Regional Dysfunction Research Articles

Dopamine modulates belief updating but not surprise in the midbrain and ventral striatum

Schizophrenia (SCZ) is a severe neuropsychiatric disease associated with dysfunction of brain regions and networks. Recent, functional magnetic resonance imaging (fMRI) studies have determined that the global signal (GS) is an important source of the local neuronal activity. However, the dynamics of this effect in SCZ remains unknown. To address this issue, 39 drug-naive patients with early-onset schizophrenia (EOS) and 31 age-, gender- and education-matched healthy controls underwent resting-state fMRI scans. Dynamic functional connectivity (DFC) was employed to assess the dynamic patterns of the GS in EOS. Dynamic analysis demonstrated that the topography of the GS in EOS can be divided into five different states. In the state1, the GS mainly affected the sensory regions. In the state2, the GS mainly affected the default mode network (DMN). In the state3, the GS mainly affected the frontoparietal network and the cingulate-opercular network. In the state4, the GS mainly affected the sensory and subcortical regions. In the state5, the GS mainly affected the sensory regions and DMN. In particular, the changes in the cerebellum, putamen and supramarginal gyrus was inversely proportional to the clinical symptoms. Our findings demonstrate that the influence of the GS on brain networks is dynamic and changes of this relationship may associate with clinical behavior in SCZ.

Altered brain network centrality in patients with late monocular blindness: a resting-state fMRI study.

IntroductionThe aim of the study was to investigate the underlying functional network brain activity changes in patients with late monocular blindness (MB) and the relationship with their clinical features using the voxel-wise degree centrality (DC) method.Material and methodsA total of 32 patients with MB (25 males and 7 females), and 32 healthy controls (HCs) (25 males and 7 females) closely matched in age, sex, and education, underwent resting-state functional magnetic resonance imaging scans. The DC method was used to assess local features of spontaneous brain activity. Correlation analysis was performed to explore the relationships between the observed mean DC signal values of the different areas and clinical features in these patients.ResultsCompared with HCs, MB patients had significantly lower DC values in the bilateral cuneus/V1/V2, and significantly higher DC values in the left inferior temporal gyrus and bilateral medial frontal gyrus. However, there was no relationship between the observed mean DC values of the different brain areas and the behavioral performance.ConclusionsLate monocular blindness involves brain function network dysfunction in many regions, which might indicate impairment of the visual cortex and other vision-related brain regions in the MBs.

Multi-Scale Feature Combination of Brain Functional Network for eMCI Classification

People suffering from mild cognitive impairment (MCI) are at an increased risk of developing Alzheimer’s disease (AD) or another dementia. High prevalence will possibly be reduced if early interventions could be applied to the stage of early MCI (eMCI). In network-based classification, brain functional networks are often constructed, relying on the entire time series. It can lead to the neglect of the complex and dynamic interaction relationships among brain regions. As a result, the features derived from this type of functional network may fail to serve as an effective disease biomarker. To address this problem, we proposed a multi-scale feature combination framework for the eMCI classification. In this framework, global static features, time-varying features, and more refined features could be able to flexibly extract from static functional networks, dynamic functional networks, and high-order functional networks, respectively. Then, they are utilized to train and test the classification model in the form of feature combination. The experimental results have verified that the proposed method achieves superior classification accuracy than other competed methods in the eMCI classification, indicating a great potential in understanding the dysfunction of the brain regions.

Cardiovascular Disease among Female Veterans of the 1991 Gulf War Era.

