Volumetric Assessment of the Insula in a Normally Functioning Human Brain Using Magnetic Resonance Imaging / Evaluación Volumétrica de la Ínsula en un Cerebro Humano que Funciona Normalmente Utilizando Imágenes de Resonancia Magnética

SUMMARY: Volumetric assessment of brain structures is an important tool in neuroscience research and clinical practice. The volumetric measurement of normally functioning human brain helps detect age-related changes in some regions, which can be observed at varying degrees. This study aims to estimate the insular volume in the normally functioning human brain in both genders, different age groups, and side variations. A cross-sectional retrospective study was conducted on 42 adult Sudanese participants in Al-Amal Hospital, Sudan, between May to August 2022, using magnetic resonance imaging (MRI) and automatic brain segmentation through a software program (BrainSuite). The statistical difference in total insular volume on both sides of the cerebral hemisphere was small. The insular volume on the right side was greater in males, while the left side showed no difference between both genders. A statistically significant difference between males and females was found (p > 0.05), and no statistical difference in different age groups was found according to the one-way ANOVA test (p>0.05). Adult Sudanese males showed a larger insular volume than females. MRI can be used to morphometrically assess the insula to detect any pathological variations based on volume changes.

La evaluación volumétrica de las estructuras cerebrales es una herramienta importante en la investigación y la práctica clínica de la neurociencia. La medición volumétrica del cerebro humano, que funciona normalmente, ayuda a detectar cambios relacionados con la edad en algunas regiones, las cuales se pueden observar en diversos grados. Este estudio tuvo como objetivo estimar el volumen insular en el cerebro humano que funciona normalmente, en ambos sexos, de diferentes grupos de edad y sus variaciones laterales. Se realizó un estudio retrospectivo transversal en 42 participantes sudaneses adultos en el Hospital Al-Amal, Sudán, entre mayo y agosto de 2022, utilizando imágenes de resonancia magnética y segmentación automática del cerebro a través de un software (BrainSuite). Fue pequeña la diferencia estadística en el volumen insular total, en los hemisferios cerebrales. El volumen insular del lado derecho fue mayor en los hombres, mientras que el lado izquierdo no mostró diferencia entre ambos sexos. Se encontró una diferencia estadísticamente significativa entre hombres y mujeres (p > 0,05), y no se encontró diferencia estadística en los diferentes grupos de edad, según la prueba de ANOVA de una vía (p> 0,05). Los hombres sudaneses adultos mostraron un mayor volumen insular que las mujeres. La resonancia magnética se puede utilizar para evaluar morfométricamente la ínsula y para detectar cualquier variación patológica basada en cambios de volumen.

As artérias lenticuloestriadas podem interferir na extensão da ressecção tumoral e sobrevida nos gliomas da ínsula? / Can lenticulostriated arteries interfere with the extent of tumor resection and survival in insula gliomas?

Introdução: Os gliomas são tumores encefálicos e da medula espinhal que se originam nas células gliais e cuja progressão invade o tecido cerebral adjacentee e dentre eles um dos mais desafiadores são localizados no lobo cerebral da ínsula. Estas artérias irrigam estruturas nobres e sua lesão pode produzir danos sensitivos, motores e de linguagem. Objetivo: Descrever o impacto da extensão da ressecção, sobrevida global e dos resultados funcionais após a cirurgia dos gliomas insulares, quando estes tumores estejam ou não envolvidos pelas artérias lenticuloestriadas. Métodos: Revisão integrativa nas plataformas virtuais em português e inglês, buscando AND ou OR dados através dos seguintes descritores "Gliomas da ínsula, Mapeamento cerebral, Artérias lenticuloestriadas". A busca inicial foi baseada no título e/ou resumo. Decididos os trabalhos incluíveis foi realizada a leitura na íntegra dos textos. Ao total foram estudados 55 artigos. Resultados: O lobo da ínsula fica "escondido" pela sobreposição dos lobos frontal, parietal e temporal. Para alcançá-lo pode-se realizar as abordagens transsilviana ou transcortical. Ocorre que ao chegar na ínsula visualiza-se significativa ramificação constituída pelas artérias lenticuloestriadas, cuja manipulação pode determinar déficit neurológico e, ao se aprofundar no córtex insular, depara-se com outras estruturas tão importantes quanto a própria ínsula. O conhecimento anatômico das artérias lenticuloestriadas e suas relações é de fundamental importância para a ressecção de glioma insular, pois o comprometimento delas e da artéria cerebral média podem determinar a isquemia dos núcleos da base e da cápsula interna. Conclusão: O tratamento dos gliomas insulares permanece como grande desafio. Devido à sua localização e possibilidade de desenvolvimento de déficits neurológicos na manipulação cirúrgica é necessário não somente conhecer sua localização topográfica, mas também a íntima relação vascular com as artérias lenticuloestriadas. O envolvimento delas pelo tumor possui implicações na sobrevida e na preservação da função neurológica. O conhecimento detalhado da anatomia da região é fundamental para diminuir complicações que afetem grandemente a qualidade de vida dos pacientes.

