太溪和丘墟穴捻针时不同脑功能区的激活

A number of previous studies of acupuncture acupoint specificity have used sham acupoints,sham acupuncture or meridian acupoints at a great distance from each other as controls in functional MRI (fMRI) experiments.However,few studies have compared different meridian acupoints within the same segment,which are associated with similarly intense needle sensations.We performed fMRI on 12 healthy young volunteers and observed differences in brain activation elicited by acupuncture of the Taixi (KI 3) and Qiuxu (GB 40) acupoints.Acupuncture was applied at the Taixi and Qiuxu acupoints,using a multiple-block fMRI design with three blocks,involving three alternations of resting and task phases.After scanning,needle sensation was assessed.The behavioral results revealed that the subjective needle sensation was similar between the Taixi and Qiuxu acupoints.The fMRI results revealed that acupuncture at the right Taixi acupoint activated the right superior temporal gyrus (BA 22),left middle frontal gyrus (BA 46) and inferior frontal gyrus (BA 45),bilateral parietal lobe postcentral gyrus (BA 2),right parietal lobe (BA 3),and left parietal lobe (BA 40).Acupuncture at the right Qiuxu acupoint activated the left superior temporal gyrus (BA 42),right parietal lobe postcentral gyrus (BA 40,BA 43),right inferior frontal gyrus (BA 47),bilateral superior temporal gyrus (BA 22),and right insula BA13.These results suggest that the right Taixi and Qiuxu acupoints activated different brain areas.     

Modulatory effect of International standard Scalp Acupuncture on brain activation in the elderly as revealed by resting-state fMRI

The specific mechanisms by which acupuncture affects the central nervous system are unclear. In the International Standard Scalp Acupuncture system, acupuncture needles are applied at the middle line of the vertex, anterior parietal-temporal oblique line, and the posterior parietal-temporal oblique line. We conducted a single-arm prospective clinical trial in which seven healthy elderly volunteers(three men and four women; 50–70 years old) received International Standard Scalp Acupuncture at MS5(the mid-sagittal line between Baihui(DU20) and Qianding(DU21)), the left MS6(line joining Sishencong(EX-HN1) and Xuanli(GB6)), and the left MS7(line joining DU20 and Qubin(GB7)).After acupuncture, resting-state functional magnetic resonance imaging demonstrated changes in the fractional amplitude of low frequency fluctuations and regional homogeneity in various areas, showing remarkable enhancement of regional homogeneity in the bilateral anterior cingulate, left medial frontal gyrus, supramarginal gyrus, right middle frontal gyrus, and inferior frontal gyrus. Functional connectivity based on a seed region at the right middle frontal gyrus(42, 51, 9) decreased at the bilateral medial superior frontal gyrus. Our data preliminarily indicates that the international standard scalp acupuncture in healthy elderly participants specifcally enhances the correlation between the brain regions involved in cognition and implementation of the brain network regulation system and the surrounding adjacent brain regions.The study was approved by the Ethics Committee of the China-Japan Union Hospital at Jilin University, China, on July 18, 2016(approval No.2016 ks043).     

Brain functional changes in facial expression recognition in patients with major depressive disorder before and after antidepressant treatment A functional magnetic resonance imaging study

Functional magnetic resonance imaging was used during emotion recognition to identify changes in functional brain activation in 21 first-episode, treatment-naive major depressive disorder patients before and after antidepressant treatment. Following escitalopram oxalate treatment, patients exhibited decreased activation in bilateral precentral gyrus, bilateral middle frontal gyrus, left middle temporal gyrus, bilateral postcentral gyrus, left cingulate and right parahippocampal gyrus, and increased activation in right superior frontal gyrus, bilateral superior parietal lobule and left occipital gyrus during sad facial expression recognition. After antidepressant treatment, patients also exhibited decreased activation in the bilateral middle frontal gyrus, bilateral cingulate and right parahippocampal gyrus, and increased activation in the right inferior frontal gyrus, left fusiform gyrus and right precuneus during happy facial expression recognition. Our experimental findings indicate that the limbic-cortical network might be a key target region for antidepressant treatment in major depressive disorder.     

