Introduction:Herpes zoster-related pain has different phases, and the changes in glymphatic function during disease development are unknown. This study investigated stage-dependent changes in glymphatic function and mood scale scores in patients with herpes zoster-related pain, including their interrelationships.Methods:A total of 43 patients with herpes zoster (HZ), 54 with subacute herpetic neuralgia (SHN), 37 with postherpetic neuralgia (PHN) and 30 pain-free controls (PFC) were ultimately included in this study. Diffusion tensor imaging analysis of the perivascular space (DTI-ALPS) index was used to evaluate glymphatic function. All participants were assessed with the visual analog scale (VAS), the 90-item Symptom Checklist-90-Revised (SCL-90-R), the Hamilton Depression Scale (HAMD), and the Hamilton Anxiety Scale (HAMA). Analysis of Varivance (ANOVA) was used to determine whether there was a difference in the DTI-ALPS index among the 4 groups. Spearman correlation analysis was used to determine the correlation between the DTI-ALPS index and each clinical scale.Results:DTI-ALPS indices were significantly lower on the left and right sides and mean in the PHN group than in the PFC group (left: P=0.025; right: P=0.014; mean: P=0.006). HAMA, HAMD, VAS-SCL-90-R, and HAMD-SCL-90-R scores showed significant positive/negative correlations across all 3 patient groups, whereas the HAMA-SCL-90-R correlation was significant in the SHN and PHN groups.Discussion:Glymphatic dysfunction is observed in cases of zoster pain chronification, and the severity of mood disorders increases across disease stages. These findings provide both a clinical reference for how to qualify patients more comprehensively and a neuroimaging aspect to explore the mechanisms of PHN pathogenesis.

INTRODUCTION:Herpes zoster-related pain has different phases, and the changes in glymphatic function during disease development are unknown. This study investigated stage-dependent changes in glymphatic function and mood scale scores in patients with herpes zoster-related pain, including their interrelationships. METHODS:A total of 43 patients with herpes zoster (HZ), 54 with subacute herpetic neuralgia (SHN), 37 with postherpetic neuralgia (PHN) and 30 pain-free controls (PFC) were ultimately included in this study. Diffusion tensor imaging analysis of the perivascular space (DTI-ALPS) index was used to evaluate glymphatic function. All participants were assessed with the visual analog scale (VAS), the 90-item Symptom Checklist-90-Revised (SCL-90-R), the Hamilton Depression Scale (HAMD), and the Hamilton Anxiety Scale (HAMA). Analysis of Varivance (ANOVA) was used to determine whether there was a difference in the DTI-ALPS index among the 4 groups. Spearman correlation analysis was used to determine the correlation between the DTI-ALPS index and each clinical scale. RESULTS:DTI-ALPS indices were significantly lower on the left and right sides and mean in the PHN group than in the PFC group (left: P =0.025; right: P =0.014; mean: P =0.006). HAMA, HAMD, VAS-SCL-90-R, and HAMD-SCL-90-R scores showed significant positive/negative correlations across all 3 patient groups, whereas the HAMA-SCL-90-R correlation was significant in the SHN and PHN groups. DISCUSSION:Glymphatic dysfunction is observed in cases of zoster pain chronification, and the severity of mood disorders increases across disease stages. These findings provide both a clinical reference for how to qualify patients more comprehensively and a neuroimaging aspect to explore the mechanisms of PHN pathogenesis.

