Objective To evaluate the changes of brain metabolism with 18F-fluorodeoxyglucose (FDG) PET/CT in patients with disorders of consciousness (DOC).Methods This retrospective study,from January 2007 to October 2016,included 40 patients (26 males,14 females,age range:17-73 years)in the vegetative state (VS),12 patients (11 males,1 female,age range:25-53 years) in the minimally conscious state (MCS),and 11 patients (10 males,1 female,age range:12-68 years) in the state of recovering from DOC.All patients underwent 18F-FDG PET/CT imaging.The standardized uptake value (SUV) of multiple brain areas among 3 groups of patients was calculated and compared.One-way analysis of variance was used for data analysis.Results The SUV in different encephalic regions among 3 groups were significantly different (F values:6.214-13.642,all P＜0.01) except for mesencephalon.Compared with MCS group,the SUV of cerebral cortex of VS group was lower (t values:2.263-3.548,all P＜0.05).Compared with the recovered group,the SUV of cerebral cortex and cerebellum of VS group was lower (t values:1.299-5.136,all P＜0.05).Compared with the recovered group,the SUV of parietal lobe,temporal lobe,occipital lobe,thalamus and cerebellum of MCS group was lower (t values:1.962-2.841,all P＜0.05).Conclusion 18F-FDG PET/CT may be significant in evaluating brain function of DOC patients.

Adult ; Aged ; Coma ; physiopathology ; Consciousness ; physiology ; Consciousness Disorders ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Persistent Vegetative State ; physiopathology ; Photic Stimulation ; methods ; Recovery of Function ; physiology ; Treatment Outcome

Visual fixation is an item in the visual function subscale of the Coma Recovery Scale-Revised (CRS-R). Sometimes clinicians using the behavioral scales find it difficult to detect because of the motor impairment in patients with disorders of consciousness (DOCs). Brain-computer interface (BCI) can be used to improve clinical assessment because it directly detects the brain response to an external stimulus in the absence of behavioral expression. In this study, we designed a BCI system to assist the visual fixation assessment of DOC patients. The results from 15 patients indicated that three showed visual fixation in both CRS-R and BCI assessments and one did not show such behavior in the CRS-R assessment but achieved significant online accuracy in the BCI assessment. The results revealed that electroencephalography-based BCI can detect the brain response for visual fixation. Therefore, the proposed BCI may provide a promising method for assisting behavioral assessment using the CRS-R.
Adolescent ; Adult ; Aged ; Brain ; physiopathology ; Brain-Computer Interfaces ; Consciousness Disorders ; diagnosis ; physiopathology ; Diagnosis, Computer-Assisted ; methods ; Electroencephalography ; methods ; Evoked Potentials ; Female ; Fixation, Ocular ; physiology ; Humans ; Male ; Middle Aged ; Neurologic Examination ; Pilot Projects ; Severity of Illness Index ; User-Computer Interface

A number of studies have indicated that disorders of consciousness result from multifocal injuries as well as from the impaired functional and anatomical connectivity between various anterior forebrain regions. However, the specific causal mechanism linking these regions remains unclear. In this study, we used spectral dynamic causal modeling to assess how the effective connections (ECs) between various regions differ between individuals. Next, we used connectome-based predictive modeling to evaluate the performance of the ECs in predicting the clinical scores of DOC patients. We found increased ECs from the striatum to the globus pallidus as well as from the globus pallidus to the posterior cingulate cortex, and decreased ECs from the globus pallidus to the thalamus and from the medial prefrontal cortex to the striatum in DOC patients as compared to healthy controls. Prediction of the patients' outcome was effective using the negative ECs as features. In summary, the present study highlights a key role of the thalamo-basal ganglia-cortical loop in DOCs and supports the anterior forebrain mesocircuit hypothesis. Furthermore, EC could be potentially used to assess the consciousness level.
Adult ; Bayes Theorem ; Connectome ; Consciousness Disorders ; diagnostic imaging ; physiopathology ; Female ; Humans ; Machine Learning ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neural Pathways ; diagnostic imaging ; physiopathology ; Prognosis ; Prosencephalon ; diagnostic imaging ; physiopathology ; Young Adult

