1
|
Touponse G, Malacon K, Li G, Yoseph E, Han S, Zygourakis C. Provider's exposure to diversity contributes to socioeconomic disparities in lumbar and cervical fusion outcomes. World Neurosurg X 2024; 23:100382. [PMID: 38756754 PMCID: PMC11097082 DOI: 10.1016/j.wnsx.2024.100382] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
Background Studies report patient race, income, and education influence spinal fusion outcomes; fewer studies, however, examine the influence of provider factors such as exposure to diversity or cultural sensitivity. Objective To examine how providers' experience with diverse patient populations affects spinal fusion outcomes. Methods Retrospective review of 39,680 patients undergoing lumbar and cervical fusions, 2003-2021, in Clinformatics® Data Mart national database. We used the provider patient racial diversity index (pRDI)-a published metric of physician exposure to diverse patients-to divide patients into groups based their provider's category (I, II, III) where patients treated by category III providers had surgeons with the most diverse patient populations. Multivariate regression models on propensity score-matched cohorts examined the association between patient SES and provider category on post-operative outcomes. Results Black patients had decreased discharge home (OR 0.67; 95% CI 0.54-0.83) compared to white patients. Patients treated by category III providers had increased length of stay (Coeff. 0.62; 95% CI 0.43-0.81), charge (Coeff. 36800; 95% CI 29,200-44,400), and decreased discharge home (OR 0.90; 95% CI 0.83-0.97) compared to patients treated by category I providers. Asian patients treated by category II providers had decreased readmission (OR 0.38; 95% CI 0.14-0.96), and Black patients treated by category III providers had increased discharge home (OR 1.41; 95% CI 1.1-1.9) compared to those treated by category I providers. Conclusion While our study found two specific instances of improved spine surgery outcomes for minority patients treated by providers serving diverse patient populations, we present mixed findings overall. This study serves as the foundation for future research to better understand how provider pRDI affects outcomes in patients undergoing lumbar and cervical spine surgery.
Collapse
Affiliation(s)
- Gavin Touponse
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Karen Malacon
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Guan Li
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Ezra Yoseph
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Summer Han
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
- Quantative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Corinna Zygourakis
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
2
|
Pugazenthi S, Malacon K, Kim NC, Stuebe CM, Yoh N, Bhanja D, Walker E, Bauman MMJ, Becker K, Johnson GW, Caston RM, Lee H, Strahle JM, Ben-Haim S. Barriers to neurosurgery for medical students: a national study focused on the intersectionality of gender and race. J Neurosurg 2024:1-12. [PMID: 38759239 DOI: 10.3171/2024.2.jns232038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/14/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVE Despite 51.2% of medical school graduates being female, only 29.8% of neurosurgery residency applicants are female. Furthermore, only 12.6% of neurosurgery applicants identify as underrepresented in medicine (URM). Evaluating the entry barriers for female and URM students is crucial in promoting the equity and diversity of the neurosurgical workforce. The objective of this study was to evaluate barriers to neurosurgery for medical students while considering the interaction between gender and race. METHODS A Qualtrics survey was distributed widely to US medical students, assessing 14 factors of hesitancy toward neurosurgery. Likert scale responses, representing statement agreeability, converted to numeric values on a 7-point scale were analyzed by Mann-Whitney U-test and ANOVA comparisons with Bonferroni correction. RESULTS Of 540 respondents, 68.7% were female and 22.6% were URM. There were 22.6% male non-URM, 7.4% male URM, 53.5% female non-URM, and 15.2% female URM respondents. The predominant reasons for hesitancy toward neurosurgery included work/life integration, length of training, competitiveness of residency position, and perceived malignancy of the field. Females were more hesitant toward neurosurgery due to maternity/paternity needs (p = 0.005), the absence of seeing people like them in the field (p < 0.001), and opportunities to pursue health equity work (p < 0.001). Females were more likely to have difficulties finding a mentor in neurosurgery who represented their identities (p = 0.017). URM students were more hesitant toward neurosurgery due to not seeing people like them in the field (p < 0.001). Subanalysis revealed that when students were stratified by both gender and URM status, there were more reasons for hesitancy toward neurosurgery that had significant differences between groups (male URM, male non-URM, female URM, and female non-URM students), suggesting the importance of intersectionality in this analysis. CONCLUSIONS The authors highlight the implications of gender and racial diversity in the neurosurgical workforce on medical student interest and recruitment. Their findings suggest the importance of actively working to address these barriers, including 1) maternity/paternity policy reevaluation, standardization, and dissemination; and 2) actively providing resources for the creation of mentorship relationships for both women and URM students in an effort to create a workforce that aligns with the changing demographics of medical graduates to continue to improve diversity in neurosurgery.
