Electroacupuncture was performed at the Wangu （GB 12） acupoint, whose position is similar to the cerebellar fastigial nucleus in rats with post-stroke depression. Results showed that the expression of nuclear factor...Electroacupuncture was performed at the Wangu （GB 12） acupoint, whose position is similar to the cerebellar fastigial nucleus in rats with post-stroke depression. Results showed that the expression of nuclear factor-κB and the levels of tumor necrosis factor-α and interleukin-1β decreased. Simultaneously, the extent of edema in the hippocampus and frontal lobe decreased, and the morphology of the nerve cells recovered to near normal. In addition, fluoxetine treatment displayed a similar effect on post-stroke depression as electroacupuncture at GB 12 acupoint. The results indicate that electroacupuncture at GB 12 acupoint can reduce the levels of cytokines in the hippocampus and frontal lobe of rats with post-stroke depression, and thus provide a neuroprotective effect on post-stroke depression.展开更多
Electroacupuncture （EA） has been clinically used to treat depression and has resulted in favorable effects in China. However, results from animal studies and pathology do not reflect the influence of electroacupunct...Electroacupuncture （EA） has been clinically used to treat depression and has resulted in favorable effects in China. However, results from animal studies and pathology do not reflect the influence of electroacupuncture treatment on in vivo physiological functions. To thoroughly and dynamically observe pathological changes during depression, the present study established EA ＋ fluoxetine and fluoxetine groups to observe depression in patients. 1H-magnetic resonance spectroscopy was utilized to determine the correlation between hippocampal frontal lobe metabolite changes and mental disorder scale. Results revealed significantly increased N-acetylaspartate （NAA）/creatine （Cr） in the bilateral hippocampus and right frontal lobe of depression patients treated with EA compared with fluoxetine. Changes in NAA/Cr in bilateral hippocampus and right frontal lobe in both groups, before and after treatment, negatively correlated with severity and curative effects. Choline/Cr changes in the bilateral frontal lobes of both groups were significant before and after treatment, but negatively correlated with curative effects. Choline/Cr changes in the bilateral hippocampus were significant in the EA ＋ fluoxetine group before and after treatment, but negatively correlated with severity and the curative effects of depression. These results demonstrate abnormal biochemical metabolism in bilateral frontal lobes and hippocampus of depression patients, and show that EA significantly altered biochemical indices in the frontal lobes and hippocampus compared with fluoxetine.展开更多
<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">Bilateral frontal lobes cerebral contusion and laceration is one unique...<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">Bilateral frontal lobes cerebral contusion and laceration is one unique brain injury in neurosurgery department. It is characteristic of recessive attacking and develops quickly. The unilateral cerebral falx incision is a new minimally invasive surgery </span><span style="font-family:Verdana;">that </span><span style="font-family:""><span style="font-family:Verdana;">can solve bilateral frontal lobes cerebral contusion and laceration in one surgery. However, it has some limitations in removal of contralateral frontal hematoma and hemostasis due to the limited field of view under the microscope. The unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy can acquire a good illumination and field of view. This is beneficial to complete removal of contralateral hematoma, effective hemostasis and retaining brain tissue functions to the maximum extent. </span><b><span style="font-family:Verdana;">Case Presentation:</span></b><span style="font-family:Verdana;"> The patient, a 55-year-old man, was hospitalized for “consciousness disorder by 12 h because of car accident”. </span><b><span style="font-family:Verdana;">Physical Examination: </span></b><span style="font-family:Verdana;">Coma, GCS score of E1V2M5, bilateral pupil diameter of 2 mm, presence of light response, contusion of scalp at the left top, peripheral dysphoria and bilateral Bartter syndrome negative. The patient has a history of non-traumatic cerebral stroke 3 years ago.</span><b><span style="font-family:Verdana;"> Head CT: </span></b><span style="font-family:Verdana;">Longitudinal fracture of frontal parietal occipital bone, bilateral frontal lobes contusion and laceration, subarachnoid hemorrhage. </span><b><span style="font-family:Verdana;">Diagnosis:</span></b><span style="font-family:Verdana;"> Bilateral frontal lobes contusion and laceration, longitudinal fracture of frontal parietal occipital bone, subarachnoid hemorrhage and hematoma of scalp. In emergency treatment, unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy was performed. The surgery has achieved satisfying effect. </span><b><span style="font-family:Verdana;">Discussion: </span></b><span style="font-family:Verdana;">This case realized the goal of removing contralateral frontal hematoma through unilateral craniotomy under a neuroendoscopy. Due to the clear field of view, it retained extracerebral layer structures of contralateral olfactory nerve protection frontotemporal completely. Moreover, this surgical technique is conducive to intraoperative recognition of pericallosal</span><span style="background:yellow;"> </span><span style="font-family:Verdana;">arteries and lateral fractured blood vessels. It also involves protection, which conforms to the minimally invasive philosophy. The proposed surgical technology can eliminate contralateral frontal hematoma under a good field of view. However, it is suggested not to manage with the further operation on patients who have brain swelling and difficulties in exposure of cerebral falx. These patients need to determine causes of brain swelling and choose bilateral craniectomy if necessary. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">Unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy is a new application of minimally invasive philosophy in craniocerebral injury operation. It still needs further clinical verifications and experience accumulation.展开更多
