Posterior Lobe Research Articles

Utilization of Artificial Intelligence to Improve Door-In Door-Out Times for Mechanical Thrombectomy-Eligible Patients at a Hub-and-Spoke Community-Based Comprehensive Stroke Center: A Single Case Study Presentation

Background: Delays in the transfer of patients with hyperacute stroke may lead to treatment ineligibility due to the degree of cerebral hypoxic injury suffered. Cloud-based artificial intelligence applications may improve transfer times and expand access to advanced therapies. One case between a community-based comprehensive stroke center (CSC) and a primary stroke center (PSC) using a third-party telemedicine service and shared cloud-based artificial intelligence application may provide insight in opportunities to improve stroke systems of care. Case Presentation: A 62-year-old female with a past medical history of hypertension, current everyday tobacco smoker, and marijuana user presented to an outlying emergency department (ED) with dense left-sided hemiplegia affecting the arm and leg, right-sided gaze preference, and severe dysarthria. Her last known well (LKW) time was 0900 hours. CNS imaging revealed a right middle cerebral artery occlusion, visible to members of the CSC stroke team through the use of a cloud-based artificial intelligence cell phone application. The patient was treated with intravenous thrombolytics at the PSC, and she was transferred to the CSC, where she underwent a diagnostic cerebral arteriogram with carotid artery stenting. Later, Magnetic Resonance Imaging (MRI) of the brain revealed a 3.5 cm x 2.5 cm hemorrhagic lesion in the right frontal lobe and diffusion restriction in the right frontal and right posterior temporal lobes. The patient’s hospital stay was three days and, at the time of discharged, her modified Rankin score and NIHSS were zero. She was discharged on dual antiplatelet therapy, statin therapy, and nicotine replacement. Utilization of Artificial Intelligence: Transfer delays are complicated by organizing care at PSC and CSC and can be lengthy when communication across different facilities and subspecialties. Implementing cloud-based AI image sharing in stroke systems of care has reduced DIDO times by providing rapid imaging interpretation, streamlining communication, and enhancing coordination between PSCs and CSCs. Conclusions: Our case presentation showed how a hub-and-spoke model combined with cloud-based AI utilization can improve DIDO times and enhance stroke systems of care.

Altered Effective Connectivity of the Pain Matrix in Herpes Zoster and Postherpetic Neuralgia Patients: Granger Causality Analysis of Resting-State fMRI.

Shingles can cause long-term pain and negative emotions, along with changes in brain function. In this study, Granger Causality Analysis (GCA) was used to compare herpes zoster (HZ) and postherpetic neuralgia (PHN) differences in effective connections within the "pain matrix" between patients and healthy controls to further understand patterns of interaction between brain regions and explore the relationship between changes in effective connections and clinical features. Resting-state functional magnetic resonance imaging (fMRI) scans were performed on 55 HZ; 55 PHN; and 50 age-, sex- matched healthy controls (HCs). The brain regions associated with the pain matrix are used as the seeds of effective connectivity. GCA was used to analyze effective connections in brain regions that differed significantly between groups. Then the correlation between GCA values and clinical indicators was studied. Compared with HC, GCA values between the thalamus and the amygdala, between the thalamus and the precentral gyrus, from the thalamus to the postcentral gyrus, and from the parahippocampal gyrus to the amygdala, anterior cingulate gyrus were significantly reduced in HZ patients. Compared with HC, GCA values between the insular and the postcentral gyrus, from the insular to the inferior parietal lobe, and from the postcentral gyrus to the amygdala were significantly reduced in PHN patients. Compared with HZ, GCA values between the inferior parietal lobe and the parahippocampal gyrus, between the inferior parietal lobe and the anterior cingulate gyrus, and from the anterior cingulate gyrus to the amygdala were significantly increased in PHN patients. The visual analogue scale (VAS) score of PHN patients was positively correlated with the GCA value from the central posterior lobe to the insula. PHN and HZ patients showed a broad reduction in effective connections, mainly reflected in abnormal pain pathway regulation, pain perception, negative emotion and memory production, providing new perspectives to understand the neuroimaging mechanisms of shingles.

