Hong Lei

Interests

Teaching

My major interest in teaching is to provide education and training to medical students and other trainees in integrating neurological knowledge, basic examination and decision making skills into patient care.

Research

My scientific interests include basic, translational and clinical research in movement disorders.

Courses

Scholarly Contributions

Chapters

• Lei, H., & Wang, M. (2015). Sleep Disorders and Neuroregulation. In Eye Diseases Associated with Sleep Disorders(pp 1-15). Hauppauge, NY: Nova Science.

Journals/Publications

• Neill, M., Fisher, J. M., Kay, M. D., Zhang, T., Sherman, S. J., Lei, H., Chou, Y. H., & Kuo, P. H. (2020). Multi-parametric optimization of dopamine transporter SPECT software quantification for diagnosis of parkinsonian syndromes.. The Journal of Nuclear Medicine, 61, 1557-1557.
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  1557 Objectives: Evaluate diagnostic accuracy of the parameters generated by a commercial quantification software for dopamine transporter (DaT) SPECT. Methods: Diagnosis of a Parkinsonian syndrome (PS) was determined by a neurologist after at least two years of clinical follow-up and knowing result of DaT scan. Iodine-123 ioflupane DaT SPECT scans were quantified using DaTQUANT (GE Healthcare), which quantifies and compares regions of interest in the striatum, reporting Specific Binding Ratio (SBR) and Z-score for right and left sides. The ROI corresponding to the most abnormal side and therefore lowest quantification value (Z-score) was selected. We then fit a series of logistic regression models to predict PS status using the multiple variables provided by the quantification software. Both single- and multi-predictor models were explored where one predictor was fixed as the best predictor from the single-predictor models, using a maximum of two additional predictors. Prediction accuracy, sensitivity, and specificity were evaluated using leave-one-out cross validation. One-sided 95% confidence intervals for accuracy were constructed as bootstrap case cross-validation percentile intervals with bias reduction (1). Results: A total of 129 DaTscans were included with 79 patients diagnosed with PS. Three single variables demonstrated the highest accuracy, 0.90, including whole putamen, anterior putamen, and posterior putamen. Using the same threshold, the anterior and posterior putamen also demonstrated the highest single parameter specificity of 0.88 while maintaining a sensitivity of 0.91. The entire putamen demonstrated a higher sensitivity, 0.94, but a lower specificity of 0.84. The threshold Z-scores were -1.9 for the posterior putamen, -1.4 for the anterior putamen, and -1.3 for the whole putamen. Based on our results and prior publications, the posterior putamen was selected for the construction of multi-parametric models (2-4). Six multi-parametric models produced the highest accuracy, 0.91. Three of these models demonstrated a higher sensitivity, 0.92, with a specificity of 0.88. Two models demonstrated a higher specificity, 0.94, but a lower sensitivity 0.89. The last model had sensitivity and specificity values of 0.91 and 0.90, respectively. The most sensitive model with the best accuracy as well as the narrowest confidence interval utilized the caudate, posterior putamen, and putamen asymmetry. The most specific model with the best accuracy as well as narrowest confidence interval utilized the posterior putamen, putamen asymmetry, and caudate asymmetry. The multi-parametric model with the highest overall sensitivity utilized the posterior putamen, caudate asymmetry, and the putamen to caudate ratio with accuracy, sensitivity, and specificity of 0.89, 0.96, and 0.78, respectively. CONCLUSION:The most accurate single variable predictors for a Parkinsonian syndrome are the anterior, posterior, and whole putamen with an accuracy of 0.90. A model incorporating the posterior putamen, caudate, and putamen asymmetry increases the accuracy to 0.91 with sensitivity of 0.92 and specificity of 0.88. A model incorporating the posterior putamen, putamen asymmetry, and caudate asymmetry attained the same accuracy (0.91) with higher specificity (0.94) but lower sensitivity (0.89). The multiparametric model with the highest sensitivity (0.96) included the posterior putamen, caudate asymmetry, and putamen to caudate ratio, but this significantly lowered the specificity (0.78).
• Lundeen, T., Covington, M., Krupinski, E., Avery, R., Lei, H., Sherman, S., & Kuo, P. (2019). Accuracy of Dopamine Transporter Imaging with I-123 Ioflupane in Hispanic and Non-Hispanic Patients. Journal of nuclear medicine technology.
