Gray Matter Volume Abnormalities in Depressive Patients With and Without Anxiety Disorders

Comorbidity with anxiety disorder is a relatively common occurrence in major depressive disorder. However, the unique and shared neuroanatomical characteristics of depression and anxiety disorders have not been fully identified. The aim of this study was to identify gray matter abnormalities and their clinical correlates in depressive patients with and without anxiety disorders.We applied voxel-based morphometry and region-of-interest analyses of gray matter volume (GMV) in normal controls (NC group, n = 28), depressive patients without anxiety disorder (DP group, n = 18), and depressive patients with anxiety disorder (DPA group, n = 20). The correlations between regional GMV and clinical data were analyzed.The DP group showed decreased GMV in the left insula (INS) and left triangular part of the inferior frontal gyrus when compared to the NC group. The DPA group showed greater GMV in the midbrain, medial prefrontal cortex, and primary motor/somatosensory cortex when compared to the NC group. Moreover, the DPA group showed greater GMV than the DP group in the frontal, INS, and temporal lobes. Most gray matter anomalies were significantly correlated with depression severity or anxiety symptoms. These correlations were categorized into 4 trend models, of which 3 trend models (ie, Models I, II, and IV) revealed the direction of the correlation between regional GMV and depression severity to be the opposite of that between regional GMV and anxiety symptoms. Importantly, the left INS showed a trend Model I, which might be critically important for distinguishing depressive patients with and without anxiety disorder.Our findings of gray matter abnormalities, their correlations with clinical data, and the trend models showing opposite direction may reflect disorder-specific symptom characteristics and help explain the neurobiological differences between depression and anxiety disorder.     

Increased signal intensity of spinal cord on T2W magnetic resonance imaging for cervical spondylotic myelopathy patients: Risk factors and prognosis (a STROBE-compliant article)

To investigate the risk factors for progression of increased signal intensity (ISI) on T2W magnetic resonance imaging (MRI) and its prognostic value in patients with cervical spondylotic myelopathy (CSM).A total of 109 patients with CSM were included in this study. All the patients were treated with anterior cervical discectomy and fusion. MRI was performed for all 109 patients preoperatively and at the final follow-up. Radiological evaluation included ISI, anterior compression (AC) of dural and spinal cord, hyperintensity region (HR) at the involved level. Clinical data including Japanese Orthopedic Association (JOA) score, Neck Disability Index (NDI) score, and Visual Analogue Scale were collected and evaluated. Patients were divided into 2 groups according to ISI grades (Group A: no hyper-intensity; Group B: presence of ISI). Then all patients presented with ISI were divided into 2 subgroups based on the range of HR (Group B1: hyper-intensity diameter accounts for less than half of the spinal cord diameter at the involved level; Group B2, hyper-intensity diameter accounts for more than half of the spinal cord diameter at the involved level). AC, disease duration, age, and gender were analyzed as potential risk factors.Significantly better JOA and NDI scores were observed in Group A preoperatively and at the final follow-up, compared to Group B (P < .05). Disease duration was found significantly longer in patients with ISI (P < .05). Notably better JOA and NDI scores were noticed in Group B1 rather than Group B2 (P < .05). Logistical regression showed that disease duration was the only factor that significantly correlated with the progress of ISI (P < .001).CSM patients with ISI on T2W MR images had poorer surgical outcomes compared to others, while the increased range of HR may deteriorate preoperative neurological function. Moreover, patients with longer disease duration had greater risk of ISI in spinal cord.     