BACKGROUND： Inducible nitric oxide synthase （iNOS） cannot be detected in the neurons and glial cells of normal rats, but iNOS can be found in some neurons and glial cells of rats following ischemic, traumatic, neur...BACKGROUND： Inducible nitric oxide synthase （iNOS） cannot be detected in the neurons and glial cells of normal rats, but iNOS can be found in some neurons and glial cells of rats following ischemic, traumatic, neurotoxic or inflammatory damage. OBJECTIVE： To investigate iNOS expression and iNOS-positive cell types at various time points following damage to the rat frontal lobe using a sharp instrument. DESIGN： A nerve molecular biology, randomized, controlled study. TIME AND SETTING： This experiment was performed at the Department of Human Anatomy, Institute of Neurobiology, Medical School of Nantong University, between April 2006 and December 2007. MATERIALS： Rabbit anti-iNOS antibody （Santa Cruz, USA）, biotin labeled goat anti-rabbit antibody （Sigma, USA）, reverse transcription kit （Biouniquer, Hong Kong, China） and horseradish peroxidase labeled goat anti-rabbit antibody （Pierce, USA） were used for this study. METHODS： A total of 112 healthy rats aged 3 months were randomly assigned into a sham operation group （n = 28） and a damage group （n = 84）. Rat models of frontal lobe damage were induced in the damage group using a sharp instrument to make an incision in the frontal lobe cortex. In the sham operation group, the rat bone window was opened but brain tissues were left intact. MAIN OUTCOME MEASURES： Parameters were measured at 3, 6, 12, 24, 72, 120 and 168 hours following damage in both groups. Pathological changes were observed using Nissl staining and hematoxylin-eosin staining. Expression of iNOS mRNA, iNOS protein and iNOS-positive cells were examined by RT-PCR, Western blot analysis and immunohistochemistry, respectively. RESULTS： A large number of inflammatory cells infiltrated the damaged region 12 and 24 hours following damage, iNOS mRNA and iNOS protein expression increased in and around the damaged region 3 hours following damage, reached a peak at 24 hours, and then gradually decreased. The changes in iNOS-positive cell number reflected the changes in iNOS mRNA and iNOS protein expression after damage, iNOS was mainly found in neural cells at 3 and 6 hours, in macrophages at 12 and 24 hours, and in glial cells at 72 and 120 hours after damage. iNOS-positive cells were few in and surrounding the damaged region at 168 hours. There were a few iNOS-positive neural cells in the rat frontal lobe cortex in the sham operation group. CONCLUSION： Neurons, macrophages and glial cells can express iNOS following rat frontal lobe damage caused by a sharp instrument. The levels of iNOS expression, and the cell types expressing iNOS, change with time.展开更多
The aim of the present study is to investigate the brain functional network changes of patients with frontal lobe epilepsy(FLE)by resting-state functional magnetic resonance imaging(rsfMRI)and graph theoretical analys...The aim of the present study is to investigate the brain functional network changes of patients with frontal lobe epilepsy(FLE)by resting-state functional magnetic resonance imaging(rsfMRI)and graph theoretical analysis.rsfMRI is performed in 46 adult patients with FLE and 46 age matched healthy controls(HCs).A functional network is built from these subjects,and the topological properties of such network are analyzed quantitatively using graph theoretical methods.According to the results,both FLE patients and HCs exhibit prominent small world features.Compared with HCs,FLE shows a decrease in local efficiency(Eloc),clustering coefficient,nodal efficiency as well as nodal degree.Furthermore,FLE(seven)has fewer hubs than HCs(ten).The functional abnormalities in the network organization suggest functional disturbances in patients with FLE.This study helps to gain new insights into the functional disorder in patients with FLE.The networks built here can also be a set of potential biomarkers for the diagnosis,monitoring and the treatment of FLE.展开更多
Objective: This study aimed to carry out a topographical analysis of frontal lobe executive function components in post-stroke patients. Methods: A descriptive, cross-sectional study. The assessment using the WCST (Wi...Objective: This study aimed to carry out a topographical analysis of frontal lobe executive function components in post-stroke patients. Methods: A descriptive, cross-sectional study. The assessment using the WCST (Wisconsin Card Sorting Test) included sixteen patients with a clinical diagnosis of CVA and frontal lobe impairment. Results from the two groups were compared (patients with right frontal lobe impairment and patients with left frontal lobe impairment). Statistical analysis was performed using the program “Statistical Package for Social Sciences” (SPSS) Version 20.0. For comparison between groups was used Mann-Whitney test and considered the alpha level of 0.05 on the statistically significant results. Results: There was no statistically significant difference between the groups, thus showing that executive functions are symmetrically distributed across the frontal lobes. Conclusion: Executive functions are symmetrically organized across the two frontal lobes, since the comparison between the groups did not demonstrate a statistically significant difference for any of the variables of WSCT.展开更多
