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Depression is an emotional disorder characterized by significant and persistent depression, and it is a serious mental disorder with high incidence rate, high disability rate and high suicide rate. Suicide is the most dangerous clinical symptom of depression, causing great harm to individuals, families and society. At present, the prevention of suicidal behavior in patients with depression mainly depends on the experience of clinicians, but there is a lack of an accurate predictive model. Understanding the neurobiological basis of suicidal behavior in patients with depression will help to effectively prevent suicidal behavior in patients with depression and reduce the social burden. In recent years, structural and functional magnetic resonance imaging (fMRI) technology has been used to explore the neuroimaging charictristics for the depression patient with or without suicidal ideation or suicidal behavior. It mainly involves the abnormal changes of orbitofrontal lobe, temporal parietal lobe, cingulate gyrus, hippocampus, striatum and other brain regions, and brain core cognitive network, especially prefrontal limbic system.It is clear that abnormal changes of brain structure or function were significantly associated with suicidal severity in depression patients. More studies are needed to explore the changes of brain structure and function in depression patients with suicidal ideation or suicidal behavior, and look for thepotentially neuroimaging markers that can be used to identify whether depression is accompanied by suicidal ideation/behavior in the early clinical stage.
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Posterior cortical atrophy (PCA) is a kind of neurodegenerative dementia. The core feature of the PCA includes progressive decline in visual processing and other posterior parietal-occipital cortex-related cognitive functions. Recently, neuroimaging features of PCA from magnetic resonance imaging/single photon emission computed tomography/ 18F-deoxyglucose positron emission tomography-computer tomography studies represent the typical characteristics of cortical atrophy, hypoperfusion, and hypometabolism in the posterior parietal-occipital cortex. The most common neuropathological changes of PCA are amyloid plaques deposition and neurofibrillary tangles in posterior cortex, while the molecular biomarkers are decreased amyloid β-protein 1-42 together with increased T-tau and/or P-tau in cerebral spinal fluid. From this point, PCA is also considered as an atypical form of Alzheimer′s disease (AD). However, individuals fulfilling the criteria for the core clinico-radiological PCA syndrome, can also fulfill the core clinical criteria for any other neurodegenerative syndrome, and represent negative AD-related pathophysiological biomarkers. Heterogeneity within the PCA syndrome and pathophysiological biomarkers prompt the PCA working group to establish a new consensus on PCA classification and diagnostic criteria, which is proposed for use in a number of different research contexts and the research of AD, atypical AD and related syndromes. This paper gives a brief introduction and interpretation of the newly proposed classification and diagnostic criteria of PCA.
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In recent years,magnetic resonance imaging (MRI) has been widely used in the early diagnosis as well as long-term follow-up study of Alzheimer's disease (AD).The studies were reviewed which applied the structural MRI and arterial spin labeling MRI (ASL-MRI) in AD over the past 20 years,and found more gray matter volume loss in multiple brain structures in individuals with AD spectrum.Among them,medial temporal lobe atrophy and posterior cortical atrophy are the most diagnostic.Meanwhile,cerebral blood flow changes in various brain regions with the progression of the AD.More investigations combining the changes of gray matter volume and cerebral blood flow to explore pathophysiological mechanisms underlying cognitive decline in AD spectrum are necessary in the future.
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Objective To investigate the characteristics of amygdala neural circuitry in comorbidity of late-life depression (LLD) and cognitive impairment. Methods Twenty-four LLD,eighteen amnestic mild cognitive impairments (aMCI),thirteen aMCI with depression (dMCI) and thirty cognitive normal (CN) subjects completed resting-state functional magnetic resonance imaging scan. Main effects of depression and MCI and their interactions on the intrinsic amygdala functional connectivity network ( AFCN) connectivity were examined. Behavioral significance of AFCN that voxel-wised amygdala connectivity correlating with de-pression severity and memory scores were also tested after controlling the effects of covariates,including age, gender,education, gray matter atrophy, and group. Results The immediate memory and delayed memory function in the aMCI group (-0. 75 ± 0. 77 and -1. 13 ± 0. 56) and the dMCI group (-1. 07 ± 0. 79 and-1. 00±0. 52) were significantly lower than those of the CN group (0. 46±0. 73 and 0. 60±0. 61),and the difference was statistically significant (P<0. 01). Depression and anxiety in the LLD group (1. 00±0. 53 and 0. 93±0. 98) and the dMCI group (0. 86±0. 80 and 0. 78±0. 82) were significantly higher than those of the CN group (-0. 92±0. 25 and -0. 74±0. 22),and the difference was statistically significant (P<0. 01). Brain network analysis showed that separated neural circuits were implicated in the depression and cognitive im-pairment. Importantly,interactive effects of depression and MCI on the AFCN were also identified,especially in the bilateral somatomotor area,inferior parietal cortex/precuneus,posterior cingulate cortex,right medial prefrontal cortex/dorsolateral prefrontal cortex and hippocampus. Behavioral significance of AFCN also re-vealed the distinctive neural circuits involved in the depression severity and memory deficits,respectively. Conjunction analysis further identified the overlapped neural circuits associated with depression and memory deficits were primarily in the left DLPFC,insula,hippocampus,right inferior prefrontal cortex and dorsomedi-al prefrontal cortex. Conclusions Depression and cognitive impairment synergistically facilitate functional decoupling of AFCN and thus compromise the integrity of amygdala networks. Distinct depression-related or MCI-related neural constructs represent the characteristics of clinical phenotype of depression or MCI alone, while overlapped circuits probably reveal the neural basis of comorbidity of LLD and MCI.