Proprioceptive engagement of the human cerebellum studied with 7T-fMRI

Abstract Proprioception, the process of perceiving our bodies in space, is a key aspect of self-perception. The cerebellar cortex is believed to play a critical role in proprioception. However, our understanding of the functional involvement of the cerebellum in proprioception remains limited due to the intricate, thin, and highly folded structure of the human cerebellar cortex, which is more challenging to resolve using in-vivo MRI compared to the cerebral cortex. In this study, we employed high-resolution, B1-shimmed, functional magnetic resonance imaging (fMRI) at 7T to investigate proprioceptive involvement of the cerebellum in humans. We used two tasks designed to differentially require proprioceptive information processing: midline-contralateral-finger-touch and simultaneous-unilateral-finger-flexing. We assessed responses to these tasks across three gradient directions inspired by the mesoscale cerebellar functional organisation, akin to laminar and columnar fMRI approaches in the cerebral cortex. Movements requiring higher proprioceptive engagement, in the midline-contralateral-finger-touch task, elicited stronger activations in both anterior and posterior lobe motor areas of the cerebellum (lobules V and VIIIa/b). We identified distinct activation patterns for the two tasks within these cerebellar motor regions, which may reflect differing functional roles of these motor areas. Midline-contralateral-finger-touch responses were found more medial than simultaneous-unilateral-finger-flexing responses in lobule V and deeper into the cerebellar fissures in lobule VIII. These findings contribute to a deeper understanding of cerebellar functional organisation, the cerebellar involvement in proprioception and may offer insights into addressing proprioceptive deficits associated with neurological conditions.

Pattern and extent of intrahepatic infiltration of perihilar cholangiocarcinoma - A case-control study based on liver panoramic digital pathology.

The extent of intrahepatic infiltration of perihilar cholangiocarcinoma (PHCC) remains unclear. This research aimed to explore the pattern and extent of intrahepatic infiltration of PHCC to guide surgical treatment and pathological research. This study included 62 patients diagnosed with PHCC who underwent major hepatectomy. A whole-mount digital liver pathology system (WDLPS) for hepatectomy specimens greater than 10 × 10cm was used to panoramically assess the intrahepatic infiltration extent of PHCC. The distal intrahepatic infiltration (DIHI) and radial liver invasion (RLI) were important parts of intrahepatic infiltration for PHCC explored by WDLPS. The study confirmed that 75.8% of PHCCs had RLI and the infiltration distance in all patients were within 15,000 µm, 62.9% of PHCCs had DIHI greater than 1cm away from the main tumor in liver parenchyma. The recurrence-free survival rates and overall survival rates of patients with DIHI were poorer than the patients without DIHI (P＜0.0001, P=0.0038). Arterial invasion on the resected side could be an excellent predictor. A total of 105 liver lobes were resected from 62 PHCC patients. The invasion rates of the left lateral, left medial, right anterior, and right posterior lobe of PHCC were 79%, 100, 100%, and 69% respectively. The presence of DIHI in most PHCCs was a significant predictor of poor postoperative recurrence and survival. Based on the extent of intrahepatic infiltration, minor hepatectomy was not suitable as the curative surgery for PHCC. Major hepatectomy and liver transplantation were the ideal radical treatment.

An MRI-based study of the insula in a South African population.

The insula, a cortical structure buried deep within the sylvian fissure, has long posed a surgical challenge. Comprehensive knowledge of the insular anatomy is therefore integral to preoperative planning and safe interventional procedures. Since magnetic resonance imaging (MRI) is a favoured modality for the identification of cerebral structures, this study aimed to investigate the morphology and morphometry of the insula in a South African population, using MRI scans. One-hundred MRI studies of insulae (n = 200 hemispheres) were retrospectively analysed for morphological features and morphometric parameters. The insulae were predominantly trapezoidal in shape (Laterality: Left: 82%; Right: 78%; Sex: Male: 84%, Female: 76%). The central insular sulcus was almost always "well seen" (Laterality: Left: 97%; Right: 99%; Sex: Male: 99%, Female: 97%). The middle short insular gyrus (MSG) was most variable in visibility, especially when compared across the sexes (p = 0.004). Insular gyri widths were comparable in both cerebral hemispheres; the posterior long gyrus (PLG) presented with the smallest mean widths. Anterior lobule (AL) widths were larger than those of the posterior lobule (PL). Widths of the insular gyri and lobules were generally larger in males than in females. The MSG and PLG widths in the left hemisphere, AL width in the right hemisphere, and the PL width in both hemispheres were significantly larger in males than in females (p = 0.001; p = 0.005; p = 0.041; p = 0.001, p = 0.015, respectively). MRI scans may be used to accurately interpret insular anatomy. The data obtained may aid neurosurgeons to perform safe insula-related surgical procedures.