Acupuncture for ischemic stroke:cerebellar activation may be a central mechanism following Deqi

The needling sensation of Deqi during acupuncture is a key factor of influencing acupuncture outcome.Recent studies have mainly focused on the brain function effects of Deqi in a physiological state.Functional magnetic resonance imaging(f MRI)on the effects of acupuncture at Waiguan(SJ5)in pathological and physiological states is controversial.In this study,12 patients with ischemic stroke received acupuncture at Waiguan(SJ5)and simultaneously underwent f MRI scanning of the brain,with imaging data of the activated areas obtained.Based on the patient’s sensation,imaging data were allocated to either the Deqi group or non-Deqi group.In the Deqi group,the activated/deactivated areas were the left superior temporal gyrus(BA39)/right anterior lobe of the cerebellum and left thalamus.In the non-Deqi group,the activated areas included the medial frontal gyrus of the right frontal lobe(BA11),right limbic lobe(BA30,35),and left frontal lobe(BA47),while the only deactivated area was the right parietal lobe(BA40).Compared with the non-Deqi group,the Deqi group exhibited marked activation of the right anterior lobe of the cerebellum and right limbic lobe(BA30).These findings confirm that the clinical effect of Deqi during acupuncture is based on brain functional changes.Cerebellar activation may be one of the central mechanisms of acupuncture in the treatment of ischemic stroke.     

Changes of brain gray matter structure in Parkinson’s disease patients with dementia

Voxel-based morphometry is gaining considerable interest for studies examining Parkinson’s disease dementia patients.In this study,12 patients with clinically defined Parkinson’s disease and dementia and 12 non-demented patients with Parkinson’s disease were examined using a T1WI three-dimensional fast spoiled gradient echo sequence.Gray matter data were analyzed using a voxel-based morphometry method and independent sample t-test based on Statistical Parametric Mapping 5 software.Differences in gray matter volume were represented with statistical parametric mapping.Compared with Parkinson’s disease patients without dementia,decreased gray matter volume in Parkinson’s disease dementia patients was observed in the bilateral superior temporal gyrus,bilateral posterior cingulate and left cingulate gyrus,right parahippocampal gyrus and hippocampus,right precuneus and right cuneus,left inferior frontal gyrus and left insular lobe.No increased gray matter volume was apparent.These data indicate that gray matter atrophy in the limbic system and cerebral neocortex is related to the presence of dementia.     

帕金森静止性震颤者脑局部一致性的功能磁共振评价

Regional homogeneity analysis of low-frequency blood oxygenation level-dependent signals from neighboring voxels enables the analysis of local neuronal synchrony. Both structural magnetic resonance imaging and resting-state functional magnetic resonance imaging scans were collected from nine Parkinson’s disease patients with right resting tremor, and from eight age-matched normal controls. Regional homogeneity was compared between Parkinson’s disease patients and controls. The results revealed that regional homogeneity was increased in several brain regions, including the right precuneus, right superior parietal gyrus, left anterior cingulate cortex, right middle frontal gyrus and right inferior frontal gyrus. Conversely, regional homogeneity was decreased in the cerebellar vermis in Parkinson’s disease patients compared with healthy controls.     

Regional gray matter atrophy and neuropsychologcal problems in relapsing-remitting multiple sclerosis

In multiple sclerosis, gray matter atrophy is extensive, and cognitive deficits and mood disorders are frequently encountered. It has been conjectured that focal atrophy is associated with emotional decline. However, conventional MRI has revealed that the pathological characteristics cannot fully account for the mood disorders. Moreover, there is no correlation between cognitive disorders and MRI results in clinically isolated syndromes or in cases of definite multiple sclerosis. In this casecontrol study, voxel-based morphometric analysis was performed on 11 subjects with relapsing-remitting multiple sclerosis, and the results show that these patients exhibit gray matter atrophy. Moreover, the gray matter atrophy in the superior and middle gyri of the right frontal lobe in patients with multiple sclerosis was correlated with scores from the Hamilton Anxiety Rating Scale. The scores obtained with the Repeatable Battery for the Assessment of Neuropsychological Status were associated with gray matter atrophy in the middle gyrus of the left frontal lobe, the superior and middle gyrus of the right frontal lobe, the middle gyrus of the left cingulate, the superior and middle gyri of the left frontal lobe, and the triangular area of the left frontal lobe. However, there was no statistical significance. These findings suggest that the cingulate and frontal cortices of the dominant hemisphere are the most severely atrophic regions of the brain, and this atrophy is correlated with cognitive decline and emotional abnormalities.     

