Volume 102 ·  Issue 35 ·  2022

Cardiovascular diseases (CVD) is an urgent threat to Chinese. It is of primary importance to assess risk for cardiovascular diseases. However, there are some limitations about traditional tools for CVD risk assessment. Recently, numbers of clinical trials demonstrated that CVD risk assessments based on cardiovascular biomarkers would significantly improve sensitivity and specificity of prediction. The comment review the limitations of traditional tools for CVD risk assessment, the application value of novel tools and advances of cardiovascular biomarkers in CVD prediction. It is benefit for precise stratification and management of general population during risk stage. Archieving the strategic goal of"Healthy China"would be promising soon.

Neuroimaging technologies can non-invasively characterize the structure and function of addiction brain, reveal the neural mechanism of addictive behavior, and provide a priori for the potential targets of brain stimulation. Neuroimaging technologies has played an important role in the study of drug addiction diseases, relapse prediction, and therapeutic evaluation of non-invasive brain stimulations, but it also faces many challenges. In this manuscript, we discuss the classification and analysis methods of neuroimaging technologies, its application in addiction and challenges, thus to promote the application of neuroimaging technology in the treatment of drug addiction.

B-type natriuretic peptide (BNP) and N-terminal B-type natriuretic peptide precursor (NT-proBNP) are cardiac function biomarkers, and they are also the first biomarkers of choice for the diagnosis and differential diagnosis, disease severity and prognosis assessment of heart failure. However, with the continuous deepening of clinical research and the widespread application of new heart failure treatment drugs, the laboratory testing and clinical application of BNP/NT-proBNP face many problems that require further consensus: (1) BNP or NT-proBNP, which is more "easy to use"? Is it necessary to perform both BNP and NT-proBNP testing? (2) Is the in vitro stabilization time of BNP/NT-proBNP the same as its in vivo half-life? (3) What is the consistency between the detection platforms of BNP or NT-proBNP? Can BNP and NT-proBNP test results be converted to each other? (4) There are many factors affecting BNP/NT-proBNP detection. How to ensure the quality of BNP/NT-proBNP detection? How to carry out performance verification? (5) How to standardize the reporting of BNP/NT-proBNP test results? What influencing factors need to be considered when interpreting BNP/NT-proBNP test results? (6) Is it necessary to establish a BNP/NT-proBNP reference interval and medical decision level in the Chinese population? (7) Is the BNP/NT-proBNP cut-off for excluding and diagnosing heart failure applicable to heart failure with preserved ejection fraction? What is the BNP/NT-proBNP target value to assess the prognosis of heart failure? What is the BNP/NT-proBNP intervention cut-off for preventing heart failure? How to determine BNP/NT-proBNP monitoring frequency in patients with heart failure? (8) How to determine the BNP/NT-proBNP cut-off for excluding and diagnosing heart failure in patients with renal insufficiency and obesity? (9) Can both BNP/NT-proBNP be used for the efficacy evaluation of new heart failure treatment drugs such as nesiritide, sacubitril/valsartan and the prognosis evaluation of related patients? (10) In addition to heart failure, what other diseases can BNP/NT-proBNP be applied to? In view of this, the Cardiovascular Expert Committee of Laboratory Physicians Branch of Chinese Medical Doctors Association organized domestic laboratory experts and clinical experts to write this consensus. Aiming at the above 10 key issues, the latest research progress and domestic application requirements of BNP/NT-proBNP are expounded from both laboratory and clinical perspectives, respectively, to guide and standardize the laboratory testing and clinical application of BNP/NT-proBNP.

