Thyroid carcinomas with a variable insular component: prognostic significance of histopathologic patterns

BACKGROUND: An insular growth pattern may be observed focally both in papillary and follicular thyroid carcinoma. The aim of the current study was to determine whether a greater extension of the insular component (IC) influences different clinical and histologic features at diagnosis, and a different tumor aggressiveness in terms of frequency in the occurrence of metastases as well as survival. METHODS: Thirty-three patients with histopathologic findings consistent with IC were included in the study. IC was focal (<50% of the tumor area) in 16 patients and predominant (>50% of the tumor area) in 17 patients. These 2 groups were compared with a control group of 66 patients with differentiated thyroid carcinoma. RESULTS: At diagnosis, carcinomas with predominant IC differed from those with focal IC with regard to greater tumor size and a higher frequency of extrathyroidal extension and distant metastases. Patient follow-up ranged from 5 to 188 months. The cumulative rate of distant metastases was significantly higher in patients with predominant IC. At the time of last follow-up, carcinomas with predominant IC demonstrated a lesser frequency of disease-free outcome (P = .002) and a higher number of tumor-related deaths (P = .002), either when distant metastases were present (P = .03) or absent (P = .05) at the time of diagnosis. CONCLUSIONS: The presence of predominant IC is associated with a poor prognosis in terms of ongoing disease or death. Predominant IC should be considered a separate entity from not only the classical papillary or follicular carcinomas but also the focal IC tumor.     

Insular thyroid carcinoma in a patient with Cowden syndrome

Cowden syndrome is an autosomal dominant disorder characterized by benign and malignant hamartomatous lesions that can develop from all three germ cell derivatives. This disorder predisposes patients to develop malignant tumors of the breast, endometrium, and thyroid. We present a patient with clinically relevant manifestations of Cowden syndrome, with genetic verification, impacting by way of airway compromise due to hamartomas, urinary tract abnormalities, and insular thyroid cancer. This case illustrates the value of recognizing Cowden syndrome at an earlier stage when the patient could have received appropriate management to decrease the morbidity of untreated hamartomatous growths, and an elective thyroidectomy would have been a viable option to manage his malignancy. Through this case report, we provide further insight into management of this disorder. Laryngoscope, 2010     

海岛地区居民高血压患病现状及影响因素分析

目的了解福建省霞浦县海岛乡居民高血压患病率及相关危险因素,为制定适合于海岛地区的高血压干预措施提供依据。方法采用问卷及体格检查形式调查海岛乡4个村1 408名≥30岁居民的高血压患病率和相关危险因素情况,应用χ²检验及logistic回归分析方法分析该地区居民高血压患病因素。结果海岛地区居民高血压患病率为38.5%,标化患病率为28.4%;多因素logistic回归分析结果表明,海岛地区居民高血压患病的危险因素为年龄高、大量饮酒和体质指数高,保护因素为重度体力活动。结论福建省海岛地区居民高血压患病率较高,减少饮酒、控制肥胖、适当增加体力活动有助于高血压的防治。     

Cortico-subcortical activation patterns for itch and pain imagery

The imagery of itch and pain evokes emotional responses and covert motor responses (scratching to itch and withdrawal to pain). This suggests some similarity in cerebral mechanisms. However, itch is more socially contagious than pain, as evidenced by the fact that scratching behaviors can be easily initiated by watching itch-inducing situations, whereas withdrawal is less easily initiated by watching painful situations. Thus, we assumed that the cerebral mechanisms of itch imagery partly differ from those of pain imagery in particular with respect to motor regions. We addressed this issue in 18 healthy subjects using functional magnetic resonance imaging. The subjects were instructed to imagine itch and pain sensations in their own bodies while viewing pictures depicting stimuli associated with these sensations. Itch and pain imagery activated the anterior insular cortex (aIC) and motor-related regions such as supplementary motor area, basal ganglia, thalamus, and cerebellum. Activity in these regions was not significantly different between itch and pain imagery. However, functional connectivity between motor-related regions and the aIC showed marked differences between itch and pain imagery. Connectivity with the aIC was stronger in the primary motor and premotor cortices during pain imagery and stronger in the globus pallidus during itch imagery. These findings indicate that brain regions associated with imagery of itch are the same as those involved in imagery of pain, but their functional networks differ. These differences in brain networks may explain why motor responses to itch are more socially contagious than those related to pain.     

Insular dopamine D2 receptors and novelty seeking personality in Parkinson's disease.

Novelty seeking is a temperament trait characterized by impulsiveness and exploratory behavior. Dopamine has been suggested to be the primary neurotransmitter modulator of novelty seeking, and in young healthy subjects, a correlation between increased novelty seeking and decreased insular cortical dopamine D2 receptor availability has been reported. The proposed link between dopamine deficiency and reduction in novelty seeking in Parkinson's disease is controversial. The present study examined whether a link between insular D2 receptor availability and novelty seeking can be replicated in Parkinson's disease patients. [11C]FLB 457 positron emission tomography imaging was carried out in 28 patients with Parkinson's disease, and the data were analyzed using voxel-based statistical analysis. The results demonstrated a negative correlation between the novelty seeking score and the dopamine D2 availability bilaterally in the insular cortex (corrected P=0.001; r=-0.74 [right hemisphere]; r=-0.66 [left hemisphere]). The results provide further support for a relationship between novelty seeking and insular D2 receptors. They indicate that the association is cross-cultural, independent of age, and unaffected by dopaminergic degeneration.     

