in the brain, primarily led by microglia, and subsequent hypomyelination. However, microglia can release both damaging and trophic factors in response to injury, and a comprehensive assessment of these factors in the preterm central nervous system (CNS) has not been carried out. Method: A custom antibody array was used to assess relative levels of 50 inflammation- and myelination-associated proteins in the cerebrospinal fluid (CSF) of preterm infants in comparison to term controls. Results: Fifteen proteins differed between the groups: BDNF, BTC, C5a, FasL, Follistatin, IL-1β, IL-2, IL-4, IL-9, IL-17A, MIP-1α, MMP8, SPP1, TGFβ, and TNFβ (p < 0.05). To investigate the temporal regulation of these proteins after injury, we mined a gene expression dataset of microglia isolated from a mouse model of developmental white matter injury. Microglia in the experimental model showed dynamic temporal expression of genes encoding these proteins, with an initial and sustained pro-inflammatory response followed by a delayed anti-inflammatory response, and a continuous expression of genes predicted to inhibit healthy myelination. Conclusion: Preterm CSF shows a distinct neuroinflammatory profile compared to term controls, suggestive of a complex neural environment with concurrent damaging and reparative signals. We propose that limitation of pro-inflammatory responses, which occur early after perinatal insult, may prevent expression of myelination-suppressive genes and support healthy white matter development.
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Affiliation(s)
- James P Boardman
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom.,Centre for Clinical Brain Sciences, Chancellor's Building, The University of Edinburgh, Edinburgh, United Kingdom
| | - Graeme Ireland
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Gemma Sullivan
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Rozalia Pataky
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Bobbi Fleiss
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,PROTECT, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,PremUP, Paris, France
| | - Pierre Gressens
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,PROTECT, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,PremUP, Paris, France
| | - Veronique Miron
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
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Sparrow SA, Anblagan D, Drake AJ, Telford EJ, Pataky R, Piyasena C, Semple SI, Bastin ME, Boardman JP. Diffusion MRI parameters of corpus callosum and corticospinal tract in neonates: Comparison between region-of-interest and whole tract averaged measurements. Eur J Paediatr Neurol 2018; 22:807-813. [PMID: 29804802 PMCID: PMC6148214 DOI: 10.1016/j.ejpn.2018.05.003] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 03/28/2018] [Accepted: 05/11/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Measures of white matter (WM) microstructure inferred from diffusion magnetic resonance imaging (dMRI) are useful for studying brain development. There is uncertainty about agreement between FA and MD values obtained from region-of-interest (ROI) versus whole tract approaches. We investigated agreement between dMRI measures using ROI and Probabilistic Neighbourhood Tractography (PNT) in genu of corpus callosum (gCC) and corticospinal tracts (CST). MATERIALS AND METHODS 81 neonates underwent 64 direction DTI at term equivalent age. FA and MD values were extracted from a 8 mm3 ROI placed within the gCC, right and left posterior limbs of internal capsule. PNT was used to segment gCC and CSTs to calculate whole tract-averaged FA and MD. Agreement between values obtained by each method was compared using Bland-Altman statistics and Pearson's correlation. RESULTS Across the 3 tracts the mean difference in FA measured by PNT and ROI ranged between 0.13 and 0.17, and the 95% limits of agreement did not include the possibility of no difference. For MD, the mean difference in values obtained from PNT and ROI ranged between 0.101 and 0.184 mm2/s × 10-3 mm2/s: the mean difference in gCC was 0.101 × 10-3 mm2/s with 95% limits of agreement that included the possibility of no difference, but there was significant disagreement in MD values measured in the CSTs. CONCLUSION Agreement between dMRI measures of neonatal WM microstructure calculated from ROI and whole tract averaged methods is weak. ROI approaches may not provide sufficient representation of tract microstructure at the level of neural systems in newborns.
