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Nešković N, Marczi S, Mandić D, Mraovic B, Škiljić S, Kristek G, Vinković H, Kvolik S. ANALGESIC EFFECT OF TRAMADOL IS NOT ALTERED BY POSTOPERATIVE SYSTEMIC INFLAMMATION AFTER MAJOR ABDOMINAL SURGERY. Acta Clin Croat 2021; 60:268-275. [PMID: 34744277 PMCID: PMC8564835 DOI: 10.20471/acc.2021.60.02.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/29/2020] [Indexed: 12/04/2022] Open
Abstract
Tramadol is a commonly used analgesic in intensive care units (ICUs) for acute postoperative pain. Conversion of tramadol into active metabolites may be impaired in inflammatory states. Catechol-O-methyltransferase may influence pain. The aim of the study was to examine differences in the analgesic effect of tramadol between ICU patients with and without signs of systemic inflammation. Forty-three patients were admitted to ICU after a major abdominal surgery. The patients received a dose of 100 mg of tramadol intravenously every 6 hours during the first 24 hours after surgical procedure. Pain scores were measured by the Numeric Rating Scale before and 30 minutes after tramadol administration in awake patients. Systemic inflammation was considered when at least two of the following postoperative parameters were present in the first 24 hours of ICU admission: fever or hypothermia, tachycardia, pCO2 <4.3 kPa, white blood cells >12000/mm3 or <4000/mm3, or preoperative value of C-reactive protein (CRP) >50 mg/L or/and procalcitonin (PCT) >0.5 mg/L. Catechol-O-methyltransferase was analyzed postoperatively. Fifteen (34.8%) patients met the criteria for systemic inflammation. Tramadol was proven to be an effective analgesic for the treatment of postoperative pain regardless of the presence of systemic inflammation (p<0.05). Lower perception of pain before tramadol application was observed in patients with systemic inflammation, but the difference was not significant. A negative correlation was observed between the preoperative values of CRP and PCT and the analgesic effect of tramadol assessed at the second measurement point (r=-0.358, p=0.03, and r=-0.364, p=0.02, respectively). Catechol-O-methyltransferase variants were not in correlation with pain and opioid consumption. Based on our findings, tramadol is effective in lowering pain scores after major abdominal surgery irrespective of the presence of systemic inflammation.
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Affiliation(s)
| | - Saška Marczi
- 1Osijek University Hospital Centre, Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Osijek University Hospital Centre, Department of Transfusion Medicine, Laboratory of Molecular and HLA Diagnostics, Osijek, Croatia; 4Osijek University Hospital Centre, Department of Clinical and Laboratory Diagnostics, Osijek, Croatia; 5University of Missouri, Department of Anesthesiology and Perioperative Medicine, School of Medicine, Columbia, USA
| | - Dario Mandić
- 1Osijek University Hospital Centre, Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Osijek University Hospital Centre, Department of Transfusion Medicine, Laboratory of Molecular and HLA Diagnostics, Osijek, Croatia; 4Osijek University Hospital Centre, Department of Clinical and Laboratory Diagnostics, Osijek, Croatia; 5University of Missouri, Department of Anesthesiology and Perioperative Medicine, School of Medicine, Columbia, USA
| | - Boris Mraovic
- 1Osijek University Hospital Centre, Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Osijek University Hospital Centre, Department of Transfusion Medicine, Laboratory of Molecular and HLA Diagnostics, Osijek, Croatia; 4Osijek University Hospital Centre, Department of Clinical and Laboratory Diagnostics, Osijek, Croatia; 5University of Missouri, Department of Anesthesiology and Perioperative Medicine, School of Medicine, Columbia, USA
| | - Sonja Škiljić
- 1Osijek University Hospital Centre, Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Osijek University Hospital Centre, Department of Transfusion Medicine, Laboratory of Molecular and HLA Diagnostics, Osijek, Croatia; 4Osijek University Hospital Centre, Department of Clinical and Laboratory Diagnostics, Osijek, Croatia; 5University of Missouri, Department of Anesthesiology and Perioperative Medicine, School of Medicine, Columbia, USA
| | - Gordana Kristek
- 1Osijek University Hospital Centre, Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Osijek University Hospital Centre, Department of Transfusion Medicine, Laboratory of Molecular and HLA Diagnostics, Osijek, Croatia; 4Osijek University Hospital Centre, Department of Clinical and Laboratory Diagnostics, Osijek, Croatia; 5University of Missouri, Department of Anesthesiology and Perioperative Medicine, School of Medicine, Columbia, USA
