Cerebellar Vermis

小脑 Vermis
  • 文章类型: Journal Article
    背景:人类小脑作为整合感觉运动神经网络的后脑结构出现,认知,和整个生命周期的情感处理。小脑解剖结构和功能的发展研究很少。我们检查了小脑前疣的年龄依赖性MRI形态学,小叶I-V和后新皮质小叶VI-VII及其与感觉运动和认知功能的关系。
    方法:通常发育中的儿童(TDC;n=38;9-15岁)和健康成人(HAC;n=31;18-40)参与高分辨率MRI。使用手动分割计算机辅助FreeSurfer图像分析程序[http://surfer。nmr.mgh.哈佛。edu].神经心理学评分(WASI-II)被标准化,并与前牙体积相关,后疣,TBV。
    结果:TBV与年龄无关。TDC中I-V和VI-VII的体积显著减少。VI-VII与I-V的比率(〜60%)在年龄组中是稳定的;I-V与视觉空间运动技能相关;VI-VII与口头,视觉抽象和FSIQ。
    结论:在TDC中,前I-V和后VI-VII疣均未达到成人体积。青春期灰质高峰的“倒U”发育轨迹并不能解释这一发现。少突胶质细胞/髓鞘形成的长期发育假说被认为是TDC小脑疣体积降低的一个原因。
    BACKGROUND: The human cerebellum emerges as a posterior brain structure integrating neural networks for sensorimotor, cognitive, and emotional processing across the lifespan. Developmental studies of the cerebellar anatomy and function are scant. We examine age-dependent MRI morphometry of the anterior cerebellar vermis, lobules I-V and posterior neocortical lobules VI-VII and their relationship to sensorimotor and cognitive functions.
    METHODS: Typically developing children (TDC; n=38; age 9-15) and healthy adults (HAC; n=31; 18-40) participated in high-resolution MRI. Rigorous anatomically informed morphometry of the vermis lobules I-V and VI-VII and total brain volume (TBV) employed manual segmentation computer-assisted FreeSurfer Image Analysis Program [http://surfer.nmr.mgh.harvard.edu]. The neuropsychological scores (WASI-II) were normalized and related to volumes of anterior, posterior vermis, and TBV.
    RESULTS: TBVs were age independent. Volumes of I-V and VI-VII were significantly reduced in TDC. The ratio of VI-VII to I-V (∼60%) was stable across age-groups; I-V correlated with visual-spatial-motor skills; VI-VII with verbal, visual-abstract and FSIQ.
    CONCLUSIONS: In TDC neither anterior I-V nor posterior VI-VII vermis attained adult volumes. The \"inverted U\" developmental trajectory of gray matter peaking in adolescence does not explain this finding. The hypothesis of protracted development of oligodendrocyte/myelination is suggested as a contributor to TDC\'s lower cerebellar vermis volumes.
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  • 文章类型: Journal Article
    背景:生长受限的胎儿可能会在其神经解剖结构上发生改变,可以在产前成像中检测到。我们的目的是比较胎儿生长受限(FGR)和对照胎儿之间的call体长度(CCL)和小脑vermian高度(CVH)测量值,并将它们与生长受限胎儿的脑多普勒测速仪相关联。
    方法:这是一项妊娠20周后FGR的前瞻性队列,超声测量CCL和CVH。对照组由没有FGR的胎儿组成,这些胎儿在妊娠20周后进行了生长超声检查。我们比较了FGR和对照组之间CCL或CVH的差异。我们还测试了FGR组中CCL和CVH与大脑中动脉(MCA)搏动指数(PI)和椎动脉(VA)PI的相关性。通过头围(HC)调整CCL和CVH测量值。
    结果:分别在68和55例胎儿中获得了CCL和CVH。与对照胎儿相比,FGR胎儿的CCL/HC较小(差异=0.03,95%CI:[0.02,0.04],p<0.001)。与NG胎儿相比,FGR胎儿的CVH/HC更大(差异=0.1,95%CI:[-0.01,0.02],p=<.001)。VAPIMoM与CVH/HC呈负相关(rho=-0.53,p=0.007),而CCL/HC与VAPI无相关性。CCL/HC和CVH/HC均与MCAPI无关。
    结论:CCL/HC和CVH/HC测量显示生长受限胎儿与对照组相比存在差异。我们还发现了VAPI和CVH/HC之间的反比关系。神经超声检查评估在FGR评估中的潜在用途需要继续探索。
    BACKGROUND: Growth-restricted fetuses may have changes in their neuroanatomical structures that can be detected in prenatal imaging. We aim to compare corpus callosal length (CCL) and cerebellar vermian height (CVH) measurements between fetal growth restriction (FGR) and control fetuses and to correlate them with cerebral Doppler velocimetry in growth-restricted fetuses.