Recent clinical studies have identified exercise-induced transient postural tachycardia and abnormal heart-rate variability in patients with Gulf War Illness (GWI) (Rayhan et al. 2013; Garner et al. 2018; Blanchard et al. 2018). Altered heart rate variability may reflect autonomic dysfunction and atrophy in the cardio-regulatory regions of the brainstem (Rayhan et al. 2013). However, the long-term cardiovascular effects of abnormal autonomic nervous system functioning in patients with GWI are unknown (Blanchard et al. 2018). In additional clinical research studies, veterans with GWI have been found to have higher levels of cytokines such as interleukins (Coughlin 2017), which are inflammatory factors associated with increased risk of coronary heart disease and other chronic diseases (Lampert et al. 2006). Using data from the Veterans Affairs (VA) Cooperative Studies Program 585 Gulf War Era Cohort and Biorepository (Khalil et al. 2018), this study examined the prevalence of cardiovascular disease among female veterans who served during the Gulf War or Gulf War Era. A total of 301 women veterans participated in the survey. Mean ages in 2016 were 53 years among women who were deployed and 54 years among women who were not deployed. About one-fifth of the participants were > 60 years of age. About three-quarters of the participants were white, 17–20% were Black or African American, and the remainder were American Indian/Alaska Native, Asian/Pacific Islander, or other race. About 6–8% of the participants were Hispanic or Latino. The majority of the participants had completed some college or received a college degree. In this sample, 12–13% of the participants were current cigarette smokers, 35% self-reported high blood pressure, and 40–41% self-reported high cholesterol. Compared to women veterans not deployed to the Gulf, deployed women veterans were not more likely to report cardiovascular disease (heart attack, coronary artery disease, congestive heart failure, stroke, or peripheral vascular disease). About 6.9% percent of the women who were deployed to the Gulf reported cardiovascular disease as compared to 11.2% of the women who were not deployed (odds ratio = 0.6, 95% confidence interval 0.3–1.4, P < 0.2). Twenty-seven years after the 1990–1991 Gulf War, women veterans who were deployed to the Gulf continue to report similar levels of cardiovascular disease risk factors (cigarette smoking, high blood pressure, high cholesterol) as non-deployed women veterans who served during the Gulf War era. Women veterans deployed to the 1990–1991 Gulf War do not appear to be at increased risk of cardiovascular disease, although studies with longer duration of follow-up and larger sample sizes are needed.

Usefulness of Triiodothyronine Replacement Therapy in Patients With ST Elevation Myocardial Infarction and Borderline/Reduced Triiodothyronine Levels (from the THIRST Study)

The aim of the study was to investigate whether TH replacement therapy is safe and impact infarct size, left ventricular (LV) volumes and function in patients with acute myocardial infarction (AMI) and low T3 syndrome (LT3S). Thirty-seven AMI/LT3S patients were randomly treated or untreated with liothyronine (T3) therapy (maximum dosage 15 mcg/m2/die) in addition to standardized treatment (T3-treated group, n = 19; untreated group, n = 18). TH and thyroxine (TSH) during hospital stay and at 1-month and 6 months were evaluated. At discharge and at 6 months LV volumes, ejection fraction, wall motion score index (WMSI) and infarct extent were measured by cardiac MR. T3-treated patients had a significant increase in fT3 (p = 0.003 and p <0.001) at discharge and 1-month. These patients had no signs or symptoms of hyperthyroidism or arrhythmias. At follow-up, there was a significant reduction in WMSI in both groups (T3-treated group: Δ = -0.12, p = 0.001; untreated group: Δ = -0.04, p = 0.04) and the difference value (discharge/follow-up) was significantly higher in T3-treated group than in untreated group (mean difference between groups = 0.08, 95% confidence interval [CI]: 0.01 to 0.15, p = 0.05). Also, stroke volume increased significantly in the T3-treated group (Δ = 3.4, 95% CI: 0.8 to 6, p <0.01) at follow-up. In conclusion, this is the first pilot experience in which T3 replacement therapy resulted safe and able to improve regional dysfunction in patients with STEMI/LT3S.

Distinct Incidence of Takotsubo Syndrome Between Amyotrophic Lateral Sclerosis and Synucleinopathies: A Cohort Study.

