Publications by authors named "Yong-An Chung"

123 Publications

A Review of Neuroimaging Studies in Persistent Postural-Perceptual Dizziness (PPPD).

Nucl Med Mol Imaging 2021 Apr 7;55(2):53-60. Epub 2021 Jan 7.

Department of Nuclear Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

Persistent postural-perceptual dizziness (PPPD) is a functional vestibular disease characterized by persistent dizziness, unsteadiness, and/or non-spinning vertigo, and is the most common vestibular syndrome in young adults. A stiffened postural control strategy, shift to reliance on visual over vestibular information, and hypervigilance to the environment have been suggested as possible pathophysiological mechanisms of PPPD. However, the exact mechanisms remain unclear. Recently, neuroimaging studies using magnetic resonance imaging and single photon emission computed tomography have provided pivotal insights into the pathophysiology of PPPD. The aim of this review was to evaluate and summarize the existing data on neuroimaging studies in PPPD. In summary, these studies fairly consistently reported decreased brain structure, function, and connectivity among the areas involved in multisensory vestibular processing and spatial cognition, and increased function and connectivity in the visual processing areas in patients with PPPD. The detected brain changes might reflect maladaptive and compensatory mechanisms including dysfunctional integration of multisensory vestibular information and visual dependence. Notably, various factors including personality traits (i.e., neuroticism), psychiatric comorbidities (i.e., anxiety and depression), and triggering factors (i.e., peripheral vestibular lesions) seem to modulate brain functional activity and connectivity patterns, possibly accounting for some differences across the results. Future studies should carefully control for these confounding effects in order to draw firm conclusions.
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http://dx.doi.org/10.1007/s13139-020-00675-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053630PMC
April 2021

A pilot clinical study of low-intensity transcranial focused ultrasound in Alzheimer's disease.

Ultrasonography 2021 Jan 16. Epub 2021 Jan 16.

Department of Nuclear Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Purpose: Increasing attention has been paid to low-intensity transcranial focused ultrasound (tFUS) for its potential therapeutic effects in Alzheimer's disease (AD). While preclinical studies have shown promising therapeutic effects of low-intensity tFUS in AD models, its efficacy and safety remain unclear in humans. In this pilot study, we investigated the effects of low-intensity tFUS on blood-brain barrier opening, the regional cerebral metabolic rate of glucose (rCMRglu), and cognition in patients with AD.

Methods: After receiving institutional review board approval, four patients with AD received tFUS to the hippocampus immediately after an intravenous injection of a microbubble ultrasound contrast agent. Sonication was delivered at low-intensity, at a pressure level below the threshold for blood-brain barrier opening. Patients underwent brain magnetic resonance imaging, 18F-fluoro-2-deoxyglucose positron emission tomography, and neuropsychological assessments before and after the tFUS procedure. A whole-brain voxel-wise paired t test was conducted to compare rCMRglu before and after tFUS.

Results: The sonication, as anticipated, did not show evidence of active blood-brain barrier opening on T1 dynamic contrast-enhanced magnetic resonance imaging. rCMRglu in the superior frontal gyrus (P<0.001), middle cingulate gyrus (P<0.001), and fusiform gyrus increased after tFUS (P=0.001). Patients demonstrated mild improvement in measures of memory, executive, and global cognitive function following tFUS. No adverse events were reported.

Conclusion: These results suggest that hippocampal sonication with low-intensity tFUS may have beneficial effects on cerebral glucose metabolism and cognitive function in patients with AD. Further larger studies are needed to confirm the therapeutic efficacy of tFUS in AD.
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http://dx.doi.org/10.14366/usg.20138DOI Listing
January 2021

Imaging Characteristics of Brain SPECT, PET, and MRI in Neurosyphilis.

Nucl Med Mol Imaging 2021 Feb 6;55(1):48-51. Epub 2021 Feb 6.

Department of Neurology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

The incidence of neurosyphilis has declined since effective penicillin therapy against was introduced. However, the diagnosis of neurosyphilis early in the disease course is very important in order to select appropriate antibiotic therapy. We report brain MRI, SPECT with Tc-99m ECD, and PET with F-18 FDG findings before antibiotic therapy in a neurosyphilis patient with neurological symptoms. The cerebral cortices showed hypoperfusion with a patchy distribution on SPECT and foci with high signal intensity on MRI, suggesting ischemia. Brain PET showed areas with hypometabolism in the temporoparietal lobes bilaterally.
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http://dx.doi.org/10.1007/s13139-021-00684-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881059PMC
February 2021

Prognostic value of pretreatment F-18 fluorodeoxyglucose PET/CT in colorectal cancer with unresectable metastasis.

Nucl Med Commun 2021 Jun;42(6):639-645

Department of Radiology, Incheon St.Mary's Hospital, College of Medicine, The Catholic University of Korea.

Purpose: The aim of the study was to assess the prognostic value of pretreatment PET/computed tomography (CT) scans in colorectal cancer (CRC) patients with unresectable metastasis.

Materials And Methods: We retrospectively reviewed the pretreatment PET/CT images of 82 CRC patients with unresectable metastasis and their medical records. On PET/CT images, maximum standardized uptake value (SUVmax) of primary tumor, highest SUVmax of metastatic tumors and number of metastatic organs were identified. The patients were further divided into single and multiple organ metastases groups according to the extent of disease. Survival analysis was performed with the clinical variables and metabolic parameters from PET/CT.

Results: In a total of 82 patients, the age of patients, highest SUVmax of metastatic tumors and number of metastatic organs were independent prognostic factors for overall survival (OS) (all P < 0.05), whereas the SUVmax of primary tumor was not. On multivariate analysis, only the SUVmax of metastatic tumor was a significant prognostic factor in the single organ metastasis group (P = 0.047), whereas the age and highest SUVmax of metastatic tumors were independent prognostic factors in the multiple organ metastases group (all P < 0.05).

Conclusion: The highest SUVmax of metastatic tumors was an independent prognostic factor for OS in CRC patients with unresectable metastasis.
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http://dx.doi.org/10.1097/MNM.0000000000001384DOI Listing
June 2021

PET Hypometabolism of the Prefrontal-Cingulate Cortices in Internet Gaming Disorder.