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Affiliation(s)
- Sarah A Sparrow
- MRC Centre for Reproductive Health, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Devasuda Anblagan
- Centre for Clinical Brain Sciences, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Amanda J Drake
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Emma J Telford
- MRC Centre for Reproductive Health, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Rozalia Pataky
- MRC Centre for Reproductive Health, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Chinthika Piyasena
- MRC Centre for Reproductive Health, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK; University/BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Scott I Semple
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK; Clinical Research Imaging Centre, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Mark E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - James P Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK; Centre for Clinical Brain Sciences, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.
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Telford EJ, Cox SR, Fletcher-Watson S, Anblagan D, Sparrow S, Pataky R, Quigley A, Semple SI, Bastin ME, Boardman JP. A latent measure explains substantial variance in white matter microstructure across the newborn human brain. Brain Struct Funct 2017; 222:4023-4033. [PMID: 28589258 PMCID: PMC5686254 DOI: 10.1007/s00429-017-1455-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 05/24/2017] [Indexed: 01/12/2023]
Abstract
A latent measure of white matter microstructure (g WM) provides a neural basis for information processing speed and intelligence in adults, but the temporal emergence of g WM during human development is unknown. We provide evidence that substantial variance in white matter microstructure is shared across a range of major tracts in the newborn brain. Based on diffusion MRI scans from 145 neonates [gestational age (GA) at birth range 23+2-41+5 weeks], the microstructural properties of eight major white matter tracts were calculated using probabilistic neighborhood tractography. Principal component analyses (PCAs) were carried out on the correlations between the eight tracts, separately for four tract-averaged water diffusion parameters: fractional anisotropy, and mean, radial and axial diffusivities. For all four parameters, PCAs revealed a single latent variable that explained around half of the variance across all eight tracts, and all tracts showed positive loadings. We considered the impact of early environment on general microstructural properties, by comparing term-born infants with preterm infants at term equivalent age. We found significant associations between GA at birth and the latent measure for each water diffusion measure; this effect was most apparent in projection and commissural fibers. These data show that a latent measure of white matter microstructure is present in very early life, well before myelination is widespread. Early exposure to extra-uterine life is associated with altered general properties of white matter microstructure, which could explain the high prevalence of cognitive impairment experienced by children born preterm.
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Affiliation(s)
- Emma J Telford
- MRC Centre for Reproductive Health, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Simon R Cox
- Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9JZ, UK
- Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK
| | - Sue Fletcher-Watson
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Devasuda Anblagan
- MRC Centre for Reproductive Health, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
- Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9JZ, UK
- Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Sarah Sparrow
- MRC Centre for Reproductive Health, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Rozalia Pataky
- MRC Centre for Reproductive Health, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Alan Quigley
- Department of Radiology, Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh, EH9 1LF, UK
| | - Scott I Semple
- University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
- Clinical Research Imaging Centre, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Mark E Bastin
- Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9JZ, UK
- Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - James P Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
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Serag A, Wilkinson AG, Telford EJ, Pataky R, Sparrow SA, Anblagan D, Macnaught G, Semple SI, Boardman JP. SEGMA: An Automatic SEGMentation Approach for Human Brain MRI Using Sliding Window and Random Forests. Front Neuroinform 2017; 11:2. [PMID: 28163680 PMCID: PMC5247463 DOI: 10.3389/fninf.2017.00002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 08/31/2016] [Accepted: 01/05/2017] [Indexed: 11/29/2022] Open
Abstract
Quantitative volumes from brain magnetic resonance imaging (MRI) acquired across the life course may be useful for investigating long term effects of risk and resilience factors for brain development and healthy aging, and for understanding early life determinants of adult brain structure. Therefore, there is an increasing need for automated segmentation tools that can be applied to images acquired at different life stages. We developed an automatic segmentation method for human brain MRI, where a sliding window approach and a multi-class random forest classifier were applied to high-dimensional feature vectors for accurate segmentation. The method performed well on brain MRI data acquired from 179 individuals, analyzed in three age groups: newborns (38–42 weeks gestational age), children and adolescents (4–17 years) and adults (35–71 years). As the method can learn from partially labeled datasets, it can be used to segment large-scale datasets efficiently. It could also be applied to different populations and imaging modalities across the life course.
