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Bernstein JD, Lin GY, Yan C, DeConde A. Negative Sinus Biopsy Does Not Rule Out Orbital Invasive Fungal Sinusitis. Ear Nose Throat J 2024:1455613241235540. [PMID: 38409750 DOI: 10.1177/01455613241235540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Affiliation(s)
- Jeffrey D Bernstein
- Department of Otolaryngology-Head and Neck Surgery, UC San Diego Health, La Jolla, CA, USA
| | - Grace Y Lin
- Department of Pathology, UC San Diego Health, La Jolla, CA, USA
| | - Carol Yan
- Department of Otolaryngology-Head and Neck Surgery, UC San Diego Health, La Jolla, CA, USA
| | - Adam DeConde
- Department of Otolaryngology-Head and Neck Surgery, UC San Diego Health, La Jolla, CA, USA
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2
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Hom DB, Bernstein JD. Reducing Risks of Facial Scarring. Facial Plast Surg Clin North Am 2023; 31:195-207. [PMID: 37001923 DOI: 10.1016/j.fsc.2023.01.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Risk factors for the formation of facial scars include skin type, ethnicity, scar location, and certain medical conditions that contribute to poor or delayed healing. Risk of scar can be reduced with appropriate surgical planning, including proper placement and design of incisions, meticulous skin closure, aseptic technique, and wound care to improve healing. Common pathologic scars include hypertrophic scars and keloid scars, each of which has unique approaches to surgical revision and medical treatment due to their respective risks of recurrence. Topical scar therapies, medical therapies, and surgical revision techniques for improvement in final scar appearance are discussed.
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Affiliation(s)
- David B Hom
- Department of Otolaryngology-Head and Neck Surgery, University of California - San Diego, 200 West Arbor Drive, Mail Code 8895, San Diego, CA 92103, USA.
| | - Jeffrey D Bernstein
- Department of Otolaryngology-Head and Neck Surgery, University of California - San Diego, 200 West Arbor Drive, Mail Code 8895, San Diego, CA 92103, USA
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Bernstein JD, Marcus S, Wang HY, Vahabzadeh-Hagh AM. Suspicious Laryngeal Mass: A Case Of Recurrent Mantle Cell Lymphoma. Ear Nose Throat J 2023:1455613231170085. [PMID: 37056056 DOI: 10.1177/01455613231170085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Affiliation(s)
- Jeffrey D Bernstein
- Department of Otolaryngology - Head and Neck Surgery, University of California-San Diego, La Jolla, CA, USA
| | - Samuel Marcus
- University of California-San Diego, La Jolla, CA, USA
| | - Huan-You Wang
- Department Medicine, Division of Anatomic Pathology, University of California-San Diego, La Jolla, CA, USA
| | - Andrew M Vahabzadeh-Hagh
- Department of Otolaryngology - Head and Neck Surgery, University of California-San Diego, La Jolla, CA, USA
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4
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Bernstein JD, Kruczek S, Laub N, Carvalho D. Extensive Tongue Laceration in an Edentulous Infant: Is It Child Abuse? Ear Nose Throat J 2023:1455613221149803. [PMID: 36637022 DOI: 10.1177/01455613221149803] [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] [Indexed: 01/14/2023] Open
Abstract
It is important for medical providers to distinguish between accidental and abusive mechanisms of injury in children. In the absence of a serious trauma, an isolated tongue laceration and oromaxillofacial trauma in a young, edentulous infant raises significant concern for abuse. The presented case demonstrates a unique injury pattern and serves as an opportunity to explore the multidisciplinary approach to infant trauma in Otolaryngology. Presented is an edentulous infant who sustained a deep splitting laceration of the oral tongue as a result of being dropped a short distance onto carpeted floor. This injury pattern, in the absence of other trauma, raised concern for abuse. Hospital social work and Child Abuse Pediatrics further investigated the matter. A surveillance camera video was produced which demonstrated the blunt force of the fall, coupled with the friction sliding on the floor, ripped open the infant's tongue and left a pattern otherwise suspicious for sharp object laceration. To our knowledge, this is the first report describing a full-thickness tongue laceration after a fall from a caregiver's arms onto carpeted ground. This case underscores the responsibility of the astute provider coupled with a multidisciplinary team to identify or rule out potential child abuse.
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Affiliation(s)
- Jeffrey D Bernstein
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Sara Kruczek
- Department of Pediatrics, Division of Child Abuse Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Natalie Laub
- Department of Pediatrics, Division of Child Abuse Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Daniela Carvalho
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Diego, La Jolla, CA, USA
- Division of Pediatric Otolaryngology, Rady Children's Hospital, San Diego, CA, USA
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Leung KL, Segal RM, Bernstein JD, Orosco RK, Reid CM. Surgical ergonomics: Assessment of surgeon posture and impact of training device during otolaryngology procedures. Laryngoscope Investig Otolaryngol 2022; 7:1351-1359. [PMID: 36258864 PMCID: PMC9575056 DOI: 10.1002/lio2.901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To identify factors associated with cervical‐thoracic spine posture in otolaryngology surgeries and evaluate the efficacy of a commercially available posture‐training device in enhancing surgeon ergonomics. Methods Over 3 months, neck and spine posture from individuals performing otolaryngology surgeries was recorded using UpRight Go 2™. Average baseline posture was first recorded and biofeedback was later introduced to attempt to correct posture. The proportion of time spent in upright/neutral cervical‐thoracic spine posture was correlated with surgeon and procedure characteristics and compared to proportion of upright posture time after biofeedback intervention. Results The proportion of upright operating time was significantly different between procedure subtypes and surgical approaches with best performance in rhinology procedures and worst performance in head and neck surgeries (90% vs. 62%; both p < .001). Female gender, shorter stature, and use of sitting stools were associated with greater proportion of surgery spent upright (all p < .05). Loupes use was associated with less time in upright posture (p < .001). With biofeedback intervention, 8 of 10 subjects demonstrated an average of 5% improvement in operating upright, with most improvement found when performing laryngology procedures (7%) and least improvement in head and neck procedures (2%). Conclusions While surgeon posture varies across otolaryngology surgeries, sitting and minimizing the use of loupes may help promote a more ergonomic operating environment and improve surgeon posture. Although the efficacy of biofeedback intervention from a commercially available posture‐training device differs among otolaryngologists, exploration of alternative interventions and incorporation of an ergonomics curriculum is warranted to address postural issues experienced by many surgeons. Level of Evidence 3.
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Affiliation(s)
- Karen L. Leung
- School of Medicine UC San Diego San Diego California USA
| | | | - Jeffrey D. Bernstein
- Department of Otolaryngology ‐ Head & Neck Surgery, Department of Surgery UC San Diego Health San Diego California USA
| | - Ryan K. Orosco
- Department of Otolaryngology ‐ Head & Neck Surgery, Department of Surgery UC San Diego Health San Diego California USA
| | - Chris M. Reid
- Division of Plastic Surgery, Department of Surgery UC San Diego Health San Diego California USA
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6
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Bernstein JD, DeConde AS, Coffey CS. Steroid-eluting Stent Placement for Refractory Stenosis of Parotid Megaduct After Sialodochoplasty. Ear Nose Throat J 2022:1455613221109751. [PMID: 35734889 DOI: 10.1177/01455613221109751] [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] [Indexed: 11/15/2022] Open
Abstract
Salivary megaduct with stricture is characterized by recurrent pain, swelling, and infection, leading to reduced quality of life. Surgical management includes sialodochoplasty, however, recurrence is common and repeated surgery can lead to further scarring. In the sinuses, drug-eluting stents (DES) are used to reduce scarring after surgery, yet no such technology exists for salivary megaduct with stricture.We trialed DES for this condition with promising results which may pave the way for future development.