Axial spondyloarthritis (axSpA) is a chronic autoimmune disease characterized by pain, limited movement of axial joints, and impaired physical function and structure. It has a high incidence and disability rate, which brings great burden to patients individuals, families and society. At present, axSpA's compliance management (T2T) strategy mainly focuses on the control of inflammation and the relief of the disease, and reflects the effect of treatment and the progression of the disease by evaluating the activity of the disease. In this process, there is still a lack of convenient and comprehensive comprehensive evaluation system for the restoration and evaluation of physical function and healthy quality of life, and there is also a lack of standardized and standardized guidance and suggestions. The Rheumatology and Molecular Immunity Branch of National Health Industry Enterprise Management Association formed a consensus group composed of 52 experts, and put forward consensus opinions on physical function and healthy quality of life of axial spondyloarthritis from the biological-psychological-social level. This consensus puts forward 7 opinions, and constructs a 25-item 5-dimensional comprehensive assessment scale of axial spondyloarthritis physical function from the aspects of pain, spinal activity, whole body activity, social environment, mental health, etc., aiming to provide guidance for the standardized and systematic assessment of axSpA physical function in China.

To investigate the dynamic characteristics of brain spontaneous activity in betel quid dependence (BQD) chewers and its relationship with clinical indexes.

This study was conducted in Hainan General Hospital from April to December 2019 and the data of 53 BQD chewers (37 males and 16 females, aged 20 to 58(38±11) years) and 37 healthy controls (HC) (24 males and 13 females, aged 23-57(42±12) years) were collected. All these subjects underwent resting-state functional magnetic resonance imaging (rs-fMRI) scan. The dynamic characteristics of resting fMRI indexes, including dynamic amplitude of low-frequency fluctuations (ALFF), regional homogeneity (ReHo) and degree centrality (DC) of these subjects were calculated using the sliding time window method, parameters such as age and dynamic local consistency were analyzed and compared between the two groups. Pearson correlation was used to analyze the relationship between dynamic indexes, betel quid dependence score (BQDS) and disease duration in BQD group.

BQD chewers showed decreased dynamic ALFF in the left orbital prefrontal cortex (0.138±0.041 vs 0.171±0.070), the right temporal pole superior temporal gyrus (0.277±0.070 vs 0.319±0.086) and the right inferior parietal lobule (0.223±0.052 vs 0.259±0.088) than HC (all P<0.05). For regional homogeneity, BQD chewers showed a decrease dynamic ReHo in the right inferior temporal gyrus (0.055±0.008 vs 0.061±0.009), the orbital prefrontal cortex (0.058±0.005 vs 0.063±0.008), the right inferior frontal gyrus (0.081±0.006 vs 0.087±0.011), the right superior occipital gyrus (0.056±0.007 vs 0.062±0.008), the left precentral gyrus (0.068±0.008 vs 0.074±0.008), and the left superior frontal gyrus (0.058±0.008 vs 0.064±0.009) than HC (allP<0.05). BQD chewers showed an increase dynamic ReHo in the right precuneus (0.095±0.009 vs 0.089±0.008) (P<0.05). There was no significant difference in DC between the two groups (allP>0.05). The relationships between three dynamic ALFF and BQDS (r=-0.104, -0.015, -0.119), seven dynamic ReHo and BQDS (r=-0.099, -0.141, -0.055, -0.078, -0.027, -0.111, -0.090), three dynamic ALFF and disease duration (r=-0.122, -0.095, -0.171), and seven dynamic ReHo and disease duration (r=0.242, -0.252, 0.035, 0.056, 0.047, 0.081, 0.169) were not statistically significant (all P>0.05).

BQD chewers showed a decrease dynamic ReHo and/or ALFF in multiple brain regions dominated by prefrontal cortex, and an increase dynamic ReHo in the right precuneus.

To investigate the alterations in effective connection of default mode network (DMN) in long-term male smokers and its correlation with clinical characteristics of smoking.

