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Hall JD, Green JM, Chen YCA, Liu Y, Zhang H, Sundman MH, Chou YH. Exploring the potential of combining transcranial magnetic stimulation and electroencephalography to investigate mild cognitive impairment and Alzheimer's disease: a systematic review. GeroScience 2024:10.1007/s11357-024-01075-6. [PMID: 38356029 DOI: 10.1007/s11357-024-01075-6] [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: 09/11/2023] [Accepted: 01/02/2024] [Indexed: 02/16/2024] Open
Abstract
Transcranial magnetic stimulation (TMS) and electroencephalography (EEG) are non-invasive techniques used for neuromodulation and recording brain electrical activity, respectively. The integration of TMS-EEG has emerged as a valuable tool for investigating the complex mechanisms involved in age-related disorders, such as mild cognitive impairment (MCI) and Alzheimer's disease (AD). By systematically synthesizing TMS-EEG studies, this review aims to shed light on the neurophysiological mechanisms underlying MCI and AD, while also exploring the practical applications of TMS-EEG in clinical settings. PubMed, ScienceDirect, and PsychInfo were selected as the databases for this review. The 22 eligible studies included a total of 592 individuals with MCI or AD as well as 301 cognitively normal adults. TMS-EEG assessments unveiled specific patterns of corticospinal excitability, plasticity, and brain connectivity that distinguished individuals on the AD spectrum from cognitively normal older adults. Moreover, the TMS-induced EEG features were observed to be correlated with cognitive performance and the presence of AD pathological biomarkers. The comprehensive examination of the existing studies demonstrates that the combination of TMS and EEG has yielded valuable insights into the neurophysiology of MCI and AD. This integration shows great potential for early detection, monitoring disease progression, and anticipating response to treatment. Future research is of paramount importance to delve into the potential utilization of TMS-EEG for treatment optimization in individuals with MCI and AD.
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Affiliation(s)
- J D Hall
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA
| | - Jacob M Green
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA
| | - Yu-Chin A Chen
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA
| | - Yilin Liu
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA
| | - Hangbin Zhang
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA
| | - Mark H Sundman
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA
| | - Ying-Hui Chou
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA.
- Evelyn F McKnight Brain Institute, Arizona Center On Aging, and BIO5 Institute, University of Arizona, Tucson, AZ, USA.
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Mizell JM, Wang S, Frisvold A, Alvarado L, Farrell-Skupny A, Keung W, Phelps CE, Sundman MH, Franchetti MK, Chou YH, Alexander GE, Wilson RC. Differential impacts of healthy cognitive aging on directed and random exploration. Psychol Aging 2024; 39:88-101. [PMID: 38358695 PMCID: PMC10871551 DOI: 10.1037/pag0000791] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Deciding whether to explore unknown opportunities or exploit well-known options is a ubiquitous part of our everyday lives. Extensive work in college students suggests that young people make explore-exploit decisions using a mixture of information seeking and random behavioral variability. Whether, and to what extent, older adults use the same strategies is unknown. To address this question, 51 older adults (ages 65-74) and 32 younger adults (ages 18-25) completed the Horizon Task, a gambling task that quantifies information seeking and behavioral variability as well as how these strategies are controlled for the purposes of exploration. Qualitatively, we found that older adults performed similar to younger adults on this task, increasing both their information seeking and behavioral variability when it was adaptive to explore. Quantitively, however, there were substantial differences between the age groups, with older adults showing less information seeking overall and less reliance on variability as a means to explore. In addition, we found a subset of approximately 26% of older adults whose information seeking was close to zero, avoiding informative options even when they were clearly the better choice. Unsurprisingly, these "information avoiders" performed worse on the task. In contrast, task performance in the remaining "information seeking" older adults was comparable to that of younger adults suggesting that age-related differences in explore-exploit decision making may be adaptive except when they are taken to extremes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | - Siyu Wang
- University of Arizona, Department of Psychology
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Hildebrand L, Huskey A, Dailey N, Jankowski S, Henderson-Arredondo K, Trapani C, Patel SI, Chen AYC, Chou YH, Killgore WDS. Transcranial Magnetic Stimulation of the Default Mode Network to Improve Sleep in Individuals With Insomnia Symptoms: Protocol for a Double-Blind Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e51212. [PMID: 38277210 PMCID: PMC10858423 DOI: 10.2196/51212] [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: 07/24/2023] [Revised: 12/24/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Cortical hyperarousal and ruminative thinking are common aspects of insomnia that have been linked with greater connectivity in the default mode network (DMN). Therefore, disrupting network activity within the DMN may reduce cortical and cognitive hyperarousal and facilitate better sleep. OBJECTIVE This trial aims to establish a novel, noninvasive method for treating insomnia through disruption of the DMN with repetitive transcranial magnetic stimulation, specifically with continuous theta burst stimulation (cTBS). This double-blind, pilot randomized controlled trial will assess the efficacy of repetitive transcranial magnetic stimulation as a novel, nonpharmacological approach to improve sleep through disruption of the DMN prior to sleep onset for individuals with insomnia. Primary outcome measures will include assessing changes in DMN functional connectivity before and after stimulation. METHODS A total of 20 participants between the ages of 18 to 50 years with reported sleep disturbances will be recruited as a part of the study. Participants will then conduct an in-person screening and follow-on enrollment visit. Eligible participants then conduct at-home actigraphic collection until their first in-residence overnight study visit. In a double-blind, counterbalanced, crossover study design, participants will receive a 40-second stimulation to the left inferior parietal lobule of the DMN during 2 separate overnight in-residence visits. Participants are randomized to the order in which they receive the active stimulation and sham stimulation. Study participants will undergo a prestimulation functional magnetic resonance imaging scan and a poststimulation functional magnetic resonance imaging scan prior to sleep for each overnight study visit. Sleep outcomes will be measured using clinical polysomnography. After their first in-residence study visit, participants conduct another at-home actigraphic collection before returning for their second in-residence overnight study visit. RESULTS Our study was funded in September 2020 by the Department of Defense (W81XWH2010173). We completed the enrollment of our target study population in the October 2022 and are currently working on neuroimaging processing and analysis. We aim to publish the results of our study by 2024. Primary neuroimaging outcome measures will be tested using independent components analysis, seed-to-voxel analyses, and region of interest to region of interest analyses. A repeated measures analysis of covariance (ANCOVA) will be used to assess the effects of active and sham stimulation on sleep variables. Additionally, we will correlate changes in functional connectivity to polysomnography-graded sleep. CONCLUSIONS The presently proposed cTBS protocol is aimed at establishing the initial research outcomes of the effects of a single burst of cTBS on disrupting the network connectivity of the DMN to improve sleep. If effective, future work could determine the most effective stimulation sites and administration schedules to optimize this potential intervention for sleep problems. TRIAL REGISTRATION ClinicalTrials.gov NCT04953559; https://clinicaltrials.gov/ct2/show/NCT04953559. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51212.
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Affiliation(s)
- Lindsey Hildebrand
- Department of Psychiatry, University of Arizona, Tucson, AZ, United States
| | - Alisa Huskey
- Department of Psychiatry, University of Arizona, Tucson, AZ, United States
| | - Natalie Dailey
- Department of Psychiatry, University of Arizona, Tucson, AZ, United States
| | - Samantha Jankowski
- Department of Psychiatry, University of Arizona, Tucson, AZ, United States
| | | | | | - Salma Imran Patel
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, AZ, United States
| | | | - Ying-Hui Chou
- Department of Psychology, University of Arizona, Tucson, AZ, United States
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Succar B, Chou YH, Hsu CH, Rapcsak S, Trouard T, Zhou W. Carotid Revascularization is Associated with Improved Mood in Patients with Advanced Carotid Disease. Ann Surg 2024:00000658-990000000-00754. [PMID: 38258598 DOI: 10.1097/sla.0000000000006216] [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] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To investigate the impact of carotid interventions on patients' mental condition in patients with carotid stenosis. SUMMARY BACKGROUND DATA Ongoing research highlights the impact of carotid interventions on neurocognitive function in patients with advanced carotid atherosclerosis. However, data regarding the impact of carotid revascularization on mood is scarce. METHODS A total of 157 patients undergoing carotid revascularization were prospectively recruited. The primary outcome was depression, evaluated pre-operatively, and at 1-,6- and 12-month post-intervention using the long form of the geriatric depression scale (GDS-30) questionnaire. Other tests were also used to assess cognition at the respective timepoints. Statistical analyses were performed to assess the postoperative outcomes compared to baseline. RESULTS Baseline depression (GDS>9) was observed in 49(31%) subjects, whereas 108(69%) patients were not depressed (GDS≤9). The average pre-operative GDS score was 15.42 ± 4.40(14.2-16.7) and 4.28 ±2.9(3.7-4.8) in the depressed and non-depressed groups, respectively. We observed a significant improvement in GDS scores within the depressed group at 1-month (P=0.002), 6-months (P=0.027), and 1-year (P<0.001) post-intervention compared to preop, whereas the non-depressed group had similar post-op GDS scores at all time points compared to baseline. Significant improvement in measures of executive function was seen in non-depressed patients at all three timepoints whereas depressed patients showed an improvement at 1-year follow-up. CONCLUSIONS Our study highlights improvement in mood among patients with advanced carotid disease who screened positive for depression at baseline. Further studies with larger sample sizes are warranted to investigate the association between depression, carotid disease, and carotid intervention.
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Affiliation(s)
- Bahaa Succar
- The University of Arizona, Department of Surgery, Division of Vascular Surgery, Tucson, AZ
| | - Ying-Hui Chou
- The University of Arizona, Department of Psychiatry, Tucson, AZ
| | - Chiu-Hsieh Hsu
- The University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, AZ
| | - Steven Rapcsak
- The University of Arizona, Department of Psychiatry, Tucson, AZ
| | - Theodore Trouard
- The University of Arizona, Department of Biomedical Imaging, Tucson, AZ
| | - Wei Zhou
- The University of Arizona, Department of Surgery, Division of Vascular Surgery, Tucson, AZ
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Sundman MH, Avila De Vault BE, Chen AYC, Madhavan L, Fuglevand AJ, Chou YH. The (hyper)excitable brain: what can a ubiquitous TMS measure reveal about cognitive aging? Neurobiol Aging 2023; 132:250-252. [PMID: 37827912 PMCID: PMC10982121 DOI: 10.1016/j.neurobiolaging.2023.09.007] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Mark H Sundman
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, AZ, USA
| | | | - Allison Yu-Chin Chen
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Lalitha Madhavan
- Departments of Neurology and Molecular and Cellular Biology, College of Medicine, University of Arizona, Tucson, AZ, USA; Evelyn F McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, AZ, USA
| | - Andrew J Fuglevand
- Departments of Physiology and Neuroscience, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Ying-Hui Chou
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, AZ, USA; Evelyn F McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, AZ, USA.
