Faculty Bibliography

What makes human brains distinctive? The answer is hidden at least partially in the myriad synaptic connections made between neurons - the connectome. The foveal retina is a primate specialization which presents a feasible site for deriving a complete connectome of a human CNS structure. In the fovea, cells and circuits are miniaturized and compressed to densely sample the visual image at highest resolution and initiate form, color and motion perception. Here we provide a draft connectome of all neurons in a human fovea. We found synaptic connections, distinct to humans, linking short-wavelength sensitive cones to color vision pathways. Moreover, by reconstructing excitatory synaptic pathways arising from cone photoreceptors we found that over 95% of foveal ganglion cells contribute to only three major pathways to the brain. Our study reveals unique features of a human neural system and opens a door to a complete foveal connectome.

OBJECTIVE:The purpose of this study is to review the current literature on the effect of hypovitaminosis D on voice. STUDY DESIGN/METHODS:Narrative review. METHODS:The literature search from electronic databases included PubMed/MEDLINE, EMBASE, SCOPUS, and Google Scholar. Search terms included voice, voice quality, voice disorders, larynx, laryngology, acoustic analysis, vitamin D, calcitriol, cholecalciferol, vitamin D deficiency, and vitamin D insufficiency. All studies on patients with vitamin D deficiency, which included subjective and objective voice assessments, were reviewed. RESULTS:A total of 39 studies were retrieved. Only four studies met the above-mentioned inclusion criteria and hence were included in this review. The total number of subjects analyzed was 466. The subjective voice outcome measures used were the Voice Handicap Index-10 (VHI-10), self-reported phonatory symptoms, and the GRBAS scale. Objective voice outcome measures included fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, maximum phonation time, and dysphonia severity index. CONCLUSION/CONCLUSIONS:Vitamin D deficiency has no significant effect on laryngeal muscles. There was no statistically significant difference in VHI-10 score, self-reported dysphonia, perceptual voice evaluation scores, or any of the acoustic measures between those with or without vitamin D deficiency.

BACKGROUND AND PURPOSE/OBJECTIVE:Na) MRI provides unique information about ionic homeostasis in the brain. However, in vivo quantification of regional brain sodium is highly challenging due to low SNR and limited spatial resolution. Here, we employ our novel anatomically guided reconstruction (AGR) method to overcome these challenges and enable precise quantification of regional brain total sodium concentration (TSC). MATERIALS AND METHODS/METHODS:< 0.05. RESULTS:. CONCLUSIONS:The AGR helps sodium quantification in healthy human brains by reducing the partial volume effect and variance of TSC in non-cortical brain regions. Our normative values of TSC in the brain regions set the stage to better understand derangements of sodium metabolism and homeostasis in neurological disease. ABBREVIATIONS/BACKGROUND:= sodium-potassium pump; PVC= partial volume correction; PVE= partial volume effect; TSC= total sodium concentration; VH= vitreous humor.

BACKGROUND:Patients undergoing plastic surgery often have higher rates of psychiatric disorders, which may influence surgical outcomes and quality of life (QoL). METHODS:A retrospective review of patients with and without psychiatric comorbidities who underwent reduction mammoplasty or body contouring (panniculectomy and/or abdominoplasty) from 2016 to 2022 was conducted. Propensity-score matching considered age, BMI, ethnicity, bariatric surgery history, ptosis, and breast tissue mass. Demographics, clinical characteristics, and postoperative outcomes were compared. QoL was assessed using pre- and postoperative BREAST-Q and BODY-Q. A literature review using PubMed, MEDLINE, Embase, Scopus, and COCHRANE databases was performed on surgical outcomes of patients with psychiatric disorders undergoing plastic surgery. RESULTS:Among 554 patients, 194 underwent body contouring (97 with and 97 without psychiatric diagnoses), and 360 had reduction mammoplasties (180 each). Body contouring patients averaged 46.7 years with a BMI of 31.2; psychiatric comorbidities were linked to increased surgical site occurrences (AOR 3.02) and longer hospital stays (AOR 1.73). Reduction mammoplasty patients averaged 36.3 years with a BMI of 29.7; psychiatric comorbidities predicted more readmissions and ED visits (AOR 4.86). Both groups showed improved postoperative QoL, regardless of psychiatric status. All 7 studies included in the literature review reported higher complication rates in patients with psychiatric diagnoses. CONCLUSIONS:Psychiatric comorbidities are associated with higher complication rates and healthcare utilization in plastic surgery. Nonetheless, these patients observe comparable postoperative QoL improvements, underscoring the benefit of these procedures. Appropriate pre- or post-operative interventions should be considered to optimize outcomes and satisfaction in this vulnerable patient population.

