Irony comprehension: Social conceptual knowledge and emotional response

Verbal irony conveys various emotional messages, from criticism to humor, that differ from the meaning of the actual words. To understand irony, we need conceptual knowledge of irony in addition to an understanding of context. We investigated the neural mechanism of irony comprehension, focusing on two overlooked issues: conceptual knowledge and emotional response. We studied 35 healthy subjects who underwent functional MRI. During the scan, the subject examined first‐person‐view stories describing verbal interactions, some of which included irony directed toward the subject. After MRI, the subject viewed the stories again and rated the degree of irony, humor, and negative emotion evoked by the statements. We identified several key findings about irony comprehension: (1) the right anterior superior temporal gyrus may be responsible for representing social conceptual knowledge of irony, (2) activation in the medial prefrontal cortex and the right anterior inferior temporal gyrus might underlie the understanding of context, (3) modulation of activity in the right amygdala, hippocampus, and parahippocampal gyrus is associated with the degree of irony perceived, and (4) modulation of activity in the right dorsolateral prefrontal cortex varies with the degree of humor perceived. Our results clarified the differential contributions of the neural loci of irony comprehension, enriching our understanding of pragmatic language communication from a social behavior point of view. Hum Brain Mapp 35:1167–1178, 2014. © 2013 Wiley Periodicals, Inc.     

Fatigue and relating to others 3 months after the 2011 Great East Japan Earthquake

Most inhabitants of Tohoku district suffer from chronic fatigue after the 2011 Great East Japan Earthquake. Chronic fatigue following disasters may lead to serious illness, even death. Posttraumatic growth appears to counteract fatigue. We predicted that the chronic fatigue would be inversely related to the posttraumatic growth factor “relating to others,” as represented by mutual helping and a strong sense of connection with humanity. Young 59 healthy volunteers, residing in Miyagi prefecture, were recruited 3 months after the disaster. We measured the subjects? total scores on the Japanese version of the Checklist Individual Strength questionnaire (CIS), the Trait Anxiety (T-A) subscale of the State–Trait Anxiety Inventory (STAI), the Center for Epidemiologic Studies Depression Scale (CES-D), and four subscores on the posttraumatic growth inventory (PTGI). Stepwise regression analyses were conducted with score on the CIS as the dependent variable and other scores as independent variables. Scores on the “relating to others” factor of the PTGI showed a significant negative relationship with the CIS score, whereas the scores on the T-A subscale of the STAI and the CES-D were positively related to the CIS score. Human ties and mutual help were negatively related to the degree of the chronic fatigue.     

Vulnerable atherosclerotic plaque features: findings from coronary imaging

Pathological studies have suggested that features of vulnerable atherosclerotic plaques likely to progress and lead to acute cardiovascular events have specific characteristics. Given the progress of intravascular coronary imaging technology, some large prospective studies have detected features of vulnerable atherosclerotic plaques using these imaging modalities. However, the rate of cardiovascular events, such as acute coronary syndrome, has been found to be considerably reduced in the limited follow-up period available in the statin era. Additionally, not all disrupted plaques lead to thrombus formation with clinical presentation. If sub-occlusive or occlusive thrombus formation does not occur, a thrombus on a disrupted plaque will organize without any symptoms, forming a “healed plaque”. Although vulnerable plaque detection using intracoronary imaging is focused on “thin-cap fibroatheroma” leading to plaque rupture, superficial plaque erosion is increasingly recognized; however, the underlying mechanism of thrombus formation on eroded plaques is not well understood. One of intravascular imaging, optical coherence tomography (OCT) has the highest image resolution and has enabled detailed characterization of the plaque in vivo. Here, we reviewed the status and limitations of intravascular imaging in terms of detecting vulnerable plaque through mainly OCT studies. We suggested that vulnerable plaque should be reconsidered in terms of eroded plaque and healed plaque and that both plaque and circulating blood should be assessed in greater detail accordingly.