Acupuncture at Waiguan （SJ5） and sham points influences activation of functional brain areas of ischemic stroke patients： a functional magnetic resonance imaging study

Most studies addressing the specificity of meridians and acupuncture points have focused mainly on the different neural effects of acupuncture at different points in healthy individuals. This study examined the effects of acupuncture on brain function in a pathological context. Sixteen patients with ischemic stroke were randomly assigned to true point group （true acupuncture at right Waiguan （SJ5）） and sham point group （sham acupuncture）. Results of functional magnetic resonance imaging revealed activation in right parietal lobe （Brodmann areas 7 and 19）, the right temporal lobe （Brodmann area 39）, the right limbic lobe （Brodmann area 23） and bilateral oc-cipital lobes （Brodmann area 18）. Furthermore, inhibition of bilateral frontal lobes （Brodmann area 4, 6, and 45）, right parietal lobe （Brodmann areas 1 and 5） and left temporal lobe （Brodmann area 21 ） were observed in the true point group. Activation in the precuneus of right parietal lobe （Brodmann area 7） and inhibition of the left superior frontal gyrus （Brodmann area 10） was observed in the sham group. Compared with sham acupuncture, acupuncture at Waiguan in stroke patients inhibited Brodmann area 5 on the healthy side. Results indicated that the altered specificity of sensation-associated cortex （Brodmann area 5） is possibly associated with a central mechanism of acupuncture at Waiguan for stroke patients.     

Brain activation and inhibition after acupuncture at Taichong and Taixi: resting-state functional magnetic resonance imaging

Acupuncture can induce changes in the brain. However, the majority of studies to date have focused on a single acupoint at a time. In the present study, we observed activity changes in the brains of healthy volunteers before and after acupuncture at Taichong(LR3) and Taixi(KI3) using resting-state functional magnetic resonance imaging. Fifteen healthy volunteers underwent resting-state functional magnetic resonance imaging of the brain 15 minutes before acupuncture, then received acupuncture at Taichong and Taixi using the nail-pressing needle insertion method, after which the needle was retained in place for 30 minutes. Fifteen minutes after withdrawal of the needle, the volunteers underwent a further session of resting-state functional magnetic resonance imaging, which revealed that the amplitude of low-frequency fluctuation, a measure of spontaneous neuronal activity, increased mainly in the cerebral occipital lobe and middle occipital gyrus(Brodmann area 18/19), inferior occipital gyrus(Brodmann area 18) and cuneus(Brodmann area 18), but decreased mainly in the gyrus rectus of the frontal lobe(Brodmann area 11), inferior frontal gyrus(Brodmann area 44) and the center of the posterior lobe of the cerebellum. The present findings indicate that acupuncture at Taichong and Taixi specifically promote blood flow and activation in the brain areas related to vision, emotion and cognition, and inhibit brain areas related to emotion, attention, phonological and semantic processing, and memory.     

Structural changes in the gray matter of unmedicated patients with obsessive-compulsive disorder: a voxel-based morphometric study

The aim of the current study was to use whole brain voxel-based morphometry（VBM）to assess the gray matter（GM）changes in unmedicated patients with obsessive-compulsive disorder（OCD）compared with normal controls.We compared the GM volumes in28 patients with 22 matched healthy controls using a1.5T MRI.Three-dimensional T1-weighted magnetic resonance images were obtained from all participants.VBM was performed to detect GM volume differences between the two groups.We detected increased regional GM volumes in the bilateral middle temporal gyri,bilateral middle occipital gyri,bilateral globus pallidus,right inferior parietal gyrus,left superior parietal gyrus,right parahippocampus,right supramarginal gyrus,right medial superior frontal gyrus,and left inferior frontal opercular cortex in the OCD patients relative to controls（P〈0.001,uncorrected,cluster size〉100 voxels）.No decreased GM volume was found in the OCD group compared with normal controls.Our findings suggest that structural changes in the GM are not limited to fronto-striato-thalamic circuits in the pathogenesis of OCD.Temporo-parietal cortex may also play an important role.     

