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Chen M, Joshi KC, Kolb B, Sitton CW, Pujara DK, Abraham MG, Ortega-Gutierrez S, Kasner SE, Hussain SM, Churilov L, Blackburn S, Sundararajan S, Hu YC, Herial N, Arenillas JF, Tsai JP, Budzik RF, Hicks W, Kozak O, Yan B, Cordato D, Manning NW, Parsons M, Hanel RA, Aghaebrahim A, Wu T, Cardona Portela P, Gandhi CD, Al-Mufti F, Perez de la Ossa N, Schaafsma J, Blasco J, Sangha N, Warach S, Kleinig TJ, Johns H, Shaker F, Abdulrazzak MA, Ray A, Sunshine J, Opaskar A, Duncan KR, Xiong W, Al-Shaibi FK, Samaniego EA, Nguyen TN, Fifi JT, Tjoumakaris SI, Jabbour P, Mendes Pereira V, Lansberg MG, Sila C, Bambakidis NC, Davis S, Wechsler L, Albers GW, Grotta JC, Ribo M, Hassan AE, Campbell B, Hill MD, Sarraj A. Clinical relevance of intracranial hemorrhage after thrombectomy versus medical management for large core infarct: a secondary analysis of the SELECT2 randomized trial. J Neurointerv Surg 2024:jnis-2023-021219. [PMID: 38471760 DOI: 10.1136/jnis-2023-021219] [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: 11/02/2023] [Accepted: 02/18/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The incidence of intracerebral hemorrhage (ICH) and its effect on the outcomes after endovascular thrombectomy (EVT) for patients with large core infarcts have not been well-characterized. METHODS SELECT2 trial follow-up imaging was evaluated using the Heidelberg Bleeding Classification (HBC) to define hemorrhage grade. The association of ICH with clinical outcomes and treatment effect was examined. RESULTS Of 351 included patients, 194 (55%) and 189 (54%) demonstrated intracranial and intracerebral hemorrhage, respectively, with a higher incidence in EVT (134 (75%) and 130 (73%)) versus medical management (MM) (60 (35%) and 59 (34%), both P<0.001). Hemorrhagic infarction type 1 (HBC=1a) and type 2 (HBC=1b) accounted for 93% of all hemorrhages. Parenchymal hematoma (PH) type 1 (HBC=1c) and type 2 (HBC=2) were observed in 1 (0.6%) EVT-treated and 4 (2.2%) MM patients. Symptomatic ICH (sICH) (SITS-MOST definition) was seen in 0.6% EVT patients and 1.2% MM patients. No trend for ICH with core volumes (P=0.10) or Alberta Stroke Program Early CT Score (ASPECTS) (P=0.74) was observed. Among EVT patients, the presence of any ICH did not worsen clinical outcome (modified Rankin Scale (mRS) at 90 days: 4 (3-6) vs 4 (3-6); adjusted generalized OR 1.00, 95% CI 0.68 to 1.47, P>0.99) or modify EVT treatment effect (Pinteraction=0.77). CONCLUSIONS ICH was present in 75% of the EVT population, but PH or sICH were infrequent. The presence of any ICH did not worsen functional outcomes or modify EVT treatment effect at 90-day follow-up. The high rate of hemorrhages overall still represents an opportunity for adjunctive therapies in EVT patients with a large ischemic core.
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Affiliation(s)
- Michael Chen
- Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Krishna C Joshi
- Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Bradley Kolb
- Rush University Medical Center, Chicago, Illinois, USA
| | - Clark W Sitton
- Diagnostic & Interventional Imaging, UT Houston, Houston, Texas, USA
| | | | - Michael G Abraham
- Neurology and Radiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Santiago Ortega-Gutierrez
- Neuroloy, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Scott E Kasner
- Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shazam M Hussain
- Cleveland Clinic Stroke Program, Cleveland Clinic, Cleveland Heights, Ohio, USA
| | | | - Spiros Blackburn
- Neurosurgery, University of Texas Medical School at Houston Vivian L Smith Department of Neurosurgery, Houston, Texas, USA
| | | | - Yin C Hu
- Neurosurgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Nabeel Herial
- Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Juan F Arenillas
- Stroke Unit, Neurology Department, Stroke Unit. Neurology Department. Universitary Hospital, Valladolid (Spain), Valladolid, Spain
| | - Jenny P Tsai
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - William Hicks
- OhioHealth Neurological Physicians, Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Osman Kozak
- Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Abington Memorial Hospital, Abington, Pennsylvania, USA
| | - Bernard Yan
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Dennis Cordato
- Department of Neurology and Neurophysiology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Nathan W Manning
- Institute of Neurosciences, UNSW Prince of Wales Clinical School, Sydney, New South Wales, Australia
- Advanced Endovascular Therapy, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Mark Parsons
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | | | - Amin Aghaebrahim
- Neurological Institute, Lyerley Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Teddy Wu
- Neurology, Christchurch Hospital, Christchurch, Canterbury, New Zealand
| | | | - Chirag D Gandhi
- Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Fawaz Al-Mufti
- Neurology and Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | | | - Joanna Schaafsma
- Medicine - Div. Neurology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jordi Blasco
- Neurointerventional Department C.D.I, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Navdeep Sangha
- Kaiser Permanente Southern California, Los Angeles, California, USA
| | - Steven Warach
- University of Texas at Austin Dell Seton Medical Center, Austin, Texas, USA
| | - Timothy J Kleinig
- Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Hannah Johns
- University of Melbourne, Parkville, Victoria, Australia
| | - Faris Shaker
- Neurology, University of Texas McGovern Medical School, Houston, Texas, USA
| | | | - Abhishek Ray
- Neurological Surgery, University Hospitals, Cleveland, Ohio, USA
| | - Jeffery Sunshine