Herpes zoster (HZ) and postherpetic neuralgia (PHN) are severe neuropathic pain disorders. However, the alterations in their macroscopic brain-functional architecture and their potential molecular correlations remain poorly understood. This study was aimed at characterizing the altered functional connectivity patterns in the brains of patients with HZ and PHN using a connectome gradient analysis and further explore the potential associations with gene expression patterns through a spatial transcriptomics correlation analysis. In this study, 95 patients with HZ, 89 patients with PHN, and 84 matched healthy controls were characterized through a connectome gradient analysis. Additionally, transcriptomic neuroimaging association analyses were conducted using gene expression data derived from the Allen Human Brain Atlas and case‒control gradient differences to identify the genes that were associated with gradient variations. Finally, an enrichment analysis was performed on the identified significant genes to explore the biological pathways and cell types in which they may be involved. Compared with the healthy controls, HZ exhibited in the whole-brain gradients shrinkage. HZ showed abnormal subgradient values within the sensorimotor and dorsal attention networks, with exploratory associations to anxiety scores. PHN was characterized by reduced main gradient values in the frontoparietal control network, with exploratory associations to depression scores. The transcriptomic neuroimaging association analysis revealed that the gradient abnormalities in HZ were spatially correlated with gene expression patterns involving synaptic functions and ion channels, whereas the abnormalities in PHN were spatially correlated with the genes involved in postsynaptic signaling and the regulation of endogenous opioids. Cellular analysis indicated that HZ-associated genes were predominantly enriched in inhibitory and excitatory neurons and astrocytes, whereas PHN-associated genes were enriched in both neuron types. This study is the first to identify functional connectome and associated gene expression profiles in HZ and PHN through a cross-scale perspective that encompasses both functional connectome gradients and gene expressions. Our findings provide novel insights into the spatial transcriptomic correlates of functional alterations in the brain under these conditions and provide a foundation for conducting hypothesis-driven research on potential biomarkers and therapeutic strategies.

Abstract Objectives To evaluate the value of contrast-enhanced CT in diagnosing ultrasonography-unspecified adnexal torsion (AT). Methods Surgically confirmed patients with painful pelvic masses (n = 165) were retrospectively collected from two institutes. Two senior radiologists independently reviewed the CT images and determined the Hounsfield unit difference between non-contrast vs portal venous phases (ΔHUPV-NC) in both derivation and validation samples. The cutoff value, sensitivity, specificity, predictivity, and reproducibility of the ΔHUPV-NC and other visually assessed CT signs were analyzed and compared using the receiver-operating characteristic curve, multivariable regression, and inter-rater agreement assays, respectively. Results Women with twisted (n = 73 [47 ± 19 years]) or untwisted (n = 92 [40 ± 15 years]) adnexal lesions were reviewed. The ΔHUPV-NC ≤ 17.5 HU (AUC: 0.91 [95% CI: 0.86, 0.96]; sensitivity: 95% [95% CI: 87, 98]; and specificity: 88% [95% CI: 80, 94]) was the independent predictor of AT (OR: 137 [95% CI: 39, 481], p < 0.001). After training in ΔHUPV-NC measurement, the agreement between two junior residents and the consensus increased from fair (resident-1: 0.29 [95% CI: 0.17, 0.41]; resident-2: 0.24 [95% CI: 0.1, 0.39]) to substantial (resident-1: 0.75 [95% CI: 0.65, 0.85]; resident-2: 0.72 [95% CI: 0.62, 0.83]). The post-training diagnostic accuracy (both residents: 81% [95% CI: 74, 87]) was higher than the pre-training accuracy (resident-1: 67% [95% CI: 59, 74], p = 0.007; resident-2: 66% [95% CI: 58, 73], p = 0.002). Conclusion The sign of ΔHUPV-NC ≤ 17.5 HU in contrast-enhanced CT can be used to predict the ultrasonography-unspecified AT. Critical relevance statement The decreased attenuation difference between non-contrast vs portal venous phases, a quantitative measurement-based CT sign, highlights the value of using contrast-enhanced CT as a second-line imaging approach after an equivocal ultrasonographic examination to diagnose AT in emergency settings. Key Points The value of contrast-enhanced CT in diagnosing ultrasonography-unspecified AT is underestimated. The ΔHUPV-NC ≤ 17.5 HU is the only predictor to diagnose the ultrasonography-unspecified AT. Contrast-enhanced CT can be used as a second-line imaging approach after an equivocal ultrasonographic examination. Graphical Abstract