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Li ST, Chou YH, Huang HJ, Chang HC, Lee YC. Exploring the Benefits of 3D-Printed Bolus in Cone Beam CT for Modified Radical Mastectomy Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e685. [PMID: 37786014 DOI: 10.1016/j.ijrobp.2023.06.2152] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To improve the accuracy of superficial dose coverage for patients undergoing modified radical mastectomy (MRM), boluses are frequently applied to the skin surface of targeted region during radiotherapy. The irregular curvature of MRM breast cases results in discrepancies of dosimetry and poor contact. Additionally, the presence of an air gap causes unnecessary high-dose escalation and uncertainty in dose calculation, making the use of commercial flat bolus problematic. This study evaluated the effectiveness of 3D-printed bolus by comparing it to commercial bolus in setup variations and dosimetric compliance through daily cone-beam computed tomography (CBCT) scans. MATERIALS/METHODS Ten patients underwent MRM were divided into 2 groups. 5 patients treated with 0.5 cm commercial bolus as group A while the other 5 patients covered by 3D Bolus as group B. 3D bolus was made of polylactic acid filament (PLA) and contoured in advance with thickness of 0.5 cm on the surface of target. Positional errors were recorded through daily image guidance and compared with the images. Both groups had right-sided breast with neck lymph nodes involved and received 50 Gy in 25 fractions using 4 partial arcs of the volumetric modulated arc therapy (VMAT) technique. The CBCTs were recalculated through treatment planning system (TPS) to assess superficial dose coverage. A two-tailed student's t-test was applied. RESULTS Groups A and B pitch angles were -0.203 ± 0.837° and 0.334 ± 0.909° (p = 0.0003). Roll angle were 0.313 ± 0.728° and -0.633 ± 1.286° (p = 0.0000013). Yaw angle were -0.034 ± 0.872° and 0.018 ± 0.883° (p = 0.721). There was a trend of differences in the Z-axis and significant statistical differences in the pitch and roll angles due to aligning gel layers directly with group A's body surface, while 3D bolus rigidly adherence to group B's delineated curve. In the planned target volume (PTV), the CI and HI of group A were 0.9448±0.0208 and 1.2061±0.0448, respectively, while 0.9776±0.0144 and 1.1472±0.0206 (p<0.005) were for group B. As for the superficial region, which is defined from body surface to 0.5cm inside PTV, CI and HI of A were 0.8290±0.0599 and 1.4675±0.2434, while for B, they were 0.9753±0.0214 and 1.1330±0.0126, respectively (p<0.005). CONCLUSION The study analyzed the results through image comparison and investigated the CI and HI between two types of boluses. The 3D bolus reduces setup errors and improves dose coverage especially when superficial region is concerned. Better consistency of patient repositioning and dosimetry can be achieved and proved by daily assessment of CBCT scan. The customization of 3D bolus with integration of TPS and CT scans provides a solution to the inadequacies of commercial bolus. The results suggest that the use of 3D bolus is a promising development in radiation therapy for MRM breast cancer patients.
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Affiliation(s)
- S T Li
- Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Y H Chou
- Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - H J Huang
- Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - H C Chang
- Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Y C Lee
- Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
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Chou YH, Hsia JY, Kao PF, Chang BJ, Lu XP, Liao YH, Chiang KT, Shen WC. Predicting Treatment Response of Esophageal Cancer Treated by Concurrent Chemoradiotherapy Using Pre- and Posttreatment 18F-FDG PET Metabolic Characteristics. Int J Radiat Oncol Biol Phys 2023; 117:e462-e463. [PMID: 37785479 DOI: 10.1016/j.ijrobp.2023.06.1661] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) This study hypothesizes that metabolic characteristics of esophageal tumors can be used to predict treatment response, which considers changes in the primary tumor and lymph nodes, for patients receiving neoadjuvant concurrent chemoradiotherapy (CCRT). MATERIALS/METHODS This study retrospectively included 60 esophageal cancer patients receiving CCRT followed by surgery. All patients received 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) examinations prior to CCRT and in the interval between CCRT and surgery. On the pre-treatment FDG PET/CT images, the maximum standardized uptake value (SUVMaxPre) within the primary tumor was identified. By computerized methods, the CT images of pre- and post-treatment FDG PET/CT were registered. Then, the coordinates of SUVMaxPre were transformed to the post-treatment FDG PET images and delineated a sphere with a diameter of 5 cm to indicate the tumor position. After excluding air, the sphere was partitioned into several metabolic volumes by the optimal dichotomy of high and low metabolic FDG uptakes. Finally, the volume with the shortest distance to the center was adopted and represented by the maximum standardized uptakes (SUVMaxPost). Two additional features, SUVDiff and SUVDiffR, were defined as SUVMaxPost - SUVMaxPre and (SUVMaxPost - SUVMaxPre) / SUVMaxPre. Besides, for defining treatment response, the patients with and without residual tumors were defined as ypT+ and ESOCR based on the histopathology results of surgery. The ESOCR was further classified into pCR to indicate the absence of lymph node metastasis and LNM for remaining. Finally, the area under the receiver operating characteristic curve analysis (AUC) was conducted to assess the features' ability to differentiate two treatment responses. Kruskal-Wallis test was used to evaluate the differences in features between treatment responses. RESULTS Of the 60 patients, 55 were men (92%), and the mean age was 58. The number of tumors at the esophagus's upper, middle, and lower third were 8, 18, and 34, respectively. Ninety-eight percent of the tumors were squamous cell carcinomas (59/60). The patient numbers of ypT+ and ESOCR were 43 and 17 of which contained 13 pCR and 4 LNM. The SUVDiff and SUVDiffR exhibited a significant ability to identify the ESOCR with AUC = .337 (p = .05) and AUC = .290 (p = .012), respectively. In addition, a statistically significant difference was found among the three groups of ypT+, pCR, and LNM on SUVMaxPre (H = 6.252 and p = .044), SUVDiff (H = 7.948 and p = .019), and SUVDiffR (H = 8.405 and p = .015). In the post-hoc tests corrected by the Bonferroni, the difference between ypT+ and LNM was significant on these features. CONCLUSION The metabolic characteristics extracted from pre- and post-treatment FDG PET/CT images could indicate treatment response and disease progression. Further studies are warranted.
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Affiliation(s)
- Y H Chou
- Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
| | - J Y Hsia
- Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - P F Kao
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Nuclear Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - B J Chang
- Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - X P Lu
- Department of Nuclear Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Y H Liao
- Artificial Intelligence Center, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - K T Chiang
- Artificial Intelligence Center, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - W C Shen
- Artificial Intelligence Center, Chung Shan Medical University Hospital, Taichung, Taiwan
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Succar B, Chou YH, Hsu CH, Rapcsak S, Trouard T, Zhou W. Cognitive effects of carotid revascularization in octogenarians. Surgery 2023; 174:1078-1082. [PMID: 37550167 PMCID: PMC10528540 DOI: 10.1016/j.surg.2023.07.010] [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: 02/10/2023] [Revised: 06/01/2023] [Accepted: 07/08/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Cognitive impairment is the epitome of cerebrovascular diseases, causing a significant economic burden on our health care system. Growing evidence has indicated the benefits of carotid interventions in patients with severe carotid atherosclerosis. However, the neurocognitive outcome of carotid revascularization in octogenarians is not clearly understood. We aim to evaluate postintervention cognitive changes in seniors older than 80 years. METHODS We prospectively recruited 170 patients undergoing carotid interventions. Neurocognitive testing was performed preoperatively and at 1, 6, and 12 months postoperatively. Episodic memory was assessed with Rey's Auditory Verbal Learning Test. Other executive functions and language measures were also evaluated at individual time points. Raw test scores were converted to z-scores or scaled scores adjusted for age and education. The sample was divided into 2 groups based on age: octogenarian (≥80 years) and nonoctogenarian (<80 years old). Postoperative cognitive scores were compared to baseline within each subcohort. RESULTS A total of 23 subjects (13%) were octogenarians, and 147 (87%) were younger than 80 years. Younger patients demonstrated significant cognitive improvements up to 12 months postop compared to the baseline. However, octogenarians exhibited a lack of improvement in verbal memory, measures of executive function, and language at all 3 postintervention time points. CONCLUSION Carotid interventions improve cognitive functions in younger patients with carotid occlusive atherosclerosis. However, no cognitive benefits were seen in male seniors older than 80 years. Further investigations are warranted to better understand the postinterventional cognitive changes in octogenarians.
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Affiliation(s)
- Bahaa Succar
- Department of Surgery, Division of Vascular Surgery, The University of Arizona, Tucson, AZ
| | - Ying-Hui Chou
- Department of Psychiatry, The University of Arizona, Tucson, AZ
| | - Chiu-Hsieh Hsu
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ
| | - Steven Rapcsak
- Department of Psychiatry, The University of Arizona, Tucson, AZ
| | - Theodore Trouard
- Department of Biomedical Imaging, The University of Arizona, Tucson, AZ
| | - Wei Zhou
- Department of Surgery, Division of Vascular Surgery, The University of Arizona, Tucson, AZ.
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Kuo PH, Chen AYC, Rodriguez RJ, Stuehm C, Chalasani P, Chen NK, Chou YH. Transcranial Magnetic Stimulation for the Treatment of Chemo Brain. Sensors (Basel) 2023; 23:8017. [PMID: 37836847 PMCID: PMC10575384 DOI: 10.3390/s23198017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/04/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023]
Abstract
This pilot feasibility study aimed to evaluate the effects of transcranial magnetic stimulation (TMS) on chemotherapy-related cognitive impairment (CRCI), and we report here on the first patient. BACKGROUND Deleterious cognitive changes due to chemotherapy or CRCI are commonly referred to as "chemo brain". With the increasing survival of cancer patients, this poorly understood and inadequately treated condition will likewise have an increasing toll on individuals and society. Since there is no approved treatment for chemo brain, we have initiated a therapeutic trial using transcranial magnetic stimulation (TMS), a non-invasive brain stimulation technique approved in many countries for the treatment of neurologic and psychiatric conditions like migraine and depression. CASE PRESENTATION A 58-year-old woman, diagnosed 7 years prior with left breast cancer, underwent partial mastectomy with sentinel lymph node biopsy. She then received four cycles of adjuvant chemotherapy followed by radiation therapy. Afterwards, she was on tamoxifen for 4 years and then switched to aromatase inhibitors. The patient's CRCI started during chemotherapy and severely impaired her quality of life for an additional two years. In the third year after chemotherapy, the CRCI partially cleared to stabilize to the level at the time of presentation for this trial. The patient continues to have memory difficulties and decreased concentration, which makes multi-tasking very difficult to impossible. She is reliant on memory aids at work and at home. The participant underwent 10 consecutive sessions of TMS during weekdays for 2 weeks. Stimulation was directed to the left dorsolateral prefrontal cortex. After TMS, the participant significantly improved in memory function on neuropsychological testing. While she reported no subjective differences in concentration or memory, she did report an improvement in her sleep. Functional magnetic resonance imaging of the brain before and after TMS showed increased resting-state functional connectivity between the stimulation site and several brain regions. Remarkably, after 6 years of chemo brain and remaining in the same position at work due to her inability to concentrate and multi-task, she applied for and received a promotion 5-6 months after her TMS treatments. CONCLUSIONS This first patient in the phase 1 clinical trial testing of TMS for the treatment of "chemo brain" provided important lessons for feasibility and insights into mechanisms of potential benefit.
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Affiliation(s)
- Phillip H. Kuo
- Departments of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, AZ 85721, USA
| | - Allison Yu-Chin Chen
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, AZ 85721, USA;
| | | | - Carol Stuehm
- Department of Medical Imaging, University of Arizona, Tucson, AZ 85721, USA;
| | - Pavani Chalasani
- Division of Hematology-Oncology, George Washington Cancer Center, Washington, DC 20037, USA;
| | - Nan-Kuei Chen
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85721, USA;
| | - Ying-Hui Chou
- Brain Imaging and TMS Laboratory, Department of Psychology, Evelyn F McKnight Brain Institute, Arizona Center on Aging, BIO5 Institute, University of Arizona, Tucson, AZ 85721, USA;
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Chou YH, Lee YN, Su CH, Yeh HI, Wu YJ. AD-9308 ameliorates the impacts of 4-HNE on the progress of pulmonary arterial hypertension in aldehyde dehydrogenase 2*1*2 knock-in mice. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.3062] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Endothelial dysfunctions play a critical role on the development of pulmonary arterial hypertension (PAH). It has been reported that the one-year mortality rate is still up to 15% even with PAH-targeted therapy, implying that there may be untargeted pathways. 4-hydroxynenonal (4-HNE), an unsaturated aldehyde, is highly induced in the lungs of PAH animals and its serum levels were also reported to be higher in PAH patients. 4-HNE is metabolized by mitochondrial aldehyde dehydrogenase (ALDH2), which is dysfunctional in near 40% of East Asian people. Currently, the impacts of 4-HNE on endothelial dysfunctions in the development of PAH are unclear. In terms of translational medicine, we proposed that modulation of 4-HNE level may alleviate the progress of PAH patients with ALDH2 deficiency.