基于结构磁共振成像评估皮质下缺血性脑血管病伴认知障碍患者灰质萎缩的影像学研究

目的 基于结构磁共振成像(sMRI)中的体素形态测量法(VBM)全自动分割脑组织,探索皮质下缺血性脑血管病(SIVD)伴认知障碍患者脑灰质体积变化与认知损害领域的相关性。方法 收集2020年9月至2022年9月牡丹江医学院附属红旗医院神经内科患者80例,根据神经心理学评估认知水平下降程度将受试者分为皮质下缺血性脑血管病痴呆组(SIVD-AD) 23例,轻度认知障碍组(SIVD-MCI)33例和无认知障碍组(SIVD-NCI)24例。应用3.0T MRI采集3D-T1TFE矢状位结构像,在MATLAB平台SPM12软件包中的VBM-CAT12工具箱将脑组织进行全自动分割,最终在DPABI软件中进行感兴趣区勾画,所有图像均应用Viewer软件包中的AAL模板进行萎缩部位校准。结果 与SIVD-NCI组相比,SIVD-MCI组主要在右侧额上回、额中回及颞中回中存在灰质萎缩改变;SIVD-AD组主要在双侧梭状回、双侧扣带回、双侧嗅皮层、左侧额上回、左侧额中回、左侧海马旁回、左侧直回、左侧岛叶、右侧尾状核等存在萎缩改变。结论 sMRI具有非侵入无辐射的特点,可作为一般人群中MCI及AD的有效筛查...     

首次发作晚发抑郁与轻度认知损害脑萎缩模式的比较研究

目的用优化的基于体素的形态学研究方法(VBM)比较首次发作晚发抑郁(LOD)与轻度认知功能损害(MCI)患者的脑萎缩模式,探索LOD患者脑结构与认知功能的关系。方法选择LOD、MCI及正常老人39例,分为LOD组9例,MCI组14例和NC组16例,用简易精神状态检查量表和认知功能筛检工具评估3组总体认知功能,跨文化神经心理成套测验评估不同领域认知功能。用VBM对颅脑高分辨率3D T_1WI进行分析。结果与NC组比较,LOD组双侧额叶、边缘系统和顶叶多个脑区明显萎缩(P<0.01)。与MCI组比较,LOD组双侧额叶和边缘系统多个脑区明显萎缩(P<0.01)。LOD组物品记忆功能评分与额叶和边缘系统多个脑区灰质体积呈正相关(r=0.49～0.76,P<0.01),言语流畅性评分与右侧颞上回呈正相关(r=0.72,P<0.01)。结论首次发作LOD患者认知相关的脑区灰质萎缩较MCI更广泛和明显;患者额叶与边缘系统灰质萎缩与认知下降相关。     

Effects of perinatal HIV-infection on the cortical thickness and subcortical gray matter volumes in young adulthood

Brain atrophy has been observed in perinatally HIV-infected patients (PHIV) despite initiation on combined antiretroviral treatment (cART), but neuroimaging studies are limited. We aimed to evaluate cortical thickness (CT) and subcortical gray matter (GM) volumes of PHIV youths with stable immunovirological situation and with a normal daily performance.A prospective cross-sectional study was conducted. A total of 25 PHIV patients on cART and 25 HIV-negative (HIV-) controls matched by age, sex, level of education, and socioeconomic status underwent a magnetic resonance imaging scan. CAT12 toolbox was used to extract CT values from T1w images using parcellations from Desikan–Killiany atlas (DK40). To measure regional brain volumes, native segmented images were parceled in regions of interest according to the Neuromorphometrics Atlas. Neuropsychological assessment and psychopathological symptoms were documented.Fifty participants were included (60% females, median age 20 years [interquartile range, IQR 19–23], 64% Whites). No differences regarding neuropsychological tests or psychopathological symptoms were found between groups (all P > .05). All participants presented an average performance in the Fluid Intelligence (FI) test (PHIV mean: −0.12, HIV- mean: 0.24), When comparing CT, PHIV-infected patients showed thinner cortices compared with their peers in fusiform gyrus (P = .000, P = .009), lateral-orbitofrontal gyrus (P = .006, P = .0024), and right parsobitalis gyrus (P = .047). Regarding subcortical GM volumes, PHIV patients showed lower right amygdala (P = .014) and left putamen (P = .016) volumes when compared with HIV- controls. Within the PHIV group, higher CD4 count was associated with higher volumes in right putamen (B = 0.00000038, P = .045). Moreover, increased age at cART initiation and lower nadir CD4 count was associated with larger volumes in left accumbens (B = 0.0000046, P = .033; B = −0.00000008, P = .045, respectively).PHIV patients showed thinner cortices of areas in temporal, orbito-frontal and occipital lobes and lower volumes of subcortical GM volumes when compared with the HIV- control group, suggesting cortical and subcortical brain alterations in otherwise neuroasymptomatic patients. Nevertheless, larger and longitudinal studies are required to determine the impact of HIV on brain structure in PHIV patients and to further identify risk and protective factors that could be implicated.     