Introduction: Gliomas are brain and spinal cord tumors that originate in glial cells and whose progression invades the adjacent brain tissue and among them one of the most challenging are located in the cerebral lobe of the insula. These arteries supply noble structures and their damage can cause sensory, motor and language damage. Objective: To describe the impact of the extent of resection, overall survival and functional results after surgery for insular gliomas, when these tumors are or are not involved by lenticulostriate arteries. Methods: Integrative review on virtual platforms in Portuguese and English, searching for AND or OR data using the following descriptors "Insula gliomas, Brain mapping, Lenticulostriate arteries". The initial search was based on the title and/or abstract. Once the included works were decided, the texts were read in full. In total, 55 articles were studied. Results: The insula lobe is "hidden" by the overlap of the frontal, parietal and temporal lobes. To achieve this, transsylvian or transcortical approaches can be performed. It turns out that when arriving at the insula, a significant branch made up of lenticulostriate arteries is seen, the manipulation of which can cause neurological deficits and, when going deeper into the insular cortex, one comes across other structures as important as the insula itself. Anatomical knowledge of the lenticulostriate arteries and their relationships is of fundamental importance for the resection of insular glioma, as their involvement and that of the middle cerebral artery can determine ischemia of the basal ganglia and internal capsule. Conclusion: The treatment of insular gliomas remains a major challenge. Due to its location and the possibility of developing neurological deficits during surgical manipulation, it is necessary not only to know its topographic location, but also the intimate vascular relationship with the lenticulostriate arteries. Their involvement by the tumor has implications for survival and preservation of neurological function. Detailed knowledge of the region's anatomy is essential to reduce complications that greatly affect patients' quality of life.

To Blame or Not? Modulating Third-Party Punishment with the Framing Effect / 神经科学通报·英文版

People as third-party observers, without direct self-interest, may punish norm violators to maintain social norms. However, third-party judgment and the follow-up punishment might be susceptible to the way we frame (i.e., verbally describe) a norm violation. We conducted a behavioral and a neuroimaging experiment to investigate the above phenomenon, which we call the "third-party framing effect". In these experiments, participants observed an anonymous perpetrator deciding whether to keep her/his economic benefit while exposing a victim to a risk of physical pain (described as "harming others" in one condition and "not helping others" in the other condition), then they had a chance to punish that perpetrator at their own cost. Our results showed that the participants were more willing to execute third-party punishment under the harm frame compared to the help frame, manifesting a framing effect. Self-reported anger toward perpetrators mediated the relationship between empathy toward victims and the framing effect. Meanwhile, activation of the insula mediated the relationship between mid-cingulate cortex activation and the framing effect; the functional connectivity between these regions significantly predicted the size of the framing effect. These findings shed light on the psychological and neural mechanisms of the third-party framing effect.

Effect of acupuncture on pain-emotion related brain regions in patients with cervical spondylosis of cervical type: a fMRI study / 中国针灸

OBJECTIVE@#To observe the changes of functional connectivity of brain pain-emotion regulation region in patients with cervical spondylosis of cervical type by functional magnetic resonance imaging (fMRI).@*METHODS@#Thirty-two subjects were selected. Of them, 16 patients with cervical spondylosis of cervical type were divided into an observation group and 16 healthy subjects into a control group. The patients in the observation group were treated with acupuncture at Tianzhu (BL 10), Jingbailao (EX-HN 15), Jianzhongshu (SI 15) and @*RESULTS@#In the observation group, the VAS score was (1.94±1.12) after the treatment, which was lower than (5.62±1.20) before treatment (@*CONCLUSION@#Pain involves the formation and expression of "pain-emotion-cognition". Acupuncture can systematically regulate the brain functional connections between cognitive regions such as dorsal prefrontal lobe and anterior cingulate gyrus and emotional regions such as insula and VTA in patients with cervical spondylosis of cervical type, suggesting that acupuncture has a multi-dimensional and comprehensive regulation effect on pain.