Collapse
Affiliation(s)
- Sangami Pugazenthi
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Karen Malacon
- 2Department of Neurosurgery, Stanford School of Medicine, Palo Alto, California
| | - Nora C Kim
- 3Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York
| | - Caren M Stuebe
- 4Department of Neurosurgery, Texas A&M School of Medicine, Bryan, Texas
| | - Nina Yoh
- 5Department of Neurosurgery, Columbia University Medical Center, New York, New York
| | - Debarati Bhanja
- 6Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania
| | - Erin Walker
- 7University of South Carolina School of Medicine Greenville, South Carolina
| | - Megan M J Bauman
- 8Department of Neurosurgery, Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kathryn Becker
- 9The University of Toledo College of Medicine, Toledo, Ohio
| | - Gabrielle W Johnson
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Rose M Caston
- 10Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Hedwig Lee
- 11Department of Sociology, Duke School of Medicine, Durham, North Carolina; and
| | - Jennifer M Strahle
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sharona Ben-Haim
- 12Department of Neurosurgery, University of California, San Diego, California
| |
Collapse
|
3
|
Wadhwa H, Leung C, Sklar M, Malacon K, Rangwalla T, Williamson T, Castillo TN, Amanatullah DF, Zygourakis CC. Costs and Outcomes of Total Joint Arthroplasty in Medicare Beneficiaries Are Not Meaningfully Associated with Industry Payments. J Bone Joint Surg Am 2024; 106:337-345. [PMID: 37992189 DOI: 10.2106/jbjs.23.00768] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Prior studies have demonstrated that industry payments affect physician prescribing patterns, but their effect on orthopaedic surgical costs is unknown. This study examines the relationship between industry payments and the total costs of primary total joint arthroplasty, as well as operating room cost, length of stay, 30-day mortality, and 30-day readmission. METHODS Open Payments data were matched across a 20% sample of Medicare-insured patients undergoing primary elective total hip arthroplasty (THA) (n = 130,872) performed by 7,539 surgeons or primary elective total knee arthroplasty (TKA) (n = 230,856) performed by 8,977 surgeons from 2013 to 2015. Patient, hospital, and surgeon-specific factors were gathered. Total and operating room costs, length of stay, mortality, and readmissions were recorded. Multivariable linear and logistic regression models were used to identify the risk-adjusted relationships between industry payments and the primary and secondary outcomes. RESULTS In this study, 96.7% of THA surgeons and 97.4% of TKA surgeons received industry payments. After multivariable risk adjustment, for each $1,000 increase in industry payments, the total costs of THA increased by $0.50 (0.003% of total costs) and the operating room costs of THA increased by $0.20 (0.003% of total costs). Industry payments were not associated with TKA cost. Industry payments were not associated with 30-day mortality after either THA or TKA. Higher industry payments were independently associated with a marginal decrease in the length of stay for patients undergoing THA (0.0045 days per $1,000) or TKA (0.0035 days per $1,000) and a <0.1% increase in the odds of 30-day readmission after THA for every $1,000 in industry payments. The median total THA costs