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Affiliation(s)
- Jeffrey D Bernstein
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Adam S DeConde
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Charles S Coffey
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Diego, La Jolla, CA, USA
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7
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Bernstein JD, Bracken DJ, Abeles SR, Orosco RK, Weissbrod PA. Surgical wound classification in otolaryngology: A state‐of‐the‐art review. World J Otorhinolaryngol Head Neck Surg 2022; 8:139-144. [PMID: 35782398 PMCID: PMC9242420 DOI: 10.1002/wjo2.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/05/2021] [Indexed: 12/04/2022] Open
Abstract
Objective To describe the issues related to the assignment of surgical wound classification as it pertains to Otolaryngology—Head & Neck surgery, and to present a simple framework by which providers can assign wound classification. Data Sources Literature review. Conclusion Surgical wound classification in its current state is limited in its utility. It has recently been disregarded by major risk assessment models, likely due to inaccurate and inconsistent reporting by providers and operative staff. However, if data accuracy is improved, this metric may be useful to inform the risk of surgical site infection. In an era of quality‐driven care and reimbursement, surgical wound classification may become an equally important indicator of quality. In its current state, surgical wound classification has been disregarded as a key metric, likely due to habitual inaccuracies in procedure categorization. A new paradigm for surgical wound classification specific to Otolaryngology—Head & Neck Surgery is presented. The possibility of surgical wound classification serving as an important indicator of quality of care is discussed and contextualized in current health care trends.
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Affiliation(s)
- Jeffrey D. Bernstein
- Department of Otolaryngology University of California San Diego La Jolla California USA
| | - David J. Bracken
- Department of Otolaryngology University of California San Diego La Jolla California USA
| | - Shira R. Abeles
- Department of Medicine, Division of Infectious Disease and Global Public Health University of California San Diego San Diego California USA
| | - Ryan K. Orosco
- Department of Otolaryngology University of California San Diego La Jolla California USA
- Moores Cancer Center University of California San Diego La Jolla California USA
| | - Philip A. Weissbrod
- Department of Otolaryngology University of California San Diego La Jolla California USA
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8
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Bernstein JD, Harmon M, Watson D. COVID-19 and the Otolaryngology Residency Match: Rising Incidence of Home Matches. Laryngoscope 2022; 132:1934-1938. [PMID: 35038190 PMCID: PMC9015343 DOI: 10.1002/lary.30028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/21/2021] [Accepted: 01/09/2022] [Indexed: 11/20/2022]
Abstract
Objectives/Hypothesis To quantify the effect of the coronavirus disease 2019 (COVID‐19) pandemic upon the 2020 to 2021 residency match for Otolaryngology‐Head and Neck Surgery (OHNS). Study Design Retrospective cohort design. Methods Residency match outcomes for all applicants to our institution during 2020 to 2021 were collected from the National Residency Matching Program including medical school of origin and matched program. Matches were categorized as to home‐program, within‐region, or out‐of‐region and sorted by US geographic region. Matches from the 2020 to 2021 cycle were compared to those from 2019 to 2020, as well as averages and trends from match cycles 2016 to 2020. Statistical analysis included descriptive statistics and chi‐square testing. Results During 2020 to 2021, there were 436 applicants to our single OHNS program. From 2019–2020 to 2020–2021, the match rate decreased significantly for groups studied, including: All applicants (72.0% [268/372] to 64.7% [282/436]; P = .025); all US MD Senior applicants (76.5% [254/332] to 68.9% [262/380]; P = .024); and US MD Seniors specifically without a home program (77.5% [31/40] to 56.4% [22/39]; P = .046). The match rate for US MD Seniors with a home program did not change significantly (76.4% [223/292] to 70.4% [240/341]; P = .09). From 2019–2020 to 2020–2021, the proportion of US MD seniors who matched to home‐program increased significantly (22.0% [49/223] to 30.0% [72/240]; P = .05). Conclusion The COVID‐19 pandemic saw high volumes of OHNS applicants with an overall decreased rate of matching compared to previous years. These changes particularly affected applicants without home programs. Home‐program matching increased significantly, likely as a consequence of the limitations placed on in‐person away experiences including interviews. Laryngoscope, 132:1934–1938, 2022
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Affiliation(s)
- Jeffrey D Bernstein
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego Health, La Jolla, California, USA
| | - Matthew Harmon
- UCSD School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Deborah Watson
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego Health, La Jolla, California, USA
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9
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Said M, Jang SS, Luong T, Bernstein JD, DeConde AS, Yan CH. Measurements of health utility value in COVID-19 olfactory dysfunction. Int Forum Allergy Rhinol 2021; 12:863-867. [PMID: 34821478 DOI: 10.1002/alr.22930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Mena Said
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA, USA
| | - Sophie S Jang
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA, USA
| | - Thanh Luong
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA, USA
| | - Jeffrey D Bernstein
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA, USA
| | - Adam S DeConde
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA, USA
| | - Carol H Yan
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA, USA
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10
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Bernstein JD, Ball LL, Nardone ZB, Watson D. A virtual sub-internship for otolaryngology-head and neck surgery. Laryngoscope Investig Otolaryngol 2021; 6:952-957. [PMID: 34667837 PMCID: PMC8513432 DOI: 10.1002/lio2.637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/03/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE During the COVID-19 pandemic, away rotations were suspended for safety purposes. This led to the development of online interactive learning modules for students, now known as virtual sub-internships (VSIs). To date, VSIs within otolaryngology-head and neck surgery (OHNS) have been limited in their description and design. STUDY DESIGN Cross-sectional survey. SETTING ACGME-accredited OHNS residency program. METHODS Our curriculum for an OHNS VSI is presented. Based on the model used by our OHNS residency program, the VSI consisted of a 2-week block of activities and interactive small-group discussions. A post-VSI feedback survey was distributed to participants; results are reported. RESULTS Six 2-week VSI sessions were administered. Twenty-one individuals participated from all US regions, median 4 individuals per session. Fifteen participants (71.4%) completed the feedback survey. Of survey respondents, 20% lacked a home OHNS residency program, and no respondents' home-programs featured a VSI. All respondents were satisfied with the schedule and organization of the VSI, and 73.3% (11 of 15) felt it was of appropriate duration. All respondents reported a high degree of familiarity with the program, with a greater (86.7%) or equal (13.3%) level of interest in applying to the residency program as a result of participating in the VSI. CONCLUSION This VSI curriculum offers a well-received virtual learning experience for medical students applying to OHNS residency. It provides an opportunity for programs to expand their appeal to potential applicants who may otherwise be restricted in their ability to travel.
