Differences in regional homogeneity between patients with Crohn's disease with and without abdominal pain revealed by resting-state functional magnetic resonance imaging

Abnormal pain processing in the central nervous system may be related to abdominal pain in patients with Crohn's disease (CD). The purpose of this study was to investigate changes in resting-state brain activity in patients with CD in remission and its relationship with the presence of abdominal pain. Twenty-five patients with CD and with abdominal pain, 25 patients with CD and without abdominal pain, and 32 healthy subjects were scanned using a 3.0-T functional magnetic resonance imaging scanner. Regional homogeneity (ReHo) was used to assess resting-state brain activity. Daily pain scores were collected 1 week before functional magnetic resonance imaging. We found that patients with abdominal pain exhibited lower ReHo values in the insula, middle cingulate cortex (MCC), and supplementary motor area and higher ReHo values in the temporal pole. In contrast, patients without abdominal pain exhibited lower ReHo values in the hippocampal/parahippocampal cortex and higher ReHo values in the dorsomedial prefrontal cortex (all P < 0.05, corrected). The ReHo values of the insula and MCC were significantly negatively correlated with daily pain scores for patients with abdominal pain (r = -0.53, P = 0.008 and r = -0.61, P = 0.002, respectively). These findings suggest that resting-state brain activities are different between remissive patients with CD with and without abdominal pain and that abnormal activities in insula and MCC are closely related to the severity of abdominal pain

Abstracts of the 6th International Academic Medical Congress of Maranhão (VI COIMAMA) 2019

Abstracts of the 6th International Academic Medical Congress of Maranhão (VI COIMAMA) 201

Interaction of psychological, physiological and neuronal processes in functional dyspepsia

Functional dyspepsia is characterized by postprandial fullness, early satiation, epigastric pain, bloating, and nausea symptoms in the absence of structural changes in the gastrointestinal tract. Numerous works have been performed to identify the peripheral characteristics of functional dyspepsia and its association with dyspeptic symptoms, including changes of gastric motility, visceral sensitivity, secretion of hormones, functions of immune system. However, the pathophysiological mechanisms involved and standard treatment strategies are still lacking. The role of the dysfunction of the brain-gut axis and the effect of the food ingestion in the gastrointestinal symptoms of functional dyspepsia patients have therefore been attracting more interest in recent years. How the food is processed differently in the peripheral and in the central nervous system in functional dyspepsia has, however, received little attention in comparison to other functional gastrointestinal disorders. In this thesis, we used various approaches to examine the physiological and neuronal mechanisms in functional dyspepsia patients. We commenced by summarizing previous functional neuroimaging studies to establish their limitations. To bridge the resulting research gap, we investigated physiological and attentional responses to visual food cues, and measured the altered brain activity before and after the food ingestion in functional dyspepsia patients. In the paper I, we reviewed the current status of brain research related to functional dyspepsia and were able to clearly show a knowledge gap regarding neural mechanisms of food-related factors in functional dyspepsia patients. In paper II, we introduced how to design the neuroimaging study and interpret the results of it to clinicians. In paper III, we report findings of an eyetracking and behavioral study on functional dyspepsia patients. The patients showed 1) greater dyspeptic symptoms even after ingestion of a lower calorie and food intake from standard breakfast; 2) decreased pleasantness ratings to food images; and 3) reduced visual attention to food images in comparison to healthy controls. In paper IV, we report findings of a functional magnetic resonance imaging study during meal ingestion (yoghurt with different fat content and label info) in functional dyspepsia patients. The patients showed 1) greater abdominal pain, burning, and discomfort after high fat labeled yogurt ingestion than after low fat labeled yogurt ingestion irrespective of fat content, 2) increased activity in occipital areas before and after ingestion irrespective of fat content and label and increased activity in the middle frontal gyrus before ingestion, 3) increased functional connectivity between the insula and the precuneus after ingestion of yogurt with low fat label, and 4) greater nausea-related increased functional connectivity between the insula and the occipital gyrus after ingestion of high fat yogurt than of low fat yogurt. Furthermore, bidirectional influences between quality of life and depression, as mediated by dyspeptic symptoms and the impact of food craving on the amplitude of brain activity in the middle frontal gyrus, as mediated by depression in functional dyspepsia patients were recorded. In conclusion, the abnormal dietary behavior, reduced positive emotional response and visual attention to food images, and the role of cognitive perception of fat on the aggravation of dyspeptic symptoms should be considered in clinics and in research for functional dyspepsia

Regional Homogeneity and Multivariate Pattern Analysis of Cervical Spondylosis Neck Pain and the Modulation Effect of Treatment

Objects: We investigated brain functional alteration in patients with chronic cervical spondylosis neck pain (CSNP) compared to healthy controls (HCs) and the effect of intervention.Methods: 104 CSNP patients and 96 matched HCs were recruited. Patients received 4 weeks of treatment. Resting-state fMRI and Northwick Park Neck Pain Questionnaire (NPQ) were collected before and after treatment. Resting state regional homogeneity (rs-ReHo) and multivariate pattern analysis (MVPA) were applied to (1) investigate rs-ReHo differences between CSNP patients and controls and the effect of longitudinal treatment and (2) classify CSNP patients from HCs and predict clinical outcomes before treatment using MVPA.Results: We found that (1) CSNP patients showed decreased rs-ReHo in the left sensorimotor cortex and right temporo-parietal junction (rTPJ), and rs-ReHo at the rTPJ significantly increased after treatment; (2) rs-ReHo at rTPJ was associated with NPQ at baseline, and pre- and post-treatment rs-ReHo changes at rTPJ were associated with NPQ changes in CSNP patients; and (3) MVPA could discriminate CSNP patients from HCs with 72% accuracy and predict clinical outcomes with a mean absolute error of 19.6%.Conclusion: CSNP patients are associated with dysfunction of the rTPJ and sensorimotor area.Significance: rTPJ plays on important role in the pathophysiology and development of CSNP

Acupuncture

Acupuncture may have about 4000 years of history, but it has only been clinically accepted in the West for some 40 years. Acupuncture receives both praise from its users and skepticism from its critics. High-quality scientific studies have advanced, but the technique of acupuncture in health services has stagnated. In this current scenario of contrasts, Acupuncture - Resolving Old Controversies and Pointing New Pathways intends to be a modern reference for scholars, without totally exhausting the subject. The editors expect this work to assist with the advancement of the scientific understanding and clinical usage of acupuncture. The authors are well versed in the subject and, along with literature reviews, are able to add their own impressions. In this book, some traditional fundamentals of ancient Asian medicine are translated into the current scientific knowledge of neurophysiology and mechanisms of action. Specific variations of acupuncture, such as the scalp microsystem technique, are discussed and explained. Practical aspects, such as education on acupuncture, are enriched with descriptions of novel treatments. The therapeutic use of acupuncture and related techniques is explored regarding their incorporation into a comprehensive integrative medicine approach. As editors, we thank the contributing authors for their exquisite work, and we congratulate IntechOpen for its efforts in book production. For you, the readers, we hope to match the trust you put in this work, and we hope you find it useful

Psychological factors in chronic low back pain: an investigation of the role of physical and psychological factors in the severity of illness

Summary available: p. [xvi]