应用基于体素的形态学测量在不同程度OSAHS脑灰质密度变化的研究

目的应用基于体素的形态学测量(VBM)技术初步探讨不同程度的OSAHS对大脑微观结构的影响。 方法应用PHILIPS 3.0 T磁共振对通过脑MRI-VBM技术比较研究2016年1月至2017年12月我院确诊的轻、中、重度OSAHS患者的脑结构变化情况。 结果①本研究对55例确诊的OSAHS患者依据睡眠呼吸暂停低通气指数(AHI)将其分为轻、中、重度,各组间年龄、性别及海拔无明显差异(均P>0.05),轻度组平均血氧饱和度(MSpO₂)、最低氧饱和度(LSpO₂)均明显高于中度、重度组(P<0.05),重度OSAHS组AHI显著高于轻度、中度组(P＝0.000); ②中度OSAHS患者与轻度OSAHS患者VBM-MRI相比较,包括左侧杏仁核、左侧海马、左侧脑岛脑灰质体积减少;③重度OSAHS患者与轻度OSAHS患者VBM-MRI相比较,右侧海马旁回脑灰质体积减少;④重度OSAHS患者与中度OSAHS患者VBM-MRI相比较：包括左侧脑岛、左侧尾状核、左侧豆状壳核脑灰质体积增加;左侧丘脑、右侧丘脑脑灰质体积减少。 结论不同程度的OSAHS患者间歇缺氧下导致脑灰质有不同程度的变化,说明了OSAHS对患者的脑结构有着一定程度的影响。     

遗忘型轻度认知损害基于体素的脑形态学研究

目的利用优化的基于体素的形态学研究方法,比较遗忘型轻度认知损害(aMCI)和轻度阿尔茨海默病(AD)患者脑灰质体积。方法选取aMCI患者9例(aMCl组)、轻度AD患者13例(AD组)和正常老年志愿者7例(对照组),经T_2加权像排除颅内存在白质高密度信号,对其进行高分辨率三维T_1加权像扫描,数据在参数统计软件包SPM5下进行头颅标准化、优化、分割和平滑等处理。结果 aMCI组的双侧颞上回、额中回、中央前回、扣带回、顶下小叶、左侧颞中回、中央后回、海马旁回、右侧岛回和旁中央小叶等结构灰质体积小于对照组,差异有统计学意义(P<0.01)。aMCI组的双侧颞上回、齿状回、额上回、额中回、岛回、左侧楔前叶、中央后回、右侧颞中回、颞下回、额下回、顶上小叶和海马旁回等结构灰质体积大于AD组,差异有统计学意义(P<0.01)。结论基于体素的形态学研究能够发现aMCI患者颞、顶、额叶均存在一定程度萎缩,其萎缩程度与累及范围均介于正常老人与轻度AD之间。     

The influence of carotid atherosclerosis on surgical outcomes of patients with cervical spondylotic myelopathy: A retrospective study

The appearance of atherosclerosis in the carotid artery may be suggest the possibility of atherosclerosis in the spinal cord artery, which can cause spinal cord ischemia and further lead to neural element damage.According to the inclusion and exclude standard, there are 137 patients with cervical spondylotic myelopathy (CSM) incorporating retrospective analysis. These patients were consecutively admitted into The Second Hospital- Cheeloo College of Medicine-Shandong University from January 2016 to December 2018 and have accepted surgical treatment. All patients were examined by color Doppler ultrasound to detect carotid atherosclerosis before surgery. All patients were divided into 2 groups according to the presence or absence of carotid atherosclerosis: carotid atherosclerosis group (n = 88) and noncarotid atherosclerosis group (n = 49). All patients were followed up for at least 12 months after surgery. Demographic and surgery-related data were collected and analyzed to identify potential factors that affect the surgical outcomes in CSM.The average age of carotid atherosclerosis group (51 males and 37 females), and noncarotid atherosclerosis group (24 males and 25 females) were 62.02 ± 10.34 years (range, 38–85 years) and 49.61 ± 10.28 years (range, 26–67 years), respectively.In carotid atherosclerosis group: pre and postoperative modify Japanese Orthopedic Association Scores (mJOA score) were 11.58 ± 1.82 and 14.36 ± 1.64; the recovery rate of mJOA score was 45.57% ± 13.28%. In noncarotid atherosclerosis group: pre and postoperative mJOA score were 12.00 ± 2.11 and 15.04 ± 1.70; the recovery rate of mJOA score was 53.90% ± 13.22%. Univariate logistic regression analysis demonstrated that gender (P = .004), age ≥65 years (P = .001), duration of symptoms ≥12 months (P = .040), smoking history (P < .001), preoperative mJOA score ≤11 (P = .007) and carotid atherosclerosis (P = .004) were related to poor surgical outcomes. Multivariate logistic regression analysis showed significant correlations between poor surgical outcomes and age ≥65 years (P = .047), smoking history (P = .010), preoperative mJOA score ≤11 (P = .008) or carotid atherosclerosis (P = .047).Carotid atherosclerosis may be a risk factor for poor surgical outcomes in CSM.     

