Inferior Areas Research Articles

Swing Door Compressive Fracture Technique for Turbinoplasty: Retrospective Study Based on Computed Tomography and NOSE Scale.

Treatment of inferior turbinate hypertrophy is performed using different techniques in rhinoplasty. However, the reported results are not consistent. In this study, we aimed to evaluate the outcomes of Swing door compressive fracture (SDCF) technique for turbinoplasty using computed tomography (CT) and Nasal Obstruction Symptom Evaluation (NOSE) scale. This study involved retrospective analysis of 24 patients who underwent inferior turbinoplasty using Swing door compressive fracture (SDCF) technique with or without septoplasty. The angle between the inferior turbinate and lateral nasal wall, total area, inferior turbinate area and the area medial to inferior turbinate were measured preoperatively and postoperatively using coronal section CT images for objective evaluation. Moreover, the NOSE scale was used for subjective evaluation. The angle between inferior turbinate and lateral nasal wall was decreased by 25.3% after the treatment (p <0.0001). Inevitably, postoperative total nasal airway area (area 1) did not face a statistically significant change (p = 0.6878). On the other hand, the area of inferior turbinate (area 2) decreased significantly compared to preoperative value (p = 0.0021), while the area 3, the area medial to inferior turbinate was widened 1.5 times postoperatively. The total preoperative NOSE score was moderate (39.58 ± 22.31%) and it was decreased to mild (5.83 ± 8.81%) after the treatment (p <0.0001). The Swing door compressive fracture (SDCF) technique for turbinoplasty is an effective and straightforward modality. However, the further study involving more patients and longer follow-up period is mandatory. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Emotional regulation in non-suicidal self-injury – research on the use of transcranial direct current stimulation (tDCS)

IntroductionDSM-5 defines non-suicidal self-injury (NSSI) as socially unaccepted, direct, repeated and deliberate harm done to one’s own body. It is estimated that in a general population approximately 13-29% of adolescents present NSSI, and 70-80% among hospitalized youth. It seems that emotional dysregulation is the core characteristic of NSSI manifesting by self-harm behaviors, impulsiveness, lack of emotional awareness and experiencing high intensity of negative emotion. Emotional dysregulation is a pivotal characteristic of NSSI. Rationale of this theory is provided by the results of psychological and psychophysiological studies as well as those presenting brain activity. Neuroimaging data point to a variant pattern of brain activity of adolescents with NSSI during perception of emotionally negative stimuli i.e. hyperactivity in amygdala – a structure responsible for fear and automatic reaction to exciting stimuli and low activity of inferior frontal gyrus area – a structure responsible for inhibition and interpretation of social interactions. This activity pattern suggests a disorder of cortico-subcortical neuronal connections.ObjectivesThe aim was to verify tDCS as a therapeutic aid for patients who exhibit NSSI despite implementation of pharmacotherapy and psychotherapy.MethodsWe investigated the modulation effect of tDCS treatment at the right inferior frontal gyrus (rIFG) in hospitalized adolescents with NSSI.ResultsPreliminary tDCS stimulation results indicate potential usefulness of this method in regulating emotions and improving executive functions.ConclusionsPrefrontal cortex stimulation may restore balance in aforementioned connections and, as a result, positively influence an emotional regulation i.e. lower the impulsiveness, agitation and, by doing so, decrease NSSI frequency.DisclosureNo significant relationships.

Loneliness inside of the brain: evidence from a large dataset of resting-state fMRI in young adult

Although loneliness itself is a natural emotion, prolonged loneliness is detrimental to human health. Despite its detrimental effect, few loneliness-related neuroimaging studies have been published and some have limitations on the sample size number. This study aims to find the difference in resting-state functional connectivity associated with loneliness within a big sample size via the seed-based approach. Functional connectivity analysis was performed on a large cohort of young adults (N = 1336) using the seed-based functional connectivity approach to address the concern from previous studies. The analysis yielded statistically significant positive correlations between loneliness and functional connectivities between the inferior frontal gyrus and supplementary motor area, precentral gyrus, and superior parietal lobule. Additionally, the analysis replicated a finding from a previous study, which is increased functional connectivities between the inferior frontal gyrus and supplementary motor area. In conclusion, greater loneliness is reflected by stronger functional connectivity of the visual attention brain area.