The rates of type 2 diabetes (T2DM) continue to parallel the rising rates of obesity in the United States, increasingly affecting adolescents as well as adults. Hippocampal and frontal lobe reductions have been found ...The rates of type 2 diabetes (T2DM) continue to parallel the rising rates of obesity in the United States, increasingly affecting adolescents as well as adults. Hippocampal and frontal lobe reductions have been found in older adults with type 2 diabetes, and we sought to ascertain if these brain alterations were also present in obese adolescents with T2DM. In a cross-sectional study we compared MRI-based regional brain volumes of 18 obese adolescents with T2DM and 18 obese controls without evidence of marked insulin resistance. Groups were matched on age, sex, school grade, ethnicity, socioeconomic status, body mass index, and waist circumference. Relative to obese controls, adolescents with T2DM had significantly reduced hippocampal and prefrontal volumes, and higher rates of global cerebral atrophy. Hemoglo-bin A1c, an index of long-term glycemic control, was inversely associated with prefrontal volume and positively associ-ated with global cerebral atrophy (both p < 0.05). Brain integrity is negatively impacted by T2DM already during ado-lescence, long before the onset of overt macrovascular disease. Paralleling the findings of greater vascular and renal complications among obese adolescents with severe insulin resistance and T2DM relative to their age-matched peers with type 1 diabetes, we find clear evidence of possible brain complications. Our findings call for aggressive and early intervention to limit the negative impact of obesity-associated insulin resistance leading to T2DM on the developing brains of adolescents.展开更多
ALD, which is the X-linked adrenoleukodystrophy (X-ALD), is a rare inherited metabolic disease caused by an enzyme deficiency leading to accumulation of saturated very long chain fatty acid (VLCFA), especially in brai...ALD, which is the X-linked adrenoleukodystrophy (X-ALD), is a rare inherited metabolic disease caused by an enzyme deficiency leading to accumulation of saturated very long chain fatty acid (VLCFA), especially in brain and adrenal cortex. Its prevalence is currently estimated at 1:30,000 to 50,000 in males in Japan. We report a 34-year-old man, who acts of theft, peep and obscenity with adult onset cerebral adrenoleukodystrophy (ALD). An elevated VLCFA and a point mutation in the ABCD1 gene confirmed the diagnosis of ALD. Diffusion-weighted MRI revealed a high intensity area in the white matter of the frontal lobes. T2-weighted image revealed diffuse high signal intensity in the deep white matter. MR diffusion-weighted image revealed high signal intensity area in the white matter of the frontal lobes.?Proton magnetic resonance spectroscopy?(H-MRS) of the white matter of the frontal lobes revealed an extreme decrease of?N-acetylaspartate (NAA) and an increase of the choline (Cho)/creatinine (Cr) ratio. The mild?hypoperfusion was detected in the both cerebral hemispheres by the single photon emission CT (SPECT). The genetic phenotype was detected and he was diagnosed adult onset ALD. The only neurological sign was deviant behaviors as frontal lobe symptoms;despite a diffuse high signal intensity was detected in the deep white matter in the MRI examination. Psychiatric symptomatology is presented and may be one of the earliest manifestations of ALD. Psychiatrists as well as and physicians may encounter ALD.展开更多
Background:Frontal lobe epilepsy(FLE),the second most common refractory focal epilepsy,of which focal cortical dysplasia(FCD)is a common etiology.Electrophysiological analysis offers crucial insights into FCD subtype ...Background:Frontal lobe epilepsy(FLE),the second most common refractory focal epilepsy,of which focal cortical dysplasia(FCD)is a common etiology.Electrophysiological analysis offers crucial insights into FCD subtype differentiation.Thus,we aim to evaluate scalp electroencephalography(EEG)and stereoelectroencephalography(SEEG)features,clinical characteristics,and postsurgical outcomes in a uniform series of patients with pathologically confirmed FCD type I or II who underwent FLE surgery.Methods:Thirty-four consecutive patients were retrospectively analyzed.The interictal and ictal EEG and SEEG features,clinical characteristics,and surgical outcomes were evaluated.Results:Six interictal EEG patterns were identified.Focal continuous fast epileptiform discharges were only encountered in FCD II,with a high specificity of 100%.Continuous periodic spikes were predominantly observed in FCD II,with a high specificity of 94.4%;while repetitive discharges were largely observed in FCD I,with a specificity of 94.4%.Patients with a shorter epilepsy duration were more likely to show continuous irregular slowing(P=0.034).Five EEG ictal onset patterns(IOPs)were identified.Spikes and slow waves were observed only in the FCD I group,whereas alpha activity was observed only in the FCD II group.Four interictal SEEG patterns were identified.Continuous periodic spikes were most frequently observed in the FCD II group(P=0.044).Seven SEEG IOPs values were identified.Slow-wave or baseline shift followed by low-voltage fast activity(LVFA)and delta brush were observed only in FCD I.In contrast,preictal spiking followed by LVFA was mostly observed in the FCD II.Fast activity was observed only in the FCD I group.The average follow-up time was 1.8 years,and favorable surgical outcomes were observed more often in patients with FCD II(66.7%)than in those with FCD I(44.4%)but without significance(P?0.315).Conclusion:FCD subtypes share distinct EEG and SEEG signatures,and some special patterns may be indicative of specific subtypes.展开更多
Objective： To study the effect and indications ofintracranial pressure （ICP） monitoring for frontal lobe contusion patients. Methods： During January 2005-December 2008, 34 cases of frontal lobe contusion received ...Objective： To study the effect and indications ofintracranial pressure （ICP） monitoring for frontal lobe contusion patients. Methods： During January 2005-December 2008, 34 cases of frontal lobe contusion received ICP monitoring in our department （monitoring group）. Different treatment protocols were adopted according to the results of ICP. Mean-while 46 cases of same type of head-injured patients who did not undergo ICP monitoring served as control group. Results： We found that ICP elevated dramatically within 24 hours after head injury if the contusions were located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or dispersed in bilateral lobe. After half a year follow-up and on the basis of Glasgow Coma Scale assessment, the monitoring group showed better outcome than the control group with good recovery in 24 cases （70.6%）, moderate disability in 7 cases （20.6%）, severe disability in 2 （5.88%） and death in 1 （2.94%）. The outcome of control group displayed good condition in 25 cases （54.3%）, moderate disabilities in 8 （17.4%）, severe disability in 7 （15.2%）, and death in 6 （13.0%）. Conclusions： Frontal lobe contusions are vulnerable and complex head injuries, especially when the contusions are located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or diffused in bilateral lobes. These patients should undergo ICP monitoring regardless of their consciousness status. IflCP elevates over 25 mm Hg, the craniotomy is mandatory and will markedly reduce the mortality and disability of these patients.展开更多