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  Racial and ethnic disparities in the prevalence of neurodegenerative diseases exist. This study examines the agreement between gold standard diagnosis and visual assessment of dopamine transporter (DaT) imaging in Hispanic and non-Hispanic patients being evaluated for Parkinsonian syndromes (PS).
• Lei, H. (2018). Simple Patient Care Instructions Translate Best: Safety Guidelines for Physician Use of Google Translate. Journal of Clinical Outcomes Management.. Journal of Clinical Outcomes Management, 25(1).
• Lei, H., Toosizadeh, N., Schwenk, M., Sherman, S., Karp, S., Sternberg, E., & Najafi, B. (2016). A Pilot Clinical Trial to Objectively Assess the Efficacy of Electroacupuncture on Gait in Patients with Parkinson's Disease Using Body Worn Sensors. PloS one, 11(5), e0155613.
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  Gait disorder, a key contributor to fall and poor quality of life, represents a major therapeutic challenge in Parkinson's disease (PD). The efficacy of acupuncture for PD remains unclear, largely due to methodological flaws and lack of studies using objective outcome measures.
• Covington, M. F., Sherman, S., Lewis, D., Lei, H., Krupinski, E., & Kuo, P. H. (2015). Patient Survey on Satisfaction and Impact of 123I-Ioflupane Dopamine Transporter Imaging. PloS one, 10(7), e0134457.
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  Patients were surveyed to assess the impact of dopamine transporter imaging on diagnostic confidence, change in treatment plan, effect on medication compliance, and subjective well-being. Surveys were sent to 140 patients who completed dopamine transporter imaging an average of 18 months prior. Sixty-five surveys from patients (46%) were returned. Questions assessed patients' perceived impact of the imaging on their care. Increased diagnostic confidence following imaging was reported by 69% of patients. Changes to treatment plan from imaging were reported by 24% of patients. Overall satisfaction with the study and its impact was reported by 70% of patients. Dopamine transporter imaging increased diagnostic confidence among patients and overall patient satisfaction with the impact of imaging on clinical care was high.
• Toosizadeh, N., Lei, H., Schwenk, M., Sherman, S. J., Sternberg, E., Mohler, J., & Najafi, B. (2015). Does integrative medicine enhance balance in aging adults? Proof of concept for the benefit of electroacupuncture therapy in Parkinson's disease. Gerontology, 61(1), 3-14.
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  Postural balance and potentially fall risk increases among older adults living with neurological diseases, especially Parkinson's disease (PD). Since conventional therapies such as levodopa or deep brain stimulation may fail to alleviate or may even worsen balance, interest is growing in evaluating alternative PD therapies.
• Toosizadeh, N., Mohler, J., Lei, H., Parvaneh, S., Sherman, S., & Najafi, B. (2015). Motor Performance Assessment in Parkinson's Disease: Association between Objective In-Clinic, Objective In-Home, and Subjective/Semi-Objective Measures. PloS one, 10(4), e0124763.
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  Advances in wearable technology allow for the objective assessment of motor performance in both in-home and in-clinic environments and were used to explore motor impairments in Parkinson's disease (PD). The aims of this study were to: 1) assess differences between in-clinic and in-home gait speed, and sit-to-stand and stand-to-sit duration in PD patients (in comparison with healthy controls); and 2) determine the objective physical activity measures, including gait, postural balance, instrumented Timed-up-and-go (iTUG), and in-home spontaneous physical activity (SPA), with the highest correlation with subjective/semi-objective measures, including health survey, fall history (fallers vs. non-fallers), fear of falling, pain, Unified Parkinson's Disease Rating Scale, and PD stage (Hoehn and Yahr). Objective assessments of motor performance were made by measuring physical activities in the same sample of PD patients (n = 15, Age: 71.2±6.3 years) and age-matched healthy controls (n = 35, Age: 71.9±3.8 years). The association between in-clinic and in-home parameters, and between objective parameters and subjective/semi-objective evaluations in the PD group was assessed using linear regression-analysis of variance models and reported as Pearson correlations (R). Both in-home SPA and in-clinic assessments demonstrated strong discriminatory power in detecting impaired motor function in PD. However, mean effect size (0.94±0.37) for in-home measures was smaller compared to in-clinic assessments (1.30±0.34) for parameters that were significantly different between PD and healthy groups. No significant correlation was observed between identical in-clinic and in-home parameters in the PD group (R = 0.10-0.25; p>0.40), while the healthy showed stronger correlation in gait speed, sit-to-stand duration, and stand-to-sit duration (R = 0.36-0.56; p