Navegando por la fisura silviana: anatomía microquirúrgica, neuroimágenes y técnica quirúrgica / Navigating the sylvian fissure: microsurgical anatomy, neuroimaging, and surgical technique

Objetivo: Describir la anatomía quirúrgica de la fisura silviana (FS) a través de disecciones cadavéricas y neuroimágenes; desarrollar su aplicación microquirúrgica. Materiales y métodos: Se estudiaron 10 hemisferios cadavéricos humanos fijados y un cráneo humano en seco, a través de la disección de fibras blancas y de la anatomía arterial y neural, utilizando un microscopio quirúrgico. Las arterias cerebrales fueron inyectadas con silicona coloreada. La anatomía quirúrgica fue correlacionada con la anatomía neuroimagenológica. Finalmente, se recolectó la experiencia microquirúrgica adquirida y, a su vez, la anatomía del Complejo Silviano, fue revisada. Resultados: La FS se extiende desde la cara basal a la lateral del cerebro. Cada superficie tiene una parte superficial (tronco silviano y sus ramos), intermedia (compartimientos anterior y opercular lateral) y profunda (compartimiento esfenoidal, hendidura insular anterior y lateral y la región retroinsular). En 7 de los 10 hemisferios, el surco central no se intersectó con la FS en la superficie lateral del cerebro. En el 80% de los hemisferios, la principal bifurcación de la arteria cerebral media se localizó en o proximal al limen insular. Debajo de la pars triangularis se localiza el punto más ancho de la superficie lateral de la FS. Los autores comienzan la disección de la misma en o proximalmente a este punto. Conclusiones: El conocimiento anatómico profundo y su aplicación a las neuroimágenes, son herramientas esenciales para el planeamiento prequirúrgico y son requisitos mandatorios para operar con seguridad a través y alrededor de la FS

Objective: The aim of this study is to describe the microsurgical anatomy of the sylvian fissure, through cadaveric dissections and neuroimaging and to elucidate its clinical application for microsurgery. Methods: One human skull and ten cadaveric human hemispheres were studied through white matter fiber dissections and arterial and neural anatomy of the sylvian fissure and insular dissections under the microscope. The cerebral arteries were perfused with colored latex. The surgical anatomy was correlated with neuroimaging anatomy. Finally, the microsurgical experienced gained applying this anatomical knowledge was gathered, and the literature about the anatomy of the sylvian complex was revised, as well. Results: The Sylvian fissure extends from the basal to the lateral surface of the brain. Each surface has a superficial (sylvian stem and its rami), intermediate (anterior and lateral opercular compartments) and deep parts (sphenoidal compartment, anterior and lateral insular clefts and retroinsular region). In 7 out of 10 hemispheres, the central sulcus did not intersect with the sylvian fissure on the lateral surface of the brain. In 80% of the hemispheres, the middle cerebral artery main bifurcation was localized at or proximal to the limen insulae. Beneath the pars triangularis, the widest point of the lateral surface of the sylvian fissure is located. The authors start dissecting the sylvian fissure at this point. Conclusion: The thorough anatomical knowledge with its clinical application in modern neuroimaging are essential tools for preoperative planning and are mandatory requisites to safely operate through and around the sylvian fissure anatomical complex.

El lóbulo de la ínsula: Parte 2 - Anatomía microquirúrgica y correlación clínico-quirúrgica / The lobe of the insula: Part 2 - Microsurgical anatomy and clinical-surgical correlation

Introducción: El conocimiento profundo de la anatomía microquirúrgica del lóbulo de la ínsula es crucial para operar pacientes con tumores en esta región. Objetivo: El objetivo de la segunda parte de este estudio es correlacionar la anatomía microquirúrgica con casos ilustrativos retirados de nuestra casuística de 35 pacientes en los cuales fueron realizados 44 cirugías de tumores en relación con el lóbulo de la ínsula. Material y Métodos: A lo largo de marzo de 2007 y agosto de 2014, 44 microcirugías fueron realizadas en 35 pacientes portadores de tumores insulares y los hallazgos de las cirugías y mapeo cerebral se correlacionaron con la anatomía microquirúrgica. Resultados: De una serie de 44 pacientes con tumores de la ínsula, la mayoría de los casos eran gliomas de bajo grado de malignidad (29 casos). El inicio de los síntomas en 34 pacientes fue epilepsia, siendo esta refractaria al tratamiento medicamentoso en 12 casos. El grado de resección fue subtotal o total en la mayoría de los casos de la serie. La mejoría en la calidad de vida (epilepsia, etc.) estuvo presente en más de la mitad de los pacientes. El déficit neurológico permanente estuvo presente en tres pacientes. Conclusión: En los tumores insulares, es tan importante el conocimiento profundo de la anatomía, como el saber utilizar e interpretar en tiempo real las observaciones de la monitorización neurofisiológica intraoperatoria.