BACKGROUND:Alcohol Withdrawal Syndrome occurs in 1 in 43 hospitalized patients and is associated with increased morbidity. Pharmacotherapy for patients hospitalized with alcohol withdrawal syndrome are incompletely described. Understanding current practice patterns is essential to improving outcomes and addressing variability in care. OBJECTIVE:To identify alcohol withdrawal syndrome treatment practice patterns across United States hospitals. DESIGN/METHODS:Multicenter retrospective cohort study with data collected between quarter 1 of 2016 and quarter 3 of 2022 using Premier Incorporated Artificial Intelligence Healthcare Database (~ 25% of United States hospital admissions; excludes emergency room care). PARTICIPANTS/METHODS:A total of 245,271 adult inpatients with a primary diagnosis of alcohol withdrawal syndrome. MAIN MEASURES/METHODS:The outcomes were alcohol withdrawal syndrome medication treatment patterns, including initial treatment regimens, dosage trends, and factors associated with medication choice. KEY RESULTS/RESULTS:Among 245,271 patients with alcohol withdrawal syndrome, 226,816 [92.5%] received benzodiazepines, 28,123 (11.5%) phenobarbital, and 113,746 (46.4%) other AWS agents within the first five days of admission. The most common initial treatment regimens were benzodiazepines alone (56.0%), benzodiazepines and other agents together (22.2%), and benzodiazepines and phenobarbital together (3.8%). Median daily benzodiazepine dose (diazepam equivalents) peaked on hospital day 2 (46.2 [interquartile range 23.1-84.2] mg), whereas median daily phenobarbital dose peaked on hospital day 1 (260 [120-520] mg). Type of medication used was associated with level of care at admission, hospital facility, and United States geographical region. In adjusted analyses, the admission hospital was associated with phenobarbital use (median odds ratio 4.21 [95% confidence interval 4.03-4.40]), benzodiazepine use (median odds ratio 3.09 [2.96-3.23]) and other agents (median odds ratio 1.65 [1.62-1.67]). CONCLUSIONS:Alcohol withdrawal syndrome treatment varied by level of care at admission and hospital, highlighting significant variability in practice patterns. These findings inform future trials comparing the effectiveness of different medication regimens.

OBJECTIVE:To determine inter-reader reliability and diagnostic accuracy of MSKI-RADS among early-career radiologists with different experience levels. MATERIALS AND METHODS/METHODS:This is a retrospective multicenter study of MRIs of proven musculoskeletal (MSK) infections. MSKI-RADS categories included: 0-incomplete imaging, I-negative for infection, II-superficial soft tissue infection, III-deeper soft tissue infection, IV-possible osteomyelitis (OM), V-highly suggestive of OM, VI-known OM, and NOS-nonspecific bony lesions unrelated to infection. There were 22 readers from 9 institutions with 1-8 years of radiology experience, including radiology residents, MSK radiology clinical fellows, and junior MSK attendings. After initial training with expert readers, a dataset of 210 cases across a spectrum of extremity infections from a single institution was evaluated. The readers recorded the following for each case: MSKI-RADS score, final qualitative diagnosis, and confidence levels for both. Inter-reader agreements (ICC) and accuracy were obtained. RESULTS:Among 210 cases, there were 17 negative, 32 superficial soft tissue infections, 39 deeper soft tissue infections, 24 possible OM, 41 highly suggestive of OM, 18 known OM, and 39 NOS cases. A moderate inter-reader agreement was seen for 22 readers (ICC: 0.57 (CI = 0.52, 0.67)). The average true positive rates for non-infectious cases (I and NOS), soft tissue infection (II and III), and bony infection (IV and V) were 70% (95% CI: 67-73%), 66% (95% CI: 63-68%), and 82% (95% CI: 80-84%), respectively. Average true positive rates for classes V and VI were 80% (95% CI: 77-82%) and 86% (95% CI: 82-89%), respectively. Overall, MSKI-RADS reader accuracy was 66 ± 10%, higher than the qualitative diagnosis accuracy of 59 ± 11% (p < 0.05). Average confidence levels for MSKI-RADS score and final qualitative diagnosis were 3.56 ± 0.91 and 3.52 ± 0.92, respectively (p > 0.05). CONCLUSION/CONCLUSIONS:MSKI-RADS is an accurate and reliable MRI-based classification system for the diagnosis of a spectrum of musculoskeletal infections among early-career radiologists, like expert readers. KEY POINTS/CONCLUSIONS:Question What is the inter-reader reliability and diagnostic accuracy of the musculoskeletal infection reporting and data system (MSKI-RADS) among early-career radiologists with different experience levels? Findings Overall reader accuracy using MSKI-RADS was significantly higher than the accuracy for final qualitative diagnoses, like the results of the initial validation study with expert readers. Clinical relevance MSKI-RADS is valid and reliable for diagnosis and grading of a spectrum of extremity musculoskeletal infections for early career radiologists of different experience levels, like expert readers.