- Radiology, University Hospitals-Case Medical Center, Cleveland, Ohio, USA
| | - Amanda Opaskar
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Kelsey R Duncan
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Wei Xiong
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | - Edgar A Samaniego
- Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Thanh N Nguyen
- Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Johanna T Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Pascal Jabbour
- Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
| | - Maarten G Lansberg
- Department of Neurology, Stanford Stroke Center, Stanford University, Stanford, California, USA
| | - Cathy Sila
- Neurological Institute, University Hospitals- Case Medical Center, Cleveland, Ohio, USA
- Neurology, Case Western Reserve University School of Medicine
| | - Nicholas C Bambakidis
- Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Stephen Davis
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Lawrence Wechsler
- University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Gregory W Albers
- Neurology & Neurological Sciences, Stanford University, Stanford, California, USA
| | - James C Grotta
- Neurology, Memorial Hermann Hospital/UT Houston, Houston, Texas, USA
| | - Marc Ribo
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Spain
- Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Bruce Campbell
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael D Hill
- Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Clinical Neurosciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Amrou Sarraj
- Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Badve C, Yu A, Dastmalchian S, Rogers M, Ma D, Jiang Y, Margevicius S, Pahwa S, Lu Z, Schluchter M, Sunshine J, Griswold M, Sloan A, Gulani V. MR Fingerprinting of Adult Brain Tumors: Initial Experience. AJNR Am J Neuroradiol 2016; 38:492-499. [PMID: 28034994 DOI: 10.3174/ajnr.a5035] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/11/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR fingerprinting allows rapid simultaneous quantification of T1 and T2 relaxation times. This study assessed the utility of MR fingerprinting in differentiating common types of adult intra-axial brain tumors. MATERIALS AND METHODS MR fingerprinting acquisition was performed in 31 patients with untreated intra-axial brain tumors: 17 glioblastomas, 6 World Health Organization grade II lower grade gliomas, and 8 metastases. T1, T2 of the solid tumor, immediate peritumoral white matter, and contralateral white matter were summarized within each ROI. Statistical comparisons on mean, SD, skewness, and kurtosis were performed by using the univariate Wilcoxon rank sum test across various tumor types. Bonferroni correction was used to correct for multiple-comparison testing. Multivariable logistic regression analysis was performed for discrimination between glioblastomas and metastases, and area under the receiver operator curve was calculated. RESULTS Mean T2 values could differentiate solid tumor regions of lower grade gliomas from metastases (mean, 172 ± 53 ms, and 105 ± 27 ms, respectively; P = .004, significant after Bonferroni correction). The mean T1 of peritumoral white matter surrounding lower grade gliomas differed from peritumoral white matter around glioblastomas (mean, 1066 ± 218 ms, and 1578 ± 331 ms, respectively; P = .004, significant after Bonferroni correction). Logistic regression analysis revealed that the mean T2 of solid tumor offered the best separation between glioblastomas and metastases with an area under the curve of 0.86 (95% CI, 0.69-1.00; P < .0001). CONCLUSIONS MR fingerprinting allows rapid simultaneous T1 and T2 measurement in brain tumors and surrounding tissues. MR fingerprinting-based relaxometry can identify quantitative differences between solid tumor regions of lower grade gliomas and metastases and between peritumoral regions of glioblastomas and lower grade gliomas.
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Affiliation(s)
- C Badve
- From the Department of Radiology (C.B., S.D., D.M., S.P., J.S., M.G., V.G.), University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - A Yu
- School of Medicine (A.Y., M.R., Z.L.)
| | - S Dastmalchian
- From the Department of Radiology (C.B., S.D., D.M., S.P., J.S., M.G., V.G.), University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - M Rogers
- School of Medicine (A.Y., M.R., Z.L.)
| | - D Ma
- From the Department of Radiology (C.B., S.D., D.M., S.P., J.S., M.G., V.G.), University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Y Jiang
- Department of Biomedical Engineering (Y.J., M.G., V.G.)
| | - S Margevicius
- Department of Epidemiology and Biostatistics (S.M., M.S.), Case Western Reserve University, Cleveland, Ohio
| | - S Pahwa
- From the Department of Radiology (C.B., S.D., D.M., S.P., J.S., M.G., V.G.), University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Z Lu
- School of Medicine (A.Y., M.R., Z.L.)
| | - M Schluchter
- Department of Epidemiology and Biostatistics (S.M., M.S.), Case Western Reserve University, Cleveland, Ohio
| | - J Sunshine
- From the Department of Radiology (C.B., S.D., D.M., S.P., J.S., M.G., V.G.), University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - M Griswold
- From the Department of Radiology (C.B., S.D., D.M., S.P., J.S., M.G., V.G.), University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio.,Department of Biomedical Engineering (Y.J., M.G., V.G.)
| | - A Sloan
- Departments of Neurosurgery and Pathology (A.S.), University Hospitals-Cleveland Medical Center, Seidman Cancer Center and the Case Comprehensive Cancer Center, Cleveland, Ohio
| | - V Gulani
- From the Department of Radiology (C.B., S.D., D.M., S.P., J.S., M.G., V.G.), University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio.,Department of Biomedical Engineering (Y.J., M.G., V.G.)