Why psychosis is frequently associated with Parkinson's disease?

Psychosis is a common non-motor symptom of Parkinson’s disease whose pathogenesis remains poorly understood.Parkinson’s disease in conjunction with psychosis has been shown to induce injury to extracorticospinal tracts as well as within some cortical areas.In this study,Parkinson’s disease patients with psychosis who did not receive antipsychotic treatment and those without psychosis underwent diffusion tensor imaging.Results revealed that in Parkinson’s disease patients with psychosis,damage to the left frontal lobe,bilateral occipital lobe,left cingulated gyrus,and left hippocampal white-matter fibers were greater than damage to the substantia nigra or the globus pallidus.Damage to white-matter fibers in the right frontal lobe and right cingulate gyrus were also more severe than in the globus pallidus,but not the substantia nigra.Damage to frontal lobe and cingulate gyrus white-matter fibers was more apparent than that to occipital or hippocampal fiber damage.Compared with Parkinson’s disease patients without psychosis,those with psychosis had significantly lower fractional anisotropy ratios of left frontal lobe,bilateral occipital lobe,left cingulated gyrus,and left hippocampus to ipsilateral substantia nigra or globus pallidus,indicating more severe damage to white-matter fibers.These results suggest that psychosis associated with Parkinson’s disease is probably associated with an imbalance in the ratio of white-matter fibers between brain regions associated with psychiatric symptoms(frontal lobe,occipital lobe,cingulate gyrus,and hippocampus) and those associated with the motor symptoms of Parkinson’s disease(the substantia nigra and globus pallidus).The relatively greater damage to white-matter fibers in psychiatric symptom-related brain regions than in extracorticospinal tracts might explain why psychosis often occurs in Parkinson’s disease patients.     

Regional brain structural abnormality in ischemic stroke patients：a voxel-based morphometry study

Our previous study used regional homogeneity analysis and found that activity in some brain areas of patients with ischemic stroke changed significantly.In the current study,we examined structural changes in these brain regions by taking structural magnetic resonance imaging scans of 11 ischemic stroke patients and 15 healthy participants,and analyzing the data using voxel-based morphometry.Compared with healthy participants,patients exhibited higher gray matter density in the left inferior occipital gyrus and right anterior white matter tract.In contrast,gray matter density in the right cerebellum,left precentral gyrus,right middle frontal gyrus,and left middle temporal gyrus was less in ischemic stroke patients.The changes of gray matter density in the middle frontal gyrus were negatively associated with the clinical rating scales of the Fugl-Meyer Motor Assessment(r=–0.609,P=0.047) and the left middle temporal gyrus was negatively correlated with the clinical rating scales of the nervous functional deficiency scale(r=–0.737,P=0.010).Our findings can objectively identify the functional abnormality in some brain regions of ischemic stroke patients.     

Evidence of cortical reorganization of language networks atfer stroke with subacute Broca’s aphasia:a blood oxygenation level dependent-functional magnetic resonance imaging study

Aphasia is an acquired language disorder that is a common consequence of stroke. hTe pathogenesis of the disease is not fully understood, and as a result, current treatment options are not satisfactory. Here, we used blood oxygenation level-dependent functional magnetic reso-nance imaging to evaluate the activation of bilateral cortices in patients with Broca’s aphasia 1 to 3 months atfer stroke. Our results showed that language expression was associated with multiple brain regions in which the right hemisphere participated in the generation of lan-guage. hTe activation areas in the letf hemisphere of aphasia patients were signiifcantly smaller compared with those in healthy adults. hTe activation frequency, volumes, and intensity in the regions related to language, such as the letf inferior frontal gyrus (Broca’s area), the letf superior temporal gyrus, and the right inferior frontal gyrus (the mirror region of Broca’s area), were lower in patients compared with healthy adults. In contrast, activation in the right superior temporal gyrus, the bilateral superior parietal lobule, and the letf inferior temporal gyrus was stronger in patients compared with healthy controls. hTese results suggest that the right inferior frontal gyrus plays a role in the recovery of language function in the subacute stage of stroke-related aphasia by increasing the engagement of related brain areas.     

