High resolution magic angle spinning 1H NMR of childhood brain and nervous system tumours

<p>Abstract</p> <p>Background</p> <p>Brain and nervous system tumours are the most common solid cancers in children. Molecular characterisation of these tumours is important for providing novel biomarkers of disease and identifying molecular pathways which may provide putative targets for new therapies. 1H magic angle spinning NMR spectroscopy (1H HR-MAS) is a powerful tool for determining metabolite profiles from small pieces of intact tissue and could potentially provide important molecular information.</p> <p>Methods</p> <p>Forty tissue samples from 29 children with glial and primitive neuro-ectodermal tumours were analysed using HR-MAS (600 MHz Varian gHX nanoprobe). Tumour spectra were fitted to a library of individual metabolite spectra to provide metabolite values. These values were then used in a two tailed t-test and multi-variate analysis employing a principal component analysis and a linear discriminant analysis. Classification accuracy was estimated using a leave-one-out analysis and B632+ bootstrapping.</p> <p>Results</p> <p>Glial tumours had significantly (two tailed t-test p < 0.05) higher creatine and glutamine and lower taurine, phosphoethanolamine, phosphorylcholine and choline compared with primitive neuro-ectodermal tumours. Classification accuracy was 90%. Medulloblastomas (n = 9) had significantly (two tailed t-test p < 0.05) higher creatine, glutamine, phosphorylcholine, glycine and scyllo-inositol than neuroblastomas (n = 7), classification accuracy was 94%. Supratentorial primitive neuro-ectodermal tumours had metabolite profiles in keeping with other primitive neuro-ectodermal tumours whilst ependymomas (n = 2) had metabolite profiles intermediate between pilocytic astrocytomas (n = 10) and primitive neuro-ectodermal tumours.</p> <p>Conclusion</p> <p>HR-MAS identified key differences in the metabolite profiles of childhood brain and nervous system improving the molecular characterisation of these tumours. Further investigation of the underlying molecular pathways is required to assess their potential as targets for new agents.</p

MR spectroscopy-based brain metabolite profiling in propionic acidaemia: metabolic changes in the basal ganglia during acute decompensation and effect of liver transplantation

Background: Propionic acidaemia (PA) results from deficiency of Propionyl CoA carboxylase, the commonest form presenting in the neonatal period. Despite best current management, PA is associated with severe neurological sequelae, in particular movement disorders resulting from basal ganglia infarction, although the pathogenesis remains poorly understood. The role of liver transplantation remains controversial but may confer some neuro-protection. The present study utilises quantitative magnetic resonance spectroscopy (MRS) to investigate brain metabolite alterations in propionic acidaemia during metabolic stability and acute encephalopathic episodes.Methods: Quantitative MRS was used to evaluate brain metabolites in eight children with neonatal onset propionic acidaemia, with six elective studies acquired during metabolic stability and five studies during acute encephalopathic episodes. MRS studies were acquired concurrently with clinically indicated MR imaging studies at 1.5 Tesla. LCModel software was used to provide metabolite quantification. Comparison was made with a dataset of MRS metabolite concentrations from a cohort of children with normal appearing MR imaging.Results: MRI findings confirm the vulnerability of basal ganglia to infarction during acute encephalopathy. We identified statistically significant decreases in basal ganglia glutamate+glutamine and N-Acetylaspartate, and increase in lactate, during encephalopathic episodes. In white matter lactate was significantly elevated but other metabolites not significantly altered. Metabolite data from two children who had received liver transplantation were not significantly different from the comparator group.Conclusions: The metabolite alterations seen in propionic acidaemia in the basal ganglia during acute encephalopathy reflect loss of viable neurons, and a switch to anaerobic respiration. The decrease in glutamine + glutamate supports the hypothesis that they are consumed to replenish a compromised Krebs cycle and that this is a marker of compromised aerobic respiration within brain tissue. Thus there is a need for improved brain protective strategies during acute metabolic decompensations. MRS provides a non-invasive tool for which could be employed to evaluate novel treatments aimed at restoring basal ganglia homeostasis. The results from the liver transplantation sub-group supports the hypothesis that liver transplantation provides systemic metabolic stability by providing a hepatic pool of functional propionyl CoA carboxylase, thus preventing further acute decompensations which are associated with the risk of brain infarction

The BRAIN-Q, a tool for assessing self-reported sport-related concussions for epidemiological studies