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Badve C, Yu A, Ma D, Jiang Y, Deshmane A, Gulani V, Sunshine J, Sloan A, Griswold M. NI-07 * MAGNETIC RESONANCE FINGERPRINTING OF BRAIN TUMORS: INITIAL CLINICAL RESULTS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou264.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Patsalides A, Bulsara KR, Hsu DP, Abruzzo T, Narayanan S, Jayaraman MV, Duckwiler G, Klucznik RP, Kelly M, Hirsch JA, Heck D, Sunshine J, Frei D, Alexander MJ, Do HM, Meyers PM. Standard of practice: embolization of ruptured and unruptured intracranial aneurysms. J Neurointerv Surg 2013; 5:283-8. [DOI: 10.1136/neurintsurg-2012-010645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sunshine J, Shekhar K, Heckerman D, Chakraborty AK, Frahm N. Preferential targeting of co-evolving Gag residues in long-term non progressors. Retrovirology 2012. [PMCID: PMC3441664 DOI: 10.1186/1742-4690-9-s2-p278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sunshine J, Sandhu G, Sloan A, Griswold M. O-030 Laser thermotherapy of malignant brain lesions using MRI for needle guidance and real-time temperature mapping: Abstract O-030 Figure 1. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455a.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sharma J, Shams T, Blackham K, Hsu D, Tarr R, Sunshine J. P-004 Endovascular management of acute ischemic stroke based on perfusion studies: a single center experience. J Neurointerv Surg 2011. [DOI: 10.1136/neurintsurg-2011-010097.38] [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: 11/03/2022]
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Hicks MD, Buratti BJ, Nettles J, Staid M, Sunshine J, Pieters CM, Besse S, Boardman J. A photometric function for analysis of lunar images in the visual and infrared based on Moon Mineralogy Mapper observations. ACTA ACUST UNITED AC 2011. [DOI: 10.1029/2010je003733] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Pieters CM, Goswami JN, Clark RN, Annadurai M, Boardman J, Buratti B, Combe JP, Dyar MD, Green R, Head JW, Hibbitts C, Hicks M, Isaacson P, Klima R, Kramer G, Kumar S, Livo E, Lundeen S, Malaret E, McCord T, Mustard J, Nettles J, Petro N, Runyon C, Staid M, Sunshine J, Taylor LA, Tompkins S, Varanasi P. Character and Spatial Distribution of OH/H2O on the Surface of the Moon Seen by M3 on Chandrayaan-1. Science 2009; 326:568-72. [DOI: 10.1126/science.1178658] [Citation(s) in RCA: 497] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Arons E, Suntum T, Sunshine J, Orthwein A, Margulies I, Stetler-Stevenson M, Kreitman RJ. Molecular distinctions between variant and classic hairy cell leukemia. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.18002] [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: 11/20/2022] Open
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Rao VM, Parker L, Levin DC, Sunshine J, Bushee G. Use trends and geographic variation in neuroimaging: nationwide medicare data for 1993 and 1998. AJNR Am J Neuroradiol 2001; 22:1643-9. [PMID: 11673155 PMCID: PMC7974442] [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: 02/22/2023]
Abstract
BACKGROUND AND PURPOSE Powerful tools, including CT and MR imaging, have revolutionized neuroimaging. These are routinely used, but the extent and variation of use has not been studied. Our purposes were to determine the use rates of MR imaging and CT (of spine, brain, or head and neck), myelography, conventional angiography, and MR angiography in diagnosing neurologic disorders; to study trends in use; and to determine regional variations in use. METHODS We used the National Part B Medicare Database for 1993 and 1998 to compare rates of use for these procedures in 10 geographic regions. RESULTS In 1993 and 1998, respectively, 13,897 and 19,431 (39.8% increase) neuroimaging procedures were performed per 100,000 Medicare beneficiaries nationwide. Use of brain or head and neck CT (30.4%) and MR imaging (43.6%), spinal CT (3.5%) and MR imaging (83.0%), myelography (56.6%), and conventional angiography (24.3%) increased in 1998 versus 1993. Increases in MR angiography were not assessed, because this procedure was not reimbursable in 1993. Regional use of brain or head and neck and spinal CT and MR studies varied considerably; ratios of highest and lowest rates were 1.38-1.56. Use of MR angiography, myelography, and conventional angiography varied three- to fourfold. CONCLUSION Use of MR and CT studies of the brain or head and neck and of the spine increased considerably in the Medicare population between 1993 and 1998. Use of conventional invasive procedures such as myelography and angiography increased strikingly, contrary to the expected decline. Regional use varied substantially.
