22 research outputs found

    A novel scoring system to predict the outcomes of adult patients with hypoxic-ischemic encephalopathy

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    <p><b>Background:</b> Adult patients with hypoxic-ischemic encephalopathy (HIE) often incur large costs, but their outcomes are poor. Currently, there is lack of a comprehensive quantitative approach to predict patient prognoses.</p> <p><b>Methods</b>: A total of 73 adult patients with HIE participated in this prospective, observational study. Clinical assessments, laboratory tests, and electrophysiological examinations were conducted within 3 days after HIE occurred. Logistic regression model was used to identify independent factors associated with patient outcomes.</p> <p><b>Results</b>: After a 6-month follow-up, 44 (61.1%) patients survived, 28 (38.9%) patients died, and one patient was lost to follow-up. The level of blood calcium and lactate, the presence of electroencephalography reactivity, and Glasgow Coma Scale (GCS) score were significantly associated with the patient’s outcome. Based on the regression coefficients from logistic regression analysis, we constructed a scoring system (CEGL; C: calcium, E: EEG reactivity, G: GCS, L: lactate) to predict the possibility of a patient’s death. The area under the receiver operating characteristic curve was 0.91 (P < 0.001, 95% CI [0.87–0.95]) with a specificity of 97.7% and a positive predictive value of 97.4%.</p> <p><b>Conclusion:</b> CEGL score can provide clinicians useful information for assessment of patient prognosis within 6 months after HIE.</p

    The Brain Activity in Brodmann Area 17: A Potential Bio-Marker to Predict Patient Responses to Antiepileptic Drugs

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    <div><p>In this study, we aimed to predict newly diagnosed patient responses to antiepileptic drugs (AEDs) using resting-state functional magnetic resonance imaging tools to explore changes in spontaneous brain activity. We recruited 21 newly diagnosed epileptic patients, 8 drug-resistant (DR) patients, 11 well-healed (WH) patients, and 13 healthy controls. After a 12-month follow-up, 11 newly diagnosed epileptic patients who showed a poor response to AEDs were placed into the seizures uncontrolled (SUC) group, while 10 patients were enrolled in the seizure-controlled (SC) group. By calculating the amplitude of fractional low-frequency fluctuations (fALFF) of blood oxygen level-dependent signals to measure brain activity during rest, we found that the SUC patients showed increased activity in the bilateral occipital lobe, particularly in the cuneus and lingual gyrus compared with the SC group and healthy controls. Interestingly, DR patients also showed increased activity in the identical cuneus and lingual gyrus regions, which comprise Brodmann’s area 17 (BA17), compared with the SUC patients; however, these abnormalities were not observed in SC and WH patients. The receiver operating characteristic (ROC) curves indicated that the fALFF value of BA17 could differentiate SUC patients from SC patients and healthy controls with sufficient sensitivity and specificity prior to the administration of medication. Functional connectivity analysis was subsequently performed to evaluate the difference in connectivity between BA17 and other brain regions in the SUC, SC and control groups. Regions nearby the cuneus and lingual gyrus were found positive connectivity increased changes or positive connectivity changes with BA17 in the SUC patients, while remarkably negative connectivity increased changes or positive connectivity decreased changes were found in the SC patients. Additionally, default mode network (DMN) regions showed negative connectivity increased changes or negative changes with BA17 in the SUC patients. The abnormal increased in BA17 activity may be a key point that plays a substantial role in facilitating seizure onset.</p></div

    Maps of fALFF differences.

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    <p><b>A:</b> SUC vs. control. Compared with healthy controls, the SUC patients showed significantly increased fALFF values in the warm color regions, including the bilateral cuneus, bilateral lingual gyrus, bilateral superior/middle/inferior occipital gyrus, and right posterior cingulate. <b>B:</b> SUC vs. SC. Compared with SC patients, the SUC patients showed significantly increased fALFF values in the warm color regions of the bilateral cuneus, bilateral lingual gyrus, bilateral middle temporal-occipital area, and right fusiform gyrus. <b>C:</b> DR vs. controls. The DR patients showed significantly increased fALFF values in the warm color regions of the bilateral cuneus, bilateral middle occipital gyrus, bilateral fusiform, and right middle temporal-occipital area. <b>D:</b> DR vs. WH. Compared with WH patients, the DR patients showed significantly increased fALFF values in the warm color regions of the left cuneus, bilateral fusiform, and right middle occipital gyrus. <b>E:</b> SC vs. CON. Compared with the healthy controls, the SC patients showed significantly increased fALFF values in the warm color region of the left inferior occipital gyrus. In contrast, the cold color regions in the right fusiform gyrus represent the area with decreased fALFF values in SC patients compared with controls. <b>F:</b> WH vs. CON. The WH patients showed only showed decreased fALFF values in the cold color region of the right fusiform gyrus. The statistical threshold was set at P < 0.05 with a cluster size > 351 mm<sup>3</sup>, which corresponded to a corrected P < 0.05.</p