were $300 higher (p < 0.001), whereas the median TKA costs were $150 lower (p < 0.001), for surgeons receiving the highest 5% of industry payments. These surgical procedures were more often performed in large urban areas, in hospitals with a higher number of beds, with a higher wage index, and by more experienced surgeons and were associated with a 0.4 to 1-day shorter length of stay (p < 0.001). CONCLUSIONS Although most arthroplasty surgeons received industry payments, a minority of surgeons received the majority of payments. Overall, arthroplasty costs and outcomes were not meaningfully impacted by industry relationships. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Harsh Wadhwa
- School of Medicine, Stanford University, Stanford, California
| | - Christopher Leung
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California
| | - Matthew Sklar
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California
| | - Karen Malacon
- School of Medicine, Stanford University, Stanford, California
| | - Taiyeb Rangwalla
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California
| | | | - Tiffany N Castillo
- Department of Orthopaedic Surgery, Santa Clara Valley Medical Center, San Jose, California
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California
| | - Derek F Amanatullah
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California
| | - Corinna C Zygourakis
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California
| |
Collapse
|
4
|
Malacon K, Beach I, Touponse G, Rangwalla T, Lee J, Zygourakis C. Trends in Management of Osteoporosis Following Primary Vertebral Compression Fracture. J Endocr Soc 2023; 7:bvad085. [PMID: 37388575 PMCID: PMC10306270 DOI: 10.1210/jendso/bvad085] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose Osteoporosis affects more than 200 million individuals worldwide and predisposes to vertebral compression fractures (VCFs). Given undertreatment of fragility fractures, including VCFs, we investigate current anti-osteoporotic medication prescribing trends. Methods Patients 50 and older with a diagnosis of primary closed thoracolumbar VCF between 2004 and 2019 were identified from the Clinformatics® Data Mart database. Multivariate analysis was performed for demographic and clinical treatment and outcome variables. Results Of 143 081 patients with primary VCFs, 16 780 (11.7%) were started on anti-osteoporotic medication within a year; 126 301 (88.3%) patients were not started on medication. The medication cohort was older (75.4 ± 9.3 vs 74.0 ± 12.3 years, P < .001), had higher Elixhauser Comorbidity Index scores (4.7 ± 6.2 vs 4.3 ± 6.7, P < .001), was more likely to be female (81.1% vs 64.4%, P < .001), and was more likely to have a formal osteoporosis diagnosis (47.8% vs 32.9%) than the group that did not receive medication. Alendronate (63.4%) and calcitonin (27.8%) were the most commonly initiated medications. The proportion of individuals receiving anti-osteoporotic medication within the year following VCF peaked in 2008 (15.2%), then declined until 2012 with a modest increase afterward. Conclusions Osteoporosis remains undertreated after low-energy VCFs. New anti-osteoporotic medication classes have been approved in recent years. Bisphosphonates remain the most prescribed class. Increasing recognition and treatment of osteoporosis is paramount to decreasing the risk of subsequent fractures.
