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Pompoco CJ, Curtin K, Taylor S, Paulson C, Shumway C, Conley M, Barker DJ, Swiston C, Stagg B, Ritch R, Wirostko BM. Summary of Utah Project on Exfoliation Syndrome (UPEXS): using a large database to identify systemic comorbidities. BMJ Open Ophthalmol 2021; 6:e000803. [PMID: 34765740 PMCID: PMC8552159 DOI: 10.1136/bmjophth-2021-000803] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/07/2021] [Indexed: 01/15/2023] Open
Abstract
The purpose of the Utah Project on Exfoliation Syndrome (UPEXS) is to identify associations between exfoliation syndrome (XFS) and other diseases that share the commonality of abnormalities in elastin and Lysyl Oxidase-Like 1 gene regulation. The UPEXS is unique because it uses the Utah Population Database, which is linked to the Utah genealogy, that contains a compilation of large pedigrees of most families in the state of Utah that go back multiple generations (3 to ≥11). The health and medical records of these family members are linked to vital records and can be used effectively in studies focused on genetic disorders like XFS, where familial clustering of a disorder is a trend. There is increasing evidence that patients with XFS have a higher risk of certain systemic disorders that reflect the systemic tissue abnormalities of XFS. Epidemiological studies focused on patients with XFS have shown that there is an increased risk of these individuals developing other pathologies that have abnormalities in extracellular matrix metabolism and repair. UPEXS has focused on suspected comorbidities that involve abnormalities in elastin maintenance, a protein that plays a role in the makeup of the extracellular matrix. In this paper, the results from the analysis of chronic obstructive pulmonary disease, inguinal hernias, pelvic organ prolapse, obstructive sleep apnoea and atrial fibrillation are summarised along with the utility of using such a large dataset.
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Affiliation(s)
- Christian James Pompoco
- Department of Ophthalmology & Visual Science, University of Utah School of Medicine, John Moran Eye Center, Salt Lake City, Utah, USA
| | - Karen Curtin
- Department of Ophthalmology & Visual Science, University of Utah School of Medicine, John Moran Eye Center, Salt Lake City, Utah, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Samuel Taylor
- Department of Ophthalmology & Visual Science, University of Utah School of Medicine, John Moran Eye Center, Salt Lake City, Utah, USA
| | - Chase Paulson
- Department of Ophthalmology & Visual Science, University of Utah School of Medicine, John Moran Eye Center, Salt Lake City, Utah, USA
| | - Caleb Shumway
- Department of Ophthalmology, BronxCare Hospital Center, New York, New York, USA
| | - Matt Conley
- Department of Ophthalmology & Visual Science, University of Utah School of Medicine, John Moran Eye Center, Salt Lake City, Utah, USA
| | - D James Barker
- Department of Ophthalmology & Visual Science, University of Utah School of Medicine, John Moran Eye Center, Salt Lake City, Utah, USA
| | - Cole Swiston
- Department of Ophthalmology & Visual Science, University of Utah School of Medicine, John Moran Eye Center, Salt Lake City, Utah, USA
| | - Brian Stagg
- Department of Ophthalmology & Visual Science, University of Utah School of Medicine, John Moran Eye Center, Salt Lake City, Utah, USA
| | - Robert Ritch
- Einhorn Clinical Research, Department of New York Eye and Ear Infirmatory of Mount Sinai, New York, New York, USA
| | - Barbara M Wirostko
- Department of Ophthalmology & Visual Science, University of Utah School of Medicine, John Moran Eye Center, Salt Lake City, Utah, USA
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Ellis N, Werner L, Balendiran V, Shumway C, Jiang B, Mamalis N. Posterior capsule opacification prevention by an intraocular lens incorporating a micropatterned membrane on the posterior surface. J Cataract Refract Surg 2021; 46:102-107. [PMID: 32050239 DOI: 10.1016/j.jcrs.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