Front Psychiatry 2020 15;11:566518. Epub 2021 Jan 15.

Department of Radiology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.

Recently, excessive and uncontrolled use of online games has been recognized as a public concern. Although previous neuroimaging studies have reported structural and functional brain deficits in Internet gaming disorder (IGD), very few studies have investigated the regional cerebral metabolic rate of glucose (rCMRglu). This study investigated the differences in rCMRglu between individuals with IGD and healthy controls using 18F-fluoro-2-deoxyglucose positron emission tomography (18F-FDG PET). A total of 23 adults with IGD and 23 controls underwent brain 18F-FDG PET scans and completed self-report questionnaires. A whole-brain voxel-wise analysis of rCMRglu was conducted and associations between rCMRglu and severity of IGD were assessed. The IGD group showed higher impulsivity ( = 0.04) and lower self-control ( = 0.002) than the control group. In addition, the IGD group had lower FDG uptake in the left medial orbitofrontal gyrus, left middle cingulate cortex, left superior frontal gyrus, and right anterior cingulate cortex ( < 0.001). A significant negative association was found between the rCMRglu in the right anterior cingulate cortex and the number of fulfilled diagnostic criteria for IGD (β = -0.50, = 0.02). Our results suggest that IGD may be associated with deficits of glucose metabolism in the prefrontal-cingulate cortices.
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http://dx.doi.org/10.3389/fpsyt.2020.566518DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843565PMC
January 2021

Effects of transcranial direct current stimulation on addictive behavior and brain glucose metabolism in problematic online gamers.

J Behav Addict 2020 Dec 23. Epub 2020 Dec 23.

1Department of Nuclear Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

Background And Aims: Some online gamers may encounter difficulties in controlling their gaming behavior. Previous studies have demonstrated beneficial effects of transcranial direct current stimulation (tDCS) on various kinds of addiction. This study investigated the effects of tDCS on addictive behavior and regional cerebral metabolic rate of glucose (rCMRglu) in problematic online gamers.

Methods: Problematic online gamers were randomized and received 12 sessions of either active (n = 13) or sham tDCS (n = 13) to the dorsolateral prefrontal cortex over 4 weeks (anode F3/cathode F4, 2 mA for 30 min, 3 sessions per week). Participants underwent brain 18F-fluoro-2-deoxyglucose positron emission tomography scans and completed questionnaires including the Internet Addiction Test (IAT), Brief Self-Control Scale (BSCS), and Behavioral Inhibition System/Behavioral Activation System scales (BIS/BAS) at the baseline and 4-week follow-up.

Results: Significant decreases in time spent on gaming (P = 0.005), BIS (P = 0.03), BAS-fun seeking (P = 0.04), and BAS-reward responsiveness (P = 0.01), and increases in BSCS (P = 0.03) were found in the active tDCS group, while decreases in IAT were shown in both groups (P < 0.001). Group-by-time interaction effects were not significant for these measures. Increases in BSCS scores were correlated with decreases in IAT scores in the active group (β = -0.85, P < 0.001). rCMRglu in the left putamen, pallidum, and insula was increased in the active group compared to the sham group (P for interaction < 0.001).

Discussion And Conclusions: tDCS may be beneficial for problematic online gaming potentially through changes in self-control, motivation, and striatal/insular metabolism. Further larger studies with longer follow-up period are warranted to confirm our findings.
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http://dx.doi.org/10.1556/2006.2020.00092DOI Listing
December 2020

Altered Regional Cerebral Blood Perfusion in Mild Cognitive Impairment Patients with Dizziness.

Diagnostics (Basel) 2020 Sep 30;10(10). Epub 2020 Sep 30.

Department of Neurology, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul 21431, Korea.

Dizziness is a common symptom among the general population, especially in the elderly. Previous studies have reported that dizziness may be associated with various cognitive functions including memory impairment. However, few studies have investigated the neural correlates of dizziness in patients with cognitive impairment. The aim of this study was to examine regional cerebral blood flow (rCBF) in mild cognitive impairment (MCI) patients with or without dizziness using single photon emission computed tomography (SPECT). A total of 50 patients with MCI were recruited. All participants underwent technetium-99m ethyl cysteinate dimer brain SPECT and a neuropsychological battery and completed the Dizziness Handicap Inventory (DHI). Participants were divided into a dizziness group (DHI ≥ 1, = 18) and a non-dizziness group (DHI = 0, = 32). Voxel wise differences in rCBF between the groups were estimated. SPECT analysis revealed decreased rCBF in the left superior temporal gyrus, left lateral orbital gyrus, and right middle frontal gyrus in the dizziness group compared with the non-dizziness group ( < 0.005). No significant clusters of increased rCBF were observed in the dizziness group compared with the non-dizziness group. Results of the neuropsychological tests showed a significant difference in Controlled Oral Word Association Test performance between MCI patients with and without dizziness. In conclusion, MCI patients with dizziness showed multifocal frontal and left temporal hypoperfusion compared with patients without dizziness. Our results suggest that hypoperfusion in the frontal and temporal cortices might be reflecting the negative impact of dizziness in MCI patients.
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http://dx.doi.org/10.3390/diagnostics10100777DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599883PMC
September 2020

The Impact of Amyloid-Beta Positivity with 18F-Florbetaben PET on Neuropsychological Aspects in Parkinson's Disease Dementia.

Metabolites 2020 Sep 23;10(10). Epub 2020 Sep 23.

Department of Neurology, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul 21431, Korea.

The neuropathology of Parkinson's disease dementia (PDD) is heterogenous, and the impacts of each pathophysiology and their synergistic effects are not fully understood. The aim of this study was to evaluate the frequency and impacts of co-existence with Alzheimer's disease in patients with PDD by using 18F-florbetaben PET imaging. A total of 23 patients with PDD participated in the study. All participants underwent 18F-florbetaben PET and completed a standardized neuropsychological battery and assessment of motor symptoms. The results of cognitive tests, neuropsychiatric symptoms, and motor symptoms were analyzed between the positive and negative 18F-florbetaben PET groups. Four patients (17.4%) showed significant amyloid burden. Patients with amyloid-beta showed poorer performance in executive function and more severe neuropsychiatric symptoms than those without amyloid-beta. Motor symptoms assessed by UPDRS part III and the modified H&Y Scale were not different between the two groups. The amyloid PET scan of a patient with PDD can effectively reflect a co-existing Alzheimer's disease pathology. Amyloid PET scans might be able to help physicians of PDD patients showing rapid progression or severe cognitive/behavioral features.
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http://dx.doi.org/10.3390/metabo10100380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598210PMC
September 2020

Prefrontal White Matter Abnormalities Associated With Pain Catastrophizing in Patients With Complex Regional Pain Syndrome.