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Affiliation(s)
- Ahmed Serag
- MRC Centre for Reproductive Health, University of Edinburgh Edinburgh, UK
| | | | - Emma J Telford
- MRC Centre for Reproductive Health, University of Edinburgh Edinburgh, UK
| | - Rozalia Pataky
- MRC Centre for Reproductive Health, University of Edinburgh Edinburgh, UK
| | - Sarah A Sparrow
- MRC Centre for Reproductive Health, University of Edinburgh Edinburgh, UK
| | - Devasuda Anblagan
- MRC Centre for Reproductive Health, University of EdinburghEdinburgh, UK; Centre for Clinical Brain Sciences, University of EdinburghEdinburgh, UK
| | - Gillian Macnaught
- Clinical Research Imaging Centre, University of Edinburgh Edinburgh, UK
| | - Scott I Semple
- Clinical Research Imaging Centre, University of EdinburghEdinburgh, UK; Centre for Cardiovascular Science, University of EdinburghEdinburgh, UK
| | - James P Boardman
- MRC Centre for Reproductive Health, University of EdinburghEdinburgh, UK; Centre for Clinical Brain Sciences, University of EdinburghEdinburgh, UK
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5
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Anblagan D, Pataky R, Evans MJ, Telford EJ, Serag A, Sparrow S, Piyasena C, Semple SI, Wilkinson AG, Bastin ME, Boardman JP. Association between preterm brain injury and exposure to chorioamnionitis during fetal life. Sci Rep 2016; 6:37932. [PMID: 27905410 PMCID: PMC5131360 DOI: 10.1038/srep37932] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [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: 06/22/2016] [Accepted: 11/02/2016] [Indexed: 12/27/2022] Open
Abstract
Preterm infants are susceptible to inflammation-induced white matter injury but the exposures that lead to this are uncertain. Histologic chorioamnionitis (HCA) reflects intrauterine inflammation, can trigger a fetal inflammatory response, and is closely associated with premature birth. In a cohort of 90 preterm infants with detailed placental histology and neonatal brain magnetic resonance imaging (MRI) data at term equivalent age, we used Tract-based Spatial Statistics (TBSS) to perform voxel-wise statistical comparison of fractional anisotropy (FA) data and computational morphometry analysis to compute the volumes of whole brain, tissue compartments and cerebrospinal fluid, to test the hypothesis that HCA is an independent antenatal risk factor for preterm brain injury. Twenty-six (29%) infants had HCA and this was associated with decreased FA in the genu, cingulum cingulate gyri, centrum semiovale, inferior longitudinal fasciculi, limbs of the internal capsule, external capsule and cerebellum (p < 0.05, corrected), independent of degree of prematurity, bronchopulmonary dysplasia and postnatal sepsis. This suggests that diffuse white matter injury begins in utero for a significant proportion of preterm infants, which focuses attention on the development of methods for detecting fetuses and placentas at risk as a means of reducing preterm brain injury.
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Affiliation(s)
- Devasuda Anblagan
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Rozalia Pataky
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Margaret J Evans
- Department of Pathology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Emma J Telford
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Ahmed Serag
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Sarah Sparrow
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Chinthika Piyasena
- Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Scott I Semple
- Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.,Clinical Research Imaging Centre, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | | | - Mark E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - James P Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
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6
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Pataky R, Howie FA, Girardi G, Boardman JP. Complement C5a is present in CSF of human newborns and is elevated in association with preterm birth. J Matern Fetal Neonatal Med 2016; 30:2413-2416. [PMID: 27806664 PMCID: PMC5556752 DOI: 10.1080/14767058.2016.1251896] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Neuroinflammation contributes to developmental brain injury associated with preterm birth, but the mediators that drive it are incompletely understood. Previous studies have shown that complement C5a is present and injurious in the brains of foetal mice exposed to preterm labour. Here, we demonstrate that C5a is present in the cerebrospinal fluid of newborn human infants and that levels are elevated in those born preterm. The difference is not explained by systemic infection. Complement activation in the neonatal brain and its role as a potential therapeutic target in preterm brain injury warrant further study. Activation in the neonatal brain and its role as a potential therapeutic target for preterm brain injury warrants further study.