Takotsubo syndrome (TTS) is an acute cardiac syndrome characterized by regional left ventricular dysfunction with a peculiar circumferential pattern, which typically results in apical ballooning. Evidence indicates a pivotal role of catecholamines in TTS, and researchers have discussed multiple hypotheses on the etiology, including multivessel coronary spasm, myocardial stunning, excessive transient ventricular afterload, and cardiac sympathetic overactivity with local noradrenaline spillover. Although central nervous system disorders, such as stroke and epilepsy, are known to trigger TTS, the incidence and clinical features of TTS in neurodegenerative disorders are poorly understood. Here, we retrospectively examined TTS cases in a single-center cohort composed of 250 patients with amyotrophic lateral sclerosis (ALS) and 870 patients with synucleinopathies [582 patients with Parkinson's disease (PD), 125 patients with dementia with Lewy bodies (DLB), and 163 patients with multiple system atrophy (MSA)] and identified 4 (1.6%, including 2 women) cases with ALS and no cases with synucleinopathies. Two ALS patients underwent autopsy and the pathological findings were compatible with the chronological changes identified in catecholamine-induced cardiomyopathy. A literature review identified 16 TTS cases with ALS, 1 case each with PD and DLB, and no cases with MSA. When current and previous TTS cases with ALS were concatenated: 55% (11/20) were female; 35% (7/20) had a bulbar-onset and 45% (9/20) had a limb-onset; the mean age of TTS onset was 63.3 ± 9.0 years and the mean interval time from ALS onset to TTS development was 4.9 ± 3.0 years; no (0/16) patients developed TTS within 12 months after ALS onset; 50% (10/20) underwent artificial ventilations; the mortality was 17% (3/18); and most cases had precipitating factors, and TTS development was associated with gastrostomy, tracheostomy, or infections in 45% (9/20) of the patients. This study demonstrated that ALS is a considerable predisposing factor of TTS and that synucleinopathies rarely cause TTS. The distinct TTS incidence between ALS and synucleinopathies may be due to cardiac sympathetic overactivity in ALS and may also be affected by cardiac sympathetic denervation in synucleinopathies. Moreover, the etiology of TTS in ALS may be reasonably explained by the two-hit theory.

Structural correlates of cognitive impairment in normal pressure hydrocephalus.

ObjectivesThe pathological bases for the cognitive and neuropsychiatric symptoms in normal pressure hydrocephalus (NPH) have not been elucidated. However, the symptoms may indicate dysfunction of subcortical regions. Previously, volume reductions of subcortical deep grey matter (SDGM) structures have been observed in NPH patients. The present study used automated segmentation methods to investigate whether SDGM structure volumes are associated with cognitive and neuropsychiatric measures.MethodsFourteen NPH patients and eight healthy controls were included in the study. Patients completed neuropsychological tests of general cognition, verbal learning and memory, verbal fluency and measures of apathy and depression pre‐ and postshunt surgery. Additionally, patients underwent 3 Tesla T1‐weighted magnetic resonance imaging at baseline and 6 months postoperatively. Controls were scanned once. SDGM structure volumes were estimated using automated segmentation (FSL FIRST). Since displacement of the caudate nuclei occurred for some patients due to ventriculomegaly, patient caudate volumes were also estimated using manual tracing. Group differences in SDGM structure volumes were investigated, as well as associations between volumes and cognitive and neuropsychiatric measures in patients.ResultsVolumes of the caudate, thalamus, putamen, pallidum, hippocampus and nucleus accumbens (NAcc) were significantly reduced in the NPH patients compared to controls. In the NPH group, smaller caudate and NAcc volumes were associated with poorer performance on neuropsychological tests and increased severity of neuropsychiatric symptoms, while reduced volume of the pallidum was associated with better performance on the MMSE and reduced apathy.ConclusionsStriatal volume loss appears to be associated with cognitive and neuropsychiatric changes in NPH.

Altered Slc25 family gene expression as markers of mitochondrial dysfunction in brain regions under experimental mixed anxiety/depression-like disorder

BackgroundDevelopment of anxiety- and depression-like states under chronic social defeat stress in mice has been shown by many experimental studies. In this article, the differentially expressed Slc25* family genes encoding mitochondrial carrier proteins were analyzed in the brain of depressive (defeated) mice versus aggressive mice winning in everyday social confrontations. The collected samples of brain regions were sequenced at JSC Genoanalytica (http://genoanalytica.ru/, Moscow, Russia).ResultsChanges in the expression of the 20 Slc25* genes in the male mice were brain region- and social experience (positive or negative)-specific. In particular, most Slc25* genes were up-regulated in the hypothalamus of defeated and aggressive mice and in the hippocampus of defeated mice. In the striatum of defeated mice and in the ventral tegmental area of aggressive mice expression of mitochondrial transporter genes changed specifically. Significant correlations between expression of most Slc25* genes and mitochondrial Mrps and Mrpl genes were found in the brain regions.ConclusionAltered expression of the Slc25* genes may serve as a marker of mitochondrial dysfunction in brain, which accompanies the development of many neurological and psychoemotional disorders.