Reciprocal and Topographic Connections Between the Piriform and Prefrontal Cortices in the Rat: A Tracing Study Using the B Subunit of the Cholera Toxin

In the present study, the reciprocal connections between the piriform cortex and the prefrontal areas are described on the basis of experiments using the anterograde and the retrograde transport of the cholera toxin B subunit (CTb). Following CTb injections placed in the anterior part of the piriform cortex, retrogradely labeled cells and anterogradely labeled fibers were mainly found in the ventrolateral and lateral orbital areas as well as in the anterior part of the agranular insular cortex. Following injections placed in the posterior part of the piriform cortex, the CTb labeling was primarily observed in the infralimbic area and the posterior part of the agranular insular cortex. Thus, we described a topographical organization of the direct reciprocal connections between the anterior and the posterior parts of the piriform cortex parts and some prefrontal areas. This could support a differential modulation of the olfactory processing along the rostrocaudal dimension of the piriform cortex. Copyright © 1996 Elsevier Science Inc.     

锥体束示踪成像技术在经侧裂岛叶肿瘤切除术中的应用

目的利用锥体束示踪成像技术指导经侧裂岛叶肿瘤切除手术。方法对18例岛叶肿瘤患者行经外侧裂岛叶肿瘤切除手术,分别在术前和术后两次进行磁共振弥散张量成像(diffusion tensor imaging,DTI),并应用白质纤维束示踪技术(fiber tracking)进行DTI原始影像数据后处理,得到锥体束示踪成像(tractography)。观察手术前后锥体束的形态、结构和空间位置的变化,通过测量其连续性、完整性以及空间位移以评估肿瘤占位效应及经侧裂岛叶肿瘤切除术对锥体束的影响。结果18例患者手术均行经侧裂岛叶肿瘤切除术,13例全切除,5例次全切除。手术前后均实现锥体束示踪成像,在锥体束示踪成像上可以精确测定有效锥体束条数。结论锥体束示踪成像可以清晰显示手术前后锥体束的形态、结构和空间位置及受肿瘤推移幅度,可用于指导经侧裂岛叶肿瘤手术的术前计划。     

Anterior insula activity and the effect of agency on the Stimulus-Preceding Negativity

If you know that you are the author of a freely chosen action and that you bear responsibility for its outcome, then you are said to have “a sense of agency.” When there is a delay between action and outcome, this response must be remembered if you are to learn from the experience. Previous studies have shown that the Stimulus-Preceding Negativity (SPN) recorded during the delay interval is larger under conditions that foster a sense of agency. In an EEG experiment (N = 27), we confirmed that the SPN is larger when participants have a choice between two responses in a gambling task as compared to when there is only a single button and the computer determines the monetary outcome. This SPN agency effect was largest over right prefrontal cortex and it did not vary significantly between trial blocks in which only gains or only losses were possible. Participants in a second experiment (N = 26) performed the same task while activity in anterior insular cortex, a known SPN generator, was measured via functional magnetic resonance image (fMRI). An essentially identical pattern of results was obtained: Activity was greater on choice than no-choice trials, especially for the right hemisphere, and no effect of contextual valence was observed. Although parallel observations such as these cannot warrant causal inference, our findings are consistent with the assumption that anterior insular cortex contributes to the effect of agency on the SPN.     

The anterior insular and anterior cingulate cortices in emotional processing for self-face recognition

Individuals can experience embarrassment when exposed to self-feedback images, depending on the extent of the divergence from the internal representation of the standard self. Our previous work implicated the anterior insular cortex (AI) and the anterior cingulate cortex (ACC) in the processing of embarrassment; however, their exact functional contributions have remained uncertain. Here, we explored the effects of being observed by others while viewing self-face images on the extent of embarrassment, and the activation and connectivity patterns in the AI and ACC. We conducted functional magnetic resonance imaging hyperscanning in pairs of healthy participants using an interaction system that allowed an individual to be observed by a partner in real time. Being observed increased the extent of embarrassment reported when viewing self-face images; a corresponding increase in self-related activity in the right AI suggested that this region played a direct role in the subjective experience. Being observed also increased the functional connectivity between the caudal ACC and prefrontal regions, which are involved in processing the reflective self. The ACC might therefore serve as a hub, integrating information about the reflective self that is used in evaluating perceptual self-face images.     

Hemispherotomy in children: A retrospective analysis of 152 surgeries at a single center and predictors for long-term seizure outcome

Objective

Completeness as a predictor of seizure freedom is broadly accepted in epilepsy surgery. We focused on the requirements for a complete hemispherotomy and hypothesized that the disconnection of the insula contributes to a favorable postoperative seizure outcome. We analyzed surgical and nonsurgical predictors influencing long-term seizure outcome before and after a modification of our hemispherotomy technique.

Methods

We retrospectively studied surgical procedures, electroclinical parameters, magnetic resonance imaging (MRI) results, and follow-up data in all children who had undergone hemispherotomy between 2001 and 2018 at our institution. We used logistic regression models to analyze the influence of different factors on seizure outcome.

Results

A total of 152 patients were eligible for seizure outcome analysis only. Of these, 140 cases had complete follow-up data for ≥24 months and provide the basis for the following results. The median age at surgery was 4.3 years (range = .3–17.9 years). Complete disconnection (including the insular tissue) was achieved in 63.6% (89/140). At 2-year follow-up, seizure freedom (Engel class IA) was observed in 34.8% (8/23) with incomplete insular disconnection, whereas this was achieved in 88.8% (79/89) with complete surgical disconnection (p < .001, odds ratio [OR] = 10.41). In the latter group (n = 89), a potentially epileptogenic contralateral MRI lesion was the strongest predictor for postoperative seizure recurrence (OR = 22.20).

Significance

Complete surgical disconnection is the most important predictor of seizure freedom following hemispherotomy and requires disconnection of the insular tissue at the basal ganglia level. Even if the hemispherotomy is performed surgically completely, a potentially epileptogenic contralateral lesion on preoperative MRI significantly reduces the chances of postoperative seizure freedom.