This study assessed whole-brain functional connectivity and network graph theory indices in patients with chronic rhinosinusitis with (CRSwOD) and without (CRSsOD) olfactory dysfunction. We also analyzed correlations between the abnormal network metrics and clinical indices. We acquired resting-state functional magnetic resonance images from 31 patients with CRSsOD, 26 with CRSwOD, and 25 healthy controls (HCs). Functional connectivity was computed and graph theory metrics were evaluated based on the Dosenbach-160 Atlas; relationships between neuroimaging indicators and clinical scales were assessed using Pearson correlation analysis. The results showed that CRSsOD patients had 11 edges with greater strength than HCs, CRSwOD patients had 1 greater edge than HCs, and CRSsOD patients had 5 greater edges than CRSwOD patients. Nodal degree centrality and efficiency in the right posterior occipital region were significantly altered in patients with CRSsOD compared with those in CRSwOD and in HCs. Five and two edges correlated with clinical scales in patients with CRSsOD and CRSwOD, respectively, whereas no correlations in global and nodal indicators were found. These results imply that distinct brain network patterns, particularly in the occipital cortex, could be a valid neuroimaging marker for related diagnosis and prognosis of CRSsOD and CRSwOD patients, and contribute to our better understanding of the central neural mechanisms of CRSwOD, providing new ideas for the clinical management of CRSwOD.

Purpose:In this study, we aim to explore the changes in network graph theory indices of structural covariance networks (SCNs) in PHN patients with different disease durations. Patients and Methods:High-resolution T1 magnetic resonance images were collected from 109 subjects. We constructed SCNs based on cortical thickness data and analyzed the changes in global and regional network measures of PHN patients and herpes zoster (HZ) patients, and get hubs of each group. Results:(1) PHN patients with a disease duration >6 months had reduced global efficiency (P=0.035) and increased characteristic shortest path length (P=0.028). (2) Nodal efficiency of the right pars opercularis was greater in both HZ and PHN patients with a disease duration of 1 to 3 months (P<0.001); in PHN patients with a disease duration > 6 months, the nodal degree of the left pars triangularis and nodal efficiency of the right middle temporal gyrus were greater (P<0.001). (3) The right supramarginal gyrus was the common hub of healthy controls (HCs) and HZ patients, the right pars opercularis was the common hub of HZ patients and PHN patients with a disease duration of 1 to 3 months, and the bilateral superior frontal gyrus was the common hub of HZ patients and PHN patients with a disease duration >6 months. Conclusion:There have changes in SCN indices in PHN patients with different disease durations. PHN patients with a disease duration >6 months had increased SCN integration and diminished information transfer capability between nodes, which complemented the topological properties of previous PHN networks. Eglobal and Lp can be considered as potential imaging markers for future clinical restaging of PHN.

OBJECTIVE : This study aimed to investigate the changes in resting-state functional connectivity (rsFC) of the sensorimotor network(SMN) in patients with herpes zoster(HZ) and postherpetic neuralgia patients(PHN). Then, We applied machine learning to distinguish PHN/HZ patients from healthy controls(HC). METHODS : HZ (n=53), PHN (n=57), and HC (n=50) were included, and resting-state functional magnetic resonance imaging (rs-fMRI) was performed on them. Seed-based and ROI-to-ROI analyses were applied to evaluate connectivity inside and between the SMN and other voxels throughout the brain. After that, we used machine learning to separate patients with PHN/HZ from those with HC. RESULTS : Compared to HC, there was a substantial reduction in functional connectivity between the lateral SMN (R), lateral SMN (L), and superior SMN in PHN patients. There was a disruption of rsFC between SMN subregions and several brain regions (insula, parietal, occipital, and superior frontal gyrus) in PHN. These damaged FCs were linked positively with clinical data (such as mood scores, disease duration, and VAS scores). Furthermore, We discovered that the rsFC value of SMN could successfully classify PHN patients from other types of pain with an accuracy of 85.7% when applied to a machine-learning approach. CONCLUSION : Significant changes occurred in the rsFC of SMN in HZ and PHN. Suggesting that the role of SMN in HZ/PHN may help understand the pathophysiology and development of these diseases.