Thickened Retinal Nerve Fiber Layers Associated With High-Altitude Headache.

Purpose: This study aimed to quantify the different quadrants of the optic nerve head (ONH) and macular parameters and their changes during exposure to high altitude, and to assess their correlation with high-altitude headache (HAH). Methods: Spectral-domain optical coherence tomography (OCT) was used to quantify changes in the retinal structure in 109 healthy subjects during acute exposure to high altitude (3,700 m). Self-reported symptoms of HAH and acute mountain sickness AMS were assessed using Lake Louise Score (LLS), alongside measurements of physiological parameters (oxygen saturation [SpO2], heart rate [HR], hemoglobin level [Hb], and red blood cell [RBC] count). Measurements were taken before and after exposure to the high-altitude environment. The correlations of these parameters and changes at ONH were examined. Results: With the exposure to high altitude, the incidence of AMS was 44.0% and the frequency of HAH was 67.0% (54.1% mild, 12.9% moderate-severe). As for systemic parameters measured at high altitude, the participants exhibited significantly lower SpO2, higher resting HR, higher Hb, and a higher RBC (all p < 0.05). Key stereometric parameters used to describe ONH [superior, inferior, nasal, temporal, and mean retinal nerve fiber layer (RNFL) thickness] and macula (macular thickness) increased at high altitude compared with baseline. Most parameters of ONH changed, especially superior, inferior, and mean RNFL thickness (p < 0.05). There was a significant correlation between the ratios of RNFL at ONH and HAH [mean thickness (r = 0.246, p = 0.01); inferior (r = 0.216, p = 0.02); nasal (r = 0.193, p = 0.04)]. No associations between parameters of ONH and AMS or LLS were observed. Conclusion: The high-altitude environment can increase RNFL thickness at ONH. Furthermore, we found that the ratios of mean thickness, inferior area, and nasal area correlated positively with HAH, which provides new insights for understanding of the underlying pathological mechanisms of high-altitude retinopathy (HAR).

The Evolution of Language‐Related Long Association Pathways: A Comparative Study Between Humans and Rhesus Macaques

The human brain stands out from other primates for its large size. After the split with our last common ancestor (LCA) with chimpanzees—our closest living relative—, the hominin brain expanded threefold, and the frontal and parietal operculum underwent substantial morphological reorganization, likely reflecting language acquisition in our species. The increase of brain size was not homogeneous: the inferior frontal and the parietal areas had a disproportionally large expansion while the occipital lobe retained its absolute size. These evolutionary changes are even more pronounced when human brains are compared to those of Old World monkeys. However, the amount of change in long association pathways within these highly modified regions is not well understood.This study aims to identify differences and similarities in homologous pathways of the human language network in the macaque brain. We hypothesize that language‐related pathways projecting to/from the inferior frontal and parietal areas will exhibit substantial reorganization in humans.Using state‐of‐the‐art, publicly available diffusion MRI data of a healthy (in vivo) adult human (MGH‐USC) [1] and 6 ex vivo rhesus macaque (Oxford University, PRIME‐DE) [2] brains, we reconstructed and virtually dissected in DSI Studio three association pathways: the arcuate fasciculus (AF), the frontal aslant tract (FAT), and the parietal‐projecting portion of the extreme capsule (pEmC). We show that the course and terminal projections of the FAT (inferior frontal and supplementary motor area) and the pEmC (superior parietal lobule and frontal cortical areas) are highly evolutionarily preserved in both species despite their crucial role in language in humans. In stark contrast, the AF underwent a major modification in its posterior segment, as previously reported.Our results suggest that evolutionary changes in the regional volumetric morphology of the brain do not necessarily imply similarly large changes in the relative volumes and trajectories of underlying white matter pathways. In addition, the current results suggest that the structural basis of human language functions already existed, at least to some extent, in the LCA with macaques. Functional and behavioral studies are needed to understand the role of this white matter network in both species.

