Brain and autonomic association accompanying stochastic decision-making.

To examine the functional association between brain and autonomic activities accompanying decision-making, we simultaneously recorded regional cerebral blood flow using (15)O-water positron emission tomography and event-related brain potentials (ERPs) time-locked to feedback of reward and punishment, as well as cardiovascular parameters, during a stochastic decision-making task. We manipulated the uncertainty of outcomes in the task; specifically, we compared a condition with high predictability of reward/punishment (contingent-reward condition) and a condition with low predictability of reward/punishment (random-reward condition). The anterior cingulate cortex (ACC) was commonly activated in both conditions. Compared with the contingent-reward condition, the orbitofrontal and right dorsolateral prefrontal cortices and dorsal striatum were activated in the random-reward condition, where subjects had to continue to seek contingency between stimuli and reward/punishment. Activation of these brain regions correlated with a positive component of ERPs locked to feedback signals (feedback-related positivity), which showed an association with behavioral decision-making in the contingent-reward condition. Furthermore, cardiovascular responses were attenuated in the random-reward condition, where continuous attention and contingency monitoring were needed, and such attenuation of cardiovascular responses was mediated by vagal activity that was governed by the rostral ACC. These findings suggest that the prefrontal-striatal network provides a neural basis for decision-making and modulation over the peripheral autonomic activity accompanying decision-making.

Regulation of natural killer cell redistribution by prefrontal cortex during stochastic learning.

Acute stress elicits redistribution of lymphocyte subsets, especially natural killer (NK) cells, probably for preparatory defense against potential invasion of antigens in fight-flight situations. We previously reported that regulation of lymphocyte redistribution is based on the evaluation of the controllability of a stressor (Kimura, K., Ohira, H., Isowa, T., Matsunaga, M., Murashima, S. 2007. Regulation of lymphocytes redistribution via autonomic nervous activity during stochastic learning. Brain Behav. Immun. 21, 921-934; Ohira, H., Isowa, T., Nomura, M., Ichikawa, N., Kimura, K., Miyakoshi, M., Iidaka, T., Fukuyama, S., Nakajima, T., Yamada, J. 2008. Imaging brain and immune association accompanying cognitive appraisal of an acute stressor. Neuroimage 39, 500-514). Specifially, lymphocyte redistribution is somewhat attenuated when a stressor is uncontrollable, probably to save biological energy in a situation where appropriate coping is unclear. We infer that this phenomenon might reflect top-down regulation over peripheral immune function by higher-ordered brain regions. To investigate the neural basis of such a phenomenon, we simultaneously recorded regional cerebral blood flow using (15)O-water positron emission tomography and cardiovascular (blood pressure and heart rate), neuroendocrine (epinephrine, norepinephrine, and adrenocorticotropic hormone), and immune (proportions of NK cells and helper T cells in blood) indices in 16 male subjects who performed a stochastic learning task with manipulation of controllability (controllable vs. uncontrollable). Consistent with previous studies, the proportion of peripheral NK cells was attenuated in an uncontrollable stress condition. The dorsolateral prefrontal and orbitofrontal cortices were activated in the uncontrollable situation but not in the controllable condition, and additionally, these prefrontal brain regions significantly correlated with the degree of redistribution of NK cells in the uncontrollable condition. The results of the study suggest these brain regions are involved in both evaluation of the controllability of a stressor and regulation of immune function.

Polymorphism of the serotonin transporter gene modulates brain and physiological responses to acute stress in Japanese men.

