Posterior Lobe Research Articles

Depersonalization and derealization as sequelae of a temporal lobe lesion: a case report

BackgroundDepersonalization and derealization can occur not just from psychiatric causes but also from various organic etiologies, such as seizures and intracerebral structural abnormalities. However, there have been no previous reported cases to the authors’ knowledge detailing isolated depersonalization and derealization in the absence of clinical seizure activity or other psychiatric pathology, as sequelae of structural intracerebral lesions.Case presentationIn this case report, we detail the unique presentation of a 68-year-old woman under the care of palliative medicine who experienced depersonalization and derealization secondary to a metastatic lesion in her temporal lobe, in the parahippocampal gyrus to medial occipitotemporal gyrus region. These symptoms were present in the absence of any clinical seizure activity or other psychiatric symptomatology and largely resolved with the use of steroidal therapy, before returning secondary to disease progression.ConclusionsWe discuss the relationship among isolated depersonalization and derealization with pathology of the left posterior temporal lobe in the context of this interesting case. This case expands our knowledge of the neurobiology of these phenomena, given the specific localization of the intracerebral pathology and temporal specificity of symptoms relative to tumor growth and treatment course.

Supra- and infra-tentorial degeneration patterns in primary lateral sclerosis: a multimodal longitudinal neuroradiology study

BackgroundPrimary lateral sclerosis (PLS) is traditionally solely associated with progressive upper motor neuron dysfunction manifesting in limb spasticity, gait impairment, bulbar symptoms and pseudobulbar affect. Recent studies have described frontotemporal dysfunction in some patients resulting in cognitive manifestations. Cerebellar pathology is much less well characterised despite sporadic reports of cerebellar disease.MethodsA multi-timepoint, longitudinal neuroimaging study was conducted to characterise the evolution of both intra-cerebellar disease burden and cerebro-cerebellar connectivity. The volumes of deep cerebellar nuclei, cerebellar cortical volumes, cerebro-cerebellar structural and functional connectivity were assessed longitudinally in a cohort of 43 individuals with PLS.ResultsCerebello-frontal, -temporal, -parietal, -occipital and cerebello-thalamic structural disconnection was detected at baseline based on radial diffusivity (RD) and cerebello-frontal decoupling was also evident based on fractional anisotropy (FA) alterations. Functional connectivity changes were also detected in cerebello-frontal, parietal and occipital projections. Volume reductions were identified in the vermis, anterior lobe, posterior lobe, and crura. Among the deep cerebellar nuclei, the dorsal dentate was atrophic. Longitudinal follow-up did not capture statistically significant progressive changes. Significant primary motor cortex atrophy and inter-hemispheric transcallosal degeneration were also captured.ConclusionsPLS is not only associated with upper motor neuron dysfunction, but cerebellar cortical volume loss and deep cerebellar nuclear atrophy can also be readily detected. In addition to intra-cerebellar disease burden, cerebro-cerebellar connectivity alterations also take place. Our data add to the evolving evidence of widespread neurodegeneration in PLS beyond the primary motor regions. Cerebellar dysfunction in PLS is likely to exacerbate bulbar, gait and dexterity impairment and contribute to pseudobulbar affect.

Molecular basis underlying changes of brain entropy and functional connectivity in major depressive disorders after electroconvulsive therapy.

Electroconvulsive therapy (ECT) is widely used for treatment-resistant depression. However, it is unclear whether/how ECT can be targeted to affect brain regions and circuits in the brain to dynamically regulate mood and cognition. This study used brain entropy (BEN) to measure the irregular levels of brain systems in 46 major depressive disorder (MDD) patients before and after ECT treatment. Functional connectivity (FC) was further adopted to reveal changes of functional couplings. Moreover, transcriptomic and neurotransmitter receptor data were used to reveal genetic and molecular basis of the changes of BEN and functional connectivities. Compared to pretreatment, the BEN in the posterior cerebellar lobe (PCL) significantly decreased and FC between the PCL and the right temporal pole (TP) significantly increased in MDD patients after treatment. Moreover, we found that these changes of BEN and FC were closely associated with genes' expression profiles involved in MAPK signaling pathway, GABAergic synapse, and dopaminergic synapse and were significantly correlated with the receptor/transporter density of 5-HT, norepinephrine, glutamate, etc. CONCLUSION: These findings suggest that loops in the cerebellum and TP are crucial for ECT regulation of mood and cognition, which provides new evidence for the antidepressant effects of ECT and the potential molecular mechanism leading to cognitive impairment.