Arch Phys Med Rehabil 2021 02 10;102(2):216-224. Epub 2020 Aug 10.

Ewha Brain Institute, Ewha W. University, Seoul, South Korea; Department of Brain and Cognitive Sciences, Ewha W. University, Seoul, South Korea.

Objective: To investigate altered prefrontal white matter integrity in complex regional pain syndrome (CRPS) and its relation with the degree of pain catastrophizing.

Design: Cross-sectional study.

Setting: University hospital.

Participants: Twenty-one CRPS patients and 49 patients without CRPS (N=70).

Interventions: Not applicable.

Main Outcome Measures: The fractional anisotropy values within the prefrontal regions reflecting the structural integrity of white matter were measured in CRPS patients and patients without CRPS using diffusion tensor imaging. The degree of pain catastrophizing was also evaluated in CRPS patients.

Results: The structural integrity of the prefrontal white matter was lower in CRPS patients than in patients without CRPS (P=.03). In addition, lower structural integrity in the prefrontal cortex was correlated with a higher degree of pain catastrophizing among CRPS patients (r= -0.54, P=.01).

Conclusions: Our findings suggest that pain catastrophizing, which is frequently reported in patients with CRPS, may be associated with the dysfunction of the prefrontal white matter.
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http://dx.doi.org/10.1016/j.apmr.2020.07.006DOI Listing
February 2021

Possible neuroprotective effects of rasagiline in Alzheimer's disease: a SPECT study.

Acta Radiol 2021 Jun 9;62(6):784-790. Epub 2020 Jul 9.

Department of Nuclear Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Background: The current lack of effective treatments for Alzheimer's disease (AD) and the rapidly increasing burden of the disease highlight the urgent need to find new treatments. Despite accumulating evidence of the beneficial effects of rasagiline in neurodegenerative diseases such as Parkinson's disease, the effects of rasagiline on the brains of patients with AD have not been elucidated.

Purpose: To examine the effects of rasagiline on regional cerebral flow (rCBF) in patients with AD using single photon emission computed tomography (SPECT).

Material And Methods: Among 22 patients with AD, 11 patients received adjunctive rasagiline at 1 mg/day in conjunction with acetylcholinesterase inhibitors (AChEI); 11 patients were only treated with AChEI for about 1.6 years. All patients underwent brain technetium-99m hexamethylpropylene amine oxime SPECT scans and clinical assessments at baseline and follow-up visits. Annual percent changes in rCBF were compared between the groups in a voxel-wise manner.

Results: SPECT analysis revealed that the rasagiline-treated group showed more increased rCBF in the cingulate gyrus, inferior frontal gyrus, putamen, and thalamus compared to the comparison group ( < 0.005).

Conclusion: We demonstrated that adjunctive rasagiline treatment may have beneficial effects on brain perfusion in patients with AD, suggesting potential neuroprotective effects.
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http://dx.doi.org/10.1177/0284185120940264DOI Listing
June 2021

FKBP5-associated miRNA signature as a putative biomarker for PTSD in recently traumatized individuals.

Sci Rep 2020 02 25;10(1):3353. Epub 2020 Feb 25.

Ewha Brain Institute, Ewha W. University, Seoul, South Korea.

The epigenetic regulation of microRNA (miRNA) expression related to the FK506-binding protein 5 (FKBP5) gene may contribute to the risk of stress-related disorders such as posttraumatic stress disorder (PTSD). Here, we identified candidate miRNAs derived from FKBP5 knockout mice as a potential diagnostic biomarker of PTSD. Using a translational approach, candidate miRNAs found to alter in expression within the medial prefrontal cortex of FKBP5 knockout mice were selected. Each candidate miRNA was examined in the serum of 48 recently traumatized individuals with PTSD and 47 healthy individuals. Multimodal imaging was also conducted to identify the neural correlates for the expression of candidate exosomal miRNAs in response to trauma exposure. Differential miRNA expression was found according to PTSD diagnosis in two composite marker groups. The differential miRNA expression between the composite marker groups contributed to PTSD symptom severity, which may be explained by differential recruitment of prefrontolimbic activity in brain imaging. The present study reveals that a set of circulating exosomal miRNAs showing altered expression in FKBP5 knockout mice play a potential role as epigenetic markers of PTSD. The corroborative evidence from multiple levels including molecular, brain, and behavioral indicates that these epigenetic biomarkers may serve as complementary measures for the diagnosis and prognosis prediction of PTSD in recently traumatized individuals.
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http://dx.doi.org/10.1038/s41598-020-60334-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7042218PMC
February 2020

Prognostic value of F-FDG PET/CT metabolic parameters in small cell lung cancer.

J Int Med Res 2020 Apr 27;48(4):300060519892419. Epub 2019 Dec 27.

Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Objective: To compare the prognostic values of metabolic parameters from pretreatment PET/CT between limited disease (LD) and extensive disease (ED) small cell lung cancer (SCLC) patients.

Methods: Data on 118 newly diagnosed SCLC patients (50 LD and 68 ED) who underwent pretreatment positron emission tomography-computed tomography (PET/CT) were reviewed. For PET, metabolic parameters were measured for: (1) primary tumor, maximum standardized uptake value (SUVmax), metabolic tumor volume, and total lesion glycolysis; and (2) all tumor lesions, SUVmax of the hottest tumor, whole body metabolic tumor volume (WBMTV), and whole body total lesion glycolysis (WBTLG). Prognostic values of metabolic parameters and other clinical variables were analyzed to predict overall survival (OS).