    METHODS: This was a prospective cohort of FGR after 20 weeks of gestation with ultrasound measurements of CCL and CVH. Control cohort was assembled from fetuses without FGR who had growth ultrasound after 20 weeks of gestation. We compared differences of CCL or CVH between FGR and controls. We also tested for the correlations of CCL and CVH with middle cerebral artery (MCA) pulsatility index (PI) and vertebral artery (VA) PI in the FGR group. CCL and CVH measurements were adjusted by head circumference (HC).
    RESULTS: CCL and CVH were obtained in 68 and 55 fetuses, respectively. CCL/HC was smaller in FGR fetuses when compared to control fetuses (difference = 0.03, 95% CI: [0.02, 0.04], p < 0.001). CVH/HC was larger in FGR fetuses compared to NG fetuses (difference = 0.1, 95% CI: [-0.01, 0.02], p = < 0.001). VA PI multiples of the median were inversely correlated with CVH/HC (rho = -0.53, p = 0.007), while CCL/HC was not correlated with VA PI. Neither CCL/HC nor CVH/HC was correlated with MCA PI.
    CONCLUSIONS: CCL/HC and CVH/HC measurements show differences in growth-restricted fetuses compared to a control cohort. We also found an inverse relationship between VA PI and CVH/HC. The potential use of neurosonography assessment in FGR assessment requires continued explorations.
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  • 文章类型: Journal Article
    为了研究中脑生长,包括语料库(CC),根据子宫动脉(UtA)搏动指数(PI)值,晚期胎儿生长受限(FGR)的小脑疣(CV)和皮质发育。
    这是一项前瞻性研究,包括以异常的脑胎盘比率(CPR)为特征的晚期FGR的单胎胎儿。根据UtAPI值,FGR胎儿分为正常≤95百分位数)和异常(>95百分位数)。在妊娠33-44周时进行神经超声检查,以评估CC和CV长度以及Sylvian裂(SF)的深度,顶枕骨(POF)和钙质裂(CF)。神经超声检查变量针对胎儿头围大小进行归一化。
    该研究队列包括60例FGR晚期的胎儿,39具有正常的UtAPI,21具有异常的PI值。后者在CC(中位数(四分位距)正常35.9(28.49-45.53)与异常UtAPI25.31(19.76-35.13)mm方面表现出显着差异;p<0.0022),CV(正常25.78(18.19-29.35)异常UtAPI17.03(14.07-24.16)mm;p=0.0067);SF(正常10.58(8.99-11.97)与异常UtAPI7.44(6.23-8.46)mm;p<0.0001),POF(正常6.85(6.35-8.14)vs异常UtAPI4.82(3.46-7.75)mm;p<=0.0184)和CF(正常04.157(2.85-5.41)vs异常UtAPI2.33(2.49-4.01));p<0.0382)。
    与正常子宫PI相比,UtAPI异常的晚发性FGR胎儿的CC和CV长度较短,皮质发育延迟。这些发现支持大脑发育异常与子宫胎盘循环变化之间存在联系。
    UNASSIGNED: To investigate midbrain growth, including corpus callusum (CC), cerebellar vermis (CV) and cortical development in late fetal growth restriction (FGR) depending on uterine artery (UtA) Pulsatility Index (PI) values.