A short (S) variant, compared to a long (L) variant, of the promoter region of the serotonin transporter gene-linked polymorphic region (5HTTLPR) has been related to emotional hyper-reactivity. We tested whether the 5HTTLPR could modulate acute stress responses in the brain and, the cardiovascular and neuroendocrine systems. Ten Japanese male participants carrying double copies of the S alleles and 10 Japanese males carrying S and L alleles conducted a mental arithmetic task, and their regional cerebral blood flow by (15)O positron emission tomography and cardiovascular and neuroendocrine parameters were measured. During the acute stress task, the participants with the SS alleles showed stronger reactivity in blood pressure and secretion of epinephrine, compared to the participants with the SL and LL alleles. Furthermore, the SS carriers showed greater activation in stress-related brain regions such as the hypothalamus, cerebellum, midbrain, and pulvinar compared to the SL and LL carriers during the acute stress task. The present findings indicated that the S allele of the 5HTTLPR is associated with greater brain and physiological reactivity to acute stress in Japanese men.

Associations among central nervous, endocrine, and immune activities when positive emotions are elicited by looking at a favorite person.

Recent studies on psychoneuroimmunology have indicated that positive psychological events are related to immune functions; however, limited information is available regarding associations among the central nervous, endocrine, and immune systems when positive emotions are elicited. In the present study, we demonstrated associations among these systems by simultaneously recording brain, endocrine, and immune activities when positive emotions were evoked in participants as they watched films featuring their favorite persons. Interestingly, the activity of peripheral circulating natural killer cells and the peripheral dopamine level were elevated while participants experienced positive emotions, and these values were positively correlated. The following brain regions were significantly activated in the positive condition relative to the control condition: medial prefrontal cortex, thalamus, hypothalamus, subcallosal gyrus, posterior cingulate cortex, superior temporal gyrus, and cerebellum. Further, covariate analyses indicated that these brain regions were temporally associated with endocrine and immune activities. These results suggest that while an individual experiences positive emotions, the central nervous, endocrine, and immune systems may be interrelated and attraction for favorite persons may be associated with the activation of the innate immune function via the dopaminergic system.

Genetic variations in the human cannabinoid receptor gene are associated with happiness.

Happiness has been viewed as a temporary emotional state (e.g., pleasure) and a relatively stable state of being happy (subjective happiness level). As previous studies demonstrated that individuals with high subjective happiness level rated their current affective states more positively when they experience positive events, these two aspects of happiness are interrelated. According to a recent neuroimaging study, the cytosine to thymine single-nucleotide polymorphism of the human cannabinoid receptor 1 gene is associated with sensitivity to positive emotional stimuli. Thus, we hypothesized that our genetic traits, such as the human cannabinoid receptor 1 genotypes, are closely related to the two aspects of happiness. In Experiment 1, 198 healthy volunteers were used to compare the subjective happiness level between cytosine allele carriers and thymine-thymine carriers of the human cannabinoid receptor 1 gene. In Experiment 2, we used positron emission tomography with 20 healthy participants to compare the brain responses to positive emotional stimuli of cytosine allele carriers to that of thymine-thymine carriers. Compared to thymine-thymine carriers, cytosine allele carriers have a higher subjective happiness level. Regression analysis indicated that the cytosine allele is significantly associated with subjective happiness level. The positive mood after watching a positive film was significantly higher for the cytosine allele carriers compared to the thymine-thymine carriers. Positive emotion-related brain region such as the medial prefrontal cortex was significantly activated when the cytosine allele carriers watched the positive film compared to the thymine-thymine carriers. Thus, the human cannabinoid receptor 1 genotypes are closely related to two aspects of happiness. Compared to thymine-thymine carriers, the cytosine allele carriers of the human cannabinoid receptor 1 gene, who are sensitive to positive emotional stimuli, exhibited greater magnitude positive emotions when they experienced positive events and had a higher subjective happiness level.

Neural and sympathetic activity associated with exploration in decision-making: further evidence for involvement of insula.

