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<meta name="DC.Title" content="Evaluation of Encephaloduroarteriosynangiosis Efficacy Using Probabilistic Independent Component Analysis Applied to Dynamic Susceptibility Contrast Perfusion MRI" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5041" />
<meta name="DC.Date" content="2017-01-19" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2017 American Society of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Indirect cerebral revascularization has been successfully used for treatment in Moyamoya disease and symptomatic intracranial atherosclerosis. While angiographic neovascularization has been demonstrated after surgery, measurements of local tissue perfusion are scarce and may not reflect the reported successful clinical outcomes. We investigated probabilistic independent component analysis and conventional perfusion parameters from DSC-MR imaging to measure postsurgical changes in tissue perfusion.

MATERIALS AND METHODS: In this prospective study, 13 patients underwent unilateral indirect cerebral revascularization and DSC-MR imaging before and after surgery. Conventional perfusion parameters (relative cerebral blood volume, relative cerebral blood flow, and TTP) and probabilistic independent components that reflect the relative contributions of DSC signals consistent with arterial, capillary, and venous hemodynamics were calculated and examined for significant changes after surgery. Results were compared with postsurgical DSA studies to determine whether changes in tissue perfusion were due to postsurgical neovascularization.

RESULTS: Before surgery, tissue within the affected hemisphere demonstrated a high probability for hemodynamics consistent with venous flow and a low probability for hemodynamics consistent with arterial flow, whereas the contralateral control hemisphere demonstrated the reverse. Consistent with symptomatic improvement, the probability for venous hemodynamics within the affected hemisphere decreased with time after surgery ( P = .002). No other perfusion parameters demonstrated this association. Postsurgical DSA revealed an association between an increased preoperative venous probability in the symptomatic hemisphere and neovascularization after surgery.

CONCLUSIONS: Probabilistic independent component analysis yielded sensitive measurements of changes in local tissue perfusion that may be associated with newly formed vasculature after indirect cerebral revascularization surgery.

