Surprise: Unexpected Action Execution and Unexpected Inhibition Recruit the Same Fronto-Basal-Ganglia Network

Unexpected and thus surprising events are omnipresent and oftentimes require adaptive behavior such as unexpected inhibition or unexpected action. The current theory of unexpected events suggests that such unexpected events just like global stopping recruit a fronto-basal-ganglia network. A global suppressive effect impacting ongoing motor responses and cognition is specifically attributed to the subthalamic nucleus (STN). Previous studies either used separate tasks or presented unexpected, task-unrelated stimuli during response inhibition tasks to relate the neural signature of unexpected events to that of stopping. Here, we aimed to test these predictions using a within task design with identical stimulus material for both unexpected action and unexpected inhibition using functional magnetic resonance imaging (fMRI) for the first time. To this end, 32 healthy human participants of both sexes performed a cue-informed go/nogo task comprising expected and unexpected action and inhibition trials during fMRI. Using conjunction, contrast, and Bayesian analyses, we demonstrate that unexpected action elicited by an unexpected go signal and unexpected inhibition elicited by an unexpected nogo signal recruited the same fronto-basal-ganglia network which is usually assigned to stopping. Furthermore, the stronger the unexpected action-related activity in the STN region was the more detrimental was the effect on response times. The present results thus complement earlier findings and provide direct evidence for the unified theory of unexpected events while ruling out alternative task and novelty effects.SIGNIFICANCE STATEMENT This is the first study using functional magnetic resonance imaging (fMRI) to test whether unexpected events regardless of whether they require unexpected action or inhibition recruit a fronto-basal-ganglia network just like stopping. In contrast to previous studies, we used identical stimulus material for both conditions within one task. This enabled us to directly test predictions of the current theory of unexpected events and, moreover, to test for condition-specific neural signatures. The present results underpin that both processes recruit the same neural network while excluding alternative task and novelty effects. The simple task design thus provides an avenue to studying surprise as a pure form of reactive inhibition in neuropsychiatric patients displaying inhibitory deficits who often have a limited testing capacity.     

新鲜标本的下胫腓联合韧带解剖特点及临床意义

目的： 研究新鲜标本下胫腓联合韧带的解剖学特点,为下胫腓联合韧带相关损伤及韧带重建提供解剖学依 据。方法： 选取新鲜胫腓下联合标本,剥离新鲜标本的下胫腓联合的肌、血管及筋膜组织,对下胫腓联合前、后、 横韧带进行解剖学测量,包括胫腓下联合前、后、横韧带的近端长度、远端长度、平均宽度、与水平面的夹角、 冠状面的夹角等相关解剖学数据。结果： 下胫腓联合前韧带近、远端平均长度为（8.51±0.70）mm、（19.03±1.35） mm,平均宽度（15.98±1.17） mm,与水平面、冠状面夹角分别为（42.27±3.43）°、（20.50±4.69）° ;下胫腓联 合后韧带近、远端平均长度为（9.32±0.62）mm、（16.92±1.76）mm,平均宽度（14.36±0.88）mm,与水平 面、冠状面夹角分别为（40.96±3.16）°、（13.10±1.99）°;下胫腓联合横韧带近、远端平均长度为（18.46±2.48） mm、（21.87±2.52）mm,平均宽度（4.56±0.17）mm,与水平面、冠状面夹角分别为（30.60±3.65）°、（13.48±1.60）°。 对左右、男女的下胫腓联合前、后、横韧带的解剖学数据进行对比,差异均无统计学意义。结论： 了解下胫腓联 合韧带各解剖结构及其特点,有助于指导下胫腓联合韧带损伤的修复和重建,帮助外科医生制定手术方案,改善 预后。     

Prenatal diagnosis of anomalous connection of the inferior caval vein to the left atrium associated with common arterial trunk

Anomalous connection of the inferior caval vein to the left atrium is exceedingly rare, and has even been considered by some authors an anatomic and embryologic impossibility. This study demonstrates for the first time the existence of this rare malformation, diagnosed on prenatal echo, and confirmed on post-mortem examination in a 24 WG fetus, in association with a common arterial trunk.     

Thin superficial inferior epigastric artery perforator flap for reconstruction of the tongue

The superficial inferior epigastric artery (SIEA) flap is widely used in the repair of large soft tissue defects of the extremities and in breast reconstruction. Because of the high fat content of the abdomen, it has been less used for glossectomy reconstruction. Here we present a series of seven patients who each underwent reconstruction with a thin SIEA flap after resection of the tongue. There were six men and one woman (mean age 48, range 24–66 years). All patients underwent preoperative computed tomographic (CT) angiography, and colour Doppler ultrasound (US) was used to select and map the most suitable SIEA. The flap was raised above the Scarpa's layer while adjusted the plane of dissection according to the specific needs for bulk in each case. All the flaps survived; one flap required a secondary anastomosis because of a venous anastomotic embolus. The size of flap used was 5.0 cm × 6.0 cm - 7.0 cm × 9.0 cm, and the flap was 0.8 cm-1.4 cm thick. The functional outcome was evaluated at 6 - 18 months follow up, when speech and swallowing were both good in all cases. The dissection above the pubic symphysis is an important refinement of the SIEA flap, and we conclude that the thin SIEA flap is a good choice for reconstruction after excision of cancer of the tongue.     

Prognostic Implications of Progressive Systemic Ventricular Dysfunction in Congenitally Corrected Transposition of Great Arteries

ObjectivesThe purpose of this study was to determine the risk factors for and prognostic implications of progressive right ventricular systolic dysfunction (RVD) in adults with congenitally corrected transposition of great arteries.BackgroundThere are no effective therapies for RVD; hence the need to identify and modify risk factors for progressive RVD.MethodsRV systolic function was assessed by using RV longitudinal strain (RV-LS). The first echocardiogram (baseline echocardiogram) and all subsequent annual echocardiograms performed within 5 years from the baseline echocardiogram were analyzed. Progressive RVD (temporal decline in RV-LS) was assessed as the average annual change in RV-LS within 5 years of imaging follow-up.ResultsOf 186 patients (mean age 40 ± 12 years), the RV-LS at baseline was –17% ± 4%, and the annual decline in RV-LS was –4% (95% CI: –6 to –2). The risk factors for progressive RVD were left ventricular (LV) systolic dysfunction, LV pacing, and systemic hypertension. Cardiovascular events (heart failure hospitalization, heart transplant, and death) occurred in 57 (27%) patients. Progressive RVD was associated with cardiovascular events, independent of RV systolic function at baseline. In subgroup analyses assessing impact of therapies (medical therapy, cardiac resynchronization therapy, and tricuspid valve replacement), only tricuspid valve replacement was associated with improvement in RV systolic function when performed before onset of RVD.ConclusionsPatients with congenitally corrected transposition of great arteries were at risk for progressive RVD, and the risk factors for progressive RVD were LV pacing, systemic hypertension, and concomitant LV dysfunction. Further studies are required to determine whether strict blood pressure control and early tricuspid valve replacement will prevent progressive RVD.