We found that 4-HNE alone was not sufficient to induce pulmonary artery endothelial cell (PAEC) functional changes, including proliferation, migration and tube formation, whereas their effects emerge from the depletion of ALDH2. We further mimicked human ALDH2 functional deficiency by using daidzin (DZN), an inhibitor which is able to block the substrate binding site of ALDH2. ALDH2 functional inhibition alone did not induce any PAEC functional change, while an add-on of 4-HNE impaired PAEC functions. In addition, 4-HNE significantly reduced eNOS activity with combined DZN treatment. Consistent with the mechanism of ALDH2 activity-mediated angiogensis, ALDH2 enhancers Alda-1 and AD-5591 completely reverse the anti-angiogenic effects of 4-HNE in the presence of DZN. To further confirm whether ALDH2 functional deficiency impact on PAH development in mammals, heterozygous ALDH2*1/*2 transgenic and wild-type mice were subjected to chronic hypoxia to induce PAH. ALDH2*1/*2 transgenic mice had similar right ventricular systolic pressure (RVSP) as wild-type mice. However, after exposure to chronic hypoxia, ALDH2*1/*2 transgenic mice indeed developed a significantly higher RVSP than that in wild-type mice. Furthermore, we demonstrated that 4-HNE expression was profoundly enhanced in ALDH2*1/*2 transgenic mice by chronic hypoxia-induced PAH with pulmonary artery smooth muscle cell hyperplasia. More importantly, we found that AD-9308, an enhancer of ALDH2 significantly decreased hypoxia-induced RVSP elevation in heterozygous ALDH2*1/*2 transgenic mice.
Taken together, our data demonstrate that 4-HNE and ALDH2 functional deficiency potentially contribute to PAH development and worsening, and that ALDH2 enhancers may be promising as a PAH adjunct therapy, particularly for patients with ALDH2 nonfunctional alleles.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Technology, Taiwan
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Affiliation(s)
- Y H Chou
- Mackay Medical College, Institute of Biomedical Sciences , New Taipei , Taiwan
| | - Y N Lee
- Mackay Memorial Hospital, Departments of Medical Research , Taipei , Taiwan
| | - C H Su
- Mackay Memorial Hospital, Cardiovascular Center , Taipei , Taiwan
| | - H I Yeh
- Mackay Memorial Hospital, Cardiovascular Center , Taipei , Taiwan
| | - Y J Wu
- Mackay Medical College, Department of Medicine , New Taipei , Taiwan
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11
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Zhou W, Succar B, Murphy DP, Ashouri Y, Chou YH, Hsu CH, Rapcsak S, Trouard T. Carotid Intervention Improves Cognitive Function in Patients With Severe Atherosclerotic Carotid Disease. Ann Surg 2022; 276:539-544. [PMID: 35972513 PMCID: PMC9387545 DOI: 10.1097/sla.0000000000005555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Carotid revascularization procedures are effective in stroke prevention in appropriately selected patients. We sought to understand the effects of the carotid intervention on cognitive function in a well-defined cohort of prospectively recruited patients. METHODS A total of 170 consecutive patients undergoing carotid intervention for severe carotid stenosis were recruited. Patients received neuropsychometric testing preintervention, and at 1, 6, and 12 months postoperative. Patients were screened with the Mini-Mental State Examination. Rey Auditory Verbal Learning test (RAVLT) test was the primary outcome measure and multiple cognitive tests were used to evaluate executive function. Paired t test and McNemar test were performed to compare age-adjusted and education-adjusted postoperative scores at the individual time point with the preoperative scores. RESULTS Our patients had a high prevalence of cardiovascular risks and 51.2% of whom were symptomatic. The usages of statin and antiplatelet were high (88.8% and 69.4%, respectively). A total of 140 patients had 1 or more postoperative neuropsychometric tests in addition to their preoperative tests were included. The average RAVLT preoperative score was lower ( z =-0.79, SD=1.3, confidence interval: -1 to -0.53) than the age-adjusted norm. We observed a significant improvement in RAVLT memory scores at 1 and 6 months postoperative compared with preoperative. We also observed significant improvement in multiple executive functions measures up to 12 months postoperative. The improvement on patients with preoperative stroke symptoms was less consistent. CONCLUSIONS This prospective study showed that carotid intervention improved memory and executive function in patients with the severe carotid occlusive disease. It highlights the cognitive benefit of the carotid intervention in appropriately selected patients.
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Affiliation(s)
- Wei Zhou
- Department of Surgery, University of Arizona, Tucson, AZ
| | - Bahaa Succar
- Department of Surgery, University of Arizona, Tucson, AZ
| | - Devin P Murphy
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ
| | - Yazan Ashouri
- Department of Surgery, University of Arizona, Tucson, AZ
| | - Ying-Hui Chou
- Department of Psychiatry, University of Arizona, Tucson, AZ
| | - Chiu-Hsieh Hsu
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Steven Rapcsak
- Department of Psychiatry, University of Arizona, Tucson, AZ
| | - Theodore Trouard
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ
- Department of Biomedical Imaging, University of Arizona, Tucson, AZ
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12
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Chou YH, Sundman M, Ton That V, Green J, Trapani C. Cortical excitability and plasticity in Alzheimer's disease and mild cognitive impairment: A systematic review and meta-analysis of transcranial magnetic stimulation studies. Ageing Res Rev 2022; 79:101660. [PMID: 35680080 DOI: 10.1016/j.arr.2022.101660] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 09/29/2021] [Revised: 05/13/2022] [Accepted: 05/30/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation technique. When stimulation is applied over the primary motor cortex and coupled with electromyography measures, TMS can probe functions of cortical excitability and plasticity in vivo. The purpose of this meta-analysis is to evaluate the utility of TMS-derived measures for differentiating patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) from cognitively normal older adults (CN). METHODS Databases searched included PubMed, Embase, APA PsycInfo, Medline, and CINAHL Plus from inception to July 2021. RESULTS Sixty-one studies with a total of 2728 participants (1454 patients with AD, 163 patients with MCI, and 1111 CN) were included. Patients with AD showed significantly higher cortical excitability, lower cortical inhibition, and impaired cortical plasticity compared to the CN cohorts. Patients with MCI exhibited increased cortical excitability and reduced plasticity compared to the CN cohort. Additionally, lower cognitive performance was significantly associated with higher cortical excitability and lower inhibition. No seizure events due to TMS were reported, and the mild adverse response rate is approximately 3/1000 (i.e., 9/2728). CONCLUSIONS Findings of our meta-analysis demonstrate the potential of using TMS-derived cortical excitability and plasticity measures as diagnostic biomarkers and therapeutic targets for AD and MCI.
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Affiliation(s)
- Ying-Hui Chou
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA; Evelyn F McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, USA.
| | - Mark Sundman
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA
| | - Viet Ton That
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA
| | - Jacob Green
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA
| | - Chrisopher Trapani
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA
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13
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Neill M, Fisher JM, Brand C, Lei H, Sherman SJ, Chou YH, Kuo PH. Practical Application of DaTQUANT with Optimal Threshold for Diagnostic Accuracy of Dopamine Transporter SPECT. Tomography 2021; 7:980-989. [PMID: 34941653 PMCID: PMC8706562 DOI: 10.3390/tomography7040081] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/28/2021] [Accepted: 12/10/2021] [Indexed: 12/11/2022] Open
Abstract
Evaluation of Parkinsonian Syndromes (PS) with Ioflupane iodine-123 dopamine transporter single photon emission computed tomography (DaT-SPECT), in conjunction with history and clinical examination, aids in diagnosis. FDA-approved, semi-quantitative software, DaTQUANTTM (GE Healthcare, Chicago, IL, USA) is available to assist in interpretation. This study aims to evaluate the optimal variables and thresholds of DaTQUANT to yield the optimal diagnostic accuracy. It is a retrospective review with three different patient populations. DaT-SPECT images from all three study groups were evaluated using DaTQUANTTM software, and both single and multi-variable logistic regression were used to model PS status. The optimal models were chosen via accuracy, sensitivity, and specificity, then evaluated on the other study groups. Among single variable models, the posterior putamen yielded the highest accuracy (84% to 95%), while balancing sensitivity and specificity. Multi-variable models did not substantially improve the accuracy. When the optimal single variable models for each group were used to evaluate the remaining two groups, comparable results were achieved. In typical utilization of DaT-SPECT for differentiation between nigrostriatal degenerative disease (NSDD) and non-NSDD, the posterior putamen was the single variable that yielded the highest accuracy across three different patient populations. The posterior putamen’s recommended thresholds for DaTQUANT are SBR ≤ 1.0, z-score of ≤−1.8 and percent deviation ≤ −0.34.
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Affiliation(s)
- Matthew Neill
- Department of Medical Imaging, University of Arizona, Tucson, AZ 85724, USA;
| | - Julia M. Fisher
- Statistics Consulting Laboratory, BIO5 Institute, University of Arizona, Tucson, AZ 85721, USA;
| | | | - Hong Lei
- Department of Neurology, University of Arizona, Tucson, AZ 85724, USA; (H.L.); (S.J.S.)
| | - Scott J. Sherman
- Department of Neurology, University of Arizona, Tucson, AZ 85724, USA; (H.L.); (S.J.S.)
| | - Ying-Hui Chou
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA;
| | - Phillip H. Kuo
- Departments of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, AZ 85724, USA
- Correspondence:
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14
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Grijalva C, Toosizadeh N, Sindorf J, Chou YH, Laksari K. Dual-task performance is associated with brain MRI Morphometry in individuals with mild cognitive impairment. J Neuroimaging 2021; 31:588-601. [PMID: 33783915 DOI: 10.1111/jon.12845] [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: 11/13/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND PURPOSE Cognitive impairment is a critical health problem in the elderly population. Research has shown that patients with mild cognitive impairment (MCI) may develop dementia in later years. Therefore, early identification of MCI could allow for interventions to help delay the progression of this devastating disease. Our objective in this study was to detect the early presence of MCI in elderly patients via neuroimaging and dual-task performance. METHODS Brain MRI scans from 21 older adult volunteers, including cognitively healthy adults (HA, n = 9, age = 68-79 years) and mild cognitively impaired (MCI, n = 12, age = 66-92 years) were analyzed using automatic segmentation techniques. Regional volume, surface area, and thickness measures were correlated with simultaneous performance of motor and cognitive tasks (dual-task) within a novel upper-extremity function (UEF) test, using multivariate analysis of variance models. RESULTS We found significant associations of dual-task performance with volume of five cortical brain regions (P ≤ .048) and thickness of 13 regions (P ≤ .043) within the frontal, temporal, and parietal lobes. There was a significant interaction effect of cognitive group on dual-task score for the inferior temporal gyrus volume (P ≤ .034), and the inferior parietal lobule, inferior temporal gyrus, and middle temporal gyrus average thickness (P ≤ .037). CONCLUSIONS This study highlighted the potential of dual-tasking and MRI morphometric changes as a simple and accurate tool for early detection of cognitive impairment among community-dwelling older adults. The strong interaction effects of cognitive group on UEF dual-task score suggest higher association between atrophy of these brain structures and compromised dual-task performance among the MCI group.