Results: In LD, SUVmax of the primary tumor was an independent prognostic factor for OS. Patients with high SUVmax showed significantly worse OS than those with low SUVmax. In ED, WBMTV and WBTLG were independent prognostic factors for OS. Patients with high WBMTV or WBTLG showed significantly worse OS than those with low WBMTV or WBTLG.

Conclusions: SUVmax of primary tumor was the only independent prognostic factor for OS in LD SCLC patients. WBMTV and WBTLG were independent prognostic factors in ED SCLC patients.
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http://dx.doi.org/10.1177/0300060519892419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607737PMC
April 2020

Transcranial Direct Current Stimulation for Online Gamers.

J Vis Exp 2019 11 9(153). Epub 2019 Nov 9.

Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea;

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that applies a weak electric current to the scalp to modulate neuronal membrane potentials. Compared to other brain stimulation methods, tDCS is relatively safe, simple, and inexpensive to administer. Since excessive online gaming can negatively affect mental health and daily functioning, developing treatment options for gamers is necessary. Although tDCS over the dorsolateral prefrontal cortex (DLPFC) has demonstrated promising results for various addictions, it has not been tested in gamers. This paper describes a protocol and a feasibility study for applying repeated tDCS over the DLPFC and neuroimaging to examine the underlying neural correlates in gamers. At baseline, individuals who play online games report average weekly hours spent on games, complete questionnaires on addiction symptoms and self-control, and undergo brain F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET). The tDCS protocol consists of 12 sessions over the DLPFC for 4 weeks (anode F3/cathode F4, 2 mA for 30 min per session). Then, a follow-up is conducted using the same protocol as the baseline. Individuals who do not play online games receive only baseline FDG-PET scans without tDCS. Changes of clinical characteristics and asymmetry of regional cerebral metabolic rate of glucose (rCMRglu) in the DLPFC are examined in gamers. In addition, asymmetry of rCMRglu is compared between gamers and non-gamers at baseline. In our experiment, 15 gamers received tDCS sessions and completed baseline and follow-up scans. Ten non-gamers underwent FDG-PET scans at the baseline. The tDCS reduced addiction symptoms, time spent on games, and increased self-control. Moreover, abnormal asymmetry of rCMRglu in the DLPFC at baseline was alleviated after tDCS. The current protocol may be useful for assessing treatment efficacy of tDCS and its underlying brain changes in gamers. Further randomized sham-controlled studies are warranted. Moreover, the protocol can be applied to other neurological and psychiatric disorders.
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http://dx.doi.org/10.3791/60007DOI Listing
November 2019

Transcranial Direct Current Stimulation for the Treatment of Parkinson's Disease: Clinical and Regional Cerebral Blood Flow SPECT Outcomes.

J Neuroimaging 2020 03 24;30(2):161-164. Epub 2019 Nov 24.

Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Background And Purpose: Over the course of treatment for Parkinson's disease (PD), the clinical effects of dopaminergic medication diminish and side effects emerge. Therefore, searching for new therapeutic alternatives or complementary treatments is required. Transcranial direct current stimulation (tDCS) could potentially complement the current therapeutic armamentarium, but only a few studies have investigated the therapeutic effects of tDCS in PD. The present pilot study aimed to investigate the effects of repeated tDCS treatment on motor symptoms and regional cerebral blood flow (rCBF) in patients with PD using single photon emission computed tomography (SPECT).

Methods: Four patients with PD received tDCS to the dorsolateral prefrontal cortex two times per week (anode F3/cathode F4, 2 mA for 30 minutes) over a period of 12 months. Patients underwent brain SPECT scans and clinical motor evaluation at baseline and 12-month follow-up. For SPECT data, voxel-wise changes in rCBF were analyzed.

Results: There was no significant change of the motor severity scale, but the follow-up SPECT showed significant hyperperfusion in the left superior frontal gyrus medial segment and left superior parietal lobule compared to baseline (P < .001).

Conclusions: This study shows that tDCS application may improve rCBF in the frontal and parietal lobes in patients with PD, suggesting beneficial effects of tDCS on brain function. Our results are preliminary and further large-scale studies are needed to confirm our findings.
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http://dx.doi.org/10.1111/jon.12681DOI Listing
March 2020

Diverging roles of the anterior insula in trauma-exposed individuals vulnerable or resilient to posttraumatic stress disorder.

Sci Rep 2019 10 29;9(1):15539. Epub 2019 Oct 29.

Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.

Distinct brain alterations in response to traumatic events may render trauma-exposed individuals either resilient or vulnerable to posttraumatic stress disorder (PTSD). This study compared regional cerebral metabolic rate of glucose (rCMRglu) among trauma-exposed individuals with current PTSD (PTSD group, n = 61), those without current PTSD (Resilience/Recovery group, n = 26), and trauma-unexposed controls (Control group, n = 54). All participants underwent brain [F]-fluorodeoxyglucose positron emission tomography (FDG-PET) scans. Voxel-wise group differences in rCMRglu among the three groups were evaluated. Associations between rCMRglu and both PTSD severity and resilience were examined. The rCMRglu in the right anterior insula and adjacent prefrontal and striatal areas was lower in the PTSD group, while higher in the Resilience/Recovery group, compared to the Control group. In addition, the lower glucose metabolism of these areas was associated with higher severity and less improvement in PTSD symptoms in the PTSD group, while the higher levels of rCMRglu were correlated with stronger resilience in the Resilience/Recovery group. This study suggests distinct roles of the anterior insula in response to trauma between the PTSD and Resilience/Recovery groups. Heightened rCMRglu in the anterior insular regions may reflect an underlying mechanism of resilience against traumatic stress, while reduced rCMRglu may indicate vulnerability to PTSD.
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http://dx.doi.org/10.1038/s41598-019-51727-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820768PMC
October 2019

Neuroprotective Effects of Rasagiline in Parkinson's Disease: A Regional Cerebral Blood Flow Study.

J Neuroimaging 2019 11 28;29(6):707-711. Epub 2019 Aug 28.

Department of Neurology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Background And Purpose: Despite accumulating evidence for the clinical efficacy and neuroprotective properties of rasagiline in Parkinson's disease (PD), effects of rasagiline on brain perfusion in PD patients have not been elucidated. The present study aimed to investigate the effects of rasagiline on regional cerebral blood flow (rCBF) in patients with PD using single-photon emission computed tomography (SPECT).