Gray and white matter changes associated with tool-use learning in macaque monkeys

We used noninvasive MRI and voxel-based morphometry (VBM) to detect changes in brain structure in three adult Japanese macaques trained to use a rake to retrieve food rewards. Monkeys, who were naive to any previous tool use, were scanned repeatedly in a 4-T scanner over 6 weeks, comprising 2 weeks of habituation followed by 2 weeks of intensive daily training and a 2-week posttraining period. VBM analysis revealed significant increases in gray matter with rake performance across the three monkeys. The effects were most significant (P < 0.05 corrected for multiple comparisons across the whole brain) in the right superior temporal sulcus, right second somatosensory area, and right intraparietal sulcus, with less significant effects (P < 0.001 uncorrected) in these same regions of the left hemisphere. Bilateral increases were also observed in the white matter of the cerebellar hemisphere in lobule 5. In two of the monkeys who exhibited rapid learning of the rake task, gray matter volume in peak voxels increased by up to 17% during the intensive training period; the earliest changes were seen after 1 week of intensive training, and they generally peaked when performance on the task plateaued. In the third monkey, who was slower to learn the task, peak voxels showed no systematic changes. Thus, VBM can detect significant brain changes in individual trained monkeys exposed to tool-use training for the first time. This approach could open up a means of investigating the underlying neurobiology of motor learning and other higher brain functions in individual animals.     

Both global gray matter volume and regional gray matter volume negatively correlate with lifetime alcohol intake in non-alcohol-dependent Japanese men: a volumetric analysis and a voxel-based morphometry

BACKGROUND: Non-alcohol-dependent heavy drinkers, as well as alcohol-dependent individuals, show brain atrophy. The purpose of this study was to evaluate whether there are correlations between global and regional gray matter volumes and the lifetime alcohol intake using volumetric analysis and voxel-based morphometry (VBM) among Japanese non-alcohol-dependent male individuals. METHODS: High-resolution three-dimensional magnetic resonance images were acquired from 405 Japanese non-alcohol-dependent male individuals. The collected images were normalized, segmented for volumetric analysis, and additionally smoothed for VBM. For volumetric analysis, the partial correlation coefficient was estimated between the gray matter ratio, which represents the percentage of gray matter volume in the intracranial volume, and the lifetime alcohol intake adjusted for the age of each subject. Multiple regression analysis was performed among regional gray matter volume, lifetime alcohol intake, and age using VBM. RESULTS: Volumetric analysis revealed that gray matter ratio showed a negative correlation with the lifetime alcohol intake adjusted for age (p=0.059, partial correlation coefficient=-0.091). The VBM revealed that the gray matter volumes of the bilateral middle frontal gyri showed a significant negative correlation with the lifetime alcohol intake adjusted for age and systolic blood pressure (left side, p=0.006, Z=4.77; right side, p=0.023, Z=4.45, and p=0.046, Z=4.27). CONCLUSIONS: Our study suggests that non-alcohol-dependent Japanese male individuals show that both global gray matter volume and regional gray matter volume have negative correlations with the lifetime alcohol intake. Our study may contribute to clarifying the mechanism underlying the brain structural changes because of alcohol influence in healthy non-alcohol-dependent individuals.     

