ASNR Young Professionals Newsletter Winter 2023
Pearls from the Pros -- Tina Young Poussaint, MD, FACR

In the latest installment of “Pearls from the Pros,” Dr. Asha Sarma interviews Dr. Tina Young Poussaint, first past president of the ASNR. She is the Lionel W. Young Chair in Radiology, Director of Neuro-oncologic Imaging, Director of the Pediatric Neuroradiology Fellowship, Chair of the Institutional Review Board, Director of the Neuroimaging Center of the Pediatric Brain Tumor Consortium, and Professor of Radiology at Boston Children’s Hospital, Harvard Medical School.

From the interview: "You may be asked to speak on a topic that is not your main area of interest, but it is still worthwhile if it is a great opportunity to get on the 'big stage.' For example, although my central career focus has been pediatric neuro-oncologic imaging, my first talk at ASNR was a general pediatric neuroradiology topic on imaging of patients with developmental delay." Read the full interview here.
Register Today for ASNR23

ASNR23 this April 29-May 3 in Chicago (or virtually) offers sessions and networking/mentoring opportunities specifically for young professionals. Don't wait to register: Early Bird rates end March 27, and members-in-training and junior members can attend for less than $500! Get all of the details and register now. 
ASNR's New Website Is Live

After a year-long project spearheaded by ASNR's Website and Social Media Committee, the new asnr.org is now live. The new site offers navigation options by career stage and practice area; an enhanced search bar to help you find what you need more easily; and a more robust section of YPC resources, including all past issues of this newsletter and Pearls from the Pros interviews. Now that the website redesign is complete, YPC members will take a deeper dive into additional resources and tools that can be added for members. Be sure to check the new site out now! 
Announcements and Important Dates 
ASSR Annual Meeting
February 8-12, 2023
Charleston, SC

ASNR 61st Annual Meeting and 2023 Foundation of the ASNR Symposium
April 29-May 3, 2023
Chicago, IL
Call for Late-Breaking Abstracts! Submit your late-breaking abstract by
February 28.

ENRS Annual Meeting
August 24-27, 2023
Isle of Palms, SC
ASHNR Annual Meeting
September 20-24, 2023
Orlando, FL

ASFNR Annual Meeting
October 6-9, 2023
Boston, MA

SENRS Annual Meeting
October 19-21, 2023
Hilton Head, SC

WNRS Annual Meeting
October 19-22, 2023
Scottsdale, AZ
Nominees Needed for ASNR-AMA Resident and Fellow Section (RFS) Representative

The ASNR is seeking nominees for the role of the ASNR-AMA Resident and Fellow Section (RFS) representative at the 2023 Annual Meeting of the AMA House of Delegates in Chicago, IL (June 10-14, 2023). The RFS representative will be reimbursed for travel costs including flight and hotel stay. Additionally, the RFS representative will be asked to provide a short summary of the meeting and highlight any key areas that ASNR should be informed about.

Please send CV of the nominee to Syed Naqvi, MD at syed.naqvi@usask.ca by February 20, 2023. Please let Syed Naqvi or Rahul Bhala (rbhala@asnr.org) know if you have any questions. 
Why You Need to Sleep: The Glymphatic System and Beyond
An ASNR–AAWR Collaboration
Mai-Lan Ho, MD
Professor of Radiology
The Ohio State University and Nationwide Children’s Hospital, Columbus, Ohio

Sleep: Everybody needs it, but few of us get enough of it, especially in medicine. No one knows the true function of sleep, though it has long been presumed necessary for physical and mental health. Between December 1963–January 1964, 17-year-old Randy Gardner set the world record by staying awake for 11 days and 24 minutes (264.4 hours). The Guinness Book of World Records later removed this category due to the health dangers of severe sleep loss, and Randy himself developed severe insomnia in his later years. Physician duty hour restrictions in North America date back to 1984, when college student Libby Zion died in the emergency department, likely of serotonin syndrome under the care of overworked residents and interns. There are numerous reports of video gamers who have died of exhaustion after days of continuous playing. In Japan, the word karoshi means “death from overwork” and is a common occupational hazard, with workers experiencing heart attacks and strokes due to prolonged lack of sleep, stress, and malnourishment. Multiple sleep disorders, such as sleep apnea, somnambulism, restless legs, and narcolepsy, are linked to disrupted neuropsychiatric function and systemic disease. The worst of these is fatal familial insomnia, an autosomal dominant genetic prion disease that causes rapidly worsening insomnia and neurologic decline beginning around 40–60 years of age and progressing to death within 6–36 months.
 