Gunshot Fracture of the Mandible

A 51-year-old male was transferred to the hospital with a gunshot injury of the lower face. Three-dimensional scan of the multislice computed tomography (MSCT) revealed a severely comminuted fracture (Panel A: arrow) of the left mandibular body at the inferior margin area (what corresponds to the gunshot marginal mandible fracture diagnosis among 12 variants of gunshot mandibular fractures)1. Also, the implantation of multiple different shape radiopaque foreign bodies (arrowhead) was also visualized along with metal artifacts. A rotated coronal scan of the MSCT (Panel B) showed linear continuation (waved arrow) of the fracture to the ramus (visualized as incomplete fracture)2, partially splitting it into medial and lateral fragments. Although the incomplete fractures are more common for the pediatric jaw fractures, in this gunshot injury the MSCT data also indicates an incomplete fracture. In this particular case, it was a gunshot compound fracture (also known as open fracture) of the mandible. 3 Intermaxillary fixation (also known as maxilla-mandibular4 or maxillomandibular fixation5) was performed for 3 weeks without open intervention in the mandible margin area. Antibiotic therapy (Ceftriaxone 1.0 g 2 times daily applying intramuscular administration) was done during 7 days after trauma.

An evolutionary gap in primate default mode network organization

SUMMARYThe human default mode network (DMN) is engaged at rest and in cognitive states such as self-directed thoughts. Interconnected homologous cortical areas in primates constitute a network considered as the equivalent. Here, based on a cross-species comparison of the DMN between humans and non-hominoid primates (macaques, marmosets, and mouse lemurs), we report major dissimilarities in connectivity profiles. Most importantly, the medial prefrontal cortex (mPFC) of non-hominoid primates is poorly engaged with the posterior cingulate cortex (PCC), though strong correlated activity between the human PCC and the mPFC is a key feature of the human DMN. Instead, a fronto-temporal resting-state network involving the mPFC was detected consistently across non-hominoid primate species. These common functional features shared between non-hominoid primates but not with humans suggest a substantial gap in the organization of the primate’s DMN and its associated cognitive functions.

Longitudinal Changes in Structural Connectivity in Young People at High Genetic Risk for Bipolar Disorder.

Recent studies of patients with bipolar disorder or at high genetic risk reveal structural dysconnections among key brain networks supporting cognitive and affective processes. Understanding the longitudinal trajectories of these networks across the peak age range of bipolar disorder onset could inform mechanisms of illness onset or resilience. Longitudinal diffusion-weighted MRI and phenotypic data were acquired at baseline and after 2 years in 183 individuals ages 12-30 years in two cohorts: 97 unaffected individuals with a first-degree relative with bipolar disorder (the high-risk group) and 86 individuals with no family history of mental illness (the control group). Whole-brain structural networks were derived using tractography, and longitudinal changes in these networks were studied using network-based statistics and mixed linear models. Both groups showed widespread longitudinal changes, comprising both increases and decreases in structural connectivity, consistent with a shared neurodevelopmental process. On top of these shared changes, high-risk participants showed weakening of connectivity in a network encompassing the left inferior and middle frontal areas, left striatal and thalamic structures, the left fusiform, and right parietal and occipital regions. Connections among these regions strengthened in the control group, whereas they weakened in the high-risk group, shifting toward a cohort with established bipolar disorder. There was marginal evidence for even greater network weakening in those who had their first manic or hypomanic episode before follow-up. Neurodevelopment from adolescence into early adulthood is associated with a substantial reorganization of structural brain networks. Differences in these maturational processes occur in a multisystem network in individuals at high genetic risk of bipolar disorder. This may represent a novel candidate to understand resilience and predict conversion to bipolar disorder.