Objective:Endoscopic repair of large anterior skull base(ASB)defects has excellent results when using multilayered repairs with a nasoseptal flap.However,in extensive intranasal tumors,a nasoseptal flap may not always...Objective:Endoscopic repair of large anterior skull base(ASB)defects has excellent results when using multilayered repairs with a nasoseptal flap.However,in extensive intranasal tumors,a nasoseptal flap may not always be available.One alternative option is a flexible single-layer ASB repair.Initial studies indicate low cerebrospinal fluid leak rates with a single-layer repair.However,the level of frontal lobe support,particularly the propensity for a significant inferior displacement of the frontal lobe,is not known.The goal of this study is to determine the frontal lobe position after single-layer acellular dermal allograft repair in large ASB defects.Study Design:Retrospective cohort study.Setting:Tertiary care medical center.Subjects and Methods:This cohort study compares the frontal lobe position in adults who underwent endoscopic endonasal ASB tumor resection and single-layer cadaveric dermal matrix repair(ASB cohort)with control subjects without intracranial abnormalities(control cohort).The ASB cohort includes subjects with an ASB defect of≥5 cm anterior/posterior and≥1.5 cm wide and who had imaging at least 2 months after surgery.The frontal lobe position is measured on sagittal CT/MRI using a reference line from the base of the sella to the nasion.A value of zero indicates that the inferior-most aspect of the frontal lobe is at the level of the nasion-sellar line.A positive value indicates that the frontal lobe is inferior to the nasion-sellar line.The ASB cohort frontal lobe position is compared with the control cohort using the Mann-WhitneyU test.A priori we set an absolute difference of 5 mm as a clinically significant difference.Results:The ASB cohort includes 47 subjects who are 57%male with an average age of 60 years(range:31-89 years).The most common ASB pathology is esthesioneuroblastoma(n=21)and 81%of the ASB cohort had postoperative radiation.The control cohort includes 20 subjects who are 60%male,with a mean age of 45 years(range:19-74 years).The majority of controls underwent imaging for head trauma(n=13).The ASB mean frontal lobe position is-0.2 mm superior to the nasion-sellar line(range:-9.2 to 10.4 mm),while the control’’s mean frontal lobe position is 1.1 mm inferior to the nasion-sellar line.This difference is not statistically significant(P=0.13)and does not reach our a priori definition of clinical significance.The frontal lobe position of ASB subjects who had radiation is closer to the nasion-sellar line as compared with those who did not undergo radiation.Conclusions:Single-layer acellular dermal graft repair maintains frontal lobe support and position in large ASB defects.展开更多
The prefrontal cortex is involved in a multitude of cognitive, emotional, motivational, and social processes, so exploring its specific functions is crucial for understanding human experience and behavior. Functional ...The prefrontal cortex is involved in a multitude of cognitive, emotional, motivational, and social processes, so exploring its specific functions is crucial for understanding human experience and behavior. Functional imaging approaches have largely contributed to the enhancement of our understanding, but might have limitations in establishing causal relationships between physiology and the related psychological and behavioral processes. Non-invasive electrical stimulation with direct or alternating currents can help to enhance our understanding with regard to specific processes, and might provide future protocols able to improve them in case of malfunctions. We review the current state of the field, and provide an outlook for future developments.展开更多
AIMTo apply the Frontal Assessment Battery to cirrhotic patients with or without overt hepatic encephalopathy (OHE) and controls. METHODSThe frontal assessment battery (FAB) was applied to 87 patients with liver cirrh...AIMTo apply the Frontal Assessment Battery to cirrhotic patients with or without overt hepatic encephalopathy (OHE) and controls. METHODSThe frontal assessment battery (FAB) was applied to 87 patients with liver cirrhosis (16 with and 71 without OHE) and 40 control subjects without cirrhosis treated at the alcohol and liver outpatient clinics and the gastroenterology ward of the Cassiano Antônio de Moraes University Hospital (Hospital Universitário Cassiano Antônio de Moraes - HUCAM), Espírito Santo, Brazil. RESULTSThe average FAB score was lower for the cirrhotic than for the non-cirrhotic patients (10.6 ± 3.67 vs 12.25 ± 2.72, P = 0.015). The FAB score was lower for the cirrhotic patients with OHE than for the patients without OHE (8.25 ± 4.55 vs 11.14 ± 3.25, P = 0.027). The total FAB score was lower for the cirrhotic patients without OHE than for the non-cirrhotic patients, although this difference was not significant (11.14 ± 3.25 vs 12.25 ± 2.72, P = 0.067). Nevertheless, the difference in the scores on the subtest that assessed the ability to inhibit a response previously conditioned to a stimulus was significant (1.72 ± 0.93 vs 2.2 ± 0.85, P = 0.011). CONCLUSIONThe present study indicates that the FAB is a promising tool for outpatient minimal HE screening and the assessment of HE severity.展开更多
为探究单一飞行员驾驶(Single Pilot Operations,SPO)情境下,飞行员一般认知能力和特殊能力对心理负荷的影响,设计并实施SPO情境下的非正常任务场景处置试验。首先,招募47名飞行员被试,通过飞行员能力测评工具采集飞行员一般认知能力和...为探究单一飞行员驾驶(Single Pilot Operations,SPO)情境下,飞行员一般认知能力和特殊能力对心理负荷的影响,设计并实施SPO情境下的非正常任务场景处置试验。首先,招募47名飞行员被试,通过飞行员能力测评工具采集飞行员一般认知能力和特殊能力数据;然后,开展模拟飞行试验,记录被试在试验中的生理(心率、心率变异性、皮肤电、眼动及额叶血氧水平)及行为数据;最后,依据飞行员能力得分划分飞行员高、低能力组,通过独立样本t检验分析飞行员心理负荷差异性;同时,通过Spearman相关分析,分析飞行员能力具体指标与心理负荷间的关系。结果表明:能力不同的飞行员平均瞳孔直径存在显著差异;视觉反应能力、听觉反应能力、视觉记忆能力、听觉记忆能力、选择注意能力、空间表象能力和双手协调能力均与飞行员心理负荷表征指标存在显著相关性。研究结果可为未来智能化SPO驾驶舱人机功能分配设计,及SPO飞行员选拔指标确定提供一定的理论支持。展开更多