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Affiliation(s)
- Jeffrey D. Bernstein
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Laurel L. Ball
- School of MedicineUniversity of San DiegoLa JollaCaliforniaUSA
| | | | - Deborah Watson
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of CaliforniaSan DiegoCaliforniaUSA
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11
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Jafari A, de Lima Xavier L, Bernstein JD, Simonyan K, Bleier BS. Association of Sinonasal Inflammation With Functional Brain Connectivity. JAMA Otolaryngol Head Neck Surg 2021; 147:534-543. [PMID: 33830194 DOI: 10.1001/jamaoto.2021.0204] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance In recent years, there have been several meaningful advances in the understanding of the cognitive effects of chronic rhinosinusitis. However, an investigation exploring the potential link between the underlying inflammatory disease and higher-order neural processing has not yet been performed. Objective To describe the association of sinonasal inflammation with functional brain connectivity (Fc), which may underlie chronic rhinosinusitis-related cognitive changes. Design, Setting, and Participants This is a case-control study using the Human Connectome Project (Washington University-University of Minnesota Consortium of the Human Connectome Project 1200 release), an open-access and publicly available data set that includes demographic, imaging, and behavioral data for 1206 healthy adults aged 22 to 35 years. Twenty-two participants demonstrated sinonasal inflammation (Lund-Mackay score [LMS] ≥ 10) and were compared with age-matched and sex-matched healthy controls (LMS = 0). These participants were further stratified into moderate (LMS < 14, n = 13) and severe (LMS ≥ 14, n = 9) inflammation groups. Participants were screened and excluded if they had a history of psychiatric disorder and/or neurological or genetic diseases. Participants with diabetes or cardiovascular disease were also excluded, as these conditions may affect neuroimaging quality. The data were accessed between October 2019 and August 2020. Data analysis was performed between May 2020 and August 2020. Main Outcomes and Measures The primary outcome was the difference in resting state Fc within and between the default mode, frontoparietal, salience, and dorsal attention brain networks. Secondary outcomes included assessments of cognitive function using the National Institutes of Health Toolbox Cognition Battery. Results A total of 22 patients with chronic rhinosinusitis and 22 healthy controls (2 [5%] were aged 22-25 years, 26 [59%] were aged 26-30 years, and 16 [36%] were aged 31-35 years; 30 [68%] were men) were included in the analysis. Participants with sinonasal inflammation showed decreased Fc within the frontoparietal network, in a region involving bilateral frontal medial cortices. This region demonstrated increased Fc to 2 nodes within the default-mode network and decreased Fc to 1 node within the salience network. The magnitude of these differences increased with inflammation severity (dose dependent). There were no significant associations seen on cognitive testing. Conclusions and Relevance In this case-control study, participants with sinonasal inflammation showed decreased brain connectivity within a major functional hub with a central role in modulating cognition. This region also shows increased connectivity to areas that are activated during introspective and self-referential processing and decreased connectivity to areas involved in detection and response to stimuli. Future prospective studies are warranted to determine the applicability of these findings to a clinical chronic rhinosinusitis population.
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Affiliation(s)
- Aria Jafari
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston
| | - Laura de Lima Xavier
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston
| | - Jeffrey D Bernstein
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego Medical Center, La Jolla
| | - Kristina Simonyan
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston.,Department of Neurology, Massachusetts General Hospital, Boston
| | - Benjamin S Bleier
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston
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12
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Poston KL, Ua Cruadhlaoich MAI, Santoso LF, Bernstein JD, Liu T, Wang Y, Rutt B, Kerchner GA, Zeineh MM. Substantia Nigra Volume Dissociates Bradykinesia and Rigidity from Tremor in Parkinson's Disease: A 7 Tesla Imaging Study. J Parkinsons Dis 2021; 10:591-604. [PMID: 32250317 PMCID: PMC7242837 DOI: 10.3233/jpd-191890] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: In postmortem analysis of late stage Parkinson’s disease (PD) neuronal loss in the substantial nigra (SN) correlates with the antemortem severity of bradykinesia and rigidity, but not tremor. Objective: To investigate the relationship between midbrain nuclei volume as an in vivo biomarker for surviving neurons in mild-to-moderate patients using 7.0 Tesla MRI. Methods: We performed ultra-high resolution quantitative susceptibility mapping (QSM) on the midbrain in 32 PD participants with less than 10 years duration and 8 healthy controls. Following blinded manual segmentation, the individual volumes of the SN, subthalamic nucleus, and red nucleus were measured. We then determined the associations between the midbrain nuclei and clinical metrics (age, disease duration, MDS-UPDRS motor score, and subscores for bradykinesia/rigidity, tremor, and postural instability/gait difficulty). Results: We found that smaller SN correlated with longer disease duration (r = –0.49, p = 0.004), more severe MDS-UPDRS motor score (r = –0.42, p = 0.016), and more severe bradykinesia-rigidity subscore (r = –0.47, p = 0.007), but not tremor or postural instability/gait difficulty subscores. In a hemi-body analysis, bradykinesia-rigidity severity only correlated with SN contralateral to the less-affected hemi-body, and not contralateral to the more-affected hemi-body, possibly reflecting the greatest change in dopamine neuron loss early in disease. Multivariate generalized estimating equation model confirmed that bradykinesia-rigidity severity, age, and disease duration, but not tremor severity, predicted SN volume. Conclusions: In mild-to-moderate PD, SN volume relates to motor manifestations in a motor domain-specific and laterality-dependent manner. Non-invasive in vivo 7.0 Tesla QSM may serve as a biomarker in longitudinal studies of SN atrophy and in studies of people at risk for developing PD.
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Affiliation(s)
- Kathleen L Poston
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew A I Ua Cruadhlaoich
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Laura F Santoso
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.,School of Medicine, University of Massachusetts, Worcester, MA, USA.,California Institute of Technology, Pasadena, CA, USA
| | - Jeffrey D Bernstein
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.,School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Tian Liu
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, USA
| | - Yi Wang
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, USA
| | - Brian Rutt
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Geoffrey A Kerchner
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael M Zeineh
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
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Bernstein JD, Shahrestani S, Shahrvini B, Watson D. Geographic Trends in the Otolaryngology Match (2016-2020). OTO Open 2021; 5:2473974X211022611. [PMID: 34212122 PMCID: PMC8216354 DOI: 10.1177/2473974x211022611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/14/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Presenting geographic matching trends over 5 match cycles (2016-2020) to serve as a context for changes in residency match outcomes due to the coronavirus disease 2019 (COVID-19) pandemic. Study Design Retrospective review. Setting Single academic institution-affiliated otolaryngology–head and neck surgery residency program. Methods Residency match outcomes for all applicants to our institution (2015-2019) were collected from the National Residency Matching Program, including medical school and matched program. Matches were categorized as home program, home region, or out of region and sorted by US geographic region. Statistical analysis included frequencies, totals, χ2 testing, and binary logistic regression. Results From 2016 to 2020, the US MD senior match rate was 84.9%: 18.9% to home programs, 35.7% to home region, and 45.3% to out of region. Rates were similar across regions and decreased over time. Westerners matched to home programs more than Southerners or Midwesterners (27.5% vs 16.0% and 16.0%, P < .01). Southerners and Westerners were more likely to match within their regions (South: 63.1%, P = .011, odds ratio [OR] = 1.296, 95% CI, 1.060-1.584; West: 42.0%, P = .018, OR = 1.462, 95% CI, 1.066-2.004). Matching from out of region was more likely in the West and less likely in the South (West: 58.0%, P = .017, OR = 1.379, 95% CI, 1.059-1.796; South: 36.9%, P < .001, OR = 0.584, 95% CI, 0.47-0.727). Conclusion From 2016 to 2020 in otolaryngology–head and neck surgery, about 1 in 5 matches were to home institutions, a trend that appeared to be more common in the West. Over 4 out of 5 trainees match to nonhome programs, and nearly half relocate to a new region for training. Changes to travel, rotations, and interviews due to COVID-19 may influence these trends.
