Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease
Identifieur interne : 000C29 ( PascalFrancis/Checkpoint ); précédent : 000C28; suivant : 000C30Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease
Auteurs : R. E. Gross [Canada] ; W. J. Lombardi [Canada] ; A. E. Lang [Canada] ; J. Duff [Canada] ; W. D. Hutchison [Canada] ; J. A. Saint-Cyr [Canada] ; R. R. Tasker [Canada] ; A. M. Lozano [Canada]Source :
- Brain [ 0006-8950 ] ; 1999.
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- Pascal (Inist)
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Abstract
The purpose of this study was to examine the relationship between lesion location and clinical outcome following globus pallidus internus (GPi) pallidotomy for advanced Parkinson's disease. Thirty-three patients were prospectively studied with extensive neurological examinations before and at 6 and 12 months following microelectrode-guided pallidotomy. Lesion location was characterized using volumetric MRI. The position of lesions within the posteroventral region of the GPi was measured, from anteromedial to posterolateral along an axis parallel to the internal capsule. To relate lesion position to clinical outcome, hierarchical multiple regression analysis was used. The variance in outcome measures that was related to preoperative scores and lesion volume was first calculated, and then the remaining variance attributable to lesion location was determined. Lesion location along the anteromedial-to-posterolateral axis within the GPi influenced the variance in total score on the Unified Parkinson's Disease Rating Scale in the postoperative 'off' period, and in 'on' period dyskinesia scores. Within the posteroventral GPi, anteromedial lesions were associated with greater improvement in 'off' period contralateral rigidity and 'on' period dyskinesia, whereas more centrally located lesions correlated with better postoperative scores of contralateral akinesia and postural instability/gait disturbance. Improvement in contralateral tremor was weakly related to lesion location, being greater with posterolateral lesions. We conclude that improvement in specific motor signs in Parkinson's disease following pallidotomy is related to lesion position within the posteroventral GPi. These findings are consistent with the known segregated but parallel organization of specific motor circuits in the basal ganglia, and may explain the variability in clinical outcome after pallidotomy and therefore have important therapeutic implications.
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease</title><author><name sortKey="Gross, R E" sort="Gross, R E" uniqKey="Gross R" first="R. E." last="Gross">R. E. Gross</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Lombardi, W J" sort="Lombardi, W J" uniqKey="Lombardi W" first="W. J." last="Lombardi">W. J. 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Saint-Cyr</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Psychology, The Toronto Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion></affiliation><affiliation wicri:level="4"><inist:fA14 i1="05"><s1>Departments of Anatomy and Cell Biology and of Psychology, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>6 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Tasker, R R" sort="Tasker, R R" uniqKey="Tasker R" first="R. R." last="Tasker">R. R. Tasker</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Lozano, A M" sort="Lozano, A M" uniqKey="Lozano A" first="A. M." last="Lozano">A. M. Lozano</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">99-0167808</idno><date when="1999">1999</date><idno type="stanalyst">PASCAL 99-0167808 INIST</idno><idno type="RBID">Pascal:99-0167808</idno><idno type="wicri:Area/PascalFrancis/Corpus">000D80</idno><idno type="wicri:Area/PascalFrancis/Curation">001143</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000C29</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000C29</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease</title><author><name sortKey="Gross, R E" sort="Gross, R E" uniqKey="Gross R" first="R. E." last="Gross">R. E. Gross</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Lombardi, W J" sort="Lombardi, W J" uniqKey="Lombardi W" first="W. J." last="Lombardi">W. J. Lombardi</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Psychology, The Toronto Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Lang, A E" sort="Lang, A E" uniqKey="Lang A" first="A. E." last="Lang">A. E. Lang</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Movement Disorders Centre, The Toronto Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>3 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion></affiliation><affiliation wicri:level="4"><inist:fA14 i1="04"><s1>Department of Medicine, University of Toronto, Division of Neurology, The Toronto Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Duff, J" sort="Duff, J" uniqKey="Duff J" first="J." last="Duff">J. Duff</name><affiliation wicri:level="4"><inist:fA14 i1="04"><s1>Department of Medicine, University of Toronto, Division of Neurology, The Toronto Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Hutchison, W D" sort="Hutchison, W D" uniqKey="Hutchison W" first="W. D." last="Hutchison">W. D. Hutchison</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Saint Cyr, J A" sort="Saint Cyr, J A" uniqKey="Saint Cyr J" first="J. A." last="Saint-Cyr">J. A. Saint-Cyr</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Psychology, The Toronto Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion></affiliation><affiliation wicri:level="4"><inist:fA14 i1="05"><s1>Departments of Anatomy and Cell Biology and of