基金the National Natural Science Foundation of China, No. 81041058the Natural Science Foundation of Liaoning Province, No. 20092191
文摘Electroacupuncture was performed at the Wangu （GB 12） acupoint, whose position is similar to the cerebellar fastigial nucleus in rats with post-stroke depression. Results showed that the expression of nuclear factor-κB and the levels of tumor necrosis factor-α and interleukin-1β decreased. Simultaneously, the extent of edema in the hippocampus and frontal lobe decreased, and the morphology of the nerve cells recovered to near normal. In addition, fluoxetine treatment displayed a similar effect on post-stroke depression as electroacupuncture at GB 12 acupoint. The results indicate that electroacupuncture at GB 12 acupoint can reduce the levels of cytokines in the hippocampus and frontal lobe of rats with post-stroke depression, and thus provide a neuroprotective effect on post-stroke depression.
基金the National Natural Science Foundation of China,No.30701122the Key Program of Beijing Natural Science Foundation,No.7051003
文摘Electroacupuncture （EA） has been clinically used to treat depression and has resulted in favorable effects in China. However, results from animal studies and pathology do not reflect the influence of electroacupuncture treatment on in vivo physiological functions. To thoroughly and dynamically observe pathological changes during depression, the present study established EA ＋ fluoxetine and fluoxetine groups to observe depression in patients. 1H-magnetic resonance spectroscopy was utilized to determine the correlation between hippocampal frontal lobe metabolite changes and mental disorder scale. Results revealed significantly increased N-acetylaspartate （NAA）/creatine （Cr） in the bilateral hippocampus and right frontal lobe of depression patients treated with EA compared with fluoxetine. Changes in NAA/Cr in bilateral hippocampus and right frontal lobe in both groups, before and after treatment, negatively correlated with severity and curative effects. Choline/Cr changes in the bilateral frontal lobes of both groups were significant before and after treatment, but negatively correlated with curative effects. Choline/Cr changes in the bilateral hippocampus were significant in the EA ＋ fluoxetine group before and after treatment, but negatively correlated with severity and the curative effects of depression. These results demonstrate abnormal biochemical metabolism in bilateral frontal lobes and hippocampus of depression patients, and show that EA significantly altered biochemical indices in the frontal lobes and hippocampus compared with fluoxetine.
文摘<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">Bilateral frontal lobes cerebral contusion and laceration is one unique brain injury in neurosurgery department. It is characteristic of recessive attacking and develops quickly. The unilateral cerebral falx incision is a new minimally invasive surgery </span><span style="font-family:Verdana;">that </span><span style="font-family:""><span style="font-family:Verdana;">can solve bilateral frontal lobes cerebral contusion and laceration in one surgery. However, it has some limitations in removal of contralateral frontal hematoma and hemostasis due to the limited field of view under the microscope. The unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy can acquire a good illumination and field of view. This is beneficial to complete removal of contralateral hematoma, effective hemostasis and retaining brain tissue functions to the maximum extent. </span><b><span style="font-family:Verdana;">Case Presentation:</span></b><span style="font-family:Verdana;"> The patient, a 55-year-old man, was hospitalized for “consciousness disorder by 12 h because of car accident”. </span><b><span style="font-family:Verdana;">Physical Examination: </span></b><span style="font-family:Verdana;">Coma, GCS score of E1V2M5, bilateral pupil diameter of 2 mm, presence of light response, contusion of scalp at the left top, peripheral dysphoria and bilateral Bartter syndrome negative. The patient has a history of non-traumatic cerebral stroke 3 years ago.</span><b><span style="font-family:Verdana;"> Head CT: </span></b><span style="font-family:Verdana;">Longitudinal fracture of frontal parietal occipital bone, bilateral frontal lobes contusion and laceration, subarachnoid hemorrhage. </span><b><span style="font-family:Verdana;">Diagnosis:</span></b><span style="font-family:Verdana;"> Bilateral frontal lobes contusion and laceration, longitudinal fracture of frontal parietal occipital bone, subarachnoid hemorrhage and hematoma of scalp. In emergency treatment, unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy was performed. The surgery has achieved satisfying effect. </span><b><span style="font-family:Verdana;">Discussion: </span></b><span style="font-family:Verdana;">This case realized the goal of removing contralateral frontal hematoma through unilateral craniotomy under a neuroendoscopy. Due to the clear field of view, it retained extracerebral layer structures of contralateral olfactory nerve protection frontotemporal completely. Moreover, this surgical technique is conducive to intraoperative recognition of pericallosal</span><span style="background:yellow;"> </span><span style="font-family:Verdana;">arteries and lateral fractured blood vessels. It also involves protection, which conforms to the minimally invasive philosophy. The proposed surgical technology can eliminate contralateral frontal hematoma under a good field of view. However, it is suggested not to manage with the further operation on patients who have brain swelling and difficulties in exposure of cerebral falx. These patients need to determine causes of brain swelling and choose bilateral craniectomy if necessary. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">Unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy is a new application of minimally invasive philosophy in craniocerebral injury operation. It still needs further clinical verifications and experience accumulation.