Objective:Acute pericoronitis (AP) is a prevalent cause of odontogenic toothache which can significantly impact brain function. Previous research has predominantly concentrated on localized brain activity. However, the synergistic changes between brain hemispheres induced by toothache and resulting abnormal functional connectivity across the brain have not been comprehensively studied.Methods:A total of 34 patients with AP and 34 healthy individuals, matched for age, sex, and education were recruited for this study. All participants underwent resting-state functional magnetic resonance imaging (rs-MRI) scans. The voxel mirror homotopic connectivity (VMHC) method was used to identify intergroup differences. Brain regions exhibiting statistically significant differences were selected as regions of interest for further functional connectivity analysis. The partial correlation method was utilized to assess the correlation between abnormal VMHC values in different regions and clinical parameters, with age and sex included as covariates.Results:Patients with AP exhibited reduced VMHC values in the thalamus and elevated VMHC values in the inferior frontal gyrus compared with healthy controls. Subsequent functional connectivity analyses revealed extensive changes in functional networks, predominantly affecting the default, frontoparietal, cerebellar, and pain networks.Conclusion:Changes in functional patterns across these brain networks offer novel insights into the neurophysiological mechanisms underlying pain information processing.

Background: The acute changes that occur in the small-world topology of the brain in concussion patients remain unclear. Here, we investigated acute changes in the small-world organization of brain networks in concussion patients and their influence on persistent post-concussion symptoms. Methods: Eighteen concussion patients and eighteen age-matched controls were enrolled in this study. All participants underwent computed tomography, magnetic resonance imaging (MRI), susceptibility weighted imaging, and blood oxygen level-dependent functional MRI. A complex network analysis method based on graph theory was used to calculate the parameters of small-world networks under different degrees of network sparsity. All subjects were evaluated using the Glasgow Coma Scale and Rivermead Postconcussion Symptom Questionnaire. Results: Compared with the controls, the normalized cluster coefficient (γ) of whole brain networks in patients and the “small-world” index (σ) was slightly enhanced, whereas the standardized minimum path (λ) was slightly shorter. Whole brain effect (Eglobal) and local effect (Elocal) changes were not pronounced. Under the condition of minimum network sparsity (Dmin = 0.13), the numbers of nodes in the “right intraorbital superior frontal gyrus” (Anatomical Automatic Labeling, AAL26), right globus pallidus (AAL76), and bilateral temporal transverse gyrus (AAL79,80) in brain concussion patients were significantly lower. The numbers of nodes in the left subcapital lobe (AAL61) and left occipital gyrus (AAL51) were significantly higher, and the normalized cluster coefficients of the right intraorbital supraphalus (AAL26) and left posterior cingulate gyrus (AAL35) were significantly increased. The normalized clustering coefficients of the right triangular subfrontal gyrus (AAL55) (based on the normalized clustering coefficients of nodes in AAL14) and left sub-parietal lobes (AAL61) were significantly reduced. The mean local effects of nodes in the right intraorbital upper frontal gyrus (AAL26), left posterior cingulate gyrus (AAL35), and bilateral auxiliary motor cortex (AAL19, 20) were enhanced, whereas the mean local effects of the bilateral triangular inferior frontal gyrus (AAL13,14) and left insular cap (AAL11) were reduced (p < 0.05). Conclusions: The overall trend of network topology abnormalities in patients was random, and generalized and local functional abnormalities were seen. Changes in the function and affective circuitry of the resting default network were particularly pronounced in these patients, which we speculate may be one of the main drivers of the cognitive dysfunction and mood changes seen in concussion patients.