Evaluating the Rate of Primacy and Recency in Learning Word Series in Neglected Patients with Right Posterior Parietal Lobe Lesion

Evaluating the Rate of Primacy and Recency in Learning Word Series in Neglected Patients with Right Posterior Parietal Lobe Lesion

A developmental atlas of male terminalia across twelve species of Drosophila.

How complex morphologies evolve is one of the central questions in evolutionary biology. Observing the morphogenetic events that occur during development provides a unique perspective on the origins and diversification of morphological novelty. One can trace the tissue of origin, emergence, and even regression of structures to resolve murky homology relationships between species. Here, we trace the developmental events that shape some of the most diverse organs in the animal kingdom-the male terminalia (genitalia and analia) of Drosophilids. Male genitalia are known for their rapid evolution with closely related species of the Drosophila genus demonstrating vast variation in their reproductive morphology. We used confocal microscopy to monitor terminalia development during metamorphosis in twelve related species of Drosophila. From this comprehensive dataset, we propose a new staging scheme for pupal terminalia development based on shared developmental landmarks, which allows one to align developmental time points between species. We were able to trace the origin of different substructures, find new morphologies and suggest possible homology of certain substructures. Additionally, we demonstrate that posterior lobe is likely originated prior to the split between the Drosophila melanogaster and the Drosophila yakuba clade. Our dataset opens up many new directions of research and provides an entry point for future studies of the Drosophila male terminalia evolution and development.

Patterns of subregional cerebellar atrophy across epilepsy syndromes: An ENIGMA-Epilepsy study.

The intricate neuroanatomical structure of the cerebellum is of longstanding interest in epilepsy, but has been poorly characterized within the current corticocentric models of this disease. We quantified cross-sectional regional cerebellar lobule volumes using structural magnetic resonance imaging in 1602 adults with epilepsy and 1022 healthy controls across 22 sites from the global ENIGMA-Epilepsy working group. A state-of-the-art deep learning-based approach was employed that parcellates the cerebellum into 28 neuroanatomical subregions. Linear mixed models compared total and regional cerebellar volume in (1) all epilepsies, (2) temporal lobe epilepsy with hippocampal sclerosis (TLE-HS), (3) nonlesional temporal lobe epilepsy, (4) genetic generalized epilepsy, and (5) extratemporal focal epilepsy (ETLE). Relationships were examined for cerebellar volume versus age at seizure onset, duration of epilepsy, phenytoin treatment, and cerebral cortical thickness. Across all epilepsies, reduced total cerebellar volume was observed (d = .42). Maximum volume loss was observed in the corpus medullare (dmax = .49) and posterior lobe gray matter regions, including bilateral lobules VIIB (dmax = .47), crus I/II (dmax = .39), VIIIA (dmax = .45), and VIIIB (dmax = .40). Earlier age at seizure onset ( = .05) and longer epilepsy duration ( = .06) correlated with reduced volume in these regions. Findings were most pronounced in TLE-HS and ETLE, with distinct neuroanatomical profiles observed in the posterior lobe. Phenytoin treatment was associated with reduced posterior lobe volume. Cerebellum volume correlated with cerebral cortical thinning more strongly in the epilepsy cohort than in controls. We provide robust evidence of deep cerebellar and posterior lobe subregional gray matter volume loss in patients with chronic epilepsy. Volume loss was maximal for posterior subregions implicated in nonmotor functions, relative to motor regions of both the anterior and posterior lobe. Associations between cerebral and cerebellar changes, and variability of neuroanatomical profiles across epilepsy syndromes argue for more precise incorporation of cerebellar subregional damage into neurobiological models of epilepsy.