Brain regional homogeneity and function connectivity in attenuated psychosis syndrome \u2014based on a resting state fMRI study

BackgroundBy combining regional homogeneity (ReHo) and functional connectivity (FC) analyses, this study aimed to explore brain functional alterations in Attenuated Psychosis Syndrome (APS), which could provide complementary information for the neurophysiological indicators for schizophrenia (SZ) associated brain dysfunction.MethodsTwenty-one APS subjects and twenty healthy controls were enrolled in the data acquisition of demographics and clinical characteristics as well as structural and resting-state functional magnetic resonance imaging (rs-fMRI). ReHo analysis was conducted to determine the peak coordinate of the abnormal regional brain activity. Then, identified brain regions were considered as seed regions and were used to calculate FC between reginal brain voxels and whole brain voxels. Finally, potential correlations between imaging indices and clinical data were also explored.ResultsFour APS and two HC subjects were excluded because the largest dynamic translation or rotation had exceeded 2 mm / 2°. Compared with healthy controls (HCs), APS subjects exhibited higher ReHo values in the right middle temporal gyrus (MTG) and lower ReHo values in the left middle frontal gyrus (MFG), left superior frontal gyrus (SFG), left postcentral gyrus (PoCG), and left superior frontal gyrus, medial (SFGmed). Considered these areas as seed regions, the APS subjects showed abnormal enhancement in functional brain connections, predominantly in the frontal and temporal lobes.ConclusionsWe concluded that the APS subjects had spatially regional dysfunction and remoted synchronous dysfunction in the frontal and temporal lobes of the brain, and changes in ReHo and FC patterns may reveal the mechanism of brain dysfunctions and may serve as an imaging biomarker for the diagnosis and evaluation of SZ.

Aberrant Cerebral Activity in Early Postmenopausal Women: A Resting-State Functional Magnetic Resonance Imaging Study.

Background: Early postmenopausal women frequently suffer from cognitive impairments and emotional disorders, such as lack of attention, poor memory, deficits in executive function and depression. However, the underlying mechanisms of these impairments remain unclear.Method: Forty-three early postmenopausal women and forty-four age-matched premenopausal controls underwent serum sex hormone analysis, neuropsychological testing and resting-state functional magnetic resonance imaging (rs-fMRI). Degree centrality (DC) analysis was performed to confirm the peak points of the functionally abnormal brain areas as the centers of the seeds. Subsequently, the functional connectivity (FC) between these abnormal seeds and other voxels across the whole brain was calculated. Finally, the sex hormone levels, neuroimaging indices and neuropsychological data were combined to detect potential correlations.Results: Compared with the premenopausal controls, the early postmenopausal women exhibited significantly higher serum follicle-stimulating hormone (FSH) levels, more severe climacteric and depressive symptoms, worse sleep quality and more extensive cognitive impairments. Concurrently, the neuroimaging results showed elevated DC values in the left amygdala (AMYG.L), reduced DC values in the left middle occipital gyrus (MOG.L) and right middle occipital gyrus (MOG.R). When we used the AMYG.L as the seed point, FC with the left insula (INS.L), bilateral prefrontal cortex (PFC) and right superior frontal gyrus (SFG.R) was increased; these regions are related to depressive states, poor sleep quality and decreased executive function. When bilateral MOG were used as the seed points, FC with left inferior parietal gyrus (IPG.L), this area closely associated with impaired memory, was decreased.Conclusion: These results illuminated the regional and network-level brain dysfunction in early postmenopausal women, which might provide information on the underlying mechanisms of the different cognitive impairments and emotional alterations observed in this group.

