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关键词： chronic rhinosinusitis   cortical thickness   functional MRI   gray matter volume   olfaction  

摘要： Olfactory dysfunction (OD) is more common than hearing loss, partial blindness, or blindness and can have a significant impact on the quality of life. Moreover, unexplained OD is an early biomarker in neurodegenerative diseases and increases 5-year mortality risk. Structural alterations in olfactory eloquent brain regions may represent the neuroanatomical correlates of OD. Previous studies have demonstrated reduced gray matter (GM) volume in areas of presumed olfactory relevance in patients with OD. However, being cross-sectional in nature, these studies do not provide evidence of causality, for which longitudinal work is required. At present, however, longitudinal studies addressing olfactory structural plasticity are limited, both in number and methodological approach: to our knowledge, such work has not included parallel functional imaging to confirm the relevance of structural change. We therefore performed a longitudinal multimodal neuroimaging study investigating structural and functional plasticity in 24 patients undergoing surgical treatment for chronic rhinosinusitis, compared with 17 healthy controls. We demonstrated functionally significant structural plasticity within the orbitofrontal, anterior cingulate and insular cortices, and temporal poles in patients 3 months after surgery. Of interest, GM volume decreased in these regions, in association with increased psychophysical scores and BOLD signal. To our knowledge, this is the first study to demonstrate both structural and functional plasticity of the central olfactory networks, thereby confirming these areas as neuroanatomical correlates of olfactory function/dysfunction.

关键词： External branch   Laryngeal nerve   Intraoperative neuromonitoring  

摘要： Purpose of Review The external branch of the superior laryngeal nerve (EBSLN) is often overlooked, and intraoperative damage to this nerve is likely under-reported despite significant consequences. This article reviews the anatomy and identification of the EBSLN, its role in voice physiology, and the updated literature describing the role for intraoperative neuromonitoring (IONM). Recent Findings With the widespread acceptance of IONM, particularly in the identification of recurrent laryngeal nerve damage, recent studies have demonstrated a role for this technology in the surgical identification of the EBSLN. However, the ability of IONM to improve clinical outcomes with regard to the EBSLN has not been fully elucidated in the current literature. The intraoperative identification and preservation of the EBSLN require a perspicacious endocrine surgeon. While IONM can play an important role in identification, further studies are required to demonstrate its role in long-term clinical outcomes.

关键词： Self-awareness   Handwriting   Individual differences   Brain structure  

摘要： Metacognition is the ability to introspect and control ongoing cognitive processes. Despite the extensive investigation of the brain architectures supporting metacognition for perception and memory, little is known about the neural basis of metacognitive capacity for motor function, a vital aspect of human behavior. Here, using functional and structural magnetic resonance imaging (MRI), we examined the brain substrates underlying self-awareness of handwriting, a highly practiced visuomotor skill. Results showed that experienced adult writers generally overestimated their handwriting quality, and such overestimation was more pronounced in men relative to women. Individual variations in self-awareness of handwriting quality were positively correlated with gray matter volume in the left fusiform gyrus, right middle frontal gyrus and right precuneus. The left fusiform gyrus and right middle frontal gyrus are thought to represent domain-specific brain mechanisms for handwriting self-awareness, while the right precuneus that has been reported in other domains likely represents a domain-general brain mechanism for metacognition. Furthermore, the activity of these structurally related regions in a handwriting task was not correlated with self-awareness of handwriting, suggesting the correlation with metacognition was independent of task performance. Together, this study reveals that metacognition for practiced motor skills relies on both domain-general and domain-specific brain systems, extending our understanding about the neural basis of human metacognition.

关键词： Bladder pain   Neurobiology   Sensitization  

摘要： Purpose of Review In this review, we summarize the most recent literature on neurobiology of bladder pain in a systematic fashion starting with end organ, peripheral nervous system, the spinal cord, and ending with the brain. Special attention is dedicated to pain processing in patients with spinal cord injury. Recent Findings Chronic bladder pain is not an isolated entity and is in fact a result of a complex interaction between the end organ, surrounding structures, and peripheral and central nervous system. The afferent fibers collecting the information from the bladder urothelium and mucosa are a very diverse population and respond not only to stretch but also to noxious and chemical signaling. Neuroinflammation appears to be central to the process of sensitization. Imaging and molecular evidence is emerging noting actual alterations in signaling pathways and neuroanatomy in patients with chronic pelvic pain beyond the end organ. Tremendous progress has been made to better understand the complex pathophysiology of bladder pain on a molecular and neuroanatomic level. Ideally, this information can be utilized to better identify specific and individualized intervention targets for patients with chronic bladder pain.