Neural Pathways Linking Autonomous Exercise Motivation and Exercise-Induced Unhealthy Eating: A Resting-State fMRI Study.

Unhealthy food compensation following exercise contributes to the failure of exercise for weight loss. Autonomous exercise motivation is a protective factor against exercise-induced unhealthy foods licensing (EUFL). However, the neural mechanism of exercise-specific autonomous motivation and how these neural correlates link to EUFL remain uncertain. This study explored the resting-state brain activity (i.e., amplitude or fractional amplitude of low-frequency fluctuations (ALFF/fALFF) and regional homogeneity (ReHo)) and seed-based functional connectivity (rsFC) of autonomous exercise motivation among 223 (72.3% female) healthy young adults. Autonomous exercise motivation and EUFL were measured by self-report measurements. Results across resting-state indices and rsFC analysis show that autonomous exercise motivation was robustly associated with activity and connectivity within the cerebellum posterior lobe (PCB), middle frontal gyrus (MFG), and middle occipital gyrus (MOG). Specifically, the PCB acted as a hub, connecting the frontal and occipital lobes. Moreover, higher autonomous exercise motivation indirectly predicts reduced EUFL through enhanced activity in the MFG and connectivity of PCB-MOG. Neural substrate for enhanced conflict awareness and motor control may explain the protective effect of autonomous exercise motivation on post-exercise unhealthy eating. Enhancement of these functions could help regulate post-exercise eating and improve the effectiveness of exercise for weight loss.

Decreased dynamic variability of the cerebellum in the euthymic patients with bipolar disorder

BackgroundBipolar disorder (BD) is a complex mental illness characterized by different mood states, including depression, mania/hypomania, and euthymia. This study aimed to comprehensively evaluate dynamic changes in intrinsic brain activity by using dynamic fractional amplitude of low-frequency fluctuations (dfALFF) and dynamic degree centrality (dDC) in patients with BD euthymia or depression and healthy individuals.MethodsThe resting-state functional magnetic resonance imaging data were analyzed from 37 euthymic and 28 depressed patients with BD, as well as 85 healthy individuals. Using the sliding-window method, the dfALFF and dDC were calculated for each participant. These values were compared between the 3 groups using one-way analysis of variance (ANOVA). Additional analyses were conducted using different window lengths, step width, and window type to ensure the reliability of the results.ResultsThe euthymic group showed significantly lower dfALFF and dDC values of the left and right cerebellum posterior lobe compared with the depressed and control groups (cluster level PFWE < 0.05), while the latter two groups were comparable. Brain regions showing significant group differences in the dfALFF analysis overlapped with those with significant differences in the dDC analysis. These results were consistent across different window lengths, step width, and window type.ConclusionsThese findings suggested that patients with euthymic BD exhibit less flexibility of temporal functional activities in the cerebellum posterior lobes compared to either depressed patients or healthy individuals. These results could contribute to the development of neuropathological models of BD, ultimately leading to improved diagnosis and treatment of this complex illness.

Revision of the bark louse genus Bicuspidatus (Psocodea: Peripsocidae) with description of a new species from China.

Bicuspidatus is a small genus of the family Peripsocidae, erected by Li (1993) with B. pulchipunctatus as the type species. Adults of this genus can be easily distinguished from other peripsocids by the phallosome with bicuspid apical process in males or by the subgenital plate with modestly elongated, distally bilobed posterior lobe in females. Bicuspidatus currently comprises three species: B. guangdongensis Li, 1993, B. pulchipunctatus Li, 1993 and B. sigillatus Li, 1993, all are known only from Guangdong Province, China. According to previous studies, these three species can be distinguished by the markings on the forewings and a few characteristics of phallosome (Li 1993, 2002). In this study, we present a taxonomic revision of Bicuspidatus based on examination of 40 specimens collected from various localities, including the type specimens of B. guangdongensis, B. pulchipunctatus and B. sigillatus. Furthermore, 12 of them were used for molecular analyses based on partial sequences of COI gene. As a result, B. guangdongensis and B. sigillatus are here considered as junior synonyms of B. pulchipunctatus. We redescribe B. pulchipunctatus and describe a new species from Xizang Autonomous Region, China. An updated distribution map and a revised key to the species of Bicuspidatus are also provided.

