静息态fMRI评估急性酒精暴露对恒河猴脑功能的影响

目的采用静息态fMRI基于分数低频振荡幅度(fALFF)方法评估急性酒精暴露后恒河猴脑功能改变。方法分别对7只健康雄性恒河猴于静脉注射酒精前及注射后10、28、46min进行BOLD fMRI序列及3D结构像扫描,采用fALFF算法获得并比较4个时间点fALFF差异的脑区。结果 4个时间点fALFF总体差异显著的脑区为右侧中央后回、右侧岛叶、右侧小脑、左侧海马旁回、双侧额下回、小脑蚓部、右枕叶、楔前叶、左侧缘上回(P均0.05);静脉注射酒精后fALFF值减低的脑区为双侧额上回、右侧额下回、右侧梭状回、右侧角回、双侧颞上回、右枕叶、左侧外侧沟、左侧中央后回、左侧楔状叶、左侧丘脑、左侧岛叶、前扣带回(P均0.05);静脉注射酒精后fALFF值增高的脑区为右侧额下回、右侧颞中回(P均0.05)。结论酒精暴露急性期脑代谢活动发生显著变化,主要涉及默认网络、奖赏及情绪加工系统、视听皮层等。     

高定义角度纤维追踪技术重建人脑颞顶枕区短纤维束连接

目的观察人脑颞顶枕区短纤维束连接的空间走行、皮质连接及三维空间关系。方法对10名健康志愿者进行MR扫描。下载90名健康志愿者的弥散谱成像(DSI)综合数据模板(NTU-90)。应用高定义角度纤维束追踪技术(HDFT)对所收集数据进行人脑颞顶枕区3条短纤维束连接[上纵束的垂直部(SLF-V)、枕纵束(VOF)和颞顶束(TP)]重建,并分析其纤维走行、皮质连接、空间三维关系及左右侧别差异。结果 3条纤维束在10名志愿者和NTU-90中均重建成功。SLF-V纤维束起源于颞中回和颞下回后部,终止于角回和缘上回;VOF纤维束起源于下枕叶和梭状回,少量纤维来源于颞下回的后部和枕极前部,终止点位于角回和上枕叶外侧部;TP纤维束主要起源于颞中回、颞下回、梭状回和下颞-下枕结合部,连接于顶上小叶;左右侧SLF-V、VOF和TP的纤维束体积差异无统计学意义(P均0.05)。结论应用HDFT纤维束成像技术成功重建了SLF-V、VOF和TP,可为脑功能研究和神经外科手术提供解剖学依据。     

前庭功能的静息态脑功能磁共振成像

目的探讨基于局部一致性(ReHo)、低频振幅(ALFF)和低频振幅分数(fALFF)的静息态脑fMRI技术对于前庭冰水刺激诱导后脑内前庭功能相关区域的BOLD信号变化。方法纳入20名正常志愿者,在10s内将15ml 0℃冰水注入受试者右侧外耳道,采用平面回波序列和32通道头线圈采集受试者的BOLD静息态脑功能成像数据,采用MatLab 7.1和SPM 8进行数据预处理,预处理后的数据采用REST 1.4软件计算获得ReHo、ALFF和fALFF图像。结果ReHo、ALFF和fALFF图像均出现多个脑区激活增加或减低,其中3个参数值增加即激活脑区主要包括岛叶皮层、颞上回、顶下小叶、脑干、海马旁回、小脑半球等,减低即负激活脑区主要包括额上回、额中回、额下回、颞中回、枕下回、楔前叶等。结论人类存在广泛的涉及前庭信息处理的脑皮层及皮层下网络区域,静息态脑功能成像ReHo、ALFF、fALFF分析方法具有较好的一致性,具备定位前庭功能区的潜在能力。     

利用静息态功能磁共振探究颈动脉狭窄患者的认知障碍研究

目的采用静息态功能磁共振成像探讨无症状严重颈动脉狭窄患者产生认知障碍的机制。方法对2016年1月至2018年06月南京大学医学院附属鼓楼医院血管外科收治的21例无症状严重颈动脉狭窄患者和招募的21名健康人为对照组行认知量表评估和静息态磁共振检查,前瞻性分析两组人群的认知水平与影像数据的差异。结果患者组简易精神状态量表(MMSE)和蒙特利尔认知评估量表(MoCA)评分明显低于对照组,差异具有统计学意义(P0.001)。与对照组相比,患者组在右脑内侧额上回处低频振幅(ALFF)水平增加,在舌回处ALFF减少;在左侧额下回低频振幅比率较对照组增加;在颞上回局部一致性(ReHo)值较对照组增加,在右侧枕下回ReHo减少。患者组在右背外侧额上回与后扣带皮层的相关性显著低于对照组。影像学差异和认知评分之间没有显着相关性(P0.05)。结论无症状严重颈动脉狭窄存在不同程度的认知障碍,右内侧额上回、左侧额下回、颞上回、右背外侧额上回在与颈动脉狭窄相关的认知障碍的发生中可能起着重要的作用。     