前路和后路手术方式治疗老年脊髓型颈椎病的疗效比较

目的探讨老年脊髓型颈椎病（cervical spondylotic myelopathy,CSM）不同入路手术的疗效,以期提高老年CSM的临床效果。方法选择接受手术治疗的160例老年CSM患者,根据手术入路的方式分为前路组（n=80）与后路组（n=80）。前路组患者接受颈椎前路减压植骨融合术;后路组患者接受颈椎后路单开门椎管成形术。观察并比较2组患者的手术时间、术中及术后并发症、脊髓神经功能优良率及手术前后日本骨科学会评分（JOA）的变化。结果前路组平均手术时间比后路组明显缩短（P〈0.05）;前路组平均术中出血量显著少于后路组（P〈0.01）。2组脊髓神经功能优良率差异无统计学意义（P〉0.05）;2组术后JOA评分均较术前明显改善,差异有统计学意义（P〈0.05）,术后前路组JOA评分改善优于后路组（P〈0.05）。结论颈椎前路减压植骨融合术和颈椎后路单开门椎管成形术治疗CSM均具有较好的疗效;合理选择好手术适应证可提高老年CSM患者的临床疗效及减少并发症的发生。     

Predominant gray matter volume loss in patients with end-stage renal disease: a voxel-based morphometry study

To investigate the pattern of brain volume changes in patients with end-stage renal disease (ESRD) using voxel-based morphometry (VBM) and correlation with clinical and neuropsychological (NP) tests. Fifty seven ESRD patients with no anatomical abnormalities in conventional magnetic resonance imaging [24 patients with abnormal NP scores, 16 male, 39?±?12 years; 33 patients with normal NP scores, 23 male, 35?±?9.7 years] and 22 age- and gender-matched healthy controls (14 male, 36?±?10.1 years) were recruited in this study. Results from VBM analysis were analyzed with ANOVA test among 3 groups (controls, minimal nephro-encephalopathy group, non-nephro-encephalopathy group). Multiple linear regression analysis was used to investigate the effect of serum urea and creatinine, and dialysis duration on the brain volumes in ESRD patients. Correlation analysis was performed to investigate the association between NP scores with the brain volumes in ESRD patients. Compared with healthy controls, ESRD patients showed diffusely decreased gray matter volume that further decreased in the presence of encephalopathy. Multiple linear regression results showed that serum urea was negatively associated with changes in gray matter volume in many regions, while dialysis duration was negatively associated with some white matter volume changes (All P?<?0.05, AlphaSim correction). NP scores correlated with some decreased gray matter volume in ESRD patients (All P?<?0.05, AlphaSim correction). No correlation was found between white matter volume and any NP test scores in ESRD patients. This study found predominantly decreased gray matter volume in ESRD patients, which was associated with neurocognitive dysfunction. Serum urea level may be a risk factor for decreased gray matter in ESRD patients.     

CT-Guided Percutaneous Step-by-Step Radiofrequency Ablation for the Treatment of Carcinoma in the Caudate Lobe

The location of the caudate lobe and its complex anatomy make caudate lobectomy and radiofrequency ablation (RFA) under ultrasound guidance technically challenging. The objective of the exploratory study was to introduce a novel modality of treatment of lesions in caudate lobe and discuss all details with our experiences to make this novel treatment modality repeatable and educational.The study enrolled 39 patients with liver caudate lobe tumor first diagnosed by computerized tomography (CT) or magnetic resonance imaging (MRI). After consultation of multi-disciplinary team, 7 patients with hepatic caudate lobe lesions were enrolled and accepted CT-guided percutaneous step-by-step RFA treatment.A total of 8 caudate lobe lesions of the 7 patients were treated by RFA in 6 cases and RFA combined with percutaneous ethanol injection (PEI) in 1 case. Median tumor diameter was 29 mm (range, 18–69 mm). A right approach was selected for 6 patients and a dorsal approach for 1 patient. Median operative time was 64 min (range, 59–102 min). Median blood loss was 10 mL (range, 8-16 mL) and mainly due to puncture injury. Median hospitalization time was 4 days (range, 2–5 days). All lesions were completely ablated (8/8; 100%) and no recurrence at the site of previous RFA was observed during median 8 months follow-up (range 3–11 months). No major or life-threatening complications or deaths occurred.In conclusion, percutaneous step-by-step RFA under CT guidance is a novel and effective minimally invasive therapy for hepatic caudate lobe lesions with well repeatability.     