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Affiliation(s)
- V M Rao
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
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Abstract
OBJECTIVE We sought to determine the 1998 hiring activities of physician practices with respect to diagnostic radiologists. MATERIALS AND METHODS A survey was mailed to a sample of 970 radiology practices in the spring through fall of 1999; 73.0% responded. Responses were weighted to represent all practices in the United States providing diagnostic radiology services. Findings were compared with results of similar surveys from previous years. RESULTS In 1998, multiradiologist groups sought to hire 2299 (+/-148 [standard error]) diagnostic radiologists, an increase of 20% from 1977. Positions offered in 1998 were split almost equally between expansion positions and replacements for those who had left a practice. Another 422 (+/-58) positions had been vacated that practices did not seek to refill. In 1998, 621 (+/-57) diagnostic radiologists left active practice, which is more than the usual number of approximately 400 annually but less than the approximately 800 of 1996 and 1997. There was no significant association between hiring activity and the self-perceived effect of managed care on a group. CONCLUSION The pace of hiring and turnover of diagnostic radiologists increased in 1998. Positions available continue to exceed radiologists available to fill them; the excess was approximately 330 positions, which is not significantly different from the excess reported for 1997, but is higher than the (not statistically significant) net shortfall of 51 positions estimated for 1996.
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Affiliation(s)
- C Hogan
- Direct Research, LLC, 506 Moorefield Rd., S.W., Lower Level, Vienna, VA 22180, USA.
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Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to study trends in the job market in interventional radiology. MATERIALS AND METHODS Each job advertisement for a diagnostic radiologist in the American Journal of Roentgenology and Radiology between January 1991 and December 1999 was coded by practice type (academic vs private), location, and subspecialty. Positions for interventional radiologists were compared with positions for noninterventional radiologists. Data from the first 48 months (January 1991 through December 1994) were compared with data from the second 48 months (January 1995 through December 1998). Data from 1999 were grouped separately. RESULTS The nadir for all noninterventional and interventional radiology positions was seen in July 1995, and both areas have experienced great recovery since then. In December 1999, the last month of data collection, the absolute peak number of advertisements for interventional radiologists was reached. In fact, during the last half of the decade, an increasing percentage of jobs advertised for diagnostic radiologists was specifically for interventional radiologists. Statistically significant trends also occurred toward the private sector and toward positions in the Midwest and California. CONCLUSION With a help-wanted index, dramatic shifts toward the private sector and toward jobs in the Midwest and California were demonstrated in the interventional radiology job market.
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Affiliation(s)
- A M Covey
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT 06520, USA
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Covey AM, Sunshine J, Forman HP. The job market in diagnostic radiology 1999: updated findings from a help wanted index of job advertisements. AJR Am J Roentgenol 2000; 175:957-61. [PMID: 11000142 DOI: 10.2214/ajr.175.4.1750957] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [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: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to report 1999 data on the job market in diagnostic radiology detected using a help wanted index of job advertisements and to profile trends in practice type, location, and subspecialty using our previously published data as a basis for comparison. MATERIALS AND METHODS Each advertised job for a diagnostic radiologist in the American Journal of Roentgenology and RADIOLOGY: between January 1991 and December 1999 was coded by practice type, location, and subspecialty. RESULTS In 1999, 3926 positions were advertised for diagnostic radiologists, representing a 75% increase from 1998. Private practice jobs, which represented 53% of advertisements from 1991 through 1994 and 64% of ads from 1995 through 1998, increased to 66% of ads in 1999. Geographic trends in 1999 were characterized by a relative increase of jobs in the Midwest and California and a decrease in percentage (but increase in total number of ads) in the Northeast and Southwest. The demand for subspecialists continued in 1999, with only 34% of ads placed for general radiologists. A relative increase in demand for neuroradiologists, mammographers, and abdominal imagers was also seen in 1999 in comparison with previously published data from 1995 through 1998. CONCLUSION The demand for diagnostic radiologists continues to rise, with more ads placed in 1999 than any other year from 1991 through 1998. Using a help wanted index of job advertisements, we have created an indicator of changes in the diagnostic radiology job market with specific reference to practice type, geographic location, and subspecialty training.
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Affiliation(s)
- A M Covey
- Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St., SP2-332, New Haven, CT 06520, USA
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Moskowitz H, Sunshine J, Grossman D, Adams L, Gelinas L. The effect of imaging guidelines on the number and quality of outpatient radiographic examinations. AJR Am J Roentgenol 2000; 175:9-15. [PMID: 10882239 DOI: 10.2214/ajr.175.1.1750009] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [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: 11/18/2022]
Abstract
OBJECTIVE A significant percentage of outpatient diagnostic radiology is performed by nonradiologists. Studies have shown nonradiologists have higher utilization and cost, as well as quality problems. We sought to determine if, in a managed care environment, a set of guidelines limiting imaging privileges of nonradiologist physicians could decrease imaging costs while ensuring that equipment and personnel providing imaging were of the highest quality. MATERIALS AND METHODS We determined the number and type of radiographic imaging studies performed the year after these guidelines were set in place (1997) and compared these findings with those of the year before the guidelines were established (1995) and with preguideline trends. We established quality criteria and, based thereon, inspected imaging offices. RESULTS The number of radiographic examinations per 1000 enrollees decreased 20-25% from the previous trend. Nonradiologists' share of the total fell from 39% to 15%. No deficiencies were found in the inspection of five radiologists' offices, whereas significant deficiencies of equipment, equipment maintenance, or documentation of the examinations performed were found in 78% of nonradiologists' offices. None of the quality indicators monitored by the health plan showed significant change. CONCLUSION Specific guidelines can effect change in the location and number of radiologic examinations performed, with an improvement in the quality of the studies and a decrease in radiation dose and cost. No decline in quality of care appears to result, despite claims by opponents to such changes that widespread serious quality impairment would occur.
