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Lai C.-H.,Cheng Hsin General Hospital | Wu Y.-T.,National Yang Ming University
Journal of Affective Disorders | Year: 2013

Objective: Because of limited knowledge about white matter (WM) tract in panic disorder, we designed this study to investigate alterations of WM tracts in first-episode medication-naïve panic disorder patients. Methods: Thirty patients and 21 normal controls were enrolled into our study. They all received acquisitions of diffusion tensor imaging (DTI) in 30 directions. DTI images of patients and controls were preprocessed and analyzed to estimate differences of WM microintegrity between patients and controls. We obtained fractional anisotropy (FA) values from the DTI images. FA outputs of patients and controls were compared by non-parametric permutation-based method with global brain volume, age, gender and duration of illness as covariates. Correlations between severity of panic symptoms and FA values were also estimated. Results: First-episode, medication-naïve and late-onset panic disorder patients had altered integrity in WM tracts of right inferior fronto-occipital fasculi, left body of corpus callosum and left superior longitudinal fasciculus when compared to controls (corrected p<0.05). Negative correlations between PD symptoms and FA values were observed in corpus callosum of patient group (corrected p<0.05). Conclusions: WM tract alterations might represent structural pathophysiology in WM of first-episode, medication-naïve and late-onset panic disorder patients. © 2012 Elsevier B.V. All rights reserved.


This study was designed to explore regional homogeneity (ReHo), an indicator of the synchronization of brain function, in first-episode, medication-naïve and late-onset patients with panic disorder (PD). Participants comprised 30 patients and 21 healthy controls who underwent with 3-Tesla magnetic resonance imaging (MRI) scanning and ReHo functional MRI analysis. All participants were studied with clinical rating scales to assess the severity of PD symptoms. ReHo values were obtained using the REST toolbox (resting-state functional MRI data analysis toolbox). Differences in demographic data and ReHo values between the two groups were evaluated with the independent two-sample t-test function of the Statistical Package for the Social Sciences and REST. There were significant differences in clinical ratings between the two groups. No demographic differences were noted. We found decreased ReHo in the left lingual gyrus and increased ReHo in the right cuneus cortex of patients compared with controls. ReHo values of patients were negatively correlated with PD ratings in the right cuneus. ReHo differences found in the left lingual gyrus and the right cuneus might suggest sensory and inhibitory dysfunction in first-episode, medication-naïve, late-onset patients with PD. © 2012 Elsevier Ireland Ltd.


Lai C.-H.,Cheng Hsin General Hospital | Lai C.-H.,National Yang Ming University | Wu Y.-T.,National Yang Ming University
International Journal of Neuropsychopharmacology | Year: 2014

The issue of inter-hemispheric connectivity is an emerging new area in understanding the pathophysiology of depression. This study was designed to analyse the pattern of inter-hemispheric connectivity in patients with major depressive disorder (MDD). The resting-state functional magnetic resonance imaging (RFMRI) was acquired in all enrolled patients and controls. We used a method of voxel-mirrored homotopic connectivity (VMHC) to estimate the significant differences in inter-hemispheric connectivity between 44 patients with first-episode medication-naïve MDD and 27 normal controls. The patients and controls were matched for age and gender. The patients with first-episode medication-naïve MDD showed lower VMHC than normal controls in bilateral medial frontal cortex, anterior cingulate and cerebellar posterior lobe. The strength of inter-hemispheric connectivity VMHC value was negatively correlated with clinical severity of MDD. From the results, we suggested that decreased inter-hemispheric connectivity in the anterior sub-network of the default mode network and the cerebellar posterior lobe might represent an emerging finding in the pathophysiology for MDD. © CINP 2014.


Lai C.-H.,Cheng Hsin General Hospital | Lai C.-H.,National Yang Ming University
Journal of Neuropsychiatry and Clinical Neurosciences | Year: 2014

The author retrieved 10 functional magnetic resonance imaging studies about visual tasks for emotional faces in subjects with depression. The activation foci were then summarized and entered into a coordinate-based meta-analysis. The depression group showed significantly increased activations in the left striatum and left parahippocampal gyrus; the control group showed increased activations in the left medial frontal gyrus, left middle frontal gyrus, right thalamus, left anterior cingulate, and superior frontal gyrus. The study suggests that depression patients have limbic activations, and controls have fronto-thalamic activations with visual processing of emotional faces. © 2014 by the American Psychiatric Association.