PURPOSE To evaluate posterior capsule opacification (PCO) with a new hydrophobic acrylic intraocular lens (IOL) featuring a new micropatterned membrane, in comparison with a commercially available 1-piece hydrophobic acrylic IOL. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. STUDY DESIGN Experimental study. METHODS Twelve New Zealand rabbits had bilateral phacoemulsification and implantation of a ClearSight unpatterned IOL (Group 1), a ClearSight Sharklet-patterned IOL (Group 2), or a control, commercially available IOL (Group 3) (8 IOLs in each group). Slit-lamp examination was performed weekly for 4 weeks. The rabbits were then killed humanely, and their globes enucleated. Capsular bag opacification was assessed from the Miyake-Apple view, and the eyes underwent histopathology. RESULTS The mean postmortem central PCO was 1.87 ± 1.35 in Group 1, 1.06 ± 1.23 in Group 2, and 3.14 ± 0.89 in Group 3. Peripheral PCO was 2.18 ± 1.36 in Group 1, 1.5 ± 1.03 in Group 2, and 3.57 ± 0.53 in Group 3. When comparing central and peripheral PCO between Groups 1 and 3, the difference was not statistically significant, but it was statistically significant between Groups 2 and 3 (P = .003 and P = .0003, t test with Bonferroni correction). CONCLUSIONS Unique discontinuous features comprising the micropattern allow for focal adhesions to be precisely guided and therefore controlling cell migration. The patterned membrane incorporated on the posterior surface of the IOL significantly reduced capsular bag opacification compared with a commercially available control IOL.
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Affiliation(s)
- Nathan Ellis
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA
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Shumway C, Curtin K, Taylor S, Sundar KM, Wirostko BM, Ritch R. Association between Obstructive Sleep Apnea and Exfoliation Syndrome: The Utah Project on Exfoliation Syndrome. Ophthalmol Glaucoma 2020; 4:260-267. [PMID: 33007491 DOI: 10.1016/j.ogla.2020.09.016] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Exfoliation syndrome (XFS), the most common recognizable cause of open-angle glaucoma worldwide, is a systemic disorder with genetic predisposition due to variations in lysyl oxidase-like 1 (LOXL1) function, leading to altered elastin matrices in ocular and systemic tissues. Obstructive sleep apnea (OSA) is a highly prevalent disorder also involving elastic tissue dysfunction and is associated with glaucoma. Because of the similarities between the disorders, we sought to uncover any relationship in the prevalence of these diagnoses. DESIGN Case-control, retrospective cohort study. PARTICIPANTS A cohort of 81 735 patients diagnosed with OSA at ages 50 to 90 years was identified from medical records from 1996 to 2017 in the Utah Population Database. Case subjects were matched to random controls on sex and birth year in a 4:1 ratio. METHODS International Classification of Diseases, Ninth Revision (ICD-9) codes or their Tenth Revision equivalent were used to define a diagnosis of OSA (ICD-9 327.23) and a diagnosis of XFS (ICD-9 365.52 and 366.11). Conditional logistic regression odds ratios (ORs) accounting for individual matching on sex and birth year were used to estimate the risk of XFS in patients with OSA. Models included adjustment for race, obesity, tobacco use, hypertension (HTN), atrial fibrillation (AF), and chronic obstructive pulmonary disease (COPD). MAIN OUTCOME MEASURE Whether patients with OSA have an increased risk of diagnosis of XFS compared with controls without OSA. RESULTS There was an increased risk of an XFS diagnosis in patients with OSA compared with non-OSA controls (OR, 1.27; 95% confidence interval [CI], 1.02-1.59; P = 0.03). In a stratification of patients by HTN diagnosis history, patients with OSA and HTN exhibited an increased risk of XFS compared with non-OSA controls with HTN (OR, 2.67; 95% CI, 2.06-3.46; P < 0.0001). CONCLUSIONS Patients with OSA may be at an increased risk of XFS compared with patients without OSA, particularly in patients with a history of HTN.
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Affiliation(s)
- Caleb Shumway
- Department of Ophthalmology and Visual Sciences, John Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Karen Curtin
- Department of Ophthalmology and Visual Sciences, John Moran Eye Center, University of Utah, Salt Lake City, Utah; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Sam Taylor
- Department of Ophthalmology and Visual Sciences, John Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Krishna M Sundar
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Barbara M Wirostko
- Department of Ophthalmology and Visual Sciences, John Moran Eye Center, University of Utah, Salt Lake City, Utah.