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Affiliation(s)
- H Moskowitz
- Magellan Specialty Health, Windsor, CT 06095, USA
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Levin DC, Parker L, Eschelman DJ, Sunshine J, Busheé G. Do interventional radiologists pose a significant threat to the practice of vascular surgery? J Vasc Interv Radiol 1999; 10:1007-11. [PMID: 10496700 DOI: 10.1016/s1051-0443(99)70184-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 11/15/2022] Open
Abstract
PURPOSE Vascular surgeons have become concerned recently about perceived threats to their practices posed by the growth of interventional radiology. The authors studied nationwide 1996 Medicare Part B procedure data to determine the seriousness of these threats. MATERIALS AND METHODS The national Health Care Financing Administration (HCFA) Physician/Supplier Procedure Summary Master File for 1996 was searched. Two hundred thirteen distinct Current Procedural Terminology (CPT-4) codes were identified for therapeutic surgical and percutaneous interventional procedures performed to treat noncardiac vascular diseases. For each code, determination was made of total volume, specialty of the physician providers, and Medicare Part B reimbursement dollars paid to the providers as professional fees. In view of the conflicts among various specialties over peripheral vascular interventions, the authors also determined the percentages of these procedures performed by radiologists, surgeons, cardiologists, and other physicians. RESULTS A total of 759,548 noncardiac therapeutic vascular procedures (operations or percutaneous interventions) were performed during 1996 in patients receiving Medicare benefits. Radiologists performed 135,103 (17.8%) of these procedures but received only 10.4% of professional reimbursements. By contrast, surgeons performed 510,871 (67.3%) procedures, but received 78.0% of professional reimbursements. Cardiologists performed 4.7% of procedures and other specialists performed the remaining 10.3%. Radiologists performed 75.5% of percutaneous transluminal angioplasties, the majority of thrombolysis procedures, stent placements, and portal decompression procedures, and approximately half of inferior vena cava interruptions. Cardiologists performed 12.6% of percutaneous transluminal angioplasties, surgeons performed 6.3%, and other specialists performed 5.6%. CONCLUSIONS In terms of overall physician workload and professional reimbursements paid for invasive treatment of all types of noncardiac vascular disease, surgeons predominate and do not appear to be seriously threatened by interventional radiologists. Radiologists perform three-fourths of noncardiac percutaneous transluminal angioplasties and a majority of other percutaneous interventional therapies for vascular disease, but some inroads have been made by cardiologists and surgeons, particularly the former.
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Affiliation(s)
- D C Levin
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
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Selman W, Taylor C, Tarr R, Sunshine J, Lanzieri C, Suarez J, Landis D. The neurosurgeon and the acute stroke patient in the emergency department: diagnosis and management. Clin Neurosurg 1999; 45:74-85. [PMID: 10461505] [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] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- W Selman
- Department of Neurological Surgery, University Hospitals of Cleveland, OH, USA
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Levin DC, Spettell CM, Rao VM, Sunshine J, Bansal S, Busheé GR. Impact of MR imaging on nationwide health care costs and comparison with other imaging procedures. AJR Am J Roentgenol 1998; 170:557-60. [PMID: 9490930 DOI: 10.2214/ajr.170.3.9490930] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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: 02/06/2023]
Abstract
OBJECTIVE We wished to determine the extent to which MR imaging contributes to the overall costs of imaging in the United States and to compare MR imaging costs with other imaging techniques. MATERIALS AND METHODS All 23 current procedural terminology, version 4 (CPT-4) codes for MR imaging were extracted from the national 1993 Part B Medicare annual data reimbursement file. For each code, we calculated total Medicare physician reimbursements. Aggregate reimbursement for all MR imaging was compared with aggregate reimbursement for all 659 imaging-related current procedural terminology, version 4 codes and also with comparable figures for echocardiography and other categories of cardiovascular imaging. RESULTS Within the 23 MR imaging codes, 1,449,911 examinations were performed on Medicare patients in 1993, for which physicians were reimbursed $370 million. Medicare reimbursement of physicians for all 659 imaging-related procedures was $5.3 billion. Thus, MR imaging accounted for only 7% of all imaging costs. By comparison, a group of just 10 imaging codes, which are primarily cardiovascular in nature, accounted for $1.67 billion, or 32% of the entire Part B costs for imaging. Reimbursements for echocardiography alone are more than twice those for MR imaging. CONCLUSION From the national perspective, MR imaging does not appear to warrant its reputation as a costly procedure. The costs of echocardiography and other imaging related to the cardiovascular system are considerably higher.
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Affiliation(s)
- D C Levin
- Department of Radiology, Thomas Jefferson University Hospital-Jefferson Medical College, Philadelphia, PA 19107, USA
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Sunshine J. Evaluating the health risks of breast implants. N Engl J Med 1996; 335:1155; author reply 1156. [PMID: 8848020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Harms SE, Radensky P, Sunshine J, Davis DO, Okunieff P, Farr C, Spettell C. MRI efficacy and effectiveness research: who needs it and who pays for it? J Magn Reson Imaging 1996; 6:4-6. [PMID: 8851396 DOI: 10.1002/jmri.1880060103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 02/02/2023] Open
Abstract
Health care reform has made quality efficacy research in MRI important to an increasing number of audiences. Historically, the deficit of quality outcomes research in MRI was due to difficulties in study design, lack of funding, disincentives for researches and funding sources, and poor coordination. These issues would be best addressed by the formation of an MRI implementation group that would coordinate funding, planning, and dissemination of the outcomes research efforts.