Microvascular Changes After Conbercept Intravitreal Injection of PDR With or Without Center-Involved Diabetic Macular Edema Analyzed by OCTA.

PurposeTo investigate the intravitreal injection of conbercept as a treatment strategy for proliferative diabetic retinopathy (PDR) with or without center-involved diabetic macular edema (CI-DME) and evaluate its effect on the microvascular changes in the eyes.MethodsIn this prospective study, 43 patients including 29 cases (56 eyes) in CI-DME with PDR patients, and 14 cases (26 eyes) in the non-center involving diabetic macular edema (NCI-DME) with PDR patients were involved in this study. The best corrected visual acuity (BCVA), central retinal thickness (CRT), foveolar avascular zone (FAZ), and macular capillary vessel density (VD) of the superficial retinal capillary plexus (SCP) and deep retinal capillary plexus (DCP) were assessed before and after conbercept treatments for 1, 3, or 6 months.ResultsThe BCVA was significantly increased after conbercept treatment in the eyes of CI-DME patients. After 6 months of treatment with the conbercept, microvascular density of the inferior area in SCP and the central fovea area in DCP increased significantly, regardless of the central fovea involvement. The effect of the conbercept treatment on the VD of NCI-DME was higher than that of CI-DME. Then, after 6 months of treatment, the CRT of patients with CI-DME and NCI-DME were decreased significantly.ConclusionsIn this study, an intravitreal injection of conbercept significantly improved vision, alleviated macular edema in patients with DME. Conbercept treatment also altered the microvascular density in the retina.

Automatized FACEmemory\xae scoring is related to Alzheimer\u2019s disease phenotype and biomarkers in early-onset mild cognitive impairment: the BIOFACE cohort

BackgroundFACEmemory® is the first computerized, self-administered verbal episodic memory test with voice recognition. It can be conducted under minimal supervision and contains an automatic scoring system to avoid administrator errors. Moreover, it is suitable for discriminating between cognitively healthy and amnestic mild cognitive impairment (MCI) individuals, and it is associated with Alzheimer’s disease (AD) cerebrospinal fluid (CSF) biomarkers. This study aimed to determine whether FACEmemory scoring is related to performance on classical memory tests and to AD biomarkers of brain magnetic resonance imaging (MRI) and CSF in patients with early-onset MCI (EOMCI).MethodsNinety-four patients with EOMCI from the BIOFACE study completed FACEmemory, classical memory tests (the Spanish version of the Word Free and Cued Selective Reminding Test -FCSRT-, the Word List from the Wechsler Memory Scale, third edition, and the Spanish version of the Rey–Osterrieth Complex Figure Test), and a brain MRI. Eighty-two individuals also underwent a lumbar puncture.ResultsFACEmemory scoring was moderately correlated with FCSRT scoring. With regard to neuroimaging MRI results, worse execution on FACEmemory was associated with lower cortical volume in the right prefrontal and inferior parietal areas, along with the left temporal and associative occipital areas. Moreover, the total FACEmemory score correlated with CSF AD biomarkers (Aβ1-42/Aβ1-40 ratio, p181-tau, and Aβ1-42/p181-tau ratio). When performance on FACEmemory was compared among the ATN classification groups, significant differences between the AD group and normal and SNAP groups were found.ConclusionsFACEmemory is a promising tool for detecting memory deficits sensitive to early-onset AD, but it also allows the detection of memory-impaired cases due to other etiologies. Our findings suggest that FACEmemory scoring can detect the AD endophenotype and that it is also associated with AD-related changes in MRI and CSF in patients with EOMCI. The computerized FACEmemory tool might be an opportunity to facilitate early detection of MCI in younger people than 65, who have a growing interest in new technologies.

Systems-Level Analysis of Genetic Variants Reveals Functional and Spatiotemporal Context in Treatment-resistant Schizophrenia.