| | - Hrvoje Vinković
- 1Osijek University Hospital Centre, Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Osijek University Hospital Centre, Department of Transfusion Medicine, Laboratory of Molecular and HLA Diagnostics, Osijek, Croatia; 4Osijek University Hospital Centre, Department of Clinical and Laboratory Diagnostics, Osijek, Croatia; 5University of Missouri, Department of Anesthesiology and Perioperative Medicine, School of Medicine, Columbia, USA
| | - Slavica Kvolik
- 1Osijek University Hospital Centre, Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Osijek University Hospital Centre, Department of Transfusion Medicine, Laboratory of Molecular and HLA Diagnostics, Osijek, Croatia; 4Osijek University Hospital Centre, Department of Clinical and Laboratory Diagnostics, Osijek, Croatia; 5University of Missouri, Department of Anesthesiology and Perioperative Medicine, School of Medicine, Columbia, USA
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Szöllősi D, Hegedűs N, Veres DS, Futó I, Horváth I, Kovács N, Martinecz B, Dénes Á, Seifert D, Bergmann R, Lebeda O, Varga Z, Kaleta Z, Szigeti K, Máthé D. Evaluation of Brain Nuclear Medicine Imaging Tracers in a Murine Model of Sepsis-Associated Encephalopathy. Mol Imaging Biol 2019; 20:952-962. [PMID: 29736562 PMCID: PMC6244542 DOI: 10.1007/s11307-018-1201-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose The purpose of this study was to evaluate a set of widely used nuclear medicine imaging agents as possible methods to study the early effects of systemic inflammation on the living brain in a mouse model of sepsis-associated encephalopathy (SAE). The lipopolysaccharide (LPS)-induced murine systemic inflammation model was selected as a model of SAE. Procedures C57BL/6 mice were used. A multimodal imaging protocol was carried out on each animal 4 h following the intravenous administration of LPS using the following tracers: [99mTc][2,2-dimethyl-3-[(3E)-3-oxidoiminobutan-2-yl]azanidylpropyl]-[(3E)-3-hydroxyiminobutan-2-yl]azanide ([99mTc]HMPAO) and ethyl-7-[125I]iodo-5-methyl-6-oxo-4H-imidazo[1,5-a][1,4]benzodiazepine-3-carboxylate ([125I]iomazenil) to measure brain perfusion and neuronal damage, respectively; 2-deoxy-2-[18F]fluoro-d-glucose ([18F]FDG) to measure cerebral glucose uptake. We assessed microglia activity on another group of mice using 2-[6-chloro-2-(4-[125I]iodophenyl)-imidazo[1,2-a]pyridin-3-yl]-N-ethyl-N-methyl-acetamide ([125I]CLINME). Radiotracer uptakes were measured in different brain regions and correlated. Microglia activity was also assessed using immunohistochemistry. Brain glutathione levels were measured to investigate oxidative stress. Results Significantly reduced perfusion values and significantly enhanced [18F]FDG and [125I]CLINME uptake was measured in the LPS-treated group. Following perfusion compensation, enhanced [125I]iomazenil uptake was measured in the LPS-treated group’s hippocampus and cerebellum. In this group, both [18F]FDG and [125I]iomazenil uptake showed highly negative correlation to perfusion measured with ([99mTc]HMPAO uptake in all brain regions. No significant differences were detected in brain glutathione levels between the groups. The CD45 and P2Y12 double-labeling immunohistochemistry showed widespread microglia activation in the LPS-treated group. Conclusions Our results suggest that [125I]CLINME and [99mTc]HMPAO SPECT can be used to detect microglia activation and brain hypoperfusion, respectively, in the early phase (4 h post injection) of systemic inflammation. We suspect that the enhancement of [18F]FDG and [125I]iomazenil uptake in the LPS-treated group does not necessarily reflect neural hypermetabolism and the lack of neuronal damage. They are most likely caused by processes emerging during neuroinflammation, e.g., microglia activation and/or immune cell infiltration. Electronic supplementary material The online version of this article (10.1007/s11307-018-1201-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dávid Szöllősi
- Department of Biophysics and Radiation Biology, Semmelweis Univ, Budapest, H-1094, Hungary
| | - Nikolett Hegedűs
- Department of Biophysics and Radiation Biology, Semmelweis Univ, Budapest, H-1094, Hungary
| | - Dániel S Veres
- Department of Biophysics and Radiation Biology, Semmelweis Univ, Budapest, H-1094, Hungary
| | - Ildikó Futó