基金Supported by:Natural Science Research Plan for Jiangsu Colleges,No. 05KJD180165
文摘BACKGROUND： Inducible nitric oxide synthase （iNOS） cannot be detected in the neurons and glial cells of normal rats, but iNOS can be found in some neurons and glial cells of rats following ischemic, traumatic, neurotoxic or inflammatory damage. OBJECTIVE： To investigate iNOS expression and iNOS-positive cell types at various time points following damage to the rat frontal lobe using a sharp instrument. DESIGN： A nerve molecular biology, randomized, controlled study. TIME AND SETTING： This experiment was performed at the Department of Human Anatomy, Institute of Neurobiology, Medical School of Nantong University, between April 2006 and December 2007. MATERIALS： Rabbit anti-iNOS antibody （Santa Cruz, USA）, biotin labeled goat anti-rabbit antibody （Sigma, USA）, reverse transcription kit （Biouniquer, Hong Kong, China） and horseradish peroxidase labeled goat anti-rabbit antibody （Pierce, USA） were used for this study. METHODS： A total of 112 healthy rats aged 3 months were randomly assigned into a sham operation group （n = 28） and a damage group （n = 84）. Rat models of frontal lobe damage were induced in the damage group using a sharp instrument to make an incision in the frontal lobe cortex. In the sham operation group, the rat bone window was opened but brain tissues were left intact. MAIN OUTCOME MEASURES： Parameters were measured at 3, 6, 12, 24, 72, 120 and 168 hours following damage in both groups. Pathological changes were observed using Nissl staining and hematoxylin-eosin staining. Expression of iNOS mRNA, iNOS protein and iNOS-positive cells were examined by RT-PCR, Western blot analysis and immunohistochemistry, respectively. RESULTS： A large number of inflammatory cells infiltrated the damaged region 12 and 24 hours following damage, iNOS mRNA and iNOS protein expression increased in and around the damaged region 3 hours following damage, reached a peak at 24 hours, and then gradually decreased. The changes in iNOS-positive cell number reflected the changes in iNOS mRNA and iNOS protein expression after damage, iNOS was mainly found in neural cells at 3 and 6 hours, in macrophages at 12 and 24 hours, and in glial cells at 72 and 120 hours after damage. iNOS-positive cells were few in and surrounding the damaged region at 168 hours. There were a few iNOS-positive neural cells in the rat frontal lobe cortex in the sham operation group. CONCLUSION： Neurons, macrophages and glial cells can express iNOS following rat frontal lobe damage caused by a sharp instrument. The levels of iNOS expression, and the cell types expressing iNOS, change with time.
基金supported by the Natural Science Foundation of China(Nos.81422022,81271553,81201155,81171328,61131003,81401402,and 81201161)the Grant for a Young Scholar of Jinling Hospital(No.2015055)12.5 Key Grants(Nos.BWS11J063 and 10z026)
文摘The aim of the present study is to investigate the brain functional network changes of patients with frontal lobe epilepsy(FLE)by resting-state functional magnetic resonance imaging(rsfMRI)and graph theoretical analysis.rsfMRI is performed in 46 adult patients with FLE and 46 age matched healthy controls(HCs).A functional network is built from these subjects,and the topological properties of such network are analyzed quantitatively using graph theoretical methods.According to the results,both FLE patients and HCs exhibit prominent small world features.Compared with HCs,FLE shows a decrease in local efficiency(Eloc),clustering coefficient,nodal efficiency as well as nodal degree.Furthermore,FLE(seven)has fewer hubs than HCs(ten).The functional abnormalities in the network organization suggest functional disturbances in patients with FLE.This study helps to gain new insights into the functional disorder in patients with FLE.The networks built here can also be a set of potential biomarkers for the diagnosis,monitoring and the treatment of FLE.
文摘Objective: This study aimed to carry out a topographical analysis of frontal lobe executive function components in post-stroke patients. Methods: A descriptive, cross-sectional study. The assessment using the WCST (Wisconsin Card Sorting Test) included sixteen patients with a clinical diagnosis of CVA and frontal lobe impairment. Results from the two groups were compared (patients with right frontal lobe impairment and patients with left frontal lobe impairment). Statistical analysis was performed using the program “Statistical Package for Social Sciences” (SPSS) Version 20.0. For comparison between groups was used Mann-Whitney test and considered the alpha level of 0.05 on the statistically significant results. Results: There was no statistically significant difference between the groups, thus showing that executive functions are symmetrically distributed across the frontal lobes. Conclusion: Executive functions are symmetrically organized across the two frontal lobes, since the comparison between the groups did not demonstrate a statistically significant difference for any of the variables of WSCT.