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Affiliation(s)
- Carissa Grijalva
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ
| | - Nima Toosizadeh
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ.,Arizona Center on Aging, Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ.,Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona, Tucson, AZ
| | - Jacob Sindorf
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ
| | - Ying-Hui Chou
- Department of Psychology, University of Arizona, Tucson, AZ
| | - Kaveh Laksari
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ.,Department of Aerospace and Mechanical Engineering, University of Arizona, Tucson, AZ
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15
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Sundman MH, Lim K, Ton That V, Mizell JM, Ugonna C, Rodriguez R, Chen NK, Fuglevand AJ, Liu Y, Wilson RC, Fellous JM, Rapcsak S, Chou YH. Transcranial magnetic stimulation reveals diminished homoeostatic metaplasticity in cognitively impaired adults. Brain Commun 2020; 2:fcaa203. [PMID: 33376989 PMCID: PMC7750948 DOI: 10.1093/braincomms/fcaa203] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 03/30/2020] [Revised: 09/22/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022] Open
Abstract
Homoeostatic metaplasticity is a neuroprotective physiological feature that counterbalances Hebbian forms of plasticity to prevent network destabilization and hyperexcitability. Recent animal models highlight dysfunctional homoeostatic metaplasticity in the pathogenesis of Alzheimer's disease. However, the association between homoeostatic metaplasticity and cognitive status has not been systematically characterized in either demented or non-demented human populations, and the potential value of homoeostatic metaplasticity as an early biomarker of cognitive impairment has not been explored in humans. Here, we report that, through pre-conditioning the synaptic activity prior to non-invasive brain stimulation, the association between homoeostatic metaplasticity and cognitive status could be established in a population of non-demented human subjects (older adults across cognitive spectrums; all within the non-demented range). All participants (n = 40; age range, 65-74, 47.5% female) underwent a standardized neuropsychological battery, magnetic resonance imaging and a transcranial magnetic stimulation protocol. Specifically, we sampled motor-evoked potentials with an input/output curve immediately before and after repetitive transcranial magnetic stimulation to assess neural plasticity with two experimental paradigms: one with voluntary muscle contraction (i.e. modulated synaptic activity history) to deliberately introduce homoeostatic interference, and one without to serve as a control condition. From comparing neuroplastic responses across these experimental paradigms and across cohorts grouped by cognitive status, we found that (i) homoeostatic metaplasticity is diminished in our cohort of cognitively impaired older adults and (ii) this neuroprotective feature remains intact in cognitively normal participants. This novel finding suggests that (i) future studies should expand their scope beyond just Hebbian forms of plasticity that are traditionally assessed when using non-invasive brain stimulation to investigate cognitive ageing and (ii) the potential value of homoeostatic metaplasticity in serving as a biomarker for cognitive impairment should be further explored.
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Affiliation(s)
- Mark H Sundman
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | - Koeun Lim
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | - Viet Ton That
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | | | - Chidi Ugonna
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85721, USA
- Department of Medical Imaging, University of Arizona, Tucson, AZ 85721, USA
| | - Rudolph Rodriguez
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | - Nan-Kuei Chen
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85721, USA
- Department of Medical Imaging, University of Arizona, Tucson, AZ 85721, USA
| | - Andrew J Fuglevand
- Department of Physiology, College of Medicine, University of Arizona, Tucson, AZ 85721, USA
- Department of Neuroscience, College of Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Yilin Liu
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | - Robert C Wilson
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | - Jean-Marc Fellous
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85721, USA
| | - Steven Rapcsak
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
- Department of Neurology, University of Arizona, Tucson, AZ 85721, USA
| | - Ying-Hui Chou
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
- Evelyn F. McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, AZ 85721, USA
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16
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Zhou W, Black J, Wheeler G, Nisson P, Hsu CH, Chou YH, Guzman G, Trouard T. Size and Location of Subclinical Microinfarcts Affect Their Cognitive Effects. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.04.043] [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: 11/27/2022]
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17
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Chou YH, Ton That V, Chen AYC, Sundman M, Huang YZ. TMS-induced seizure cases stratified by population, stimulation protocol, and stimulation site: A systematic literature search. Clin Neurophysiol 2020; 131:1019-1020. [PMID: 32193163 DOI: 10.1016/j.clinph.2020.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Ying-Hui Chou
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA; Everlyn F McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, USA.
| | - Viet Ton That
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA
| | - Allison Yu-Chin Chen
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA
| | - Mark Sundman
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA
| | - Ying-Zu Huang
- Neuroscience Research Center, Healthy Ageing Research Center and Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
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18
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Chou YH, Ton That V, Sundman M. A systematic review and meta-analysis of rTMS effects on cognitive enhancement in mild cognitive impairment and Alzheimer's disease. Neurobiol Aging 2020; 86:1-10. [PMID: 31783330 DOI: 10.1016/j.neurobiolaging.201908.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/06/2019] [Accepted: 08/21/2019] [Indexed: 05/26/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS), a noninvasive brain stimulation technique, has emerged as a promising treatment for mild cognitive impairment (MCI) and Alzheimer's disease (AD). Currently, however, the effectiveness of this therapy is unclear because of the low statistical power and heterogeneity of previous trials. The purpose of the meta-analysis was to systematically characterize the effectiveness of various combinations of rTMS parameters on different cognitive domains in patients with MCI and AD. Thirteen studies comprising 293 patients with MCI or AD were included in this analysis. Random-effects analysis revealed an overall medium-to-large effect size (0.77) favoring active rTMS over sham rTMS in the improvement of cognitive functions. Subgroup analyses revealed that (1) high-frequency rTMS over the left dorsolateral prefrontal cortex and low-frequency rTMS at the right dorsolateral prefrontal cortex significantly improved memory functions; (2) high-frequency rTMS targeting the right inferior frontal gyrus significantly enhanced executive performance; and (3) the effects of 5-30 consecutive rTMS sessions could last for 4-12 weeks. Potential mechanisms of rTMS effects on cognitive functions are discussed.
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Affiliation(s)
- Ying-Hui Chou
- Department of Psychology, Brain Imaging and TMS Laboratory, University of Arizona, Tucson, USA; Everlyn F McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, USA.
| | - Viet Ton That
- Department of Psychology, Brain Imaging and TMS Laboratory, University of Arizona, Tucson, USA
| | - Mark Sundman
- Department of Psychology, Brain Imaging and TMS Laboratory, University of Arizona, Tucson, USA
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19
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Warren SM, Chou YH, Steklis HD. Potential for Resting-State fMRI of the Amygdala in Elucidating Neural Mechanisms of Adaptive Self-Regulatory Strategies: A Systematic Review. Brain Connect 2020; 10:3-17. [PMID: 31950847 DOI: 10.1089/brain.2019.0700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Evolutionary-developmental theories consider the evolved mechanisms underlying adaptive behavioral strategies shaped in response to early environmental cues. Identifying neural mechanisms mediating processes of conditional adaptation in humans is an active area of research. Resting-state functional magnetic resonance imaging (RS-fMRI) captures functional connectivity theorized to represent the underlying functional architecture of the brain. This allows for investigating how underlying functional brain connections are related to early experiences during development, as well as current traits and behaviors. This review explores the potential of RS-fMRI of the amygdala (AMY) for advancing research on the neural mechanisms underlying adaptive strategies developed in early adverse environments. RS-fMRI studies of early life stress (ELS) and AMY functional connectivity within the frame of evolutionary theories are reviewed, specifically regarding the development of self-regulatory strategies. The potential of RS-fMRI for investigating the effects of ELS on developmental trajectories of self-regulation is discussed.
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Affiliation(s)
- Shannon M Warren
- Norton School of Family & Consumer Sciences, The University of Arizona, Tucson, Arizona
| | - Ying-Hui Chou
- Department of Psychology, Graduate Interdisciplinary Program in Cognitive Science, Arizona Center on Aging, BIO5 Institute, Evelyn F. McKnight Brain Institute, The University of Arizona, Tucson, Arizona
| | - Horst Dieter Steklis
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, Arizona
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20
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Chou YH, Ton That V, Sundman M. A systematic review and meta-analysis of rTMS effects on cognitive enhancement in mild cognitive impairment and Alzheimer's disease. Neurobiol Aging 2019; 86:1-10. [PMID: 31783330 DOI: 10.1016/j.neurobiolaging.2019.08.020] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [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: 05/04/2019] [Revised: 08/06/2019] [Accepted: 08/21/2019] [Indexed: 12/23/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS), a noninvasive brain stimulation technique, has emerged as a promising treatment for mild cognitive impairment (MCI) and Alzheimer's disease (AD). Currently, however, the effectiveness of this therapy is unclear because of the low statistical power and heterogeneity of previous trials. The purpose of the meta-analysis was to systematically characterize the effectiveness of various combinations of rTMS parameters on different cognitive domains in patients with MCI and AD. Thirteen studies comprising 293 patients with MCI or AD were included in this analysis. Random-effects analysis revealed an overall medium-to-large effect size (0.77) favoring active rTMS over sham rTMS in the improvement of cognitive functions. Subgroup analyses revealed that (1) high-frequency rTMS over the left dorsolateral prefrontal cortex and low-frequency rTMS at the right dorsolateral prefrontal cortex significantly improved memory functions; (2) high-frequency rTMS targeting the right inferior frontal gyrus significantly enhanced executive performance; and (3) the effects of 5-30 consecutive rTMS sessions could last for 4-12 weeks. Potential mechanisms of rTMS effects on cognitive functions are discussed.
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Affiliation(s)
- Ying-Hui Chou
- Department of Psychology, Brain Imaging and TMS Laboratory, University of Arizona, Tucson, USA; Everlyn F McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, USA.
| | - Viet Ton That
- Department of Psychology, Brain Imaging and TMS Laboratory, University of Arizona, Tucson, USA
| | - Mark Sundman
- Department of Psychology, Brain Imaging and TMS Laboratory, University of Arizona, Tucson, USA
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21
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Chen NK, Chou YH, Sundman M, Hickey P, Kasoff WS, Bernstein A, Trouard TP, Lin T, Rapcsak SZ, Sherman SJ, Weingarten CP. Alteration of Diffusion-Tensor Magnetic Resonance Imaging Measures in Brain Regions Involved in Early Stages of Parkinson's Disease. Brain Connect 2019; 8:343-349. [PMID: 29877094 DOI: 10.1089/brain.2017.0558] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 11/12/2022] Open
Abstract
Many nonmotor symptoms (e.g., hyposmia) appear years before the cardinal motor features of Parkinson's disease (PD). It is thus desirable to be able to use noninvasive brain imaging methods, such as magnetic resonance imaging (MRI), to detect brain abnormalities in early PD stages. Among the MRI modalities, diffusion-tensor imaging (DTI) is suitable for detecting changes in brain tissue structure due to neurological diseases. The main purpose of this study was to investigate whether DTI signals measured from brain regions involved in early stages of PD differ from those of healthy controls. To answer this question, we analyzed whole-brain DTI data of 30 early-stage PD patients and 30 controls using improved region of interest-based analysis methods. Results showed that (i) the fractional anisotropy (FA) values in the olfactory tract (connected with the olfactory bulb: one of the first structures affected by PD) are lower in PD patients than healthy controls; (ii) FA values are higher in PD patients than healthy controls in the following brain regions: corticospinal tract, cingulum (near hippocampus), and superior longitudinal fasciculus (temporal part). Experimental results suggest that the tissue property, measured by FA, in olfactory regions is structurally modulated by PD with a mechanism that is different from other brain regions.