    Map of fALFF differences among the SUC, SC, DR, WH and control groups.

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    <p>There were significant fALFF differences among the five groups in the bilateral cuneus, lingual gyrus, inferior/middle occipital gyrus, calcarine, middle temporal-occipital area, fusiform, subcortical structure of left occipital lobe, subcortical structure of right temporal lobe, right posterior cingulated, and right cerebellum posterior lobe. The statistical threshold was set at P < 0.05 and a cluster size > 4158 mm<sup>3</sup>, which corresponded to a corrected P < 0.05.</p

    Baseline demographic and head motion characteristics for subjects.

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    <p><sup>a</sup>The P values for the gender distributions in the five groups were calculated using the chi-squared test.</p><p><sup>b</sup>The values are represented as mean±standard deviation (SD).</p><p><sup>c</sup>The P values were calculated by one-way ANOVA tests.</p><p><sup>d</sup>The head motion characteristics was represented as mean framewise displacement (FD)±SD.</p><p>Baseline demographic and head motion characteristics for subjects.</p

    Spatial overlapping maps and scatter plots showing fALFF values of overlaps.

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    <p><b>A:</b> SUC vs. CON and DR vs. CON. Overlap regions account for 20% of SUC <i>vs</i>. controls, 41.7% of DR <i>vs</i>. controls, and 15.9% of total respectively. The yellow parts represents brain regions with common fALFF changes between SUC <i>vs</i>. controls and DR <i>vs</i>. controls including the bilateral lingual gyrus, cuneus, inferior occipital gyrus, middle occipital gyrus, right superior occipital gyrus, subcortical structure of left occipital lobe, subcortical structure of right temporal lobe, and left fusiform. The red parts show regions with fALFF differences from comparison of SUC vs. CON only. The blue parts show regions with fALFF differences from comparison of DR vs. CON only. <b>B:</b> SUC vs. SC and DR vs. WH. Overlap regions account for 27.2% of SUC <i>vs</i>. SC, 24.7% of DR <i>vs</i>. WH, and 14.9% of total respectively. The yellow parts represents brain regions with common fALFF changes between SUC <i>vs</i>. SC and DR <i>vs</i>. WH were found in the bilateral middle occipital gyrus, fusiform, lingual gyrus, the right superior occipital gyrus, cuneus and cerebellum posterior lobe. The red parts show regions with fALFF differences from comparison of SUC vs. SC only. The blue parts show regions with fALFF differences from comparison of DR vs. WH only. All comparisons were restrained in the ANOVA mask. <b>C:</b> fALFF values of overlap with common brain activity changes between SUC vs. CON and DR vs. CON. The error bar represents the standard deviation. * P< 0.001. <b>D:</b> fALFF values of overlap with common brain activity changes between SUC vs. SC and DR vs. WH. The error bar represents the standard deviation. * P = 0.001, * *P< 0.001.</p

    The fALFF values of BA17 and ROC curves.

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    <p><b>A:</b> BA17 mask. <b>B:</b> A scatter plot showing fALFF values within BA17 mask in the SUC, SC, DR, WH patients and healthy controls. The error bar represents the standard deviation. * P = 0.01, ** P = 0.026. <b>C:</b> An ROC curve for the SUC patients and healthy controls. The cut-off point of the fALFF value for this curve was 1.15. Using this cut-off point, 9 out of 11 SUC patients and 10 out of 13 healthy controls were correctly identified, with a sensitivity of 81.8% and a specificity of 76.9%. <b>D:</b> An ROC curve for the SUC and SC patients with a fALFF cut-off point of 1.20. Using this cut-off point, the fALFF of BA17 could classify 8 out of 11 SUC patients and 7 out of 10 SC patients, yielding a sensitivity of 72.7% and a specificity of 70.0%.</p

    Maps of FC differences.