We previously reported that sympathetic activity was associated with exploration in decision-making indexed by entropy, which is a concept in information theory and indexes randomness of choices or the degree of deviation from sticking to recent experiences of gains and losses, and that activation of the anterior insula mediated this association. The current study aims to replicate and to expand these findings in a situation where contingency between options and outcomes is manipulated. Sixteen participants performed a stochastic decision-making task in which we manipulated a condition with low uncertainty of gain/loss (contingent-reward condition) and a condition with high uncertainty of gain/loss (random-reward condition). Regional cerebral blood flow was measured by (15)O-water positron emission tomography (PET), and cardiovascular parameters and catecholamine in the peripheral blood were measured, during the task. In the contingent-reward condition, norepinephrine as an index of sympathetic activity was positively correlated with entropy indicating exploration in decision-making. Norepinephrine was negatively correlated with neural activity in the right posterior insula, rostral anterior cingulate cortex, and dorsal pons, suggesting neural bases for detecting changes of bodily states. Furthermore, right anterior insular activity was negatively correlated with entropy, suggesting influences on exploration in decision-making. By contrast, in the random-reward condition, entropy correlated with activity in the dorsolateral prefrontal and parietal cortices but not with sympathetic activity. These findings suggest that influences of sympathetic activity on exploration in decision-making and its underlying neural mechanisms might be dependent on the degree of uncertainty of situations.

Hypofractionated high-dose irradiation with positron emission tomography data for the treatment of glioblastoma multiforme.

This research paper presents clinical outcomes of hypofractionated high-dose irradiation by intensity-modulated radiation therapy (Hypo-IMRT) with (11)C-methionine positron emission tomography (MET-PET) data for the treatment of glioblastoma multiforme (GBM). A total of 45 patients with GBM were treated with Hypo-IMRT after surgery. Gross tumor volume (GTV) was defined as the area of enhanced lesion on MRI, including MET-PET avid region; clinical target volume (CTV) was the area with 5 mm margin surrounding the GTV; planning target volume (PTV) was the area with 15 mm margin surrounding the CTV, including MET-PET moderate region. Hypo-IMRT was performed in 8 fractions; planning the dose for GTV was escalated to 68 Gy and that for CTV was escalated to 56 Gy, while keeping the dose delivered to the PTV at 40 Gy. Concomitant and adjuvant TMZ chemotherapy was administered. At a median follow-up of 18.7 months, median overall survival (OS) was 20.0 months, and median progression-free survival was 13.0 months. The 1- and 2-year OS rates were 71.2% and 26.3%, respectively. Adjuvant TMZ chemotherapy was significantly predictive of OS on multivariate analysis. Late toxicity included 7 cases of Grade 3-4 radiation necrosis. Hypo-IMRT with MET-PET data appeared to result in favorable survival outcomes for patients with GBM.

Re-irradiation of recurrent glioblastoma multiforme using 11C-methionine PET/CT/MRI image fusion for hypofractionated stereotactic radiotherapy by intensity modulated radiation therapy.

BACKGROUND: This research paper presents a valid treatment strategy for recurrent glioblastoma multiforme (GBM) using hypofractionated stereotactic radiotherapy by intensity modulated radiation therapy (HS-IMRT) planned with 11C-methionine positron emission tomography (MET-PET)/computed tomography (CT)/magnetic resonance imaging (MRI) fusion. METHODS: Twenty-one patients with recurrent GBM received HS-IMRT planned by MET-PET/CT/MRI. The region of increased amino acid tracer uptake on MET-PET was defined as the gross tumor volume (GTV). The planning target volume encompassed the GTV by a 3-mm margin. Treatment was performed with a total dose of 25- to 35-Gy, given as 5- to 7-Gy daily for 5 days. RESULTS: With a median follow-up of 12 months, median overall survival time (OS) was 11 months from the start of HS-IMRT, with a 6-month and 1-year survival rate of 71.4% and 38.1%, respectively. Karnofsky performance status was a significant prognostic factor of OS as tested by univariate and multivariate analysis. Re-operation rate was 4.8% for radiation necrosis. No other acute or late toxicity Grade 3 or higher was observed. CONCLUSIONS: This is the first prospective study of biologic imaging optimized HS-IMRT in recurrent GBM. HS-IMRT with PET data seems to be well tolerated and resulted in a median survival time of 11 months after HS-IMRT.