    UNASSIGNED: This was a prospective study including singleton fetuses with late FGR characterized by abnormal cerebral placental ratio (CPR). According to UtA PI values, the FGR fetuses were subdivided into normal ≤95th centile) and abnormal (>95th centile). Neurosonography was performed at 33-44 weeks of gestations to assess CC and CV lengths and the depth of Sylvian fissure (SF), parieto-occipital (POF) and calcarine fissures (CF). Neurosonographic variables were normalized for fetal head circumference size.
    UNASSIGNED: The study cohort included 60 fetuses with late FGR, 39 with normal UtA PI and 21 with abnormal PI values. The latter group showed significant differences in CC (median (interquartile range) normal 35.9 (28.49-45.53) vs abnormal UtA PI 25.31(19.76-35.13) mm; p < 0.0022), CV (normal 25.78 (18.19-29.35) abnormal UtA PI 17.03 (14.07-24.16)mm; p = 0.0067); SF (normal 10.58 (8.99-11.97)vs abnormal UtA PI 7.44 (6.23-8.46) mm; p < 0.0001), POF (normal 6.85 (6.35-8.14) vs abnormal UtA PI 4.82 (3.46-7.75) mm; p < = 0.0184) and CF (normal 04.157 (2.85-5.41) vs abnormal UtA PI 2.33 (2.49-4.01)); p < 0.0382).
    UNASSIGNED: Late onset FGR fetuses with abnormal UtA PI showed shorter CC and CV length and delayed cortical development compared to those with normal uterine PI. These findings support the existence of a link between abnormal brain development and changes in utero placental circulation.
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  • 文章类型: Journal Article
    目的:研究C57BL/6J小鼠妊娠中期睡眠剥夺(SD)对子代运动协调能力的影响,探讨子代小脑疣神经小胶质细胞激活诱导运动协调能力发育受损的潜在机制。
    方法:C57BL/6J孕鼠随机分为SD组和对照组。从中期妊娠的第一天(妊娠第8天,GD8)开始通过多平台方法实施SD。在出生后第21天(PND21),我们测量了运动行为的发展,并收集小脑疣组织,通过H&E染色观察小胶质细胞的活化,小胶质细胞特异性标志物离子化钙结合衔接分子-1(Iba-1)和分化簇68(CD68)的表达通过免疫组织化学,和白细胞介素-4(IL-4),白细胞介素-6(IL-6),白细胞介素-10(IL-10),和肿瘤坏死因子-α(TNF-α)的实时定量PCR(RT-qPCR)。
    结果:在SD组的后代中,与对照组相比,平衡梁试验中的总通过时间和反向爬行距离,并且从悬挂绳跌落的频率增加;在旋转杆实验中,最大转速较低,持续时间较短。Further,我们发现小脑疣组织的小胶质细胞出现了变形虫样的激活。Iba-1的平均灰度值较低,CD68阳性细胞密度增加,IL-6和TNF-α表达水平增加。
    结论:后代的运动协调能力受损,伴随着怀孕中期的SD,小脑部显示小胶质细胞激活和促炎反应。提示妊娠中期SD通过后代小脑部的炎症反应对运动协调发展的不利影响。
    OBJECTIVE: To investigate the effects of mid-pregnancy sleep deprivation (SD) in C57BL/6 J mice on the motor coordination of the offspring and to explore the potential mechanism of microglia activation in the cerebellar vermis of the offspring involved in the induction of impaired motor coordination development.
    METHODS: C57BL/6 J pregnant mice were randomly divided into the SD and control groups. SD was implemented by the multi-platform method from first day of the middle pregnancy (gestation day 8, GD8). At postnatal day 21 (PND21), we measured the development of motor behavior and collected cerebellar vermis tissues to observe the activation of microglia by H&E staining, the expression of microglia-specific markers ionized calcium-binding adaptor molecule-1 (Iba-1) and cluster of differentiation 68 (CD68) by immunohistochemical, and interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor -α (TNF-α) by real-time quantitative PCR (RT-qPCR).