Thalamic atrophy associated with painful osteoarthritis of the hip is reversible after arthroplasty: A longitudinal voxel‐based morphometric study

Objective

Voxel‐based morphometry (VBM) is a method of assessing brain gray matter volume that has previously been applied to various chronic pain conditions. From this previous work, it appears that chronic pain is associated with altered brain morphology. The present study was undertaken to assess these potential alterations in patients with painful hip osteoarthritis (OA).

Methods

We studied 16 patients with unilateral right‐sided hip pain, before and 9 months after hip arthroplasty. This enabled comparison of gray matter volume in patients with chronic musculoskeletal pain versus healthy controls, as well as identification of any changes in volume following alleviation of pain (after surgery). Assessment involved self‐completion questionnaires to assess pain, function, and psychosocial variables, and magnetic resonance imaging scanning of the brain for VBM analysis.

Results

Significant differences in brain gray matter volume between healthy controls and patients with painful hip arthritis were seen. Specifically, areas of the thalamus in patients with chronic OA pain exhibited decreased gray matter volume. Furthermore, when these preoperative changes were compared with the brain morphology of the patients 9 months after surgery, the areas of reduced thalamic gray matter volume were found to have “reversed” to levels seen in healthy controls.

Conclusion

Our findings confirm that gray matter volume decreases within the left thalamus in the presence of chronic pain and disability in patients with hip OA. The results also show that these thalamic volume changes reverse after hip arthroplasty and are associated with decreased pain and increased function. These findings have potential implications with regard to optimizing the timing of orthopedic interventions such as arthroplasty.

     

The necessity or not of the addition of fusion to decompression for lumbar degenerative spondylolisthesis patients: A PRISMA compliant meta-analysis

Background:The new emerging application of decompression combined with fusion comes with a concern of cost performance, however, it is a lack of big data support. We aimed to evaluate the necessity or not of the addition of fusion for decompression in patients with lumbar degenerative spondylolisthesis.Methods:Potential studies were selected from PubMed, Web of Science, and Cochrane Library, and gray relevant studies were manually searched. We set the searching time spanning from the creating date of electronic engines to August 2020. STATA version 11.0 was exerted to process the pooled data.Results:Six RCTs were included in this study. A total of 650 patients were divided into 275 in the decompression group and 375 in the fusion group. No statistic differences were found in the visual analog scales (VAS) score for low back pain (weighted mean difference [WMD], –0.045; 95% confidence interval [CI], –1.259–1.169; P = .942) and leg pain (WMD, 0.075; 95% CI, –1.201–1.35; P = .908), Oswestry Disability Index (ODI) score (WMD, 1.489; 95% CI, –7.232–10.211; P = .738), European Quality of Life-5 Dimensions (EQ-5D) score (WMD, 0.03; 95% CI, –0.05–0.12; P = .43), Odom classification (OR, 0.353; 95% CI 0.113–1.099; P = .072), postoperative complications (OR, 0.437; 95% CI, 0.065–2.949; P = .395), secondary operation (OR, 2.541; 95% CI 0.897–7.198; P = .079), and postoperative degenerative spondylolisthesis (OR = 8.59, P = .27). Subgroup analysis of VAS score on low back pain (OR = 0.77, 95% CI, 0.36–1.65; P = .50) was demonstrated as no significant difference as well.Conclusion:The overall efficacy of the decompression combined with fusion is not revealed to be superior to decompression alone. At the same time, more evidence-based performance is needed to supplement this opinion.     

Prognostic Significance of Statin Use in Colorectal Cancer: A Systematic Review and Meta-Analysis