Altered Function and Structure of the Cerebellum Associated with Gut-Brain Regulation in Crohn's Disease: a Structural and Functional MRI Study.

This study employed structural and functional magnetic resonance imaging (MRI) to investigate changes in the function and structure of the cerebellum associated with gut-brain axis (GBA) regulation in patients diagnosed with Crohn's disease (CD). The study comprised 20 CD patients, including 12 with active disease (CD-A) and 8 in remission (CD-R), as well as 21 healthy controls. Voxel-based morphometry (VBM) was utilized for structural analysis of cerebellar gray matter volume, while independent component analysis (ICA) was applied for functional analysis of cerebellar functional connectivity (FC). The results showed significant GMV reduction in the left posterior cerebellar lobe across all CD patients compared to HCs, with more pronounced differences in the CD-A subgroup. Additionally, an increase in mean FC of the cerebellar network was observed in all CD patients, particularly in the CD-A subgroup, which demonstrated elevated FC in the vermis and bilateral posterior cerebellum. Correlation analysis revealed a positive relationship between cerebellar FC and the Crohn's Disease Activity Index (CDAI) and a trend toward a negative association with the reciprocal of the Self-rating Depression Scale (SDS) score in CD patients. The study's findings suggest that the cerebellum may play a role in the abnormal regulation of the GBA in CD patients, contributing to a better understanding of the neural mechanisms underlying CD and highlighting the cerebellum's potential role in modulating gut-brain interactions.

Abstract We127: Infective Endocarditis in COVID-19 - An Unusual Suspect

Introduction: The COVID-19 pandemic globally overwhelmed healthcare systems and the complications associated with this illness have contributed to poor outcomes. The hypercoagulable state associated with COVID-19 is well recognized in the literature. Thromboembolic complications such as left ventricular thrombus (LVT), deep venous thrombosis (DVT) and pulmonary embolism (PE) have been increasingly reported. Dhakal et al. published an association between COVID-19 and cardiovascular disease, including possible complication by infective endocarditis (IE) which was confirmed by Amir et al. reporting the first case. Since then, there have been few reported cases. We present a case of COVID-19 in a patient who developed LVT, complicated by non-valvular IE by an underreported organism, Granulicatella adiacens. Case Presentation: A 55-year-old male with history of dental caries, provoked DVT/PE, NSTEMI x2 and STEMI in-stent restenosis requiring thrombectomy presented to the hospital with a 2-day history of shortness of breath, fatigue, cough, change in mentation and right-sided weakness. He tested positive for COVID-19 by NAAT. CXR revealed cardiomegaly and multiple bilateral infiltrates. CT head demonstrated acute ischemic stroke of the left occipital, parietal and posterior temporal lobes, also confirmed on MRI. CTA neck showed 30% stenosis of left ICA. Blood cultures x2 resulted positive for G. adiacens. Echocardiogram was obtained, demonstrating reduced EF of 35% and the presence of a large, 2.7 x 2.2cm mobile thrombus in the apical-septal region of the left ventricle, not visualized on previous echocardiogram 6 months earlier. Methods: Data was collected from direct patient care and electronic medical records. Discussion: G. adiacens is a fastidious gram-positive coccus, part of the nutritionally variant streptococci (NVS) species, and part of the normal oral and gastrointestinal flora. It is also found in dental plaques and endodontic abscesses. NVS account for less than 5% of cases of bacteremia and IE. G. adiacens account for even fewer cases. Two separate meta-analyses conducted by Quintero-Martinez et al. and George et al. failed to reveal any cases of IE attributable to G. adiacens in the setting of COVID-19 infection. In conclusion, we believe that the hypercoagulable state of COVID-19 infection led to endocardial damage and development of LVT, thereby creating a nidus for microorganism adherence from underlying dental carries resulting in thromboembolic stroke.