Liver fat volume fraction measurements based on multi-material decomposition algorithm in patients with nonalcoholic fatty liver disease: the influences of blood vessel, location, and iodine contrast

BackgroundIn recent years, spectral CT-derived liver fat quantification method named multi-material decomposition (MMD) is playing an increasingly important role as an imaging biomarker of hepatic steatosis. However, there are various measurement ways with various results among different researches, and the impact of measurement methods on the research results is unknown. The aim of this study is to evaluate the reproducibility of liver fat volume fraction (FVF) using MMD algorithm in nonalcoholic fatty liver disease (NAFLD) patients when taking blood vessel, location, and iodine contrast into account during measurement.MethodsThis retrospective study was approved by the institutional ethics committee, and the requirement for informed consent was waived because of the retrospective nature of the study. 101 patients with NAFLD were enrolled in this study. Participants underwent non-contrast phase (NCP) and two-phase enhanced CT scanning (late arterial phase (LAP) and portal vein phase (PVP)) with spectral mode. Regions of interest (ROIs) were placed at right posterior lobe (RPL), right anterior lobe (RAL) and left lateral lobe (LLL) to obtain FVF values on liver fat images without and with the reference of enhanced CT images. The differences of FVF values measured under different conditions (ROI locations, with/without enhancement reference, NCP and enhanced phases) were compared. Friedman test was used to compare FVF values among three phases for each lobe, while the consistency of FVF values was assessed between each two phases using Bland–Altman analysis.ResultsSignificant difference was found between FVF values obtained without and with the reference of enhanced CT images. There was no significant difference about FVF values obtained from NCP images under the reference of enhanced CT images between any two lobes or among three lobes. The FVF value increased after the contrast injection, and there were significant differences in the FVF values among three scanning phases. Poor consistencies of FVF values between each two phases were found in each lobe by Bland–Altman analysis.ConclusionMMD algorithm quantifying hepatic fat was reproducible among different lobes, while was influenced by blood vessel and iodine contrast.

Decoding Semantics from Dynamic Brain Activation Patterns: From Trials to Task in EEG/MEG Source Space.

The temporal dynamics within the semantic brain network and its dependence on stimulus and task parameters are still not well understood. Here, we addressed this by decoding task as well as stimulus information from source-estimated EEG/MEG human data. We presented the same visual word stimuli in a lexical decision (LD) and three semantic decision (SD) tasks. The meanings of the presented words varied across five semantic categories. Source space decoding was applied over time in five ROIs in the left hemisphere (anterior and posterior temporal lobe, inferior frontal gyrus, primary visual areas, and angular gyrus) and one in the right hemisphere (anterior temporal lobe). Task decoding produced sustained significant effects in all ROIs from 50 to 100 ms, both when categorizing tasks with different semantic demands (LD-SD) as well as for similar semantic tasks (SD-SD). In contrast, a semantic word category could only be decoded in lATL, rATL, PTC, and IFG, between 250 and 500 ms. Furthermore, we compared two approaches to source space decoding: conventional ROI-by-ROI decoding and combined-ROI decoding with back-projected activation patterns. The former produced more reliable results for word category decoding while the latter was more informative for task decoding. This indicates that task effects are distributed across the whole semantic network while stimulus effects are more focal. Our results demonstrate that the semantic network is widely distributed but that bilateral anterior temporal lobes together with control regions are particularly relevant for the processing of semantic information.