男性性活动相关的脑机制

本文从正常性功能的脑机制、性功能障碍的脑机制以及药物治疗机制等几个方面综述了近年来男性性相关的脑成像研究。研究发现男性性活动兴奋期、平台期和高潮期由不同脑区构成的神经网络控制。其中,间脑转换区在男性射精中发挥了关键的启动作用。男性性功能障碍患者在性唤起时存在眶额回和额下回的异常激活模式。血清睾酮和脱水吗啡等药物治疗性功能障碍时,主要通过改变眶额回、脑岛、屏状核和颞下回的激活状态来发挥作用。     

脊髓型多发性硬化患者默认网络及突显网络的功能连接

目的采用独立成分分析(ICA)方法分析脊髓型多发性硬化(SMS)患者脑静息态默认网络(DMN)及突显网络(SN)功能连接(FC)的异常。方法对我院22例SMS患者(SMS组)及22名健康对照者(正常对照组)行静息态fMRI,对所得数据进行ICA分析,并利用SPM8比较两组脑网络FC的差异,同时分析差异脑区的时间序列信号(FC分数)与临床扩展残疾状态量表(EDSS)评分及病程的相关性。结果与正常对照组相比,SMS组DMN的FC减弱的脑区包括双侧内侧额上回、边缘叶及双侧楔叶,FC增强的脑区包括双侧前扣带回、右侧距状皮层;SMS组SN的FC减弱的脑区为双侧内侧扣带回,FC增强的脑区延伸到双侧中央前回、左侧中央后回。两组FC分数与EDSS评分及病程均无相关性(P均0.05)。结论 SMS患者静息态DMN、SN均存在FC异常,可能与继发于脊髓病变的逆行性神经元变性或功能网络重构有关。     

健康成人膀胱储尿功能的大脑静息态功能网络连接研究

目的:研究采用静息态功能磁共振(rs-fMRI)成像技术分析健康成人膀胱储尿功能的大脑功能网络连接。方法:2014年10月~2016年10月筛选健康受试者44例,其中男19例,女25例,年龄22~50岁,均为右利手。分别在膀胱空虚状态和膀胱充盈状态进行2次rs-fMRI扫描。扫描后通过rs-fMRI分析软件Matlab、SPM8、DPABI等进行处理分析。选取左侧前额叶(X=-39,Y=45,Z=-12);右侧前额叶(X=3,Y=49,Z=40);左侧前扣带回(X=-7,Y=-30,Z=-6);右侧前扣带回(X=9,Y=42,Z=-6);左侧颞叶(X=-33,Y=-51,Z=6);左侧颞上回(X=-57,Y=-18,Z=9)6个种子点,进行全脑功能连接。结果:6个种子的全脑功能连接区域:左侧前额叶,激活区域为双侧岛叶,右侧额下回;抑制区域为左侧海马旁回,左侧枕叶,左侧前额叶。右侧前额叶,抑制区域为左侧岛叶。左侧颞叶,抑制区域为右侧眶额叶。左侧颞上回,激活区域为左侧前额叶,右侧距状回;抑制区域为右侧小脑。左侧颞叶,激活区域为海马旁回;抑制区域为右侧额下回,右侧旁中央小叶。左侧颞上回,激活区域为左侧前额叶,左侧额中回,左侧中央颞叶;抑制区域为右侧岛叶,左侧小脑,左侧颞上回。结论:通过功能连接(functional connectivity,FC)分析发现大脑控尿区域不是某一区域单独完成的,而是广泛的、存在着功能相关性的多个区域共同协调完成的。     

