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Yang S, Xiao W, Wu H, Liu Y, Feng S, Lu J, Wang T. Management Based on Multimodal Brain Monitoring May Improve Functional Connectivity and Post-operative Neurocognition in Elderly Patients Undergoing Spinal Surgery. Front Aging Neurosci 2021; 13:705287. [PMID: 34335234 PMCID: PMC8322980 DOI: 10.3389/fnagi.2021.705287] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/15/2021] [Indexed: 01/11/2023] Open
Abstract
Perioperative neurocognitive disorder (PND) is a common condition in elderly patients undergoing surgery. Sedation, analgesia, regional cerebral oxygen saturation (rSO2), and body temperature are known to be associated with PND, but few studies have examined the contribution of these factors combined in detail. This prospective, randomized, controlled, double-blinded study investigated whether anesthesia management based on multimodal brain monitoring—an anesthesia management algorithm designed by our group—could improve the post-operative cognitive function and brain functional connectivity (FC) in elderly patients undergoing elective spinal surgery with general anesthesia. The patients (aged ≥65 years) were randomized into two groups [control (Group C), n = 12 and intervention (Group I), n = 14]. Patients in Group I were managed with multimodal brain monitoring (patient state index, spectral edge frequency, analgesia nociception index, rSO2, and temperature), and those in Group C were managed with routine anesthesia management. All patients were pre- and post-operatively evaluated (7 days after surgery) with the Montreal Cognitive Assessment (MoCA). Amplitude of low-frequency fluctuation (ALFF) and FC were analyzed after resting-state functional MRI. Serum C-reactive protein (CRP) and lipopolysaccharide levels were measured, and the correlation between FC and changes in inflammatory marker levels was analyzed. Mean post-operative MoCA score was higher in Group I (24.80 ± 2.09) than in Group C (22.56 ± 2.24) (p = 0.04), with no difference in PND incidence between groups (28.57 vs. 16.67%; p = 0.47). Group I also showed significantly increased ALFF values in several brain regions after surgery (p < 0.05), and FC between the left hippocampus and left orbital inferior frontal gyrus (FG), left middle FG, left superior temporal gyrus, and left precentral gyrus was enhanced (p < 0.05), which was negatively correlated with the change in serum CRP (pre vs. post-intervention) (R = −0.58, p = 0.01). These results suggest that management of elderly patients undergoing surgery by multimodal brain monitoring may improve post-operative neurocognition and FC by reducing systemic inflammation. Clinical Trial Registration:http://www.chictr.org.cn/index.aspx, identifier: ChiCTR1900028024.
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Affiliation(s)
- Shuyi Yang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Wei Xiao
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Hao Wu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yang Liu
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Shuai Feng
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tianlong Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disease, Beijing, China
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Burks JD, Conner AK, Bonney PA, Glenn CA, Baker CM, Boettcher LB, Briggs RG, O’Donoghue DL, Wu DH, Sughrue ME. Anatomy and white matter connections of the orbitofrontal gyrus. J Neurosurg 2018; 128:1865-1872. [DOI: 10.3171/2017.3.jns162070] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVEThe orbitofrontal cortex (OFC) is understood to have a role in outcome evaluation and risk assessment and is commonly involved with infiltrative tumors. A detailed understanding of the exact location and nature of associated white matter tracts could significantly improve postoperative morbidity related to declining capacity. Through diffusion tensor imaging–based fiber tracking validated by gross anatomical dissection as ground truth, the authors have characterized these connections based on relationships to other well-known structures.METHODSDiffusion imaging from the Human Connectome Project for 10 healthy adult controls was used for tractography analysis. The OFC was evaluated as a whole based on connectivity with other regions. All OFC tracts were mapped in both hemispheres, and a lateralization index was calculated with resultant tract volumes. Ten postmortem dissections were then performed using a modified Klingler technique to demonstrate the location of major tracts.RESULTSThe authors identified 3 major connections of the OFC: a bundle to the thalamus and anterior cingulate gyrus, passing inferior to the caudate and medial to the vertical fibers of the thalamic projections; a bundle to the brainstem, traveling lateral to the caudate and medial to the internal capsule; and radiations to the parietal and occipital lobes traveling with the inferior fronto-occipital fasciculus.CONCLUSIONSThe OFC is an important center for processing visual, spatial, and emotional information. Subtle differences in executive functioning following surgery for frontal lobe tumors may be better understood in the context of the fiber-bundle anatomy highlighted by this study.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Dee H. Wu
- 3Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Contreras-Rodríguez O, Pujol J, Batalla I, Harrison BJ, Soriano-Mas C, Deus J, López-Solà M, Macià D, Pera V, Hernández-Ribas R, Pifarré J, Menchón JM, Cardoner N. Functional Connectivity Bias in the Prefrontal Cortex of Psychopaths. Biol Psychiatry 2015; 78:647-55. [PMID: 24742618 DOI: 10.1016/j.biopsych.2014.03.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/18/2014] [Accepted: 03/07/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psychopathy is characterized by a distinctive interpersonal style that combines callous-unemotional traits with inflexible and antisocial behavior. Traditional emotion-based perspectives link emotional impairment mostly to alterations in amygdala-ventromedial frontal circuits. However, these models alone cannot explain why individuals with psychopathy can regularly benefit from emotional information when placed on their focus of attention and why they are more resistant to interference from nonaffective contextual cues. The present study aimed to identify abnormal or distinctive functional links between and within emotional and cognitive brain systems in the psychopathic brain to characterize further the neural bases of psychopathy. METHODS High-resolution anatomic magnetic resonance imaging with a functional sequence acquired in the resting state was used to assess 22 subjects with psychopathy and 22 control subjects. Anatomic and functional connectivity alterations were investigated first using a whole-brain analysis. Brain regions showing overlapping anatomic and functional changes were examined further using seed-based functional connectivity mapping. RESULTS Subjects with psychopathy showed gray matter reduction involving prefrontal cortex, paralimbic, and limbic structures. Anatomic changes overlapped with areas showing increased degree of functional connectivity at the medial-dorsal frontal cortex. Subsequent functional seed-based connectivity mapping revealed a pattern of reduced functional connectivity of prefrontal areas with limbic-paralimbic structures and enhanced connectivity within the dorsal frontal lobe in subjects with psychopathy. CONCLUSIONS Our results suggest that a weakened link between emotional and cognitive domains in the psychopathic brain may combine with enhanced functional connections within frontal executive areas. The identified functional alterations are discussed in the context of potential contributors to the inflexible behavior displayed by individuals with psychopathy.