Lai C.-H.,Cheng Hsin General Hospital | Lai C.-H.,National Yang Ming University | Wu Y.-T.,National Yang Ming University
Journal of Affective Disorders | Year: 2014

Objective This study is designed to investigate the gray matter volume (GMV) deficits in patients with first-episode medication-naïve major depressive disorder (MDD). Methods We enrolled 38 patients with first-episode medication-naïve MDD and 27 controls in this project. Voxel-based morphometry was used to compare GMV differences between two groups. Besides, the relationship between GMV of patients and the severity of clinical symptoms was estimated to confirm the role of GMV deficits in clinical symptoms. The correlation between total GMV and illness duration was also performed to elucidate the impacts of untreated duration on the GMV. Results We found that first-episode medication-naïve MDD patients had significant GMV deficits in bilateral superior frontal gyri, left middle frontal gyrus, left medial frontal gyrus and left insula. The GMV of patient group was negatively correlated with the severity of clinical symptoms and the illness duration. Conclusion A pattern of GMV deficits in fronto-insula might represent the biomarker for first-episode medication-naïve MDD. © 2014 Elsevier B.V.


Lai C.-H.,Cheng Hsin General Hospital | Wu Y.-T.,National Yang Ming University
Journal of Psychiatric Research | Year: 2013

Objective: This study aimed to investigate changes in the gray matter volume (GMV) of first-episode, remitted drug-naïve patients under 6 weeks of escitalopram treatment for panic disorder (PD). We also determined any persistent GMV deficits after remission to assess for "state-dependent brain changes" and "trait-like brain changes" for PD. Method: 3-Tesla magnetic resonance imaging structural scans were performed on 21 PD patients at baseline and in their remitted state at week 6 of the study. To account for the inter-scanner bias, 21 healthy controls were also scanned twice within 6 weeks. All structural images were processed and analyzed to estimate GMV differences between patients and controls. We utilized optimized voxel-based morphometry with global brain volume, age, and gender as covariates. We also estimated the correlation between improvements in clinical rating scale scores and changes in total gray matter volumes to confirm the results of optimized voxel-based morphometry. Results: Rating scales of panic symptoms improved significantly (corrected p < 0.001). Remitted patients showed increased GMV in the left superior frontal gyrus (corrected p < 0.05) after escitalopram therapy. There were significant GMV deficits in the right precentral gyrus (corrected p < 0.05) after remission of PD symptoms. Changes in total GMV after remission were correlated with changes in clinical scores (r = 0.638; Spearman's rho p = 0.002). Conclusion: The left superior frontal gyrus (state-dependent brain changes) and the right precentral gyrus (trait-like brain changes) might be implicated in the underlying pathophysiology of PD. © 2012 Elsevier Ltd.


Lai C.-H.,Cheng Hsin General Hospital | Lai C.-H.,National Yang Ming University | Wu Y.-T.,National Yang Ming University
Psychological Medicine | Year: 2014

Background This study surveyed the characteristics of white matter (WM) micro-integrity in patients who were diagnosed with major depressive disorder (MDD) without co-morbidities. Method A total of 44 patients with MDD and 27 normal controls were enrolled in our study. Diffusion tensor imaging images of patients and controls were pre-processed and analysed to estimate differences in WM micro-integrity between patients and controls by performing comparisons of the values obtained from fractional anisotropy (FA). FA outputs of patients and controls were compared by a non-parametric permutation-based method with global brain volume, age and gender as covariates. In addition, the between-group differences of radial diffusivity (RD) and axial diffusivity (AD) were assessed to explain the alterations in FA values. Correlations between clinical variables (such as depression severity, anxiety severity, illness duration) and FA values were also estimated in each group and across both groups. Results The patients with MDD had significantly lower FA values than the controls, for the left superior longitudinal fasciculus (SLF) and the right anterior thalamic radiation (ATR). The reductions in FA values occurred in combination with elevated RD values in the bilateral SLF and decreased AD values in the bilateral ATR. FA values were negatively correlated with depression severity in the SLF and with illness duration in the right SLF and ATR. Conclusions MDD patients had significant alterations in the WM micro-integrity of the left SLF and the right ATR. © Cambridge University Press 2014.