With the global warming, the incidence of heat stroke was significantly higher than before. Severe heat stroke has a high mortality, high morbidity and consolidated central nervous system injury characteristics. The main features of severe heat stroke cerebral injury include cognitive impairment, delirium, convulsions and coma. Its mechanism is related with heat shock induced cerebral tissue ischemia and hypoxia, vascular dysfunction, secondary cascade inflammation and so on. Currently, the main treatment of heat stroke cerebral injury is the hypothermia therapy, dehydration for the reduction of intracranial pressure, naloxone and other cerebral protection and nutrition treatments. Hyperbaric oxygen therapy (HBOT) is effective in treating brain injury. HBOT can alleviate tissue ischemia and hypoxia, improve circulation, reduce cerebral edema, and anti-inflammatory, anti-oxidative damage, anti-apoptosis and other molecular biological effects. HBOT also play a wake up-promoting effect of nerve repair in the cerebral injury. The treatment of cerebral injury has been the difficulty and weakness of heat stroke research. Therefore, this article reviewed the epidemiology, pathogenesis, the therapeutic effect and mechanism of hyperbaric oxygen on cerebral injury in severe heat stroke to clarify the advantages of HBOT and to provide experimental basis for further research.

BACKGROUND: It is of great importance to study the genotype distribution of hereditary ataxia in understanding its epidemiologic rule and pathogenetic pathway.OBJECTIVE: To analyze the distribution of different genotype of hereditary ataxia in south China.DESIGN: A case-control observation.SETTING: Department of Neurology, the First Affiliated Hospital of Sun Yat-sen University.PARTICIPANTS: Forty-three patients (26 males and 17 females) with hereditary ataxia from 36 families and 38 patients with sporadic hereditary ataxia (24 males and 14 females) were selected from the Outpatient Clinic of Neurogenetics, Department of Neurology, the First Affiliated Hospital of Sun Yat-sen University between September 1998 and September 2002. At the same time, 60 healthy individuals from the patients' families and 44randomly-selected healthy physical examinees were taken as controls. All the participants were enrolled voluntarily.METHODS: The fragments of trinucleotide repeats at different sites of mutant genes were amplified with polymerase chain reaction (PCR), and then the lengths were calculated with polyacrylamide gel electrophoresis and imaging analytical software. The repeated numbers of trinucleotide repeats in all the normal and abnormal amplified alleles were calculated respectively.MAIN OUTCOME MEASURES: Different genotype distribution in patients with hereditary ataxia.RESULTS: All the subjects were involved in the analysis of results. Of the detected patients with hereditary ataxia, the Machado-Joseph disease/spinocerebellar ataxia (SCA) 3 was the most common type of autosomal dominant SCA in South China, which was 42.0%, and was followed by SCA2 (7.4%), SCA1 (4.9%), SCA7 (3.7%), SCA6 (2.5%), SCA12 (1.2%).No patient was detected to have SCA8 SCA 10, SCA 17 dentatorubropallidoluysian atrophy (DRPLA) and Friedreich ataxia (FRDA).CONCLUSION: Autosomal dominant SCA3 is the most familiar genotype in South China. Clinical detection of hereditary ataxia should be done firstly aiming at the SCA3 genotype.