Objectives: The BRAIN-Q is a tool aimed at maximising the accuracy, and minimising measurement error, for retrospectively assessing concussions. This paper reports agreement of the BRAIN-Q tool when compared to extant questionnaire questions, and reproducibility when compared with its telephonic version (tBRAIN-Q). Method: The BRAIN-Q entails a 3-stage process: defining concussion, creating a visual timeline with life events, and establishing detailed characteristics for each reported concussion. It was designed to be administered in-person by trained personnel, and was used in the BRAIN Study. Its performance was compared with the MSK Study which previously collected a few questions in a broader self-administered questionnaire; and with the tBRAIN-Q Recall, its telephonic version. Results: 101 participants were included; of these, nine were re-assessed with the tBRAIN-Q. Compared to the BRAIN-Q, the agreement with the MSK-Q for rugby-related concussion was 86.7% (kappa 0.6). Rugby-related concussion with loss of consciousness showed lower agreement (82.0% (kappa 0.6)). The comparison between the BRAIN-Q and the tBRAIN-Q showed a good reproducibility. Conclusions: The BRAIN-Q is a relatively easy tool to administer in face-to-face assessments, it showed an optimal reproducibility, it includes a well-established definition of concussion, and is used to collect detailed information on each concussion allowing for a number of subgroup analyses (e.g. by severity, by age, by context). The BRAIN-Q is easily adaptable to other sporting setting

A cluster randomized controlled trial of the effectiveness and cost-effectiveness of Intermediate Care Clinics for Diabetes (ICCD) : study protocol for a randomized controlled trial

Background World-wide healthcare systems are faced with an epidemic of type 2 diabetes. In the United Kingdom, clinical care is primarily provided by general practitioners (GPs) rather than hospital specialists. Intermediate care clinics for diabetes (ICCD) potentially provide a model for supporting GPs in their care of people with poorly controlled type 2 diabetes and in their management of cardiovascular risk factors. This study aims to (1) compare patients with type 2 diabetes registered with practices that have access to an ICCD service with those that have access only to usual hospital care; (2) assess the cost-effectiveness of the intervention; and (3) explore the views and experiences of patients, health professionals and other stakeholders. Methods/Design This two-arm cluster randomized controlled trial (with integral economic evaluation and qualitative study) is set in general practices in three UK Primary Care Trusts. Practices are randomized to one of two groups with patients referred to either an ICCD (intervention) or to hospital care (control). Intervention group: GP practices in the intervention arm have the opportunity to refer patients to an ICCD - a multidisciplinary team led by a specialist nurse and a diabetologist. Patients are reviewed and managed in the ICCD for a short period with a goal of improving diabetes and cardiovascular risk factor control and are then referred back to practice. or Control group: Standard GP care, with referral to secondary care as required, but no access to ICCD. Participants are adults aged 18 years or older who have type 2 diabetes that is difficult for their GPs to control. The primary outcome is the proportion of participants reaching three risk factor targets: HbA1c (≤7.0%); blood pressure (<140/80); and cholesterol (<4 mmol/l), at the end of the 18-month intervention period. The main secondary outcomes are the proportion of participants reaching individual risk factor targets and the overall 10-year risks for coronary heart disease(CHD) and stroke assessed by the United Kingdom Prospective Diabetes Study (UKPDS) risk engine. Other secondary outcomes include body mass index and waist circumference, use of medication, reported smoking, emotional adjustment, patient satisfaction and views on continuity, costs and health related quality of life. We aimed to randomize 50 practices and recruit 2,555 patients

Anisotropic pH-Responsive Hydrogels Containing Soft or Hard Rod-Like Particles Assembled Using Low Shear

A simple and versatile low-shear approach for assembling hydrogels containing aligned rod-like particles (RLPs) that are birefringent and exhibit pH-triggered anisotropic swelling is developed. Anisotropic composite hydrogels are prepared by applying low shear (0.1 s–1) to mixtures of pH-responsive nanogels (NGs) and RLPs. The NGs, which contained high methacrylic acid contents, acted as both shear transfer vehicles and macro-cross-linkers for anisotropic gel formation. Three model RLP systems are investigated: (i) soft triblock copolymer worms, (ii) stiff self-assembled β-sheet peptide fibers, and (iii) ultrahigh modulus nanocrystalline cellulose fibers. RLP alignment was confirmed using polarized light imaging, atomic force microscopy, and small-angle X-ray scattering as well as modulus and anisotropic swelling experiments. Unexpectedly, the composite gel containing the soft copolymer worms showed the most pronounced anisotropy swelling. The copolymer worms enabled higher RLP loadings than was possible for the stiffer RLPs. For fixed RLP loading, the extent of anisotropic swelling increased with intra-RLP bonding strength. The facile and versatile approach to anisotropic gel construction demonstrated herein is expected to enable new applications for strain sensing or biomaterials for soft tissue repair