What really happens when we sleep? This is the stuff of dreams (and legends). Most organisms have a circadian rhythm or biological clock to regulate physical, mental, and behavioral changes over the daily 24-hour cycle. In animals, the amount and type of sleep varies greatly with age, species, brain and body size, diet, social status, and environment. Human sleep cycles rotate through non-rapid eye movement (NREM) and rapid eye movement (REM) stages every 90 minutes, with most dreams occurring in REM sleep. Each stage demonstrates characteristic changes in muscle tone, eye movements, brain wave patterns, and brain region activity that can be noninvasively monitored by electroencephalography (EEG), magnetoencephalography (MEG), or functional MRI (fMRI). Neuropsychological theories for the purpose of dreams include physical (cortical processing, synaptic pruning, memory consolidation); psychoanalytic (wish fulfillment, unconscious desires, conflicts); and cognitive (problem solving, data assimilation and reorganization). There are also many supernatural connotations to sleep. In ancient mythology, the god of sleep was known as Hypnos (Greek) or Somnus (Roman). Hypnos was thought to live in the Underworld with his twin brother Thánatos (Death), in the cave of Lethe (Forgetfulness) where night and day met. In the 19th–20th centuries, Edgar Cayce was an American clairvoyant known as “The Sleeping Prophet,” due to his mystical abilities to diagnose and treat medical ailments and predict the future while asleep. Accounts of spiritual experiences associated with sleep paralysis (tetraplegia outside of REM sleep) still abound in folklore around the world.
 
In 2012, the female Danish neuroscientist Maiken Nedergaard discovered the glymphatic system in mice, which she named after a combination of “glial” and “lymphatic.” I recently gave the keynote lecture at Utrecht Brain Conference and a symposium at ISMRM 2022 on this fascinating topic. We are still learning a great deal about neurofluid circulation and exchange, but it is evident that cerebrospinal fluid (CSF) dynamics are far more complex than originally thought. Outside the brain, leaky capillaries communicate with peripheral lymphatics, enabling nutrient delivery and waste clearance. Within the brain, capillaries are sealed by tight junctions that form the blood–brain barrier. Glial cells are responsible for modulating fluid exchange between the perivascular (Virchow-Robin) and interstitial fluid spaces, controlled by aquaporin-4 (AQP4) channels. The glymphatic system also communicates downstream with arachnoid granulations, meningeal lymphatics, and neurovascular sheaths to optimize brain homeostasis. Additional barrier systems serve to further regulate the ionic microenvironment and include the brain–CSF, blood–CSF, blood–ocular, blood–labyrinth, blood–spinal cord, and blood–nerve barriers.
 
There is impressive physiologic variation in glymphatic function with the cardiac cycle, respiration, vasodynamics, and neural activity. For example, Nedergaard reported that the extracellular volume enlarged by up to 60% in rats during sleep, with brain clearance more than doubling compared to the awake state. Sleep and lifestyle habits are theorized to help with brain health by ensuring adequate nutrition and housekeeping. In addition, various neurologic disorders (dementia, stroke, tumor, trauma, infection, inflammation) can result in the final common pathway of impaired glymphatic function or “glymphedema” with progressive waste accumulation and neuronal degeneration. Improved understanding of normal and abnormal neurofluid circulation could help us to better diagnose disease and develop more targeted interventions.
 
The glymphatic system is an exciting and active area of research, with over 1100 published papers in PubMed at the time of this writing (95% in the last 5 years). Of note, many earlier papers are flawed or limited by reliance on ex vivo anatomic dissections and/or invasive experiments in animal models. Radiology provides noninvasive in vivo human imaging with multiple techniques for assessing structure and function (high-resolution anatomic, diffusion, perfusion, functional, metabolic). So—get enough rest, and maybe you can help discover the deeper implications of why we sleep!
The Young Professionals Newsletter Committee
  • Jacqueline Junn, MD, Newsletter Chair
  • Manon Kappelhof, MD, PhD
  • Asha Sarma, MD 
  • Sasha Staack, MD 
  • Elizabeth Weidman, MD


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