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Affiliation(s)
- Rozalia Pataky
- a MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute , Edinburgh , UK and
| | - Forbes A Howie
- a MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute , Edinburgh , UK and
| | - Guillermina Girardi
- b Department of Women's Health , King's College London, St Thomas' Hospital , London , UK
| | - James P Boardman
- a MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute , Edinburgh , UK and
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7
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Telford EJ, Fletcher-Watson S, Gillespie-Smith K, Pataky R, Sparrow S, Murray IC, O'Hare A, Boardman JP. Preterm birth is associated with atypical social orienting in infancy detected using eye tracking. J Child Psychol Psychiatry 2016; 57:861-8. [PMID: 26934180 DOI: 10.1111/jcpp.12546] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Preterm birth is closely associated with neurocognitive impairment in childhood including increased risk for social difficulties. Eye tracking objectively assesses eye-gaze behaviour in response to visual stimuli, which permits inference about underlying cognitive processes. We tested the hypothesis that social orienting in infancy is altered by preterm birth. METHODS Fifty preterm infants with mean (range) gestational age (GA) at birth of 29(+1) (23(+2) -33(+0) ) weeks and 50 term infants with mean (range) GA at birth 40(+2) (37(+0) -42(+3) ) weeks underwent eye tracking at median age of 7 months. Infants were presented with three categories of social stimuli of increasing complexity. Time to first fixate (TFF) and looking time (LT) on areas of interest (AoIs) were recorded using remote eye tracking. RESULTS Preterm infants consistently fixated for a shorter time on social content than term infants across all three tasks: face-scanning (fixation to eyes minus mouth 0.61s vs. 1.47s, p = .013); face pop-out task (fixation to face 0.8s vs. 1.34s, p = .023); and social preferential looking (1.16s vs. 1.5s p = .02). Time given to AoIs containing social content as a proportion of LT at the whole stimulus was lower in preterm infants across all three tasks. These results were not explained by differences in overall looking time between the groups. CONCLUSIONS Eye tracking provides early evidence of atypical cognition after preterm birth, and may be a useful tool for stratifying infants at risk of impairment for early interventions designed to improve outcome.
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Affiliation(s)
- Emma J Telford
- MRC/Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | | | | | - Rozalia Pataky
- MRC/Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Sarah Sparrow
- MRC/Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Ian C Murray
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Anne O'Hare
- Salvesen Mindroom Centre, University of Edinburgh, Edinburgh, UK
| | - James P Boardman
- MRC/Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Blesa M, Serag A, Wilkinson AG, Anblagan D, Telford EJ, Pataky R, Sparrow SA, Macnaught G, Semple SI, Bastin ME, Boardman JP. Parcellation of the Healthy Neonatal Brain into 107 Regions Using Atlas Propagation through Intermediate Time Points in Childhood. Front Neurosci 2016; 10:220. [PMID: 27242423 PMCID: PMC4871889 DOI: 10.3389/fnins.2016.00220] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 03/04/2016] [Accepted: 05/03/2016] [Indexed: 01/28/2023] Open
Abstract
Neuroimage analysis pipelines rely on parcellated atlases generated from healthy individuals to provide anatomic context to structural and diffusion MRI data. Atlases constructed using adult data introduce bias into studies of early brain development. We aimed to create a neonatal brain atlas of healthy subjects that can be applied to multi-modal MRI data. Structural and diffusion 3T MRI scans were acquired soon after birth from 33 typically developing neonates born at term (mean postmenstrual age at birth 39+5 weeks, range 37+2–41+6). An adult brain atlas (SRI24/TZO) was propagated to the neonatal data using temporal registration via childhood templates with dense temporal samples (NIH Pediatric Database), with the final atlas (Edinburgh Neonatal Atlas, ENA33) constructed using the Symmetric Group Normalization (SyGN) method. After this step, the computed final transformations were applied to T2-weighted data, and fractional anisotropy, mean diffusivity, and tissue segmentations to provide a multi-modal atlas with 107 anatomical regions; a symmetric version was also created to facilitate studies of laterality. Volumes of each region of interest were measured to provide reference data from normal subjects. Because this atlas is generated from step-wise propagation of adult labels through intermediate time points in childhood, it may serve as a useful starting point for modeling brain growth during development.