Vagal nerve activity as a moderator of brain-immune relationships.

We investigated whether vagal tone, as assessed by heart rate variability (HRV), moderates the neural correlates of immune and physiological responses to acute stress. Participants with low and high baseline HRV underwent a reversal learning task as an acute stressor. Natural killer cells, norepinephrine, and adrenocorticotropic hormone in peripheral blood changed with acute stress in the high HRV group only. Activity in the prefrontal cortex and striatum correlated with the immune and physiological indices in the high HRV group. High vagal tone may reflect more flexible top-down brain regulation of immune and physiological activity.

Brain-immune interaction accompanying odor-evoked autobiographic memory.

The phenomenon in which a certain smell evokes a specific memory is known as the Proust phenomenon. Odor-evoked autobiographic memories are more emotional than those elicited by other sensory stimuli. The results of our previous study indicated that odor-evoked autobiographic memory accompanied by positive emotions has remarkable effects on various psychological and physiological activities, including the secretion of cytokines, which are immune-signaling molecules that modulate systemic inflammation. In this study, we aimed to clarify the neural substrates associated with the interaction between odor-evoked autobiographic memory and peripheral circulating cytokines. We recruited healthy male and female volunteers and investigated the association between brain responses and the concentration of several cytokines in the plasma by using positron emission tomography (PET) recordings when an autographic memory was evoked in participants by asking them to smell an odor that was nostalgic to them. Participants experienced positive emotions and autobiographic memories when nostalgic odors were presented to them. The levels of peripheral proinflammatory cytokines, such as the tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ), were significantly reduced after experiencing odor-evoked autobiographic memory. Subtraction analysis of PET images indicated that the medial orbitofrontal cortex (mOFC) and precuneus/posterior cingulate cortex (PCC) were significantly activated during experiences of odor-evoked autobiographic memory. Furthermore, a correlation analysis indicated that activities of the mOFC and precuneus/PCC were negatively correlated with IFN-γ concentration. These results indicate that the neural networks including the precuneus/PCC and mOFC might regulate the secretion of peripheral proinflammatory cytokines during the experience of odor-evoked autobiographic memories accompanied with positive emotions.

The structure of mindful brain.

Mindfulness is currently attracting a great deal of attention as a psychotherapy technique. It is defined as bringing one's complete attention to the experiences occurring in the present moment in a nonjudgmental or accepting way. The Five Facet Mindfulness Questionnaire (FFMQ) was developed to assess individual differences in mindfulness states. The FFMQ is composed of five facets representing elements of mindfulness: non-reactivity to inner experience, non-judging, acting with awareness, describing, and observing. In the present study, we applied voxel-based morphometry to investigate the relationship between the brain structure and each facet as measured by the FFMQ. The results showed a positive association between the describing facet of mindfulness on the FFMQ and gray matter volume in the right anterior insula and the right amygdala. In conclusion, mindfulness was related with development in parts of the somatic marker circuit of the brain.

Amygdala dysfunction attenuates frustration-induced aggression in psychopathic individuals in a non-criminal population.

BACKGROUND: Individuals with psychopathy have an increased tendency toward certain types of aggression. We hypothesized that successful psychopaths, who have no criminal convictions but can be diagnosed with psychopathy in terms of personality characteristics, are skilled at regulating aggressive impulses, compared to incarcerated unsuccessful psychopaths. METHODS: In this block-designed functional magnetic resonance imaging (fMRI) study, we sought to clarify the neural mechanisms underlying differences in frustration-induced aggression as a function of psychopathy in non-criminal populations. Twenty male undergraduate students who completed a self-report psychopathy questionnaire were scanned while they completed a task in which they either could or could not punish other individuals who made unfair offers of monetary distribution. RESULTS: Individuals with high psychopathic tendencies were less likely to make a decision to inflict costly punishment on people proposing unfair offers. During this decision-making, psychopathy was associated with less amygdala activity in response to the unfairness of offers. Moreover, the amygdala dysfunction in psychopathic individuals was associated with reduced functional connectivity with dopaminergic-related areas, including the striatum, when punishment was available compared to when it was unavailable. LIMITATIONS: The possibility that levels of psychopathic traits in a regular population were milder than in incarcerated populations cannot be ruled out. CONCLUSIONS: The findings indicate that amygdala dysfunction underlies affective deficits of psychopathy. We propose that the insensitivity of the amygdala to the affective significance of social stimuli contributes to an increased risk of violation of social norms, but enhances the ability to attenuate impulses toward maladaptive aggression in successful psychopaths.