关键词： Parkinson disease   Mild cognitive impairment (MCI)   Magnetic resonance imaging (MRI)   Voxel-based morphometry (VBM)  

摘要： Introduction Mild cognitive impairment (MCI) is common in Parkinson's disease (PD), but the underlying pathological mechanism has not been fully understood. Voxel-based morphometry could be used to evaluate regional atrophy and its relationship with cognitive performances in early PD-MCI. Patients and Methods One hundred and six patients with PD were recruited from a larger cohort of patients, the Parkinson's Disease Cognitive Impairment Study (PaCoS). Subject underwent a T1-3D MRI and a complete clinical and neuropsychological evaluation. Patients were divided into PD with normal cognition (PD-NC) and PD-MCI according to the MDS level II criteria-modified for PD-MCI. A subgroup of early patients with short disease duration (<= 2 years) was also identified. VBM analysis between PD-NC and PD-MCI and between early PD-NC and PD-MCI was performed using two-sample t tests with whole-brain statistical threshold of p < 0.001 uncorrected in the entire PD group and p < 0.05 FWE inside ROIs, in the early PD. Results Forty patients were diagnosed with MCI and 66 were PD-NC. PD-MCI patients showed significant gray matter (GM) reduction in several brain regions, including frontal gyrus, precuneus, angular gyrus, temporal lobe, and cerebellum. Early PD-MCI showed reduction in GM density in superior frontal gyrus and cerebellum. Moreover, correlation analysis between neuropsychological performances and GM volume of early PD-MCI patients showed associations between performances of Raven and superior frontal gyrus volume, Stroop time and inferior frontal gyrus volume, accuracy of Barrage and volume of precuneus. Conclusion The detection of frontal and cerebellar atrophy, even at an early stage, could be used as an early marker of PD-related cognitive impairment.

关键词： Schizophrenia   MRI   MRS   Glutamate   Serotonin  

摘要： Disrupted serotonergic and glutamatergic signaling interact and contribute to the pathophysiology of schizophrenia, which is particularly relevant for the hippocampus where diverse expression of serotonin receptors is noted. Hippocampal atrophy is a well-established feature of schizophrenia, with select subfields hypothesized as particularly vulnerable due to variation in glutamate receptor densities. We investigated hippocampal anomalies in first-episode psychosis (FEP) in relation to receptor distributions by leveraging 4 sources of data: (1) ultra high-field (7-Tesla) structural neuroimaging, and (2) proton magnetic resonance spectroscopy (1H-MRS) of glutamate from 27 healthy and 41 FEP subjects, (3) gene expression data from the Allen Human Brain Atlas and (4) atlases of the serotonin receptor system. Automated methods delineated the hippocampus to map receptor density across subfields. We used gene expression data to correlate serotonin and glutamate receptor genes across the hippocampus. Measures of individual hippocampal shape-receptor alignment were derived through normative modelling and correlations to receptor distributions, termed Receptor-Specific Morphometric Signatures (RSMS). We found reduced hippocampal volumes in FEP, while CA4-dentate gyrus showed greatest reductions. Gene expression indicated 5-HT1A and 5-HT4 to correlate with AMPA and NMDA expression, respectively. Magnitudes of subfield volumetric reduction in FEP correlated most with 5-HT1A (R = 0.64, p = 4.09E-03) and 5-HT4 (R = 0.54, p = 0.02) densities as expected, and replicated using previously published data from two FEP studies. Right-sided 5-HT4-RSMS was correlated with MRS glutamate (R = 0.357, p = 0.048). We demonstrate a putative glutamate-driven hippocampal variability in FEP through a serotonin receptor-density gated mechanism, thus outlining a mechanistic interplay between serotonin and glutamate in determining the hippocampal morphology in schizophrenia.

