Study On The Brain Resting State Network Of Patients With Disorders Of Consciousness And The Reaction Of Resting State Network Induced By Acupuncturing At Hegu And Taichong

Objective:1.This paper focus on the characteristics of network related with consciousness which include default mode network functional connection,frontoparietal network functional connection and interaction between them in the patients with disorder of consciousness,and the characteristics of functional activities of whole brain resting state in patients with DOC were explored.2.Study the reaction effect induced by acupuncture in these network related with consciousness which include default mode network,frontoparietal network and the interaction between them.3.Explore the correlation between brain functional activity and scale.Methods:1.General methodIt was a case-control study.The patients were collected who suffered from disorder of consciousness caused by severe brain injury in Department of Neurosurgery ICU in Xuanwu hospital from July 2016 to February 2017.GCS and CRS-R scale were used to evaluate the state of consciousness on the day of MRI examination,the prognosis of the patients was evaluated by GOS scale after2 months.2.Data preprocessing methodUsing software SPM12 and DPABI,removing the first 10 time points,head motion correction,image normalization,image smoothing(6 mm full-width half-maximum isotropic Gaussian filter),bandpass frequency filter(0.01-0.1 Hz),the final step was covariate regression(white matter,cerebrospinal fluid,head motion and the whole brain signal).3.Resting state data analysis methodsTwo kinds of analysis methods of resting state data were used in this paper,hypothesis driven method and data driven method.The hypothesis driven method was used to analysis the functional connection in the resting state network,The PCC(MNI:-1,-49,31,r = 6mm)and dorsolateral prefrontal cortex(MNI:44,36,20,r = 6 mm)were as the seeds respectively.Based on the voxel level,Reho and DC were analyzed by data driven method.4.Statistical analysis methodIn this paper,variance analysis and two samples t test were used.The first step,mixed effects analysis of variance(2x2)was carried out,and the effect between groups,acupuncture effect and interaction effect were analyzed.Analysis of variance was performed by Gretna software.The second step,the double samples t test was performed.Based on the above results,the multiple comparison correction was performed(p value is 0.01 before correction,the cluster size is 5400 mm3,P value is 0.05 after adjusted).In addition,the Spearman correlation coefficient was used to evaluate the correlation between the scale and the brain functional activities.Results:1.General resultsIn this paper,8 cases of patients with disorders of consciousness were collected,including 7 cases of vegetative state and 1 case of coma.There are 4 males and 4 females,age from 39 to 82 years old.2.Functional activity results of brain resting state network in the patients with disorder of consciousness2.1 Default mode network functional connection resultsThe PCC was as the seed,the DMN functional connection network of each subject was obtained.Compared with the control group,the results showed that the PCC functional connection levels was significantly decreased in the patients group,and the function connectivity levels were also significantly decreased between the PCC and the medial prefrontal cortex,right hippocampus and bilateral temporal lobe.2.2 The functional connection results of the frontal parietal networkThe dorsolateral prefrontal cortex was as the seed point,the FPN functional connection was obtained each participant.Compared with the control group,the results showed that the dorsolateral prefrontal cortex functional connection levels was significantly decreased in the patients,and the function connectivity levels were also significantly decreased between the dorsolateral prefrontal cortex and left precuneus,left middle occipital gyrus,angular gyrus,supramarginal gyrus and so on.2.3 The interaction result between the default mode network and the frontal parietal networkThe PCC was as the seed,the interaction between DMN and FPN was obtained.Compared with the control group,the results showed that functional connection levels were significantly increased in the patients between the PCC and bilateral middle frontal gyrus,bilateral inferior parietal lobe,left inferior frontal gyrus,right paracentral gyrus and right middle temporal gyrus in the FPN.2.4 The whole brain functional activity results2.4.1 Functional connectivityThe PCC was as seed point and the whole brain functional connectivity mode was obtained.Some brain areas with significant differences of FC between the groups included medial prefrontal cortex,precuneus,posterior cingulate gyrus,bilateral middle frontal gyrus,left superior temporal gyrus,right angular gyrus,left inferior parietal lobe,right hippocampus and so on.2.4.2 Regional homogeneityBased on the voxel level,some brain areas with significant differences of Reho between the groups included the orbital gyrus,superior frontal gyrus,lingual gyrus,inferior frontal gyrus,medial frontal gyrus,angular gyrus,anterior cingulate cortex,supramarginal gyrus,inferior parietal lobule and so on.2.4.3 Degree centralityBased on the voxel level,some brain areas with significant differences of degree centrality between the groups included the superior frontal gyrus,orbital gyrus,precuneus,posterior cingulate gyrus,angular gyrus,supramarginal gyrus,middle frontal gyrus,inferior frontal gyrus,inferior parietal