Acute coronary syndrome (ACS) remains a major cause of morbidity and mortality worldwide. For decades, pathological and fundamental studies have primarily focused on “vulnerable plaque” resulting in ACS. The term “vulnerable plaque”, introduced in the late 1980s, refers to a coronary plaque that is most likely to result in plaque rupture.^[1] Although plaque rupture is the most frequent autopsy finding in patients with sudden cardiac death,^[2–4] plaque erosion or calcified nodules are reported to be other underlying mechanisms contributing to ACS.^[2] In the clinical setting, optical coherence tomography (OCT), a high resolution intracoronary imaging modality, has enabled characterization of the culprit plaque that are more in line with the aforementioned diagnosis of the three pathologies in the autopsy studies.^[5] Moreover, studies using OCT have demonstrated plaque erosion to be more common than previously considered.^[6] The representative three types of culprit plaque on OCT images are shown in Figure 1. Naghavi, et al.^[7] recommended that vulnerable plaque be defined in terms of morphological features to include all dangerous plaques that involve a risk of thrombosis and/or rapid progression. In addition, they suggested that not only plaque but also circulating blood plays an important role in the development of ACS.^[7] However, most intracoronary imaging studies concerning vulnerable plaque as a predisposition to ACS have focused on plaque rupture, which is frequently referred to as thin-cap fibroatheroma (TCFA). Figure 2 shows a typical OCT image of TCFA. Additionally, although ACS predominantly arises from occlusive or sub-occlusive coronary thrombosis due to disrupted plaques, non-flow-limiting thrombus may heal without clinical manifestations^[8] and it has been proposed that the healing process of disrupted plaques contributes to the episodic progression of coronary artery stenosis.^[9–12] Herein, we review the present status and the limitations of current intracoronary imaging modalities based on ACS pathogenesis, and we reevaluate the nature of vulnerable plaque through mainly OCT studies. Open in a separate windowFigure 1Representative OCT images of three types of ACS pathologies.(A): Plaque rupture was defined as the presence of fibrous cap discontinuity with a communication between the lumen and the inner core of plaque or with a cavity formation within the plaque; (B): plaque erosion was identified as the presence of an attached thrombus overlying an intact and visualized plaque, luminal surface irregularity at the culprit lesion in the absence of a thrombus, or attenuation of the underlying plaque by a thrombus without superficial lipid or calcification immediately proximal or distal to the site of the thrombus; and (C): calcified plaque was defined as the presence of superficial substantive calcium at the culprit site without evidence of a ruptured lipid plaque. ACS: acute coronary syndrome; OCT: optical coherence tomography.Open in a separate windowFigure 2Representative OCT image of TCFA.(A): Lipid plaque, defined as a signal poor region with a poorly defined or diffuse border, is shown in the whole circumference (white asterisks); and (B): the minimum fibrous thickness was measured as < 65 μm (enlarged view). OCT: optical coherence tomography; TCFA: thin cap fibroatheroma.     

Spitz nevus of the palate. Report of a case

A 4-year-old Japanese girl with a nonpigmented nodule on the anterior portion of the palate since birth is described. The overall microscopic appearance of the lesion was very similar to that of Spitz nevus of the skin. Diagnosis of Spitz nevus (mixed epithelioid cell and spindle cell nevus) was made on the basis of the clinical and histologic criteria for differentiating this lesion from malignant melanomas and common compound nevi. Positive immunostaining of epithelioid and spindle cells for S-100 protein and neuron-specific enolase was also indicative of their nevocellular nature. Review of the cases of Spitz nevus from the literature revealed that the present case most probably represents the first reported instance of this type of nevus in the oral cavity.     

Lateral and Mediastinal Lymph Node Dissection in Differentiated Thyroid Carcinoma: Indications,Benefits, and Risks

Background There are 3 compartments of regional lymph nodes to which thyroid carcinoma metastasizes: central, lateral, and mediastinal compartments. The central compartment is the nearest to the thyroid and usually dissected routinely. However, the indication for dissection of the lateral and mediastinal compartments for differentiated thyroid carcinoma remains an open question. Methods The indication for dissection of lateral and mediastinal compartments is evaluated based on previous reports, including those from our department. Results There is nothing controversial about the indication for therapeutic lateral node dissection for tumors with clinically apparent lateral node metastasis. Such cases are more likely to show recurrence, especially in previously dissected compartments, and surgeons must perform dissection carefully. Although there are no randomized studies on the indication for prophylactic lateral node dissection, it is recommended for papillary carcinoma with aggressive characteristics such as large size and massive extrathyroid extension. Prophylactic mediastinal dissection via median sternotomy is not recommended. Conclusions Node dissection of the lateral and mediastinal compartments must be performed aggressively and radically to prevent recurrence in previously dissected regions.     

Prognosis of Patients with Benign Thyroid Diseases Accompanied by Incidental Papillary Carcinoma Undetectable on Preoperative Imaging Tests

Background Despite the recent wide availability of ultrasonography and fine-needle aspiration biopsy, endocrine surgeons often encounter incidental papillary carcinoma (IPC), that is a papillary carcinoma that had gone undetected by preoperative imaging studies but was identified by pathological examination of surgical specimens resected for benign thyroid diseases. Methods The present study was developed to investigate the prognoses of 317 patients who underwent surgery for benign diseases involving IPC in comparison with the prognoses of 1,674 patients with clinically apparent papillary carcinoma detected preoperatively and diagnosed. Results None of the patients underwent further surgery such as completion total thyroidectomy and node dissection immediately after the diagnosis of IPC. To date, 7 patients (2.2%) have had recurrences; 6 of those were locoregional recurrences and one was a bone metastasis. None of the patients have died of thyroid carcinoma. The disease-free survival of IPC patients was significantly better than that of clinically apparent papillary carcinoma patients and was similar to that of the subset of patients with papillary microcarcinoma without clinically apparent metastasis. Conclusions Because IPC is associated with good prognosis, further surgery, such as completion total thyroidectomy or lymph node dissection immediately after the diagnosis of IPC is not necessary.