Sox21b underlies the rapid diversification of a novel male genital structure between Drosophila species

The emergence and diversification of morphological novelties is a major feature of animal evolution.1,2,3,4,5,6,7,8,9 However, relatively little is known about the genetic basis of the evolution of novel structures and the mechanisms underlying their diversification. The epandrial posterior lobes of male genitalia are a novelty of particular Drosophila species.10,11,12,13 The lobes grasp the female ovipositor and insert between her abdominal tergitesand, therefore, are important for copulation and species recognition.10,11,12,14,15,16,17 The posterior lobes likely evolved from co-option of a Hox-regulated gene network from the posterior spiracles10 and have sincediversified in morphology in the D.simulans clade, in particular, over the last 240,000 years, drivenby sexual selection.18,19,20,21 The genetic basis of this diversification is polygenic but, to the best ofour knowledge, none of the causative genes have been identified.22,23,24,25,26,27,28,29,30 Identifying the genes underlyingthe diversification of these secondary sexual structures is essential to understanding theevolutionary impact on copulation and species recognition. Here, we show that Sox21b negatively regulates posterior lobe size. This is consistent with expanded Sox21b expression in D.mauritiana, which develops smaller posterior lobes than D.simulans. We tested this by generating reciprocal hemizygotes and confirmed that changes in Sox21b underlie posterior lobe evolution between these species. Furthermore, we found that posterior lobe size differences caused by the species-specific allele of Sox21b significantly affect copulation duration. Taken together, our study reveals the genetic basis for the sexual-selection-driven diversification of a novel morphological structure and its functional impact on copulatory behavior.

Altered parietal operculum cortex 2 functional connectivity in benign paroxysmal positional vertigo patients with residual dizziness: A resting-state fMRI study.

To investigate changes in functional connectivity (FC) focusing on parietal operculum cortex 2 (OP2) in benign paroxysmal positional vertigo (BPPV) patients with residual dizziness (RD) after successful canalith repositioning procedure (CRP). High-resolution three-dimensional T1 and resting-state functional magnetic resonance imaging (fMRI) were performed on 55 healthy controls (HCs), 55 BPPV patients with RD, and 55 patients without RD after successful CRP. Seed-based (bilateral OP2) FC was calculated to investigate the changes in FC among the three groups. Additionally, we further explored the associations between abnormal FC and clinical symptoms. One-way analysis of covariance showed significant FC differences among the three groups. Post-hoc analysis showed that patients with RD exhibited decreased FC between left OP2 and regions of left angular gyrus (AG), thalamus, precuneus, middle frontal gyrus (MFG), and right cerebellum posterior lobe (CPL) in comparison with HCs. In addition, compared with patients without RD, patients with RD showed decreased FC between left OP2 and regions of left MFG, AG, middle temporal gyrus, and right CPL. Moreover, in patients with RD, the FC between left thalamus and OP2 was negatively correlated with duration of RD, and the FC between left AG and OP2 was negatively correlated with duration of BPPV. BPPV patients with RD showed reduced FC between brain regions involved in vestibular processing and spatial cognition; These results suggested that BPPV patients with RD might have diminished central processing of vestibular information and impaired spatial cognition.

Cerebro-cerebellar gray matter abnormalities associated with cognitive impairment in patients with recent-onset and chronic schizophrenia

Although the role of the cerebellum in schizophrenia has gained attention, its contribution to cognitive impairment remains unclear. We aimed to investigate volumetric alterations in the cerebro-cerebellar gray matter (GM) in patients with recent-onset schizophrenia (ROS) and chronic schizophrenia (CS) compared with healthy controls (HCs). Seventy-two ROS, 43 CS, and 127 HC participants were recruited, and high-resolution T1-weighted structural magnetic resonance images of the brain were acquired. We compared cerebellar GM volumes among the groups using voxel-based morphometry and examined the cerebro-cerebellar GM volumetric correlations in participants with schizophrenia. Exploratory correlation analysis investigated the functional relevance of cerebro-cerebellar GM volume alterations to cognitive function in the schizophrenia group. The ROS and CS participants demonstrated smaller cerebellar GM volumes, particularly in Crus I and II, than HCs. Extracted cerebellar GM volumes demonstrated significant positive correlations with the cerebral GM volume in the fronto-temporo-parietal association areas engaged in higher-order association. The exploratory analysis showed that smaller cerebellar GM in the posterior lobe regions was associated with poorer cognitive performance in participants with schizophrenia. Our study suggests that cerebellar pathogenesis is present in the early stages of schizophrenia and interconnected with structural abnormalities in the cerebral cortex. Integrating the cerebellum into the pathogenesis of schizophrenia will help advance our understanding of the disease and identify novel treatment targets concerning dysfunctional cerebro-cerebellar interactions.

