A5012671697- Neonatal and fetal brain pathology
- Advanced MRI Techniques and Applications
- Neonatal Respiratory Health Research
- Fetal and Pediatric Neurological Disorders
- Atomic and Subatomic Physics Research
- Infectious Encephalopathies and Encephalitis
- Traumatic Brain Injury and Neurovascular Disturbances
- Autopsy Techniques and Outcomes
- Nuclear Physics and Applications
- Advanced Neuroimaging Techniques and Applications
- Medical Imaging Techniques and Applications
- Metabolism and Genetic Disorders
- Advanced X-ray Imaging Techniques
- Infant Development and Preterm Care
- Forensic Anthropology and Bioarchaeology Studies
- Peripheral Nerve Disorders
- Botulinum Toxin and Related Neurological Disorders
- Osteoarthritis Treatment and Mechanisms
- Thermal Regulation in Medicine
- Hereditary Neurological Disorders
- Advanced NMR Techniques and Applications
- Pediatric Urology and Nephrology Studies
- Cardiac Arrest and Resuscitation
- Orthopedic Surgery and Rehabilitation
- Advanced Fluorescence Microscopy Techniques
Imperial College London
2015-2024
Hammersmith Hospital
2014-2021
UK Dementia Research Institute
2021
University College London
2018
William Harvey Research Institute
2018
Great Ormond Street Hospital
2018
Queen Mary University of London
2018
Southampton General Hospital
2018
National Institute for Health Research
2018
Boston Children's Hospital
2018
BackgroundAlthough therapeutic hypothermia reduces death or disability after neonatal encephalopathy in high-income countries, its safety and efficacy low-income middle-income countries is unclear. We aimed to examine whether alongside optimal supportive intensive care moderate severe south Asia.MethodsWe did a multicountry open-label, randomised controlled trial seven tertiary units India, Sri Lanka, Bangladesh. enrolled infants born at 36 weeks of gestation with need for continued...
In neonatal encephalopathy, the clinical manifestations of injury can only be reliably assessed several years after an intervention, complicating early prognostication and rendering trials promising neuroprotectants slow expensive. We aimed to determine accuracy thalamic proton magnetic resonance (MR) spectroscopy (MRS) biomarkers as predictors neurodevelopmental abnormalities observed encephalopathy.We did a prospective multicentre cohort study across eight intensive care units in UK USA,...
Importance The association between place of birth and hypothermic neuroprotection after hypoxic-ischemic encephalopathy (HIE) in low- middle-income countries (LMICs) is unknown. Objective To ascertain the efficacy whole-body hypothermia for protection against brain injury measured by magnetic resonance (MR) biomarkers among neonates born at a tertiary care center (inborn) or other facilities (outborn). Design, Setting, Participants This nested cohort study within randomized clinical trial...
Although major cooling trials (and subsequent guidelines) excluded babies with mild encephalopathy, anecdotal evidence suggests that is often offered to these infants. We report a national survey on current practices for encephalopathy in the UK. From 74 neonatal units contacted, 68 were centres. received 54 responses (79%) and included 48 (five due incomplete data one found later not offer cooling). Of these, 36 centres (75%) infants encephalopathy. most of participating reported targeting...
Therapeutic hypothermia reduces death and disability after moderate or severe neonatal encephalopathy in high-income countries is used as standard therapy these settings. However, the safety efficacy of cooling low- middle-income (LMICs), where 99% disease burden occurs, remains unclear. We will examine whether whole body neurodisability at 18–22 months encephalopathy, LMICs. randomly allocate 408 term near-term babies (aged ≤ 6 h) with admitted to public sector units LMIC (India, Bangladesh...
Objective To examine the effect of therapeutic hypothermia on MR biomarkers and neurodevelopmental outcomes in babies with mild hypoxic-ischaemic encephalopathy (HIE). Design Non-randomised cohort study. Setting Eight tertiary neonatal units UK USA. Patients 47 HIE NICHD neurological examination performed within 6 hours after birth. Interventions Whole-body cooling for 72 (n=32) or usual care (n=15; these 5 were cooled <12 hours). Main outcome measures MRI spectroscopy (MRS) 2 weeks...
Although therapeutic hypothermia (TH) is the standard of care for hypoxic ischaemic encephalopathy in high-income countries, safety and efficacy this therapy low-income middle-income countries (LMICs) unknown. We aimed to describe feasibility TH using a low-cost servo-controlled cooling device short-term outcomes cooled babies LMIC.We recruited with moderate or severe (aged <6 hours) admitted public sector tertiary neonatal units India over 28-month period. administered whole-body (set core...
Although brain injury after neonatal encephalopathy has been characterised well in high-income countries, little is known about such low- and middle-income countries. Such accounts for an estimated 1 million deaths per year. We used magnetic resonance (MR) biomarkers to characterise perinatal injury, examined early childhood outcomes South India. Methods recruited consecutive term or near infants with evidence of asphyxia a Thompson score ≥6 within 6 h birth, over months. performed...