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Affiliation(s)
- Jeffrey D Bernstein
- Department of Surgery, Otolaryngology-Head and Neck Surgery, University of California-San Diego, La Jolla, California, USA
| | - Shane Shahrestani
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Bita Shahrvini
- UC San Diego School of Medicine, La Jolla, California, USA
| | - Deborah Watson
- Department of Surgery, Otolaryngology-Head and Neck Surgery, University of California-San Diego, La Jolla, California, USA
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Trelle AN, Carr VA, Wilson EN, Swarovski MS, Hunt MP, Toueg TN, Tran TT, Channappa D, Corso NK, Thieu MK, Jayakumar M, Nadiadwala A, Guo W, Tanner NJ, Bernstein JD, Litovsky CP, Guerin SA, Khazenzon AM, Harrison MB, Rutt BK, Deutsch GK, Chin FT, Davidzon GA, Hall JN, Sha SJ, Fredericks CA, Andreasson KI, Kerchner GA, Wagner AD, Mormino EC. Association of CSF Biomarkers With Hippocampal-Dependent Memory in Preclinical Alzheimer Disease. Neurology 2021; 96:e1470-e1481. [PMID: 33408146 DOI: 10.1212/wnl.0000000000011477] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/02/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To determine whether memory tasks with demonstrated sensitivity to hippocampal function can detect variance related to preclinical Alzheimer disease (AD) biomarkers, we examined associations between performance in 3 memory tasks and CSF β-amyloid (Aβ)42/Aβ40 and phosopho-tau181 (p-tau181) in cognitively unimpaired older adults (CU). METHODS CU enrolled in the Stanford Aging and Memory Study (n = 153; age 68.78 ± 5.81 years; 94 female) completed a lumbar puncture and memory assessments. CSF Aβ42, Aβ40, and p-tau181 were measured with the automated Lumipulse G system in a single-batch analysis. Episodic memory was assayed using a standardized delayed recall composite, paired associate (word-picture) cued recall, and a mnemonic discrimination task that involves discrimination between studied "target" objects, novel "foil" objects, and perceptually similar "lure" objects. Analyses examined cross-sectional relationships among memory performance, age, and CSF measures, controlling for sex and education. RESULTS Age and lower Aβ42/Aβ40 were independently associated with elevated p-tau181. Age, Aβ42/Aβ40, and p-tau181 were each associated with (1) poorer associative memory and (2) diminished improvement in mnemonic discrimination performance across levels of decreased task difficulty (i.e., target-lure similarity). P-tau mediated the effect of Aβ42/Aβ40 on memory. Relationships between CSF proteins and delayed recall were similar but nonsignificant. CSF Aβ42 was not significantly associated with p-tau181 or memory. CONCLUSIONS Tests designed to tax hippocampal function are sensitive to subtle individual differences in memory among CU and correlate with early AD-associated biomarker changes in CSF. These tests may offer utility for identifying CU with preclinical AD pathology.
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Affiliation(s)
- Alexandra N Trelle
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA.
| | - Valerie A Carr
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Edward N Wilson
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Michelle S Swarovski
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Madison P Hunt
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Tyler N Toueg
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Tammy T Tran
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Divya Channappa
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Nicole K Corso
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Monica K Thieu
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Manasi Jayakumar
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Ayesha Nadiadwala
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Wanjia Guo
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Natalie J Tanner
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Jeffrey D Bernstein
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Celia P Litovsky
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Scott A Guerin
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Anna M Khazenzon
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Marc B Harrison
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Brian K Rutt
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Gayle K Deutsch
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Frederick T Chin
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Guido A Davidzon
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Jacob N Hall
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Sharon J Sha
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Carolyn A Fredericks
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Katrin I Andreasson
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Geoffrey A Kerchner
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Anthony D Wagner
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Elizabeth C Mormino
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
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Trelle AN, Carr VA, Guerin SA, Thieu MK, Jayakumar M, Guo W, Nadiadwala A, Corso NK, Hunt MP, Litovsky CP, Tanner NJ, Deutsch GK, Bernstein JD, Harrison MB, Khazenzon AM, Jiang J, Sha SJ, Fredericks CA, Rutt BK, Mormino EC, Kerchner GA, Wagner AD. Hippocampal and cortical mechanisms at retrieval explain variability in episodic remembering in older adults. eLife 2020; 9:55335. [PMID: 32469308 PMCID: PMC7259949 DOI: 10.7554/elife.55335] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/05/2020] [Indexed: 12/20/2022] Open
Abstract
Age-related episodic memory decline is characterized by striking heterogeneity across individuals. Hippocampal pattern completion is a fundamental process supporting episodic memory. Yet, the degree to which this mechanism is impaired with age, and contributes to variability in episodic memory, remains unclear. We combine univariate and multivariate analyses of fMRI data from a large cohort of cognitively normal older adults (N=100) to measure hippocampal activity and cortical reinstatement during retrieval of trial-unique associations. Trial-wise analyses revealed that (a) hippocampal activity scaled with reinstatement strength, (b) cortical reinstatement partially mediated the relationship between hippocampal activity and associative retrieval, (c) older age weakened cortical reinstatement and its relationship to memory behaviour. Moreover, individual differences in the strength of hippocampal activity and cortical reinstatement explained unique variance in performance across multiple assays of episodic memory. These results indicate that fMRI indices of hippocampal pattern completion explain within- and across-individual memory variability in older adults.
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Affiliation(s)
| | - Valerie A Carr
- Department of Psychology, Stanford University, Stanford, United States
| | - Scott A Guerin
- Department of Psychology, Stanford University, Stanford, United States
| | - Monica K Thieu
- Department of Psychology, Stanford University, Stanford, United States
| | - Manasi Jayakumar
- Department of Psychology, Stanford University, Stanford, United States
| | - Wanjia Guo
- Department of Psychology, Stanford University, Stanford, United States
| | - Ayesha Nadiadwala
- Department of Psychology, Stanford University, Stanford, United States
| | - Nicole K Corso
- Department of Psychology, Stanford University, Stanford, United States
| | - Madison P Hunt
- Department of Psychology, Stanford University, Stanford, United States
| | - Celia P Litovsky
- Department of Psychology, Stanford University, Stanford, United States
| | - Natalie J Tanner
- Department of Psychology, Stanford University, Stanford, United States
| | - Gayle K Deutsch
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, United States
| | | | - Marc B Harrison
- Department of Psychology, Stanford University, Stanford, United States
| | - Anna M Khazenzon
- Department of Psychology, Stanford University, Stanford, United States
| | - Jiefeng Jiang
- Department of Psychology, Stanford University, Stanford, United States
| | - Sharon J Sha
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, United States
| | - Carolyn A Fredericks
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, United States
| | - Brian K Rutt
- Department of Radiology & Radiological Sciences, Stanford University, Stanford, United States
| | - Elizabeth C Mormino
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, United States
| | - Geoffrey A Kerchner
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, United States
| | - Anthony D Wagner
- Department of Psychology, Stanford University, Stanford, United States
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Qualliotine JR, Jafari A, Shen S, Bernstein JD, DeConde AS. Concha Bullosa Affects Baseline and Postoperative Quality-of-Life Measures in Surgically Managed Chronic Rhinosinusitis. Am J Rhinol Allergy 2019; 34:162-169. [PMID: 31603344 DOI: 10.1177/1945892419881836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Concha bullosa (CB) is a prevalent anatomic variant and frequent surgical target in endoscopic sinus surgery (ESS). However, whether CB impacts quality-of-life (QOL) in chronic rhinosinusitis (CRS) is not well established. The purpose of this study was to investigate baseline and post-ESS QOL differences in patients with medically recalcitrant CRS with and without CB. Methods Demographic and surgical characteristics, baseline and postoperative 22-item Sino-Nasal Outcome Test (SNOT-22) scores for 137 patients with CRS who underwent primary ESS at our institution were recorded. Computed tomography (CT) scans were reviewed for Lund–Mackay score and presence of CB. Multiplanar CT was used to measure CB dimensions and estimate volume. Multivariable analysis was performed to identify differences in SNOT-22 overall and symptom-domain scores between patients with upper quartile (≥0.8 mL) CB and without CB. Results CB was found in 37% of patients with mean volume of 0.67 mL. There were no significant differences in distribution of clinicodemographic variables by large CB status. At baseline, large CB was associated with higher SNOT-22 extranasal-rhinologic domain score (9.8 vs 6.0, P < .01). Following ESS, patients with large CB reported greater improvement in SNOT-22 extranasal-rhinologic domain score (multivariable mean absolute improvement 3.8, P = .01; relative 56% vs 30%). Conclusion Patients with medically recalcitrant CRS and concomitant large CB have higher SNOT-22 extranasal-rhinologic domain scores at baseline, but also report greater intradomain improvement exceeding the subdomain’s mean clinically important difference. To our knowledge, this is the first demonstration that CB has a clinically significant impact on QOL in CRS, and surgical intervention may be helpful to address these symptoms.