Statin intake has been reported to reduce the risk of several malignancies beyond its cholesterol-lowering effects. However, little is known regarding the survival benefit of statins for patients with colorectal cancer (CRC).We conducted a systematic literature search of multiple databases for studies published before November 2014, which investigated associations between statin intake and CRC prognosis. Meta-analysis was performed using random-effects model. The primary outcomes of interest were all-cause mortality (ACM) and cancer-specific mortality (CSM).Ten studies involving 76,851 patients were eligible for this meta-analysis, with 7 studies investigating prediagnosis statin use and 5 studies reporting postdiagnosis statin use. Prediagnosis statin use was associated with reduced ACM (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.61–0.88, P = 0.001) and CSM (HR 0.80, 95% CI 0.77–0.84, P < 0.001) for patients with CRC. This effect persisted when stratified by tumor site and in studies adjusted by nonsteroidal anti-inflammatory drug use. In addition, postdiagnosis statin use was associated with decreased CSM (HR 0.70, 95% CI 0.60–0.82, P < 0.001). However, we did not note reduced ACM for postdiagnosis statin use (HR 0.93, 95% CI 0.68–1.27, P = 0.639). There appeared to be an association between postdiagnosis statin use and increased ACM in KRAS-mutated CRC.Our findings provide evidence that prediagnosis statin therapy was associated with reduced ACM and CSM in CRC patients; postdiagnosis statin therapy indicated decreased CSM. However, findings may not apply to patients with postdiagnosis statin therapy for ACM. Further studies are warranted to determine the relation between statin dose and duration on CRC survival.     

Effects of alcoholism and continued abstinence on brain volumes in both genders

Background: Alcohol abuse has detrimental effects on cerebral function, metabolism, and volume. Some of these effects were found to be at least partially reversible with continued abstinence. Furthermore, it has been reported that there are different effects of alcohol on brain volumes for women compared with men, but the results concerning the interaction between alcohol dependence and gender are inconsistent. With this study, we aimed to further investigate this question by examining the global gray matter (GM) and white matter (WM) changes as well as regional and local GM changes detected by voxel‐based morphometry (VBM) in male and female alcoholic patients a few weeks after detoxification and the corresponding changes in a subgroup of these patients 3 months later. Methods: A total of 50 patients, consecutively admitted for alcohol withdrawal treatment, participated in this study and were followed up for at least 3 months into abstinence. High‐resolution structural images were processed with SPM8 using an optimized VBM protocol. Results: Global cerebrospinal fluid (CSF) volume was increased and WM and GM volume decreased equally in male and female patients. A gender by diagnosis interaction was found neither for global nor for regional volumes or VBM data. VBM whole brain analysis yielded a significant GM volume loss in the patient group in the cingulate gyrus and the insula in both hemispheres. Region of interest analysis for the initial and 3 months follow‐up scans yielded significant gains in regional volumes, particularly the cingulate gyrus and the insula in the group of abstinent patients, whereas no volume change at all is found in the patients who had relapsed. Conclusions: Our study confirms widespread cerebral volume loss in recently detoxified alcoholics. The effects of alcohol dependence seem to have equally adverse effects on brain morphometry in males and females.     

Comparison of 2-wall versus 3-wall orbital decompression against dysthyroid optic neuropathy in visual function: A retrospective study in a Chinese population

To compare visual function of 2-wall (medial and lateral) versus 3-wall (medial, lateral, and inferior) orbital decompression in patients with dysthyroid optic neuropathy (DON).A total of 52 eyes of 37 patients underwent orbital decompression for DON between 2013 and 2019 were retrospectively reviewed. Two- or 3-wall decompression was performed in 31 eyes of 23 patients and 21 eyes of 14 patients, respectively. We examined best-corrected visual acuity (BCVA), visual field mean deviation (MD) and pattern standard deviation (PSD), pattern-reversed visual evoked potential (PVEP) for P100 latency and amplitude at 60 and 15 arcmin stimulation checkerboard size, as well as proptosis using Hertel exophthalmometry.Whether 2-wall or 3-wall decompression, all parameters of visual function were improved after surgery (all P < .05). The improvement in BCVA, MD, and PSD was not statistically significant between groups (all P > .05). Proptosis reduction was higher after 3-wall decompression (P = .011). Mean increase in P100 amplitude after 3-wall decompression was statistically higher than that of after 2-wall decompression at 60 and 15 arcmin (P = .045 and .020, respectively), while the mean decrease in P100 latency was similar between the groups (P = .821 and .655, respectively). Six patients (66.67%) had persistent postoperative diplopia and 1 patient (20%) had new-onset diplopia in 3-wall decompression group, which were higher than in 2-wall decompression group (46.15% persistent postoperative diplopia and no new-onset diplopia).Both 2-wall and 3-wall decompression can effectively improve visual function of patients with DON. Three-wall decompression provides better improvement in P100 amplitude and proptosis, however new-onset diplopia is more common with this surgical technique.     