### Abbreviations

EDAS
:   encephaloduroarteriosynangiosis
ICA
:   independent component analysis
ICAS
:   intracranial atherosclerosis
MMD
:   Moyamoya disease
rCBF
:   relative cerebral blood flow
rCBV
:   relative cerebral blood volume" />
<meta name="DC.Contributor" content="A.N. Laiwalla" />
<meta name="DC.Contributor" content="F. Kurth" />
<meta name="DC.Contributor" content="K. Leu" />
<meta name="DC.Contributor" content="R. Liou" />
<meta name="DC.Contributor" content="J. Pamplona" />
<meta name="DC.Contributor" content="Y.C. Ooi" />
<meta name="DC.Contributor" content="N. Salamon" />
<meta name="DC.Contributor" content="B.M. Ellingson" />
<meta name="DC.Contributor" content="N.R. Gonzalez" />
<meta name="article:published_time" content="2017-01-19" />
<meta name="article:section" content="ADULT BRAIN" />
<meta name="citation_title" content="Evaluation of Encephaloduroarteriosynangiosis Efficacy Using Probabilistic Independent Component Analysis Applied to Dynamic Susceptibility Contrast Perfusion MRI" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Indirect cerebral revascularization has been successfully used for treatment in Moyamoya disease and symptomatic intracranial atherosclerosis. While angiographic neovascularization has been demonstrated after surgery, measurements of local tissue perfusion are scarce and may not reflect the reported successful clinical outcomes. We investigated probabilistic independent component analysis and conventional perfusion parameters from DSC-MR imaging to measure postsurgical changes in tissue perfusion.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;In this prospective study, 13 patients underwent unilateral indirect cerebral revascularization and DSC-MR imaging before and after surgery. Conventional perfusion parameters (relative cerebral blood volume, relative cerebral blood flow, and TTP) and probabilistic independent components that reflect the relative contributions of DSC signals consistent with arterial, capillary, and venous hemodynamics were calculated and examined for significant changes after surgery. Results were compared with postsurgical DSA studies to determine whether changes in tissue perfusion were due to postsurgical neovascularization.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Before surgery, tissue within the affected hemisphere demonstrated a high probability for hemodynamics consistent with venous flow and a low probability for hemodynamics consistent with arterial flow, whereas the contralateral control hemisphere demonstrated the reverse. Consistent with symptomatic improvement, the probability for venous hemodynamics within the affected hemisphere decreased with time after surgery (&lt;i&gt;P&lt;/i&gt; = .002). No other perfusion parameters demonstrated this association. Postsurgical DSA revealed an association between an increased preoperative venous probability in the symptomatic hemisphere and neovascularization after surgery.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Probabilistic independent component analysis yielded sensitive measurements of changes in local tissue perfusion that may be associated with newly formed vasculature after indirect cerebral revascularization surgery.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_publication_date" content="2017/01/19" />
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<meta name="citation_author" content="A.N. Laiwalla" />
<meta name="citation_author_institution" content="From the Departments of Neurosurgery (A.N.L., Y.C.O.) and Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California." />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0003-4580-1074" />
<meta name="citation_author" content="F. Kurth" />
<meta name="citation_author_institution" content="From the Departments of Neurosurgery (A.N.L., Y.C.O.) and Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California." />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0001-8662-1809" />
<meta name="citation_author" content="K. Leu" />
<meta name="citation_author_institution" content="From the Departments of Neurosurgery (A.N.L., Y.C.O.) and Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California." />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0002-0523-1575" />
<meta name="citation_author" content="R. Liou" />
<meta name="citation_author_institution" content="From the Departments of Neurosurgery (A.N.L., Y.C.O.) and Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California." />
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<meta name="citation_author" content="J. Pamplona" />
<meta name="citation_author_institution" content="From the Departments of Neurosurgery (A.N.L., Y.C.O.) and Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California." />
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<meta name="citation_author" content="Y.C. Ooi" />
<meta name="citation_author_institution" content="From the Departments of Neurosurgery (A.N.L., Y.C.O.) and Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California." />
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<meta name="citation_author" content="N. Salamon" />
<meta name="citation_author_institution" content="From the Departments of Neurosurgery (A.N.L., Y.C.O.) and Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California." />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0002-3520-9467" />
<meta name="citation_author" content="B.M. Ellingson" />
<meta name="citation_author_institution" content="From the Departments of Neurosurgery (A.N.L., Y.C.O.) and Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California." />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0002-2764-6640" />
<meta name="citation_author" content="N.R. Gonzalez" />
<meta name="citation_author_institution" content="From the Departments of Neurosurgery (A.N.L., Y.C.O.) and Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California." />
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<meta name="twitter:title" content="Evaluation of Encephaloduroarteriosynangiosis Efficacy Using Probabilistic Independent Component Analysis Applied to Dynamic Susceptibility Contrast Perfusion MRI" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Indirect cerebral revascularization has been successfully used for treatment in Moyamoya disease and symptomatic intracranial atherosclerosis. While angiographic neovascularization has been demonstrated after surgery, measurements of local tissue perfusion are scarce and may not reflect the reported successful clinical outcomes. We investigated probabilistic independent component analysis and conventional perfusion parameters from DSC-MR imaging to measure postsurgical changes in tissue perfusion.

MATERIALS AND METHODS: In this prospective study, 13 patients underwent unilateral indirect cerebral revascularization and DSC-MR imaging before and after surgery. Conventional perfusion parameters (relative cerebral blood volume, relative cerebral blood flow, and TTP) and probabilistic independent components that reflect the relative contributions of DSC signals consistent with arterial, capillary, and venous hemodynamics were calculated and examined for significant changes after surgery. Results were compared with postsurgical DSA studies to determine whether changes in tissue perfusion were due to postsurgical neovascularization.

RESULTS: Before surgery, tissue within the affected hemisphere demonstrated a high probability for hemodynamics consistent with venous flow and a low probability for hemodynamics consistent with arterial flow, whereas the contralateral control hemisphere demonstrated the reverse. Consistent with symptomatic improvement, the probability for venous hemodynamics within the affected hemisphere decreased with time after surgery ( P = .002). No other perfusion parameters demonstrated this association. Postsurgical DSA revealed an association between an increased preoperative venous probability in the symptomatic hemisphere and neovascularization after surgery.

CONCLUSIONS: Probabilistic independent component analysis yielded sensitive measurements of changes in local tissue perfusion that may be associated with newly formed vasculature after indirect cerebral revascularization surgery.