Collapse
Affiliation(s)
- Karen Malacon
- School of Medicine, Stanford University Medical Center, Stanford, CA 94305, USA
| | - Isidora Beach
- Department of Neurosurgery, Larner College of Medicine at The University of Vermont, Burlington, VT 05405, USA
| | - Gavin Touponse
- School of Medicine, Stanford University Medical Center, Stanford, CA 94305, USA
| | - Taiyeb Rangwalla
- Department of Neurosurgery, Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA
| | - Jennifer Lee
- Department of Medicine, Stanford University Medical Center, Stanford, CA 94305, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Corinna Zygourakis
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA 94305, USA
| |
Collapse
|
5
|
Bilbo S, Smith C, Rendina D, Kingsbury M, Malacon K, Nguyen D, Tran J, Devlin B, Raju R, Clark M, Burgett L, Zhang J, Cetinbas M, Sadreyev R, Chen K, Iyer M. Microbial modulation prevents the effects of pervasive environmental stressors on microglia and social behavior, but not the dopamine system. Res Sq 2023:rs.3.rs-2548369. [PMID: 36798238 PMCID: PMC9934737 DOI: 10.21203/rs.3.rs-2548369/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Environmental toxicant exposure, including air pollution, is increasing worldwide. However, toxicant exposures are not equitably distributed. Rather, low-income and minority communities bear the greatest burden, along with higher levels of psychosocial stress. Both air pollution and maternal stress during pregnancy have been linked to neurodevelopmental disorders such as autism, but biological mechanisms and targets for therapeutic intervention remain poorly understood. We demonstrate that combined prenatal exposure to air pollution (diesel exhaust particles, DEP) and maternal stress (MS) in mice induces social behavior deficits only in male offspring, in line with the male bias in autism. These behavioral deficits are accompanied by changes in microglial morphology and gene expression as well as decreased dopamine receptor expression and dopaminergic fiber input in the nucleus accumbens (NAc). Importantly, the gut-brain axis has been implicated in ASD, and both microglia and the dopamine system are sensitive to the composition of the gut microbiome. In line with this, we find that the composition of the gut microbiome and the structure of the intestinal epithelium are significantly shifted in DEP/MS-exposed males. Excitingly, both the DEP/MS-induced social deficits and microglial alterations in males are prevented by shifting the gut microbiome at birth via a cross-fostering procedure. However, while social deficits in DEP/MS males can be reversed by chemogenetic activation of dopamine neurons in the ventral tegmental area, modulation of the gut microbiome does not impact dopamine endpoints. These findings demonstrate male-specific changes in the gut-brain axis following DEP/MS and suggest that the gut microbiome is an important modulator of both social behavior and microglia.
Collapse
|
6
|
Malacon K, Fatemi P, Zygourakis CC. First reported use of machine vision image guided system for unstable thoracolumbar fusion: Technical case report. Interdisciplinary Neurosurgery 2022. [DOI: 10.1016/j.inat.2022.101641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
7
|
Fernández-Castañeda A, Lu P, Geraghty AC, Song E, Lee MH, Wood J, O'Dea MR, Dutton S, Shamardani K, Nwangwu K, Mancusi R, Yalçın B, Taylor KR, Acosta-Alvarez L, Malacon K, Keough MB, Ni L, Woo PJ, Contreras-Esquivel D, Toland AMS, Gehlhausen JR, Klein J, Takahashi T, Silva J, Israelow B, Lucas C, Mao T, Peña-Hernández MA, Tabachnikova A, Homer RJ, Tabacof L, Tosto-Mancuso J, Breyman E, Kontorovich A, McCarthy D, Quezado M, Vogel H, Hefti MM, Perl DP, Liddelow S, Folkerth R, Putrino D, Nath A, Iwasaki A, Monje M. Mild respiratory COVID can cause multi-lineage neural cell and myelin dysregulation. Cell 2022; 185:2452-2468.e16. [PMID: 35768006 PMCID: PMC9189143 DOI: 10.1016/j.cell.2022.06.008] [Citation(s) in RCA: 184] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/04/2022] [Accepted: 06/07/2022] [Indexed: 12/13/2022]
Abstract
COVID survivors frequently experience lingering neurological symptoms that resemble cancer-therapy-related cognitive impairment, a syndrome for which white matter microglial reactivity and consequent neural dysregulation is central. Here, we explored the neurobiological effects of respiratory SARS-CoV-2 infection and found white-matter-selective microglial reactivity in mice and humans. Following mild respiratory COVID in mice, persistently impaired hippocampal neurogenesis, decreased oligodendrocytes, and myelin loss were evident together with elevated CSF cytokines/chemokines including CCL11. Systemic CCL11 administration specifically caused hippocampal microglial reactivity and impaired neurogenesis. Concordantly, humans with lasting cognitive symptoms post-COVID exhibit elevated CCL11 levels. Compared with SARS-CoV-2, mild respiratory influenza in mice caused similar patterns of white-matter-selective microglial reactivity, oligodendrocyte loss, impaired neurogenesis, and elevated CCL11 at early time points, but after influenza, only elevated CCL11 and hippocampal pathology persisted. These findings illustrate similar neuropathophysiology after cancer therapy and respiratory SARS-CoV-2 infection which may contribute to cognitive impairment following even mild COVID.