Methods: A total of 44 PD patients were recruited and treated with dopamine agonist, either alone or in combination with levodopa. Twenty-two of these patients (referred to as the rasagiline group) additionally received rasagiline (1 mg/day). All patients underwent brain SPECT scans and clinical assessments at baseline and follow-up visits. The mean follow-up period was 2.2 years. Changes in rCBF were compared between the rasagiline group and the comparison group in a voxel-wise manner.

Results: Annual change in Unified Parkinson's Disease Rating Scale motor score was lower in the rasagiline group compared to the comparison group (P = .01). A significant group-by-time interaction effect on rCBF was found in the right precuneus (P = .001), where rCBF was decreased in the comparison group and remained stable in the rasagiline group.

Conclusions: Our results show that adjunctive rasagiline treatment had beneficial effects on perfusion in the precuneus of PD patients, suggesting potential neuroprotective effects.
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http://dx.doi.org/10.1111/jon.12661DOI Listing
November 2019

Efficacy of nicergoline treatment in Parkinson's disease associated with dementia.

J Clin Neurosci 2019 Dec 17;70:136-139. Epub 2019 Aug 17.

Department of Neurology, Incheon Mary's Hospital, The Catholic of Korea, InCheon, South Korea. Electronic address:

Parkinson's disease (PD) has a variable spectrum of cognitive impairment. However, there are no clear evident-based management guidelines for PD with dementia (PDD). Alternative treatments for PDD are therefore required. We conducted this longitudinal study to evaluate the efficacy of nicergoline in treating PDD by analyzing changes in regional cerebral blood flow (rCBF) and neuropsychological tests before and after nicergoline administration. A total of nine PDD patients who received nicergoline therapy (PDD + N) and 14 PD patients who did not receive nicergoline therapy (PDD - N) underwent single photon emission computed tomography (SPECT) and clinical assessments at baseline and 12-month follow-up visits. The PDD + N received nicergoline at 30 mg twice per day. Changes in rCBF were compared between the groups, and correlation analysis was performed to determine possible relationship between rCBF and clinical characteristics. There were no significant differences in rCBF between the two groups at baseline. Although changes in cognitive test scores and the motor severity scale were not significantly different between baseline and the 12-month follow-up within groups, rCBF was lower in both the temporal and inferior frontal restricted areas in the PDD - N group than the PDD + N at the 12-month follow-up visit. In conclusions, nicergoline appears to delay the speed of deterioration of cognitive function in patients with PDD based on our observation of decreased rCBF in the temporal regions and inferior frontal regions of PDD - N patients compared to PDD + N patients after 12-month of nicergoline therapy. Therefore, we cautiously suggest that nicergoline administration in PDD patients may slow progression of cognitive impairment in affected brain regions.
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http://dx.doi.org/10.1016/j.jocn.2019.08.048DOI Listing
December 2019

Neural Correlates of Public Apology Effectiveness.

Front Hum Neurosci 2019 25;13:229. Epub 2019 Jul 25.

Graduate School of Culture Technology, Seoul, South Korea.

Apologizing is an effective interpersonal conflict resolution strategy, but whether, and if so how, organizations should issue public apologies after crises remains less clear. To assuage the fear of possible crisis reoccurrence, public apologies may be effective when they provide a comprehensive account of what happened and clarify actions taken by the company to address the problems. If this is so, public apologies may be most effective when the crisis source resides within the organization itself, suggesting that the company has control over it. In the current study, we first tested this hypothesis by presenting participants with multiple crisis scenarios (e.g., ignition failures in a new car model) followed by one of two written apologies: one stating that the crisis source was internal to and controllable by the organization, and the other external and uncontrollable. The internal-controllable (IC) public apology proved most effective. We then examined the neural basis of this public apology assessment and found that the frontal polar cortex appears to mediate the assessment of organizational control, and the angular gyrus uses the information for the apology assessment. Examination of complex social interactions, such as the public's reaction to corporate crises, helps to elucidate high-level brain function.
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http://dx.doi.org/10.3389/fnhum.2019.00229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6669883PMC
July 2019

The Effect of Daily Low Dose Tadalafil on Cerebral Perfusion and Cognition in Patients with Erectile Dysfunction and Mild Cognitive Impairment.

Clin Psychopharmacol Neurosci 2019 Aug;17(3):432-437

Departments of Urology College of Medicine, The Catholic University of Korea, Seoul, Korea.

Objective: The aims of this study were to investigate the effects of daily low-dose tadalafil on cognitive function and to examine whether there was a change in cerebral blood flow (CBF) in patients with erectile dysfunction (ED) and mild cognitive impairment.

Methods: Male patients aged 50 to 75 years with at least three months of ED (International Index of Erectile Function [IIEF]-5 score ≤ 21) and mild cognitive impairment (Montreal Cognitive Assessment [MoCA] score ≤ 22) were included in the study. The subjects were prescribed a low-dose PDE5 inhibitor (tadalafil 5 mg) to be taken once daily for eight weeks. Changes in MoCA score and single-photon emission computed tomography (SPECT) study between the two time-points were assessed by paired tests.

Results: Overall, 30 male patients were assigned to the treatment group in this study and 25 patients completed the eight-week treatment course. Five patients were withdrawn due to adverse events such as myalgia and dizziness. Mean baseline IIEF and MoCA scores were 7.52 ± 4.84 and 18.92 ± 1.78. After the eight-week treatment, mean IIEF and MoCA scores were increased to 12.92 ± 7.27 ( < 0.05) and 21.8 ± 1.71 ( < 0.05), respectively. Patients showed increased relative regional CBF in the postcentral gyrus, precuneus, and brainstem after tadalafil administration versus at baseline ( < 0.001).

Conclusion: The results of this prospective clinical study suggest that daily use of tadalafil 5 mg increases some regional CBF and improves cognitive function in patients with ED and mild cognitive impairment.
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http://dx.doi.org/10.9758/cpn.2019.17.3.432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6705107PMC
August 2019

Development of visual scoring system with Tc-99m DMSA renal scintigraphy to predict the risk of recurrence of symptomatic urinary tract infections in pediatric patients.