Treatment-resistant schizophrenia (TRS) occurs in one-third of the patients, but the molecular determinants of poor antipsychotic response remain unclear. We compared genetic data of patients with TRS (n = 63) with non-TRS (n = 111) by polygenic risk scores (PRS) calculated by PRSice software using PGC2_SCZ (Psychiatric Genomics Consortium - Schizophrenia) data. TRS criteria followed the International Psychopharmacology Algorithm Project SCZ algorithm. Statistical clustering and functional enrichment analyses of genes harboring TRS-linked variants were performed. Individuals on the top three deciles of schizophrenia PRS distribution exhibited higher odds of being refractory to antipsychotics than those on the bottom three deciles. Clusters of interacting variant-harboring genes were identified among the association signals. They are upregulated in the dorsolateral prefrontal, orbitofrontal, temporal, and inferior parietal areas during adolescence and early adulthood. Similar gene modules were found using transcriptional data from the same brain regions in individuals with schizophrenia. Genes were enriched among markers of cortical interneurons and somatosensory pyramidal cells. Finally, the enrichment of the clustered genes in drug-response expression signatures revealed compounds that could be employed to identify novel antipsychotic targets. In conclusion, we identified variant-harboring genes that may predispose SCZ patients to poor antipsychotic response and found statistically enriched clusters which provided functional and spatiotemporal context for TRS, suggesting that genotypic variation may converge to biological alterations at the interplay between actin dynamics and synaptic organization.

Evaluation of a Simple Clinical Language Paradigm With Respect to Sensory Independency, Functional Asymmetry, and Effective Connectivity.

The present study replicates a known visual language paradigm, and extends it to a paradigm that is independent from the sensory modality of the stimuli and, hence, could be administered either visually or aurally, such that both patients with limited sight or hearing could be examined. The stimuli were simple sentences, but required the subject not only to understand the content of the sentence but also to formulate a response that had a semantic relation to the content of the presented sentence. Thereby, this paradigm does not only test perception of the stimuli, but also to some extend sentence and semantic processing, and covert speech production within one task. When the sensory base-line condition was subtracted, both the auditory and visual version of the paradigm demonstrated a broadly overlapping and asymmetric network, comprising distinct areas of the left posterior temporal lobe, left inferior frontal areas, left precentral gyrus, and supplementary motor area. The consistency of activations and their asymmetry was evaluated with a conjunction analysis, probability maps, and intraclass correlation coefficients (ICC). This underlying network was further analyzed with dynamic causal modeling (DCM) to explore whether not only the same brain areas were involved, but also the network structure and information flow were the same between the sensory modalities. In conclusion, the paradigm reliably activated the most central parts of the speech and language network with a great consistency across subjects, and independently of whether the stimuli were administered aurally or visually. However, there was individual variability in the degree of functional asymmetry between the two sensory conditions.

Three-Year Follow-Up of Posterior Corneal Elevation in Thin Corneas After Small Incision Lenticule Extraction.

PurposeTo evaluate the changes in posterior corneal elevation in thin corneas after small incision lenticule extraction (SMILE).MethodsIn this prospective study, 97 eyes of 97 patients undergoing SMILE were recruited. Eyes were categorized into the following groups based on the preoperative minimum central corneal thickness (CCT): group A (37 eyes, 480–499 μm), group B (30 eyes, 500–529 μm), and group C (30 eyes, 530–560 μm). The posterior corneal surface was measured with a Pentacam over a 3-year follow-up period. Changes in the posterior corneal elevation at the central point (PCE), thinnest point (PTE), and predetermined area were measured.ResultsNo iatrogenic keratectasia was observed during the follow-up period. The mean changes in PCE, PTE, and the inferior area in group A were 1.14 ± 3.40 μm, −0.11 ± 3.20 μm, and −0.26 ± 1.23 μm, respectively (P ≥ 0.125). Although statistically significant change in the central-4 mm area was noted, the value was quite small (0.98 ± 1.67 μm) and was not higher than that in the other two groups (P = 0.003). For all three groups, the elevation remained stable or showed a backward change in the central annulus, while there was a small forward displacement in the 6-mm optical zone. In group A, changes in elevation values yielded negative statistical correlations with residual bed thickness and CCT (P ≤ 0.006) (except for the inferior area, the 4-mm and 6-mm optical zone).ConclusionsWith a strict preoperative assessment, SMILE achieved good safety and efficacy in correcting myopia in thin corneas and enabled a stable posterior corneal surface over a 3-year follow-up period.SynopsisCareful preoperative assessment and suitable surgical design should be taken to ensure posterior corneal stability after SMILE in thin corneas.