Regional volume changes of the brain in migraine chronification

The pathophysiology of migraine is complex.Neuroimaging studies reveal functional and structural changes in the brains of migraine patients.We sought to explore regional volume differences in intracranial structures in patients with episodic and chronic migraine.Sixteen episodic migraine patients,16 chronic migraine patients,and 24 normal controls were recruited and underwent 3.0 T MRI scanning.The volumes of 142 brain regions were calculated by an automatic volumetric algorithm and compared with clinical variables.Results demonstrated that the volumes of specific regions in the frontal and occipital lobes,and the right putamen,were increased and the volume of the fourth ventricle was decreased in the episodic migraine patients compared with controls.The volumes of the left basal forebrain,optic chiasm,and,the fourth ventricle were decreased in the chronic migraine patients,while the occipital cortex and the right putamen were larger.Compared to episodic migraine patiants,chronic migraine patients displayed larger left thalamus and smaller frontal regions.Correlation analysis showed that headache frequency was negatively correlated with the volume of the right frontal pole,right lateral orbital gyrus,and medial frontal lobes and positively correlated with the volume of the left thalamus.The sleep disturbance score was negatively correlated with the volume of the left basal forebrain.This suggests that migraine patients have structural changes in regions associated with pain processing and modulation,affective and cognitive processing,and visual perception.The remodeling of selective intracranial structures may be involved in migraine attacks.This study was approved by the Ethics Committee of Chinese PLA General Hospital(approval No.S2018-027-02)on May 31,2018.     

Modulatory effects of acupuncture on brain networks in mild cognitive impairment patients

Functional magnetic resonance imaging has been widely used to investigate the effects of acupuncture on neural activity. However, most functional magnetic resonance imaging studies have focused on acute changes in brain activation induced by acupuncture. Thus, the time course of the therapeutic effects of acupuncture remains unclear. In this study, 32 patients with amnestic mild cognitive impairment were randomly divided into two groups, where they received either Tiaoshen Yizhi acupuncture or sham acupoint acupuncture. The needles were either twirled at Tiaoshen Yizhi acupoints, including Sishencong(EX-HN1), Yintang(EX-HN3), Neiguan(PC6), Taixi(KI3), Fenglong(ST40), and Taichong(LR3), or at related sham acupoints at a depth of approximately 15 mm, an angle of ± 60°, and a rate of approximately 120 times per minute. Acupuncture was conducted for 4 consecutive weeks, five times per week, on weekdays. Resting-state functional magnetic resonance imaging indicated that connections between cognition-related regions such as the insula, dorsolateral prefrontal cortex, hippocampus, thalamus, inferior parietal lobule, and anterior cingulate cortex increased after acupuncture at Tiaoshen Yizhi acupoints. The insula, dorsolateral prefrontal cortex, and hippocampus acted as central brain hubs. Patients in the Tiaoshen Yizhi group exhibited improved cognitive performance after acupuncture. In the sham acupoint acupuncture group, connections between brain regions were dispersed, and we found no differences in cognitive function following the treatment. These results indicate that acupuncture at Tiaoshen Yizhi acupoints can regulate brain networks by increasing connectivity between cognition-related regions, thereby improving cognitive function in patients with mild cognitive impairment.     

Grey matter volume abnormalities in patients with bipolar I depressive disorder and unipolar depressive disorder:a voxelbased morphometry study

Bipolar disorder and unipolar depressive disorder(UD) may be different in brain structure. In the present study,we performed voxel-based morphometry(VBM) to quantify the grey matter volumes in 23 patients with bipolar I depressive disorder(BP1) and 23 patients with UD,and 23 age-,gender-,and educationmatched healthy controls(HCs) using magnetic resonance imaging. We found that compared with the HC and UD groups,the BP1 group showed reduced grey matter volumes in the right inferior frontal gyrus and middle cingulate gyrus,while the UD group showed reduced volume in the right inferior frontal gyrus compared to HCs. In addition,correlation analyses revealed that the grey matter volumes of these regions were negatively correlated with the Hamilton depression rating scores. Taken together,the results of our study suggest that decreased grey matter volume of the right inferior frontal gyrus is a common abnormality in BP1 and UD,and decreasedgrey matter volume in the right middle cingulate gyrus may be specifi c to BP1.     