Ann Nucl Med 2019 Sep 18;33(9):708-715. Epub 2019 Jun 18.

Department of Radiology, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea.

Objective: Vesicoureteral reflux (VUR) is a major risk factor for recurrent symptomatic urinary tract infection (UTI) in pediatric patients. In addition, dimercaptosuccinic acid renal scintigraphy (DMSA) is an important diagnostic modality of VUR. However, the value of DMSA for predicting recurrent pediatric UTI has not been studied. Therefore, we aimed to develop visual scoring system (VSS) with DMSA to predict the risk of recurrence of symptomatic urinary tract infection in pediatric patient under the age of 24 months.

Methods: Pediatric UTI patients who visited our tertiary hospital emergency department and underwent DMSA for initial work-up from January 2006 to December 2014 were reviewed retrospectively. We developed a VSS with Tc-99m DMSA renal scintigraphy. We compared sensitivity and specificity between VSS with DMSA and other variables in predicting recurrent symptomatic UTI. Laboratory indices for systemic inflammation, abnormal finding on ultrasonography, VUR on voiding cystourethrogram (VCUG), and the VSS with DMSA were considered as variables. In addition, we used Kaplan-Meier estimator analyses and Cox proportional regression analyses to evaluate the predictive value of each variable for the recurrence of symptomatic UTI.

Results: A total of 338 patients were enrolled. During the follow-up period, 42 patients (12.4%) had UTI recurrence. Visual scoring with DMSA resulted in 69.1% sensitivity and 79.4% specificity with an optimal cut-off value of score 2 (AUC = 0.790, p < 0.001). Significant predictive factors associated with recurrent symptomatic UTI were CRP ≥ 67.0 mg/L, VUR on VCUG and VSS with DMSA ≥ score 2. On multivariate analysis, the visual score with DMSA was the only independent prognostic factor for recurrent symptomatic UTI (p < 0.001; adjusted hazard ratio = 7.522; 95% CI = 2.799-20.224).

Conclusion: High scores in VSS with DMSA were associated with frequent recurrence and short recurrence periods in pediatric UTI patients. VSS with DMSA can stratify risk of recurrence in pediatric UTI patients.
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http://dx.doi.org/10.1007/s12149-019-01379-0DOI Listing
September 2019

Effects of 6-month at-home transcranial direct current stimulation on cognition and cerebral glucose metabolism in Alzheimer's disease.

Brain Stimul 2019 Sep - Oct;12(5):1222-1228. Epub 2019 Jun 4.

Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea. Electronic address:

Background: Although single or multiple sessions of transcranial direct current stimulation (tDCS) on the prefrontal cortex over a few weeks improved cognition in patients with Alzheimer's disease (AD), effects of repeated tDCS over longer period and underlying neural correlates remain to be elucidated.

Objective: This study investigated changes in cognitive performances and regional cerebral metabolic rate for glucose (rCMRglc) after administration of prefrontal tDCS over 6 months in early AD patients.

Methods: Patients with early AD were randomized to receive either active (n = 11) or sham tDCS (n = 7) over the dorsolateral prefrontal cortex (DLPFC) at home every day for 6 months (anode F3/cathode F4, 2 mA for 30 min). All patients underwent neuropsychological tests and brain F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) scans at baseline and 6-month follow-up. Changes in cognitive performances and rCMRglc were compared between the two groups.

Results: Compared to sham tDCS, active tDCS improved global cognition measured with Mini-Mental State Examination (p for interaction = 0.02) and language function assessed by Boston Naming Test (p for interaction = 0.04), but not delayed recall performance. In addition, active tDCS prevented decreases in executive function at a marginal level (p for interaction < 0.10). rCMRglc in the left middle/inferior temporal gyrus was preserved in the active group, but decreased in the sham group (p for interaction < 0.001).

Conclusions: Daily tDCS over the DLPFC for 6 months may improve or stabilize cognition and rCMRglc in AD patients, suggesting the therapeutic potential of repeated at-home tDCS.
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http://dx.doi.org/10.1016/j.brs.2019.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6703942PMC
January 2020

Brain Perfusion Correlates of Apathy in Alzheimer's Disease.

Dement Neurocogn Disord 2018 Jun 20;17(2):50-56. Epub 2018 Jul 20.

Department of Neurology, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Background And Purpose: Apathy is one of the most common neuropsychiatric symptoms in patients with Alzheimer's disease (AD). It may have adverse impacts on the progression of AD. However, its neurobiological underpinnings remain unclear. The objective of this study was to investigate differences in regional cerebral blood flow (rCBF) between AD patients with apathy and those without apathy.

Methods: Sixty-six apathetic AD patients and 66 AD patients without apathy completed Neuropsychiatric Inventory (NPI) and underwent technetium-99m hexamethylpropylene amine oxime single-photon emission computed tomography (SPECT) scans. Voxel-wise differences in rCBF between the 2 groups were examined. Association between rCBF and levels of apathy in the apathetic group was also assessed.

Results: AD patients with apathy showed lower rCBF in the bilateral orbitofrontal cortex, left putamen, left nucleus accumbens, left thalamus, and bilateral insula than those without (all <0.005). Mean perfusion across all significant clusters showed a negative linear correlation with NPI apathy score in AD patients with apathy (β=-0.25; =0.04).

Conclusions: Hypoperfusion in the prefrontal, striatal, and insular areas may be neural correlates of apathy in AD patients.
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http://dx.doi.org/10.12779/dnd.2018.17.2.50DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6427971PMC
June 2018

Correction to: Cerebral perfusion abnormalities in patients with persistent postural-perceptual dizziness (PPPD): a SPECT study.

J Neural Transm (Vienna) 2019 May;126(5):697

Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

The authors inadvertently forgot to provide the following funding information in the original publication: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Science and ICT (2018R1A6A3A11041118).
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http://dx.doi.org/10.1007/s00702-019-01977-2DOI Listing
May 2019

Precise differential diagnosis of acute bone marrow edema and hemorrhage and trabecular microfractures using naïve and gamma correction pinhole bone scans.

J Int Med Res 2019 Apr 10;47(4):1493-1503. Epub 2019 Jan 10.