Introduction: The deep knowledge of the microsurgical anatomy of the insular lobe is crucial to operate patients with tumors in this region. Objectives: Our purpose in this second part is to correlate insular surgical anatomy with illustrative cases from 4 surgeries performed on 35 patients with insular tumors. Materials and Methods: From March 2007 to August 2014, 44 microsurgeries were performed on 35 patients with insular glioma tumors. Of these, 29 cases were low-grade gliomas. Seizures were the first symptom in most cases. Total, or near total tumor resection was achieved in most of the patients. Improvement in quality of life was achieved in more than half of the patients after surgery. Moderate and permanent neurological deficits were present in 3 patients. Results: The majority of cases were low grade malignancy gliomas (29 cases). The onset of symptoms in 34 patients was epilepsy, being refractory to drug treatment in 12 cases. The degree of resection was subtotal or total in most cases of this series. The improvement in the quality of life (epilepsy, etc.) was present in more than half of the patients. Permanent neurological deficit was present in three patients. Conclusion: For insular tumors, microsurgical anatomy knowledge is as important as cortical and subcortical mapping

Parte I: Anatomía microquirúrgica tridimensional de la ínsula / Part I: Three-dimensional microsurgical anatomy of the insula

Introducción: El lóbulo de la ínsula, o ínsula, se encuentra oculto en la superficie lateral del cerebro. La ínsula está localizada profundamente en el surco lateral o cisura silviana, recubierta por los opérculos frontal, parietal y temporal. Objetivo: Estudiar la compleja anatomía del lóbulo de la ínsula, una de las regiones de mayor complejidad quirúrgica del cerebro humano, y su correlación anatómica con casos quirúrgicos. Material y Métodos: En la primera parte de este estudio presentamos los resultados de nuestras disecciones microquirúrgicas en fotografías 2 D y 3D; en la segunda parte de nuestro trabajo, la correlación anatómica con una serie de 44 cirugías en pacientes con tumores de la ínsula, principalmente gliomas, operados entre 2007 y 2014. Resultados: Extenso conjunto de fibras subcorticales, incluyendo el fascículo uncinado, fronto-occipital inferior y el fascículo arcuato, conectan la ínsula a las regiones vecinas. Varias estructuras anatómicas responsables por déficits neurológicos severos están íntimamente relacionadas con la cirugía de la ínsula, tales como lesiones de la arteria cerebral media, cápsula interna, áreas del lenguaje en el hemisferio dominante y arterias lenticuloestriadas. Conclusión: El entrenamiento en laboratorio de neuroanatomía, estudio de material impreso en 3D, el conocimiento sobre neurofisiología intra-operatoria y el uso de armamento neuroquirúrgico moderno son factores que influencian en los resultados quirúrgicos

Introduction: The insular lobe, or insula, is the cerebral lobe sitting deep in the sylvian fissure and hidden by the lateral surface of the brain. It is covered by the frontal, parietal and temporal operculum. Objectives: To study the anatomy of the insular lobe, one of the most complex parts of the human brain, and to correlate this anatomy with intraoperative findings. Materials and Methods: In the first part of this article we show the results of our dissections, documented in 2D and 3D, and focus on microsurgical anatomy. In the second part we correlate the anatomical structures with intraoperative findings from 44 insular tumor surgeries, mainly gliomas, of patients operated on from 2007 to 2014. Results: Huge bundles of subcortical fibers, like uncinate, inferior fronto-occipital and arcuate fascicles, connect the insula to the neighboring structures. Several anatomical structures related to neurological disabilities are closely related to insular surgery, like the middle cerebral artery, internal capsule, lenticulostriate arteries and cortical and subcortical language circuits. Conclusions: Microsurgical laboratory training, 3D documentation, knowledge of brain mapping and modern neurosurgical armamentarium are important factors in achieving good results with insular glioma tumors.

Changes of functional connectivity between the right anterior insula and the frontal operculum in mild cognitive impairment / 中华老年心脑血管病杂志

Objective To investigate changes of functional connectivity between the right anterior insula and the frontal operculum in mild cognitive impairment(MCI).Methods Twenty-one MCI patients served as MCI group and twenty age-and gender-matched subjects with normal cognitive function served as a control group in this study.Resting-state fMRI was performed and functional connectivity to right anterior insula and the frontal operculum was obtained with a voxel-wise manner.The difference in functional connectivity between the two groups was obtained with two -sample t-test.Results The mini-mental state examination score was significantly lower in MCI group than in control group(25.8±0.6 vs 29.2±0.3,P＜0.01).In healthy elderly,a distributed set of regions,including bilateral inferior parietal lobule,right middle and posterior cingulated cortex,right middle frontal gyrus,right mediodorsal nucleus of thalamus,right supplementary motor area,left anterior insula and the frontal operculum,left superior temporal gyrus,left inferior frontal gyrus,left precentral gyrus and left olfactory cortex(orbital and vertical gyrus),showed functional connectivity to right anterior insula and the frontal operculum.While bilateral inferior parietal lobule,right inferior frontal gyrus(opercularis,orbitalis,triangularis),right middle frontal gyrus,right middle cingulated cortex,right thalamus,left anterior insula and the frontal operculum and ACC,showed functional connectivity to right anterior insula and the frontal operculum in MCI.Compared to healthy elderly,decreased functional connectivity to right anterior insula and the frontal operculum was identified in left olfactory cortex and left superior parietal lobule,while increased in right medial prefrontal lobe.At the same time,a tendency of decreased functional connectivity to left anterior insula and the frontal operculum was also observed in left olfactory cortex.Conclusion The changes of functional connectivity to right anterior insula and the frontal operculum can be a significant biomarker in the differential diagnosis of MCI.