Purpose:This study aimed to explore the abnormal changes in short- and long-range functional connectivity density (FCD) in patients with herpes zoster (HZ) and postherpetic neuralgia (PHN). Patients and Methods:Twenty HZ patients, 22 PHN patients, and 19 well-matched healthy controls (HCs) underwent resting-state functional magnetic resonance imaging scans. We used FCD mapping, a data-driven graph theory method, to investigate local and global functional connectivity patterns. Both short- and long-range FCD were calculated and compared among the PHN, HZ, and HC groups. Then, the abnormal regions were used to calculate seed-based functional connectivity. Finally, correlation analyses were performed between the altered FCD values and clinical datas. Results:Compared with HCs, HZ patients showed significantly increased long-range FCD of the bilateral cerebellum, thalamus, parahippocampal gyrus, superior temporal gyrus and lingual gyrus. HZ patients also displayed significantly decreased short-range FCD of the bilateral posterior cingulate gyrus, median cingulate/paracingulate gyri, and left precuneus. Compared with HCs, PHN patients displayed significantly decreased long-range FCD of the bilateral superior frontal gyrus and decreased short-range FCD in the bilateral posterior cingulate gyrus, median cingulate/paracingulate gyri, and precuneus. However, there was no significant difference in either long-range or short-range FCD between the PHN and HZ patients. Long-range FCD deficit areas and the right insula showed altered functional connectivity in PHN patients. Furthermore, pain duration in patients with PHN was correlated with abnormal long-range FCD. Conclusion:Herpes zoster pain widely affects intra- and inter-regional functional connectivity, leading to disrupted short-range FCD and increased long-range FCD during different stages of the disease. Long-term chronic pain in PHN patients may impair the pain emotion regulation pathway. These findings could improve our understanding of the pathophysiological mechanisms of HZ and PHN and offer neuroimaging markers for HZ and PHN.

Background: Shingles can cause long-term pain and negative emotions, along with changes in brain function. In this study, Granger Causality Analysis (GCA) was used to compare herpes zoster (HZ) and postherpetic neuralgia (PHN) differences in effective connections within the “pain matrix” between patients and healthy controls to further understand patterns of interaction between brain regions and explore the relationship between changes in effective connections and clinical features. Methods: Resting-state functional magnetic resonance imaging (fMRI) scans were performed on 55 HZ; 55 PHN; and 50 age-, sex- matched healthy controls (HCs). The brain regions associated with the pain matrix are used as the seeds of effective connectivity. GCA was used to analyze effective connections in brain regions that differed significantly between groups. Then the correlation between GCA values and clinical indicators was studied. Results: Compared with HC, GCA values between the thalamus and the amygdala, between the thalamus and the precentral gyrus, from the thalamus to the postcentral gyrus, and from the parahippocampal gyrus to the amygdala, anterior cingulate gyrus were significantly reduced in HZ patients. Compared with HC, GCA values between the insular and the postcentral gyrus, from the insular to the inferior parietal lobe, and from the postcentral gyrus to the amygdala were significantly reduced in PHN patients. Compared with HZ, GCA values between the inferior parietal lobe and the parahippocampal gyrus, between the inferior parietal lobe and the anterior cingulate gyrus, and from the anterior cingulate gyrus to the amygdala were significantly increased in PHN patients. The visual analogue scale (VAS) score of PHN patients was positively correlated with the GCA value from the central posterior lobe to the insula. Conclusions: PHN and HZ patients showed a broad reduction in effective connections, mainly reflected in abnormal pain pathway regulation, pain perception, negative emotion and memory production, providing new perspectives to understand the neuroimaging mechanisms of shingles.