Impact of [11C]methionine positron emission tomography for target definition of glioblastoma multiforme in radiation therapy planning.

PURPOSE: The purpose of this work was to define the optimal margins for gadolinium-enhanced T(1)-weighted magnetic resonance imaging (Gd-MRI) and T(2)-weighted MRI (T(2)-MRI) for delineating target volumes in planning radiation therapy for postoperative patients with newly diagnosed glioblastoma multiforme (GBM) by comparison to carbon-11-labeled methionine positron emission tomography ([(11)C]MET-PET) findings. METHODS AND MATERIALS: Computed tomography (CT), MRI, and [(11)C]MET-PET were separately performed for radiation therapy planning for 32 patients newly diagnosed with GBM within 2 weeks after undergoing surgery. The extent of Gd-MRI (Gd-enhanced clinical target volume [CTV-Gd]) uptake and that of T(2)-MRI of the CTV (CTV-T(2)) were compared with the extent of [(11)C]MET-PET (CTV--[(11)C]MET-PET) uptake by using CT--MRI or CT--[(11)C]MET-PET fusion imaging. We defined CTV-Gd (x mm) and CTV-T(2) (x mm) as the x-mm margins (where x = 0, 2, 5, 10, and 20 mm) outside the CTV-Gd and the CTV-T(2), respectively. We evaluated the relationship between CTV-Gd (x mm) and CTV-- [(11)C]MET-PET and the relationship between CTV-T(2) (x mm) and CTV-- [(11)C]MET-PET. RESULTS: The sensitivity of CTV-Gd (20 mm) (86.4%) was significantly higher than that of the other CTV-Gd. The sensitivity of CTV-T(2) (20 mm) (96.4%) was significantly higher than that of the other CTV-T(2) (x = 0, 2, 5, 10 mm). The highest sensitivity and lowest specificity was found with CTV-T(2) (x = 20 mm). CONCLUSIONS: It is necessary to use a margin of at least 2 cm for CTV-T(2) for the initial target planning of radiation therapy. However, there is a limit to this setting in defining the optimal margin for Gd-MRI and T(2)-MRI for the precise delineation of target volumes in radiation therapy planning for postoperative patients with GBM.

Clinical value of [¹¹C]methionine PET for stereotactic radiation therapy with intensity modulated radiation therapy to metastatic brain tumors.

PURPOSE: This study investigated the clinical impact of (11)C-labeled methionine-positron emission tomography (MET-PET) for stereotactic radiation therapy with intensity modulated radiation therapy (SRT-IMRT) in metastatic brain tumors. METHODS AND MATERIALS: Forty-two metastatic brain tumors were examined. All tumors were treated with SRT-IMRT using a helical tomotherapy system. Gross tumor volume (GTV) was defined and drawn on the stereotactic magnetic resonance (MR) image, taking into account the respective contributions of MR imaging and MET-PET. Planning target volume (PTV) encompassed the GTV-PET plus a 2-mm margin. SRT-IMRT was performed, keeping the dose for PTV at 25-35 Gy in 5 fractions. The ratio of the mean value of MET uptake to the contralateral normal brain (L/N ratio) was plotted for the PTV prior to SRT-IMRT, at 3 months following SRT-IMRT, and at 6 months following SRT-IMRT. Tumor characteristic changes of MET uptake before and after SRT-IMRT were evaluated quantitatively, comparing them with MRI examination. RESULTS: Mean ± SD L/N ratios were 1.95 ± 0.83, 1.18 ± 0.21, and 1.12 ± 0.25 in the pre-SRT-IMRT group, in the 3 months post-SRT-IMRT group, and in the 6 months post-SRT-IMRT group, respectively. Differences in the mean L/N ratio between the pre-SRT-IMRT group and the 3-month post-SRT-IMRT group and between the pre-SRT-IMRT group and the 6 month post-SRT-IMRT group were statistically significant, irrespective of MRI examination. CONCLUSIONS: We showed examples of metastatic lesions demonstrating significant decreases in MET uptake following SRT-IMRT. MET-PET seems to have a potential role in providing additional information, although MRI remains the gold standard for diagnosis and follow-up after SRT-IMRT. The present study is a preliminary approach, but to more clearly define the impact of PET-based radiosurgical assessment, further experimental and clinical analyses are required.