Determinants of Quality Care and Mortality for Patients With Locally Advanced Cervical Cancer in Virginia

Outcomes for patients with locally advanced cervical cancer are influenced by receipt of all indicated components of quality care: early diagnosis and receipt of external beam radiation therapy, chemotherapy, and brachytherapy. We performed an observational cohort study to evaluate receipt of quality cancer care and mortality after cancer diagnosis among patients with locally advanced cervical cancer in Virginia.We queried the Virginia state cancer registry to identify patients with International Federation of Gynecology and Obstetrics Stage IB-IVA cervical cancer who were diagnosed during 2002 to 2012. We evaluated the influence of tumor-related, demographic, and geospatial factors on the receipt of indicated therapies and mortality. Treatment quality score of 0 to 3 was defined based upon the extent of receipt of the components of indicated therapy.A total of 1048 patients were identified; 33.1% received all 3 components of treatment and only 54.0% received brachytherapy. Predictors of higher quality score included younger age group versus 66+ years at diagnosis (18–42 odds ratio [OR] = 12.3, 95% confidence interval: 6.6, 23.0; 42–53 OR = 5.6, CI: 3.3, 9.5; 53–66 OR = 5.5, CI: 3.3, 9.1), lower tumor stages versus IVA (IB2 OR = 3.3, CI: 1.8, 6.2; II OR = 2.7, CI: 1.6, 4.5; IIIx OR = 2.1, CI: 1.3, 3.6), and treatment at a high-volume facility (OR 2.2, CI: 1.2, 4.2). Predictors of increased mortality included earlier year of diagnosis, higher tumor stage, treatment at a lower volume facility, and lower treatment quality score.In a cohort of locally advanced cervical cancer patients in Virginia, we identified a low rate of receipt of complete quality care for cervical cancer and a strong effect of facility volume on quality treatment and survival. Further research is needed to develop strategies to improve access to quality treatment and outcomes for cervical cancer.     

Relationship between cervical curvature and spinal cord drift distance after laminectomy via lateral mass screw fixation and its effect on clinical efficacy

Background:Laminectomy with lateral mass screw fixation (LCS) is considered an effective surgical procedure for cervical spondylotic myelopathy. However, varying degrees of loss of the cervical curvature were noted in some patients postoperatively. The aim of this study was to observe the relationship between cervical curvature and spinal drift distance after LCS and to determine its effect on neurological function, axial symptoms, and C5 palsy.Methods:A total of 117 consecutive cervical spondylotic myelopathy patients with normal cervical curvature underwent LCS from April 2015 to May 2017 in our institution. Of these patients, 90 patients who accepted to undergo an integrated follow-up were enrolled in this study. The patients were divided into 3 groups based on their postoperative cervical curvature. In group A (28 patients), the cervical curvature became straight postoperatively (0°≤cervical spine angle≤5°); in group B (36 patients), the cervical curvature decreased (5°<cervical spine angle≤16.5°); and in group C (26 patients), the cervical curvature remained normal (cervical spine angle>16.5°). Spinal drift distance, neurological recovery, axial symptoms, and C5 palsy in the patients were recorded and analyzed.Results:Postoperative measurements showed that there was no significant difference in laminectomy width between the groups (P > .05). The cervical spine angle was 2.7° ± 0.5° in group A, 11.2° ± 2.6° in group B, and 20.8° ± 4.1° in group C (P < .05), while the spinal drift distance was 1.2 ± 0.2 mm, 1.8 ± 0.4 mm, and 3.0 ± 0.5 mm, respectively (P < .05). The postoperative Japanese Orthopedic Association score was significantly increased in all groups (P < .05), and there was no significant difference between the groups at different time points (P > .05). However, significant differences were noted between the groups in axial symptoms (P < .05), which were analyzed via the visual analog scale score. The occurrence of C5 palsy in groups A, B, and C was 7.1% (2/28), 8.3% (3/36), and 11.5% (3/26), respectively (P > .05).Conclusion:In LCS, the cervical curvature should be maintained at the normal angle to obtain a good spinal cord drift distance and a lower incidence of axial symptoms.