    RESULTS: In the offspring of SD group, comparing to the control group, the total time of passage and the reverse crawl distance in the balance beam test, and the frequency of falls from the suspension cord was increased; with lower max rotational speed and shorter duration in the rotarod experiment. Further, we found that the microglia of cerebellar vermis tissues emerged an amoeba-like activation. The mean gray value of Iba-1 was lower, the density of positive cells of CD68 and the expression levels of IL-6 and TNF-α were increased.
    CONCLUSIONS: The motor coordination of offspring is impaired, accompanying a SD from mid-pregnancy, and the cerebellar vermis showed microglia activation and pro-inflammatory response. It suggested the adverse effects of SD from mid-gestation on the development of motor coordination through the inflammatory response in the cerebellar vermis of the offspring.
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  • 文章类型: Journal Article
    在临床报告中,后颅窝肿瘤切除术后儿童的社会交流障碍的时间过程是可变的,其评估可能有助于了解小脑在社会传播障碍发病机制中的作用,并改善康复计划。我们报告了一名女性患者(LZ)的3年认知行为随访,该患者在9岁时因髓母细胞瘤而接受了疣的手术消融。LZ发展出严重的术后小脑认知情感综合征(CCAS),具有认知执行功能障碍和行为改变,类似于自闭症谱系障碍(ASD)样综合征。在后续评估中,缺乏同理心和识别他人意图和精神状态的能力持续存在,语言修改也是如此。本病例报告证明,影响小脑和veral小叶的病变可能会导致严重的CCAS和社交技能受损,与ASD中观察到的重叠。这个病例的临床特征很重要,揭示了长期的社会损害,而认知,语言学,随着时间的推移,执行功能有所改善。前瞻性病例研究应在临床纵向评估中计划评估ASD的症状。
    The time course of socio-communicative disturbances in children after posterior fossa tumor resection is variable in clinical reports, and its assessment may help to understand the role of the cerebellum in the pathogenesis of socio-communicative disorders and improve rehabilitation plans. We report the 3-year cognitive-behavioral follow-up of a female patient (LZ) who underwent surgical ablation of the vermis due to medulloblastoma at age 9. LZ developed a severe post-operative Cerebellar Cognitive Affective Syndrome (CCAS) with cognitive-executive dysfunctions and behavioral alterations resembling an Autism Spectrum Disorder (ASD)-like syndrome. The lack of empathy and reduced ability to recognize others\' intentions and mental states persisted at follow-up evaluations, as did language alterations. The present case report evidenced that lesions affecting cerebellar and vermal lobules may cause severe CCAS and impairment of social skills overlapping with that observed in ASD. This case is significant in its clinical features, revealing long-term social impairment, while the cognitive, linguistic, and executive functioning improved over time. Prospective case studies should plan the evaluation of symptoms of ASD within the clinical longitudinal assessment.
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  • 文章类型: Journal Article
    中枢神经系统可预测地控制姿势以抵抗外部干扰;然而,具体机制尚不清楚.我们测试了以下假设:通过使用站立任务和大鼠的地板干扰,小脑Vermis在获得预测性姿势控制中起着重要作用。完好无损的,病变,和假大鼠组依次进行了70个有条件的倾斜试验,并记录运动学。在这些录音前六天,只有病变组接受了针对Vermal小叶IV-VIII的局灶性吸引手术.在序贯试验的幼稚阶段,由于干扰而导致的直立姿势和波动在各组之间大多是一致的。尽管由于学习而导致的姿势波动减少的模式在各组之间是一致的,根据腰椎位移估算的学习率在病变组显著低于完整组和假手术组.这些结果表明,小脑Vermis有助于预测性姿势控制。
    The central nervous system predictively controls posture against external disturbances; however, the detailed mechanisms remain unclear. We tested the hypothesis that the cerebellar vermis plays a substantial role in acquiring predictive postural control by using a standing task with floor disturbances in rats. The intact, lesioned, and sham groups of rats sequentially underwent 70 conditioned floor-tilting trials, and kinematics were recorded. Six days before these recordings, only the lesion group underwent focal suction surgery targeting vermal lobules IV-VIII. In the naïve stage of the sequential trials, the upright postures and fluctuations due to the disturbance were mostly consistent among the groups. Although the pattern of decrease in postural fluctuation due to learning corresponded among the groups, the learning rate estimated from the lumbar displacement was significantly lower in the lesion group than in the intact and sham groups. These results suggest that the cerebellar vermis contributes to predictive postural controls.