Evaluation of the role of spectral-domain optical coherence tomography in the early detection of macular and ganglion cell complex thickness changes in patients with rheumatologic diseases taking hydroxychloroquine

BackgroundThe aim was to investigate the effects of hydroxychloroquine (HCQ) on macular and ganglion cell complex (GCC) thickness measured by spectral-domain optical coherence tomography (SD-OCT). MethodsA total of 145 patients were included in the study. Patients who had taken HCQ for at least 6 months formed group 1 (n:81), while 34 patients with rheumatologic diseases who did not receive HCQ therapy, and 30 healthy subjects formed groups 2 and 3. The patients in group 1 were divided into two subgroups one with more than 60 months of usage (A), and the other with less than 60 months (B). All patients underwent a complete ophthalmologic examination, as well as visual field (VF) testing, and the measurement of macular and GCC thickness with SD-OCT. ResultsThe mean duration of taking HCQ was 100.96±46.97 and 26.50±14.45 months and the total dose was 843.37±489.38 g and 208.63±135.01 g in groups 1A and 1B, respectively. Patients in group 1 had significantly worse VF scores than groups 2 and 3, but no difference was found between groups 1A and 1B. The SD-OCT macular thickness was thinner in the inner and outer nasal quadrants according to the ETDRS 9 sector chart in the patients using hydroxychloroquine, while the GCC in the group 1A patients was thinner in the superior, inferior areas and inferior inner nasal, inferior-superior outer temporal quadrants compared to the other groups (p < 0.05). ConclusionAssessment of regional macular and GCC changes by SD-OCT is a valuable tool for early detection of HCQ maculopathy.

Changes in inferior vena cava area represent a more sensitive metric than changes in filling pressures during experimental manipulation of intravascular volume and tone.

AimsRemote monitoring of pulmonary artery pressure has reduced heart failure (HF) hospitalizations in chronic HF as elevation of pulmonary artery pressure provides information that can guide treatment. The venous system is characterized by high capacitance, thus substantial increases in intravascular volume can occur before filling pressures increase. The inferior vena cava (IVC) is a highly compliant venous conduit and thus a candidate for early detection of change in intravascular volume. We aimed to compare IVC cross‐sectional area using a novel sensor with cardiac filling pressures during experimental manipulation of volume status, vascular tone, and cardiac function.Methods and resultsExperiments were conducted in sheep to manipulate volume status (colloid infusion), vascular tone (nitroglycerin infusion) and cardiac function (rapid cardiac pacing). A wireless implantable IVC sensor was validated ex‐vivo and in‐vivo, and then used to measure the cross‐sectional area of the IVC. Right‐ and left‐sided cardiac filling pressures were obtained via right heart catheterization. The IVC sensor provided highly accurate and precise measurements of cross‐sectional area in ex‐vivo and in‐vivo validation. IVC area changes were more sensitive than the corresponding changes in cardiac filling pressures during colloid infusion (p < 0.001), vasodilatation (p < 0.001) and cardiac dysfunction induced by rapid pacing (p ≤ 0.02).ConclusionsInferior vena cava area can be remotely and accurately measured in real time with a wireless implantable sensor. Changes in IVC area are more sensitive than corresponding changes in filling pressures following experimental volume loading and fluid redistribution. Additional research is warranted to understand if remote monitoring of the IVC may have advantages over pressure‐based monitors in HF.