Collapse
Affiliation(s)
| | - Peiwen Lu
- Department of Immunobiology, Yale University, New Haven, CT, USA
| | - Anna C Geraghty
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Eric Song
- Department of Immunobiology, Yale University, New Haven, CT, USA
| | - Myoung-Hwa Lee
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Jamie Wood
- Abilities Research Center, Department of Rehabilitation and Human Performance, Mount Sinai School of Medicine, New York, NY, USA
| | - Michael R O'Dea
- Neuroscience Institute, NYU Grossman School of Medicine, New York, NY, USA
| | - Selena Dutton
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Kiarash Shamardani
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Kamsi Nwangwu
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Rebecca Mancusi
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Belgin Yalçın
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Kathryn R Taylor
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Lehi Acosta-Alvarez
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Karen Malacon
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Michael B Keough
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Lijun Ni
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Pamelyn J Woo
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | | | | | | | - Jon Klein
- Department of Immunobiology, Yale University, New Haven, CT, USA
| | | | - Julio Silva
- Department of Immunobiology, Yale University, New Haven, CT, USA
| | | | - Carolina Lucas
- Department of Immunobiology, Yale University, New Haven, CT, USA
| | - Tianyang Mao
- Department of Immunobiology, Yale University, New Haven, CT, USA
| | | | | | - Robert J Homer
- Department of Pathology, Yale University, New Haven, CT, USA
| | - Laura Tabacof
- Abilities Research Center, Department of Rehabilitation and Human Performance, Mount Sinai School of Medicine, New York, NY, USA
| | - Jenna Tosto-Mancuso
- Abilities Research Center, Department of Rehabilitation and Human Performance, Mount Sinai School of Medicine, New York, NY, USA
| | - Erica Breyman
- Abilities Research Center, Department of Rehabilitation and Human Performance, Mount Sinai School of Medicine, New York, NY, USA
| | - Amy Kontorovich
- Cardiovascular Research Institute, Mount Sinai School of Medicine, New York, NY, USA
| | - Dayna McCarthy
- Abilities Research Center, Department of Rehabilitation and Human Performance, Mount Sinai School of Medicine, New York, NY, USA
| | | | - Hannes Vogel
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Marco M Hefti
- Department of Pathology, University of Iowa, Iowa City, IA, USA
| | - Daniel P Perl
- Department of Pathology, Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Shane Liddelow
- Neuroscience Institute, NYU Grossman School of Medicine, New York, NY, USA; Departments of Neuroscience & Physiology and of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA; Parekh Center for Interdisciplinary Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | | | - David Putrino
- Abilities Research Center, Department of Rehabilitation and Human Performance, Mount Sinai School of Medicine, New York, NY, USA
| | - Avindra Nath
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale University, New Haven, CT, USA; Howard Hughes Medical Institute, Yale University, New Haven, CT, USA.
| | - Michelle Monje
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA; Department of Pathology, Stanford University, Stanford, CA, USA; Howard Hughes Medical Institute, Stanford University, Stanford, CA, USA.
| |
Collapse
|
8
|
Wadhwa H, Malacon K, Medress ZA, Leung C, Sklar M, Zygourakis CC. First reported use of real-time intraoperative computed tomography angiography image registration using the Machine-vision Image Guided Surgery system: illustrative case. Journal of Neurosurgery: Case Lessons 2021; 1:CASE2125. [PMID: 35855470 PMCID: PMC9245760 DOI: 10.3171/case2125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/11/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Vertebral artery injury is a devastating potential complication of C1–2 posterior fusion. Intraoperative navigation can reduce the risk of neurovascular complications and improve screw placement accuracy. However, the use of intraoperative computed tomography (CT) increases radiation exposure and operative time, and it is unable to image vascular structures. The Machine-vision Image Guided Surgery (MvIGS) system uses optical topographic imaging and machine vision software to rapidly register using preoperative imaging. The authors presented the first report of intraoperative navigation with MvIGS registered using a preoperative CT angiogram (CTA) during C1–2 posterior fusion. OBSERVATIONS MvIGS can register in seconds, minimizing operative time with no additional radiation exposure. Furthermore, surgeons can better adjust for abnormal vertebral artery anatomy and increase procedure safety. LESSONS CTA-guided navigation generated a three-dimensional reconstruction of cervical spine anatomy that assisted surgeons during the procedure. Although further study is needed, the use of intraoperative MvIGS may reduce the risk of vertebral artery injury during C1–2 posterior fusion.