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Affiliation(s)
- Nan-Kuei Chen
- 1 Department of Biomedical Engineering, University of Arizona , Tucson, Arizona.,2 Department of Medical Imaging, University of Arizona , Tucson, Arizona.,3 Arizona Center on Aging, University of Arizona , Tucson, Arizona.,4 Brain Imaging and Analysis Center, Duke University Medical Center , Durham, North Carolina.,5 Department of Radiology, Duke University Medical Center , Durham, North Carolina.,6 BIO5 Institute, University of Arizona , Tucson, Arizona
| | - Ying-Hui Chou
- 3 Arizona Center on Aging, University of Arizona , Tucson, Arizona.,7 Department of Psychology, University of Arizona , Tucson, Arizona.,8 Cognitive Science Program, University of Arizona , Tucson, Arizona
| | - Mark Sundman
- 7 Department of Psychology, University of Arizona , Tucson, Arizona
| | - Patrick Hickey
- 9 Department of Neurology, Kaiser Permanente, Los Angeles, California
| | - Willard S Kasoff
- 10 Division of Neurosurgery, Department of Surgery, University of Arizona , Tucson, Arizona.,11 Department of Neurology, University of Arizona , Tucson, Arizona
| | - Adam Bernstein
- 1 Department of Biomedical Engineering, University of Arizona , Tucson, Arizona
| | - Theodore P Trouard
- 1 Department of Biomedical Engineering, University of Arizona , Tucson, Arizona.,2 Department of Medical Imaging, University of Arizona , Tucson, Arizona.,6 BIO5 Institute, University of Arizona , Tucson, Arizona.,12 Evelyn F McKnight Brain Institute, University of Arizona , Tucson, Arizona
| | - Tanya Lin
- 11 Department of Neurology, University of Arizona , Tucson, Arizona.,13 Department of Neurology, Southern Arizona VA Health Care System , Tucson, Arizona
| | - Steven Z Rapcsak
- 11 Department of Neurology, University of Arizona , Tucson, Arizona
| | - Scott J Sherman
- 11 Department of Neurology, University of Arizona , Tucson, Arizona
| | - Carol P Weingarten
- 4 Brain Imaging and Analysis Center, Duke University Medical Center , Durham, North Carolina.,14 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center , Durham, North Carolina
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22
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Sundman MH, Chen NK, Subbian V, Chou YH. The bidirectional gut-brain-microbiota axis as a potential nexus between traumatic brain injury, inflammation, and disease. Brain Behav Immun 2017; 66:31-44. [PMID: 28526435 DOI: 10.1016/j.bbi.2017.05.009] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/25/2017] [Accepted: 05/10/2017] [Indexed: 02/06/2023] Open
Abstract
As head injuries and their sequelae have become an increasingly salient matter of public health, experts in the field have made great progress elucidating the biological processes occurring within the brain at the moment of injury and throughout the recovery thereafter. Given the extraordinary rate at which our collective knowledge of neurotrauma has grown, new insights may be revealed by examining the existing literature across disciplines with a new perspective. This article will aim to expand the scope of this rapidly evolving field of research beyond the confines of the central nervous system (CNS). Specifically, we will examine the extent to which the bidirectional influence of the gut-brain axis modulates the complex biological processes occurring at the time of traumatic brain injury (TBI) and over the days, months, and years that follow. In addition to local enteric signals originating in the gut, it is well accepted that gastrointestinal (GI) physiology is highly regulated by innervation from the CNS. Conversely, emerging data suggests that the function and health of the CNS is modulated by the interaction between 1) neurotransmitters, immune signaling, hormones, and neuropeptides produced in the gut, 2) the composition of the gut microbiota, and 3) integrity of the intestinal wall serving as a barrier to the external environment. Specific to TBI, existing pre-clinical data indicates that head injuries can cause structural and functional damage to the GI tract, but research directly investigating the neuronal consequences of this intestinal damage is lacking. Despite this void, the proposed mechanisms emanating from a damaged gut are closely implicated in the inflammatory processes known to promote neuropathology in the brain following TBI, which suggests the gut-brain axis may be a therapeutic target to reduce the risk of Chronic Traumatic Encephalopathy and other neurodegenerative diseases following TBI. To better appreciate how various peripheral influences are implicated in the health of the CNS following TBI, this paper will also review the secondary biological injury mechanisms and the dynamic pathophysiological response to neurotrauma. Together, this review article will attempt to connect the dots to reveal novel insights into the bidirectional influence of the gut-brain axis and propose a conceptual model relevant to the recovery from TBI and subsequent risk for future neurological conditions.
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Affiliation(s)
- Mark H Sundman
- Department of Psychology, University of Arizona, Tucson, AZ, USA.
| | - Nan-Kuei Chen
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | - Vignesh Subbian
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA; Department of Systems and Industrial Engineering, University of Arizona, Tucson, AZ, USA
| | - Ying-Hui Chou
- Department of Psychology, University of Arizona, Tucson, AZ, USA; Cognitive Science Program, University of Arizona, Tucson, AZ, USA; Arizona Center on Aging, University of Arizona, Tucson, AZ, USA
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23
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Madden DJ, Parks EL, Tallman CW, Boylan MA, Hoagey DA, Cocjin SB, Packard LE, Johnson MA, Chou YH, Potter GG, Chen NK, Siciliano RE, Monge ZA, Honig JA, Diaz MT. Sources of disconnection in neurocognitive aging: cerebral white-matter integrity, resting-state functional connectivity, and white-matter hyperintensity volume. Neurobiol Aging 2017; 54:199-213. [PMID: 28389085 DOI: 10.1016/j.neurobiolaging.2017.01.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 05/20/2015] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 01/12/2023]
Abstract
Age-related decline in fluid cognition can be characterized as a disconnection among specific brain structures, leading to a decline in functional efficiency. The potential sources of disconnection, however, are unclear. We investigated imaging measures of cerebral white-matter integrity, resting-state functional connectivity, and white-matter hyperintensity volume as mediators of the relation between age and fluid cognition, in 145 healthy, community-dwelling adults 19-79 years of age. At a general level of analysis, with a single composite measure of fluid cognition and single measures of each of the 3 imaging modalities, age exhibited an independent influence on the cognitive and imaging measures, and the imaging variables did not mediate the age-cognition relation. At a more specific level of analysis, resting-state functional connectivity of sensorimotor networks was a significant mediator of the age-related decline in executive function. These findings suggest that different levels of analysis lead to different models of neurocognitive disconnection, and that resting-state functional connectivity, in particular, may contribute to age-related decline in executive function.
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Affiliation(s)
- David J Madden
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
| | - Emily L Parks
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Catherine W Tallman
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA
| | - Maria A Boylan
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA
| | - David A Hoagey
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA
| | - Sally B Cocjin
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA
| | - Lauren E Packard
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA
| | - Micah A Johnson
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA
| | - Ying-Hui Chou
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Guy G Potter
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Nan-Kuei Chen
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA; Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Rachel E Siciliano
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA
| | - Zachary A Monge
- Center for Cognitive Neuroscience, Duke University, Durham, NC, USA
| | - Jesse A Honig
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA
| | - Michele T Diaz
- Department of Psychology, Pennsylvania State University, University Park, PA, USA
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24
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Chou YH, Sundman M, Whitson HE, Gaur P, Chu ML, Weingarten CP, Madden DJ, Wang L, Kirste I, Joliot M, Diaz MT, Li YJ, Song AW, Chen NK. Maintenance and Representation of Mind Wandering during Resting-State fMRI. Sci Rep 2017; 7:40722. [PMID: 28079189 PMCID: PMC5227708 DOI: 10.1038/srep40722] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 07/13/2016] [Accepted: 12/09/2016] [Indexed: 11/09/2022] Open
Abstract
Major advances in resting-state functional magnetic resonance imaging (fMRI) techniques in the last two decades have provided a tool to better understand the functional organization of the brain both in health and illness. Despite such developments, characterizing regulation and cerebral representation of mind wandering, which occurs unavoidably during resting-state fMRI scans and may induce variability of the acquired data, remains a work in progress. Here, we demonstrate that a decrease or decoupling in functional connectivity involving the caudate nucleus, insula, medial prefrontal cortex and other domain-specific regions was associated with more sustained mind wandering in particular thought domains during resting-state fMRI. Importantly, our findings suggest that temporal and between-subject variations in functional connectivity of above-mentioned regions might be linked with the continuity of mind wandering. Our study not only provides a preliminary framework for characterizing the maintenance and cerebral representation of different types of mind wandering, but also highlights the importance of taking mind wandering into consideration when studying brain organization with resting-state fMRI in the future.
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Affiliation(s)
- Ying-Hui Chou
- Department of Psychology, University of Arizona, Tucson, AZ, USA.,Cognitive Science Program, University of Arizona, Tucson, AZ, USA.,Arizona Center on Aging, University of Arizona, Tucson, AZ, USA
| | - Mark Sundman
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Heather E Whitson
- Department of Medicine and Ophthalmology, Duke University Medical Center, Durham, NC, USA.,Geriatrics Research Education and Clinical Center, Durham Veterans Administration Hospital, Durham, NC, USA
| | - Pooja Gaur
- Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
| | - Mei-Lan Chu
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA
| | - Carol P Weingarten
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - David J Madden
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Lihong Wang
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA.,Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | - Imke Kirste
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA
| | - Marc Joliot
- Neuroimaging Group (GIN), UMR5293, CEA CNRS Université de Bordeaux, Bordeaux, CEDEX, France
| | - Michele T Diaz
- Department of Psychology, Penn State University, University Park, PA, USA
| | - Yi-Ju Li
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Allen W Song
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA.,Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Nan-Kuei Chen
- Arizona Center on Aging, University of Arizona, Tucson, AZ, USA.,Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA.,Department of Radiology, Duke University Medical Center, Durham, NC, USA.,Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA.,Department of Medical Imaging, University of Arizona, Tucson, AZ, USA
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25
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Madden DJ, Parks EL, Tallman CW, Boylan MA, Hoagey DA, Cocjin SB, Johnson MA, Chou YH, Potter GG, Chen NK, Packard LE, Siciliano RE, Monge ZA, Diaz MT. Frontoparietal activation during visual conjunction search: Effects of bottom-up guidance and adult age. Hum Brain Mapp 2017; 38:2128-2149. [PMID: 28052456 DOI: 10.1002/hbm.23509] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 07/26/2016] [Revised: 12/16/2016] [Accepted: 12/18/2016] [Indexed: 11/09/2022] Open
Abstract
We conducted functional magnetic resonance imaging (fMRI) with a visual search paradigm to test the hypothesis that aging is associated with increased frontoparietal involvement in both target detection and bottom-up attentional guidance (featural salience). Participants were 68 healthy adults, distributed continuously across 19 to 78 years of age. Frontoparietal regions of interest (ROIs) were defined from resting-state scans obtained prior to task-related fMRI. The search target was defined by a conjunction of color and orientation. Each display contained one item that was larger than the others (i.e., a size singleton) but was not informative regarding target identity. Analyses of search reaction time (RT) indicated that bottom-up attentional guidance from the size singleton (when coincident with the target) was relatively constant as a function of age. Frontoparietal fMRI activation related to target detection was constant as a function of age, as was the reduction in activation associated with salient targets. However, for individuals 35 years of age and older, engagement of the left frontal eye field (FEF) in bottom-up guidance was more prominent than for younger individuals. Further, the age-related differences in left FEF activation were a consequence of decreasing resting-state functional connectivity in visual sensory regions. These findings indicate that age-related compensatory effects may be expressed in the relation between activation and behavior, rather than in the magnitude of activation, and that relevant changes in the activation-RT relation may begin at a relatively early point in adulthood. Hum Brain Mapp 38:2128-2149, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- David J Madden
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Emily L Parks
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Catherine W Tallman
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina
| | - Maria A Boylan
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina
| | - David A Hoagey
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina
| | - Sally B Cocjin
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina
| | - Micah A Johnson
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina
| | - Ying-Hui Chou
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Guy G Potter
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Nan-Kuei Chen
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina.,Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Lauren E Packard
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina
| | - Rachel E Siciliano
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina
| | - Zachary A Monge
- Center for Cognitive Neuroscience, Duke University, Durham, North Carolina
| | - Michele T Diaz
- Department of Psychology, and Social, Life, and Engineering Sciences Imaging Center, Pennsylvania State University, University Park, Pennsylvania
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26
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Song X, Panych LP, Chou YH, Chen NK. A Study of Long-Term fMRI Reproducibility Using Data-Driven Analysis Methods. Int J Imaging Syst Technol 2014; 24:339-349. [PMID: 26023254 PMCID: PMC4444074 DOI: 10.1002/ima.22111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The reproducibility of functional magnetic resonance imaging (fMRI) is important for fMRI-based neuroscience research and clinical applications. Previous studies show considerable variation in amplitude and spatial extent of fMRI activation across repeated sessions on individual subjects even using identical experimental paradigms and imaging conditions. Most existing fMRI reproducibility studies were typically limited by time duration and data analysis techniques. Particularly, the assessment of reproducibility is complicated by a fact that fMRI results may depend on data analysis techniques used in reproducibility studies. In this work, the long-term fMRI reproducibility was investigated with a focus on the data analysis methods. Two spatial smoothing techniques, including a wavelet-domain Bayesian method and the Gaussian smoothing, were evaluated in terms of their effects on the long-term reproducibility. A multivariate support vector machine (SVM)-based method was used to identify active voxels, and compared to a widely used general linear model (GLM)-based method at the group level. The reproducibility study was performed using multisession fMRI data acquired from eight healthy adults over 1.5 years' period of time. Three regions-of-interest (ROI) related to a motor task were defined based upon which the long-term reproducibility were examined. Experimental results indicate that different spatial smoothing techniques may lead to different reproducibility measures, and the wavelet-based spatial smoothing and SVM-based activation detection is a good combination for reproducibility studies. On the basis of the ROIs and multiple numerical criteria, we observed a moderate to substantial within-subject long-term reproducibility. A reasonable long-term reproducibility was also observed from the inter-subject study. It was found that the short-term reproducibility is usually higher than the long-term reproducibility. Furthermore, the results indicate that brain regions with high contrast-to-noise ratio do not necessarily exhibit high reproducibility. These findings may provide supportive information for optimal design/implementation of fMRI studies and data interpretation.