A total of 131 subjects through WeChat platform and underwent resting-state functional magnetic resonance (rs-fMRI) examinations were recruited, including 76 long-term smokers [long-term smoking group, male, aged 20 to 55 (32.1±6.3) years] and 55 non-smokers [healthy controls, male, aged 20 to 55(32.3±7.4) years] from January 2014 to December 2018. Long-term smokers were defined as those who smoked at least 10 cigarettes per day for more than 2 years, and met the Diagnostic and Statistical Manual of Mental Disorders-Four Edition (DSM-Ⅳ) criteria for substance dependence. Four major nodes of DMN, including left inferior parietal lobule (LIPL), right inferior parietal lobule (RIPL), posterior cingulate cortex (PCC), medial prefrontal cortex (mPFC) were chosen as for the region of interest. The effective connectivity (EC) alterations of DMN between smoking group and healthy controls were compared using dynamic causal modeling (DCM). The correlation between EC with significant difference among the two groups and Nicotine Dependence Scale (FTND) score, pack-year score and smoking duration were evaluated.

Compared to the healthy controls, the EC of LIPL to PCC and PCC to mPFC were decreased in the smoking group (EC = -0.091, -0.174, respectively, Bayesian-PP>0.95), and the EC of RIPL to PCC was increased (EC = 0.136, Bayesian-PP>0.95). Besides, EC of LIPL to PCC showed negative correlation with pack-year scores(r=-0.282,P=0.017). No significant linear correlations were observed between EC with significant group difference and FTND score or smoking duration (r=-0.103、-0.089,all P>0.05).

Long-term smokers showed multiple abnormalities in IPL-PCC-mPFC circuits, and associated with the pack-year scores.

To explore the alterations of cerebral cortical thickness in severe nicotine addicts by using surface-based morphology (SBM) method and further analyzing the association of these changes with smoking-related characteristics.

Data were retrospectively collected from August 2014 to August 2019 from severe nicotine addicts [aged 25 to 52(38±8)years] and 56 non-smokers healthy volunteers [aged 22 to 51(36±8)years]. All subjects underwent 3.0 T magnetic resonance scans, and FreeSurfer software was used to analyze the difference in cortical thickness between the two groups, and Pearson correlation analysis was used to explore the correlation between the nicotine dependence group and smoking-related characteristics.

Compared to control group, the severe nicotine dependence group had a significant reduction in the cortical thickness in 9 areas of the brain, the left cerebral cortex, including: middletemporal, precentral, superiorfrontal, insula [(2.78±0.10) mm vs (2.92±0.17) mm, (2.57±0.15) mm vs (2.70±0.14) mm, (2.63±0.18) mm vs (2.76±0.15) mm, (3.01±0.10) mm vs (3.13±0.13) mm, all P<0.01, respectively], and the right cerebral cortex including: temporalpole, rostralmiddlefrontal, superiorfrontal, postcentral, parsopercularis [(3.12±0.14) mm vs (3.26±0.19) mm, (2.71±0.16) mm vs (2.87±0.18) mm, (2.96±0.15) mm vs (3.10±0.20) mm, (2.57±0.15) mm vs (2.71±0.15) mm, (2.54±0.11) mm vs (2.65±0.15) mm, allP<0.05, respectively]. The cortical thickness of left insular was positively correlated with the initial smoking age (r=0.403,P=0.009), while the cortical thickness of the other brain regions had no significant correlation with smoking-related characteristics (all P>0.05).

Significant alterations were observed in cortical thickness in severe nicotine addicts, and there is a correlation between the thickness of the left insular cortex and the age of initial smoking.

To explore the value of MRI diffusion tensor imaging (DTI) in the white matter changes of short-term methamphetamine (MA) abstinence.

The data of DTI, demographics features, general information of addiction and impulsivity scale eleven (BIS-11) of 55 short-term MA addicts who were from Changsha, Zhuzhou and Yueyang compulsory detoxification centers in Hunan province, including 40 males and 15 females, aged 14-45 (37.24±7.31) years old, and 52 healthy controls, including 40 males and 12 females aged 18-59 (40.3±9.1) years were collected prospectively from August 2017 to December 2018. The differences of DTI indicators between the two groups were compared by tract-based spatial statistics (TBSS), and then the correlation between the different indicators and the age of first MA use, time of MA use, daily dose used, BIS-11 score were performed.