Quantification of Tc-99m-ethyl cysteinate dimer brain single photon emission computed tomography images using statistical probabilistic brain atlas in depressive end-stage renal disease patients:Correlation with disease severity and symptom factors

This study adapted a statistical probabilistic anatomical map of the brain for single photon emission computed tomography images of depressive end-stage renal disease patients. This research aimed to investigate the relationship between symptom clusters, disease severity, and cerebral blood flow. Twenty-seven patients (16 males, 11 females) with stages 4 and 5 end-stage renal disease were enrolled, along with 25 healthy controls. All patients underwent depressive mood assessment and brain single photon emission computed tomography. The statistical probabilistic anatomical map images were used to calculate the brain single photon emission computed tomography counts. Asymmetric index was acquired and Pearson correlation analysis was performed to analyze the correlation between symptom factors, severity, and regional cerebral blood flow. The depression factors of the Hamilton Depression Rating Scale showed a negative correlation with cerebral blood flow in the left amygdale. The insomnia factor showed negative correlations with cerebral blood flow in the left amygdala, right superior frontal gyrus, right middle frontal gyrus, and left middle frontal gyrus. The anxiety factor showed a positive correlation with cerebral glucose metabolism in the cerebellar vermis and a negative correlation with cerebral glucose metabolism in the left globus pallidus, right inferior frontal gyrus, both temporal poles, and left parahippocampus. The overall depression severity (total scores of Hamilton Depression Rating Scale) was negatively correlated with the statistical probabilistic anatomical map results in the left amygdala and right inferior frontal gyrus. In conclusion, our results demonstrated that the disease severity and extent of cerebral blood flow quantified by a probabilistic brain atlas was related to various brain areas in terms of the overall severity and symptom factors in end-stage renal disease patients.     

精神分裂症患者记忆围棋子位置时的脑激活区域

BACKGROUND： Go, a traditional Chinese chess-like game, requires many unknown functions of the brain including attention, imaging, problem solving and processing of spatial working memory. To date, it remains uncertain whether the intellectual activities required to play Go are related to the frontal lobe. OBJECTIVE： To investigate various patterns of brain region activity while schizophrenic patients and normal subjects engaged in memorizing piece placement in the Chinese game of Go. Spatial working memory was measured in order to validate whether the prefrontal lobe participates in this memory process.
DESIGN, TIME AND SETTING： Non-randomized, concurrent control trial was performed at Second Xiangya Hospital of Central South University, between May and December 2004.
PARTICIPANTS： A total of nine Chinese schizophrenic patients with no brain or bodily diseases and not undergoing electroshock treatment, who were in accordance with the DSM-Ⅳ criteria for schizophrenia, as well as thirteen healthy staffs and students with matched age, sex, and education were included. Patients and control subjects had no neurological disorders or mental retardation. In addition, all participants were right-handed. METHODS： The cognitive task for functional magnetic resonance imaging was a block design experiment. Both groups were asked to remember the placement of pieces in the Chinese game of Go on a computer screen. A brain activation map was analyzed in SPM99.
MAIN OUTCOME MEASURES： Brain responses were compared with regard to activation region size, volume, and asymmetry indices. RESULTS： Compared with the control group, the reaction time was significantly delayed in schizophrenics performing the working memory task （P 〈 0.05）. When performing the tasks, normal subjects showed significant activation of the bilateral dorsolateral prefrontal lobe with left dominance; the asymmetry indices were： frontal lobe, ＋0.32; temporal lobe, 0.58; parietal lobe, 0.41 ; and occipital lobe, 0.34. On the other hand, schizophrenics showed right dominance and had a broader activation region of the prefrontal lobe （asymmetry indices： frontal lobe, 0.10; temporal lobe, ＋0.38; parietal lobe, ＋0.24; and occipital lobe, 0.00）. When comparing the normal group subtracted with the schizophrenic group, no significant lateralization was found in the frontal lobes but significant activation was found in the left anterior central gyrus, left middle frontal gyrus and in both sides of the cingulate gyrus. Comparing the schizophrenic group subtracted with the normal group, there was significant right lateralization of the frontal lobe and abnormally activated regions on both sides of the anterior central gyrus, middle frontal gyrus, left inferior frontal gyrus, right medial frontal gyrus and the right insular lobe. CONCLUSION： Different brain activation regions are involved in memorizing the placement of pieces in Chinese Go between schizophrenia and healthy subjects. Schizophrenics showed right dominance and border activation range, indicating that the prefrontal cortex plays an important role in memory information processing and resource allocation when remembering piece placement in the game of Go.     