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Affiliation(s)
- Jesse R Qualliotine
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego, San Diego, California
| | - Aria Jafari
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego, San Diego, California
| | - Sarek Shen
- School of Medicine, University of California San Diego, La Jolla, California
| | - Jeffrey D Bernstein
- School of Medicine, University of California San Diego, La Jolla, California
| | - Adam S DeConde
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego, San Diego, California
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17
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La C, Linortner P, Bernstein JD, Ua Cruadhlaoich MAI, Fenesy M, Deutsch GK, Rutt BK, Tian L, Wagner AD, Zeineh M, Kerchner GA, Poston KL. Hippocampal CA1 subfield predicts episodic memory impairment in Parkinson's disease. Neuroimage Clin 2019; 23:101824. [PMID: 31054380 PMCID: PMC6500913 DOI: 10.1016/j.nicl.2019.101824] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/15/2019] [Accepted: 04/09/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Parkinson's disease (PD) episodic memory impairments are common; however, it is not known whether these impairments are due to hippocampal pathology. Hippocampal Lewy-bodies emerge by Braak stage 4, but are not uniformly distributed. For instance, hippocampal CA1 Lewy-body pathology has been specifically associated with pre-mortem episodic memory performance in demented patients. By contrast, the dentate gyrus (DG) is relatively free of Lewy-body pathology. In this study, we used ultra-high field 7-Tesla to measure hippocampal subfields in vivo and determine if these measures predict episodic memory impairment in PD during life. METHODS We studied 29 participants with PD (age 65.5 ± 7.8 years; disease duration 4.5 ± 3.0 years) and 8 matched-healthy controls (age 67.9 ± 6.8 years), who completed comprehensive neuropsychological testing and MRI. With 7-Tesla MRI, we used validated segmentation techniques to estimate CA1 stratum pyramidale (CA1-SP) and stratum radiatum lacunosum moleculare (CA1-SRLM) thickness, dentate gyrus/CA3 (DG/CA3) area, and whole hippocampus area. We used linear regression, which included imaging and clinical measures (age, duration, education, gender, and CSF), to determine the best predictors of episodic memory impairment in PD. RESULTS In our cohort, 62.1% of participants with PD had normal cognition, 27.6% had mild cognitive impairment, and 10.3% had dementia. Using 7-Tesla MRI, we found that smaller CA1-SP thickness was significantly associated with poorer immediate memory, delayed memory, and delayed cued memory; by contrast, whole hippocampus area, DG/CA3 area, and CA1-SRLM thickness did not significantly predict memory. Age-adjusted linear regression models revealed that CA1-SP predicted immediate memory (beta[standard error]10.895[4.215], p < .05), delayed memory (12.740[5.014], p < .05), and delayed cued memory (12.801[3.991], p < .05). In the fully-adjusted models, which included all five clinical measures as covariates, only CA1-SP remained a significant predictor of delayed cued memory (13.436[4.651], p < .05). CONCLUSIONS In PD, we found hippocampal CA1-SP subfield thickness estimated on 7-Tesla MRI scans was the best predictor of episodic memory impairment, even when controlling for confounding clinical measures. Our results imply that ultra-high field imaging could be a sensitive measure to identify changes in hippocampal subfields and thus probe the neuroanatomical underpinnings of episodic memory impairments in patients with PD.
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Affiliation(s)
- Christian La
- Department of Neurology and Neurological Sciences, Stanford University, 300 Pasteur Dr. Room H3144, MC 5235, Stanford, CA 94305, United States of America
| | - Patricia Linortner
- Department of Neurology and Neurological Sciences, Stanford University, 300 Pasteur Dr. Room H3144, MC 5235, Stanford, CA 94305, United States of America
| | - Jeffrey D Bernstein
- Department of Neurology and Neurological Sciences, Stanford University, 300 Pasteur Dr. Room H3144, MC 5235, Stanford, CA 94305, United States of America
| | - Matthew A I Ua Cruadhlaoich
- Department of Neurology and Neurological Sciences, Stanford University, 300 Pasteur Dr. Room H3144, MC 5235, Stanford, CA 94305, United States of America
| | - Michelle Fenesy
- Department of Neurology and Neurological Sciences, Stanford University, 300 Pasteur Dr. Room H3144, MC 5235, Stanford, CA 94305, United States of America
| | - Gayle K Deutsch
- Department of Neurology and Neurological Sciences, Stanford University, 300 Pasteur Dr. Room H3144, MC 5235, Stanford, CA 94305, United States of America
| | - Brian K Rutt
- Department of Radiology, Stanford University, 1201 Welch Road. Room PS-064, MC 5488, Stanford, CA 94305, United States of America
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University, 150 Governor's Lane. Room T160C, MC 5464, Stanford, CA 94305, United States of America
| | - Anthony D Wagner
- Department of Psychology, Stanford University, Jordan Hall. Bldg 420, MC 2130, Stanford, CA 94305, United States of America
| | - Michael Zeineh
- Department of Radiology, Stanford University, 1201 Welch Road. Room PS-064, MC 5488, Stanford, CA 94305, United States of America
| | - Geoffrey A Kerchner
- Department of Neurology and Neurological Sciences, Stanford University, 300 Pasteur Dr. Room H3144, MC 5235, Stanford, CA 94305, United States of America
| | - Kathleen L Poston
- Department of Neurology and Neurological Sciences, Stanford University, 300 Pasteur Dr. Room H3144, MC 5235, Stanford, CA 94305, United States of America; Department of Neurosurgery, Stanford University, 300 Pasteur Dr. Room H3144, MC 5235, Stanford, CA 94305, United States of America.