Psychology, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>6 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Tasker, R R" sort="Tasker, R R" uniqKey="Tasker R" first="R. R." last="Tasker">R. R. Tasker</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Lozano, A M" sort="Lozano, A M" uniqKey="Lozano A" first="A. M." last="Lozano">A. M. Lozano</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Brain</title><title level="j" type="abbreviated">Brain</title><idno type="ISSN">0006-8950</idno><imprint><date when="1999">1999</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Brain</title><title level="j" type="abbreviated">Brain</title><idno type="ISSN">0006-8950</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Evolution</term><term>Human</term><term>Localization</term><term>Microelectrode</term><term>Nuclear magnetic resonance imaging</term><term>Pallidum</term><term>Parkinson disease</term><term>Section</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Parkinson maladie</term><term>Section</term><term>Microélectrode</term><term>Pallidum</term><term>Imagerie RMN</term><term>Localisation</term><term>Evolution</term><term>Homme</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The purpose of this study was to examine the relationship between lesion location and clinical outcome following globus pallidus internus (GPi) pallidotomy for advanced Parkinson's disease. Thirty-three patients were prospectively studied with extensive neurological examinations before and at 6 and 12 months following microelectrode-guided pallidotomy. Lesion location was characterized using volumetric MRI. The position of lesions within the posteroventral region of the GPi was measured, from anteromedial to posterolateral along an axis parallel to the internal capsule. To relate lesion position to clinical outcome, hierarchical multiple regression analysis was used. The variance in outcome measures that was related to preoperative scores and lesion volume was first calculated, and then the remaining variance attributable to lesion location was determined. Lesion location along the anteromedial-to-posterolateral axis within the GPi influenced the variance in total score on the Unified Parkinson's Disease Rating Scale in the postoperative 'off' period, and in 'on' period dyskinesia scores. Within the posteroventral GPi, anteromedial lesions were associated with greater improvement in 'off' period contralateral rigidity and 'on' period dyskinesia, whereas more centrally located lesions correlated with better postoperative scores of contralateral akinesia and postural instability/gait disturbance. Improvement in contralateral tremor was weakly related to lesion location, being greater with posterolateral lesions. We conclude that improvement in specific motor signs in Parkinson's disease following pallidotomy is related to lesion position within the posteroventral GPi. These findings are consistent with the known segregated but parallel organization of specific motor circuits in the basal ganglia, and may explain the variability in clinical outcome after pallidotomy and therefore have important therapeutic implications.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0006-8950</s0></fA01><fA03 i2="1"><s0>Brain</s0></fA03><fA05><s2>122</s2></fA05><fA06><s3>p.3</s3></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease</s1></fA08><fA11 i1="01" i2="1"><s1>GROSS (R. E.)</s1></fA11><fA11 i1="02" i2="1"><s1>LOMBARDI (W. J.)</s1></fA11><fA11 i1="03" i2="1"><s1>LANG (A. E.)</s1></fA11><fA11 i1="04" i2="1"><s1>DUFF (J.)</s1></fA11><fA11 i1="05" i2="1"><s1>HUTCHISON (W. D.)</s1></fA11><fA11 i1="06" i2="1"><s1>SAINT-CYR (J. A.)</s1></fA11><fA11 i1="07" i2="1"><s1>TASKER (R. R.)</s1></fA11><fA11 i1="08" i2="1"><s1>LOZANO (A. M.)</s1></fA11><fA14 i1="01"><s1>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></fA14><fA14 i1="02"><s1>Department of Psychology, The Toronto Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>6 aut.</sZ></fA14><fA14 i1="03"><s1>Movement Disorders Centre, The Toronto Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>3 aut.</sZ></fA14><fA14 i1="04"><s1>Department of Medicine, University of Toronto, Division of Neurology, The Toronto Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>3 aut.</sZ><sZ>4 aut.</sZ></fA14><fA14 i1="05"><s1>Departments of Anatomy and Cell Biology and of Psychology, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>6 aut.</sZ></fA14><fA20><s1>405-416</s1></fA20><fA21><s1>1999</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>998</s2><s5>354000074603980030</s5></fA43><fA44><s0>0000</s0><s1>© 1999 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>29 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>99-0167808</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Brain</s0></fA64><fA66 i1="01"><s0>GBR</s0></fA66><fC01 i1="01" l="ENG"><s0>The purpose of this study was to examine the relationship between lesion location and clinical outcome following globus pallidus internus (GPi) pallidotomy for advanced Parkinson's disease. Thirty-three patients were prospectively studied with extensive neurological examinations before and at 6 and 12 months following microelectrode-guided pallidotomy. Lesion location was characterized using volumetric MRI. The position of lesions within the posteroventral region of the GPi was measured, from anteromedial to posterolateral along an axis parallel to the internal capsule. To relate lesion position to clinical outcome, hierarchical multiple regression analysis was used. The variance in outcome measures that was related to preoperative scores and lesion volume was first calculated, and then the remaining variance attributable to lesion