Dynamics of the Secretory Activity of the Female Moose Mammary Gland During the First Lactation at the Sumarokovskaya Moose Farm

For the first time, comprehensive research have been conducted to study the morphology and function of the mammary gland of domesticated first-calf moose. The mammary gland is an organ of dense consistency, consisting of four grouped hills divided into left and right halves, in which, in turn, the anterior and posterior lobes are distinguished, consisting of glandular (62.8%) and connective tissues (37.2%). Data on the secretory function duration, which varies from 120 to 42 days, and the productive qualities of the mammary gland (175.7 and 20.3 liters, respectively) in female moose with different activities of coming to the farm for milking are presented and systematized. The clarified features of the activity of the secretory system of the mammary gland of the moose-heifer represent the “standard.” Thus, they are essential to analyze species characteristics, comparative morphology, and physiology of lactation as a standard criterion for improving animal productivity at the stage of domestication, as well as to organize measures for the prevention of breast diseases in moose. The object of the study is elk cows of the first lactation (n= 221 heads). Depending on the activity of moose coming to the farm during lactation, they were divided into four groups: 1st - with 100% activity, 2nd – 99-80%, 3rd - 79-50%, and 4th – with 49% activity or less. The scientific information presented in the paper was obtained using morphological, histological, zootechnical, and statistical methods. Morphometric analysis showed the ratio of parenchyma and stroma in the mammary gland in domesticated moose 1.7:1. The glandular apparatus of the udder in the studied female moose secreted significantly higher in animals of the first (duration of lactation 120 days, lactation milk yield – 175.7±3.36 l) and the second groups (109 days and milk yield 122.9 ± 2.31 l) compared to the animals of the third (96 days and a yield of 80.4 ± 3.77 l) and fourth (42 days and a yield of 20.3 ± 1.06 l) groups. The analysis of the secretory activity of the mammary gland in female moose with different activities of coming to milking during the first lactation showed that domestication is a complex and lengthy process. There is still a long and purposeful work to be done to improve the issues of morphology, physiology of the lactation process, and regulation of growth and development of the mammary gland. Moreover, it is essential to organize and improve measures for the raising of moose replacements to transfer them to a milking herd. This will not only domesticate the moose on the farm and strengthen their attachment to humans but also prepare the animals for the upcoming productive period.

Ego- and Geo-Centered References: A Functional Neuroimagery Study

Introduction: The integration of vestibular, visual, and somatosensory cues allows the perception of space through the orientation of our body and surrounding objects with respect to gravity. The main goal of this study was to identify the cortical networks recruited during the representation of body midline and the representation of verticality. Methods: Thirty right-handed healthy participants were evaluated using fMRI. Brain networks activated during a subjective straight-ahead (SSA) task were compared to those recruited during a subjective vertical (SV) task. Results: Different patterns of cortical activation were observed, with differential increases in the angular gyrus and left cerebellum posterior lobe during the SSA task, in right rolandic operculum and cerebellum anterior lobe during the SV task. Discussion: The activation of these areas involved in visuo-spatial functions suggests that bodily processes of great complexity are engaged in body representation and vertical perception. Interestingly, the common brain networks involved in SSA and SV tasks were comprised of areas of vestibular projection that receive multisensory information (parieto-occipital areas) and the cerebellum, and reveal a predominance of the right cerebral and cerebellar hemispheres. The outcomes of this first fMRI study designed to unmask common and specific neural mechanisms at work in gravity- or body-referenced tasks pave a new way for the exploration of spatial cognitive impairment in patients with vestibular or cortical disorders.