Postherpetic neuralgia (PHN) is a neuropathic pain syndrome characterized by persistent burning or stinging pain, and its underlying pathogenesis is still unclear. Although conventional resting-state magnetic resonance imaging (rs-fMRI) studies have revealed abnormal resting-state functional connectivity (rsFC) in PHN patients, dynamic functional connectivity (dFC) remains unexplored. In this paper, a sliding time window method was used to generate a dFC matrix, and rs-fMRI data from 55 PHN patients, 55 Herpes Zoster (HZ) patients, and 50 healthy controls (HCs) were analyzed. Machine learning was used to determine whether these abnormal dFC values could be used as neuroimaging markers of the transition from HZ to PHN. All dFC matrices were clustered into two reoccurring states, and the state transition metrics were obtained. We found that patients with PHN were in State 1, which is characterized by weak connections between the networks, more often than patients with HZ (p < 0.05). We also found that in State 1, compared with that in HCs, the dFC between the BGN and SN in HZ patients increased. In State 2, the dFC of PHN patients was lower than that of HZ patients and HCs, and the dFC was mainly observed in the DMN, SN, DAN, VN and LN. The results of the SVM classifier revealed that the change in dFC between the BGN and DMN may be a strong neuroimaging marker of the transition from HZ to PHN. These findings further our understanding of the neuropathological mechanism of PHN.

ObjectiveTo review and analyze the functional connectivity (FC) abnormalities in the brain olfactory network (ON) of patients with chronic rhinosinusitis with olfactory dysfunction (CRSwOD) and explore the relationship between these FC abnormalities and olfactory dysfunction, providing clues to the neurophysiological mechanisms underlying CRSwOD.MethodsFC analysis on the ON of patients with CRSwOD and patients with chronic rhinosinusitis without olfactory dysfunction (CRSsOD) identified the regions of the ON with abnormal FC in CRSwOD patients, and the correlation between abnormal FC and clinical scales for chronic rhinosinusitis was analyzed.Results(1) Compared with the CRSsOD group, CRSwOD patients showed decreased FC between the bilateral orbitofrontal cortex (OFC) and the right middle frontal gyrus, (2) Receiver operating characteristic (ROC) curve analysis revealed that the FC value between the right middle frontal gyrus and the left OFC (area under the curve (AUC) = 0.852, sensitivity: 0.821, specificity: 0.800, p < 0.001) was more capable of distinguishing whether CRS patients may have olfactory dysfunction than the FC value between the right middle frontal gyrus and the right OFC (AUC = 0.827, sensitivity: 0.893, specificity: 0.667, p < 0.001), and (3) Lund-Kennedy scores were positively correlated with the FC values between the right middle frontal gyrus and the left OFC (r = 0.443, p < 0.018). Lund-Mackay scores were also positively correlated with the FC values between the right middle frontal gyrus and the left OFC (r = 0.468, p < 0.012). Questionnaire of Olfactory Disorders-Negative Statements scores were negatively correlated with the FC values between the right middle frontal gyrus and the left OFC (r = −0.481, p < 0.001).ConclusionPersistent nasal inflammation affects the FC between the middle frontal gyrus and the OFC, which may serve as a potential imaging marker for identifying CRSwOD. The severity of nasal inflammation and olfactory damage is closely related to the FC between the middle frontal gyrus and OFC, and the abnormal changes in this FC can be used to explain the neurophysiological mechanisms behind the occurrence of olfactory dysfunction in patients.

To evaluate the altered network topological properties and their clinical relevance in patients with posttraumatic diffuse axonal injury (DAI). Forty-seven participants were recruited in this study, underwent 3D T1-weighted and resting-state functional MRI, and had single-subject morphological brain networks (MBNs) constructed by Kullback–Leibler divergence and functional brain networks (FBNs) constructed by Pearson correlation measurement interregional similarity. The global and regional properties were analyzed and compared using graph theory and network-based statistics (NBS), and the relationship with clinical manifestations was assessed. Compared with those of the healthy subjects, MBNs of patients with DAI showed a higher path length ( Lp : P = 0.021, λ : P = 0.011), lower clustering ( γ : P = 0.002) and less small-worldness ( σ : P = 0.002), but there was no significant difference in the global properties of FBNs ( P : 0.161–0.216). For nodal properties of MBNs and FBNs, several regions showed significant differences between patients with DAI and healthy controls (HCs) ( P < 0.05, FDR corrected). NBS analysis revealed that MBNs have more altered morphological connections in the frontal parietal control network and interhemispheric connections ( P < 0.05). DAI-related global or nodal properties of MBNs were correlated with physical disability or dyscognition ( P < 0.05/7, with Bonferroni correction), and the alteration of functional topology properties mediates this relationship. Our results suggested that disrupted morphological topology properties, which are mediated by FBNs and correlated with clinical manifestations of DAI, play a critical role in the short-term and medium-term phases after trauma.