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
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Shumway C, Aggarwal S, Park ST, Wade M, Kedhar S. Complicated case of Mycobacterium abscessus conjunctivitis in Sjögren's syndrome. Am J Ophthalmol Case Rep 2020; 19:100765. [PMID: 32548334 PMCID: PMC7286968 DOI: 10.1016/j.ajoc.2020.100765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/11/2019] [Revised: 05/13/2020] [Accepted: 05/31/2020] [Indexed: 10/26/2022] Open
Abstract
Purpose To report a case of conjunctivitis due to Mycobacterium abscessus in the setting of keratoconjunctivitis sicca due to Sjögren's syndrome in the absence of other known risk factors such as surgery, trauma or immunosuppressive therapy. Observations A 61-year-old woman with a history of keratoconjunctivitis sicca secondary to Sjögren's syndrome presented with dryness, irritation, redness, and discharge in her left eye for 2 months. She was diagnosed with chronic conjunctivitis and began a regimen of moxifloxacin and an ocular ointment of dexamethasone, neomycin, and polymyxin with no improvement of symptoms. Concurrent cultures grew Mycobacterium abscessus and the patient began treatment with amikacin drops, oral clarithromycin and intravenous imipenem, followed by amikacin drops, oral clarithromycin, and oral clofazimine, but her course was complicated by a perforated corneal ulcer that required a corneal patch graft. The patient eventually recovered despite persistent colonization. Conclusions/importance We present a case of Mycobacterium abscessus conjunctivitis in a patient with keratoconjunctivitis sicca secondary to Sjögren's syndrome without previous history of surgery, trauma, or other known risk factors. Because of low suspicion and clinician awareness, ocular nontuberculous mycobacteria (NTM) infection may have a delayed diagnosis and treatment. Clinicians should consider NTM in the differential diagnosis in patients with autoimmune disease such as Sjögren's syndrome. Treatment may be lengthy, requiring topical and systemic antibiotics and is often complicated due to resistance.
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Affiliation(s)
- Caleb Shumway
- John A. Moran Eye Center, University of Utah, Salt Lake City, 84132, United States
| | - Sahil Aggarwal
- Gavin Herbert Eye Institute, University of California, Irvine, 92697, United States
| | - Steven T Park
- Division of Infectious Diseases, University of California, Irvine Medical Center, United States
| | - Matthew Wade
- Gavin Herbert Eye Institute, University of California, Irvine, 92697, United States
| | - Sanjay Kedhar
- Gavin Herbert Eye Institute, University of California, Irvine, 92697, United States
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Bhatter P, Cao L, Crochetiere A, Raefsky SM, Cuevas LR, Enendu K, Frisch EH, Shumway C, Gore C, Browne AW. Using a Macro Lens for Anterior Segment Imaging in Rural Panama. Telemed J E Health 2020; 26:1414-1418. [PMID: 32031913 DOI: 10.1089/tmj.2019.0152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/25/2022] Open
Abstract
Background: Visual impairment, specifically anterior segment pathology, presents a significant burden of disease in the world. Introduction: Inexpensive tools are necessary to improve eye health of residents in developing countries where care is difficult to access. Our study aimed at determining whether a $5 macro lens attached to a smartphone camera is an effective anterior segment imaging method for screening diseases. Materials and Methods: Fifty four (n = 54) patients had anterior segment imaging performed by using an Easy Macro lens and an iPhone. Imaging was performed at the Floating Doctors' mobile clinic sites in Panama. Images were sent back and graded by two board-certified ophthalmologists using a modified version of the FOTO-ED scale. Statistical analysis was performed by using a Wilcoxon signed-rank test to compare grades between the two imaging modalities. Results: There was no significant difference in overall clinical utility of images obtained by the iPhone versus Easy Macro lens. The iPhone was significantly superior in imaging of the lens and conjunctiva, whereas the Easy Macro lens was superior in regards to the anterior chamber, iris, and lens. Discussion: The imaging modality that best captures pathology is dependent on what part of the anterior segment is being examined. An imaging protocol with a pair of images, one from a smartphone and one from a macro lens, would have significant clinical utility. Conclusion: Our study demonstrates how minimally trained users can deliver effective eye screening via a telemedicine-based approach in a resource-deprived setting. Future directions would be to develop a telemedicine protocol and determine whether it improves clinically measurable outcomes in patients.