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Affiliation(s)
- Oren Contreras-Rodríguez
- Bellvitge Biomedical Research Institute-IDIBELL (OC-R, CS-M, RH-R, JMM, NC), Psychiatry Department, Bellvitge University Hospital, CIBERSAM at Barcelona; Department of Clinical Psychology and Institute of Neuroscience F. Olóriz (OC-R), University of Granada; MRI Research Unit (OC-R, JPu, BJH, JD, ML-S, DM), CRC Mar, Hospital del Mar at Barcelona, Spain
| | - Jesus Pujol
- Department of Clinical Psychology and Institute of Neuroscience F. Olóriz (OC-R), University of Granada; MRI Research Unit (OC-R, JPu, BJH, JD, ML-S, DM), CRC Mar, Hospital del Mar at Barcelona, Spain; Centro Investigación Biomédica en Red de Salud Mental (JPu), CIBERSAM G21, Barcelona, Spain.
| | - Iolanda Batalla
- GSS (IB, VP, JPi), Hospital Santa Maria and Biomedical Research Institute at Lleida
| | - Ben J Harrison
- Department of Clinical Psychology and Institute of Neuroscience F. Olóriz (OC-R), University of Granada; MRI Research Unit (OC-R, JPu, BJH, JD, ML-S, DM), CRC Mar, Hospital del Mar at Barcelona, Spain; Melbourne Neuropsychiatry Centre (BJH), Department of Psychiatry, The University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Carles Soriano-Mas
- Bellvitge Biomedical Research Institute-IDIBELL (OC-R, CS-M, RH-R, JMM, NC), Psychiatry Department, Bellvitge University Hospital, CIBERSAM at Barcelona
| | - Joan Deus
- Department of Clinical Psychology and Institute of Neuroscience F. Olóriz (OC-R), University of Granada; MRI Research Unit (OC-R, JPu, BJH, JD, ML-S, DM), CRC Mar, Hospital del Mar at Barcelona, Spain; Department of Clinical and Health Psychology (JD), Autonomous University of Barcelona, Spain
| | - Marina López-Solà
- Department of Clinical Psychology and Institute of Neuroscience F. Olóriz (OC-R), University of Granada; MRI Research Unit (OC-R, JPu, BJH, JD, ML-S, DM), CRC Mar, Hospital del Mar at Barcelona, Spain; Department of Psychology and Neuroscience (ML-S), University of Colorado, Boulder, Colorado
| | - Dídac Macià
- Department of Clinical Psychology and Institute of Neuroscience F. Olóriz (OC-R), University of Granada; MRI Research Unit (OC-R, JPu, BJH, JD, ML-S, DM), CRC Mar, Hospital del Mar at Barcelona, Spain
| | - Vanessa Pera
- GSS (IB, VP, JPi), Hospital Santa Maria and Biomedical Research Institute at Lleida; Child-Juvenile Mental Health Center of Sant Joan de Déu at Lleida (VP), Lleida, Spain
| | - Rosa Hernández-Ribas
- Bellvitge Biomedical Research Institute-IDIBELL (OC-R, CS-M, RH-R, JMM, NC), Psychiatry Department, Bellvitge University Hospital, CIBERSAM at Barcelona
| | - Josep Pifarré
- GSS (IB, VP, JPi), Hospital Santa Maria and Biomedical Research Institute at Lleida
| | - José M Menchón
- Bellvitge Biomedical Research Institute-IDIBELL (OC-R, CS-M, RH-R, JMM, NC), Psychiatry Department, Bellvitge University Hospital, CIBERSAM at Barcelona
| | - Narcís Cardoner
- Bellvitge Biomedical Research Institute-IDIBELL (OC-R, CS-M, RH-R, JMM, NC), Psychiatry Department, Bellvitge University Hospital, CIBERSAM at Barcelona
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Kawamura M. [Emotion and Brodmann's areas: special reference on area 12]. Rinsho Shinkeigaku 2010; 50:1010-1011. [PMID: 21921546 DOI: 10.5692/clinicalneurol.50.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Brodmann's brain maps, assembled in 1909, are still in use, but understanding of their animal-human homology is uncertain. Furthermore, in 1909, Brodmann did not identify human Area 12 (BA12); a location now important to understanding of frontotemporal lobar degeneration (FTLD) and emotional function. We found Brodmann did identify human BA12 in later maps (1910 and 1914), not in the 1909 monograph. Because of its current link with FTLD, BA 12's translation from animal (1909) to human (1910 and 1914) is not only an historical puzzle. It impacts how Brodmann's areas, based on comparative animal-human cyto-architecture, are widely used in current research as functional loci in human brain. If Brodmann's maps are of current value, then an accurate rather than a generic Brodmann number is in order.
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