Transsylvian transopercular peri-central core hemispherotomy for treating epilepsy: anatomy, surgical technique, and clinical outcome.

The objective of this study was to display the anatomical landmarks, surgical technique, and clinical outcome of transsylvian transopercular peri-central core hemispherotomy (TTPH) for treating refractory epilepsy. From 2011 to 2023, 26 patients (12 with Rasmussen syndrome, 8 with hemimegalencephaly/cortical malformations, and 6 with hypoxic-ischemic encephalopathy; mean [range] age 11.3 years [16 months to 35 years]; 13 females; and 13 with right-side pathology) underwent TTPH. The mean (range) follow-up was 88 (14-156) months. The intradural surgical time, use and amount of blood transfusion, postoperative fever, hospital stay, weight at surgery, and seizure onset to surgery interval are reported. TTPH consists of 1) sylvian fissure opening, 2) coagulation of the M2 and M3 branches, 3) frontoparietal opercula removal, 4) suprainsular resection, 5) insula removal, 6) selective amygdalohippocampectomy, 7) disconnection of the posterior temporal and occipital lobes using the tentorium and falx as landmarks, 8) intraventricular callosotomy, and 9) disconnection of the basal frontal lobe. In cortical malformation, the gray-white matter interface serves as a landmark. The average intradural operating time was 7 hours 18 minutes (3 hours 33 minutes to 13 hours 45 minutes); all patients were Engel class I; and 2 patients presented with procedure-related complications (meningitis and transient abducens nerve palsy). No patient required shunt surgery or reoperation. TTPH offers anatomical landmarks as intraoperative guides and has achieved good seizure control and low complication rates.

Analyzing brain-activation responses to auditory stimuli improves the diagnosis of a disorder of consciousness by non-linear dynamic analysis of the EEG

Although auditory stimuli benefit patients with disorders of consciousness (DOC), the optimal stimulus remains unclear. We explored the most effective electroencephalography (EEG)-tracking method for eliciting brain responses to auditory stimuli and assessed its potential as a neural marker to improve DOC diagnosis. We collected 58 EEG recordings from patients with DOC to evaluate the classification model’s performance and optimal auditory stimulus. Using non-linear dynamic analysis (approximate entropy [ApEn]), we assessed EEG responses to various auditory stimuli (resting state, preferred music, subject’s own name [SON], and familiar music) in 40 patients. The diagnostic performance of the optimal stimulus-induced EEG classification for vegetative state (VS)/unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) was compared with the Coma Recovery Scale-Revision in 18 patients using the machine learning cascade forward backpropagation neural network model. Regardless of patient status, preferred music significantly activated the cerebral cortex. Patients in MCS showed increased activity in the prefrontal pole and central, occipital, and temporal cortices, whereas those in VS/UWS showed activity in the prefrontal and anterior temporal lobes. Patients in VS/UWS exhibited the lowest preferred music-induced ApEn differences in the central, middle, and posterior temporal lobes compared with those in MCS. The resting state ApEn value of the prefrontal pole (0.77) distinguished VS/UWS from MCS with 61.11% accuracy. The cascade forward backpropagation neural network tested for ApEn values in the resting state and preferred music-induced ApEn differences achieved an average of 83.33% accuracy in distinguishing VS/UWS from MCS (based on K-fold cross-validation). EEG non-linear analysis quantifies cortical responses in patients with DOC, with preferred music inducing more intense EEG responses than SON and familiar music. Machine learning algorithms combined with auditory stimuli showed strong potential for improving DOC diagnosis. Future studies should explore the optimal multimodal sensory stimuli tailored for individual patients.Trial registration: The study is registered in the Chinese Registry of Clinical Trials (Approval no: KYLL-2023-414, Registration code: ChiCTR2300079310).