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Objective To investigate the changes of regional homogeneity ( ReHo) in Parkinson's disease (PD) patients with depression and their relationship with major depressive disorder.Methods A total of 42 PD patients without depression , 20 PD patients with depression, 20 major depressive disorder patients and 47 well-matched healthy controls were scanned with resting-state functional magnetic resonance imaging for ReHo analysis.The Hamilton Depression Scale (HAMD), Unified Parkinson's Disease Rating Scale (UPDRS-Ⅲ) and Hoehn-Yahr stage were used to assess the clinical symptoms , then the correlations between abnormal brain regions and clinical data were explored.Results ( 1 ) The main effect of Parkinson's disease: PD group showed higher ReHo in left ventrolateral prefrontal cortex and right precuneus, but lower ReHo in bilateral supplementary motor area and left angular gyrus.(2) The main effect of depression: The depression group had increased ReHo in bilateral cerebellum , and decreased ReHo in bilateral precentral gyrus , postcentral gyrus , left inferior frontal gyrus, left posterior cingulate gyrus , left supplementary motor area , right dorsolateral prefrontal cortex , right inferior parietal gyrus and right calcarine.(3) Interactive effect of PD and depression : Interactive brain areas included bilateral middle frontal gyrus, left inferior frontal cortex and supramarginal gyrus.(4) The ReHo of the brain regions under main effect of depression including right dorsolateral prefrontal cortex (r＝-0.526, P＜0.01) and right inferior parietal gyrus ( r＝-0.456, P＜0.01) had significant negative correlation with HAMD scores. Conclusion PD patients with depression have abnormal brain function , and PD with depression is not simply an overlay of PD and major depressive disorder.
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PurposeTo investigate the independent risk factors of refractory hypertension for effective screening and treatment.Materials and Methods 142 patients with refractory hypertension underwent renal angiography, morbidity of renal artery stenosis (RAS) and angiography results were analyzed using univariate and multivariate Logistic regression.Results Thirty-eight cases of RAS were identiifed with incidence of 26.8%. Univariate analysis indicated that diabetes, peripheral artery disease and coronary heart disease were the predictor for RAS (P<0.05 orP<0.01). Multivariate regression analysis demonstrated that peripheral artery disease (OR 5.011, 95%CI 2.17-8.93,P<0.001) was independent risk factors for RAS. Diabetes and coronary heart disease were not independent risk factors.Conclusion Peripheral artery disease is independent risk factor for RAS among patients with refractory hypertension, which can serve as a screening index of renal angiography or renal angioplasty and stenting for RAS.
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Objective To evaluate the clinical efficacy of transcatheter super-selective hepatic artery embolization (TAE) in treating symptomatic polycystic liver disease (PLD). Methods A total of 8 patients with PLD, who were admitted to authors’ hospital during the period from 2009 to 2013 to receive TAE, were enrolled in this study. The patients included 6 females and 2 males with a mean age of 59.5 years (54-65 years). The used embolic agents were polyvinyl alcohol (PVA) microspheres and micro spring coils. Both plain and contrast-enhanced CT scans of the upper abdomen were performed before TAE as well as at 12 months after TAE; the total volume of the hepatic cysts was measured and the changes of the cystic volume were determined. Statistical analysis was conducted using paired t test. Results The technical success rate was 100%. After TAE, the patients developed fever and different degrees of discomfort at liver area, which were disappeared after active symptomatic medication, and no serious complications occurred. The patients were followed up for 12 months , the mean total volume of the intrahepatic cysts decreased from preoperative (5 794±2 066) cm3 (range 3 120-8 935 cm3) to postoperative (3 832±1 525) cm3 (range 2 019-5 925 cm3), the difference was statistically significant (t=6.971, P<0.001). The reduction ratio of total volume of intrahepatic cysts was 34.6%±11.3%(24.3%-60.4%). Conclusion For symptomatic polycystic liver disease, transcatheter super-selective hepatic arterial embolization is a newly-developed treatment. This technique is safe and effective with reliable response and fewer complications. Therefore, it should be recommended in clinical practice.