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Affiliation(s)
- Xiaomu Song
- Department of Electrical Engineering, School of Engineering, Widener University, Chester, PA 19013
| | - Lawrence P. Panych
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
| | - Ying-Hui Chou
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC 27710
| | - Nan-Kuei Chen
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC 27710
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27
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Whitson HE, Chou YH, Potter GG, Diaz MT, Chen NK, Lad EM, Johnson MA, Cousins SW, Zhuang J, Madden DJ. Phonemic fluency and brain connectivity in age-related macular degeneration: a pilot study. Brain Connect 2014; 5:126-35. [PMID: 25313954 DOI: 10.1089/brain.2014.0277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/13/2022] Open
Abstract
Age-related macular degeneration (AMD), the leading cause of blindness in developed nations, has been associated with poor performance on tests of phonemic fluency. This pilot study sought to (1) characterize the relationship between phonemic fluency and resting-state functional brain connectivity in AMD patients and (2) determine whether regional connections associated with phonemic fluency in AMD patients were similarly linked to phonemic fluency in healthy participants. Behavior-based connectivity analysis was applied to resting-state, functional magnetic resonance imaging data from seven patients (mean age=79.9±7.5 years) with bilateral AMD who completed fluency tasks prior to imaging. Phonemic fluency was inversely related to the strength of functional connectivity (FC) among six pairs of brain regions, representing eight nodes: left opercular portion of inferior frontal gyrus (which includes Broca's area), left superior temporal gyrus (which includes part of Wernicke's area), inferior parietal lobe (bilaterally), right superior parietal lobe, right supramarginal gyrus, right supplementary motor area, and right precentral gyrus. The FC of these reference links was not related to phonemic fluency among 32 healthy individuals (16 younger adults, mean age=23.5±4.6 years and 16 older adults, mean age=68.3±3.4 years). Compared with healthy individuals, AMD patients exhibited higher mean connectivity within the reference links and within the default mode network, possibly reflecting compensatory changes to support performance in the setting of reduced vision. These findings are consistent with the hypothesis that phonemic fluency deficits in AMD reflect underlying brain changes that develop in the context of AMD.
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Affiliation(s)
- Heather E Whitson
- 1 Department of Medicine, Duke University Medical Center , Durham, North Carolina
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28
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Li W, Langkammer C, Chou YH, Petrovic K, Schmidt R, Song AW, Madden DJ, Ropele S, Liu C. Association between increased magnetic susceptibility of deep gray matter nuclei and decreased motor function in healthy adults. Neuroimage 2014; 105:45-52. [PMID: 25315786 DOI: 10.1016/j.neuroimage.2014.10.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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: 06/06/2014] [Revised: 08/19/2014] [Accepted: 10/05/2014] [Indexed: 12/18/2022] Open
Abstract
In the human brain, iron is more prevalent in gray matter than in white matter, and deep gray matter structures, particularly the globus pallidus, putamen, caudate nucleus, substantia nigra, red nucleus, and dentate nucleus, exhibit especially high iron content. Abnormally elevated iron levels have been found in various neurodegenerative diseases. Additionally, iron overload and related neurodegeneration may also occur during aging, but the functional consequences are not clear. In this study, we explored the correlation between magnetic susceptibility--a surrogate marker of brain iron--of these gray matter structures with behavioral measures of motor and cognitive abilities, in 132 healthy adults aged 40-83 years. Latent variables corresponding to manual dexterity and executive functions were obtained using factor analysis. The factor scores for manual dexterity declined significantly with increasing age. Independent of gender, age, and global cognitive function, increasing magnetic susceptibility in the globus pallidus and red nuclei was associated with decreasing manual dexterity. This finding suggests the potential value of magnetic susceptibility, a non-invasive quantitative imaging marker of iron, for the study of iron-related brain function changes.
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Affiliation(s)
- Wei Li
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC 27710, USA; Research Imaging Institute, University of Texas Health Science Center at San Antonio, TX 78229, USA; Department of Ophthalmology, University of Texas Health Science Center at San Antonio, TX 78229, USA
| | | | - Ying-Hui Chou
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC 27710, USA
| | - Katja Petrovic
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Allen W Song
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC 27710, USA; Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
| | - David J Madden
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC 27710, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria.
| | - Chunlei Liu
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC 27710, USA; Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
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29
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Chou YH, Chen NK, Madden DJ. Functional brain connectivity and cognition: effects of adult age and task demands. Neurobiol Aging 2013; 34:1925-34. [PMID: 23523269 DOI: 10.1016/j.neurobiolaging.2013.02.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 03/16/2012] [Revised: 02/09/2013] [Accepted: 02/15/2013] [Indexed: 11/18/2022]
Abstract
Previous neuroimaging research has documented that patterns of intrinsic (resting state) functional connectivity (FC) among brain regions covary with individual measures of cognitive performance. Here, we examined the relation between intrinsic FC and a reaction time (RT) measure of performance, as a function of age group and task demands. We obtained filtered, event-related functional magnetic resonance imaging data, and RT measures of visual search performance, from 21 younger adults (19-29 years old) and 21 healthy, older adults (60-87 years old). Age-related decline occurred in the connectivity strength in multiple brain regions, consistent with previous findings. Among 8 pairs of regions, across somatomotor, orbitofrontal, and subcortical networks, increasing FC was associated with faster responding (lower RT). Relative to younger adults, older adults exhibited a lower strength of this RT-connectivity relation and greater disruption of this relation by a salient but irrelevant display item (color singleton distractor). Age-related differences in the covariation of intrinsic FC and cognitive performance vary as a function of task demands.
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Affiliation(s)
- Ying-Hui Chou
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC 27710, USA
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30
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Young DE, Wagenaar RC, Lin CC, Chou YH, Davidsdottir S, Saltzman E, Cronin-Golomb A. Visuospatial perception and navigation in Parkinson's disease. Vision Res 2010; 50:2495-504. [PMID: 20837045 DOI: 10.1016/j.visres.2010.08.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 07/23/2010] [Accepted: 08/20/2010] [Indexed: 11/25/2022]
Abstract
A shifted field of view, an altered perception of optic flow speed, and gait asymmetries may influence heading direction in Parkinson's disease (PD). PD participants (left body-side onset, LPD, n=14; right body-side onset, RPD, n=9) and Healthy Control participants (n=17) walked a virtual hallway in which the optic flow speeds of the walls varied. Three-dimensional kinematics showed participants veered away from the faster moving wall. Although veering normally occurs toward the side with smaller step length, in both LPD and RPD this bias was overridden by a shifted field of view, which caused veering in the opposite direction, toward the side of the brain with more basal ganglia damage.
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Affiliation(s)
- Daniel E Young
- College of Health and Rehabilitation Sciences, Sargent College, Department of Psychology, Boston University, Boston, MA 02215, United States
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31
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Chou YH, Wagenaar RC, Saltzman E, Giphart JE, Young D, Davidsdottir R, Cronin-Golomb A. Effects of optic flow speed and lateral flow asymmetry on locomotion in younger and older adults: a virtual reality study. J Gerontol B Psychol Sci Soc Sci 2009; 64:222-31. [PMID: 19276239 DOI: 10.1093/geronb/gbp003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The purpose of the study is to investigate whether there are age-related differences in locomotion due to changes in presence of vision, optic flow speed, and lateral flow asymmetry using virtual reality technology. Gait kinematics and heading direction were measured using a three-dimensional motion analysis system. Although older and younger adults were affected differentially by the availability of vision, a greater dependence on optic flow information in older adults during walking was not found. Linear relations were observed between walking performance and flow speed as well as heading direction and flow asymmetry. The findings suggest that the ability to integrate optic flow information into the multimodal system for assessment of walking speed and heading direction is comparable in older and younger adults.
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Affiliation(s)
- Ying-Hui Chou
- Department of Physical Therapy and Athletic Training, Boston University, Massachusetts, USA.
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32
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Sathy BN, Chou YH, Li HJ, Chang C, Chow KPN. Dynamic contrast-enhanced and T2-weighted magnetic resonance imaging study of the correlation between tumour angiogenesis and growth kinetics. Lab Anim 2008; 43:53-9. [PMID: 19015174 DOI: 10.1258/la.2007.007105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Accumulating evidence indicates that tumour growth is angiogenesis-dependent. Non-invasive assessment of the relationship between tumour growth and associated angiogenesis is essential for diagnosis and for therapeutic interventions. We utilized a combination of high-resolution T2-weighted and dynamic contrast-enhanced magnetic resonance imaging to investigate the dynamics of angiogenesis during tumour growth in a mouse tumour model expressing Epstein-Barr virus-encoded latent membrane protein 1 isolated from a nasopharyngeal carcinoma in Taiwan. Serial imaging acquisitions were performed starting on the third day after subcutaneous implantation of tumours, through day 28. We observed a progressive increase in tumour volume until day 14, followed by rapid and exponential growth. The volume transfer constant, K(trans), also increased significantly on day 14, and then gradually decreased, suggesting that the angiogenic switching occurs prior to significant tumour growth. At the initial stage, the K(trans) values were significantly higher in the tumour peripheral region than in the tumour core, but, during tumour growth, the K(trans) values in the region between the tumour periphery and core gradually increased, becoming larger than those of the periphery. These results demonstrate that the ability to perform repeated measurements assessing the correlation between tumour growth kinetics and tumour angiogenesis makes it possible to determine the critical time of angiogenic switching prior to rapid tumour growth, as well as suggesting the timing of therapy.