Transcranial direct current stimulation over the left posterior temporal lobe modulates semantic control: Evidence from episodic memory distortions

Evidence accumulates to show that semantic cognition requires, in addition to semantic representations, control processes that regulate the accessibility and use of semantic knowledge in a task- and time-appropriate fashion. Semantic control has been recently proposed to rely on a distributed network that includes the posterior temporal cortex. Along these lines, recent meta-analyses of neuroimaging data and studies with patients suffering from semantic aphasia have suggested that the left posterior middle temporal gyrus (pMTG) is critically involved whenever situational context must constrain semantic retrieval. In the present experiment, we used transcranial direct current stimulation over the left posterior temporal lobe in an attempt to interfere with semantic control while participants performed a DRM task, a procedure for inducing conceptually-based false recognition that is contingent on both activation and control processes. Paralleling findings with patients suffering from brain damage restricted to the temporoparietal cortex, anodal stimulation (relative to sham stimulation) resulted in increased false recognition but intact true recognition. These findings fit well with the idea that the left pMTG is a key component of a semantic control network, the alteration of which results in memory performance that is affected by the intrusion of contextually-inappropriate semantic information.

P-20 Primary hyperparathyroidism associated with maltoma of the thyroid gland: imaging challenges

Abstract Introduction Primary hyperparathyroidism (PHP) and malignancies are the most common causes of hypercalcemia. Nevertheless, PHP might be observed in coexisting with malignancies. We aimed to present a patient who underwent surgery for PHP and was diagnosed with thyroid MALToma. Clinical Case A 65-year-old female presented with fatigue for one year. The patient's medical history was unremarkable. On examination, thyroid gland was non-palpable. On laboratory, serum calcium (Ca), phosphorus (P) and parathormone (PTH) levels were 11 mg/dL (R: 8.8-10.6), 2.4 mg/dL (R: 2.5-4.5) and 157 pg/mL, respectively; vitamin-D was 23.63 µg/L and increased urinary Ca (400 mg per-day). She was euthyroid, and thyroid antibody elevated. Ultrasound (US) revealed multiple hypoechoic areas and a lesion (18×14 mm) in the vicinity of inferior right thyroid gland. Parathyroid scintigraphy revealed significant increase of metabolic activity posterior to the right lobe of the thyroid. She underwent right thyroid lobectomy thyroidectomy. Pathology revealed mucosa-associated lymphoid tissue (MALT) lymphoma of the thyroid. No parathyroid lesion noted. Then she was referred to our clinic. US revealed hypoechoic areas at remaining thyroid with no extra finding. We performed tru-cut biopsy from thyroid lesion. On immunochemistry, lymphoid cells were diffusely immunoreactive for CD3, CD5, CD20 and CD43 in the ymphocytes. Ki-67 index was 40%. Hence, the diagnosis of MALT lymphoma of the thyroid gland in the background of Hashimoto's thyroiditis. PTH staining of patient's previous pathology specimen was unremarkable. Pretreatment baseline 18F-flurodeoxyglucose PET/CT (FDG) revealed increased uptake (SUVmax: 5.1) in hypodense nodular structure in the posterior left lobe of the thyroid gland (Figure 1). FDG was suggestive of stage IE. Mild 18F-FCH uptake was observed suspected as parathyroid lesion next to the inferior left lobe. 4D-CT showed similar results. All imaging methods and we examined patient via US that revealed hypoechoic lesion with polar blood supply in the left lobe inferior (parathyroid adenoma). The patient were under rituximab 375 mg/m2 per week for 4 cycles. At the end of treatment, there were no sign of residual disease. Reoperation has not been planned due to the improvement of the patient's symptoms, and lymphoma with indolent course. Conclusion 10% of PHP cases may have a concomitant malignancy, while association with lymphoma is even rarer. MALT lymphoma of the thyroid gland is a rare malignancy with an indolent course. The combination of these two rare conditions hard to orchestrate. As in our case, detection of parathyroid lesions becomes more difficult in the background of a low grade lymphoma. Indolent lymphomas have limited sensitivity with FDG. FCH could be more sensitive for discriminating parathyroid lesions and indolent lymphomas. It may be useful to confirm the localization of the PHP in such cases using multiple techniques involving FCH.Figure 1.Pre-treatment avid FCH uptake (A, B) and mild FDG uptake (C, D) related with thyroid MALToma; post-treatment complete remission shown in FDG (E, F); highly vascular paratracheal lesion at 4D-CT (G, H asterixis), the same lesion with mild FCH uptake (I-N arrows) and the same lesion with hypoechoic sonographic appearance evaluated as parathyroid adenoma (O arrow).