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Affiliation(s)
- S E Harms
- Department of Radiology, Baylor University Medical Center, Dallas, TX, USA
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Abstract
RATIONALE AND OBJECTIVES We surveyed diagnostic radiology group preferences and considerations in hiring radiologists and compared these findings with those of a survey performed in 1990. We sought to identify changes in hiring practices that might have occurred because of socioeconomic changes. We also sought to identify features of job candidates that make them more attractive to hiring groups. METHODS One hundred surveys were mailed to a stratified random sample of diagnostic radiology groups identified by the American College of Radiology. We solicited information on the importance of various attributes and the level of experience of a candidate, the fellowship training considered most desirable, and the effect of changes in the health care socioeconomic environment. The responses were weighted by group size and geographic location to estimate what results might have been obtained if we had surveyed all groups in the United States. RESULTS Seventy-five groups returned the survey. The two most important factors in choosing a candidate were motivation and radiologic knowledge. The fellowships that groups that were hiring considered to be the most desirable were body imaging, neuroradiology, and angiography/interventional radiology. Groups overwhelmingly preferred recent training over long experience. CONCLUSION Fellowship training increases a candidate's marketability, but the two factors that hiring groups consider the most important are motivation and radiologic knowledge.
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Affiliation(s)
- S E Campbell
- Department of Radiology, University of Virginia Health Sciences Center, Charlottesville, USA
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Smythe WD, Lopes-Gautier R, Ocampo A, Hui J, Segura M, Soderblom LA, Matson DL, Kieffer HH, McCord TB, Fanale FP, Calvin WM, Sunshine J, Barbinis E, Carlson RW, Weissman PR. Galilean satellite observation plans for the near-infrared mapping spectrometer experiment on the Galileo spacecraft. ACTA ACUST UNITED AC 1995. [DOI: 10.1029/95je01766] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
OBJECTIVE In response to anecdotal reports of grave deterioration in the job market for graduates of radiology training programs, the American College of Radiology undertook a systematic appraisal of this job market for 1994. MATERIALS AND METHODS Between mid-April and mid-May 1994, the American College of Radiology surveyed 40 directors of randomly chosen diagnostic radiology training programs and 20 directors of randomly chosen radiation oncology training programs. We achieved a response rate of 80% or more in both categories. The survey asked, among other questions, the number of graduates, how many had jobs, the number of offers received by graduates this year and last, and how difficult the job market was relative to recent years. RESULTS Directors reported that 96% of graduating residents and 86% of graduating diagnostic fellows had commitments for positions. Of those with commitments, 94% of residents and 84% of diagnostic fellows were reported to have jobs that reasonably matched their training and job goals. Program directors estimated that the average graduate received two job offers but, on average, rated the job market as somewhat more difficult than was typical of recent years and reported that 1993 graduates had received more job offers. Plans to change size were reported for one fourth of programs, but the job market situation was not an important reason for these planned changes. CONCLUSION Although the overwhelming majority of 1994 graduates obtained jobs, and these overwhelmingly were jobs of interest, program directors reported that the job market was weakening. Given the changes in the socioeconomic environment--managed care, for example--and the changing job market, training programs should give more attention to the job market in planning for changes in size.
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Affiliation(s)
- J Sunshine
- Research Department, American College of Radiology, Reston, VA 22091
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Crowe JP, Adler LP, Shenk RR, Sunshine J. Positron emission tomography and breast masses: comparison with clinical, mammographic, and pathological findings. Ann Surg Oncol 1994; 1:132-40. [PMID: 7834438 DOI: 10.1007/bf02303557] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.9] [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: 01/27/2023]
Abstract
BACKGROUND Positron emission tomography (PET) is a means of imaging tissue based upon its metabolic activity. Initial studies in the field of oncology suggest that PET may be useful for diagnosis, staging, and treatment of various tumors. METHODS Twenty-eight patients with 37 breast lesions were studied with PET using [fluorine-18] 2-deoxy-2-fluoro-D-glucose (FDG) to assess which clinicopathological characteristics relate to FDG accumulation by the primary tumor. RESULTS PET-FDG was found to successfully discriminate malignant from benign breast lesions (p = 0.02) and identify axillary lymph node metastases. FDG uptake by the primary tumor was found to be independent of age, menopausal status, race, tumor size, laterality, histologic differentiation, ploidy, DNA index, estrogen or progesterone receptor value, pathologic stage, and serum glucose. Higher tumor nuclear grade and S-phase were associated with more FDG accumulation by the primary tumor compared with normal breast tissue. PET-FDG correctly identified five malignant lesions that were indeterminant for cancer both on clinical breast examination and mammography and identified one occult cancer that was neither palpable nor apparent mammographically. PET-FDG correctly identified clinical occult axillary metastatic cancer in five patients. CONCLUSIONS This study shows that PET-FDG imaging can distinguish malignant from benign breast lesions among a diverse group of patients and suggests that PET-FDG may not only allow for preoperative staging of patients but also provide information about prognosis. This study provides impetus for continued research into PET-FDG imaging of breast lesions, which could have a major impact on the treatment of breast cancer.