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Affiliation(s)
- B N Sathy
- Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan, Republic of China
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33
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Chou YH, Coster WJ, Latham CAT, Li PL, Chung MJ, Shie JH. Voluntary Manual Exploration and Vision in Rod Bisection. Percept Mot Skills 2008; 107:70-80. [DOI: 10.2466/pms.107.1.70-80] [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: 11/15/2022]
Abstract
Two experiments were carried out to investigate contributions of voluntary manual exploration and vision to rod-bisection performance when the rod was placed in different spatial positions. Analysis showed both voluntary manual exploration and vision contributed to the accuracy of rod-bisection performance in healthy adults (Exp. 1: 12 men, 13 women; Exp. 2: 10 men, 11 women). Advantages of voluntary manual exploration were related to rod position and initial search direction. Results are discussed with regard to ecological approach to action and perception, two cortical systems (ventral and dorsal streams) for perception and control of actions, and the hemispheric activation hypothesis.
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Affiliation(s)
- Ying-Hui Chou
- Department of Occupational Therapy & Rehabilitation Counseling, Boston University, Department of Occupational Therapy, Fu-Jen Catholic University
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Chou YH, Chao PL, Tsai MJ, Cheng HH, Chen KB, Yang DM, Yang CH, Lin AMY. Arsenite-induced cytotoxicity in dorsal root ganglion explants. Free Radic Biol Med 2008; 44:1553-61. [PMID: 18226606 DOI: 10.1016/j.freeradbiomed.2007.12.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Revised: 11/20/2007] [Accepted: 12/05/2007] [Indexed: 11/30/2022]
Abstract
Peripheral neuropathy is common in people chronically overexposed to arsenic. We studied sodium arsenite (arsenite)-induced cytotoxicity in dorsal root ganglion (DRG) explants. Incubation with arsenite concentration- and time-dependently increased the expression of stress proteins, heat shock protein 70, and heme oxygenase-1 in DRG explants. Furthermore, apoptosis was involved in the arsenite-induced cytotoxicity in the treated DRG. Elevation in cytosolic cytochrome c levels and reduction in procaspase 3 levels suggested an involvement of the mitochondrial pathway in arsenite-induced apoptosis in this preparation. At the same time, increases in the activating transcription factor-4 and C/EBP homologous protein and reduction in procaspase 12 levels indicated activation of the endoplasmic reticulum (ER) pathway in the arsenite-induced cytotoxicity in DRG explants. Salubrinal (30 microM), an ER inhibitor, was found to attenuate arsenite-induced DNA fragmentation and reduction in procaspase 12 in DRG explants. Cytotoxic effects by arsenite, sodium arsenate (arsenate), monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) were compared, and the potency was as follows: arsenite >>> arsenate>MMA and DMA. Recombinant adenovirus vectors encoding glial-cell-derived neurotrophic factor (AdGDNF) genes allowed a stable delivery of GDNF genes to the infected cells in DRG explants. Applied in this manner, AdGDNF was found to inhibit arsenite-induced DNA fragmentation in DRG explants. Moreover, AdGDNF attenuated the arsenite-induced reduction in procaspases 3 and 12 levels. Taken together, our study demonstrates that arsenite is capable of inducing cytotoxicity in DRG explants. Both ER and mitochondria pathways are involved in the arsenite-induced apoptosis in DRG explants. Glial-cell-derived neurotrophic factor appears to be protective against arsenite-induced peripheral neuropathy.
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Affiliation(s)
- Y H Chou
- Department of Physiology, National Yang-Ming University, Taipei, Taiwan
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Liao CM, Tsai JW, Ling MP, Liang HM, Chou YH, Yang PT. Organ-specific toxicokinetics and dose-response of arsenic in tilapia Oreochromis mossambicus. Arch Environ Contam Toxicol 2004; 47:502-510. [PMID: 15499501 DOI: 10.1007/s00244-004-3105-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We appraised organ-specific toxicokinetics and dose responses of arsenic burdens in tilapia Oreochromis mossambicus. We kinetically linked an Area-under-the-curve (AUC)-based acute toxicity model and a pharmacodynamic model to derive dose-response relationships between equilibrium organ-specific arsenic concentrations and mortality effects. The AUC-based acute toxicity model was also used to derive organ-specific internal effect concentration (IEC)-time-response relationships, which can also be applied to predict a time-mortality profile. We conducted a 7-day exposure experiment to obtain toxicokinetic parameters, whereas the AUC-based acute toxicity model was verified with LC50(t) data obtained from a 7-day acute toxicity bioassay. Our results demonstrated that 96-hour LC50 and incipient LC50 for tilapia exposed to arsenic are 28.68 (95% confidence interval to 24.92 to 32.44) and 25.55 mg L(-1), respectively. Dose-response relationships followed the Hill equation, which could be expressed as organ-specific bioconcentration factors and incipient LC50. Organ-specific dose-response relationships showed that muscle, gill, and liver have a relatively steep sigmoid dose-response profile in that IEC50 were 26.6, 62.5, and 78.5 microg g(-1) dry wt (dw), respectively. Organ-specific arsenic internal lethal burdens were the highest in the gill and the lowest in the muscle in waterborne-exposed tilapia. The IEC and target-organ concentrations derived in this study can be used in site-specific risk assessment.
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Affiliation(s)
- C M Liao
- Department of Bioenvironmental Systems Engineering, National Taiwan University, Taipei, 10617, China.
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Chuang YY, Huang YC, Lee CY, Lin TY, Lien R, Chou YH. Methicillin-resistant Staphylococcus aureus bacteraemia in neonatal intensive care units: an analysis of 90 episodes. Acta Paediatr 2004; 93:786-90. [PMID: 15244228 DOI: 10.1080/08035250410028084] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
AIM To delineate the clinical features of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in infants hospitalized at the neonatal intensive care unit. METHODS Episodes of MRSA bacteraemia in Chang Gung Children's Hospital neonatal intensive care unit from 1997 to 1999 were reviewed for incidence, predisposing factors, clinical presentations, treatment and outcome. RESULTS Ninety episodes of MRSA bacteraemia were identified. The overall rate of MRSA bacteraemia was 1.05 per 1000 patient days during the 3-y period. Most of the patients were premature infants (76%), with prior operation or invasive procedures (39%), had an indwelling intravascular catheter (79%) and exposure to antibiotic therapy (96%). A localized cutaneous infection was found in 53.3% of the episodes. The most common clinical diagnoses were catheter-related infections (54.4%), skin and soft tissue infections (21.1%), bacteraemia without a focus (20%) and pneumonia (16.7%). Metastatic infection occurred in 18% of these infants. Among the patients treated with vancomycin for < or = 14 d, 88.7% did not develop any complications, and 11.3% developed a recurrence. CONCLUSIONS MRSA is an established pathogen in our NICU. MRSA bacteraemia in the neonates predominantly presented as catheter-related infections, and metastatic infections were not infrequently seen. In uncomplicated MRSA bacteraemia, treatment with vancomycin for < or = 14 d seems to be adequate.
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Affiliation(s)
- Y Y Chuang
- Division of Paediatric Infectious Diseases, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
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Lin MC, Cheng HH, Lin HY, Chen YC, Chen YP, Chang-Chien GP, Chou YH, Liao CM, Dai CF, Han BC, Liu CW. Arsenic accumulation and acute toxicity in aquacultural juvenile milkfish (Chanos chanos) from blackfoot disease area in Taiwan. Bull Environ Contam Toxicol 2004; 72:248-254. [PMID: 15106758 DOI: 10.1007/s00128-003-9041-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- M C Lin
- Graduate Institute of Environment Management, Nanhua University, Chiayi, 622 Taiwan, Republic of China
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Abstract
Renal anemia is mainly caused by inadequate synthesis of erythropoietin from diseased kidneys. At the present time, recombinant human erythropoietin (rHuEPO) is used to correct anemia successfully in most patients with end-stage renal diseases. Nevertheless, poor response to rHuEPO still exists in some hemodialysis patients and its mechanism in some cases remains obscure. Herein, we describe a rare case of rHuEPO hyporesponsiveness due to mechanical hemolysis induced by a traumatic carotid-jugular arteriovenous fistula (AVF) in the presence of subclinical aluminum intoxication. Following surgical resection of the traumatic AVF and 8 months of desferrioxamine treatment, the responsiveness to rHuEPO was restored and the rHuEPO dose requirements reduced.
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Affiliation(s)
- K L Kuo
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Tsai JW, Chou YH, Chen BC, Liang HM, Liao CM. Growth toxicity bioassays of abalone Haliotis diversicolor supertexta exposed to waterborne zinc. Bull Environ Contam Toxicol 2004; 72:70-77. [PMID: 15058656 DOI: 10.1007/s00128-003-0242-7] [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] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- J W Tsai
- Department of Bioenvironmental Systems Engineering, National Taiwan University, Taipei, Republic of China
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Tsai WT, Chou YH. A review of environmental and economic regulations for promoting industrial waste recycling in Taiwan. Waste Manag 2004; 24:1061-1069. [PMID: 15567671 DOI: 10.1016/j.wasman.2004.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/29/2004] [Indexed: 05/24/2023]
Abstract
The objective of this paper is to present a compilation of recent Taiwan government laws/regulations to promote industrial waste recycling. The description is thus centered on legislation/regulations concerning general industrial wastes recycling in the policies of environmental protection, economic incentives and engineering technologies (3E) that have become effective since 2001. The regulatory system, including Waste Disposal Act, Resource Recycling/Reuse Act, Environmental Basis Law, and Statute for Upgrading Industries, not only gives financial incentives, but also provides technical assistance and information transfer on promoting industrial waste recycling. In order to further utilize the recyclable resources and upgrade the environmental technology, Taiwan's Environmental Protection Administration (EPA), in cooperation with the Ministry of Economic Affairs (MOEA), has jointly ventured some promotion programs, which highlight an Industrial Waste Exchange Information Center and Environmental Technology Park Development Program, also described in the paper.
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Affiliation(s)
- W T Tsai
- Department of Environmental Engineering and Science, Chia Nan University of Pharmacy and Science, Tainan 717, Taiwan.
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Wu SC, Chou YH. Measurement of serum vitamin E isomers in fullterm and preterm infants. Chang Gung Med J 2001; 24:793-8. [PMID: 11858395] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND This study was conducted with the following aims: (1) to construct a methodology by high-performance liquid chromatography (HPLC) to measure vitamin E levels in our neonatal units; (2) to establish a reference range of serum vitamin E levels in fullterm neonates and their mothers; and (3) to compare these to levels in the preterm group. METHODS During a 6-month period from September 1996 to February 1997, cord blood of 34 uneventful fullterm neonates (gestational age 38-42 weeks, birth weight 2840-3530 g) and venous blood of their healthy mothers were collected. Venous blood of 35 preterm neonates (gestational age 28-34 weeks, birth weight 940-1980 g) was collected at the same time. Serum vitamin E levels were measured by HPLC. The serum vitamin E/total lipids ratio was also examined. RESULTS Serum levels of alpha-tocopherol in 34 fullterm neonates and their mothers were 0.212+/-0.127 and 1.160+/-0.513 mg/dl, and of gamma-tocopherol were 0.029+/-0.019 and 0.214+/-0.122 mg/dl, respectively. All fullterm neonates except 2 had serum levels less than 0.5 mg/dl. There was a positive relationship between serum E levels and total lipids. In addition, the correlation between neonatal vitamin E/total lipids ratios and maternal vitamin E/total lipids ratio was statistically significant. The serum level of alpha-tocopherol in 35 preterm infants was 0.170+/-0.090 mg/dl and that of gamma-tocopherol was 0.020+/-0.015 mg/dl; both levels were much lower than those of their fullterm counterparts. But the vitamin E/total lipids ratios did not significantly differ. CONCLUSIONS We conclude that (1) measurement of serum vitamin E levels by the HPLC method is practical, and is useful in evaluating deficiencies in preterm infants and possibly useful in monitoring the adequacy after supplementation in future study, and (2) preterm infants had a much lower level of serum tocopherol, but no difference was seen in vitamin E/total lipids ratio.