The longitudinal relationship between central plastic changes and clinical presentations of peripheral hearing impairment remains unknown. Previously, we reported a unique plastic pattern of "healthy-side dominance" in acute unilateral idiopathic sudden sensorineural hearing loss (ISSNHL). This study aimed to explore whether such hemispheric asymmetry bears any prognostic relevance to ISSNHL along the disease course. Using magnetoencephalography (MEG), inter-hemispheric differences in peak dipole amplitude and latency of N100m to monaural tones were evaluated in 21 controls and 21 ISSNHL patients at two stages: initial and fixed stage (1 month later). Dynamics/Prognostication of hemispheric asymmetry were assessed by the interplay between hearing level/hearing gain and ipsilateral/contralateral ratio (I/C) of N100m latency and amplitude. Healthy-side dominance of N100m amplitude was observed in ISSNHL initially. The pattern changed with disease process. There is a strong correlation between the hearing level at the fixed stage and initial I/C(amplitude) on affected-ear stimulation in ISSNHL. The optimal cut-off value with the best prognostication effect for the hearing improvement at the fixed stage was an initial I/C(latency) on affected-ear stimulation of 1.34 (between subgroups of complete and partial recovery) and an initial I/C(latency) on healthy-ear stimulation of 0.76 (between subgroups of partial and no recovery), respectively. This study suggested that a dynamic process of central auditory plasticity can be induced by peripheral lesions. The hemispheric asymmetry at the initial stage bears an excellent prognostic potential for the treatment outcomes and hearing level at the fixed stage in ISSNHL. Our study demonstrated that such brain signature of central auditory plasticity in terms of both N100m latency and amplitude at defined time can serve as a prognostication predictor for ISSNHL. Further studies are needed to explore the long-term temporal scenario of auditory hemispheric asymmetry and to get better psychoacoustic correlates of pathological hemispheric asymmetry in ISSNHL.


Ko M.-L.,Cheng Hsin General Hospital
Journal of Minimally Invasive Gynecology | Year: 2010

Subcutaneous emphysema is a known complication of laparoscopic surgery. Occasionally, subcutaneous emphysema is severe enough to cause pneumopericardium. This case report describes a rare but potentially serious complication of pneumopericardium occurring after laparoscopy. Contributing factors and possible etiologies are discussed. © 2010 AAGL.


Lai C.-H.,Cheng Hsin General Hospital
Psychiatry Research - Neuroimaging | Year: 2013

We designed this study to perform a meta-analysis of gray matter (GM) findings in major depressive disorder (MDD) by using the signed differential mapping (SDM) toolbox. The Pubmed, ScienceDirect and Scopus databases were searched, and only studies published or published online before November 2010 have been included. Twenty voxel-based morphometry (VBM) studies of adult MDD patients were entered in the meta-analysis by SDM toolbox with threshold criteria set as error probability less than 0.00005 and cluster more than 50 voxels. Onset age, numbers of patients and controls, gender ratio of both groups, ratio of medicated patients, depression rating scores, illness duration, co-morbidity and existence of corrected p value were also meta-regressed as covariates to exclude confounding biases. Voxel-wise meta-analytic results of these 20. VBM studies in MDD patients revealed that GM deficits were observed in the right anterior cingulate cortex and left anterior cingulate cortex when patients were compared with controls. The findings remained mostly unchanged in jackknife sensitivity analyses. The potential confounding factors had little impact on the results. This meta-analysis suggested GM deficits of the anterior cingulate cortex might be important in the etiology of MDD. © 2012 Elsevier Ireland Ltd.

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