There were significant differences in BIS total score(P<0.001), BIS motivational impulsivity(P<0.001) and BIS attentional impulsivity(P=0.003) between MA group and healthy control group in short-term withdrawal. And compared with the healthy control group, the fractional anisotropy (FA) (0.58±0.02 vs 0.56±0.02,0.77±0.02 vs 0.75±0.04,0.79±0.04 vs 0.76±0.06; all P<0.05), axial diffusivity (AD) (0.57±0.01 vs 0.56±0.02,P=0.001) and mean diffusivity (MD) (0.66±0.02 vs 0.65±0.02,0.52±0.07 vs 0.51±0.06; both P<0.05)values in the MA group were all increased (P<0.05), but there was no significant difference in the radial diffusivity (RD) value (P>0.05). The white matter areas with increased FA value were located in the knee and body of corpus callosum, bilateral anterior corona radiata and left superior corona radiata; the areas with increased AD value were located in the knee, body and pressure of corpus callosum, bilateral anterior limb of internal capsule, posterior limb of internal capsule, anterior, superior and posterior corona radiata, external capsule and superior longitudinal fasciculus; and the areas with increased MD value were mainly located in the right superior longitudinal fasciculus, anterior and posterior limb of internal capsule. The corpus callosum, where there was a difference in FA between the two groups, was positively correlated with the daily dose of MA (r=0.301, P=0.026).

MA addicted individuals with short-term withdrawal have white matter edema and damage, and the degree of corpus callosum damage is positively correlated with the daily dose of MA,which is helpful to understand the pathophysiological process of white matter damage in the nervous system and the potential mechanism of neuropsychiatric symptoms in short-term withdrawal MA addicted individuals.

To analyze the correlation of muscle strength with cognitive function and medial temporal lobe atrophy (MTA) in patients with mild to moderate Alzheimer′s disease (AD).

General information, sarcopenia-related indicators, neuropsychological tests and MTA score were collected in 80 confirmed AD patients (41 mild and 39 moderate patients) and 43 normal controls (NC) from the Memory Disorders Clinic of Department Of Neurology in the Second Affiliated Hospital of Soochow University between January and December 2021. Appendicular skeletal muscle mass index (ASMI), grip strength and 5-times sit-to-stand time and 6-m gait speed were used for assessing muscle mass, muscle strength and physical function, respectively. Cognitive function was assessed by Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment scale (MoCA), Memory and Executive Screening Scale (MES), Digit Symbol Substitution Test (DSST), Digital Span Test (DST) and Verbal Fluency Task (VFT), respectively. DST included Forward Digit Span Test (FDST) and Backward Digit Span Test (BDST). All the subjects underwent 3.0T coronal three-dimensional gradient echo sequence MRI. MTA scale was performed to evaluate the degree of medial temporal lobe atrophy. The differences in the sarcopenia-related indicators, cognitive score and MTA score were analyzed among the three groups, and the partial correlation analysis was performed between the inter-groups.