Resting-State Functional Connectivity of the Cerebellum in Patients with Chronic Low Back Pain.

Chronic low back pain (cLBP) affects nociceptive responses in the cerebellum, which leads to increased pain perception and sensorimotor control dysfunction. This study aimed to investigate altered functional connectivity in the anterior and posterior lobes of the cerebellum during cLBP. Twenty patients with cLBP and 18 healthy participants underwent 3.0 T resting-state functional magnetic resonance imaging. The bilateral lobule V of the anterior cerebellum and Crus I of the posterior cerebellum were selected as the region of interest for identifying the corresponding networks. The left lobule V had a greater intrinsic connectivity with the left insular cortex, left orbitofrontal cortex, and bilateral medial prefrontal cortex in patients with cLBP. In contrast, the right lobule V and bilateral Crus I had a significantly decreased connectivity with the contralateral multimodal cerebral networks, including the default mode network, salience network, and emotional network. The cerebellum had mechanistic implications in pain-related changes, which are involved in motor control, cognition, and emotion processing. These findings provide a novel perspective on the role of functional subregions in cLBP, which add to the growing body of evidence that the cerebellum can be a potential target for noninvasive brain stimulation for chronic pain treatment.

Myxoinflammatory fibroblastic sarcoma of the liver: Case report and literature review.

Myxoinflammatory fibroblastic sarcoma (MIFS) is a rare low-grade malignant soft tissue sarcoma that primarily affects the distal extremities in adults, with the highest incidence in patients in their 40s and 50s. It has a high local recurrence rate and a low metastasis rate. Although MIFSs have been documented in other sites, an MIFS in the liver is highly unusual. Herein, we present a case of a patient with hepatic MIFS. The patient was a 58-year-old Chinese man with abdominal pain as the primary symptom. Abdominal computed tomography and magnetic resonance imaging revealed a mass in the right posterior lobe of the liver. The patient underwent surgical excision, and the excised specimen was identified as MIFS. Three years later, the patient returned to our hospital for abdominal pain. Computed tomography and magnetic resonance imaging revealed a mass in liver segments 2/3/4. Postoperative pathological examination of the tumor revealed the recurrence of MIFS. The patient underwent surgical resection of the MIFS. The patient received multiple pirarubicin-based chemotherapy treatments and an ALK inhibitor (anlotinib) within 6 months after surgery, but the tumor recurred. MIFS can not only occur in the proximal limbs, trunk, head, and neck but can also affect the abdominal organs. Surgical resection remains the primary treatment option for MIFS in the absence of any contraindications. Because the recurrence rate of MIFS is high, meticulous long-term monitoring is required.

The cerebellum: the 'little' brain and its big role.

Reports from recent years provide compelling evidence about the structure and the existence of functional topography in the cerebellum. However, most of them focused on the motor functions of the cerebellum. Recent studies suggest the involvement of the posterior lobe of the cerebellum in the context of neurodegenerative and cognitive disorders. The pathophysiology of these diseases is not sufficiently understood, and recent studies indicate that it could also affect additional subregions of the cerebellum. Anatomical and clinical studies, combined with neuroimaging, provide new ways of thinking about the organization and functioning of the cerebellum. This review summarizes knowledge about the topography and functions of the cerebellum, and focuses on its anatomical and functional contributions to the development of neurological diseases.

An update on the endocrine manifestations of antiphospholipid syndrome.

Antiphospholipid Syndrome (APS), characterized by hypercoagulability and pregnancy morbidity, poses a significant clinical challenge when involving organ systems, such as the endocrine system. APS can directly and indirectly influence the anterior and posterior lobes of the pituitary gland. The thyroid gland exhibits involvement, especially in patients with positive anticardiolipin antibodies, yet the clinical significance of the relationship with APS remains elusive. The pancreas, often overlooked, manifests in diverse ways, from pancreatitis to implications in diabetes. Adrenal insufficiency emerges as a common endocrine manifestation of APS, with adrenal hemorrhage or infarction being a presenting manifestation. Adrenal gland involvement has also been reported in the context of catastrophic APS. Pregnancy complications and infertility might be effects of APS on the female ovaries, while testicular torsion and decreased sperm concentration and total sperm count have been reported as rare effects of APS on male testes.