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Affiliation(s)
- Manuel Blesa
- MRC Centre for Reproductive Health, University of Edinburgh Edinburgh, UK
| | - Ahmed Serag
- MRC Centre for Reproductive Health, University of Edinburgh Edinburgh, UK
| | | | - Devasuda Anblagan
- MRC Centre for Reproductive Health, University of EdinburghEdinburgh, UK; Centre for Clinical Brain Sciences, University of EdinburghEdinburgh, UK
| | - Emma J Telford
- MRC Centre for Reproductive Health, University of Edinburgh Edinburgh, UK
| | - Rozalia Pataky
- MRC Centre for Reproductive Health, University of Edinburgh Edinburgh, UK
| | - Sarah A Sparrow
- MRC Centre for Reproductive Health, University of Edinburgh Edinburgh, UK
| | - Gillian Macnaught
- Clinical Research Imaging Centre, University of Edinburgh Edinburgh, UK
| | - Scott I Semple
- Clinical Research Imaging Centre, University of Edinburgh Edinburgh, UK
| | - Mark E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh Edinburgh, UK
| | - James P Boardman
- MRC Centre for Reproductive Health, University of EdinburghEdinburgh, UK; Centre for Clinical Brain Sciences, University of EdinburghEdinburgh, UK
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Seow H, Pataky R, Lawson B, O'Leary EM, Sutradhar R, Fassbender K, McGrail K, Barbera L, Mpa MD, Burge F, Peacock SJ, Hoch JS. Temporal association between home nursing and hospital costs at end of life in three provinces. ACTA ACUST UNITED AC 2016; 23:S42-51. [PMID: 26985145 DOI: 10.3747/co.23.2971] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research has demonstrated that increases in palliative homecare nursing are associated with a reduction in the rate of subsequent hospitalizations. However, little evidence is available about the cost-savings potential of palliative nursing when accounting for both increased nursing costs and potentially reduced hospital costs. METHODS Our retrospective cohort study included cancer decedents from British Columbia, Ontario, and Nova Scotia who received any palliative nursing in the last 6 months of life. A Poisson regression analysis was used to determine the association of increased nursing costs (in 2-week blocks) on the relative average hospital costs in the subsequent 2-week block and on the overall total cost (hospital costs plus nursing costs in the preceding 2-week block). RESULTS The cohort included 58,022 cancer decedents. Results of the analysis for the last month of life showed an association between increased nursing costs and decreased relative hospital costs in comparisons with a reference group (>0 to 1 hour nursing in the block): the maximum decrease was 55% for Ontario, 31% for British Columbia, and 38% for Nova Scotia. Also, increased nursing costs in the last month were almost always associated with lower total costs in comparison with the reference. For example, cost savings per person-block ranged from $376 (>10 nursing hours) to $1,124 (>4 to 6 nursing hours) in British Columbia. CONCLUSIONS In the last month of life, increased palliative nursing costs (compared with costs for >0 to 1 hour of nursing in the block) were associated with lower relative hospital costs and a lower total cost in a subsequent block. Our research suggests a cost-savings potential associated with increased community-based palliative nursing.