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Affiliation(s)
- J P Crowe
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Abstract
OBJECTIVE The American College of Radiology (ACR), the principal professional organization of United States radiologists, receives numerous requests for information on the characteristics of radiology groups. This report describes the basic characteristics of radiology groups in the United States. We defined radiology groups as any practice with two or more radiologists or radiation oncologists, including academic departments, units in multispecialty groups, and staff of government facilities. MATERIALS AND METHODS To collect basic information on radiology groups, the ACR conducted a mail census of all identified radiology groups in the United States during late 1991 and early 1992. Follow-up was conducted by mail and telephone. To make the responses accurately representative of all radiology groups, we weighted the approximately 2000 responses to correspond to known control totals for the number of groups of each of seven size categories in each of the four census regions (Northeast, Midwest, South, and West). These control totals were obtained from the ACR's 1990 Manpower Survey, which showed a total of approximately 3200 radiology groups. RESULTS Approximately one fourth of all groups have two radiologists, one fourth have three or four radiologists, one fourth have five to seven radiologists, and one fourth have eight or more radiologists. Academic groups were relatively large; almost 50% had 11 or more radiologists. Nonmetropolitan areas had very few large groups, and metropolitan center cities had relatively few small groups. Ninety-two percent of all groups practiced at hospitals, and 73% of all groups practiced at nonhospital offices or centers. The median number of practice sites for all groups was three, including both hospital and nonhospital sites. Eighty-eight percent of all groups provided diagnostic radiology services, 23% provided radiation oncology, 12% offered both, and 11% were oncology-only groups. Relatively many academic groups (25%) were oncology-only groups; very few radiology groups (2%) in multispecialty practices were oncology-only groups. The diagnostic radiology techniques available from the largest percentages of groups were general radiography (plain film), sonography, mammography, and CT. One eighth of academic groups that provided diagnostic services did not report providing mammography, compared with only a few percent of all groups in the United States that provided diagnostic services. CONCLUSION Half of all groups have two to four radiologists, and this has not changed since at least 1986. A substantial percentage of groups that perform diagnostic radiology do not provide MR, interventional, or nuclear medicine services. This is particularly true of relatively small groups. These characteristics may become the source of some problems as managed care becomes more prominent and larger groups, offering a full range of services and practicing at several sites, are favored by managed care organizations that seek to contract with one group for all their radiology services.
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Affiliation(s)
- S Bansal
- Research Department, American College of Radiology, Reston, VA 22091
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Abstract
Because of concern about pressures from hospitals for changes in their contracts with radiology practices, the American College of Radiology undertook a stratified sample survey of radiology practices and their contracts with hospitals in late 1989 and early 1990. After three remailings, the survey obtained 904 valid responses for a 64% response rate. It found (weighting data to represent all radiology practices in the nation) that 91% of radiology practices provide services in hospitals. There are contracts at 57% of these hospital sites, and hospitals use tax-exempt bond financing in 54% of the sites with contracts. One year is the most common duration of contracts, and 90 days is the most common cancellation period (89% of contracts can be canceled during the contract's term). Eighty-six percent of contracts are exclusive; 73% are automatically renewable ("evergreen"). Separate billing exists in well over 90% of hospitals with contracts. Two percent of contracts require radiologists to provide equipment; 4% require them to provide support staff. There are fixed-fee arrangements in 9% of contracts and percent compensation arrangements in 3%. Hospitals share in radiologists' fees as a charge for contractual privileges in 5% of contracts. Twenty-seven percent of contracts require hospital approval for radiologists' fee increases; 19% require radiologists to participate with Blue Shield or Medicare. If a contract characteristic is predominant nationally, it is predominant in every region, for solo, small, medium, and large practices, and whether or not hospitals use tax-exempt bond financing. There is, however, some modest variation in frequency of contract provisions. Multivariate analysis shows that most such variation reflects true effects of region and other variables, not statistical artifacts. Region was a statistically significant determinant of 11 of 17 contract characteristics studied. Practice size was a statistically significant determinant of only about half as many characteristics. The survey found some interference in the independence of radiology practices (e.g., required hospital approval of fee increases), questionable clauses (e.g., mandated provision of equipment), and even illegal ones (hospitals charging a fee for contract privileges). Knowledge of the survey findings can make individual radiology practices more effective in negotiations with hospitals and assist the profession in forming a strategy to oppose disadvantageous and illegal provisions.
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Affiliation(s)
- J Sunshine
- Research Department, American College of Radiology, Reston, VA 22091
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Affiliation(s)
- M Lopiano
- Department of Radiology and Nuclear Medicine, St. John's Hospital, Oxnard, CA 93030
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Abstract
The neural cell adhesion molecule (NCAM) can influence a number of diverse intercellular events, including junctional communication, the association of axons with pathways and targets, and signals that alter levels of neurotransmitter enzymes. These pleiotropic effects appear to reflect the ability of NCAM to regulate membrane-membrane contact required to initiate specific interactions between other molecules. Such regulation can occur through changes in either NCAM expression or the molecule's content of polysialic acid (PSA). When NCAM with a low PSA content is expressed, adhesion is increased and contact-dependent events are triggered. In contrast, the large excluded volume of NCAM PSA can inhibit cell-cell interactions through hindrance of overall membrane apposition.