基于分数低频振幅观察长时程电刺激诱发健康人肢体麻木后脑功能变化

目的 利用静息态功能MRI(rs-fMRI)分数低频振幅（fALFF）观察长时程电刺激（LTES）诱发健康人肢体麻木感后不同脑区功能变化。方法 前瞻性对27名健康人以LTES诱发单侧肢体麻木感,每日1次、每次30 min,持续1周;分别于开始刺激前日及末次刺激次日采集脑rs-fMRI,并于予5 min短时程电刺激后要求受试者采用视觉模拟评分法（VAS）对麻木感进行评分。比较LTES前、后各脑区fALFF,针对存在显著差异脑区分析其fALFF值变化及其差值与VAS评分差值的相关性。结果LTES后双侧顶上小叶、右侧颞中回、左侧海马旁回及右侧缘上回fALFF值降低,而双侧伏隔核、右侧中央后回、左侧小脑及右侧壳核fALFF值升高（P均<0.05）。LTES前、后左侧顶上小叶fALFF差值与VAS评分差值呈负相关（r=-0.422,P=0.029）。结论 LTES所诱发的肢体麻木感涉及感觉运动皮层及情绪等相关脑区,尤以左侧顶上小叶最为重要。     

三叉神经痛患者半月节射频热凝术前后静息态fMRI的变化

目的 利用功能MR研究三叉神经痛患者半月节射频热凝术(PRT)前后脑功能局部一致性(ReHo)变化。方法 对31例接受PRT手术的三叉神经痛患者在术前1周及术后6个月分别进行MR扫描,采集其大脑结构及静息态功能图像;同时记录患者的疼痛视觉模拟量表(VAS)评分、面部麻木程度及患病时间。比较患者手术前后全脑ReHo值出现显著变化的脑区,再将这些脑区的平均ReHo值与临床观察指标进行相关分析。结果 与术前相比,患者术后右侧梭状回(FG)和双侧前扣带回(ACC)的ReHo值显著增高(P均0.05),而左侧顶下小叶(IPL)、右侧距状回、右侧颞中回(MTG)、左侧中央后回(PoCG)以及左侧岛叶的ReHo值显著降低(P均0.05)。左侧PoCG的ReHo值与手术前后VAS评分呈正相关,术前右侧MTG的ReHo值与手术前后VAS的变化值呈负相关。结论 PRT术后多个脑区的Re-Ho出现显著变化,这些区域与痛觉感知、情感表达及情绪体验密切相关,其中左侧PoCG具有作为靶点判断疼痛部位及评估疼痛强度的潜在价值。     

新式剖宫产新生儿窒息术中复苏护理

目的:探讨新式副宫产手术后出现新生儿窒息的抢救措施及复苏后护理.方法:30例患儿根据Apgar评分窒息程度分为轻度窒息共26例,重度窒息共4例,接复苏方案对窒息的新生儿进行急救复苏及护理.结果:重度窒息4例在手术室行复苏术后转儿科治疗,轻度窒息26例复苏后直接送产科病房,两组新生儿在护理前后Apgar评分差异均有统计学意义.结论:新生儿窒息抢救成功取决于及时正确的复苏技术及复苏后的护理,快速有效的抢救和严格认真的护理及医护密切配合,是提高抢救剖宫产手术窒息新生儿成功率、降低死亡率的有力保证.     

Effects of sertraline on brain current source of the high beta frequency band: analysis of electroencephalography during audiovisual erotic stimulation in males with premature ejaculation

To identify the effects of sertraline, a selective serotonin reuptake inhibitor, for the treatment of premature ejaculation (PE), changes in brain current-source density (CSD) of the high beta frequency band (22-30 Hz) induced by sertraline administration were investigated during audiovisual erotic stimulation. Eleven patients with PE (36.9±7.8 yrs) and 11 male volunteers (24.2±1.9 years) were enrolled. Scalp electroencephalography (EEG) was conducted twice: once before sertraline administration and then again 4 h after the administration of 50 mg sertraline. Statistical non-parametric maps were obtained using the EEG segments to detect the current-density differences in the high beta frequency bands (beta-3, 22-30 Hz) between the EEGs before and after sertraline administration in the patient group and between the patient group and controls after the administration of sertraline during the erotic video sessions. Comparing between before and after sertraline administration in the patients with PE, the CSD of the high beta frequency band at 4 h after sertraline administration increased significantly in both superior frontal gyri and the right medial frontal gyrus (P<0.01). The CSD of the beta-3 band of the patients with PE were less activated significantly in the middle and superior temporal gyrus, lingual and fusiform gyrus, inferior occipital gyrus and cuneus of the right cerebral hemisphere compared with the normal volunteers 4 h after sertraline administration (P<0.01). In conclusion, sertraline administration increased the CSD in both the superior frontal and right middle temporal gyrus in patients with PE. The results suggest that the increased neural activity in these particular cerebral regions after sertraline administration may be associated with inhibitory effects on ejaculation in patients with PE.     