Functional connectome hierarchy of thalamus impacts fatigue in acute stroke patients.

This study aimed to explore the topographic features of thalamic subregions, functional connectomes and hierarchical organizations between thalamus and cortex in poststroke fatigue patients. We consecutively recruited 121 acute ischemic stroke patients (mean age: 59years) and 46 healthy controls matched for age, sex, and educational level. The mean age was 59years (range 19-80) and 38% of acute stroke patients were females. Resting-state functional and structural magnetic resonance imaging were conducted on all participants. The fatigue symptoms were measured using the Fatigue Severity Scale. The thalamic functional subdivisions corresponding to the canonical functional network were defined using the winner-take-all parcellation method. Thalamic functional gradients were derived using the diffusion embedding analysis. The results suggested abnormal functional connectivity of thalamic subregions primarily located in the temporal lobe, posterior cingulate gyrus, parietal lobe, and precuneus. The thalamus showed a gradual increase from the medial to the lateral in all groups, but the right thalamus shifted more laterally in poststroke fatigue patients than in non- poststroke fatigue patients. Poststroke fatigue patients also had higher gradient scores in the somatomotor network and the right medial prefrontal and premotor thalamic regions, but lower values in the right lateral prefrontal thalamus. The findings suggested that poststroke fatigue patients had altered functional connectivity and thalamocortical hierarchical organizations, providing new insights into the neural mechanisms of the thalamus.

Smaller total and subregional cerebellar volumes in posttraumatic stress disorder: a mega-analysis by the ENIGMA-PGC PTSD workgroup

Although the cerebellum contributes to higher-order cognitive and emotional functions relevant to posttraumatic stress disorder (PTSD), prior research on cerebellar volume in PTSD is scant, particularly when considering subregions that differentially map on to motor, cognitive, and affective functions. In a sample of 4215 adults (PTSD n = 1642; Control n = 2573) across 40 sites from the ENIGMA-PGC PTSD working group, we employed a new state-of-the-art deep-learning based approach for automatic cerebellar parcellation to obtain volumetric estimates for the total cerebellum and 28 subregions. Linear mixed effects models controlling for age, gender, intracranial volume, and site were used to compare cerebellum volumes in PTSD compared to healthy controls (88% trauma-exposed). PTSD was associated with significant grey and white matter reductions of the cerebellum. Compared to controls, people with PTSD demonstrated smaller total cerebellum volume, as well as reduced volume in subregions primarily within the posterior lobe (lobule VIIB, crus II), vermis (VI, VIII), flocculonodular lobe (lobule X), and corpus medullare (all p-FDR < 0.05). Effects of PTSD on volume were consistent, and generally more robust, when examining symptom severity rather than diagnostic status. These findings implicate regionally specific cerebellar volumetric differences in the pathophysiology of PTSD. The cerebellum appears to play an important role in higher-order cognitive and emotional processes, far beyond its historical association with vestibulomotor function. Further examination of the cerebellum in trauma-related psychopathology will help to clarify how cerebellar structure and function may disrupt cognitive and affective processes at the center of translational models for PTSD.