A Comparison of Global Longitudinal, Circumferential, and Radial Strain to Predict Outcomes After Cardiac Surgery

Myocardial strain measured by speckle-tracking echocardiography detects subtle regional and global left ventricular dysfunction. Myocardial strain is measured in the longitudinal, circumferential, and radial dimensions; however, it is unclear which dimension of strain is the best predictor of postoperative outcomes. A secondary analysis of prospectively collected data from a clinical trial (NCT01187329). The cardiothoracic surgical operating rooms of an academic tertiary-care center. Cardiothoracic surgery patients with aortic stenosis having aortic valve replacement (AVR) with or without coronary artery bypass grafting enrolled in a clinical trial. Myocardial deformation analysis from standardized investigative transesophageal echocardiographic examinations performed after induction of anesthesia. The authors compared the ability of intraoperative global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) strain to predict adverse postoperative outcomes, including prolonged hospitalization and the need for pharmacologic hemodynamic support after cardiac surgery. The association of GLS, GCS, and GRS with prolonged hospitalization (>7 days) and the need for pharmacologic hemodynamic support, with epinephrine or norepinephrine after cardiopulmonary bypass, were assessed using separate multivariable logistic regression models with adjustment for multiple comparisons. Of 100 patients, 86 had acceptable measurements for GLS analysis, 73 for GCS, and 72 for GRS. Worse GLS was associated with prolonged hospitalization [odds ratio [OR] (98.3% confidence interval [CI]) of 1.21 (1.01-1.46) per-unit worsening in strain (p = 0.01, significance criterion <0.0167)] and the need for inotropic support with epinephrine [OR (99.2% CI) of 1.81 (1.10-2.97) per-unit worsening in strain (p = 0.002, significance criterion <0.0083)], but not norepinephrine. GCS and GRS were not associated with adverse outcomes. GLS, but not GCS or GRS, predicts prolonged hospitalization and the requirement for inotropic support with epinephrine after AVR.

Regional diastolic dysfunction in post-infarction heart failure: role of local mechanical load and SERCA expression.

AimsRegional heterogeneities in contraction contribute to heart failure with reduced ejection fraction (HFrEF). We aimed to determine whether regional changes in myocardial relaxation similarly contribute to diastolic dysfunction in post-infarction HFrEF, and to elucidate the underlying mechanisms.Methods and resultsUsing the magnetic resonance imaging phase-contrast technique, we examined local diastolic function in a rat model of post-infarction HFrEF. In comparison with sham-operated animals, post-infarction HFrEF rats exhibited reduced diastolic strain rate adjacent to the scar, but not in remote regions of the myocardium. Removal of Ca2+ within cardiomyocytes governs relaxation, and we indeed found that Ca2+ transients declined more slowly in cells isolated from the adjacent region. Resting Ca2+ levels in adjacent zone myocytes were also markedly elevated at high pacing rates. Impaired Ca2+ removal was attributed to a reduced rate of Ca2+ sequestration into the sarcoplasmic reticulum (SR), due to decreased local expression of the SR Ca2+ ATPase (SERCA). Wall stress was elevated in the adjacent region. Using ex vivo experiments with loaded papillary muscles, we demonstrated that high mechanical stress is directly linked to SERCA down-regulation and slowing of relaxation. Finally, we confirmed that regional diastolic dysfunction is also present in human HFrEF patients. Using echocardiographic speckle-tracking of patients enrolled in the LEAF trial, we found that in comparison with controls, post-infarction HFrEF subjects exhibited reduced diastolic train rate adjacent to the scar, but not in remote regions of the myocardium.ConclusionOur data indicate that relaxation varies across the heart in post-infarction HFrEF. Regional diastolic dysfunction in this condition is linked to elevated wall stress adjacent to the infarction, resulting in down-regulation of SERCA, disrupted diastolic Ca2+ handling, and local slowing of relaxation.

Takotsubo Cardiomyopathy Mimicking Myocardial Infarction in a Man with Myasthenic Crisis: A Case Report and Literature Review.