Eighty AD patients (24 males and 56 females) were included, aged (72±7) years old, with 41 mild and 39 moderate patients. Meanwhile, 43 NC included 19 males and 24 females, with a mean age of (70±6) years old. The disease duration in moderate AD patients was longer than that of mild AD patients [34.0 (25.0, 43.5) months vs 24.0 (11.0, 34.0) months, P<0.001]. The differences of sarcopenia-related indicators and MTA score among the three groups were statistically significant (allP<0.001), including 5-times sit-to-stand time [(13.6±1.8) s vs (11.5±1.7) s vs (10.3±1.9) s,P<0.001] and MTA score [2.0 (2.0, 3.0) vs 1.0 (1.0, 2.0) vs 0 (0, 0),P<0.001]. In neuropsychological tests, compared to the NC group, MMSE, MoCA, MES and VFT scores in mild and moderate AD groups were lower (allP<0.001); meanwhile, compared to the mild AD group, the moderate group had lower MMSE, MoCA, MES, DSST and VFT scores (allP<0.001). In sarcopenia-related indicators, muscle strength in particular was correlated with widespread cognitive functioning domains and MTA score in AD patients. Grip strength was positively correlated with MMSE, MoCA , MES, FDST (r=0.387, 0.418, 0.522 and 0.484, respectively, all P<0.001), DSST (r=0.327, P=0.006) and VFT score (r=0.354, P=0.003), and negatively correlated with MTA score (r=-0.631, P<0.001). 5-times sit-to-stand time was negatively correlated with MMSE, MoCA, MES, DSST, FDST, VFT score (r=-0.583, -0.587, -0.814, -0.591, -0.552 and -0.485, respectively, all P<0.001), and BDST (r=-0.355, P=0.003) strongly positively correlated with MTA score (r=0.836, P<0.001). ASMI was positively correlated with MMSE, MoCA, MES, DSST, FDST score (r=0.257, 0.238, 0.428, 0.282 and 0.364, respectively, all P<0.05), and negatively correlated with MTA score (r=-0.377, P=0.001). 6-m gait speed was positively correlated with MMSE, MoCA, MES, DSST, FDST score (r=0.419, 0.486, 0.699, 0.559 and 0.500, respectively, all P<0.001), BDST and VFT score (r=0.384、0.377, respectively, both P=0.001), and strongly negatively correlated with MTA score (r=-0.803, P<0.001).

Patients with mild to moderate AD have widespread cognitive impairment. Muscle mass, muscle strength and physical function are all significantly impaired. Compared to muscle mass and physical function, decreased muscle strength is significantly associated with widespread cognitive decline and increased degree of medial temporal lobe atrophy.

To evaluate the safety and clinical efficacy of bilateral percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral burst fractures.

It was a prospective study, 28 patients with osteoporotic thoraco-lumbar burst fractures who were treated in Beijing Chao-Yang Hospital from January 2021 to July 2021 were included, including 10 males and 18 females, with a median age of 73.6 years (range: 56.0-87.0 years). The X-ray radiographs, bone mineral density (BMD), CT three-dimensional reconstruction scan and MRI were taken and measured before operation to observe the fracture location and the posterior wall of the vertebral body, and further to determine the diagnosis. The X-ray radiographs and CT three-dimensional reconstruction scans were taken on the first day after operation and the last follow-up to observe whether there were bone cement leakage or not. The changes of kyphosis angle (KA), the height of anterior wall (HAW) and the height of posterior wall (HPW) before the operation, on the 1st day post operation and at the last follow-up were recorded. The visual analogue scale (VAS) of back pain and Oswestry dysfunction index (ODI) before the operation, 1 day post operation and at the last follow-up were used to evaluate the clinical effect of the operation.

All the patients were followed up for (12.2±6.0) months. The HAW on the 1st day post operation [(22.5±2.0) mm] was significantly increased as compared with that before the operation [(21.2±2.4) mm] (P<0.05). The HAW at the last follow-up [(18.9±1.6) mm] decreased signficantly as compared with that on the 1st day post opertion [(22.5±2.0) mm] (P<0.05). The HPW was also significantly corrected after surgery (P<0.05). At the end of the follow-up, the HPW [(27.2±1.3) mm] was comparable with that on the 1st day after surgery [(27.5±1.6) mm] (P>0.05). The KA on the 1st day after the operation (14.2°±1.5°) decreased significantly when compared with that before the operation (18.8°±1.3°) (P<0.05), but it was increased to 17.6°±1.4° at the last follow-up and was higher than that on the 1st day after the operation (P<0.05). There were bone cement leakage in 5 cases and adjacent vertebral fracture in 1 case. The VAS and ODI scores were all significantly lower on the 1st day and at last follow-up than that before the operation (allP<0.05).

Bilateral PKP is effective, safe and reliable in the treatment of osteoporotic vertebral burst fracture. Careful evaluation of preoperative imaging data, accurate puncture and timing of bone cement injection are the key factors to ensure the success of the operation.

To explore the influencing factors of health-related quality of life (HRQoL) in patients with knee osteoarthritis, and to analyze the non-surgical treatment of knee osteoarthritis.