关键词： Addiction   Cocaine dependence   Dual diagnosis   Neuroanatomy   Personality disorders  

摘要： Cocaine dependence (CD) is highly comorbid with personality disorders, with implications for poorer treatment response. The neurobiological mechanisms of this comorbidity are unclear. We aimed to test the role of comorbid personality disorders in the neuroanatomy of CD. We examined 4 groups using high-resolution structural neuroimaging, psychological questionnaires and cognitive tests: CD (n = 19), CD and personality disorder type B (CD + B, n = 21), CD and personality disorder C (CD + C, n = 13) and 21 controls. We compared groups in neuroanatomy and hypothesised that (i) CD would show altered striatal areas ascribed to reward processing (i.e., accumbens, caudate and putamen), (ii) CD + B and CD + C would show altered areas supporting emotional regulation/social valuation and anxiety/avoidance (i.e., OFC and amygdala). The CD + B group had larger caudate volumes than CD (p = .01, d = 0.94) and reduced lateral OFC thickness than CD + C (p = .056, d = 0.71). Exploratory correlations showed that altered neural integrity of the OFC and of the caudate nucleus in these groups exacerbated with worse personality disorder severity and impulsivity scores. CD with and without comorbid personality disorders may have partially distinct underlying mechanisms and targets for treatment.

关键词： Empathy   Cocaine hydrochloride   Coca paste   Social cognition   Brain correlates  

摘要： Reduced empathic abilities are frequently observed in drug abusers. These deficits may compromise interpersonal interactions and contribute to diminished social functioning. However, previous evidence regarding empathy and addiction is behaviorally unspecific and virtually null in terms of their brain structural or functional correlates. Moreover, no previous study has investigated how empathy is affected by drugs whose consumption is particularly characterized by counter-empathic behaviors. Here, we conducted the first assessment of neurocognitive correlates of empathy for pain in dependent users (predominantly men) of smoked cocaine (SC, coca paste, n = 37). We compared their performance in the empathy task with that of two groups matched in relevant demographic variables: 24 dependent users of insufflated cocaine hydrochloride (CC) and 21 healthy controls. In addition, we explored the structural anatomy and functional connectivity (FC) correlates of empathic impairments across groups. Our results showed that, compared to CC and controls, SC users exhibited a selective reduction of empathic concern for intentional harms. These impairments were associated with lower gray matter volumes in regions subserving social cognition (i.e., right inferior parietal lobule, supramarginal and angular gyri). Furthermore, reduced empathic concern correlated with FC within affective empathy and social cognition networks, which are also linked to cognitive changes reported in addiction (i.e., inferior frontal and orbital gyri, posterior insula, supplementary motor area, cingulate cortex). Our findings suggest that chronic consumption of SC may involve reduced empathic concern and relevant neuroanatomical and FC abnormalities, which, in turn, may result in social interaction dysfunction. These results can inform theoretical and applied developments in neuropsychopharmacology.

关键词： 人体解剖学   临床思维能力   操作能力  

摘要： 在医学史的发展历程中,《解剖学基础》一直扮演着十分重要的角色,基于其重要性,老师在教学过程中要让学生临床思维能力的提高和掌握基本理论知识齐头并进,只有这样,人体解剖学教学才能变得能有意义,而不是简单的纸上谈兵。学好解剖学既有利于提高学生们上课的专注度,也有利于促进医学事业的发展,为医学事业更好的发展奠定坚实的基础。

关键词： 人体解剖学   实验教学模式   改革方式  

摘要： 在医学领域,人体解剖学是所有学科的基础,只有掌握好解剖学的相关知识,我们才能学好其他的医学学科。但是面对各地高校扩大招生,师资经费不足,学生素质下降等问题,学校应该立即对其实验教学模式进行优化改革,从而推动解剖标本资源的整合。将传统实验教学模式与现代信息化技术相结合,并且利用网络平台面向社会群体进行相关宣传活动,使越来越多的人关注人体解剖学。本文以人体解剖学的相关实验活动为基础,进一步分析研究改革的方法与路径。