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Affiliation(s)
- Param Bhatter
- School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Louie Cao
- School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Austin Crochetiere
- School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Sophia M Raefsky
- School of Medicine, University of California, Irvine, Irvine, California, USA.,Insitute of Clinical and Translational Science, University of California, Irvine, Irvine, California, USA
| | - Laura R Cuevas
- School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Kaosoluchi Enendu
- School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Emily H Frisch
- School of Medicine, University of California, Irvine, Irvine, California, USA.,Insitute of Clinical and Translational Science, University of California, Irvine, Irvine, California, USA
| | - Caleb Shumway
- School of Medicine, University of California, Irvine, Irvine, California, USA.,John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Charlotte Gore
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California, USA
| | - Andrew W Browne
- Insitute of Clinical and Translational Science, University of California, Irvine, Irvine, California, USA.,Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California, USA.,Department of Biomedical Engineering, University of California, Irvine, Irvine, California, USA
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Shumway C, Ellis N, Heczko J, Jiang B, Werner L, Mamalis N. Evaluation of the capsular safety of a new hybrid phacoemulsification tip in a cadaver eye model. J Cataract Refract Surg 2019; 45:1660-1664. [PMID: 31585853 DOI: 10.1016/j.jcrs.2019.06.016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/17/2019] [Accepted: 06/21/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the use of a new hybrid phacoemulsification tip made with a high strength polymer overmold designed to prevent posterior capsule rupture (PCR) compared with a metal tip. SETTING John A. Moran Eye Center, University of Utah, USA. DESIGN Experimental study. METHODS This ex vivo crossover study compared a new phacoemulsification tip to a metal tip. After a preliminary experiment applying the tips to the posterior capsule with the bevel down, 10 phakic cadaver eyes were prepared using the Miyake-Apple technique, after which each tip was tested in a series. After lensectomy, the posterior capsule was subjected to direct contact from the tip with the bevel up. The vacuum limit was set to 150 mm Hg, and the aspiration flow rate to 30 cc/min, after which the torsional power was increased by increments of 5% up to a maximum amplitude of 60%. The primary endpoint was the torsional power required to produce PCR. RESULTS Vacuum alone did not cause PCR with either tip. All tests showed that a higher torsional power was required for PCR with the hybrid tip. With the bevel directed upward, the hybrid tip required higher torsional power before PCR than the metal tip (55% ± 10.0% [SD] versus 15% ± 4.1%, respectively) (P value < .001). This indicates that there is a lower likelihood for PCR with the hybrid tip. CONCLUSION The hybrid tip used in this study can be an effective means of preventing surgical complications such as PCR. This tip would be useful for experienced surgeons as well as for those who are in training.
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Affiliation(s)
- Caleb Shumway
- John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Nathan Ellis
- John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Joshua Heczko
- John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Bill Jiang
- John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Liliana Werner
- John A. Moran Eye Center, University of Utah, Salt Lake City, USA.