Traumatic axonal injury (TAI) may result in the disruption of brain functional networks and is strongly associated with cognitive impairment. However, the neural mechanisms affecting the neurocognitive function after TAI remain to be elucidated. We collected the resting-state functional magnetic resonance imaging data from 28 patients with TAI and 28 matched healthy controls. An automated anatomical labeling atlas was used to construct a functional brain connectome. We utilized a graph theoretical approach to investigate the alterations in global and regional network topologies, and network-based statistics analysis was utilized to localize the connected networks more precisely. The current study revealed that patients with TAI and healthy controls both showed a typical small-world topology of the functional brain networks. However, patients with TAI exhibited a significantly lower local efficiency compared to healthy controls, whereas no significant difference emerged in other small-world properties (Cp, Lp, γ, λ, and σ) and global efficiency. Moreover, patients with TAI exhibited aberrant nodal centralities in some regions, including the frontal lobes, parietal lobes, caudate nucleus, and cerebellum bilaterally, and right olfactory cortex. The network-based statistics results showed alterations in the long-distance functional connections in the subnetwork in patients with TAI, involving these brain regions with significantly altered nodal centralities. These alterations suggest that brain networks of individuals with TAI present aberrant topological attributes that are associated with cognitive impairment, which could be potential biomarkers for predicting cognitive dysfunction and help understanding the neuropathological mechanisms in patients with TAI.

Objective Resting-state functional magnetic resonance imaging (rs-fMRI) and Granger causality analysis (GCA) were used to observe the characteristics of amygdala and whole-brain effect connections in patients with herpes zoster (HZ) and post-herpetic neuralgia (PHN) and to determine their relationship with clinical features.Methods Rs-fMRI scans were performed on 50 HZ; 50 PHN; and 50 age-, sex- and education-year-matched healthy controls (HCs). Bilateral amygdala subregions were used as seeds for functional connectivity (FC). GCA was used to analyze the effective connection of brain regions that were significantly different among groups. Then, the correlation between FC, and GCA values and clinical indices was investigated.Results: PHN had impaired FC between the amygdala subregion with the putamen, cortex, anterior cingulate cortex (ACC) to HCs and reduced FC of medial amygdala (MeA) with the parieto-occipital lobe and motor cortex to HZ; HZ had reduced FC of the lateral amygdala (LA) with the insula to HCs. GCA values from the bilateral LA to the bilateral ACC, left MeA to the bilateral ACC and left putamen, and right ACC to the bilateral MeA were reduced in PHN patients compared to HCs. Compared with HCs, the GCA values from the left MeA to the left ACC and right putamen were reduced in HZ. The GCA values from the amygdala subregion to the ACC were positively correlated with HAMA or HAMD scores in PHN.Conclusion: PHN showed reduced FC between the amygdala subregions and cortico-putamen and decreased effective connectivity from the amygdala subregion to the ACC and putamen.Advances in knowledge: HZ and PHN patients had significant changes in effective connectivity in brain regions, including diverse functional areas emanating from and projecting to the amygdala. The current findings will provide a new perspective for understanding the neuropathophysiological mechanism HZ and PHN.

The purpose of this study was to explore the resting-state functional connectivity (FC) changes among the pain matrix and other brain regions in herpes zoster (HZ) and postherpetic neuralgia (PHN) patients. Fifty-four PHN patients, 52 HZ patients, and 54 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging (rs-fMRI) scans. We used a seed-based FC approach to investigate whether HZ and PHN patients exhibited abnormal FC between the pain matrix and other brain regions compared to HCs. A random forest (RF) model was constructed to explore the feasibility of potential neuroimaging indicators to distinguish the two groups of patients. We found that PHN patients exhibited decreased FCs between the pain matrix and the putamen, superior temporal gyrus, middle frontal gyrus, middle cingulate gyrus, amygdala, precuneus, and supplementary motor area compared with HCs. Similar results were observed in HZ patients. The disease durations of PHN patients were negatively correlated with those aforementioned impaired FCs. The results of machine learning experiments showed that the RF model combined with FC features achieved a classification accuracy of 75%. Disrupted FC among the pain matrix and other regions in HZ and PHN patients may affect multiple dimensions of pain processing.