Collapse
|
9
|
Vogt K, Zimmerman DM, Schlichting M, Hernandez-Nunez L, Qin S, Malacon K, Rosbash M, Pehlevan C, Cardona A, Samuel ADT. Internal state configures olfactory behavior and early sensory processing in Drosophila larvae. Sci Adv 2021; 7:7/1/eabd6900. [PMID: 33523854 PMCID: PMC7775770 DOI: 10.1126/sciadv.abd6900] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/04/2020] [Indexed: 05/07/2023]
Abstract
Animals exhibit different behavioral responses to the same sensory cue depending on their internal state at a given moment. How and where in the brain are sensory inputs combined with state information to select an appropriate behavior? Here, we investigate how food deprivation affects olfactory behavior in Drosophila larvae. We find that certain odors repel well-fed animals but attract food-deprived animals and that feeding state flexibly alters neural processing in the first olfactory center, the antennal lobe. Hunger differentially modulates two output pathways required for opposing behavioral responses. Upon food deprivation, attraction-mediating uniglomerular projection neurons show elevated odor-evoked activity, whereas an aversion-mediating multiglomerular projection neuron receives odor-evoked inhibition. The switch between these two pathways is regulated by the lone serotonergic neuron in the antennal lobe, CSD. Our findings demonstrate how flexible behaviors can arise from state-dependent circuit dynamics in an early sensory processing center.
Collapse
Affiliation(s)
- Katrin Vogt
- Department of Physics, Harvard University, Cambridge, MA 02138, USA.
- Center for Brain Science, Harvard University, Cambridge, MA 02138, USA
| | - David M Zimmerman
- Department of Physics, Harvard University, Cambridge, MA 02138, USA
- Center for Brain Science, Harvard University, Cambridge, MA 02138, USA
- Harvard Graduate Program in Biophysics, Harvard University, Cambridge, MA 02138, USA
| | - Matthias Schlichting
- Department of Biology, Howard Hughes Medical Institute, Brandeis University, Waltham, MA 02454, USA
| | - Luis Hernandez-Nunez
- Department of Physics, Harvard University, Cambridge, MA 02138, USA
- Center for Brain Science, Harvard University, Cambridge, MA 02138, USA
- Center for Systems Biology, Harvard University, Cambridge, MA 02138, USA
| | - Shanshan Qin
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | - Karen Malacon
- Department of Physics, Harvard University, Cambridge, MA 02138, USA
- Center for Brain Science, Harvard University, Cambridge, MA 02138, USA
| | - Michael Rosbash
- Department of Biology, Howard Hughes Medical Institute, Brandeis University, Waltham, MA 02454, USA
| | - Cengiz Pehlevan
- Center for Brain Science, Harvard University, Cambridge, MA 02138, USA
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | - Albert Cardona
- Howard Hughes Medical Institute, Janelia Research Campus, Ashburn, VA 20147, USA
- Neurobiology Division, MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, UK
- Department of Physiology, Development, and Neuroscience, University of Cambridge, Cambridge CB2 3DY, UK
| | - Aravinthan D T Samuel
- Department of Physics, Harvard University, Cambridge, MA 02138, USA.
- Center for Brain Science, Harvard University, Cambridge, MA 02138, USA
| |
Collapse
|