应用基于体素的形态学测量技术观察帕金森病灰质改变

目的应用基于体素的形态学测量（VBM）方法,研究帕金森病（PD）患者灰质异常区域及分布特征,从结构上初步探讨其与PD患者非运动症状（NMS）的联系。方法采集3.0T高场强MR高分辨T1WI,运用VBM方法对16例PD患者（PD组）及16名健康人（对照组）的大脑灰质图像进行比较,并用VBM对两组数据的灰质密度差异进行分析,结果采用国际通用的统计参数图表示。结果 PD患者的脑灰质密度较对照组广泛降低,这些区域包括双侧颞叶、双侧枕叶、左侧顶叶、左侧壳核、右侧海马、右侧额叶、右侧岛叶及两侧小脑等区域。结论 VBM方法能较全面、准确、定量地表现PD患者广泛存在的脑灰质密度降低区域,为PD患者的NMS提供了脑结构的神经影像学依据。     

Functional MRI of sentence comprehension in children with dyslexia: beyond word recognition

Sentence comprehension (SC) studies in typical and impaired readers suggest that reading for meaning involves more extensive brain activation than reading isolated words. Thus far, no reading disability/dyslexia (RD) studies have directly controlled for the word recognition (WR) components of SC tasks, which is central for understanding comprehension processes beyond WR. This experiment compared SC to WR in 29, 9-14 year olds (15 typical and 14 impaired readers). The SC-WR contrast for each group showed activation in left inferior frontal and extrastriate regions, but the RD group showed significantly more activation than Controls in areas associated with linguistic processing (left middle/superior temporal gyri), and attention and response selection (bilateral insula, right cingulate gyrus, right superior frontal gyrus, and right parietal lobe). Further analyses revealed this overactivation was driven by the RD group's response to incongruous sentences. Correlations with out-of-scanner measures showed that better word- and text-level reading fluency was associated with greater left occipitotemporal activation, whereas worse performance on WR, fluency, and comprehension (reading and oral) were associated with greater right hemisphere activation in a variety of areas, including supramarginal and superior temporal gyri. Results provide initial foundations for understanding the neurobiological correlates of higher-level processes associated with reading comprehension.     

Comparison of brain structure between pain-susceptible and asymptomatic individuals following experimental induction of low back pain

Background ContextPeripheral differences often do not adequately account for variation in reports of pain intensity in people with musculoskeletal pain.PurposeHere we sought to determine the extent to which structural differences in the brain (grey matter density) of pain free individuals might relate to subsequent pain (or lack thereof) after standardized peripheral muscle injury (ie, micro trauma from high intensity exercise).Study DesignThis was an observational laboratory-based study that was a secondary analysis from a larger trial.MethodsParticipants completed baseline testing (functional MRI and quantitative pain testing) followed by high intensity trunk exercise to induce delayed onset muscle soreness in the erector spinae. Forty-eight hours later, back pain intensity ratings were collected and all participants were re-imaged. Grey matter density was determined using voxel-based morphometry. The “asymptomatic” group (no reports of any pain within 48 hours after induction) to a ‘pain’ group (rating of pain at rest and movement pf>20 on a 101-point numeric rating scale).ResultsOur results revealed several large clusters where, compared to participants with pain, asymptomatic participants had significant greater grey matter density. These brain regions included left medial frontal gyrus, left middle occipital gyrus, left middle temporal gyrus, left inferior frontal gyrus, and right superior frontal gyrus.ConclusionsLower grey matter density in brain regions previously linked to discriminative, emotional, and cognitive aspects of cortical processing are associated with reporting musculoskeletal pain after a standardized peripheral muscle injury.Clinical SignificanceCortical gray matter density of people without any pain may influence response to a standardized high intensity exercise protocol. This finding adds further support to the relevance of central factors in explaining the tremendous individual variability in pain report following acute musculoskeletal injury.     

Idiom comprehension: a prefrontal task?