BACKGROUND: Hyperbaric oxygen therapy has been considered as an effective therapy for prevention and cure of cerebral infarction traditionally.However, some scholars suggested that hyperbaric oxygen therapy could also result in cerebral infarction, although the mechanism is unclear.OBJECTIVE: To investigate the cause of cerebral infarction due to hyperbaric oxygen therapy.DESIGN: Case-control trial with patients as subjects.SETTING: Department of Hyperbaric Oxygen, Guangzhou General Hospital of Guangzhou Military Area Command of Chinese PLA.PARTICIPANTS: From December 1996 to March 1998, 192 inpatients receiving hyperbaric oxygen therapy were recruited into the trial from the Department of Hyperbaric Oxygen, Guangzhou General Hospital of Guangzhou Military Area Command of Chinese PLA. There were 127 males and 65 females aged 9-78 years. Patients admitted to the department of hyperbaric oxygen were eligible if they had hypoxia or ischemia induced disease and had no contraindication to hyperbaric oxygen therapy. Patients were recruited into the study regardless of the gender, and all patients and their family gave informed consent before enrollment. Patients were excluded if they did not receive hyperbaric oxygen therapy. According to the Diagnosis and Curing Criteria of Clinical Diseases, 6 patients developed into cerebral infarction during hyperbaric oxygen therapy, 3 males and 3 females, at the age of 51-76 years.METHODS: Patients were exposed to oxygen at 0.2 MPa in hyperbaric chamber used for many persons, and inhaled oxygen with a facemask once a day for 80 minutes with an interval of 10 minutes at the 40th minute. Ten days was considered as one course. Background and risk factors were analyzed in 6patients with cerebral infarction and 186 patients without cerebral infarction.MAIN OUTCOME MEASURES: Analysis of distribution of risk factors among cerebral infarction patients, and risk factor levels in patients without cerebral infarction.RESULTS: Among the 6 patients with cerebral infarction, hyperlipidemia was in all 6 cases, hypertension in 5 cases, primary cerebral infarction or hemorrhage in 5 cases, ≥ 60 years old or hyperviscosity in 4 cases, and diabetes mellitus in 1 case. Risk factor aggregation existed in the patients with over four risk factors. Of the 6 patients with cerebral infarction due to hyperbaric oxygen therapy, 5 cases had 4 risk factors and 1 had 5 risk factors. Of the 186 patients without cerebral infarction, 25 cases had 4 risk factors, and no case had 5 risk factors. The risk factor aggregation was relatively impossible (x2 = 54. 37, P ＜ 0. 05 ).CONCLUSION: Risk factor aggregation was found in all cerebral infarction patients, which is closely associated with the probability of cerebral infarction resulting from hyperbaric oxygen therapy.

BACKGROUND: It is believed previously that hyperbaric oxygen(HBO)therapy can prevent stroke, but some scholars think HBO therapy on the contrary can induce stroke although its pathogen and prevention are unclear.OBJECTIVE: To study the reason of cerebral thrombosis induced by HBO and the preventive effects of the medicine.DESIGN: A retrospective study based on patients as subjects.SETTING: Department of HBO in a military area command hospital ofChinese PLA.PARTICIPANTS: Totally 192 hospitalized patients receiving HBO therapy in Guangzhou General Hospital of Guangzhou Military Area Command of Chinese PLA were selected, in which there were 127 males and 65 females aged between 9 and 78 years old. A total of 6 cases including 3 male and 3 female cases aged between 51 and 76 years old developed cerebral thrombosis during therapy.METHODS: The background factors of 192 patients who received HBO therapy and the included 6 cerebral thrombosis cases were analyzed. Totally preventive effects of the medicine on a cluster level of different risk factor. Three groups of patients received different interventions under the prerequisites of routine medications including blood-activating and stasis-eliminating, neurotrophy, and vasodilator patients of nitric ether group received oral administration of isosorbide dinitrate or glycerin trinitrate; patients of calcium antagonist group received oral administration of Sibelium or Novarsc; and patients of no specific medication group did not receive any preventive medicine.MAIN OUTCOME MEASURES: Patients' symptoms, physical signs andhead CT or MRI.RESULTS: The risk factor of cerebral thrombosis induced by HBO was the basic disease of hyperlipidemia or hypertension, etc. A total of 115 cases had the cluster with less than 4 risk factors and none of them developed thrombosis. A total of 31 cases had the cluster with 4 or more than 4 risk factors and 6 of them developed thrombosis with greatly increased morbidity. Above the level of 4 risk factors, nitrate ether had effective preventive effect(0/13) while there was 33.3% of the patients(5/15) in calcium antagonist group developed thrombosis, and the difference between the above two groups was significant( P ＜ 0.05).CONCLUSION: The cluster level of risk factors has close relationship with the probability of thrombosis induced by HBO. Nitrate ether has significant preventive effects.