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    <p><b>A:</b> ANOVA results for SUC, SC and control patients. There were significant FC differences among the three groups in the warm color regions of bilateral precuneus, cingulate, superior/middle/inferior/ frontal gyrus, superior parietal lobule, thalamus, superior/middle/inferior occipital gyrus, fusiform gyrus, middle brain and right parahippocampal gyrus. <b>B:</b> SUC <i>vs</i>. controls. Compared with healthy controls, the SUC patients showed significantly positive connectivity increased changes or positive connectivity changes in the warm color regions, including the bilateral superior parietal lobule, the bilateral superior/middle occipital gyrus, and the right middle temporal gyrus, while negative connectivity increased changes or negative connectivity changes in the cold color regions, including the bilateral inferior part of precuneus, anterior cingulated gyrus, posterior cigulated gyrus, midbrain, and middle frontal gyrus. <b>C:</b> SC <i>vs</i>. controls. Compared with healthy controls, the SC patients showed significantly positive connectivity change in the warm color regions located in the subcortical structure of right frontal lobe. The cold color regions included two kinds of connectivity changes: the negative connectivity increased changes or negative connectivity changes were observed in the regions of the right middle temporal gyrus, the right fusiform, and the right parahippocampal gyrus, and the positive connectivity decreased changes were found in the bilateral middle occipital gyrus and the right lingual gyrus. <b>D:</b> SUC <i>vs</i>. SC. Compared with SC patients, the SUC patients showed significantly positive connectivity increased changes or positive connectivity changes in the warm color regions, including the bilateral superior parietal lobule, superior occipital gyrus, middle occipital gyrus, right fusiform, and right parahippocampa gyrus. Negative connectivity increased changes or negative connectivity changes were observed in the cold color regions of the bilateral inferior part of precuneus, anterior cingulated cortex, posterior cingulate cortex, middle frontal gyrus, and thalamus. The statistical threshold was set at P < 0.05 with a cluster size > 4158 mm<sup>3</sup> for <b>Fig 5A</b> and cluster size > 567 mm<sup>3</sup> for <b>Fig 5B–BD</b>.</p

    Regions showing fALFF differences among SUC, SC, DR, WH patients and healthy controls.

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    <p><sup><b>a</b></sup>Brain region where the peak voxel was located.</p><p><sup><b>b</b></sup>The Brodmann area where the peak voxel was located</p><p><sup><b>c</b></sup>The x, y, z, coordinates of the peak voxel in the Montreal Neurological Institute (MNI) space.</p><p>Regions showing fALFF differences among SUC, SC, DR, WH patients and healthy controls.</p

    Abnormal Regional Homogeneity in Patients with Essential Tremor Revealed by Resting-State Functional MRI

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    <div><p>Essential tremor (ET) is one of the most common movement disorders in human adults. It can be characterized as a progressive neurological disorder of which the most recognizable feature is a tremor of the arms or hands that is apparent during voluntary movements such as eating and writing. The pathology of ET remains unclear. Resting-state fMRI (RS-fMRI), as a non-invasive imaging technique, was employed to investigate abnormalities of functional connectivity in ET in the brain. Regional homogeneity (ReHo) was used as a metric of RS-fMRI to assess the local functional connectivity abnormality in ET with 20 ET patients and 20 age- and gender-matched healthy controls (HC). The ET group showed decreased ReHo in the anterior and posterior bilateral cerebellar lobes, the bilateral thalamus and the insular lobe, and increased ReHo in the bilateral prefrontal and parietal cortices, the left primary motor cortex and left supplementary motor area. The abnormal ReHo value of ET patients in the bilateral anterior cerebellar lobes and the right posterior cerebellar lobe were negatively correlated with the tremor severity score, while positively correlated with that in the left primary motor cortex. These findings suggest that the abnormality in cerebello-thalamo-cortical motor pathway is involved in tremor generation and propagation, which may be related to motor-related symptoms in ET patients. Meanwhile, the abnormality in the prefrontal and parietal regions may be associated with non-motor symptoms in ET. These findings suggest that the ReHo could be utilized for investigations of functional-pathological mechanism of ET.</p></div
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