### Abbreviations

EDAS
:   encephaloduroarteriosynangiosis
ICA
:   independent component analysis
ICAS
:   intracranial atherosclerosis
MMD
:   Moyamoya disease
rCBF
:   relative cerebral blood flow
rCBV
:   relative cerebral blood volume" />
<meta name="og-title" property="og:title" content="Evaluation of Encephaloduroarteriosynangiosis Efficacy Using Probabilistic Independent Component Analysis Applied to Dynamic Susceptibility Contrast Perfusion MRI" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2017/01/19/ajnr.A5041" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Indirect cerebral revascularization has been successfully used for treatment in Moyamoya disease and symptomatic intracranial atherosclerosis. While angiographic neovascularization has been demonstrated after surgery, measurements of local tissue perfusion are scarce and may not reflect the reported successful clinical outcomes. We investigated probabilistic independent component analysis and conventional perfusion parameters from DSC-MR imaging to measure postsurgical changes in tissue perfusion.

MATERIALS AND METHODS: In this prospective study, 13 patients underwent unilateral indirect cerebral revascularization and DSC-MR imaging before and after surgery. Conventional perfusion parameters (relative cerebral blood volume, relative cerebral blood flow, and TTP) and probabilistic independent components that reflect the relative contributions of DSC signals consistent with arterial, capillary, and venous hemodynamics were calculated and examined for significant changes after surgery. Results were compared with postsurgical DSA studies to determine whether changes in tissue perfusion were due to postsurgical neovascularization.

RESULTS: Before surgery, tissue within the affected hemisphere demonstrated a high probability for hemodynamics consistent with venous flow and a low probability for hemodynamics consistent with arterial flow, whereas the contralateral control hemisphere demonstrated the reverse. Consistent with symptomatic improvement, the probability for venous hemodynamics within the affected hemisphere decreased with time after surgery ( P = .002). No other perfusion parameters demonstrated this association. Postsurgical DSA revealed an association between an increased preoperative venous probability in the symptomatic hemisphere and neovascularization after surgery.

CONCLUSIONS: Probabilistic independent component analysis yielded sensitive measurements of changes in local tissue perfusion that may be associated with newly formed vasculature after indirect cerebral revascularization surgery.

### Abbreviations

EDAS
:   encephaloduroarteriosynangiosis
ICA
:   independent component analysis
ICAS
:   intracranial atherosclerosis
MMD
:   Moyamoya disease
rCBF
:   relative cerebral blood flow
rCBV
:   relative cerebral blood volume" />
<meta name="og-type" property="og:type" content="article" />
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">A.N. Laiwalla</span>, <span class="highwire-citation-author" data-delta="1">F. Kurth</span>, <span class="highwire-citation-author" data-delta="2">K. Leu</span>, <span class="highwire-citation-author" data-delta="3">R. Liou</span>, <span class="highwire-citation-author" data-delta="4">J. Pamplona</span>, <span class="highwire-citation-author" data-delta="5">Y.C. Ooi</span>, <span class="highwire-citation-author" data-delta="6">N. Salamon</span>, <span class="highwire-citation-author" data-delta="7">B.M. Ellingson</span> and <span class="highwire-citation-author" data-delta="8">N.R. Gonzalez</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">January 2017,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5041 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-51878--61147830446" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">A.N. Laiwalla </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Neurosurgery (A.N.L., Y.C.O.) and Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.N.%2BLaiwalla%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Laiwalla%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.N.%2BLaiwalla%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-4580-1074" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.N. Laiwalla</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">F. Kurth </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Neurosurgery (A.N.L., Y.C.O.) and Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=F.%2BKurth%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kurth%20F&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AF.%2BKurth%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-8662-1809" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for F. 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Leu </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Neurosurgery (A.N.L., Y.C.O.) and Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=K.%2BLeu%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Leu%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AK.%2BLeu%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-0523-1575" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K. 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Liou </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Neurosurgery (A.N.L., Y.C.O.) and Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.%2BLiou%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Liou%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AR.%2BLiou%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-0370-9694" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R. 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Pamplona </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Neurosurgery (A.N.L., Y.C.O.) and Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BPamplona%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Pamplona%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BPamplona%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-6920-8297" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. 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Ooi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Neurosurgery (A.N.L., Y.C.O.) and Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Y.C.%2BOoi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ooi%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AY.C.%2BOoi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-8475-9484" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Y.C. 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