4 Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

Objective: To analyze the performance of sequential naïve pinhole bone scan (nPBS) and gamma correction pinhole bone scan (GCPBS), reinforced by ImageJ densitometry and pixelized microfracture measurement, for making specific diagnoses of bone marrow edema (BME), bone marrow hemorrhage (BMH), and trabecular microfractures (TMF).

Methods: We prospectively examined BME, BMH, TMF, and normal trabeculae in 10 patients using sequential nPBS and GCPBS. The intensity of technetium-hydroxydiphosphonate (Tc-HDP) uptake was measured using a pixelized method and calculated using ImageJ densitometry in terms of arbitrary units (AU). This overall method was termed a visuospatial-mathematic assay (VSMA). We analyzed the ability of the calculated AU values to discriminate between the four states using GraphPad Prism software, with reference to previous morphological data.

Results: The calculated values were categorized as ≤50 AU for normal trabecula, 51-100 AU for BME, 101-150 AU for BMH, and ≥151 AU for TMF. The difference in uptake between normal trabecula and BME was significant and the differences among BME, BMH, and TMF were highly significant.

Conclusion: VSMA is a useful technique for refining objective individual diagnoses and for differentiating and quantitating BME, BMH, and TMF.
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http://dx.doi.org/10.1177/0300060518819910DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6460595PMC
April 2019

Transcranial direct current stimulation for online gamers: A prospective single-arm feasibility study.

J Behav Addict 2018 Dec 12;7(4):1166-1170. Epub 2018 Nov 12.

2 Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul, South Korea.

Aim: Excessive use of online games can have negative influences on mental health and daily functioning. Although the effects of transcranial direct current stimulation (tDCS) have been investigated for the treatment of addiction, it has not been evaluated for excessive online game use. This study aimed to investigate the feasibility and tolerability of tDCS over the dorsolateral prefrontal cortex (DLPFC) in online gamers.

Methods: A total of 15 online gamers received 12 active tDCS sessions over the DLPFC (anodal left/cathodal right, 2 mA for 30 min, 3 times per week for 4 weeks). Before and after tDCS sessions, all participants underwent F-fluoro-2-deoxyglucose positron emission tomography scans and completed the Internet Addiction Test (IAT), Brief Self Control Scale (BSCS), and Beck Depression Inventory-II (BDI-II).

Results: After tDCS sessions, weekly hours spent on games (p = .02) and scores of IAT (p < .001) and BDI-II (p = .01) were decreased, whereas BSCS score was increased (p = .01). Increases in self-control were associated with decreases in both addiction severity (p = .002) and time spent on games (p = .02). Moreover, abnormal right-greater-than-left asymmetry of regional cerebral glucose metabolism in the DLPFC was partially alleviated (p = .04).

Conclusions: Our preliminary results suggest that tDCS may be useful for reducing online game use by improving interhemispheric balance of glucose metabolism in the DLPFC and enhancing self-control. Larger sham-controlled studies with longer follow-up period are warranted to validate the efficacy of tDCS in gamers.
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http://dx.doi.org/10.1556/2006.7.2018.107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6376367PMC
December 2018

Cerebral perfusion abnormalities in patients with persistent postural-perceptual dizziness (PPPD): a SPECT study.

J Neural Transm (Vienna) 2019 02 31;126(2):123-129. Epub 2018 Oct 31.

Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

Persistent postural-perceptual dizziness (PPPD) is a recently defined syndrome with chronic dizziness interrupting daily life. Although the high levels of anxiety and functional changes in postural control strategy and multi-sensory information processing and integration may be underlying the pathophysiology, its neural mechanisms are poorly understood. The aim of this study was to examine the regional cerebral blood flow (rCBF) in patients with PPPD using single photon emission computed tomography (SPECT). A total of 25 patients with PPPD and 25 healthy controls participated in the study. All participants underwent brain SPECT and the patients completed the Dizziness Handicap Inventory. SPECT images were compared between the groups, and the correlation of rCBF and disease severity/duration was assessed in patients. Compared with controls, PPPD patients showed a significantly decreased rCBF in the insula and frontal lobe, mainly in the left posterior insula, bilateral superior frontal gyrus, right inferior frontal gyrus, right precentral gyrus, and left medial orbital gyrus. Additionally, PPPD patients showed a significant rCBF increase in the bilateral cerebellum compared with controls. The results of our study suggest that the altered rCBF in the insular, frontal, and cerebellar cortices might be reflecting the process of maladaptation and the compensatory responses for the changes in PPPD.
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http://dx.doi.org/10.1007/s00702-018-1948-3DOI Listing
February 2019

Prediction of postoperative lung function in lung cancer patients using perfusion scintigraphy.

Acta Radiol 2019 Apr 30;60(4):488-495. Epub 2018 Jul 30.

2 Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Background: Predicting postoperative lung function is critical in lung cancer patients. Perfusion scintigraphy has been used to estimate postoperative function after lung resection.

Purpose: To evaluate the usefulness of the posterior oblique method in relation to other conventional processing methods for predicting postoperative lung function using lung perfusion scintigraphy.

Material And Methods: Fifty-five patients with non-small-cell lung cancer who underwent lobectomy were enrolled. Forced expiratory volume in 1 s (FEV1) values were obtained from preoperative and postoperative pulmonary function tests. After performing lung perfusion scintigraphy, predicted FEV1 values were calculated using the segment, conventional, posterior, and posterior oblique methods. Postoperative FEV1 values were compared with predicted FEV1 values.

Results: The mean value of the preoperative FEV1 was 2.29 L and that of the postoperative FEV1 was 1.89 L. The mean values of the predicted postoperative FEV1 values for the segment, conventional, posterior, and posterior oblique were 1.83 L, 1.94 L, 1.88 L, and 1.89 L, respectively. Between the observed and predicted FEV1 values, there was a strong correlation without significant difference except for conventional method. Bland-Altman analysis showed that segment and posterior methods underestimated the FEV1, whereas conventional and posterior oblique methods overestimated the FEV1.