lobule and so on.2.5 Other network functional connection resultsCompared with the control group,the patient’s visual network,dorsal attention,ventral attention,somatosensory movement,the subcortical network and so on were significantly decreased in the functional connectivity.The functional connectivity were also decreased significantly between somatosensory movement and visual network,subcortical network and medial temporal lobe network.3.The reaction results of the brain resting state network functional activity induced by acupuncture3.1 The DMN functional connectionAfter acupuncture,compared with the control group,the functional connection strength was still decreased significantly between the PCC and precuneus,medial prefrontal cortex,bilateral angular gyrus,right hippocampus and so on which were included in the DMN in the patient group.Compared with the baseline level before acupuncture,after acupuncture,there was no significantly change of DMN functional connectivity which was already decreased.3.2 The frontoparietal network functional connectionAfter acupuncture,compared with the control group,the functional connection level was still decreased significantly between the dorsolateral prefrontal cortex and right medial superior frontal gyrus,left cingulate gyrus,left inferior parietal margin angular gyrus and so on in the patient group.Compared with the baseline level before acupuncture,after acupuncture,the functional connection increased significantly between the dorsolateral prefrontal cortex and superior temporal gyrus and cerebellum.3.3 The interaction between the DMN and FPNAfter acupuncture,compared with the control group,the functional connection level were still increased significantly between the PCC and bilateral middle frontal gyrus,right superior frontal gyrus,left insula,left supramarginal gyrus,bilateral inferior parietal lobe which were included in FPN in the patient group.Compared with the baseline level before acupuncture,after acupuncture,the functional connection level of FPN decreased significantly especially the right superior frontal gyrus and right supramarginal gyrus.3.4 The whole brain functional activity results3.4.1 Functional connectivityThe PCC was as the seed,there was no brain area which showed significant difference of functional connectivity between the two groups and acupuncture effect at the same time.For all the subjects,after the acupuncture,there were some brain areas showed significant changes of the functional connectivity,including the cerebellum,left middle temporal gyrus,left amygdala,left superior temporal gyrus,left fusiform gyrus and right supramarginal gyrus.3.4.2 Regional homogeneitySome brain areas showed significant difference of Reho between the two groups and acupuncture effect at the same time,which included the left cuneus,calcarine gyrus,inferior parietal lobule,angular gyrus,supramarginal gyrus,middle frontal gyrus,left precuneus and so on.Compared with the baseline,after the acupuncture,there were significant changes of Reho for all subjects in the following brain areas:medial frontal gyrus,lingual gyrus,insula,right middle frontal gyrus,superior frontal gyrus,cuneus,inferior parietal lobule and so on.3.4.3 Degree centralitySome brain areas showed significant difference of DC between the two groups and acupuncture effect at the same time,which included middle frontal gyrus,orbital gyrus,superior frontal gyrus,inferior frontal gyrus,cingulate gyrus and so on.Compared with baseline,the brain areas of all subjects showed significant changes in the DC after acupuncture:right cerebellum,lingual gyrus,inferior frontal gyrus,superior frontal gyrus and so on.3.5 Other network functional connectionCompared with the control group,the functional connections were still decreased after acupuncture in the visual network,dorsal attention,ventral attention,somatosensory movement network,subcortical network and so on,the functional connections still were also decreased between somatosensory movement network and visual network,dorsal attention network and ventral attention networks,whereas,the functional connections were increased significantly between the default mode network and the dorsal attention network,visual network and ventral attention network.4.The correlation between the scale and brain function activityBefore acupuncture,the correlation between the scale and the functional connection between the PCC and medial prefrontal cortex as follows:CRS-R:r=-0.27;GOS:r=-0.25.Before acupuncture,Posterior cingulate gyrus and right middle frontal gyrus:CRS-R,r=-0.415;GCS,r=-0.335;GOS,r=-0.512.Posterior cingulate gyrus and right inferior parietal gyrus:CRS-R,r=0.671;GCS:r=0.683;GOS:r=0.627.Conclusion:1.The features of brain functional activity in the patients of DOCThe most prominent features are significantly decreased functional connection in the DMN,FPN and the interaction between them in the patients of DOC,and which may be used as a diagnostic marker of consciousness disorders.The resting state network functional activity of DOC is significantly common abnormal.2.The wake-promoting mechanism of acupuncture treatmentAcupuncture at Hegu and Taichong has significant positive effects on the interaction between DMN and FPN,this positive effect has been achieved maybe through promoting the communication of function between the internal and external awareness.3.Evaluation and prediction role of brain function activities on DOCThe functional interaction between DMN and FPN may be play an objective role of evaluating and predicting the disorder of consciousness.