Demographic variables, treatment modalities, imaging data, and 12-item short form health survey (SF-12) scores of patients with knee osteoarthritis in orthopedic outpatient departments of five hospitals in Beijing from December 2017 to November 2018 were collected to analyze influencing factors of HRQoL and non-surgical treatment.

A total of 2 034 patients were included. There were 530 males (26.1%) and 1 504 females (73.9%), with a mean age of (59.17±10.22) years. In terms of physical quality of life, female patients with knee osteoarthritis had lower physical components summary (PCS) compared with male patients (β=-0.521, P=0.036); patients aged ≥64 years had lower PCS than those aged<55 years (β=-0.636,P=0.026). Patients with an education of more than 12 years had higher PCS than those with less than 10 years (β=1.063, P<0.001). Compared to patients with mild clinical symptoms, the PCS of patients with moderate clinical symptoms was lower (β=-0.860,P=0.002), while the PCS of those with severe clinical symptoms was much lower (β=-1.126, P<0.001). Patients treated with combination therapy had higher PCS than untreated patients (β=0.731,P=0.005). In terms of mental quality of life, compared to patients engaged in sedentary work, the mental components summary (MCS) of patients engaged in mild manual labor jobs was lower (β=-0.712, P=0.015); Compared to patients with a Charson comorbidity index of 0, patients with a Charlson comorbidity index ≥ 2 had lower MCS (β=-1.183, P=0.007). In the past 12 months, 648 (31.9%), 143 (7.0%), 406 (20.0%), 680 (33.4%), 343 (16.9%), 681 (33.5%), 170 (8.4%) patients had used non-steroid anti-inflammatory drugs (NSAIDs), acetaminophen, glucosamine/chondroitin formulations, physical therapy, articular cavity puncture injection, traditional Chinese medicine treatment and exercise therapy, respectively. Total of 451 patients (22.2%) received monotherapy and 889 patients (43.7%) received combination therapy.

The major non-surgical treatment methods for patients with knee osteoarthritis in Beijing are NSAIDs, physiotherapy and traditional Chinese medicine. Combination therapy is used more frequently than monotherapy. Physical quality of life is related to gender, age, education, severity of symptoms and treatment, while mental quality of life is related to occupational labor and comorbidities.

Child 1, male, 11 years old, was diagnosed with acute B lymphocytic leukemia with positive TCF3-HLF fusion gene because of weakness of limbs with ecchymosis in both lower limbs without obvious inducement, which did not fade after compression. Child 2, male, 15 years old, was diagnosed with acute B lymphocytic leukemia and positive BCR-ABL1 (P210) fusion gene with obvious bilateral hip pain and limited movement without obvious trigger. All of them were in the high-risk group. Two children received sequential chemotherapy under the CCLG-ALL-2008 protocol for acute lymphoblastic leukemia (CCLG-ALL-2008 protocol) without negative minimal residual (MRD) or gene quantification. After one course of belintoumab treatment, MRD and gene quantification turned negative, and received allogeneic hematopoietic stem cell transplantation within 1 month after the end of treatment. Acute graft-versus-host disease occurred in both children after operation, which was relieved after symptomatic treatment. At present, the MRD and gene quantification of the children were negative on regular re-examination, and their condition was stable.

Entropy, an originally thermodynamic concept was introduced into functional magnetic resonance imaging (fMRI) to measure regularity and unpredictability on time scales. There is a negative spatiotemporal linear correlation between time domain functional entropy and functional connection, which is considered to be an important index of brain information processing ability, and can provide information that regional perfusion and low frequency fluctuation amplitude cannot provide. As a basic feature of brain functional signals, the time-domain functional entropy of fMRI has been used to reveal physiological and pathological states such as consciousness and aging (such as Alzheimer's disease, schizophrenia, major depression, autism spectrum disorder, addiction and multiple sclerosis), which provides a new sharp tool for understanding brain diseases. This article describes the advantages and limitations, physiological basis and significance, clinical application and future direction of fMRI time domain functional entropy and its analysis technology, in order to provide help for colleagues in related professional fields to further understand functional entropy.