Fear Network Model in Panic Disorder: The Past and the Future

The core concept for pathophysiology in panic disorder (PD) is the fear network model (FNM). The alterations in FNM might be linked with disturbances in the autonomic nervous system (ANS), which is a common phenomenon in PD. The traditional FNM included the frontal and limbic regions, which were dysregulated in the feedback mechanism for cognitive control of frontal lobe over the primitive response of limbic system. The exaggerated responses of limbic system are also associated with dysregulation in the neurotransmitter system. The neuroimaging studies also corresponded to FNM concept. However, more extended areas of FNM have been discovered in recent imaging studies, such as sensory regions of occipital, parietal cortex and temporal cortex and insula. The insula might integrate the filtered sensory information via thalamus from the visuospatial and other sensory modalities related to occipital, parietal and temporal lobes. In this review article, the traditional and advanced FNM would be discussed. I would also focus on the current evidences of insula, temporal, parietal and occipital lobes in the pathophysiology. In addition, the white matter and functional connectome studies would be reviewed to support the concept of advanced FNM. An emerging dysregulation model of fronto-limbic-insula and temporooccipito-parietal areas might be revealed according to the combined results of recent neuroimaging studies. The future delineation of advanced FNM model can be beneficial from more extensive and advanced studies focusing on the additional sensory regions of occipital, parietal and temporal cortex to confirm the role of advanced FNM in the pathophysiology of PD.

Multimodal Assessment of Neural Substrates in Computerized Cognitive Training: A Preliminary Study

BACKGROUND AND PURPOSE: Several studies have validated the clinical efficacy of computerized cognitive training applications. However, few studies have investigated the neural substrates of these training applications using simultaneous multimodal neuroimaging modalities. We aimed to determine the effectiveness of computerized cognitive training and corresponding neural substrates through a multimodal approach. METHODS: Ten patients with mild cognitive impairment (MCI), six patients with subjective memory impairment (SMI), and 10 normal controls received custom-developed computerized cognitive training in the memory clinic of a university hospital. All of the participants completed 24 sessions of computerized cognitive training, each lasting 40 minutes and performed twice weekly. They were assessed using neuropsychological tests (both computerized and conventional), electroencephalography, fluorodeoxyglucose positron-emission tomography (FDG-PET), volumetric magnetic resonance imaging (MRI), and diffusion-tensor imaging (DTI) at pre- and posttraining. RESULTS: The patients with MCI exhibited significant improvements in the trail-making test–black & white-B, and memory domain of the computerized cognitive assessment. Subjects with normal cognition exhibited significant improvements in scores in the language and attention-/psychomotor-speed domains. There were no significant changes in subjects with SMI. In the pre- and posttraining evaluations of the MCI group, FDG-PET showed focal activation in the left anterior insula and anterior cingulate after training. Volumetric MRI showed a focal increase in the cortical thickness in the rostral anterior cingulate. DTI revealed increased fractional anisotropy in several regions, including the anterior cingulate. CONCLUSIONS: The anterior cingulate and anterior insula, which are parts of the salience network, may be substrates for the improvements in cognitive function induced by computerized cognitive training.

Separate Neural Networks for Gains and Losses in Intertemporal Choice / 神经科学通报·英文版

An important and unresolved question is how human brain regions process information and interact with each other in intertemporal choice related to gains and losses. Using psychophysiological interaction and dynamic causal modeling analyses, we investigated the functional interactions between regions involved in the decision-making process while participants performed temporal discounting tasks in both the gains and losses domains. We found two distinct intrinsic valuation systems underlying temporal discounting in the gains and losses domains: gains were specifically evaluated in the medial regions, including the medial prefrontal and orbitofrontal cortices, and losses were evaluated in the lateral dorsolateral prefrontal cortex. In addition, immediate reward or punishment was found to modulate the functional interactions between the dorsolateral prefrontal cortex and distinct regions in both the gains and losses domains: in the gains domain, the mesolimbic regions; in the losses domain, the medial prefrontal cortex, anterior cingulate cortex, and insula. These findings suggest that intertemporal choice of gains and losses might involve distinct valuation systems, and more importantly, separate neural interactions may implement the intertemporal choices of gains and losses. These findings may provide a new biological perspective for understanding the neural mechanisms underlying intertemporal choice of gains and losses.