Medial prefrontal cortex-dorsal anterior cingulate cortex connectivity during behavior selection without an objective correct answer.

Life choices (e.g., occupational choice) often include situations with two or more possible correct answers, thereby putting us in a situation of conflict. Recent reports have described that the evaluation of conflict might be crucially mediated by neural activity in the dorsal anterior cingulate cortex (dACC), although the reduction of conflict might rather be associated with neural activity in the medial prefrontal cortex (MPFC). What remains unclear is whether these regions mutually interact, thereby raising the question of their functional connectivity during conflict situations. Using psychophysiological interaction (PPI) analyses of functional magnetic resonance imaging (fMRI) data, this study shows that the dACC co-varied significantly higher with the MPFC during an occupational choice task with two possible correct answers when compared to the control task: a word-length task with one possible correct answer. These results suggest that the MPFC has a functional relation with dACC, especially in conflict situations where there is no objective correct answer. Taken together, this lends support to the assumption that the MPFC might be crucial in biasing the decision, thereby reducing conflict.

Genetic variations in the serotonin transporter gene-linked polymorphic region influence attraction for a favorite person and the associated interactions between the central nervous and immune systems.

Limbic system activation that occurs when a person experiences several emotions is primarily represented by the amygdala output that influences autonomic brainstem nuclei that control autonomic nervous function, thus modulating the endocrine and immune systems. Amygdala activity is modulated by the serotonin transporter gene-linked polymorphic region (5HTTLPR); however, whether variations in 5HTTLPR influence central nervous and immune activities in response to positive stimuli remains unclear. Here, we found that seeing a favorite person induced significantly higher amygdala activity in individuals with the 5HTTLPR SS genotype than in others. This activity was positively correlated with changes in the NK cell proportion among peripheral lymphocytes. Thus, 5HTTLPR influences attraction and the associated interactions between the central nervous and immune systems in affectively positive situations.

Neural bases of behavior selection without an objective correct answer.

Life choice (e.g. occupation choice) often includes situations with two or more possible answers. How does the brain respond to such conflict-ridden situations? We investigated whether the dorsal anterior cingulate cortex (dACC) evaluates the degree of conflict between possible answers. Additionally, we investigated whether the medial prefrontal cortex (MPFC) or the medial temporal lobe (MTL) has a function in behavior selection with plural possible answers. We used an occupational choice task (e.g. which occupation do you think you could do better?-dancer or chemist) with two possible answers and a word-length task (e.g. which word is longer?-dentist or comedian) that has a correct answer. The conflicts in each task were manipulated. Results showed that the dACC and the MTL were activated when the conflict during occupational choice was large, and that the MPFC and posterior cingulate cortex were activated more in the occupational choice task than in the word-length task. Our results show that the dACC evaluates the degree of conflict between possible answers, and that the MTL, MPFC, and posterior cingulate cortex have a function in behavior selection without an objective correct answer. It is thought that the MTL functions to reduce conflict when a large-conflict is detected in the dACC. Furthermore, the MPFC and posterior cingulate are thought to have a function of biasing any of the plural answers in behavior selection without an objective answer.