文摘The rates of type 2 diabetes (T2DM) continue to parallel the rising rates of obesity in the United States, increasingly affecting adolescents as well as adults. Hippocampal and frontal lobe reductions have been found in older adults with type 2 diabetes, and we sought to ascertain if these brain alterations were also present in obese adolescents with T2DM. In a cross-sectional study we compared MRI-based regional brain volumes of 18 obese adolescents with T2DM and 18 obese controls without evidence of marked insulin resistance. Groups were matched on age, sex, school grade, ethnicity, socioeconomic status, body mass index, and waist circumference. Relative to obese controls, adolescents with T2DM had significantly reduced hippocampal and prefrontal volumes, and higher rates of global cerebral atrophy. Hemoglo-bin A1c, an index of long-term glycemic control, was inversely associated with prefrontal volume and positively associ-ated with global cerebral atrophy (both p < 0.05). Brain integrity is negatively impacted by T2DM already during ado-lescence, long before the onset of overt macrovascular disease. Paralleling the findings of greater vascular and renal complications among obese adolescents with severe insulin resistance and T2DM relative to their age-matched peers with type 1 diabetes, we find clear evidence of possible brain complications. Our findings call for aggressive and early intervention to limit the negative impact of obesity-associated insulin resistance leading to T2DM on the developing brains of adolescents.
文摘ALD, which is the X-linked adrenoleukodystrophy (X-ALD), is a rare inherited metabolic disease caused by an enzyme deficiency leading to accumulation of saturated very long chain fatty acid (VLCFA), especially in brain and adrenal cortex. Its prevalence is currently estimated at 1:30,000 to 50,000 in males in Japan. We report a 34-year-old man, who acts of theft, peep and obscenity with adult onset cerebral adrenoleukodystrophy (ALD). An elevated VLCFA and a point mutation in the ABCD1 gene confirmed the diagnosis of ALD. Diffusion-weighted MRI revealed a high intensity area in the white matter of the frontal lobes. T2-weighted image revealed diffuse high signal intensity in the deep white matter. MR diffusion-weighted image revealed high signal intensity area in the white matter of the frontal lobes.?Proton magnetic resonance spectroscopy?(H-MRS) of the white matter of the frontal lobes revealed an extreme decrease of?N-acetylaspartate (NAA) and an increase of the choline (Cho)/creatinine (Cr) ratio. The mild?hypoperfusion was detected in the both cerebral hemispheres by the single photon emission CT (SPECT). The genetic phenotype was detected and he was diagnosed adult onset ALD. The only neurological sign was deviant behaviors as frontal lobe symptoms;despite a diffuse high signal intensity was detected in the deep white matter in the MRI examination. Psychiatric symptomatology is presented and may be one of the earliest manifestations of ALD. Psychiatrists as well as and physicians may encounter ALD.
基金supported by grants from the Capital Medical University Natural Foundation(No.PYZ20119)Epilepsy Research Fund of the China Association against Epilepsy(No.CU-B-2021-24)Beijing Natural Science Foundation(No.L182015).
文摘Background:Frontal lobe epilepsy(FLE),the second most common refractory focal epilepsy,of which focal cortical dysplasia(FCD)is a common etiology.Electrophysiological analysis offers crucial insights into FCD subtype differentiation.Thus,we aim to evaluate scalp electroencephalography(EEG)and stereoelectroencephalography(SEEG)features,clinical characteristics,and postsurgical outcomes in a uniform series of patients with pathologically confirmed FCD type I or II who underwent FLE surgery.Methods:Thirty-four consecutive patients were retrospectively analyzed.The interictal and ictal EEG and SEEG features,clinical characteristics,and surgical outcomes were evaluated.Results:Six interictal EEG patterns were identified.Focal continuous fast epileptiform discharges were only encountered in FCD II,with a high specificity of 100%.Continuous periodic spikes were predominantly observed in FCD II,with a high specificity of 94.4%;while repetitive discharges were largely observed in FCD I,with a specificity of 94.4%.Patients with a shorter epilepsy duration were more likely to show continuous irregular slowing(P=0.034).Five EEG ictal onset patterns(IOPs)were identified.Spikes and slow waves were observed only in the FCD I group,whereas alpha activity was observed only in the FCD II group.Four interictal SEEG patterns were identified.Continuous periodic spikes were most frequently observed in the FCD II group(P=0.044).Seven SEEG IOPs values were identified.Slow-wave or baseline shift followed by low-voltage fast activity(LVFA)and delta brush were observed only in FCD I.In contrast,preictal spiking followed by LVFA was mostly observed in the FCD II.Fast activity was observed only in the FCD I group.The average follow-up time was 1.8 years,and favorable surgical outcomes were observed more often in patients with FCD II(66.7%)than in those with FCD I(44.4%)but without significance(P?0.315).Conclusion:FCD subtypes share distinct EEG and SEEG signatures,and some special patterns may be indicative of specific subtypes.
文摘Objective： To study the effect and indications ofintracranial pressure （ICP） monitoring for frontal lobe contusion patients. Methods： During January 2005-December 2008, 34 cases of frontal lobe contusion received ICP monitoring in our department （monitoring group）. Different treatment protocols were adopted according to the results of ICP. Mean-while 46 cases of same type of head-injured patients who did not undergo ICP monitoring served as control group. Results： We found that ICP elevated dramatically within 24 hours after head injury if the contusions were located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or dispersed in bilateral lobe. After half a year follow-up and on the basis of Glasgow Coma Scale assessment, the monitoring group showed better outcome than the control group with good recovery in 24 cases （70.6%）, moderate disability in 7 cases （20.6%）, severe disability in 2 （5.88%） and death in 1 （2.94%）. The outcome of control group displayed good condition in 25 cases （54.3%）, moderate disabilities in 8 （17.4%）, severe disability in 7 （15.2%）, and death in 6 （13.0%）. Conclusions： Frontal lobe contusions are vulnerable and complex head injuries, especially when the contusions are located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or diffused in bilateral lobes. These patients should undergo ICP monitoring regardless of their consciousness status. IflCP elevates over 25 mm Hg, the craniotomy is mandatory and will markedly reduce the mortality and disability of these patients.