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18
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Wisse LE, Daugherty AM, Olsen RK, Berron D, Carr VA, Stark CE, Amaral RS, Amunts K, Augustinack JC, Bender AR, Bernstein JD, Boccardi M, Bocchetta M, Burggren A, Chakravarty MM, Chupin M, Ekstrom A, de Flores R, Insausti R, Kanel P, Kedo O, Kennedy KM, Kerchner GA, LaRocque KF, Liu X, Maass A, Malykhin N, Mueller SG, Ofen N, Palombo DJ, Parekh MB, Pluta JB, Pruessner JC, Raz N, Rodrigue KM, Schoemaker D, Shafer AT, Steve TA, Suthana N, Wang L, Winterburn JL, Yassa MA, Yushkevich PA, la Joie R. A harmonized segmentation protocol for hippocampal and parahippocampal subregions: Why do we need one and what are the key goals? Hippocampus 2017; 27:3-11. [PMID: 27862600 PMCID: PMC5167633 DOI: 10.1002/hipo.22671] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/06/2016] [Accepted: 10/17/2016] [Indexed: 01/08/2023]
Abstract
The advent of high-resolution magnetic resonance imaging (MRI) has enabled in vivo research in a variety of populations and diseases on the structure and function of hippocampal subfields and subdivisions of the parahippocampal gyrus. Because of the many extant and highly discrepant segmentation protocols, comparing results across studies is difficult. To overcome this barrier, the Hippocampal Subfields Group was formed as an international collaboration with the aim of developing a harmonized protocol for manual segmentation of hippocampal and parahippocampal subregions on high-resolution MRI. In this commentary we discuss the goals for this protocol and the associated key challenges involved in its development. These include differences among existing anatomical reference materials, striking the right balance between reliability of measurements and anatomical validity, and the development of a versatile protocol that can be adopted for the study of populations varying in age and health. The commentary outlines these key challenges, as well as the proposed solution of each, with concrete examples from our working plan. Finally, with two examples, we illustrate how the harmonized protocol, once completed, is expected to impact the field by producing measurements that are quantitatively comparable across labs and by facilitating the synthesis of findings across different studies. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Laura E.M. Wisse
- Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Ana M. Daugherty
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Champaign, USA
| | - Rosanna K. Olsen
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - David Berron
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
| | - Valerie A. Carr
- Department of Psychology, Stanford University, Palo Alto, USA
- Department of Psychology, San Jose State University, San Jose, USA
| | - Craig E.L. Stark
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, USA
| | - Robert S.C. Amaral
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, Canada
- Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Canada
| | - Katrin Amunts
- Institute of Neuroscience and Medicine, INM-1, Research Center Jülich, Jülich, Germany
- JARA-BRAIN, Jülich-Aachen Research Alliance, Jülich, Germany
- C. and O. Vogt Institute for Brain Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jean C. Augustinack
- AA Martinos Center for Biomedical Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | - Andrew R. Bender
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Jeffrey D. Bernstein
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, USA
| | - Marina Boccardi
- LANVIE Laboratory of Neuroimaging of Aging, University of Geneva, Geneva, Switzerland
| | - Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
| | - Alison Burggren
- Department of Psychiatry and Biobehavioural Sciences, University of California Los Angeles, Los Angeles, USA
| | - M. Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, Canada
- Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal, Canada
| | - Marie Chupin
- INSERM, CNRS, UMR-S975, Institut du Cerveau et de la Moelle Epinière (ICM), Paris, France
| | - Arne Ekstrom
- Center for Neuroscience, University of California Davis, Davis, USA
- Department of Psychology, University of California Davis, Davis, USA
| | - Robin de Flores
- INSERM U1077, Université de Caen Normandie, UMR-S1077, Ecole Pratique des Hautes Etudes, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Ricardo Insausti
- Human Neuroanatomy Laboratory and C.R.I.B., School of Medicine, University of Castilla-La Mancha, Albacete, Spain
| | - Prabesh Kanel
- Department of Computer Science, Florida State University, Tallahassee, USA
| | - Olga Kedo
- Institute of Neuroscience and Medicine, INM-1, Research Center Jülich, Jülich, Germany
| | - Kristen M. Kennedy
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, USA
| | - Geoffrey A. Kerchner
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, USA
| | | | - Xiuwen Liu
- Department of Computer Science, Florida State University, Tallahassee, USA
| | - Anne Maass
- School of Public Health and Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, USA
| | - Nicolai Malykhin
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
- The Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Susanne G. Mueller
- Department of Radiology, University of California, San Francisco, USA
- Center for Imaging of Neurodegenerative Diseases, San Francisco VA Medical Center, San Francisco, USA
| | - Noa Ofen
- Psychology Department, Wayne State University, Detroit, USA
- Institute of Gerontology, Wayne State University, Detroit, USA
| | | | - Mansi B. Parekh
- Department of Radiology, Stanford University, Palo Alto, USA
| | - John B. Pluta
- Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Jens C. Pruessner
- McGill Centre for Studies in Aging, Faculty of Medicine, McGill University, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
| | - Naftali Raz
- Psychology Department, Wayne State University, Detroit, USA
- Institute of Gerontology, Wayne State University, Detroit, USA
| | - Karen M. Rodrigue
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, USA
| | - Dorothee Schoemaker
- McGill Centre for Studies in Aging, Faculty of Medicine, McGill University, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
| | - Andrea T. Shafer
- Psychology Department, Wayne State University, Detroit, USA
- Institute of Gerontology, Wayne State University, Detroit, USA
| | - Trevor A. Steve
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Nanthia Suthana
- Department of Psychiatry and Biobehavioural Sciences, University of California Los Angeles, Los Angeles, USA
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, USA
| | - Lei Wang
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Julie L. Winterburn
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, Canada
- Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal, Canada
| | - Michael A. Yassa
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, USA
- Department of Neurology, University of California Irvine, Irvine, USA
| | - Paul A. Yushkevich
- Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Renaud la Joie
- INSERM U1077, Université de Caen Normandie, UMR-S1077, Ecole Pratique des Hautes Etudes, Centre Hospitalier Universitaire de Caen, Caen, France
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19
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Yushkevich PA, Amaral RSC, Augustinack JC, Bender AR, Bernstein JD, Boccardi M, Bocchetta M, Burggren AC, Carr VA, Chakravarty MM, Chételat G, Daugherty AM, Davachi L, Ding SL, Ekstrom A, Geerlings MI, Hassan A, Huang Y, Iglesias JE, La Joie R, Kerchner GA, LaRocque KF, Libby LA, Malykhin N, Mueller SG, Olsen RK, Palombo DJ, Parekh MB, Pluta JB, Preston AR, Pruessner JC, Ranganath C, Raz N, Schlichting ML, Schoemaker D, Singh S, Stark CEL, Suthana N, Tompary A, Turowski MM, Van Leemput K, Wagner AD, Wang L, Winterburn JL, Wisse LEM, Yassa MA, Zeineh MM. Quantitative comparison of 21 protocols for labeling hippocampal subfields and parahippocampal subregions in in vivo MRI: towards a harmonized segmentation protocol. Neuroimage 2015; 111:526-41. [PMID: 25596463 PMCID: PMC4387011 DOI: 10.1016/j.neuroimage.2015.01.004] [Citation(s) in RCA: 226] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/25/2014] [Accepted: 01/01/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE An increasing number of human in vivo magnetic resonance imaging (MRI) studies have focused on examining the structure and function of the subfields of the hippocampal formation (the dentate gyrus, CA fields 1-3, and the subiculum) and subregions of the parahippocampal gyrus (entorhinal, perirhinal, and parahippocampal cortices). The ability to interpret the results of such studies and to relate them to each other would be improved if a common standard existed for labeling hippocampal subfields and parahippocampal subregions. Currently, research groups label different subsets of structures and use different rules, landmarks, and cues to define their anatomical extents. This paper characterizes, both qualitatively and quantitatively, the variability in the existing manual segmentation protocols for labeling hippocampal and parahippocampal substructures in MRI, with the goal of guiding subsequent work on developing a harmonized substructure segmentation protocol. METHOD MRI scans of a single healthy adult human subject were acquired both at 3 T and 7 T. Representatives from 21 research groups applied their respective manual segmentation protocols to the MRI modalities of their choice. The resulting set of 21 segmentations was analyzed in a common anatomical space to quantify similarity and identify areas of agreement. RESULTS The differences between the 21 protocols include the region within which segmentation is performed, the set of anatomical labels used, and the extents of specific anatomical labels. The greatest overall disagreement among the protocols is at the CA1/subiculum boundary, and disagreement across all structures is greatest in the anterior portion of the hippocampal formation relative to the body and tail. CONCLUSIONS The combined examination of the 21 protocols in the same dataset suggests possible strategies towards developing a harmonized subfield segmentation protocol and facilitates comparison between published studies.