Bradicardia extrema por infarto talámico paramediano bilateral / Extreme bradycardia due to bilateral paramedian thalamic infarction

RESUMEN Alteraciones autonómicas agudas por infartos cerebrales se han descrito con frecuencia comprometiendo la región insular, dentro de las anormalidades se han documentado alteraciones de severidad variable del ritmo cardíaco, incluyendo la bradicardia extrema sintomática; en la literatura solo hay un reporte de caso de bradi-cardia extrema asociado a un infarto talámico paramediano bilateral, a continuación, describimos un segundo caso de un infarto talámico con la misma presentación.

SUMMARY Acute autonomic disturbances due to cerebral in farcts has been describe frequently with association of the insular cortex, within the describe abnormalities had been document a variety of cardiac disturbances including extreme symptomatic bradycardia; In the literature just exist a case report of extreme bradycardia associate with a bilateral paramedian thalamic infarct, in the following article, we describe a second case of this infarct with the same presentation.

Hallazgos morfométricos y funcionales acerca de la ínsula en población VIH+ con apatía / Morphometric and functional findings about the insula in HIV+ population with apathy

La corteza insular es uno de los componentes de la zona paralímbica que presenta conexiones con áreas corticales y subcorticales. El estudio en personas viviendo con VIH (PVVIH), donde la apatía es frecuente, la implicó como modulador de respuesta emocional y ejecutiva. El objetivo es describir morfométricamente y funcionalmente la ínsula en relación con estructuras cerebrales corticales y subcorticales en PVVIH con apatía en comparación con controles y con PVVIH sin apatía, a fin de determinar su implicancia. Estudiamos 23 encéfalos de PVVIH de sexo masculino con apatía según evaluaciones neuropsiquiátricas. Se utilizó resonancia magnética (RM) con protocolo cognitivo para cuantificación y tomografía por emisión de fotón único (SPECT) para evaluar la perfusión cortical, aplicados a: cortezas frontales, insulares, núcleos caudados y cuerpos amigdalinos. Registramos reducción significativa morfométrica de la corteza del cíngulo anterior izquierdo, núcleo caudado ipsilateral y cortezas dorso-laterales en VIH+ con apatía; la ínsula anterior registró una reducción no significativa (p=0,4). En el análisis funcional se determinó hipoperfusión en las cortezas del cíngulo anterior izquierdo, insular anterior izquierda y en el caudado de forma asimétrica; con hipoperfusiones relativas en regiones del hemisferio derecho. La perfusión de la ínsula anterior izquierda fue correlativa con la del caudado ipsilateral y proporcional a la severidad en el test de apatía. Concluimos que en la cohorte evaluada de pacientes viviendo con VIH y apatía hallamos un significativo compromiso funcional de la corteza insular anterior, correlativo con la afectación funcional y morfométrica de los núcleos caudados. La implicancia de la corteza insular sugiere su participación en la psicopatología de la apatía, parámetro vinculado con el déficit de interés por las actividades e iniciativas.

The insular cortex is one of the components of the paralimbic zone that has connections with cortical and subcortical areas. The study in people living with HIV (PLHIV), in which apathy is frequent, implicated the structure as a modulator of emotional and executive responses. The objective is to make a description based on morphometry and functionality of the insula in relation to cortical and subcortical structures in PLHIV with apathy compared to controls and compared to PLHIV without apathy, in order to determine its implication. We studied 23 brains of male PLHIV with apathy according to neuropsychiatric evaluations. Magnetic resonance imaging (MRI) with cognitive quantification protocol and Single photon emission tomography (SPECT) to evaluate cortical perfusion were used applied to: frontal cortices, insular cortex, caudate nuclei and amygdaloid bodies. We recorded a significant morphometric reduction of the left anterior cingulate cortex, left caudate nucleus and dorso-lateral cortex in PLHIV with apathy; anterior insula cortex recorded a non-significant reduction (p = 0.4). Functional analysis showed hypoperfusion in the left anterior cingulum cortex, left anterior insular region and caudate nucleus´s perfusion were assymetrically; relative hypoperfusion were found in right hemisphere regions. The perfusion of the left anterior insula was correlated with ipsilateral caudate and proportional to the severity in the apathy test. We concluded in the cohort evaluated patients living with HIV and apathy found a significant functional compromise of the anterior insular cortex, correlated with morphometric and functional impairment of the caudate nuclei. The implication of the insular cortex suggests their participation in the psychopathology of apathy, parameter linked with the deficit of interest in the activities and initiatives.