Takotsubo Cardiomyopathy is a syndrome characterized by transient and reversible regional myocardial dysfunction in the absence of obstructive coronary artery disease classically resulting in ventricular apical ballooning. It has a strong female predominance with onset generally in seventh decade of life, with hypothesized pathophysiology related to excess of catecholaminergic stimulation, particularly during episodes of physical or emotional stress. Takotsubo cardiomyopathy has been previously reported during myasthenic crisis, the acute deterioration of myasthenia gravis typically involving respiratory failure that is also associated with physical or emotional stress. We present the case of an atypically young male patient with classical takotsubo cardiomyopathy in the setting of myasthenic crisis after thymectomy initially concerning for ST segment elevation myocardial infarction, and a review of the literature of takotsubo cardiomyopathy in myasthenic crisis.

The time course of blood brain barrier leakage and its implications on the progression of methamphetamine-induced seizures

The initial goals of these experiments were to determine: 1) if blood-brain barrier (BBB) breakdown was a cause or an effect of METH-induced seizures; 2) all the brain regions where BBB is disrupted as seizures progress; and 3) the correlations between body temperature and vascular leakage and neurodegeneration. A fourth objective was added after initial experimentation to determine if sub-strain differences existed in adult male C57 B6 J (Jackson laboratories, JAX) versus C57 B6N (Charles River, CR) mice involving their susceptibility to BBB breakdown and seizure severity. With the 1st “maximal” intensity myoclonic-tonic seizure (MCT) varying degrees of IgG infiltration across the BBB (≤1 mm2) were prominent in olfactory system (OS) associated regions and in thalamus, hypothalamus and neocortex. IgG infiltration areas in the OS-associated regions of the bed nucleus of the stria terminalis, septum and more medial amygdala nuclei, and the hypothalamus were increased significantly by the time continuous behavioral seizures (CBS) developed. Mice receiving METH that had body temperatures of ≥40 °C had IgG infiltration along with MCT or CBS but peak body temperatures above 40 °C did not significantly increase IgG infiltration. Neurodegeneration seen at ≥6 h was restricted to the OS in both JAX and CR mice and was most prominent in the posteromedial cortical amygdaloid nucleus. Neurodegeneration in the anterior septum (tenia tecta) was seen only in the JAX mice. We hypothesize that METH-induced hypertension and hyperthermia lead to BBB breakdown and other vascular dysfunctions in the OS brain regions resulting in OS hyperexcitation. Excitation of the OS neural network then leads to the development of seizures. These seizures in turn exacerbate the energy depletions and the reactive oxygen stress produced by hyperthermia further damaging the BBB and vascular function. These events form a recurrent cycle that results in ever increasing seizure activity and neurotoxicity.

Altered Dynamic Functional Network Connectivity in Frontal Lobe Epilepsy.

Frontal lobe epilepsy has recently been associated with disrupted brain functional connectivity; variations among various resting-state networks (RSNs) across time remains largely unclear. This study applied dynamic functional network connectivity (dFNC) analysis to investigate functional patterns in the temporal and spatial domains of various functional systems in FLE. Resting-state fMRI data were acquired from 19 FLE patients and 18 controls. Independent component analysis was used to decompose RSNs, which were grouped into seven functional systems. Sliding windows and clustering approach were used to identify the dFNC patterns. Then, state-specific connectivity pattern and dynamic functional state interactions (dFSIs) were evaluated. Compared with healthy controls, FLE patients exhibited decreased dFNC in almost all four patterns, changes that were mostly related to the frontoparietal system, suggesting a disturbed communication of the frontoparietal system with other systems in FLE. Additionally, regarding the fundamental connectivity pattern (state 3 in this study), FLE showed decreased time spent in this state. Moreover, the duration positively correlated with seizure onset. Furthermore, significantly reduced dynamic connections in this state were observed in the frontoparietal system linked to the cerebellar and subcortical systems. These findings imply abnormal fundamental dynamic interactions and dysconnectivity associated with the subcortical and cerebellar regulation of dysfunctions in frontoparietal regions in FLE. Finally, based on the developed FSI analysis, temporal dynamic abnormalities among states were observed in FLE. Therefore, this altered dynamic FNC extended our understanding of the abnormalities in the frontoparietal system in FLE. The dynamic FNC provided novel insight into the fundamental pathophysiological mechanisms in FLE.