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  • 文章类型: Journal Article
    目的:研究中脑生长,根据脐静脉血流量(UVBF)值进行细分,包括call体(CC)和小脑疣(CV)和晚期胎儿生长受限(FGR)的皮质发育。
    方法:这是一项对胎盘大脑比率异常的单胎胎儿晚期FGR(PCR)的前瞻性研究。FGR胎儿进一步细分为正常(≥第五百分位)和异常(<第五百分位)UVBF血流量校正为AC(UVBF/AC),在妊娠33-34周进行神经超声检查,以评估CC和CV长度以及Sylvian裂(SF)的深度,顶枕骨(POF)和钙质裂(CF)。神经超声检查变量针对胎儿头围大小进行归一化。
    结果:研究队列包括60个晚期FGR,31的UVBF/AC值正常,29的UVBF/AC值异常。后一组在CC(中位数(四分位距(IQR)正常0.96(0.73-1.16)与异常UVBF/AC0.60(0.47-0.87);p<0.0001)),CV(正常1.04(0.75-1.26)与异常UVBF(AC0.76(0.62-1.18);p=0.0319),SF(正常0.83(0.74-0.93)与异常UVBF/AC0.56(0.46-0.68);p<0.0001),POF(正常0.80(0.71-0.90)与异常UVBF/ACl0.49(0.39-0.90);p≤0.0072)和CF(正常0.83(0.56-1.01)与异常UVBF/AC0.72(0.53-0.80);p<0.029)。
    结论:与脐静脉血流动力学正常的胎儿相比,脐静脉血流减少的晚发性FGR胎儿的CC和CV长度较短,皮质发育延迟。这些发现支持大脑发育异常与脐静脉循环变化之间存在联系。
    OBJECTIVE: To investigate midbrain growth, including corpus callusum (CC) and cerebellar vermis (CV) and cortical development in late fetal growth restricted (FGR) subclassified according to the umbilical vein blood flow (UVBF) values.
    METHODS: This was a prospective study on singleton fetuses late FGR with abnormal placental cerebral ratio (PCR). FGR fetuses were further subdivided into normal (≥fifth centile) and abnormal (RESULTS: The study cohort included 60 late FGR, 31 with normal UVBF/AC and 29 with abnormal UVBF/AC values. The latter group showed significant differences in CC (median (interquartile range (IQR) normal 0.96 (0.73-1.16) vs. abnormal UVBF/AC 0.60 (0.47-0.87); p<0.0001)), CV (normal 1.04 (0.75-1.26) vs. abnormal UVBF (AC 0.76 (0.62-1.18)); p=0.0319), SF (normal 0.83 (0.74-0.93) vs. abnormal UVBF/AC 0.56 (0.46-0.68); p<0.0001), POF (normal 0.80 (0.71-0.90) vs. abnormal UVBF/AC l 0.49 (0.39-0.90); p≤0.0072) and CF (normal 0.83 (0.56-1.01) vs. abnormal UVBF/AC 0.72 (0.53-0.80); p<0.029).
    CONCLUSIONS: Late onset FGR fetuses with of reduced umbilical vein flow showed shorter CC and CV length and a delayed cortical development when compared to those with normal umbilical vein hemodynamics. These findings support the existence of a link between abnormal brain development and changes in umbilical vein circulation.