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Affiliation(s)
- H Seow
- Department of Oncology, McMaster University, Hamilton, ON
| | - R Pataky
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC
| | - B Lawson
- Department of Family Medicine, Dalhousie University, Halifax, NS
| | - E M O'Leary
- Department of Oncology, McMaster University, Hamilton, ON
| | - R Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, ON;; Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - K Fassbender
- Department of Palliative Care Medicine, University of Alberta, Edmonton, AB
| | - K McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - L Barbera
- Department of Oncology, McMaster University, Hamilton, ON
| | - M D Mpa
- Institute for Clinical Evaluative Sciences, Toronto, ON;; Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - F Burge
- Department of Family Medicine, Dalhousie University, Halifax, NS
| | - S J Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC;; BC Cancer Agency and University of British Columbia, Vancouver, BC
| | - J S Hoch
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC;; Institute for Clinical Evaluative Sciences, Toronto, ON;; Toronto Health Economics and Technology Assessment Collaborative, Faculty of Pharmacy, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON;; Pharmacoeconomics Research Unit, Centre for Excellence in Economic Analysis Research, St. Michael's Hospital, Toronto, ON
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Sparrow S, Manning JR, Cartier J, Anblagan D, Bastin ME, Piyasena C, Pataky R, Moore EJ, Semple SI, Wilkinson AG, Evans M, Drake AJ, Boardman JP. Epigenomic profiling of preterm infants reveals DNA methylation differences at sites associated with neural function. Transl Psychiatry 2016; 6:e716. [PMID: 26784970 PMCID: PMC5068883 DOI: 10.1038/tp.2015.210] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/18/2015] [Accepted: 11/19/2015] [Indexed: 12/13/2022] Open
Abstract
DNA methylation (DNAm) plays a determining role in neural cell fate and provides a molecular link between early-life stress and neuropsychiatric disease. Preterm birth is a profound environmental stressor that is closely associated with alterations in connectivity of neural systems and long-term neuropsychiatric impairment. The aims of this study were to examine the relationship between preterm birth and DNAm, and to investigate factors that contribute to variance in DNAm. DNA was collected from preterm infants (birth<33 weeks gestation) and healthy controls (birth>37 weeks), and a genome-wide analysis of DNAm was performed; diffusion magnetic resonance imaging (dMRI) data were acquired from the preterm group. The major fasciculi were segmented, and fractional anisotropy, mean diffusivity and tract shape were calculated. Principal components (PC) analysis was used to investigate the contribution of MRI features and clinical variables to variance in DNAm. Differential methylation was found within 25 gene bodies and 58 promoters of protein-coding genes in preterm infants compared with controls; 10 of these have neural functions. Differences detected in the array were validated with pyrosequencing. Ninety-five percent of the variance in DNAm in preterm infants was explained by 23 PCs; corticospinal tract shape associated with 6th PC, and gender and early nutritional exposure associated with the 7th PC. Preterm birth is associated with alterations in the methylome at sites that influence neural development and function. Differential methylation analysis has identified several promising candidate genes for understanding the genetic/epigenetic basis of preterm brain injury.
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Affiliation(s)
- S Sparrow
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - J R Manning
- MRC Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, UK
| | - J Cartier
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - D Anblagan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - M E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - C Piyasena
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - R Pataky
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - E J Moore
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - S I Semple
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | | | - M Evans
- Department of Pathology, NHS Lothian, Edinburgh, UK
| | - A J Drake
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - J P Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK,MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Room W1.26, Edinburgh EH16 4TJ, UK. E-mail:
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Barbera L, Seow H, Sutradhar R, Chu A, Burge F, Fassbender K, McGrail K, Lawson B, Liu Y, Pataky R, Potapov A. Quality of end-of-life cancer care in Canada: a retrospective four-province study using administrative health care data. Curr Oncol 2015; 22:341-55. [PMID: 26628867 PMCID: PMC4608400 DOI: 10.3747/co.22.2636] [Citation(s) in RCA: 36] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The quality of data comparing care at the end of life (eol) in cancer patients across Canada is poor. This project used identical cohorts and definitions to evaluate quality indicators for eol care in British Columbia, Alberta, Ontario, and Nova Scotia. METHODS This retrospective cohort study of cancer decedents during fiscal years 2004-2009 used administrative health care data to examine health service quality indicators commonly used and previously identified as important to quality eol care: emergency department use, hospitalizations, intensive care unit admissions, chemotherapy, physician house calls, and home care visits near the eol, as well as death in hospital. Crude and standardized rates were calculated. In each province, two separate multivariable logistic regression models examined factors associated with receiving aggressive or supportive care. RESULTS Overall, among the identified 200,285 cancer patients who died of their disease, 54% died in a hospital, with British Columbia having the lowest standardized rate of such deaths (50.2%). Emergency department use at eol ranged from 30.7% in Nova Scotia to 47.9% in Ontario. Of all patients, 8.7% received aggressive care (similar across all provinces), and 46.3% received supportive care (range: 41.2% in Nova Scotia to 61.8% in British Columbia). Lower neighbourhood income was consistently associated with a decreased likelihood of supportive care receipt. INTERPRETATION We successfully used administrative health care data from four Canadian provinces to create identical cohorts with commonly defined indicators. This work is an important step toward maturing the field of eol care in Canada. Future work in this arena would be facilitated by national-level data-sharing arrangements.