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Affiliation(s)
- U Rutishauser
- Department of Developmental Genetics and Anatomy, Case Western Reserve University School of Medicine, Cleveland, OH 44106
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Sunshine J, Balak K, Rutishauser U, Jacobson M. Changes in neural cell adhesion molecule (NCAM) structure during vertebrate neural development. Proc Natl Acad Sci U S A 1987; 84:5986-90. [PMID: 3475717 PMCID: PMC298988 DOI: 10.1073/pnas.84.16.5986] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Changes in carbohydrate and polypeptide form of the neural cell adhesion molecule (NCAM) have been documented during the development of central nervous system tissue in both chicken and frog. The carbohydrate variations reflect a high and low content of polysialic acid, and for the two vertebrates examined the expression of these forms is similar. At very early stages of neural development NCAM with a low content of polysialic acid is present, during histogenesis of the central nervous system NCAM with a high content of polysialic acid dominates, and there is a gradual return to NCAM with a low content of polysialic acid as the animals approach maturity. In contrast, the order of expression of the major NCAM polypeptide forms is different in the chicken and frog. These findings suggest that changes in sialic acid are a fundamental aspect of the function of NCAM in development, whereas NCAM polypeptide differences may affect events associated with a particular vertebrate. Studies have demonstrated that a decreased sialic acid content enhances the adhesion properties of NCAM. On this basis, we propose that NCAM with a low content of polysialic acid functions both to maintain integrity of neuroepithelium during morphogenesis of the early embryo and to stabilize differentiated structures in the adult, while the decreased adhesive function of NCAM with a high content of polysialic acid provides more plasticity in cell interactions during cell migration, axon outgrowth, and formation of neural circuits.
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Abstract
The spatiotemporal pattern of expression of the neural cell adhesion molecule NCAM was mapped immunohistochemically in embryos of the frog Xenopus, from blastula to early swimming stages, using a polyclonal antibody that recognizes Xenopus NCAM. The neural plate stage was the earliest at which NCAM could be detected. The initial sites of NCAM immunoreactivity were neural ectoderm, somitic mesoderm, and chordamesoderm. During formation of the neural tube, NCAM immunoreactivity became restricted to the neuroectoderm and its derivatives. During closure of the neural tube and for 2-4 hr thereafter, NCAM was expressed in a distinctive radial pattern in coronal sections of the neural tube. NCAM was observed in neural crest cells before migration and after formation of cranial and spinal ganglia. During the period of initial neurite outgrowth, NCAM became concentrated in the developing central nerve fiber pathways. NCAM was seen on peripheral nerves from the time of their initial outgrowth and it was strongly expressed at neuromuscular junctions during the period of their formation. These results show that NCAM is expressed after neural induction and functions during morphogenesis of the neural plate and tube, some neural crest derivatives, development of nerve fiber tracts, and formation of neuromuscular connections.
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Maier CE, Watanabe M, Singer M, McQuarrie IG, Sunshine J, Rutishauser U. Expression and function of neural cell adhesion molecule during limb regeneration. Proc Natl Acad Sci U S A 1986; 83:8395-9. [PMID: 3464959 PMCID: PMC386935 DOI: 10.1073/pnas.83.21.8395] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The neural cell adhesion molecule (NCAM) has been detected in regenerating limb bud of adult newts in addition to brain and peripheral nerves. In the regenerating tissue, NCAM was found primarily on mesenchymal cells and also in wound epidermis. Infusion of Fab fragments of antibodies to NCAM into limb buds at the early blastema stage delayed the regenerative process. Previous studies have indicated that NCAM serves as a homophilic ligand for adhesion among cells that express this molecule and, in doing so, can influence the interaction of nerves with their environment. The expression of NCAM in regenerating limb and the effects of antibody infusion are therefore consistent with the observation that limb regeneration requires interactions among axons and mesenchymal cells.
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Abstract
After reviewing 21 patients who have had percutaneous abdominal abscess drainage, we believe that the procedure should be considered for those abscesses that are unilocular without septations, with safe access being a key variable dictating the use of percutaneous abdominal abscess drainage rather than surgery. A computerized tomographic scan of the abdomen should be employed at some stage of the percutaneous abdominal abscess drainage procedure to facilitate safe access to the abscess and to distinguish a synchronous abscess where present. In addition, we believe that percutaneous abdominal abscess drainage should be considered for postsurgical abscesses only and not those that are spontaneous in nature or where the original abnormality cannot be accurately surmised. With regard to catheter management, frequent irrigation of the catheter must be carried out at least every 4 to 6 hours, with high levels of antibiotics present in the blood before irrigation. This must be done to obviate the most frequent and potentially lethal complication of the procedure, namely sepsis. Percutaneous abdominal abscess drainage, although safe for the most part, is capable of inducing considerable morbidity. Our data suggest that percutaneous abdominal abscess drainage is not as efficacious as previous reports have suggested. Traditional surgical drainage techniques are best utilized for those abscesses that are multiple, highly viscous, inaccessible, spontaneous, or unresponsive to percutaneous abdominal abscess drainage.
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