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  • 文章类型: Journal Article
    三叉神经核复合体的小脑投射是小脑输入的主要群体之一。尽管这种投影在小脑功能处理和组织中是必不可少的,其形态组织尚未得到系统的阐明。本研究通过小叶特异性逆行神经元标记和顺行标记单轴突重建解决了这个问题。小脑投射主要来自三叉神经脊髓核(Sp5I)和三叉神经主感觉核(Pr5)的极间细分。虽然CrusII,副瓣小叶,小叶IX,简单的小叶是主要目标,parafculus,其他小叶接受了一些投影。重建的单个三叉小脑轴突平均显示出77.8个苔藓纤维末端,通常在多个小叶中,但没有核络脉。与斑马阳性区室相比,斑马阴性或轻阳性区室中的终末更多。虽然Pr5轴突主要投射到同侧小腿II,Sp5I轴突主要投射到小腿II和旁小叶,通常是双侧的,或主要是小叶IX总是同侧。小叶IX型Sp5I神经元特异性表达Gpr26。Gpr26标记的神经元标记产生了独特的苔藓纤维分布,在小叶IX的背外侧密集,并横向延伸至小叶IX的背正中顶点。在向间脑投射的上升Sp5I轴突的侧支中观察到向小脑核的投射。总之,三叉小脑投影的多个种群显示小脑小叶的投影不同。投影通常与脑桥投影互补,并与报道的口面感受野排列部分匹配。
    The cerebellar projection from the trigeminal nuclear complex is one of the major populations of the cerebellar inputs. Although this projection is essential in cerebellar functional processing and organization, its morphological organization has not been systematically clarified. The present study addressed this issue by lobule-specific retrograde neuronal labeling and single axonal reconstruction with anterograde labeling. The cerebellar projection arose mainly from the interpolaris subdivision of the spinal trigeminal nucleus (Sp5I) and the principal trigeminal sensory nucleus (Pr5). Although crus II, paramedian lobule, lobule IX, and simple lobule were the major targets, paraflocculus, and other lobules received some projections. Reconstructed single trigeminocerebellar axons showed 77.8 mossy fiber terminals on average often in multiple lobules but no nuclear collaterals. More terminals were located in zebrin-negative or lightly-positive compartments than in zebrin-positive compartments. While Pr5 axons predominantly projected to ipsilateral crus II, Sp5I axons projected either predominantly to crus II and paramedian lobule often bilaterally, or predominantly to lobule IX always ipsilaterally. Lobule IX-predominant-type Sp5I neurons specifically expressed Gpr26. Gpr26-tagged neuronal labeling produced a peculiar mossy fiber distribution, which was dense in the dorsolateral lobule IX and extending transversely to the dorsal median apex in lobule IX. The projection to the cerebellar nuclei was observed in collaterals of ascending Sp5I axons that project to the diencephalon. In sum, multiple populations of trigeminocerebellar projections showed divergent projections to cerebellar lobules. The projection was generally complementary with the pontine projection and partly matched with the reported orofacial receptive field arrangement.
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  • 文章类型: Journal Article
    背景:伴有小脑发育不全和皮质畸形的巨型体-call体综合征是一种罕见的神经系统疾病,与典型的临床和影像学特征有关。该综合征是由MAST1基因的致病变异引起的,它编码一种微管相关蛋白,该蛋白主要在发育中的神经系统的有丝分裂后神经元中表达。
    方法:对来自脐带血样本的胎儿DNA和来自外周血淋巴细胞的基因组DNA进行全外显子组测序。通过Sanger测序验证了潜在的致病变异。
    结果:一名26岁的初产妇在妊娠25周时被转诊到我们的产前中心,原因是胎儿大脑中的超声异常。脑部异常包括透明室间隔宽,浅层和不完全双侧外侧裂池,双侧侧脑室扩张,call体增生,间脑,和皮质发育不良.脑干或小脑半球未见明显异常,但是小脑的疣很小.全外显子组测序确定了一个从头,杂合错义变体,c.695T>C(第Leu232Pro),在MAST1基因中,并考虑了mega体-call体综合征的遗传诊断。
    结论:本研究是中国人群中报道的首例MAST1相关疾病的产前病例,扩大了MAST1基因的突变谱。
    BACKGROUND: Mega-corpus-callosum syndrome with cerebellar hypoplasia and cortical malformations is a rare neurological disorder that is associated with typical clinical and imaging features. The syndrome is caused by pathogenic variants in the MAST1 gene, which encodes a microtubule-associated protein that is predominantly expressed in postmitotic neurons in the developing nervous system.