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Affiliation(s)
- L. Barbera
- Odette Cancer Centre, Department of Radiation Oncology, Toronto, ON
- Department of Radiation Oncology, University of Toronto, Toronto, ON
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - H. Seow
- Institute for Clinical Evaluative Sciences, Toronto, ON
- Department of Oncology, McMaster University, Hamilton, ON
| | - R. Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - A. Chu
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - F. Burge
- Department of Family Medicine, Dalhousie University, Halifax, NS
| | - K. Fassbender
- Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Edmonton, AB
| | - K. McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - B. Lawson
- Department of Family Medicine, Dalhousie University, Halifax, NS
| | - Y. Liu
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - R. Pataky
- Canadian Centre for Applied Research in Cancer Control, BC Cancer Research Centre, Vancouver, BC
| | - A. Potapov
- Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Edmonton, AB
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Anblagan D, Bastin ME, Sparrow S, Piyasena C, Pataky R, Moore EJ, Serag A, Wilkinson AG, Clayden JD, Semple SI, Boardman JP. Tract shape modeling detects changes associated with preterm birth and neuroprotective treatment effects. Neuroimage Clin 2015; 8:51-8. [PMID: 26106527 PMCID: PMC4473726 DOI: 10.1016/j.nicl.2015.03.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 02/19/2015] [Revised: 03/17/2015] [Accepted: 03/26/2015] [Indexed: 12/14/2022]
Abstract
Preterm birth is associated with altered connectivity of neural circuits. We developed a tract segmentation method that provides measures of tract shape and integrity (probabilistic neighborhood tractography, PNT) from diffusion MRI (dMRI) data to test the hypotheses: 1) preterm birth is associated with alterations in tract topology (R), and tract-averaged mean diffusivity (〈D〉) and fractional anisotropy (FA); 2) neural systems are separable based on tract-averaged dMRI parameters; and 3) PNT can detect neuroprotective treatment effects. dMRI data were collected from 87 preterm infants (mean gestational age 29(+1) weeks, range 23(+2) -34(+6)) at term equivalent age and 24 controls (mean gestational age 39(+6) weeks). PNT was used to segment eight major fasciculi, characterize topology, and extract tract-averaged〈D〉and FA. Tract topology was altered by preterm birth in all tracts except the splenium (p < 0.05, false discovery rate [FDR] corrected). After adjustment for age at scan, tract-averaged〈D〉was increased in the genu and splenium, right corticospinal tract (CST) and the left and right inferior longitudinal fasciculi (ILF) in preterm infants compared with controls (p < 0.05, FDR), while tract-averaged FA was decreased in the splenium and left ILF (p < 0.05, FDR). Specific fasciculi were separable based on tract-averaged〈D〉and FA values. There was a modest decrease in tract-averaged〈D〉in the splenium of preterm infants who had been exposed to antenatal MgSO4 for neuroprotection (p = 0.002). Tract topology is a biomarker of preterm brain injury. The data provide proof of concept that tract-averaged dMRI parameters have utility for evaluating tissue effects of perinatal neuroprotective strategies.
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Affiliation(s)
- Devasuda Anblagan
- MRC Centre for Reproductive Health, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Mark E. Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Sarah Sparrow
- MRC Centre for Reproductive Health, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Chinthika Piyasena
- Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Rozalia Pataky
- MRC Centre for Reproductive Health, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Emma J. Moore
- MRC Centre for Reproductive Health, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Ahmed Serag
- MRC Centre for Reproductive Health, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | | | - Jonathan D. Clayden
- Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Scott I. Semple
- Clinical Research Imaging Centre, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - James P. Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
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