Antenna development, function and its direct or indirect impact on physiology and behaviour of Drosophila melanogaster

AbstractSensory mechanotransduction is the process of deciphering physical stimuli into neural electrical receptor potentials, essential to Drosophila, the fruit fly. Nearly every aspect of an adult Drosophila intricate behavioural repertoire that involves the senses of proprioception, hearing, touch, olfaction, balancing and graviception. Mechanotransduction are mediated by a wide variety of specialized sensilla and sensory neurons that comprise the antenna. The eye and antenna of Drosophila melanogaster are derived from a cluster of approximately 23 cells that are set aside during embryonic development and are constantly divided during the three larval stages, organizing into an epithelial sac known as the eye‐antennal imaginal disc. During late larval and pupal development, the forward lobe of this epithelium, known as the antennal disc, gives rise to the antenna (an organized tripartite structure), whereas the posterior lobe, known as the eye disc, gives rise to the eye. The development of the antenna is a complex and intricate process that relies on the interplay of numerous genes. Each gene involved contributes to the regulatory network that governs the formation, differentiation, and patterning of specific structures within the antenna, ensuring its proper functionality. Thus, aberrant expression or mutation of any gene results in a faulty antenna. The defectiveness appears in terms of antennal structure leading to loss of function including defective behaviour found in an organism. A similar kind of structure–function relation of hearing with a behavioural defect has been reported in vertebrates. Some of the behavioural defects associated with genes are conserved in both vertebrates and Drosophila. Thus, a behavioural assay is an adaptable approach to studying the functionality of various genes associated with the antennae. Here a crucial relationship is established between the genetic regulation of mechanosensory neurons and an organism's behaviour. The current review summarizes antennae development, function and several methods used to study the mechanosensory behaviour associated with Drosophila antennae.

Expression of Retinaldehyde Dehydrogenases in the Pituitary Glands of Fetus and Adult Mice.

Retinoic acid (RA) plays a critical role in cell growth and tissue development. RA is synthesized from retinoids through oxidation processes by the retinaldehyde dehydrogenase (Raldh) family. However, the expression of Raldhs during pituitary development and the identification of Raldh-expressing cells in the adult pituitary have not been fully elucidated. Here, we performed in situ hybridization to localize the three Raldh isoforms (Raldh1-3) in fetal and adult mouse pituitary glands. The results showed that Raldh2 expression was observed in Rathke's pouch from embryonic day 13.5 (E13.5), and this expression was sustained in the anterior lobe of the pituitary primordium from E15.5 to E17.5. In contrast, Raldh1 and Raldh3 were rarely detectable. Real-time PCR analysis revealed that Raldh2 was the predominant isoform expressed in the adult pituitary, although Raldh1 was also expressed to a lesser extent. In the adult pituitary, Raldh1-expressing cells were primarily observed in the posterior lobe. Raldh2-expressing cells were found in the marginal cell layer and parenchyma of the anterior lobe and were immunopositive for aldolase C (folliculostellate cells), but not for anterior pituitary hormones. These results suggest that RA is an important regulatory factor in the functions of the pituitary throughout its development in mice.

