Cytoarchitectonic mapping of the human frontal operculum-New correlates for a variety of brain functions.

The human frontal operculum (FOp) is a brain region that covers parts of the ventral frontal cortex next to the insula. Functional imaging studies showed activations in this region in tasks related to language, somatosensory, and cognitive functions. While the precise cytoarchitectonic areas that correlate to these processes have not yet been revealed, earlier receptorarchitectonic analysis resulted in a detailed parcellation of the FOp. We complemented this analysis by a cytoarchitectonic study of a sample of ten postmortem brains and mapped the posterior FOp in serial, cell-body stained histological sections using image analysis and multivariate statistics. Three new areas were identified: Op5 represents the most posterior area, followed by Op6 and the most anterior region Op7. Areas Op5-Op7 approach the insula, up to the circular sulcus. Area 44 of Broca's region, the most ventral part of premotor area 6, and parts of the parietal operculum are dorso-laterally adjacent to Op5-Op7. The areas did not show any interhemispheric or sex differences. Three-dimensional probability maps and a maximum probability map were generated in stereotaxic space, and then used, in a first proof-of-concept-study, for functional decoding and analysis of structural and functional connectivity. Functional decoding revealed different profiles of cytoarchitectonically identified Op5-Op7. While left Op6 was active in music cognition, right Op5 was involved in chewing/swallowing and sexual processing. Both areas showed activation during the exercise of isometric force in muscles. An involvement in the coordination of flexion/extension could be shown for the right Op6. Meta-analytic connectivity modeling revealed various functional connections of the FOp areas within motor and somatosensory networks, with the most evident connection with the music/language network for Op6 left. The new cytoarchitectonic maps are part of Julich-Brain, and publicly available to serve as a basis for future analyses of structural-functional relationships in this region.

[Adjustment Disorder, Depression, Stress Symptoms, Corona Related Anxieties and Coping Strategies during the Corona Pandemic (COVID-19) in Swiss Medical Staff]. / Anpassungsstörung, Depression, Stresssymptome, Corona bezogene Sorgen und Bewältigungsstrategien während der Corona Pandemie (COVID-19) bei Schweizer Klinikpersonal.

BACKGROUND: International studies point to increased mental health problems of medical staff during the Corona pandemic (COVID-19). This is the first study to investigate mental health, i. e. adjustment disorder, depression, stress symptoms, Corona related fears as well as coping mechanisms in this group in a German-speaking country. MATERIAL AND METHODS: In April 2020, N=100 subjects were recruited that currently are engaged in a hospital. A series of standardized assessments were included: adjustment disorder (ADNM-20), depression (PHQ-9), stress symptoms and coping strategies (SCI). Currently, cross-sectional data are analyzed, because the study is still going on and longitudinal data is not yet assessed. RESULTS: Frequencies of adjustment disorder and depression are 8 and 15%, respectively. Two hierarchical regression models were run to predict adjustment disorder and depression; predictive power was higher for the first (41 vs. 35%). Fear of infection was reported to be higher regarding one's family than oneself. Nursing staff, those with preloads, and women were found to report more mental health problems. Those with direct contact to people that fell ill with COVID-19 did not differ from those with no direct contact. DISCUSSION: Currently, medical staff has a high risk for being mentally stressed. China, being epidemically experienced, has published principles for psychiatric interventions in January 2020. This might be relevant for Switzerland, too. Specific psychotherapeutic interventions, targeting at cognitive restructuring and sensitizing regarding dealing with alcohol and cigarettes, may be needed in order to protect this vulnerable group of person during and after the Corona pandemic.

Electroconvulsive therapy can benefit from controlled hyperventilation using a laryngeal mask.

Hypocapnia through hyperventilation is a well-known procedure in electroconvulsive therapy (ECT) to enhance seizure activity. However, it has mostly been applied in an uncontrolled manner. Originally intended for a better management of the supraglottic airway, laryngeal masks are more suited to monitor levels of CO(2) during hyperventilation than face masks and thereby provide for the possibility of controlled hyperventilation (CHV). The impact of CHV was retrospectively studied in 114 consecutive patients; 65 of them had received ECT with CHV and 49 had received ECT with uncontrolled hyperventilation (UHV) directly prior to the time period when the laryneal mask was introduced to the ECT treatment procedure. The CO(2) level in the CHV group was aimed at 30 mmHg or below. CHV considerably enhanced the seizure activity leading to changes in clinically determined parameters of the treatment course: the necessity for increasing the electric charge, for re-stimulations (trend) and for bilateral stimulations was lower in the CHV group as compared to the UHV group. The improvement in the Global Assessment of Functioning Scores was not different in both groups. CHV was associated with a higher amount of prolonged seizures, with a reduced number of delirious symptoms after treatments and an attenuating effect on heart rate. Concluding, CHV can help to maintain the applied electric charge low without worsening the clinical outcome. Therefore, it is a helpful technical improvement. However, it should be used carefully with regard to prolonged seizures.