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Affiliation(s)
- Paul A Yushkevich
- Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, USA.
| | - Robert S C Amaral
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Canada
| | - Jean C Augustinack
- A.A. Martinos Center for Biomedical Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, USA
| | | | - Jeffrey D Bernstein
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, USA; Stanford Center for Memory Disorders, USA
| | - Marina Boccardi
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Italy
| | - Martina Bocchetta
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Alison C Burggren
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | | | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Canada; Department of Psychiatry, Department of Biomedical Engineering, McGill University, Canada
| | - Gaël Chételat
- INSERM U1077, Universitè de Caen Basse-Normandie, UMR-S1077, Ecole Pratique des Hautes Etudes, CHU de Caen, U1077, Caen, France
| | - Ana M Daugherty
- Institute of Gerontology, Wayne State University, USA; Psychology Department, Wayne State University, USA
| | - Lila Davachi
- Department of Psychology, New York University, USA; Center for Neural Science, New York University, USA
| | | | - Arne Ekstrom
- Center for Neuroscience, University of California, Davis, USA; Department of Psychology, University of California, Davis, USA
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands
| | - Abdul Hassan
- Center for Neuroscience, University of California, Davis, USA
| | - Yushan Huang
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - J Eugenio Iglesias
- A.A. Martinos Center for Biomedical Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, USA; Basque Center on Cognition, Brain and Language (BCBL), Donostia-San Sebastian, Spain
| | - Renaud La Joie
- INSERM U1077, Universitè de Caen Basse-Normandie, UMR-S1077, Ecole Pratique des Hautes Etudes, CHU de Caen, U1077, Caen, France
| | - Geoffrey A Kerchner
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, USA; Stanford Center for Memory Disorders, USA
| | | | - Laura A Libby
- Center for Neuroscience, University of California, Davis, USA
| | - Nikolai Malykhin
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada; Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada
| | - Susanne G Mueller
- Department of Radiology, University of California, San Francisco, USA; Center for Imaging of Neurodegenerative Diseases, San Francisco VA Medical Center, USA
| | | | | | | | - John B Pluta
- Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, USA; Department of Biostatistics, University of Pennsylvania, USA
| | - Alison R Preston
- Department of Psychology, The University of Texas at Austin, USA; Center for Learning and Memory, The University of Texas at Austin, USA; Department of Neuroscience, The University of Texas at Austin, USA
| | - Jens C Pruessner
- McGill Centre for Studies in Aging, Faculty of Medicine, McGill University, Canada; Department of Psychology, McGill University, Canada
| | - Charan Ranganath
- Department of Psychology, University of California, Davis, USA; Center for Neuroscience, University of California, Davis, USA
| | - Naftali Raz
- Institute of Gerontology, Wayne State University, USA; Psychology Department, Wayne State University, USA
| | - Margaret L Schlichting
- Department of Psychology, The University of Texas at Austin, USA; Center for Learning and Memory, The University of Texas at Austin, USA
| | - Dorothee Schoemaker
- McGill Centre for Studies in Aging, Faculty of Medicine, McGill University, Canada; Department of Psychology, McGill University, Canada
| | - Sachi Singh
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, USA
| | - Craig E L Stark
- Department of Neurobiology and Behavior, University of California, Irvine, USA
| | - Nanthia Suthana
- Department of Neurosurgery, University of California, Los Angeles, USA
| | | | - Marta M Turowski
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, USA
| | - Koen Van Leemput
- A.A. Martinos Center for Biomedical Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, USA; Department of Applied Mathematics and Computer Science, Technical University of Denmark, Denmark
| | - Anthony D Wagner
- Department of Psychology, Stanford University, USA; Neurosciences Program, Stanford University, USA
| | - Lei Wang
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, USA; Department of Radiology, Northwestern University Feinberg School of Medicine, USA
| | - Julie L Winterburn
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Canada
| | - Laura E M Wisse
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands
| | - Michael A Yassa
- Department of Neurobiology and Behavior, University of California, Irvine, USA
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Kerchner GA, Czirr E, Bernstein JD, Wyss‐Coray T, Rutt BK. IC‐P‐166: CEREBROSPINAL FLUID TAU, BUT NOT AMYLOID, TRACKS ATROPHY IN ALZHEIMER‐VULNERABLE HIPPOCAMPAL SUBFIELDS. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Eva Czirr
- Stanford UniversitySanta ClaraCaliforniaUnited States
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21
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Kerchner GA, Czirr E, Bernstein JD, Wyss‐Coray T, Rutt BK. P1‐265: CEREBROSPINAL FLUID TAU, BUT NOT AMYLOID, TRACKS ATROPHY IN ALZHEIMER'S‐VULNERABLE HIPPOCAMPAL SUBFIELDS. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Eva Czirr
- Stanford UniversitySanta ClaraCaliforniaUnited States
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22
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Kerchner GA, Berdnik D, Shen JC, Bernstein JD, Fenesy MC, Deutsch GK, Wyss-Coray T, Rutt BK. APOE ε4 worsens hippocampal CA1 apical neuropil atrophy and episodic memory. Neurology 2014; 82:691-7. [PMID: 24453080 DOI: 10.1212/wnl.0000000000000154] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Using high-resolution structural MRI, we endeavored to study the relationships among APOE ε4, hippocampal subfield and stratal anatomy, and episodic memory. METHODS Using a cross-sectional design, we studied 11 patients with Alzheimer disease dementia, 14 patients with amnestic mild cognitive impairment, and 14 age-matched healthy controls with no group differences in APOE ε4 carrier status. Each subject underwent ultra-high-field 7.0-tesla MRI targeted to the hippocampus and neuropsychological assessment. RESULTS We found a selective, dose-dependent association of APOE ε4 with greater thinning of the CA1 apical neuropil, or stratum radiatum/stratum lacunosum-moleculare (CA1-SRLM), a hippocampal subregion known to exhibit early vulnerability to neurofibrillary pathology in Alzheimer disease. The relationship between the ε4 allele and CA1-SRLM thinning persisted after controlling for dementia severity, and the size of other hippocampal subfields and the entorhinal cortex did not differ by APOE ε4 carrier status. Carriers also exhibited worse episodic memory function but similar performance in other cognitive domains compared with noncarriers. In a statistical mediation analysis, we found support for the hypothesis that CA1-SRLM thinning may link the APOE ε4 allele to its phenotypic effects on memory. CONCLUSIONS The APOE ε4 allele segregated dose-dependently and selectively with CA1-SRLM thinning and worse episodic memory performance in a pool of older subjects across a cognitive spectrum. These findings highlight a possible role for this gene in influencing a critical hippocampal subregion and an associated symptomatic manifestation.
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Affiliation(s)
- Geoffrey A Kerchner
- From the Departments of Neurology and Neurological Sciences (G.A.K., D.B., J.C.S., J.D.B., M.C.F., G.K.D., T.W.-C.) and Radiology (B.K.R.), Stanford University School of Medicine, Stanford; and Center for Tissue Regeneration, Repair and Restoration (T.W.-C.), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
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Lynch DC, Teplin SE, Willis SE, Pathman DE, Larsen LC, Steiner BD, Bernstein JD. Interim evaluation of the Rural Health Scholars Program. Teach Learn Med 2001; 13:36-42. [PMID: 11273377 DOI: 10.1207/s15328015tlm1301_7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND The imperative to address physician maldistribution has been directed in part at medical schools. DESCRIPTION The Rural Health Scholars Program (RHSP) is an enrichment initiative that has been implemented at 2 medical schools to increase the number of students likely to practice primary care in rural, underserved areas. It is a longitudinal program that includes a skill-building workshop; a 5-week summer preceptorship with community-based preceptors in rural, underserved areas; and opportunities to return to preceptorship sites during 3rd- and 4th-year rotations. Students also attend community-based and teleconference seminars and workshops, as well as informal social gatherings. EVALUATION A static-group comparison design was used to compare program participants with nonparticipants regarding residency program types and locations. CONCLUSIONS The RHSP is meeting some interim objectives conducive to its long-term goal of developing physicians who will practice primary care medicine in rural, underserved areas of North Carolina.