• Kuo, P. H., Lei, H. H., Avery, R., Krupinski, E. A., Bauer, A., Sherman, S., McMillan, N., Seibyl, J., & Zubal, G. I. (2014). Evaluation of an Objective Striatal Analysis Program for Determining Laterality in Uptake of ¹²³I-Ioflupane SPECT Images: Comparison to Clinical Symptoms and to Visual Reads. Journal of nuclear medicine technology, 42(2), 105-8.
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  An automated objective striatal analysis (OSA) software program was applied to dopamine transporter (123)I-ioflupane images acquired on subjects with varying severities of parkinsonism. The striatal binding ratios (SBR) of the left and right putamina (relative to the occipital lobe) were computed, and the laterality of that measure was compared with clinical symptoms and visual reads. The objective over-read of OSA was evaluated as an aid in confirming the laterality of disease onset.
• Kuo, P. H., Avery, R., Krupinski, E., Lei, H., Bauer, A., Sherman, S., McMillan, N., Seibyl, J., & Zubal, G. (2013). Receiver-operating-characteristic analysis of an automated program for analyzing striatal uptake of 123I-ioflupane SPECT images: calibration using visual reads. Journal of nuclear medicine technology, 41(1), 26-31.
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  A fully automated objective striatal analysis (OSA) program that quantitates dopamine transporter uptake in subjects with suspected Parkinson's disease was applied to images from clinical (123)I-ioflupane studies. The striatal binding ratios or alternatively the specific binding ratio (SBR) of the lowest putamen uptake was computed, and receiver-operating-characteristic (ROC) analysis was applied to 94 subjects to determine the best discriminator using this quantitative method.
• Francis, B. A., Wang, M., Lei, H., Du, L. T., Minckler, D. S., Green, R. L., & Roland, C. (2005). Changes in axial length following trabeculectomy and glaucoma drainage device surgery. The British journal of ophthalmology, 89(1), 17-20.
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  This study examines the changes in axial length (AL) after trabeculectomy and glaucoma drainage device (GDD) surgery and enabled an equation to be derived allowing prediction of AL change after filtering surgery.
• Lei, H. (2003). Laser treatment in fellow eyes with large drusen: updated findings from a pilot randomized clinical trial. Ophthalmology, 110(5), 971-8.
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  To update the findings from the Choroidal Neovascularization Prevention Trial (CNVPT) with respect to resolution of drusen, incidence of choroidal neovascularization, and visual function.
• Lei, H., & Schuchard, R. A. (1997). Using two preferred retinal loci for different lighting conditions in patients with central scotomas. Investigative ophthalmology & visual science, 38(9), 1812-8.
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  Using a scanning laser ophthalmoscope, it was found that some patients with relative central scotomas reliably used two different preferred retinal loci (PRLs) at different stimulus illuminances. This article describes adaptations in a patient's PRL for fixation when dimming the stimulus increased the relative scotoma size.

Presentations

• Lei, H. (2015, September 26-28). Taking a cosmetic approach to neurological disorders with facial Botulinum toxin injections. The 11th International Congress of Cosmetic Dermatology. China.

Poster Presentations

• Lei, H. (2018, Oct 5-9). Increased Risks of Botulinum Toxin Injection in Patients with Hypermobility Ehlers Danlos Syndrome: A Case Series. The International Congress of Parkinson’s Disease and Movement Disorders®. Hong Kong.
• Byreddy, S., Zahid, U., & Lei, H. (2017, June/Spring). Abnormal DaTscan in a case of Anoxic brain injury. the 21st International Congress of Parkinson’s Disease and Movement Disorders. Vancouver, BC, Canada.