    METHODS: Fetal DNA from umbilical cord blood samples and genomic DNA from peripheral blood lymphocytes were subjected to whole-exome sequencing. The potential causative variants were verified by Sanger sequencing.
    RESULTS: A 26-year-old primigravid woman was referred to our prenatal center at 25 weeks of gestation due to abnormal ultrasound findings in the brain of the fetus. The brain abnormalities included wide cavum septum pellucidum, shallow and incomplete bilateral lateral fissure cistern, bilateral dilated lateral ventricles, hyperplastic corpus callosum, lissencephaly, and cortical dysplasia. No obvious abnormalities were observed in the brainstem or cerebellum hemispheres, but the cerebellum vermis was small. Whole-exome sequencing identified a de novo, heterozygous missense variant, c.695T>C(p.Leu232Pro), in the MAST1 gene and a genetic diagnosis of mega-corpus-callosum syndrome was considered.
    CONCLUSIONS: This study is the first prenatal case of MAST1-related disorder reported in the Chinese population and has expanded the mutation spectrum of the MAST1 gene.
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  • 文章类型: Journal Article
    OBJECTIVE: Fetuses with late growth restriction (FGR) have a higher risk of sub-optimal neurocognitive performance after birth. Previous studies have reported that impaired brain and cortical development can start in utero. The primary aim of this study was to report midline structures and cortical development in fetuses with late growth restriction according to its severity; the secondary aim was to elucidate whether the severity of FGR, as defined by the presence of abnormal Doppler findings, plays a role in affecting brain growth and maturation.
    METHODS: Prospective cross-sectional study including fetuses with late FGR undergoing neurosonography between 32 and 34 weeks of gestation. Midline structures (corpus callosum (CC) and cerebellar vermis (CV) length) and cortical development, including the depth of Sylvian (SF), parieto-occipital (POF) and calcarine (CF) were compared between FGR, small (SGA) and appropriate for gestational age (AGA) fetuses, defined upon the Delphi criteria. Sub-group analysis according to the severity of FGR (normal vs abnormal fetal Dopplers) was also performed. Univariate analysis was used to analyze the data.
    RESULTS: 52 FGR with normal, 60 with abnormal Dopplers, 64 SGA and 100 AGA fetuses were included in the analysis. SGA and FGR fetuses showed significant differences in absolute values of CC (median (interquartile range) control 43.47 (28.9-56.05), vs SGA 41.85 (27.82-51.79), vs FGR ND 38.54 (29.12-50.53), vs FGR AD 31.72 (23.8-40.19) K= 26.68; p<0.0001), CV (control 24.85 (17.55-29.21), SGA K=16.71; p=0.0008), SF (control 14.52 (10.65-16.76) vs SGA 12.71 (9.8-15.10) vs FGR ND 11.93 (9.12-13.43) VS FGR A 8.30 (6.72-10.33) K=75.82; p<0.0001), POF (control 8.56 (6.31-11.09) vs SGA 8.11 (5.58-10.43) vs FGR ND 7.81 (6.14-9.29) vs FGR AD 6.56 (4.22-7.99), K=45.06; p<0.0001) and CF ( control 9.27 (6.70-11.45) vs SGA 8.23 (5.67-10.65) vs FGR ND 7.68 (5.22-9.41) vs FGR AD 6.26 (4.48-7.19) K=46.14; p<0.0001) when compared to AGA controls with a progressive reduction across groups. When neurosonographic variables were corrected for fetal HC values, significant difference in the length of CC, SF, POF and CF but CV were observed only in FGR fetuses with abnormal Doppler when compared to AGA controls.
    CONCLUSIONS: Late onset small fetuses showed shorter CC length and a delayed cortical development when compared to control. After controlling for HC size these differences remain significant only in FGR fetuses with abnormal Dopplers. These findings support the existence of a link between brain development and impaired placental function. This article is protected by copyright. All rights reserved.
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