Assessing regional left ventricular thickening dysfunction and dyssynchrony via personalized modeling and 3D wall thickness measurements for acute myocardial infarction.

Existing clinical diagnostic and assessment methods could be improved to facilitate early detection and treatment of cardiac dysfunction associated with acute myocardial infarction (AMI) to reduce morbidity and mortality. To develop 3D personalized left ventricular (LV) models and thickening assessment framework for assessing regional wall thickening dysfunction and dyssynchrony in AMI patients. Retrospective study, diagnostic accuracy. Forty-four subjects consisting of 15 healthy subjects and 29 AMI patients. 1.5T/steady-state free precession cine MRI scans; LGE MRI scans. Quantitative thickening measurements across all cardiac phases were correlated and validated against clinical evaluation of infarct transmurality by an experienced cardiac radiologist based on the American Heart Association (AHA) 17-segment model. Nonparametric 2-k related sample-based Kruskal-Wallis test; Mann-Whitney U-test; Pearson's correlation coefficient. Healthy LV wall segments undergo significant wall thickening (P < 0.05) during ejection and have on average a thicker wall (8.73 ± 1.01 mm) compared with infarcted wall segments (2.86 ± 1.11 mm). Myocardium with thick infarct (ie, >50% transmurality) underwent remarkable wall thinning during contraction (thickening index [TI] = 1.46 ± 0.26 mm) as opposed to healthy myocardium (TI = 4.01 ± 1.04 mm). For AMI patients, LV that showed signs of thinning were found to be associated with a significantly higher percentage of dyssynchrony as compared with healthy subjects (dyssynchrony index [DI] = 15.0 ± 5.0% vs. 7.5 ± 2.0%, P < 0.01). Also, a strong correlation was found between our TI and left ventricular ejection fraction (LVEF) (r = 0.892, P < 0.01), and moderate correlation between DI and LVEF (r = 0.494, P < 0.01). The extracted regional wall thickening and DIs are shown to be strongly correlated with infarct severity, therefore suggestive of possible practical clinical utility. 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:1006-1019.

Face-to-trait inferences in patients with Parkinson’s disease

ABSTRACTIntroduction: Parkinson’s disease is a progressive neurological disorder characterized by the preferential loss of dopaminergic neurons in the substantia nigra, which project to the striatum. The disease is characterized by prominent motor symptoms, which are its cardinal features. Consequently, Parkinson’s disease has been primarily considered a disorder of movement. However, increasing evidence has indicated that Parkinson’s disease affects not only the motor domain but also the cognitive domain. Increasing evidence indicates that patients with Parkinson’s disease have an impaired ability to recognize emotional facial expressions. Recent studies have reported that other socially relevant information from faces, including face-to-trait inferences for traits such as dominance, competence, and trustworthiness, may be processed in subcortical regions, including the amygdala and caudate nucleus. However, the mechanism underlying the processing of face-to-trait inferences for these traits in patients with Parkinson’s disease is still unknown. This study aimed to assess the face-to-trait inference ability in patients with Parkinson’s disease.Method: Face-to-trait inference ability was assessed using a forced-choice method in patients with Parkinson’s disease and age- and sex-matched healthy controls.Results: Overall correct face-to-trait inferences occurred significantly less frequently in the Parkinson’s disease group than in the control group. Further analysis revealed a significant interaction between groups and the extent to which facial features were exaggerated.Conclusions: The present results suggest that the sensitivity of face-to-trait processing was linear in the Parkinson’s disease group but not in the healthy controls. These deficits may have resulted from dysfunction in subcortical regions, which may also lead to impairment in other social inferential abilities in patients with Parkinson’s disease.

Application of left ventricular strain to patients with coronary artery disease

Myocardial strain imaging has gained popularity during the last decade in various clinical scenarios. The objective of this article was to review the potential application of two-dimensional (2D) and three-dimensional (3D) strains in patients with coronary artery disease. Reports on the diagnostic accuracy of myocardial deformation analysis using 2D and 3D speckle-tracking analyses to detect significant coronary stenosis at rest or during stress and to evaluate myocardial viability are limited. A newer 2D strain approach that uses layer-specific strain analysis might be sensitive in the detection of subtle regional myocardial dysfunction induced by myocardial ischemia. However, its potential accuracy is controversial. The regional assessment of wall motion by 2D/3D strain is not recommended because of measurement variabilities. Further studies are required for the adoption of this technology in patients with coronary artery disease.