location was determined. Lesion location along the anteromedial-to-posterolateral axis within the GPi influenced the variance in total score on the Unified Parkinson's Disease Rating Scale in the postoperative 'off' period, and in 'on' period dyskinesia scores. Within the posteroventral GPi, anteromedial lesions were associated with greater improvement in 'off' period contralateral rigidity and 'on' period dyskinesia, whereas more centrally located lesions correlated with better postoperative scores of contralateral akinesia and postural instability/gait disturbance. Improvement in contralateral tremor was weakly related to lesion location, being greater with posterolateral lesions. We conclude that improvement in specific motor signs in Parkinson's disease following pallidotomy is related to lesion position within the posteroventral GPi. These findings are consistent with the known segregated but parallel organization of specific motor circuits in the basal ganglia, and may explain the variability in clinical outcome after pallidotomy and therefore have important therapeutic implications.</s0></fC01><fC02 i1="01" i2="X"><s0>002B17G</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Parkinson maladie</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Parkinson disease</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Parkinson enfermedad</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Section</s0><s5>04</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Section</s0><s5>04</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Sección</s0><s5>04</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Microélectrode</s0><s5>05</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Microelectrode</s0><s5>05</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Microeléctrodo</s0><s5>05</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Pallidum</s0><s5>06</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Pallidum</s0><s5>06</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Pallidum</s0><s5>06</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Imagerie RMN</s0><s5>07</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Nuclear magnetic resonance imaging</s0><s5>07</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Imageria RMN</s0><s5>07</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Localisation</s0><s5>16</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>Localization</s0><s5>16</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>Localización</s0><s5>16</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Evolution</s0><s5>17</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>Evolution</s0><s5>17</s5></fC03><fC03 i1="07" i2="X" l="SPA"><s0>Evolución</s0><s5>17</s5></fC03><fC03 i1="08" i2="X" l="FRE"><s0>Homme</s0><s5>20</s5></fC03><fC03 i1="08" i2="X" l="ENG"><s0>Human</s0><s5>20</s5></fC03><fC03 i1="08" i2="X" l="SPA"><s0>Hombre</s0><s5>20</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Système nerveux pathologie</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Nervous system diseases</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Sistema nervioso patología</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Système nerveux central pathologie</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Central nervous system disease</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Sistema nervosio central patología</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Encéphale pathologie</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Cerebral disorder</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Encéfalo patología</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Extrapyramidal syndrome</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Extrapyramidal syndrome</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Extrapiramidal síndrome</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="FRE"><s0>Maladie dégénérative</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="ENG"><s0>Degenerative disease</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="SPA"><s0>Enfermedad degenerativa</s0><s5>41</s5></fC07><fC07 i1="06" i2="X" l="FRE"><s0>Imagerie médicale</s0><s5>53</s5></fC07><fC07 i1="06" i2="X" l="ENG"><s0>Medical imagery</s0><s5>53</s5></fC07><fC07 i1="06" i2="X" l="SPA"><s0>Imageneria medical</s0><s5>53</s5></fC07><fN21><s1>102</s1></fN21></pA></standard></inist><affiliations><list><country><li>Canada</li></country><region><li>Ontario</li></region><settlement><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="Canada"><region name="Ontario"><name sortKey="Gross, R E" sort="Gross, R E" uniqKey="Gross R" first="R. E." last="Gross">R. E. Gross</name></region><name sortKey="Duff, J" sort="Duff, J" uniqKey="Duff J" first="J." last="Duff">J. Duff</name><name sortKey="Hutchison, W D" sort="Hutchison, W D" uniqKey="Hutchison W" first="W. D." last="Hutchison">W. D. Hutchison</name><name sortKey="Lang, A E" sort="Lang, A E" uniqKey="Lang A" first="A. E." last="Lang">A. E. Lang</name><name sortKey="Lang, A E" sort="Lang, A E" uniqKey="Lang A" first="A. E." last="Lang">A. E. Lang</name><name sortKey="Lombardi, W J" sort="Lombardi, W J" uniqKey="Lombardi W" first="W. J." last="Lombardi">W. J. Lombardi</name><name sortKey="Lozano, A M" sort="Lozano, A M" uniqKey="Lozano A" first="A. M." last="Lozano">A. M. Lozano</name><name sortKey="Saint Cyr, J A" sort="Saint Cyr, J A" uniqKey="Saint Cyr J" first="J. A." last="Saint-Cyr">J. A. Saint-Cyr</name><name sortKey="Saint Cyr, J A" sort="Saint Cyr, J A" uniqKey="Saint Cyr J" first="J. A." last="Saint-Cyr">J. A. 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