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Weiss J, Beydoun MA, Beydoun HA, Georgescu MF, Hu YH, Noren Hooten N, Banerjee S, Launer LJ, Evans MK, Zonderman AB. Pathways explaining racial/ethnic and socio-economic disparities in brain white matter integrity outcomes in the UK Biobank study. SSM Popul Health 2024; 26:101655. [PMID: 38562403 PMCID: PMC10982559 DOI: 10.1016/j.ssmph.2024.101655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/14/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
Pathways explaining racial/ethnic and socio-economic status (SES) disparities in white matter integrity (WMI) reflecting brain health, remain underexplored, particularly in the UK population. We examined racial/ethnic and SES disparities in diffusion tensor brain magnetic resonance imaging (dMRI) markers, namely global and tract-specific mean fractional anisotropy (FA), and tested total, direct and indirect effects through lifestyle, health-related and cognition factors using a structural equations modeling approach among 36,184 UK Biobank participants aged 40-70 y at baseline assessment (47% men). Multiple linear regression models were conducted, testing independent associations of race/ethnicity, socio-economic and other downstream factors in relation to global mean FA, while stratifying by Alzheimer's Disease polygenic Risk Score (AD PRS) tertiles. Race (Non-White vs. White) and lower SES predicted poorer WMI (i.e. lower global mean FA) at follow-up, with racial/ethnic disparities in FAmean involving multiple pathways and SES playing a central role in those pathways. Mediational patterns differed across tract-specific FA outcomes, with SES-FAmean total effect being partially mediated (41% of total effect = indirect effect). Furthermore, the association of poor cognition with FAmean was markedly stronger in the two uppermost AD PRS tertiles compared to the lower tertile (T2 and T3: β±SE: -0.0009 ± 0.0001 vs. T1: β±SE: -0.0005 ± 0.0001, P < 0.001), independently of potentially confounding factors. Race and lower SES were generally important determinants of adverse WMI outcomes, with partial mediation of socio-economic disparities in global mean FA through lifestyle, health-related and cognition factors. The association of poor cognition with lower global mean FA was stronger at higher AD polygenic risk.
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Affiliation(s)
- Jordan Weiss
- Stanford Center on Longevity, Stanford University, Stanford, CA, USA
| | - May A. Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, USA
| | - Hind A. Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, USA
| | - Michael F. Georgescu
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, USA
| | - Yi-Han Hu
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, USA
| | - Nicole Noren Hooten
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, USA
| | - Sri Banerjee
- Public Health Doctoral Programs, Walden University, Minneapolis, MN, USA
| | - Lenore J. Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, USA
| | - Michele K. Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, USA
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, USA
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Pozzi FE, Remoli G, Tremolizzo L, Appollonio I, Ferrarese C, Cuffaro L. Brain Health and Cognition in Older Adults: Roadmap and Milestones towards the Implementation of Preventive Strategies. Brain Sci 2024; 14:55. [PMID: 38248270 PMCID: PMC10813413 DOI: 10.3390/brainsci14010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
In this narrative review, we delve into the evolving concept of brain health, as recognized by the WHO, focusing on its intersection with cognitive decline. We emphasize the imperative need for preventive strategies, particularly in older adults. We describe the target population that might benefit the most from risk-based approaches-namely, people with subjective cognitive decline. Additionally, we consider universal prevention in cognitively unimpaired middle-aged and older adults. Delving into multidomain personalized preventive strategies, we report on empirical evidence surrounding modifiable risk factors and interventions crucial in mitigating cognitive decline. Next, we highlight the emergence of brain health services (BHS). We explain their proposed role in risk assessment, risk communication, and tailored interventions to reduce the risk of dementia. Commenting on ongoing BHS pilot experiences, we present the inception and framework of our own BHS in Monza, Italy, outlining its operational structure and care pathways. We emphasize the need for global collaboration and intensified research efforts to address the intricate determinants of brain health and their potential impact on healthcare systems worldwide.
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Affiliation(s)
- Federico Emanuele Pozzi
- School of Medicine and Surgery, University of Milano-Bicocca, 20100 Milan, Italy; (G.R.); (L.T.); (I.A.); (C.F.); (L.C.)
- Neurology Department & Brain Health Service, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, 20126 Milan, Italy
| | - Giulia Remoli
- School of Medicine and Surgery, University of Milano-Bicocca, 20100 Milan, Italy; (G.R.); (L.T.); (I.A.); (C.F.); (L.C.)
- Neurology Department & Brain Health Service, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Lucio Tremolizzo
- School of Medicine and Surgery, University of Milano-Bicocca, 20100 Milan, Italy; (G.R.); (L.T.); (I.A.); (C.F.); (L.C.)
- Neurology Department & Brain Health Service, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, 20126 Milan, Italy
| | - Ildebrando Appollonio
- School of Medicine and Surgery, University of Milano-Bicocca, 20100 Milan, Italy; (G.R.); (L.T.); (I.A.); (C.F.); (L.C.)
- Neurology Department & Brain Health Service, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, 20126 Milan, Italy
| | - Carlo Ferrarese
- School of Medicine and Surgery, University of Milano-Bicocca, 20100 Milan, Italy; (G.R.); (L.T.); (I.A.); (C.F.); (L.C.)
- Neurology Department & Brain Health Service, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, 20126 Milan, Italy
| | - Luca Cuffaro
- School of Medicine and Surgery, University of Milano-Bicocca, 20100 Milan, Italy; (G.R.); (L.T.); (I.A.); (C.F.); (L.C.)