Conclusion: Predictions with each processing method of lung perfusion scintigraphy showed nearly similar results to the actual postoperative lung function. The posterior oblique method of lung perfusion scintigraphy showed a very small difference to such an extent as to be equal to the observed FEV1, implying that this method may be applied for predicting postoperative lung function in lung cancer patients.
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http://dx.doi.org/10.1177/0284185118787355DOI Listing
April 2019

Usefulness of feature analysis of breast-specific gamma imaging for predicting malignancy.

Eur Radiol 2018 Dec 12;28(12):5195-5202. Epub 2018 Jun 12.

Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Seoul, 403-720, South Korea.

Objectives: The purpose of this study was to investigate which feature of the breast-specific gamma imaging (BSGI) uptake in women who were recently diagnosed with breast cancer was associated with malignancy.

Methods: Data on 231 newly diagnosed breast cancer patients who underwent preoperative BSGI were retrospectively reviewed. Feature analysis was done by classifying BSGI uptake into mass, non-mass, or focus/foci. Descriptors for mass, non-mass, or focus/foci were shape, distribution, number, and intensity. BSGI features of known malignancies and lesions that were additionally found by BSGI were correlated with mammographic breast density, histology, hormonal status, and clinical follow-up data obtained over at least 2 years.

Results: Among 372 breast lesions from 231 patients, 241 malignancies had been pathologically confirmed prior to BSGI and 131 additional lesions were found on BSGI. Irregular shape was more predictive of malignancy than oval shape (p=0.004) in mass uptake. Linear/ductal distribution was more predictive of malignancy than focal, regional, and segmental distribution (p<0.05) in non-mass uptake. Mammographic breast density was not associated with BSGI features. The lesion to normal ratio (LNR) was higher in the postmenopausal patients than that in the premenopausal patients (p=0.003).

Conclusions: The feature analysis of radiotracer uptake in BSGI is useful in predicting whether breast lesions are malignant or benign.

Key Points: • The feature analysis of BSGI uptake is useful in predicting malignancy. • Irregular shape was predictive of malignancy in mass uptake. • Linear/ductal distribution was predictive of malignancy in non-mass uptake.
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http://dx.doi.org/10.1007/s00330-018-5563-3DOI Listing
December 2018

A Pilot Trial to Examine the Changes in Carotid Arterial Inflammation in Renal Transplant Recipients as Assessed by 18F-Fluorodeoxyglucose (18F-FDG) Positron Emission Tomography Computed Tomography (PET/CT).

Ann Transplant 2018 Jun 15;23:412-421. Epub 2018 Jun 15.

Cardiovascular Center and Cardiology Division, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

BACKGROUND Inflammatory activity of the artery can be assessed by measuring 18F-fluorodeoxyglucose (18F-FDG) uptake with positron emission tomography computed tomography (PET/CT). Improvement in vascular function after renal transplantation has been reported, but no studies have used 18F-FDG PET/CT to examine the changes in vascular inflammation. This study investigated the changes in the inflammatory activity in the carotid artery after renal transplantation in patients with chronic kidney disease (CKD). MATERIAL AND METHODS 18F-FDG PET/CT was performed before and at 4 months after transplantation. We quantified 18F-FDG uptake as the target-to-background ratio (TBR) in the carotid artery in 10 CKD patients. TBR was evaluated in the whole carotid artery (WH) and most-diseased segment (MDS), and the mean and maximum values were analyzed. The concentrations of inflammatory cytokines, including tumor necrosis factor-alpha, interleukin-6, plasminogen activator inhibitor-1, and endothelin-1, were measured. RESULTS Eight patients showed a decrease in mean or maximum TBR. The average mean or maximum TBRs in the WH and MDS of the right and left arteries were all reduced after transplantation. The average mean TBR for the right WH decreased significantly (% reduction [95% CI]) by -5.74% [-15.37, -0.02] (p=0.047). TBRs did not correlate significantly with cytokine concentrations. The changes in cytokine concentrations after transplantation varied. CONCLUSIONS 18F-FDG uptake by the WH and MDS tended to reduce after renal transplantation. Therefore, renal transplantation may confer an anti-inflammatory effect on carotid atherosclerosis in patients with CKD; however, this effect is not large enough to be demonstrated in this study with small sample size.
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http://dx.doi.org/10.12659/AOT.909212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248031PMC
June 2018

Brain stimulation patterns emulating endogenous thalamocortical input to parvalbumin-expressing interneurons reduce nociception in mice.

Brain Stimul 2018 Sep - Oct;11(5):1151-1160. Epub 2018 May 18.

Translational Brain Research Center, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea; Dept. of Medical Science, College of Medicine, Catholic Kwandong University, Gangneung-si, Gangwon-do, South Korea. Electronic address:

Background: The bursting pattern of thalamocortical (TC) pathway dampens nociception. Whether brain stimulation mimicking endogenous patterns can engage similar sensory gating processes in the cortex and reduce nociceptive behaviors remains uninvestigated.

Objective: We investigated the role of cortical parvalbumin expressing (PV) interneurons within the TC circuit in gating nociception and their selective response to TC burst patterns. We then tested if transcranial magnetic stimulation (TMS) patterned on endogenous nociceptive TC bursting modulate nociceptive behaviors.

Methods: The switching of TC neurons between tonic (single spike) and burst (high frequency spikes) firing modes may be a critical component in modulating nociceptive signals. Deep brain electrical stimulation of TC neurons and immunohistochemistry were used to examine the differential influence of each firing mode on cortical PV interneuron activity. Optogenetic stimulation of cortical PV interneurons assessed a direct role in nociceptive modulation. A new TMS protocol mimicking thalamic burst firing patterns, contrasted with conventional continuous and intermittent theta burst protocols, tested if TMS patterned on endogenous TC activity reduces nociceptive behaviors in mice.

Results: Immunohistochemical evidence confirmed that burst, but not tonic, deep brain stimulation of TC neurons increased the activity of PV interneurons in the cortex. Both optogenetic activation of PV interneurons and TMS protocol mimicking thalamic burst reduced nociceptive behaviors.

Conclusions: Our findings suggest that burst firing of TC neurons recruits PV interneurons in the cortex to reduce nociceptive behaviors and that neuromodulation mimicking thalamic burst firing may be useful for modulating nociception.
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http://dx.doi.org/10.1016/j.brs.2018.05.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109414PMC
March 2019