| | - Nick Mamalis
- John A. Moran Eye Center, University of Utah, Salt Lake City, USA
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Werner L, Wallace KJ, Balendiran V, Shumway C, Ellis N, Mamalis N. Surface deposits mimicking calcification on a hydrophobic acrylic intraocular lens. J Cataract Refract Surg 2019; 45:1036-1039. [DOI: 10.1016/j.jcrs.2019.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 11/15/2022]
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Miner B, Purdy A, Curtis L, Simonson K, Shumway C, Baker J, Vaughan J, Percival K, Sanchez O, Lahham S, Joseph L, Fox JC. Feasibility study of first-year medical students identifying cardiac anatomy using ultrasound in rural Panama. World J Emerg Med 2015; 6:191-5. [PMID: 26401179 DOI: 10.5847/wjem.j.1920-8642.2015.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 02/10/2015] [Accepted: 06/25/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are over 15 million children who have cardiac anomalies around the world, resulting in a significant morbidity and mortality. Early recognition and treatment can improve the outcomes and lengthen life-expectancy of these patients. The NIH and WHO have promoted guidelines for screening for congenital cardiac anomalies using ultrasound in rural environments. METHODS Our study took place in Bocas Del Toro, Panama where a mobile clinic was established for community healthcare screening and ultrasonographic evaluation by medical student volunteers and volunteer clinical faculty. This was a non-blinded, investigational study utilizing a convenience sample of pediatric patients presenting for voluntary evaluation. Seven first-year medical students were recruited for the study. These students underwent a training program for advanced cardiac ultrasound instruction, termed "Pediatric Echocardiography Cardiac Screening (PECS)". RESULTS Ten patients were enrolled in the study. Nine patients had adequate images as defined by the PECS criteria and were all classified as normal cardiac pathology by the medical students, resulting in a sensitivity and specificity of 100%. A single patient was identified by medical students as having a pathologic pulmonic stenosis. This was confirmed as correct by a blinded ultrasonographer. CONCLUSIONS In this pilot study, the first-year medical students were able to correctly identify pediatric cardiac anatomy and pathology in rural Panama after undergoing a 12-hour ultrasound PECS training session. We believe that with this knowledge, minimally trained practitioners can be used to screen for cardiac anomalies in rural Panama using ultrasound.
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Affiliation(s)
- Brianna Miner
- School of Medicine, University of California Irvine, Orange, CA 92868, USA
| | - Amanda Purdy
- School of Medicine, University of California Irvine, Orange, CA 92868, USA
| | - Laura Curtis
- School of Medicine, University of California Irvine, Orange, CA 92868, USA
| | - Kevin Simonson
- School of Medicine, University of California Irvine, Orange, CA 92868, USA
| | - Caleb Shumway
- School of Medicine, University of California Irvine, Orange, CA 92868, USA
| | - Jessa Baker
- School of Medicine, University of California Irvine, Orange, CA 92868, USA
| | - Jessica Vaughan
- School of Medicine, University of California Irvine, Orange, CA 92868, USA
| | - Kara Percival
- School of Medicine, University of California Irvine, Orange, CA 92868, USA
| | - Olivia Sanchez
- School of Medicine, University of California Irvine, Orange, CA 92868, USA
| | - Shadi Lahham
- Department of Emergency Medicine, University of California Irvine, Orange, CA 92868, USA
| | - Linda Joseph
- Department of Emergency Medicine, University of California Irvine, Orange, CA 92868, USA
| | - J Christian Fox
- Department of Emergency Medicine, University of California Irvine, Orange, CA 92868, USA
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Gonzalez L, Shumway C, Morissette J, Bower JM. Developmental plasticity in cerebellar tactile maps: fractured maps retain a fractured organization. J Comp Neurol 1993; 332:487-98. [PMID: 8349844 DOI: 10.1002/cne.903320408] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Plasticity following deafferentation has been repeatedly demonstrated in topographic sensory maps in the mammalian brain. In this paper we investigated the developmental plasticity of the fractured somatotopic map found in the tactile regions of the rat cerebellum. At various stages of postnatal development between postnatal days 1 and 30, we cauterized the infraorbital branch of the trigeminal nerve, which innervates the upper lip, furry buccal pad, and vibrissae that are represented within cerebellar folium crus IIa. The organization of the crus IIa map was then examined 2 to 3 months after denervation. We found that tactile receptive fields had reorganized throughout the denervated area but maintained a fractured somatotopy. Comparison of the reorganization in different animals showed that the denervated upper lip region was consistently and predominantly replaced by representation of the upper incisors. Analysis of evoked field potentials revealed an alteration, in denervated animals, of the response of the granule cell layer to brief tactile stimulation. This response in normal animals consists of two components at different latencies. Animals lesioned later in development were less likely to have the short latency component. This result suggests a difference in the developmental sensitivity of different cerebellum-related pathways to nerve lesions.
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Affiliation(s)
- L Gonzalez
- Computation and Neural Systems Program, California Institute of Technology, Pasadena 91125
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