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Objective To investigate the features of white matter impairment and its relationship with cognition in patients with amnestic mild cognitive impairment (aMCI).Methods Eighty-three cases of aMCI and 85 normal aging volunteers were scanned with diffusion tensor imaging (DTI) using MR system.All subjects completed the neuropsychological battery.We analyzed the differences between two groups using tract-based spatial statistics and the association between regions in difference and cognition using correlation analysis.Results There were significant differences between aMCI and normal control in the neuropsychological battery including the Mini-Mental State Examination(26.2 ± 2.6 vs 28.3 ± 1.3,F =43.224,P =0.000),Mattis Dementia Rating Scale-2 (131.4 ± 6.9 vs 138.0 ± 3.5,F =62.308,P =0.000),Auditory Verbal Learning Test-delayed recall(2.4 ± 1.6 vs 7.5 ± 2.0,F =324.018,P =0.000),Boston Naming Test(8.7 ± 1.4 vs 9.2 ± 1.0,F =6.821,P =0.010),Rey-Osterrich Complex Figure Test (12.1 ± 7.3 vs 18.5 ± 6.1,F =40.674,P =0.000),Symbol Digit Modulation Test (30.0 ± 10.1 vs 38.6 ± 9.8,F =30.786,P =0.000),Trail-Making Test Part B ((256.8 ± 124.5) s vs (178.1 ± 59.0) s,F =27.601,P =0.000).Significantly higher diffusivity indexes and radial diffusivity were also found in aMCI subjects compared to healthy elders in the parahippocampal,superior longitudinal fasciculus,inferior longitudinal fasciculus,superior fronto-occipital fasciculus,inferior fronto-occipital fasciculus,unciform fasciculus,corticospinal tract,corpus callosum,cingulum,corona radiate.We also found that axial diffusivity was significantly increased in the parahippocampal,superior longitudinal fasciculus,inferior longitudinal fasciculus,superior fronto-occipital fasciculus,inferior fronto-occipital fasciculus,unciform fasciculus,corticospinal tract and corpus callosum,whereas fractional anisotropy changes were not observed in aMCI.Diffusivity indexes values in bilateral frontal lobe (left r =0.67 ; right r =0.70),left cingulum (r =0.63),parietal white matter (r =0.69) and radial diffusivity values in left parietal (r =0.68) were significantly related to Trail Making Test A among aMCI (all P ＜ 0.05).Conclusions In aMCI patients,there was a wide range of white matter damage,with no brain region-specific.Executive function deficit was related to the white matter impairment in bilateral frontal lobe,left cingulate and parietal lobe.The specificity and sensitivity of four DTI parameters fordetecting white matter lesions are variant.Trial registration Clinical Research Center of Jiangsu Province (BL2013025)
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Objective To comparative analyze the CT enhanced scan and digital substraction angiography (DSA) in showing the residual and new lesions after treatment of transcatheter arterial chemoembolization (TACE).Methods 60 cases of patients with complete clinical information and imaging data from June 2010 to February 2013 were collected,these patients were diagnosed of primary hepatocelluar carcinoma and underwent TACE treatment.The sensitivity and specificity of CT and DSA to detect the residual and new lesions after TACE treatment were analyzed.By analysis of the main factors affecting the low detection rate to seek a method that can improve PHC residual new lesions detection rate after TACE.Results There were 86 lesions in 60 cases,CT enhanced scan clearly determined the diagnosis of 49 lesions (42 residues,7 new lesions).37 lesions did not prompted to tumor recurrence (residual and new lesions).DSA as the gold standard,the sensitivity of CT enhanced scan to check out the lesions was 84.5 ％ (49/58),specificity was 100.0 ％ (28/28),the false negative rate was 15.5 ％ (9/58),the accuracy was 89.5 ％ (77/86).Enhanced CT detection rate of tumor recurrence was 57.0 ％ (49/86),the DSA detection rate of tumor recurrence was 67.4 ％ (58/86).The difference of determining tumor recurrence between the CT enhanced scan and DSA was significant (x2 =7.11,P ＜ 0.05).Conclusions Three dynamic contrast-enhanced CT scan is the first choice for follow-up examination methods after TACE for hepatocellular carcinoma,but many factors will affect the detection rate of the residual and new lesions.Compared with CT examination,DSA examination has more advantages.DSA examination should be performed when the clinical suspicion of tumor recurrence is negative after enhanced CT scan.
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Objective To evaluate DSA feature, the value, efficacy and side effect, survival time of microcathereter superselective catherization intervenetional treatment on liver metastases cancer. Methods 60 cases with liver metastases cancers were cannulated through common femoral artery by seldinger technique. If the artery was lack, second radiography was given through superselective hepatic artery. On the base of DSA feature of liver metastases, all the patients were divided into two groups: superselective- catherization group and nonsuperselective-catherization group. There were 30 patients in each group respectively. Microcathereter was used in the former to "embed" the tumor vessel and "siphonal" technique was used in the later. Compared the changes of the two groups in volume, the deposit of iodized oil in liver matastases after treating one month and the changes of ALT, ALB, TBIL in blood. The efficacy and side effect were compared in two groups. The survival time and DSA feature of using microcathereter were also analyzed. Results The DSA feature and efficacy of superselective-catherization group was better than that of non-superselective-catherization group, the side effect was mild and the survival time was longer than the former. Conclusion Microcathereter superselective catherization to treat liver metastases cancer has better efficacy, artery radiography, lighter side effect and can prolong the survival time.