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Affiliation(s)
- S C Wu
- Division of Neonatology, Chang Gung Children's Hospital, Taipei
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Li CC, Chou YH, Shen JT, Huang SP, Tsai HN, Lin HY, Huang CH. Comparison of hand-assisted laparoscopic nephroureterectomy with open surgery for upper urinary tract tumor. Kaohsiung J Med Sci 2001; 17:615-9. [PMID: 12168495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
Herein we report on our initial experience in performing nephroureterectomy by hand-assisted laparoscopic surgery, and compare the results with those performed by traditional open methods. From December 2000 to September 2001, 10 patients with upper urinary tract tumors underwent hand-assisted laparoscopic nephroureterectomy. Except for one patient who required elective conversion to open surgery due to renal vein injury, this cohort of 9 patients was compared to a group of 35 patients who had received traditional open nephroureterectomy over the last 2 years. Demographic, intraoperative and postoperative data were compared retrospectively. These two groups were similar in age, body mass index, operation time and time to postoperative oral intake. However, the hand-assisted laparoscopy group was found to have significantly less blood loss, less need for parenteral narcotic and a shorter length of time needed for postoperative hospitalization than the open group. Thus, in this report we have demonstrated hand-assisted laparoscopic nephroureterectomy to be a safe and efficacious treatment of malignant urinary collecting tumors. We believe the benefits of this minimally invasive surgery make it a viable alternative technique for management of upper urinary tract tumor.
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Affiliation(s)
- C C Li
- Department of Urology, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung 807, Taiwan
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Lin CC, Wu JC, Chou YH, Huang YH, Chang FY, Lee SD. Hereditary hemorrhagic telangiectasia: demonstration of portosystemic venous shunts using power Doppler sonography and sonographically guided percutaneous transhepatic portovenography. J Clin Ultrasound 2001; 29:517-522. [PMID: 11745863 DOI: 10.1002/jcu.10012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Hereditary hemorrhagic telangiectasia is a rare autosomal dominant inherited disease associated with vascular abnormalities, which may occur in any organ. Cases of hereditary hemorrhagic telangiectasia accompanied by intrahepatic portosystemic venous shunts, however, have rarely been described. We report a case of hereditary hemorrhagic telangiectasia in which intrahepatic portosystemic shunts were detected using power Doppler sonography and portovenography with percutaneous transhepatic contrast agent injection. On gray-scale sonography, the common hepatic artery was dilated, and dilated tubular structures mimicking dilated biliary tracts were found. Power Doppler sonography demonstrated the continuity of tortuous vascular channels connecting a branch of the right portal vein to a branch of the right hepatic vein. The dilated vascular channels and tributaries of the right hepatic vein showed a monophasic waveform pattern on spectral analysis. Portovenography showed a tangle of vascular structures connecting with a branch of the right hepatic vein.
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Affiliation(s)
- C C Lin
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road, Section 2, Taipei 112, Taiwan
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Abstract
OBJECTIVE This study was done to investigate the frequency of HLA-DRB1 antigens in juvenile-onset systemic lupus erythematosus (SLE) in the Taiwanese population. PATIENTS AND METHODS Thirty-four Taiwanese patients with juvenile onset SLE and 200 unrelated healthy controls were studied. HLA-DRB1 typing was performed with polymerase chain reaction (PCR) and the sequence-specific oligonucleotide probe (SSO) typing method. RESULT Among the 14 investigated DRB1 alleles, the frequency of HLA-DRB1*1602 was higher in juvenile onset SLE patients than the controls (15.15% vs 4.50%, odds ratio 3.66, 95% confidence interval 1.15-11.68, Pc = 0.04). Although there were differences in the frequencies of DRB1*0301, DRB1*0803, and DRB1*1501 between patients and controls, the associations were statistically insignificant. CONCLUSION The frequency of HLA-DRB1*1602 was significantly higher in patients with juvenile onset SLE than in healthy controls. This finding differs from those in the previous studies in Caucasian and Japanese adult onset SLE patients.
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Affiliation(s)
- J L Huang
- Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan
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Chou YH, Tiu CM, Hung GS, Wu SC, Chang TY, Chiang HK. Stepwise logistic regression analysis of tumor contour features for breast ultrasound diagnosis. Ultrasound Med Biol 2001; 27:1493-1498. [PMID: 11750748 DOI: 10.1016/s0301-5629(01)00466-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
To assist the ultrasound (US) differential diagnosis of solid breast tumors by using stepwise logistic regression (SLR) analysis of tumor contour features, we retrospectively reviewed 111 medical records of digitized US images of breast pathologies. They were pathologically proved benign breast tumors from 40 patients (i.e., 40 fibroadenomas) and malignant breast tumors from 71 patients (i.e., 71 infiltrative ductal carcinomas). Radiologists, before analysis by the computer-aided diagnosis (CAD) system, segmented the tumors manually. The contour features were calculated by measuring the radial length of tumor boundaries. The features selection process was accomplished using a stepwise analysis procedure. Then, an SLR model with contour features was used to classify tumors as benign or malignant. In this experiment, cases were sampled with "leave-one-out" test methods to evaluate the SLR performance using a receiver operating characteristic (ROC) curve. The accuracy of our SLR model with contour features for classifying malignancies was 91.0% (101 of 111 tumors), the sensitivity was 97.2% (69 of 71), the specificity was 80.0% (32 of 40), the positive predictive value was 89.6% (69 of 77), and the negative predictive value was 94.1% (32 of 34). The CAD system using SLR can differentiate solid breast nodules with relatively high accuracy and its high negative predictive value could potentially help inexperienced operators to avoid misdiagnoses. Because the SLR model is trainable, it could be optimized if a larger set of tumor images were supplied.
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Affiliation(s)
- Y H Chou
- Department of Radiology, Veterans General Hospital-Taipei, Taipei, Taiwan
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Chiou HJ, Chou YH, Chang CY. Ultrasonography of the wrist. Can Assoc Radiol J 2001; 52:302-11. [PMID: 11702352] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Affiliation(s)
- H J Chiou
- Department of Radiology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Chiang MC, Chou YH, Wang PJ. Auditory brainstem evoked potentials in healthy full-term and pre-term infants. Chang Gung Med J 2001; 24:557-62. [PMID: 11725625] [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] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Auditory brainstem evoked potentials (ABEP) are used to evaluate the integrity of auditory pathways. Since there are difficulties in the performance and still no reference ranges for pre-term infants in Taiwan, the purpose of this study was to evaluate the characteristics of ABEP in full-term and pre-term infants. METHODS Forty full-term and 52 pre-term infants were enrolled between January and December 1997. ABEP study was performed at 3-7 days after birth, 3, 6 and 12 months of age in the full-term group while the pre-term infants were assessed at 34-36 weeks of gestational age, at term age, and at 3, 6, 12 months of corrected age. Acoustic stimulation of mixed frequency rarefaction clicks was presented to each ear through earphones. The clicks were presented at an intensity of 70-90 dB (hearing level) and a gradual decrement of intensity to 20-40 dB to determine the threshold. Electrical activity was picked up by surface electrodes. Latency of peaks I, III, V, inter-peak latency I-III, III-V, I-V and the threshold were assessed. RESULTS In the full-term group, the peak and inter-peak latencies decreased with age. In the pre-term group, the responses of 70 dB stimulus intensity were 53.8%, 58%, 82.8%, 88.9%, 100% in the sequence and the threshold of response decreased with age. CONCLUSION There are maturational changes after birth in both full-term and pre-term infants. We conclude that ABEP study is a sensitive, non-invasive tool for the evaluation of auditory pathway in infants.
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Affiliation(s)
- M C Chiang
- Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital, Taipei, Taiwan, R.O.C
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Abstract
Lipomas of the major central veins are rare, and their sonographic features have rarely been reported. We report a case in which a lipoma of the inferior vena cava (IVC) was incidentally identified during liver sonography in a 68-year-old man. Sonography of the upper abdomen revealed coarsening of the liver echotexture, with a relatively small liver and atrophy of the right hepatic lobe. A 2-cm hypoechoic hepatic nodule was visualized in segment IV. Sonography also showed a 2.2- x 1.8-cm, highly echogenic, homogeneous nodule in the hepatic segment of the IVC at its junction with the right atrium. The lumen of the IVC was partially occluded. The CT and MRI appearances of the IVC lesion were consistent with a lipoma, which was not treated because there was no clinical evidence of obstruction. Histopathologic analysis following a sonographically guided biopsy of the liver nodule revealed hepatocellular carcinoma, which was treated by percutaneous ethanol injection.
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Affiliation(s)
- Y H Chou
- Department of Radiology, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, 201 Shih-Pai Road, Section 2, Taipei 11217, Taiwan
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Abstract
We reviewed 62 episodes (from 59 infants) of neonatal candidemia that occurred between January 1994 and June 1999. Except 5 term babies, all infants were premature (median gestational age [GA], 30 weeks) and birth weight was less than 2,500 g (median, 1,300 g). Most infants had reported risk factors and other neonatal problems. The age at onset of candidemia ranged from 15 to 173 days with a median of 34 days. In addition to catheter removal, all but one infants received antifungal agents and candidemia was eradicated subsequently in 46 episodes (75%). Eighteen infants with 19 episodes ever received fluconazole therapy. Fluconazole was administered as the first line agent in 6 episodes and successfully cleared candidemia in 5 episodes. Fluconazole was used as an alternative agent in an additional 13 episodes after amphotericin B (am B) +/- flucytosine were given for a period without a satisfactory result and eradication of candidemia was achieved in 8 episodes subsequently. All 18 infants tolerated fluconazole well and no withdrawal was required on account of its adverse effect. In contrast, am B alone was administered as the first line agent in 55 episodes and successfully cleared candidemia in 32 episodes (58%). This retrospective analysis suggests that fluconazole appears to be safe in neonates and can be used as an alternative agent in treating neonatal candidemia. A large-scaled prospective study may be needed.
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Affiliation(s)
- Y C Huang
- Division of Pediatric Infectious Diseases, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
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Chen TC, Chou TB, Ng KF, Hsieh LL, Chou YH. Hepatocellular carcinoma associated with focal nodular hyperplasia. Report of a case with clonal analysis. Virchows Arch 2001; 438:408-11. [PMID: 11355178 DOI: 10.1007/s004280000348] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We describe a hepatocellular carcinoma partially surrounded by focal nodular hyperplasia in a 65-year-old female patient. In order to clarify the relationship of the hepatocellular carcinoma and the adjacent focal nodular hyperplasia, clonal analysis was conducted. The clonal analysis was based on the methylation pattern of the polymorphic X-chromosome-linked androgen receptor gene (HUMARA). The allelic bands from the amplification of the focal nodular hyperplasia and of the hepatocellular carcinoma showed a significant reduction in the intensity of one of the two alleles as compared with two alleles of equal intensity in the buff coat after HhaI digestion, which indicated that these two parts were monoclonal. However, the inactivated allele in the focal nodular hyperplasia and that in the hepatocellular carcinoma were not identical. Therefore, the focal nodular hyperplasia and hepatocellular carcinoma probably derived from the clonal expansion of two different clones.
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Affiliation(s)
- T C Chen
- Department of Pathology, Chang Gung Memorial Hospital, 5 Fu Shin Street, Kwei San, Tao Yuan, Taiwan.
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