Neurofisiología de la empatía: una revisión de investigaciones / Neurophysiology of empathy: a review of investigations

La empatía es un constructo con múltiples definiciones y modelos explicativos, los cuales se han conformado a partir de observaciones e investigaciones en humanos y otros animales. En el presente, se revisaron estudios en humanos sanos, que vincula empatía con conducta motora, sistema nervioso autónomo y central. La evidencia presentada apoya la asociación entre empatía y el sistema de neuronas en espejo, la imitación facial, el contagio pupilar, el sistema autonómico, la interocepción, la conectividad neuronal, la ínsula, el cíngulo, entre otras. Finalmente, esta revisión incentiva el estudio, investigación y desarrollo de las múltiples áreas y disciplinas que tratan con la empatía.

Reduced Cortical Thickness in the Temporal Pole, Insula, and Pars Triangularis in Patients with Panic Disorder

PURPOSE: Recent neuroimaging findings have revealed that paralimbic and prefrontal regions are involved in panic disorder (PD). However, no imaging studies have compared differences in cortical thickness between patients with PD and healthy control (HC) subjects. MATERIALS AND METHODS: Forty-seven right-handed patients with PD who met the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders-4th edition-text revision, and 30 HC subjects were enrolled. We used the FreeSurfer software package for estimating the cortical thickness of regions of interest, including the temporal pole, insula, and pars triangularis (mid-ventrolateral prefrontal cortex). RESULTS: Cortical thickness of the temporal pole (p=0.033, right), insula (p=0.017, left), and pars triangularis (p=0.008, left; p=0.025, right) in patients with PD was significantly lower, compared with HC subjects (Benjamini-Hochberg false discovery rate correction). Exploratory analysis revealed a significant negative correlation between the cortical thickness of the right temporal pole and Beck Depression Inventory scores (r=-0.333, p=0.027) in patients with PD and positive correlations between the cortical thickness of the left pars triangularis and Panic Disorder Severity Scale (r=0.429, p=0.004), Anxiety Sensitivity Index-Revised (r=0.380, p=0.011), and Beck Anxiety Inventory (r=0.421, p=0.004) scores using Pearson's correlation. CONCLUSION: Ours study is the first to demonstrate cortical thickness reduction in the temporal pole, insula, and pars triangularis in patients with PD, compared with the HC subjects. These findings suggest that reduced cortical thickness could play an important role in the pathophysiology of PD.

Neurodevelopmental Changes in Social Reinforcement Processing: A Functional Magnetic Resonance Imaging Study

OBJECTIVE: In the current study we investigated neurodevelopmental changes in response to social and non-social reinforcement. METHODS: Fifty-three healthy participants including 16 early adolescents (age, 10–15 years), 16 late adolescents (age, 15–18 years), and 21 young adults (age, 21–25 years) completed a social/non-social reward learning task while undergoing functional magnetic resonance imaging. Participants responded to fractal image stimuli and received social or non-social reward/non-rewards according to their accuracy. ANOVAs were conducted on both the blood oxygen level dependent response data and the product of a context-dependent psychophysiological interaction (gPPI) analysis involving ventromedial prefrontal cortex (vmPFC) and bilateral insula cortices as seed regions. RESULTS: Early adolescents showed significantly increased activation in the amygdala and anterior insula cortex in response to non-social monetary rewards relative to both social reward/non-reward and monetary non-rewards compared to late adolescents and young adults. In addition, early adolescents showed significantly more positive connectivity between the vmPFC/bilateral insula cortices seeds and other regions implicated in reinforcement processing (the amygdala, posterior cingulate cortex, insula cortex, and lentiform nucleus) in response to non-reward and especially social non-reward, compared to late adolescents and young adults. CONCLUSION: It appears that early adolescence may be marked by: (i) a selective increase in responsiveness to non-social, relative to social, rewards; and (ii) enhanced, integrated functioning of reinforcement circuitry for non-reward, and in particular, with respect to posterior cingulate and insula cortices, for social non-reward.

La Insulectomía podría ser un abordaje ideal para crisis insulares y peri-insulares? / Insulectomy for insular and peri-insular seizures could be an ideal and safe approach?

La insulectomía es una técnica microquirúrgica establecida para el tratamiento de la epilepsia refractaria al tratamiento farmacológico. El origen insular de la epilepsia es inusual, sin embargo, con la investigación a través de electrodos híbridos este tipo de epilepsia ha incrementado su diagnóstico. Los autores hacen hincapié en las funciones insulares, así como los puntos de referencia anatómicos para la cirugía. Se discuten las principales complicaciones y las bases fisiológicas para las indicaciones de cirugía.

Insulectomy is an established microsurgical technique for treatment of insular epilepsy refractory to clinical management. The insular origin of epilepsy is unusual, however with depth investigation through hybrids electrodes such kind of epilepsy is increasing its diagnosis. The authors emphasizes the insular functions as well as the anatomical landmarks for surgery. The main complications are discussed and physiological basis for indications.