Neural correlates of integration processes during dynamic face perception

Integrating the spatiotemporal information acquired from the highly dynamic world around us is essential to navigate, reason, and decide properly. Although this is particularly important in a face-to-face conversation, very little research to date has specifically examined the neural correlates of temporal integration in dynamic face perception. Here we present statistically robust observations regarding the brain activations measured via electroencephalography (EEG) that are specific to the temporal integration. To that end, we generate videos of neutral faces of individuals and non-face objects, modulate the contrast of the even and odd frames at two specific frequencies (f_1 and f_2) in an interlaced manner, and measure the steady-state visual evoked potential as participants view the videos. Then, we analyze the intermodulation components (IMs: (nf_1pm mf_2), a linear combination of the fundamentals with integer multipliers) that consequently reflect the nonlinear processing and indicate temporal integration by design. We show that electrodes around the medial temporal, inferior, and medial frontal areas respond strongly and selectively when viewing dynamic faces, which manifests the essential processes underlying our ability to perceive and understand our social world. The generation of IMs is only possible if even and odd frames are processed in succession and integrated temporally, therefore, the strong IMs in our frequency spectrum analysis show that the time between frames (1/60 s) is sufficient for temporal integration.

Miniseries 2-Septal and paraseptal accessory pathways-Part III: Mid-paraseptal accessory pathways-revisiting bypass tracts crossing the pyramidal space.

The mid-paraseptal region corresponds to the portion of the pyramidal space whose right atrial aspect is known as the triangle of Koch. The superior area of this mid-paraseptal region is also para-Hisian, and is close to the compact atrioventricular node and the His bundle. The inferior sector of the mid-paraseptal area is unrelated to the normal atrioventricular conduction pathways. It is, therefore, a safe zone in which, if necessary, to perform catheter ablation. The middle part of the mid-paraseptal zone may, however, in some patients, house components of the compact atrioventricular node. This suggests the need for adopting a prudent attitude when considering catheter ablation in this area. The inferior extensions of the atrioventricular node, which may represent the substrate for the slow atrioventricular nodal pathway, take their course through the middle, and even the inferior, sectors of the mid-paraseptal region. In this review, we contend that the middle and inferior areas of the mid-paraseptal region correspond to what, in the past, was labelled by most groups as the 'midseptal' zone. We describe the electrocardiographic patterns observed during pre-excitation and orthodromic reciprocating tachycardia in patients with pathways ablated in the middle or inferior sectors of the region. We discuss the modification of the ventriculo-atrial conduction times during tachycardia after the development of bundle branch block aberrancy. We conclude that the so-called 'intermediate septal' pathways, as described in the era of surgical ablation, were insufficiently characterized. They should not be considered the surrogate of the 'midseptal' pathways defined using endocardial catheter electrode mapping.

Imaging of Heart Type Fatty Acid Binding Protein Under Acute Reperfusion Ischemia Using Radio-labeled Antibody in Rat Heart Model.

Purpose: Heart-type fatty acid binding protein (H-FABP) is primary transporter of free fatty acid and plays an important role in myocardial metabolism, which is characterized by high specificity and rapid appearance under ischemic condition. The objective of this study was to clarify the usefulness of imaging study of targeting H-FABP appearance using radio-labeled antibody, and correlation with myocardial fatty acid metabolism and perfusion in acute reperfusion ischemia. Method: Wistar rats were allotted to sham-operated control group (sham; n=4), ischemia non-reperfused group (IG; n=5), and ischemia-reperfusion group (RG; n=5). Ligation of left coronary artery (LCA) was performed for IG and RG. 20 min of ischemia was followed by 60min of reperfusion for RG. 125I labeled anti H-FABP antibody (anti H-FABP), BMIPP and 99mTc-sestamibi (MIBI) was injected intravenously. Multi-tracer digital autoradiogram was performed using µ-imager®. The ratio of radioactivity in LCA related (culprit) area to the inferior (remote) area (target uptake ratio=TUR) was generated. Results: In sham group, no visually detectable accumulation was observed for the anti H-FABP image, and TURMIBI and TURBMIPP were equivalent to 1. In IG, TURMIBI and TURBMIPP were remarkably low (0.12±0.01, 0.24±0.07). In RG, TURMIBI was significantly lower (0.20±0.03, p<0.05 vs. other groups). However, TURBMIPP was significantly higher (2.78±1.28, p<0.05) compared to the sham and IG, whereas anti H-FABP showed markedly higher ratio in the reperfused area compared to the sham and IG (3.43±0.73 vs. 0.31±0.13 and 1.09±0.07 for IG and sham; p<0.05, and <0.01, respectively). Conclusion: Anti H-FABP accumulated specifically in reperfused area under acute ischemia, and it accorded to the area where fatty acid metabolism was activated. This study has shown the future potential for clinical application in vivo imaging of acute coronary syndrome.