- Department of Biophysics and Radiation Biology, Semmelweis Univ, Budapest, H-1094, Hungary
| | - Ildikó Horváth
- Department of Biophysics and Radiation Biology, Semmelweis Univ, Budapest, H-1094, Hungary
| | - Noémi Kovács
- CROmed Translational Research Centers, Budapest, H-1047, Hungary
| | - Bernadett Martinecz
- Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary
| | - Ádám Dénes
- Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary
| | - Daniel Seifert
- Nuclear Physics Institute of the CAS, CZ 250 68, Rez, Czech Republic
| | - Ralf Bergmann
- Helmholz-Zentrum Dresden-Rossendorf, Radiopharmazie Radiopharmaceutische Biologie, Dresden, Germany
| | - Ondřej Lebeda
- Nuclear Physics Institute of the CAS, CZ 250 68, Rez, Czech Republic
| | - Zoltán Varga
- Department of Biophysics and Radiation Biology, Semmelweis Univ, Budapest, H-1094, Hungary.,Biological Nanochemistry Research Group, Institute of Materials and Environmental Chemistry, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Zoltán Kaleta
- Progressio Fine Chemical Engineering Ltd, Székesfehérvár, Hungary
| | - Krisztián Szigeti
- Department of Biophysics and Radiation Biology, Semmelweis Univ, Budapest, H-1094, Hungary.
| | - Domokos Máthé
- CROmed Translational Research Centers, Budapest, H-1047, Hungary
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Kidwell CS, Rosand J, Norato G, Dixon S, Worrall BB, James ML, Elkind MSV, Flaherty ML, Osborne J, Vashkevich A, Langefeld CD, Moomaw CJ, Woo D. Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage. Neurology 2017; 88:782-788. [PMID: 28122903 DOI: 10.1212/wnl.0000000000003630] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 11/28/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the associations among diffusion-weighted imaging (DWI) lesions, blood pressure (BP) dysregulation, MRI markers of small vessel disease, and poor outcome in a large, prospective study of primary intracerebral hemorrhage (ICH). METHODS The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a multicenter, observational study of ICH among white, black, and Hispanic patients. RESULTS Of 600 patients, mean (±SD) age was 60.8 ± 13.6 years, median (interquartile range) ICH volume was 9.1 mL (3.5-20.8), and 79.6% had hypertension. Overall, 26.5% of cases had DWI lesions, and this frequency differed by race/ethnicity (black 33.8%, Hispanic 24.9%, white 20.2%, overall p = 0.006). A logistic regression model of variables associated with DWI lesions included lower age (odds ratio [OR] 0.721, p = 0.002), higher first recorded systolic BP (10-unit OR 1.12, p = 0.002), greater change in mean arterial pressure (MAP) prior to the MRI (10-unit OR 1.10, p = 0.037), microbleeds (OR 1.99, p = 0.008), and higher white matter hyperintensity (WMH) score (1-unit OR 1.16, p = 0.002) after controlling for race/ethnicity, leukocyte count, and acute in-hospital antihypertensive treatment. A second model of variables associated with poor 90-day functional outcome (modified Rankin Scale scores 4-6) included DWI lesion count (OR 1.085, p = 0.034) as well as age, ICH volume, intraventricular hemorrhage, Glasgow Coma Scale score, WMH score, race/ethnicity, acute in-hospital antihypertensive treatment, and ICH location. CONCLUSIONS These results support the hypotheses that acute BP dysregulation is associated with the development of DWI lesions in primary ICH and that DWI lesions are, in turn, associated with poor outcomes.
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Affiliation(s)
- Chelsea S Kidwell
- From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Jonathan Rosand
- From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Gina Norato
- From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Simone Dixon
- From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Bradford B Worrall
- From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Michael L James
- From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Mitchell S V Elkind
- From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Matthew L Flaherty
- From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Jennifer Osborne
- From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Anastasia Vashkevich
- From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Carl D Langefeld
- From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Charles J Moomaw
- From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Daniel Woo
- From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC
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