STUDY OF fMRI BRAIN ACTIVITY DURING NON-HANDWRITING AND HANDWRITING TASKS ON ESSENTIAL HAND TREMOR

Essential hand tremor (EHT) is a prevalent neurological condition affecting geriatric populations, yet its underlying mechanisms remain poorly understood. This study aims to investigate the neural substrates associated with motor tasks in EHT patients, illuminating the complex neural activity characterizing this condition. Twenty participants underwent a thorough evaluation to ensure eligibility, excluding factors such as mental illness, drug dependency, or Parkinson’s disease (PD). Functional magnetic resonance imaging (fMRI) was utilized to examine brain activation patterns during non-handwriting tasks (NHWT) and handwriting tasks (HWT). Participants received training to standardize hand and forearm movements for effective fMRI assessment. fMRI data preprocessing included motion correction, filtering, removal of linear trends, normalization to Montreal Neurological Institute (MNI) space, and spatial smoothing. Distinctive patterns of brain activation were observed during motor tasks in individuals with EHT compared to controls. During NHWT, the EHT group showed significantly increased activation in the precentral gyrus, supplementary motor area, thalamus, and posterior cerebellar lobe, highlighting their role in mediating motor challenges in EHT. Similarly, during HWT, the EHT group exhibited heightened activation in the precentral gyrus and supplementary motor areas. In contrast, reduced activation was noted in the caudate nucleus, inferior temporal gyrus, and precuneus during HWT in the EHT group compared to controls. These findings align with previous research on involuntary movement disorders, such as early-stage PD, emphasizing the importance of the caudate nucleus and related regions in EHT. In conclusion, this study sheds light on the intricate neural activity underlying motor tasks in EHT patients. The identified neural regions and their functions offer insights into the neurophysiological basis of EHT-related motor impairments. These findings have the potential to enhance the understanding of EHT beyond its surface-level effects. This study has identified the brain regions involved in motor tasks affected by EHT. This sets a foundation for future research to better understand the complexities of this neurological condition. These discoveries may lead to novel therapeutic interventions tailored to address the unique challenges faced by individuals with EHT, representing a significant milestone in understanding and managing EHT.

Infratentorial hypoperfusion in multiple sclerosis

AbstractObjectivesLong‐term disability in patients with multiple sclerosis (MS) results from axonal degeneration in the central nervous system, which might follow hypoperfusion in neurodegenerative diseases. This study aimed to clarify the distribution and clinical significance of brain hypoperfusion in patients with MS.MethodsWe measured brain hypoperfusion in eight patients with relapsing–remitting MS using N‐isopropyl‐p‐iodine‐123‐iodoamphetamine single‐photon emission computed tomography with three‐dimensional stereotactic surface projection and stereotactic extraction estimation; moreover, we examined its clinical relevance.ResultsWe detected marked hypoperfusion in the brainstem and cerebellum relative to that in the cerebrum. Each infratentorial segment, the midbrain, pons, and cerebellar anterior and posterior lobes, showed more severe hypoperfusion than the frontal and parietal lobes (n = 8). This was attributed mainly to oligoclonal band (OCB)‐negative patients (n = 3), even when OCB‐positive patients (n = 5) showed a similar trend. Consistently, OCB‐negative patients had lower blood flow at the pons, and cerebellar anterior and posterior lobes than OCB‐positive patients; however, both groups showed comparable hypoperfusion in the cerebral lobes. Hypoperfusion at the posterior cerebellar lobe and pons was correlated with poor performance in the Trail Making Test Part B (n = 6), indicating cognitive cerebellar dysfunction and cerebrocerebellar conductive disturbances.ConclusionsPatients with relapsing–remitting MS had lower infratentorial perfusion, which strongly links to OCB‐negativity. The distribution of brain hypoperfusion detected by N‐isopropyl‐p‐iodine‐123‐iodoamphetamine single‐photon emission computed tomography indicated pathological heterogeneity in relapsing–remitting MS. The infratentorial hypoperfusion is possibly associated with neurodegeneration.

Pituitary neuroendocrine tumors and granular cell pituicytomas at autopsy: Incidence, cell types, locations, and histogenesis in 150 pituitary glands.

The incidence of pituitary neuroendocrine tumors has been reported high at autopsy. This study aimed to detect many tumors in both anterior and posterior lobes to prove tumor histogenesis. In total, 150 pituitary glands were studied from the University of Kansas Medical Center from 1995 to 2000. The pituitary gland was sagittally sliced from anterior to posterior into 6 to 8 sections. When H&E-stained sections revealed tumors, the tumors were immunohistochemically stained for 6 pituitary hormones. Among 150 autopsy cases, 38 (25.3%) harbored microadenomas, including 4 cases with double tumors. Twenty-three (54.7%) cases were negative to all pituitary hormones. Of the remaining 19 tumors, 13 (30.9%) were lactotrophs, with 4 cases being concomitantly somatotrophs and gonadotrophs, and 2 cases were corticotropes. More than 85% of pituitary neuroendocrine tumors were adjacent to the capsule. Thirteen (8.7%) granular cell pituicytomas were found in the posterior lobe. There were pituicytes transforming into granular cell tumors. The incidence was 25.3% for pituitary neuroendocrine tumors and 8.7% for granular cell pituicytomas. Since most pituitary neuroendocrine tumors were adjacent to the pituitary capsule, the capsule appeared to be the germinal center. Both pituitary tumors belonged to the 2 different transcription factor lineages.