Influence of microsurgical operation through lateral fissure-insula lobe approach in the treatment of hyperten-sive cerebral hemorrhage in basal ganglia region / 局解手术学杂志

Objective To explore the impact of Microsurgical operation through lateral fissure-insula lobe approach in the treatment of hypertensive cerebral hemorrhage in basal ganglia region on the clinical curative effect.Methods Selected 90 cases of patients with hyper-tensive cerebral hemorrhage in basal ganglia region in our hospital from April 2013 to December 2015.According to the random number table method,they were divided into the observation group and the control group.Regarded the even numbers as the observation group while the odd numbers as the control group,with 45 cases in each group.Patients of the two groups were all performed general anaesthesia with tracheal in-tubation.And patients of the control group were given large trauma craniotomy,while patients of the observation group were treated by micro-surgical operation through lateral fissure-insula lobe approach.Recorded the situation of surgery and postoperative recovery of patients in the two groups.In addition,compared the postoperative complications and evaluated living conditions of the two groups through activity of daily living scale(ADL)half a year after surgery.Results The good rate of recovery in the observation group was 84.44% (38 /45),while it was 51.11%(23 /45)in the control group,and there was statistically significant difference between the two groups(χ2 =11.447,P =0.000).Be-sides,the mortality rate of the observation group was 0(0 /45)half a year after surgery,while it was 8.89%(4 /45)in the control group,and there was statistically significant difference between the two groups(χ2 =4.186,P =0.041).The operation time of observation group and the automatic opening time in the observation group were obviously shorter than that of the control group(P <0.05).Moreover,the hematoma clearance rate and GCS score of the observation group 1 week after operation were significantly higher than those of the control group (P <0.05).The incidence of postoperative complications of the observation group was 8.89%(4 /45),which was significantly lower than 31.11%(14 /45)in the control group,and there was significant difference(P <0.05).Conclusion It has many advantages such as shorter operative time,faster postoperative recovery,and higher hematoma clearance rate to apply microsurgical operation through lateral fissure-insula lobe approach in the treatment of hypertensive cerebral hemorrhage in basal ganglia region.Besides,it pays attention to protecting cerebral vascular of patients.The clinical treatment effect is ideal and safe.Therefore,it is worth popularizing in clinical application.

Propuesta de evaluación neuropsicológica para casos donde exista una alteración en la percepción musical / A proposal for neuropsychological evaluation in cases where there is an alteration in musical perception

Existen diferentes condiciones que no se consideran tan relevantes, debido a que no son totalmente incapacitantes. Aun así cuando un paciente considera importante un síntoma o una condición específica, esta debe tomarse con seriedad, ya que es posible que sea una parte esencial de aquella persona. La música se considera como uno de los mayores reforzadores para el ser humano, así como una gran herramienta para la estimulación neuropsicológica. Sin embargo, poco se ha investigado en relación con este tema, razón por la que se recomienda integrar el área musical como parte de la evaluación e intervención neuropsicológica. Este artículo tiene como objetivo construir una propuesta de evaluación neuropsicológica para casos donde exista una alteración en la percepción musical. A través de un estudio de caso único, y a partir de un protocolo estándar de evaluación neuropsicológica, junto con pruebas adicionales específicas sobre música, se finaliza con una propuesta que incluye diagnósticos diferenciales como depresión, amusia y anhedonia musical. Como aportes, se establece que es una propuesta que, además de novedosa, se ha de tener en cuenta debido a la relevancia que implica el componente musical. Asimismo, se destaca la idea de evaluar al paciente de forma integral, no solo sobre su estado cognitivo general, sino además emocional, siempre teniendo en cuenta lo que el paciente precisa.

There are different conditions which are not considered as relevant because they are not totally disabling. Yet when a patient regards a symptom or a specific condition as important, it should be taken seriously, because it may be an essential part of that person. Music is considered as one of the biggest reinforcers for humans, as well as a great tool for neuropsychological stimulation. But little has been investigated in relation to this issue. It is recommended to integrate the musical area as part of the neuropsychological evaluation and intervention. This article aims to build a proposed neuropsychological assessment for cases where there is an alteration in the perception of music. Through a single case study, and from a standard neuropsychological assessment protocol, along with specific additional evidence about music, it ends with a proposal that includes differential diagnoses such as depression, musical anhedonia and amusia. As a contribution states that it is a proposal that, in addition to novelty, it should be taken into account due to the relevance that involves the musical component; and the fact that assess the patient holistically, not only on their overall cognitive state but also emotional and always taking into account what the patient needs.

Characteristics, Evaluation and Mechanism of Apraxia of Speech (review) / 中国康复理论与实践

@#Apraxia of speech (AOS) is a motor speech disorder presented with characteristic speech performance and related brain location.This article reviewed the characteristic speech performance of AOS and common assessments, discussed the mechanism and provided neurological bases of AOS in order to understand the relationship between speech performance and imaging.