Associations among positive mood, brain, and cardiovascular activities in an affectively positive situation.

It is hypothesized that experiencing positive emotions such as pleasure leads to a perception of the body being in a positive state. This study demonstrated associations among positive mood, brain, and cardiovascular activities by simultaneously recording these activities when positive emotions were evoked in participants watching films revolving around a love story. Heart rate variability analysis revealed increased parasympathetic nervous activity while watching the film. The following brain regions were significantly activated in the positive condition relative to the control condition: medial prefrontal cortex, thalamus, superior temporal gyrus, inferior frontal gyrus, and cerebellum. Further, covariate analyses indicated that these brain regions were temporally associated with subjective positive mood. Activities of brain regions considered to be related to interoceptive awareness, such as the insular cortex, anterior cingulate cortex, amygdala, and orbitofrontal cortex, were also temporally associated with the cardiovascular change. These results suggest that while an individual experiences positive emotions, activities of the central nervous system and cardiovascular system may be interrelated, and the brain may perceive the body to be in a positive state.

Imaging brain and immune association accompanying cognitive appraisal of an acute stressor.

Acute stress elicits multiple responses in autonomic, endocrine, and immune systems. Cognitive appraisal is believed to be one important modulator of such stress responses. To investigate brain substrates of crosstalks between the homeostasis-maintaining systems accompanying appraisal of stressor controllability, we simultaneously recorded regional cerebral blood flow (rCBF) using 15O-water positron emission tomography, cardiovascular indices (heart rate (HR) and blood pressure (BP)), neuroendocrine indices (concentrations of epinephrine, norepinephrine, and adrenocorticotropic hormone (ACTH) in blood), and immune indices (proportions of subsets of lymphocytes (NK cells, helper T cells, cytotoxic T cells, and B cells) in blood), in 11 male subjects who performed a mental arithmetic task with either high controllability (HC) and low controllability (LC). The LC task resulted in less sense of control in subjects than the HC task. Significant increases of rCBF in the medial and lateral orbitofrontal cortices (OFC), and in the medial and lateral prefrontal cortices (MPFC, LPFC) were observed by subtracting the HC task from the LC task. More importantly, significant positive correlations between rCBF and HR, BP, and NK cells were commonly found in the OFC and MPFC during the LC tasks, but not during the HC tasks. The present results showed for the first time that the prefrontal neural network including the OFC and MPFC might be one pivotal region for bi-directional functional association between the brain and peripheral autonomic and immune activities accompanying appraisal of an acute stressor.

Simultaneous integrated boost technique by helical tomotherapy for the treatment of glioblastoma multiforme with 11C-methionine PET: report of three cases.

We performed hypofractionated high-dose irradiation of a patient's residual glioblastoma multiforme using a simultaneous integrated boost (SIB) technique with helical tomotherapy system (HT) planning. The gross tumor volume (GTV)-1 was defined as the area of intensive (11)C-methionine (MET) uptake and GTV-2 was defined as the area of moderate MET uptake. The planning target volume (PTV)-1 encompassed GTV-1 plus a 5 mm margin, and PTV-2 encompassed GTV-2 plus a 2 mm margin. SIB with HT was performed in eight fractions, planning the dose for GTV-1 at 68 Gy (biologically effective dose: BED = 126 Gy), PTV-1 at 56 Gy (BED = 95 Gy), and PTV-2 at 40 Gy (BED = 60 Gy). In each of the target areas, the uptake value on (11)C-methionine positron emission tomography (MET-PET) was considerably decreased following SIB, although no remarkable changes were demonstrated on magnetic resonance imaging (MRI). These cases demonstrate that SIB with HT planning using MET-PET offers excellent target coverage and uniformity. In addition, SIB with HT planning using MET-PET is organ sparing and MET-PET has great efficacy for monitoring treatment response after SIB. To more clearly define the impact of SIB with HT planning using MET-PET, further investigations are required.