Lesion localization of global aphasia without hemiparesis by overlapping of the brain magnetic resonance images

Global aphasia without hemiparesis is a striking stroke syndrome involving language impairment without the typically manifested contralateral hemiparesis, which is usually seen in patients with global aphasia following large left perisylvian lesions. The objective of this study is to elucidate the specific areas for lesion localization of global aphasia without hemiparesis by retrospectively studying the brain magnetic resonance images of six patients with global aphasia without hemiparesis to define global aphasia without hemiparesis-related stroke lesions before overlapping the images to visualize the most overlapped area. Talairach coordinates for the most overlapped areas were converted to corresponding anatomical regions. Lesions where the images of more than three patients overlapped were considered significant. The overlapped global aphasia without hemiparesis related stroke lesions of six patients revealed that the significantly involved anatomi- cal lesions were as follows： frontal lobe, sub-gyral, sub-lobar, extra-nuclear, corpus callosum, and inferior frontal gyrus, while caudate, claustrum, middle frontal gyrus, limbic lobe, temporal lobe, superior temporal gyrus, uncus, anterior cingulate, parahippocampal, amygdala, and subcallosal gyrus were seen less significantly involved. This study is the first to demonstrate the heterogeneous anatomical involvement in global aphasia without hemiparesis by overlapping of the brain magnetic resonance images.     

Assessing gray matter volume in patients with idiopathic rapid eye movement sleep behavior disorder

Idiopathic rapid eye movement sleep behavior disorder(iRBD) is often a precursor to neurodegenerative disease. However, voxel-based morphological studies evaluating structural abnormalities in the brains of iRBD patients are relatively rare. This study aimed to explore cerebral structural alterations using magnetic resonance imaging and to determine their association with clinical parameters in iRBD patients. Brain structural T1-weighted MRI scans were acquired from 19 polysomnogram-confirmed iRBD patients(male:female 16:3; mean age 66.6 ± 7.0 years) and 20 age-matched healthy controls(male:female 5:15; mean age 63.7 ± 5.9 years). Gray matter volume(GMV) data were analyzed based on Statistical Parametric Mapping 8, using a voxel-based morphometry method and two-sample t-test and multiple regression analysis. Compared with controls, iRBD patients had increased GMV in the middle temporal gyrus and cerebellar posterior lobe, but decreased GMV in the Rolandic operculum, postcentral gyrus, insular lobe, cingulate gyrus, precuneus, rectus gyrus, and superior frontal gyrus. iRBD duration was positively correlated with GMV in the precuneus, cuneus, superior parietal gyrus, postcentral gyrus, posterior cingulate gyrus, hippocampus, lingual gyrus, middle occipital gyrus, middle temporal gyrus, and cerebellum posterior lobe. Furthermore, phasic chin electromyographic activity was positively correlated with GMV in the hippocampus, precuneus, fusiform gyrus, precentral gyrus, superior frontal gyrus, cuneus, inferior parietal lobule, angular gyrus, superior parietal gyrus, paracentral lobule, and cerebellar posterior lobe. There were no significant negative correlations of brain GMV with disease duration or electromyographic activity in iRBD patients. These findings expand the spectrum of known gray matter modifications in iRBD patients and provide evidence of a correlation between brain dysfunction and clinical manifestations in such patients. The protocol was approved by the Ethics Committee of Huashan Hospital(approval No. KY2013-336) on January 6, 2014. This trial was registered in the ISRCTN registry(ISRCTN18238599).