Alterations of default mode and cingulo-opercular salience network and frontostriatal circuit: A candidate endophenotype of obsessive-compulsive disorder.

Background It is gradually becoming clear that obsessive-compulsive disorder (OCD) patients have aberrant resting-state large-scale intrinsic networks of cingulo-opercular salience (SN), default mode (DMN), and front-parietal network (FPN). However, it remains unknown whether unaffected first-degree relatives of OCD patients have these alterations as a vulnerability marker to the disorder. Methods We performed resting-state functional magnetic resonance imaging (rsfMRI) scans of 47 medication-free OCD patients, 21 unaffected healthy first-degree relatives of OCD patients, and 62 healthy control (HC) participants. We explored differences between the three groups in the functional connectivity from SN (seeds: anterior-insula (AI) and dorsal anterior cingulate cortex (dACC)), DMN (seeds: medial prefrontal cortex (MPFC) and posterior parietal cortex (PCC)), and FPN (seeds: dorsolateral prefrontal cortex (DLPFC)). Results Compared to HC, both OCD patients and first-degree relatives showed significantly greater functional connectivity between AI and PCC and between DLPFC and the thalamus. Compared to first-degree relatives and HC, OCD patients showed reduced functional connectivity between PCC and DLPFC, and this altered functional connectivity was negatively correlated with anxiety and depressive symptom within OCD group. Conclusions OCD patients and unaffected first-degree relatives of OCD patients showed overlapping alterations in resting state functional connectivity between the regions of SN and DMN and between DLPFC and the thalamus. Our results suggested that alterations between large-scale intrinsic networks and within the dorsal cognitive cortico-striato-thalamo-cortical (CSTC) circuit could represent endophenotype markers of OCD.

Increased functional connectivity between presupplementary motor area and inferior frontal gyrus associated with the ability of motor response inhibition in obsessive-compulsive disorder.

Recent evidence suggests that presupplementary motor area (pre-SMA) and inferior frontal gyrus (IFG) play an important role in response inhibition. However, no study has investigated the relationship between these brain networks at resting-state and response inhibition in obsessive-compulsive disorder (OCD). We performed resting-state functional magnetic resonance imaging scans and then measured the response inhibition of 41 medication-free OCD patients and 49 healthy control (HC) participants by using the stop-signal task outside the scanner. We explored the differences between OCD and HC groups in the functional connectivity of pre-SMA and IFG associated with the ability of motor response inhibition. OCD patients showed a longer stop-signal reaction time (SSRT). Compared to HC, OCD patients exhibit different associations between the ability of motor response inhibition and the functional connectivity between pre-SMA and IFG, inferior parietal lobule, dorsal anterior cingulate cortex, insula, and anterior prefrontal cortex. Additional analysis to investigate the functional connectivity difference from the seed ROIs to the whole brain voxels revealed that, compared to HC, OCD exhibited greater functional connectivity between pre-SMA and IFG. Also, this functional connectivity was positively correlated with the SSRT score. These results provide additional insight into the characteristics of the resting-state functional connectivity of the regions belonging to the cortico-striato-thalamo-cortical circuit and the cingulo-opercular salience network, underlying the impaired motor response inhibition of OCD. In particular, we emphasize the importance of altered functional connectivity between pre-SMA and IFG for the pathophysiology of motor response inhibition in OCD.

Effectiveness of therapeutic standard concentration barium enema for colonic diverticular bleeding: Preliminary results.

PURPOSE: To evaluate the effectiveness of a therapeutic barium enema as a treatment for colonic diverticulum bleeding, by using a standard concentration as a diagnostic examination. METHODS: We retrospectively analyzed 68 cases of the patients admitted to our hospital with colonic diverticular bleeding between October 2012 and September 2017. We evaluated the following items: (1) the presence/absence of a previous history of diverticular bleeding, (2) the use of medications (anticoagulants, nonsteroidal anti-inflammatory drugs, and antiplatelet drugs), (3) the location of bleeding, (4) the presence/absence of previous treatment and the result, (5) the time between bleeding and the beginning of the barium enema, (6) procedural success, (7) the clinical success of the initial hemostasis, (8) the clinical success of preventing recurrence, and (9) complications such as perforation and diverticulitis associated with this procedure. RESULTS: Four patients (three men and one woman; age range 60-85 years; median age 76 years) who underwent therapeutic barium enema with a concentration equivalent for diagnostic purpose (78 w/v%) were included. The follow-up period ranged from 11 to 12 months (median 12 months). All three patients who received a barium enema for initial hemostasis were successfully treated. All four patients remained free from recurrence during the follow-up period. There was no complication due to barium in this series. CONCLUSION: Although we had no statistical evidence, a therapeutic barium enema with a standard concentration as a diagnostic examination may be effective for both the initial hemostasis and preventing the recurrence of colonic diverticular bleeding without complications.