Objective Diffuse axonal injury (DAI) is a common pathological process after traumatic brain injury, which may cause survivors severe functional disorders, including cognitive impairment and physical disability. Recent literature indicated lateral hypothalamus and medial hypothalamus damage during DAI. Thus, we aim to investigate whether there is imaging evidence of hypothalamic injury in patients with DAI and its clinical association. Methods Twenty-four patients with diagnosed DAI and 26 age and sex-matched healthy controls underwent resting-state functional MRI. We assessed the lateral hypothalamus and medial hypothalamus functional connectivity with seed-based analysis in DAI. Furthermore, a partial correlation was used to measure its clinical association. The prediction of the severity of DAI from the altered lateral hypothalamus and medial hypothalamus connectivity was conducted using a general linear model. Results Compared with healthy control, the DAI group showed significantly decreased lateral hypothalamus functional connectivity with the basal ganglia and cingulate gyrus, which was positively correlated with mini-mental state examination scores (Bonferroni correction at P < 0.0125). Importantly, this disrupted functional connectivity can be used to predict the patients’ cognitive state reliably (P = 0.006; P = 0.009, respectively) in DAI. Moreover, we also observed increased connectivity of medial hypothalamus with the superior temporal gyrus and the regions around the operculum. Furthermore, there was a trend of negative correlation between the medial hypothalamus functional connectivity changes to the right superior temporal gyrus and the disability rating scale scores in the DAI group. Conclusion Our results suggest that there are alterations of medial hypothalamus and lateral hypothalamus connectivity in DAI and further understand its clinical symptoms, including related cognitive impairment.

目的:探讨Team STEPPS模型应用于预防导尿管相关性尿路感染(CAUTI)管理中的实践效果.方法:基于Team STEPPS模型构建预防CAUTI管理模式,建立基于证据的多部门协作系统及CAUTI预防管理方案,比较该模式实施前后干预措施落实情况、标本送检率、标本采集不合格率、CAUTI监测情况.结果:各季度干预措施落实总体呈上升趋势,标本送检率由41.95％上升为72.90％,标本采集不合格率由11.37％下降至4.24％,CAUTI发生率由3.27‰下降至2.89‰.结论:基于Team STEPPS模型构建预防CAUTI管理模式对预防CAUTI管理有效,可一定程度降低CAUTI发生率,提升预防措施的落实.

目的 探讨专科护理质量指标数据化管理在预防医用黏胶性皮肤损伤(MARSI)中的应用效果.方法 回顾性分析2017年1月～2018年12月南昌大学第一附属医院神经内科ICU收治的1138例使用医用黏胶患者的临床资料,其中2017年1月～2017年12月收治的555例患者为对照组,2018年1月～2018年12月收治的583例患者为观察组.对照组患者采用常规护理管理方法,观察组患者采用专科护理质量指标数据化管理方法.比较两组患者的MARSI发生率、各部位MARSI发生频次、护士对MARSI知信行得分及MARSI预防措施落实率.结果 观察组患者的MARSI发生率低于对照组,差异有统计学意义(P<0.05).两组患者的MARSI发生部位比较,差异无统计学意义(P>0.05).2018年12月,护士的MARSI知信行总分高于2017年12月,差异有统计学意义(P<0.05).2018年各项预防措施落实情况每季度总体呈上升趋势.结论 专科护理质量指标数据化管理可有效降低MARSI发生率,提高护士对MARSI的知信行,从而提高护理质量.