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Affiliation(s)
- D C Lynch
- Generalist Physician Program, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA.
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Pathman DE, Taylor DH, Konrad TR, King TS, Harris T, Henderson TM, Bernstein JD, Tucker T, Crook KD, Spaulding C, Koch GG. State scholarship, loan forgiveness, and related programs: the unheralded safety net. JAMA 2000; 284:2084-92. [PMID: 11042757 DOI: 10.1001/jama.284.16.2084] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT In the mid-1980s, states expanded their initiatives of scholarships, loan repayment programs, and similar incentives to recruit primary care practitioners into underserved areas. With no national coordination or mandate to publicize these efforts, little is known about these state programs and their recent growth. OBJECTIVES To identify and describe state programs that provide financial support to physicians and midlevel practitioners in exchange for a period of service in underserved areas, and to begin to assess the magnitude of the contributions of these programs to the US health care safety net. DESIGN Cross-sectional, descriptive study of data collected by telephone, mail questionnaires, and through other available documents, (eg, program brochures, Web sites). SETTING AND PARTICIPANTS All state programs operating in 1996 that provided financial support in exchange for service in defined underserved areas to student, resident, and practicing physicians; nurse practitioners; physician assistants; and nurse midwives. We excluded local community initiatives and programs that received federal support, including that from the National Health Service Corps. MAIN OUTCOME MEASURES Number and types of state support-for-service programs in 1996; trends in program types and numbers since 1990; distribution of programs across states; numbers of participating physicians and other practitioners in 1996; numbers in state programs relative to federal programs; and basic features of state programs. RESULTS In 1996, there were 82 eligible programs operating in 41 states, including 29 loan repayment programs, 29 scholarship programs, 11 loan programs, 8 direct financial incentive programs, and 5 resident support programs. Programs more than doubled in number between 1990 (n = 39) and 1996 (n = 82). In 1996, an estimated 1306 physicians and 370 midlevel practitioners were serving obligations to these state programs, a number comparable with those in federal programs. Common features of state programs were a mission to influence the distribution of the health care workforce within their states' borders, an emphasis on primary care, and reliance on annual state appropriations and other public funding mechanisms. CONCLUSIONS In 1996, states fielded an obligated primary care workforce comparable in size to the better-known federal programs. These state programs constitute a major portion of the US health care safety net, and their activities should be monitored, coordinated, and evaluated. State programs should not be omitted from listings of safety-net initiatives or overlooked in future plans to further improve health care access. JAMA. 2000;284:2084-2092.
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Affiliation(s)
- D E Pathman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, CB7590, Chapel Hill, NC 27599, USA.
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Abstract
In the next few years, Our Community Hospital, located in the small town of Scotland Neck, NC, will undergo a conversion through which it may serve as an appropriate model for similar small hospitals in distressed rural communities. With technical and grant assistance from the Office of Rural Health and Resource Development of the North Carolina Department of Human Resources, the hospital has begun to phase out almost all acute care services and will expand and strengthen its focus on primary care, emergency medical services, and services for elderly persons. This paper addresses four issues of greatest concern to hospital administrators, rural health professionals, academics, and rural residents interested in hospital conversions: (1) community involvement during the planning process; (2) the evolution of the program's structure; (3) financing for the project; and (4) the development of cooperation between state and federal governments, foundations, and private groups. This case study describes one possible course in addressing an acute health care problem facing rural America--the viability of rural hospitals.
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Affiliation(s)
- C Kushner
- North Carolina Rural Health Research Program, University of North Carolina, Chapel Hill 27599
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Sottiurai VS, Bernstein JD. Transpubic ilio-deep femoral-anterior tibial sequential bypass with nonreversed translocated saphenous vein for limb salvage. J Vasc Surg 1988; 8:86-8. [PMID: 3385883] [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: 01/05/2023]
Abstract
We report a case of successive occlusions of aortofemoral, femorofemoral, axillofemoral, and numerous thrombectomies successfully managed by the use of nonreversed translocated saphenous vein for transpubic ilio-deep femoral-anterior tibial sequential bypass.
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Affiliation(s)
- V S Sottiurai
- Department of Surgery, Louisiana State University School of Medicine, New Orleans 70112
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Brooks EF, Bernstein JD, DeFriese GH, Graham RM. New health practitioners in rural satellite health centers: the past and future. J Community Health 1981; 6:246-56. [PMID: 6120184 DOI: 10.1007/bf01324001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Data from a 1975 and a follow-up 1979 survey of 44 rural, satellite health centers staffed by new health practitioners (NHPs)are compared to determine what changes have taken place in these centers during this period when the number of physicians in the United States has markedly increased. Of the surveyed clinics, 8 closed and 12 converted to having physicians on their staffs by 1979. The remaining 24 NHP-staffed centers realized growth in staff size and budget, patient utilization, and proportion of budget generated by revenues from patients. (Despite these positive changes, most of these 24 clinics expressed concern about their financial situations-a reflection of the considerable room for further improvement.) The general growth of the 24 NHP-staffed satellites, however, was not as substantial as that achieved by the 12 clinics staffed by physicians in 1979. The rapidly increasing supply of physicians in the United States and the potential effects of this trend on NHP-staffed rural satellite centers are discussed. Possible reasons why these satellites may continue to be of value in making primary care available in rural areas are enumerated.
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Abstract
Chronic ethanol treatment of male Sprague-Dawley rats resulted in a 50% decrease in the rate of incorporation of precursor leucine into isolated mitochondria. This decrease is manifest in a decreased labeling of three polypeptides of inner mitochondrial membranes that are the major products of in vitro mitochondrial protein synthesis under the conditions employed. Immunoprecipitation of cytochrome-c oxidase revealed that these three polypeptides are subunits 1, 2, and 3 of cytochrome-c oxidase and have apparent molecular weights of 33,000, 25,000, and 20,000. Sixty percent of the total incorporated radioactivity is associated with these polypeptides. A decrease in the contents of subunit 2 and of a second polypeptide with an apparent molecular weight of 22,000 was also noted as an effect of chronic ethanol treatment.
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Bernstein JD, Bucher JR, Penniall R. Origin of mitochondrial enzymes. V. The polypeptide character and the biosynthesis of rat liver cytochrome c oxidase polypeptides by mitochondria. J Bioenerg Biomembr 1978; 10:59-74. [PMID: 233469 DOI: 10.1007/bf00743227] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Isolated rat liver mitochondria were labeled in vitro with L-[14C]leucine. Sixty percent of the incorporated radioactivity was found to reside in subunits 1, 2, and 3 of cytochrome c oxidase with apparent molecular weights of approximately 33,000, 25,000, and 20,000, respectively. The results indicate that these are the predominant products of protein synthesis under the conditions employed. The enzyme complex, as derived by immunoprecipitation, was found to contain four additional polypeptides with apparent molecular weights of 17,000, 12,500, 7000, and 3500. A comparison of electrophoretic profiles of the rat liver and beef heart enzyme reveals that the apparent molecular weights of all polypeptides are remarkably similar.
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