Cardioprotective effects and underlying mechanism of Radix Salviamiltiorrhiza and Lignum Dalbergiaodorifera in a pig chronic myocardial ischemia model.

Traditional Chinese medicines, including Radix Salvia miltiorrhiza (SM) and Lignum Dalbergia odorifera (DO) extracts, have historically been used to treat myocardial ischemia and other cardiovascular diseases. The volatile oil of DO (DOO) is one of the main components of DO. The aim of the present study was to assess the cardioprotective effects and possible underlying mechanisms of SM-DOO in pigs with ameroid constriction-induced chronic myocardial ischemia. An ameroid constrictor was placed around the left anterior descending coronary artery of pigs to induce chronic myocardial ischemia. At weeks 2, 6 and 8, myocardial injury markers and blood gas levels were detected. At week 8, coronary angiography, echocardiography and hemodynamics analysis were performed to evaluate myocardial function. Following sacrifice, myocardial tissue was collected and subjected to morphological, histopathological and apoptosis assays. Western blotting was used to detect the protein expression of Bcl-2 associated X (Bax), Bcl-2, Akt, phosphorylated (p)-Akt, glycogen synthase kinase (GSK)-3β and p-GSK-3β. It was revealed that SM-DOO treatment following chronic myocardial ischemia significantly downregulated the expression of myocardial injury markers, ameliorated myocardial oxygen consumption, increased collateralization, reduced regional cardiac dysfunction and limited the extent of myocardial damage. Furthermore, the results of an apoptosis assay revealed that the apoptosis rate was decreased, the expression of Bax decreased and Bcl-2 increased, and the ratio of Bcl-2/Bax was increased. Further experiments indicated that treatment with SM-DOO increased the phosphorylation of Akt and GSK-3β. These findings suggest that SM-DOO treatment ameliorates myocardial injury in a chronic myocardial ischemia model, and that the underlying mechanisms responsible may be associated with the activation of the Akt/GSK-3β signal pathway. Thus, experimental evidence that SM-DOO may be an effective drug for the prevention and treatment of chronic myocardial ischemia in clinical applications has been provided.

Critical Care Ultrasonography

The use of bedside ultrasonography in the intensive care unit continues to expand due to its broad utility, including diagnosis of various conditions, evaluation of hemodynamics, and improvement in the speed and safety of certain bedside procedures. In this review, the reader will gain a better understanding of the physical properties of ultrasound waves and potential artifacts. The five standard views to perform a basic echocardiographic evaluation are described. This examination provides an adequate assessment of the left ventricle, helping to differentiate acute coronary syndrome, stress cardiomyopathy, and regional or global left ventricular dysfunction. Right ventricular function can be assessed qualitatively or, if desired, quantitatively via measurement of tricuspid annular plane excursion. Echocardiography also allows for assessment of volume status, detection of cardiac tamponade, and signs of hemodynamically significant pulmonary embolism. We also describe bedside ultrasound use for pulmonary assessment and for guidance of thoracentesis. Lung ultrasonography is very sensitive for the detection of pneumothoraces and pleural effusions. The lung parenchyma may also be evaluated by identifying various artifacts such as A-lines and B-lines to delineate underlying pulmonary pathology. Understanding these artifacts allows an experienced practitioner to detect various pathologies such as pneumonia, cardiogenic pulmonary edema, atelectasis, and other conditions. Finally, we discuss abdominal ultrasonography, including the performance of a focused assessment with sonography in trauma examination, performance of a paracentesis, and diagnosis of a pneumoperitoneum. This review contains 11 figures, 1 table, and 53 references. Key words: bedside ultrasonography, echocardiography, focused assessment with sonography in trauma (FAST), focused cardiac ultrasonography (FoCUS), point-of-care ultrasonography