Aberrant patterns of spontaneous brain activity in schizophrenia: A resting-state fMRI study and classification analysis

BackgroundSchizophrenia is a prevalent mental disorder, leading to severe disability. Currently, the absence of objective biomarkers hinders effective diagnosis. This study was conducted to explore the aberrant spontaneous brain activity and investigate the potential of abnormal brain indices as diagnostic biomarkers employing machine learning methods. MethodsA total of sixty-one schizophrenia patients and seventy demographically matched healthy controls were enrolled in this study. The static indices of resting-state functional magnetic resonance imaging (rs-fMRI) including amplitude of low frequency fluctuations (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo), and degree centrality (DC) were calculated to evaluate spontaneous brain activity. Subsequently, a sliding-window method was then used to conduct temporal dynamic analysis. The comparison of static and dynamic rs-fMRI indices between the patient and control groups was conducted using a two-sample t-test. Finally, the machine learning analysis was applied to estimate the diagnostic value of abnormal indices of brain activity. ResultsSchizophrenia patients exhibited a significant increase ALFF value in inferior frontal gyrus, alongside significant decreases in fALFF values observed in left postcentral gyrus and right cerebellum posterior lobe. Pervasive aberrations in ReHo indices were observed among schizophrenia patients, particularly in frontal lobe and cerebellum. A noteworthy reduction in voxel-wise concordance of dynamic indices was observed across gray matter regions encompassing the bilateral frontal, parietal, occipital, temporal, and insular cortices. The classification analysis achieved the highest values for area under curve at 0.87 and accuracy at 81.28% when applying linear support vector machine and leveraging a combination of abnormal static and dynamic indices in the specified brain regions as features. ConclusionsThe static and dynamic indices of brain activity exhibited as potential neuroimaging biomarkers for the diagnosis of schizophrenia.

Efficacy and safety of percutaneous transhepatic biliary radiofrequency ablation in patients with malignant obstructive jaundice.

Percutaneous transhepatic cholangiodrainage (PTCD) and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients with unresectable malignant obstructive jaundice, yet the safety and effect of endobiliary radiofrequency ablation (EB-RFA) combined PTCD is rarely reported, in this article, we report our experience of EB-RFA combined PTCD in such patients. To retrospectively study the efficacy and safety of EB-RFA combined PTCD in patients with unresectable malignant obstructive jaundice. Patients with unresectable malignant obstructive jaundice treated with EB-RFA under PTCD were selected, the bile ducts of the right posterior lobe was selected as the target bile ducts in all cases. The general conditions of all patients, preoperative tumour markers, total bilirubin (TBIL), direct bilirubin (DBIL), albumin (ALB), alkaline phosphatase (ALP), and glutamyl transferase (GGT) before and on the 7th day after the procedure, as well as perioperative complications, stent patency time and patient survival were recorded. All patients successfully completed the operation, TBIL and DBIL decreased significantly in all patients at the 7th postoperative day (P = 0.009 and 0.006, respectively); the values of ALB, ALP and GGT also decreased compared with the preoperative period, but the difference was not statistically significant. Perioperative biliary bleeding occurred in 2 patients, which was improved after transfusion of blood and other conservative treatments, pancreatitis appeared in 1 patient after the operation, no serious complication and death happened after operation. Except for 3 patients with loss of visits, the stent patency rate of the remaining 14 patients was 100% 71% and 29% at the 1st, 3rd, and 6th postoperative months respectively, with a median survival of 4 months. EB-RFA under PTCD in patients with unresectable malignant obstructive jaundice has a satisfactory therapeutic effect and high safety, which is worthy of further clinical practice.