文摘Objective:Endoscopic repair of large anterior skull base(ASB)defects has excellent results when using multilayered repairs with a nasoseptal flap.However,in extensive intranasal tumors,a nasoseptal flap may not always be available.One alternative option is a flexible single-layer ASB repair.Initial studies indicate low cerebrospinal fluid leak rates with a single-layer repair.However,the level of frontal lobe support,particularly the propensity for a significant inferior displacement of the frontal lobe,is not known.The goal of this study is to determine the frontal lobe position after single-layer acellular dermal allograft repair in large ASB defects.Study Design:Retrospective cohort study.Setting:Tertiary care medical center.Subjects and Methods:This cohort study compares the frontal lobe position in adults who underwent endoscopic endonasal ASB tumor resection and single-layer cadaveric dermal matrix repair(ASB cohort)with control subjects without intracranial abnormalities(control cohort).The ASB cohort includes subjects with an ASB defect of≥5 cm anterior/posterior and≥1.5 cm wide and who had imaging at least 2 months after surgery.The frontal lobe position is measured on sagittal CT/MRI using a reference line from the base of the sella to the nasion.A value of zero indicates that the inferior-most aspect of the frontal lobe is at the level of the nasion-sellar line.A positive value indicates that the frontal lobe is inferior to the nasion-sellar line.The ASB cohort frontal lobe position is compared with the control cohort using the Mann-WhitneyU test.A priori we set an absolute difference of 5 mm as a clinically significant difference.Results:The ASB cohort includes 47 subjects who are 57%male with an average age of 60 years(range:31-89 years).The most common ASB pathology is esthesioneuroblastoma(n=21)and 81%of the ASB cohort had postoperative radiation.The control cohort includes 20 subjects who are 60%male,with a mean age of 45 years(range:19-74 years).The majority of controls underwent imaging for head trauma(n=13).The ASB mean frontal lobe position is-0.2 mm superior to the nasion-sellar line(range:-9.2 to 10.4 mm),while the control’’s mean frontal lobe position is 1.1 mm inferior to the nasion-sellar line.This difference is not statistically significant(P=0.13)and does not reach our a priori definition of clinical significance.The frontal lobe position of ASB subjects who had radiation is closer to the nasion-sellar line as compared with those who did not undergo radiation.Conclusions:Single-layer acellular dermal graft repair maintains frontal lobe support and position in large ASB defects.
文摘The prefrontal cortex is involved in a multitude of cognitive, emotional, motivational, and social processes, so exploring its specific functions is crucial for understanding human experience and behavior. Functional imaging approaches have largely contributed to the enhancement of our understanding, but might have limitations in establishing causal relationships between physiology and the related psychological and behavioral processes. Non-invasive electrical stimulation with direct or alternating currents can help to enhance our understanding with regard to specific processes, and might provide future protocols able to improve them in case of malfunctions. We review the current state of the field, and provide an outlook for future developments.
文摘AIMTo apply the Frontal Assessment Battery to cirrhotic patients with or without overt hepatic encephalopathy (OHE) and controls. METHODSThe frontal assessment battery (FAB) was applied to 87 patients with liver cirrhosis (16 with and 71 without OHE) and 40 control subjects without cirrhosis treated at the alcohol and liver outpatient clinics and the gastroenterology ward of the Cassiano Antônio de Moraes University Hospital (Hospital Universitário Cassiano Antônio de Moraes - HUCAM), Espírito Santo, Brazil. RESULTSThe average FAB score was lower for the cirrhotic than for the non-cirrhotic patients (10.6 ± 3.67 vs 12.25 ± 2.72, P = 0.015). The FAB score was lower for the cirrhotic patients with OHE than for the patients without OHE (8.25 ± 4.55 vs 11.14 ± 3.25, P = 0.027). The total FAB score was lower for the cirrhotic patients without OHE than for the non-cirrhotic patients, although this difference was not significant (11.14 ± 3.25 vs 12.25 ± 2.72, P = 0.067). Nevertheless, the difference in the scores on the subtest that assessed the ability to inhibit a response previously conditioned to a stimulus was significant (1.72 ± 0.93 vs 2.2 ± 0.85, P = 0.011). CONCLUSIONThe present study indicates that the FAB is a promising tool for outpatient minimal HE screening and the assessment of HE severity.
文摘为探究单一飞行员驾驶(Single Pilot Operations,SPO)情境下,飞行员一般认知能力和特殊能力对心理负荷的影响,设计并实施SPO情境下的非正常任务场景处置试验。首先,招募47名飞行员被试,通过飞行员能力测评工具采集飞行员一般认知能力和特殊能力数据;然后,开展模拟飞行试验,记录被试在试验中的生理(心率、心率变异性、皮肤电、眼动及额叶血氧水平)及行为数据;最后,依据飞行员能力得分划分飞行员高、低能力组,通过独立样本t检验分析飞行员心理负荷差异性;同时,通过Spearman相关分析,分析飞行员能力具体指标与心理负荷间的关系。结果表明:能力不同的飞行员平均瞳孔直径存在显著差异;视觉反应能力、听觉反应能力、视觉记忆能力、听觉记忆能力、选择注意能力、空间表象能力和双手协调能力均与飞行员心理负荷表征指标存在显著相关性。研究结果可为未来智能化SPO驾驶舱人机功能分配设计,及SPO飞行员选拔指标确定提供一定的理论支持。