We investigated the neural correlates of idiomatic sentence processing using event-related functional magnetic resonance imaging. Twenty-two healthy subjects were presented with 62 literal sentences and 62 idiomatic sentences, each followed by a picture and were required to judge whether the sentence matched the picture or not. A common network of cortical activity was engaged by both conditions, with the nonliteral task eliciting overall greater activation, both in terms of magnitude and spatial extent. The network that was specifically activated by the nonliteral condition involved the left temporal cortex, the left superior medial frontal gyrus (Brodmann area 9), and the left inferior frontal gyrus (IFG). Activations were also present in the right superior and middle temporal gyri and temporal pole and in the right IFG. In contrast, literal sentences selectively activated the left inferior parietal lobule and the right supramarginal gyrus. An analysis of effective connectivity indicated that the medial prefrontal area significantly increased the connection between frontotemporal areas bilaterally during idiomatic processing. Overall, the present findings indicate a crucial role of the prefrontal cortex in idiom comprehension, which could reflect the selection between alternative sentence meanings.     

心律失常射频消融术后焦虑状态患者的静息态MRI低频振幅分析

目的采用低频振幅(ALFF)观察心律失常射频消融术后出现焦虑状态患者的全脑功能活动。方法收集符合纳入标准的26例心律失常射频消融术(RFCA)后焦虑状态患者作为RFCA组,纳入同期年龄、性别相匹配的26名健康志愿者作为正常对照组,2组均行fMRI,对2组有差异脑区的ALFF进行双样本t检验,提取有差异的脑区与汉密尔顿焦虑量表评分进行偏相关分析。结果与正常对照组相比,RFCA组左侧颞中回、右侧壳核、左侧杏仁核ALFF增高,左侧前额叶背外侧皮层(DLPFC)、右侧楔前叶、左侧额中叶、右侧枕中叶ALFF减低差异有统计学意义(Alphasim校正,P0.01)。左侧DLPFC的ALFF值与HAMA评分呈负相关(r=-0.872,P=0.013)。结论心律失常射频消融术后焦虑状态患者在静息状态下存在脑功能的异常,ALFF有助于为该疾病的发病机制提供更多证据。     

首发抑郁症伴自杀意念患者中缝核功能连接的改变

目的 观察首发抑郁症伴自杀意念（SI）患者中缝核功能连接（FC）改变。方法 前瞻性纳入98例首发抑郁症患者,根据伴SI与否将其分为伴SI组（n=56）与不伴SI组（n=42）;另以47名健康志愿者为对照组。以静息态功能MRI观察背侧中缝核（DRN）、中缝中央核（MRN）与全脑间的FC;比较3组及两两组间FC,分析伴SI组差异脑区FC与临床资料的相关性。结果 相比对照组,伴与不伴SI组DRN与左侧小脑及左侧壳核的FC均降低（P均<0.05）,MRN与右侧颞下回的FC均升高而与左侧额下回、右侧枕上回、左侧顶下小叶及左侧壳核的FC均降低（P均<0.05）;其中,伴SI组DRN与左侧壳核的FC高于不伴SI组（P<0.05）;相比不伴SI组及对照组,伴SI组MRN与右侧中央后回的FC升高（P均<0.05）。伴SI组MRN与左侧壳核的FC与24项汉密尔顿抑郁量表（HAMD-24）体质量得分呈正相关（r_s=0.297,P=0.026）。结论 首发抑郁症伴SI患者中缝核与皮层和皮层下区的FC存在异常改变,且其MRN与左侧壳核的FC与HAMD-24体质量得分呈正相关。     

Specific brain networks during explicit and implicit decoding of emotional prosody

To better define the underlying brain network for the decoding of emotional prosody, we recorded high-resolution brain scans during an implicit and explicit decoding task of angry and neutral prosody. Several subregions in the right superior temporal gyrus (STG) and bilateral in the inferior frontal gyrus (IFG) were sensitive to emotional prosody. Implicit processing of emotional prosody engaged regions in the posterior superior temporal gyrus (pSTG) and bilateral IFG subregions, whereas explicit processing relied more on mid STG, left IFG, amygdala, and subgenual anterior cingulate cortex. Furthermore, whereas some bilateral pSTG regions and the amygdala showed general sensitivity to prosody-specific acoustical features during implicit processing, activity in inferior frontal brain regions was insensitive to these features. Together, the data suggest a differentiated STG, IFG, and subcortical network of brain regions, which varies with the levels of processing and shows a higher specificity during explicit decoding of emotional prosody.