Electroencephalography for Early Detection of Alzheimer's Disease in Subjective Cognitive Decline.

Early detection of subjective cognitive decline (SCD) due to Alzheimer's disease (AD) is important for clinical research and effective prevention and management. This study examined if quantitative electroencephalography (qEEG) could be used for early detection of AD in SCD. Participants with SCD from 6 dementia clinics in Korea were enrolled. 18F-florbetaben brain amyloid positron emission tomography (PET) was conducted for all the participants. qEEG was performed to measure power spectrum and source cortical activity. The present study included 95 participants aged over 65 years, including 26 amyloid PET (+) and 69 amyloid PET (-). In participants with amyloid PET (+), relative power at delta band was higher in frontal (p=0.025), parietal (p=0.005), and occipital (p=0.022) areas even after adjusting for age, sex, and education. Source activities of alpha 1 band were significantly decreased in the bilateral fusiform and inferior temporal areas, whereas those of delta band were increased in the bilateral cuneus, pericalcarine, lingual, lateral occipital, precuneus, posterior cingulate, and isthmus areas. There were increased connections between bilateral precuneus areas but decreased connections between left rostral middle frontal area and bilateral frontal poles at delta band in participants with amyloid PET (+) showed. At alpha 1 band, there were decreased connections between bilateral entorhinal areas after adjusting for covariates. SCD participants with amyloid PET (+) showed increased delta and decreased alpha 1 activity. qEEG is a potential means for predicting amyloid pathology in SCD. Further longitudinal studies are needed to confirm these findings.

The Impact of Different Lung Ultrasound Protocols in the Assessment of Lung Lesions in COVID-19 Patients: Is There an Ideal Lung Ultrasound Protocol?

BackgroundIn the past months, several lung ultrasonography (LUS) protocols have been proposed, mainly on previously validated schemes independent of coronavirus disease 2019 (COVID-19).ObjectivesThe main purpose of this study was to determine the impact and accuracy of different LUS protocols proposed in COVID-19.MethodsPatients were evaluated with a standard sequence of LUS scans in 72 intercostal spaces along 14 anatomic lines in the chest. A scoring system of LUS findings was reported and then analyzed separately according to each proposed LUS protocol zones. This score was then correlated to a validated Pulmonary Inflammation Index (PII) on chest Computed Tomography (CT).ResultsThirty-two patients were enrolled. The most frequent pattern was ground-glass opacities in the chest X-ray (53.1%), chest CT (59.1%) and subpleural or lobar consolidations (40.8%) in the posteroinferior areas (p < 0.001) on LUS. The Interclass Correlation Coefficient (ICC) was significantly correlated with almost every protocol analyzed except the 8-zone (p = 0.119) and the 10-zone protocol that only included one posterior point (p = 0.052). The highest ICC was obtained with a 12-zone protocol (ICC 0.500; p = 0.027) and decreased as more points were included.ConclusionsIn conclusion, our study results suggest that performing an ultrasound protocol with 12-zone scanning, including the superior and inferior areas of the anterior, lateral and posterior regions of the chest was consistent with higher ICC and higher degree of concordance with CT. We emphasize the need of a more standardization technique to further implement and develop this imaging modality in COVID-19.