BACKGROUND:Outcome thresholds such as the minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) are commonly used to define meaningful clinical improvement. However, these measures apply uniform cutoffs that do not account for individual baseline scores. Maximal Possible Improvement (MPI) offers a patient-specific approach by considering the maximal potential gain in function or reduction in pain. The percentage of MPI (%MPI) that correlates with high postoperative patient satisfaction following the Latarjet procedure has not been defined. The purpose of this study was to (1) establish %MPI thresholds predictive of high patient satisfaction for the American Shoulder and Elbow Surgeons (ASES) score, and the Patient-Reported Outcomes Measurement Information System (PROMIS) domains of Upper Extremity Function (PUE), Pain Interference (P-Interference), and Pain Intensity (P-Intensity); and (2) identify patient-level factors associated with achieving these thresholds for ASES and PUE. METHODS:A retrospective review identified 81 eligible patients who underwent the Latarjet procedure with minimum 1-year follow-up. Preoperative and postoperative ASES, PUE, P-Interference, and P-Intensity scores, along with postoperative patient degree of satisfaction were recorded. Receiver operating characteristic curve analyses were performed to identify individual % MPI thresholds in each of the 4 scores that best predicted high satisfaction at minimum 1 year postoperatively. Univariate and multivariate logistic regression analyses were conducted sequentially to identify patient factors that were associated with achievement of the ASES and PUE thresholds. RESULTS:Among the 81 patients that met the inclusion criteria, the %MPI thresholds associated with high satisfaction were 65% for ASES (Area under the curve [AUC]: 0.86), 29% for PUE (AUC: 0.84), 57% for P-Interference (AUC: 0.78), and 59% for P-Intensity (AUC: 0.77). Higher body mass index (odds ratio [OR]: 1.16, p = 0.048) and surgery on the dominant arm (OR: 3.87, p = 0.024) were associated with higher odds of achieving the ASES threshold. Recurrent dislocations preoperatively (OR: 0.20, p = 0.022) were associated with lower odds of achieving the PUE threshold. CONCLUSION/CONCLUSIONS:The percentage of maximal possible improvement (%MPI) following the Latarjet procedure offers an individualized measure of clinical success and accounts for baseline variability and mitigates ceiling effects. Thresholds associated with high patient satisfaction following the Latarjet procedure were ≥65% for ASES, ≥29% for PUE, ≥57% for P-Interference, and ≥59% for P-Intensity.

PURPOSE/OBJECTIVE:To describe the multimodal imaging findings of the angular sign of Henle fiber layer (HFL) hyperreflectivity (ASHH) at baseline and follow-up in patients with contusion maculopathy. METHODS:Eleven eyes of ten patients were captured with multimodal imaging after non-penetrating ocular blunt trauma from a soccer ball, fist, or airsoft pellet. Baseline clinical and imaging characteristics and follow-up outcomes are presented. RESULTS:Hyper-reflective lesions extending along the HFL from the ellipsoid zone (EZ) to the outer plexiform layer consistent with ASHH were identified with optical coherence tomography (OCT). Mean presenting visual acuity (VA) was logMAR 0.59 ± 0.64 (Snellen VA 20/77, range 20/25 to counting fingers) and follow-up visual acuity was logMAR 0.43 ± 0.35 (Snellen VA 20/53, range 20/20 to 20/200). Additional OCT findings included external limiting membrane attenuation and retinal pigment epithelium (RPE) disruption. On follow-up, resolution of ASHH was accompanied by outer nuclear layer thinning with varying degrees of EZ attenuation and RPE loss. A macular hole was detected in one patient on follow-up. CONCLUSION/CONCLUSIONS:ASHH is a distinctive acute OCT feature of contusion maculopathy secondary to blunt injury, causing disruption of the photoreceptors and presumably anterograde alterations in the HFL. Associated RPE alterations may ensue, either acutely or delayed, and are a biomarker of persistent structural abnormalities and variable visual outcomes.