- Neurology Department & Brain Health Service, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, 20126 Milan, Italy
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Zhong X, Qiang Y, Wang L, Zhang Y, Li J, Feng J, Cheng W, Tan L, Yu J. Peripheral immunity and risk of incident brain disorders: a prospective cohort study of 161,968 participants. Transl Psychiatry 2023; 13:382. [PMID: 38071240 PMCID: PMC10710500 DOI: 10.1038/s41398-023-02683-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
Whether peripheral immunity prospectively influences brain health remains controversial. This study aims to investigate the longitudinal associations between peripheral immunity markers with incident brain disorders. A total of 161,968 eligible participants from the UK Biobank were included. We investigated the linear and non-linear effects of peripheral immunity markers including differential leukocytes counts, their derived ratios and C-reactive protein (CRP) on the risk of dementia, Parkinson's disease (PD), stroke, schizophrenia, bipolar affective disorder (BPAD), major depressive disorder (MDD) and anxiety, using Cox proportional hazard models and restricted cubic spline models. Linear regression models were used to explore potential mechanisms driven by brain structures. During a median follow-up of 9.66 years, 16,241 participants developed brain disorders. Individuals with elevated innate immunity markers including neutrophils, monocytes, platelets, neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) had an increased risk of brain disorders. Among these markers, neutrophils exhibited the most significant correlation with risk of dementia (hazard ratio 1.08, 95% confidence interval 1.04-1.12), stroke (HR 1.06, 95% CI 1.03-1.09), MDD (HR 1.13, 95% CI 1.10-1.16) and anxiety (HR 1.07, 95% CI 1.04-1.10). Subgroup analysis revealed age-specific and sex-specific associations between innate immunity markers with risk of dementia and MDD. Neuroimaging analysis highlighted the associations between peripheral immunity markers and alterations in multiple cortical, subcortical regions and white matter tracts, typically implicated in dementia and psychiatric disorders. These findings support the hypothesis that neuroinflammation is important to the etiology of various brain disorders, offering new insights into their potential therapeutic approaches.
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Affiliation(s)
- Xiaoling Zhong
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
- Department of Neurology, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao, China
| | - Yixuan Qiang
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological diseases, Shanghai, China
| | - Ling Wang
- Department of Neurology, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao, China
| | - Yaru Zhang
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological diseases, Shanghai, China
| | - Jieqiong Li
- Department of Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jianfeng Feng
- The Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Wei Cheng
- The Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
| | - Jintai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological diseases, Shanghai, China.
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Rivier CA, Szejko N, Renedo D, Noche RB, Acosta JN, Both CP, Sharma R, Torres-Lopez VM, Payabvash S, de Havenon A, Sheth KN, Gill TM, Falcone GJ. Polygenic Susceptibility to Hypertension and Cognitive Performance in Middle-aged Persons Without Stroke or Dementia. Neurology 2023; 101:e512-e521. [PMID: 37295956 PMCID: PMC10401683 DOI: 10.1212/wnl.0000000000207427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/04/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Mounting evidence indicates that hypertension leads to a higher risk of dementia. Hypertension is a highly heritable trait, and a higher polygenic susceptibility to hypertension (PSH) is known to associate with a higher risk of dementia. We tested the hypothesis that a higher PSH leads to worse cognitive performance in middle-aged persons without dementia. Confirming this hypothesis would support follow-up research focused on using hypertension-related genomic information to risk-stratify middle-aged adults before hypertension develops. METHODS We conducted a nested cross-sectional genetic study within the UK Biobank (UKB). Study participants with a history of dementia or stroke were excluded. We categorized participants as having low (≤20th percentile), intermediate, or high (≥80th percentile) PSH according to results of 2 polygenic risk scores for systolic and diastolic blood pressure (BP) generated with data on 732 genetic risk variants. A general cognitive ability score was calculated as the first component of an analysis that included the results of 5 cognitive tests. Primary analyses focused on Europeans, and secondary analyses included all race/ethnic groups. RESULTS Of the 502,422 participants enrolled in the UKB, 48,118 (9.6%) completed the cognitive evaluation, including 42,011 (8.4%) of European ancestry. Multivariable regression models using systolic BP-related genetic variants indicated that compared with study participants with a low PSH, those with intermediate and high PSH had reductions of 3.9% (β -0.039, SE 0.012) and 6.6% (β -0.066, SE 0.014), respectively, in their general cognitive ability score (p < 0.001). Secondary analyses including all race/ethnic groups and using diastolic BP-related genetic variants yielded similar results (p < 0.05 for all tests). Analyses evaluating each cognitive test separately indicated that reaction time, numeric memory, and fluid intelligence drove the association between PSH and general cognitive ability score (all individual tests, p < 0.05). DISCUSSION Among nondemented, community-dwelling, middle-aged Britons, a higher PSH is associated with worse cognitive performance. These findings suggest that genetic predisposition to hypertension influences brain health in persons who have not yet developed dementia. Because information on genetic risk variants for elevated BP is available long before the development of hypertension, these results lay the foundation for further research focused on using genomic data for the early identification of high-risk middle-aged adults.
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Affiliation(s)
- Cyprien A Rivier
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT.
| | - Natalia Szejko
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Daniela Renedo
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Rommell B Noche
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Julian N Acosta
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Cameron P Both
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Richa Sharma
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Victor M Torres-Lopez
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Sam Payabvash
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Adam de Havenon
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Kevin N Sheth
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Thomas M Gill
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Guido J Falcone
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
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