Background Although stillbirth is a significant health problem worldwide, the definitive cause of death remains elusive in many cases, despite detailed autopsy. In this study partly explained and unexplained stillbirths, we used next-generation sequencing to examine an extended panel 35 candidate genes known be associated with ion channel disorders sudden cardiac death. Methods Results We examined tissue from 242 stillbirths (≥22 weeks), including those where no definite could confirmed...
We examined the brain injury and neurodevelopmental outcomes in a prospective cohort of 10 babies with mild encephalopathy who had early cessation cooling therapy. All MRI spectroscopy within 2 weeks after birth assessment at years. Cooling was prematurely discontinued median age 9 hours (IQR 5–13) due to rapid clinical improvement. Five (50%) on or spectroscopy, two (20%) an abnormal outcome Premature therapy neonatal does not exclude residual adverse long-term outcomes. This study refers...
Although therapeutic hypothermia (TH) improves outcomes after neonatal encephalopathy (NE), the safety and efficacy of preemptive opioid sedation during cooling therapy is unclear. We performed a secondary analysis data from large multicountry prospective observational study (Magnetic Resonance Biomarkers in Neonatal Encephalopathy [MARBLE]) to examine association morphine infusion TH on brain injury neurodevelopmental NE. All recruited infants had 3.0 Tesla magnetic resonance imaging...
Abstract Background and Aims Histopathological diagnosis is the gold standard in many acquired inflammatory, infiltrative amyloid based peripheral nerve diseases a sensory biopsy of sural or superficial peroneal favoured where deemed necessary. The ability to determine pathology by high‐resolution imaging techniques resolving anatomy characteristics might improve obviate need for some. anatomically variable occasionally adjacent vessels can be sent analysis error. Knowing exact position...
<h3>Introduction</h3> Despite cooling, adverse outcomes are seen in up to half of the surviving infants after neonatal encephalopathy. A number novel adjunct drug therapies with cooling have been shown be highly neuroprotective animal studies, and currently awaiting clinical translation. Rigorous evaluation these phase II trials using surrogate MR biomarkers may speed their bench bedside recent systematic review single-centre studies has suggested that spectroscopy offer best promise;...
Successful neonatal brain MRI relies on having a settled infant within the scanner to permit acquisition of necessary sequences and good-quality images. Unsettledness may lead incomplete or unsuccessful scans, costly rescheduled scans with concomitant parental anxiety inconvenience. Significant motion artefact confound preclude interpretation, leading diagnostic errors.1 Use premedication assist is controversial: routine sedation can be used safely effectively in neonates2 though some report...
Post mortem imaging is playing an increasingly important role in perinatal autopsy, and correct interpretation of changes paramount. This particularly following intra-uterine fetal death, where there may be maceration. The aim this study was to investigate whether any seen on a whole body post magnetic resonance (PMMR) correspond maceration at conventional autopsy. We performed pre-autopsy PMMR 75 fetuses using 1.5 Tesla Siemens Avanto MR scanner (Erlangen, Germany). images were reported...
<b><i>Background:</i></b> Variable responses to hypothermic neuroprotection are related the clinical heterogeneity of encephalopathic babies; hence better disease stratification may facilitate development individualized neuroprotective therapies. <b><i>Objectives:</i></b> We examined if whole blood gene expression analysis can identify specific transcriptome profiles in neonatal encephalopathy. <b><i>Material and...
Abstract Cognitive impairment after traumatic brain injury remains hard to predict. This is partly because axonal injury, which of fundamental importance, difficult measure clinically. Advances in MRI allow be detected but the most sensitive approach unclear. Here, we compare performance diffusion tensor imaging, neurite orientation dispersion and density-imaging volumetric measures atrophy identification white-matter abnormalities injury. Thirty patients with moderate–severe chronic phase...
Magnetic resonance imaging (MRI) of peripheral nerves can provide image-based anatomical information and quantitative measurement. The aim this pilot study was to investigate the feasibility high-resolution MRI assessment sciatic nerve fascicles in patients with Charcot-Marie-Tooth (CMT) 1A using 7T field strength.Six CMT1A underwent on a high-gradient scanner 28-channel knee coil. Two axial images were simultaneously acquired double-echo steady-state (DESS) sequence. By comparing two DESS...
Magnetic Resonance Imaging (MRI) is a pivotal clinical diagnostic tool, yet its extended scanning times often compromise patient comfort and image quality, especially in volumetric, temporal quantitative scans. This review elucidates recent advances MRI acceleration via data physics-driven models, leveraging techniques from algorithm unrolling enhancement-based plug-and-play models to emergent full spectrum of generative models. We also explore the synergistic integration with physics-based...