The treatment of addictive diseases is a global health problem, which can be broadly divided into two categories: substance addiction and behavioral addiction. Compared with substance addiction, behavioral addiction is not regulated by other factors such as drugs, so it can be used as a very reliable research model on addiction. In recent years, the progress of medical imaging examination technology and the deepening of neuroimaging research on addiction have provided a brand-new understanding for the scientific research, clinical treatment and intervention of behavioral addiction, as well as the exploration and research of the mechanism of occurrence and development of behavioral addiction. Taking gambling disorder and online gaming disorder as examples, this paper summarizes the progress of imaging research on brain structure, function and metabolic changes in behavioral addiction patients at home and abroad, in order to provide objective basis for clinical research, diagnosis and treatment.

Although a large amount of evidence has confirmed that microglia and astrocytes have been found to play a crucial role in the occurrence and maintenance of persistent pain in animal model experiments, the role of glial cells in human pain disorders is still unknown. To this end, a new technique of positron emission tomography-magnetic resonance imaging (PET/MRI) and a recently developed radioligand (11) C-PBR28 were used to investigate, and the results showed elevated levels of transporter (TSPO), one of the markers of glial cell activation, in the brain of patients with chronic low back pain. Given that the polymorphism of Ala147Thr in the TSPO genotype affects the binding affinity to (11) C-PBR28, the authors of this study screened nine pairs of diseased groups and controls from a larger sample of subjects and compared them using a paired design. Each patient corresponded to a control group with TSPO gene polymorphism, age and sex matching (there were 7 Ala/Ala genotypes and 2 Ala/Thr genotypes, each group included 5 males and 4 females; median age difference: 1 year; age range: 29 to 63 years in the patient group and 28 to 65 years in the control group). The patient group had significantly higher standardized uptake values for multiple brain regions, including the thalamus and the presumed lumbar spine and leg somatosensory regions, compared with the control group, taking the whole brain as the standard. As predicted by animal studies, TSPO levels in the thalamus are inversely correlated with clinical pain and circulating levels of the pro-inflammatory cytokine interleukin-6, further demonstrating that TSPO expression plays a pain protective/anti-inflammatory role in humans. Due to the putative role of activated glial cells in the generation and/or maintenance of persistent pain, the present findings have important clinical implications and may help guide future pathophysiological studies of various persistent pain and pain management.

Alcohol use disorder (AUD) is a very common, refractory medical condition. Symptoms of AUD are caused by dysfunction of several neural circuits centered on the nucleus accumbens (NAc). Case reports and animal studies suggest that deep nucleus accumbens brain stimulation (NAc-DBS) treatment may be an effective harm reduction treatment for severe AUD. Six patients with severe refractory AUD received NAc-DBS, and safety measures and clinical results were recorded. Glucose metabolism in NAc was measured using positron emission tomography (FDG-PET) at baseline and at 6 months. Functional magnetic resonance imaging (fMRI) was used to characterize postoperative changes in functional connectivity of NAc to the rest of the brain, as well as the responsiveness of NAc and dorsal striatum to alcohol visual cues. The study is registered with ClinicalTrials.gov (NCT03660124). The degree of craving was reduced in all patients. Alcohol consumption, alcohol-related compulsions, and anxiety were significantly reduced at 12 months. There was no significant change in depression. FDG-PET analysis showed a decrease in NAc metabolism after 6 months, which was associated with an improvement in compulsive drinking behavior. Clinical improvement was associated with reduced functional connectivity between NAc and the visual symphysis cortex. Active deep brain stimulation (DBS) is associated with reduced activation of the dorsal striatum during passive viewing of alcohol-containing pictures. NAc-DBS is feasible and safe in patients with severe refractory AUD. It has been linked to a decrease in appetite and addictive behavior. The underlying mechanisms of this process are down-regulation of NAc, disruption of its functional connectivity to the visual symphyseal cortex, and interference with cue-evoked dorsal striatal reactivity.