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Arnts H, Coolen SE, Fernandes FW, Schuurman R, Krauss JK, Groenewegen HJ, van den Munckhof P. The intralaminar thalamus: a review of its role as a target in functional neurosurgery. Brain Commun 2023; 5:fcad003. [PMID: 37292456 PMCID: PMC10244065 DOI: 10.1093/braincomms/fcad003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/06/2022] [Accepted: 01/03/2023] [Indexed: 09/29/2023] Open
Abstract
The intralaminar thalamus, in particular the centromedian-parafascicular complex, forms a strategic node between ascending information from the spinal cord and brainstem and forebrain circuitry that involves the cerebral cortex and basal ganglia. A large body of evidence shows that this functionally heterogeneous region regulates information transmission in different cortical circuits, and is involved in a variety of functions, including cognition, arousal, consciousness and processing of pain signals. Not surprisingly, the intralaminar thalamus has been a target area for (radio)surgical ablation and deep brain stimulation (DBS) in different neurological and psychiatric disorders. Historically, ablation and stimulation of the intralaminar thalamus have been explored in patients with pain, epilepsy and Tourette syndrome. Moreover, DBS has been used as an experimental treatment for disorders of consciousness and a variety of movement disorders. In this review, we provide a comprehensive analysis of the underlying mechanisms of stimulation and ablation of the intralaminar nuclei, historical clinical evidence, and more recent (experimental) studies in animals and humans to define the present and future role of the intralaminar thalamus as a target in the treatment of neurological and psychiatric disorders.
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Affiliation(s)
- Hisse Arnts
- Department of Neurosurgery, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stan E Coolen
- Department of Neurosurgery, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | | | - Rick Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Henk J Groenewegen
- Department of Anatomy and Neurosciences, Neuroscience Campus Amsterdam, Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, The Netherlands
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
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Zheng RZ, Qi ZX, Wang Z, Xu ZY, Wu XH, Mao Y. Clinical Decision on Disorders of Consciousness After Acquired Brain Injury: Stepping Forward. Neurosci Bull 2023; 39:138-162. [PMID: 35804219 PMCID: PMC9849546 DOI: 10.1007/s12264-022-00909-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/10/2022] [Indexed: 01/22/2023] Open
Abstract
Major advances have been made over the past few decades in identifying and managing disorders of consciousness (DOC) in patients with acquired brain injury (ABI), bringing the transformation from a conceptualized definition to a complex clinical scenario worthy of scientific exploration. Given the continuously-evolving framework of precision medicine that integrates valuable behavioral assessment tools, sophisticated neuroimaging, and electrophysiological techniques, a considerably higher diagnostic accuracy rate of DOC may now be reached. During the treatment of patients with DOC, a variety of intervention methods are available, including amantadine and transcranial direct current stimulation, which have both provided class II evidence, zolpidem, which is also of high quality, and non-invasive stimulation, which appears to be more encouraging than pharmacological therapy. However, heterogeneity is profoundly ingrained in study designs, and only rare schemes have been recommended by authoritative institutions. There is still a lack of an effective clinical protocol for managing patients with DOC following ABI. To advance future clinical studies on DOC, we present a comprehensive review of the progress in clinical identification and management as well as some challenges in the pathophysiology of DOC. We propose a preliminary clinical decision protocol, which could serve as an ideal reference tool for many medical institutions.
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Affiliation(s)
- Rui-Zhe Zheng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Zeng-Xin Qi
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Zhe Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Ze-Yu Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Xue-Hai Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.
- National Center for Neurological Disorders, Shanghai, 200040, China.
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China.
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China.
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China.
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China.
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.
- National Center for Neurological Disorders, Shanghai, 200040, China.
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China.
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China.
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China.
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China.
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Garzón Diaz FA. Bioethical Aspects of Patients in a Minimally Conscious State. REVISTA LATINOAMERICANA DE BIOÉTICA 2021. [DOI: 10.18359/rlbi.5594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Outcome prediction with resting-state functional connectivity after cardiac arrest. Sci Rep 2020; 10:11695. [PMID: 32678212 PMCID: PMC7366921 DOI: 10.1038/s41598-020-68683-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 06/24/2020] [Indexed: 01/14/2023] Open
Abstract
Predicting outcome in comatose patients after successful cardiopulmonary resuscitation is challenging. Our primary aim was to assess the potential contribution of resting-state-functional magnetic resonance imaging (RS-fMRI) in predicting neurological outcome. RS-fMRI was used to evaluate functional and effective connectivity within the default mode network in a cohort of 90 comatose patients and their impact on functional neurological outcome after 3 months. The RS-fMRI processing protocol comprises the evaluation of functional and effective connectivity within the default mode network. Seed-to-voxel and ROI-to-ROI feature analysis was performed as starting point for a supervised machine-learning approach. Classification of the Cerebral Performance Category (CPC) 1–3 (good to acceptable outcome) versus CPC 4–5 (adverse outcome) achieved a positive predictive value of 91.7%, sensitivity of 90.2%, and accuracy of 87.8%. A direct link to the level of consciousness and outcome after 3 months was identified for measures of segregation in the precuneus, in medial and right frontal regions. Thalamic connectivity appeared significantly reduced in patients without conscious response. Decreased within-network connectivity in the default mode network and within cortico-thalamic circuits correlated with clinical outcome after 3 months. Our results indicate a potential role of these markers for decision-making in comatose patients early after cardiac arrest.
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Francoeur MJ, Wormwood BA, Gibson BM, Mair RG. Central thalamic inactivation impairs the expression of action- and outcome-related responses of medial prefrontal cortex neurons in the rat. Eur J Neurosci 2019; 50:1779-1798. [PMID: 30919548 DOI: 10.1111/ejn.14350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/29/2018] [Accepted: 01/10/2019] [Indexed: 12/01/2022]
Abstract
The mediodorsal (MD) and adjacent intralaminar (IL) and midline nuclei provide the main thalamic input to the medial prefrontal cortex (mPFC) and are critical for associative learning and decision-making. MD neurons exhibit activity related to actions and outcomes that mirror responses of mPFC neurons in rats during dynamic delayed non-match to position (dDNMTP), a variation of DNMTP where start location is varied randomly within an open octagonal arena to avoid confounding behavioral events with spatial location. To test whether the thalamus affects the expression of these responses in mPFC, we inhibited the central thalamus unilaterally by microinjecting muscimol at doses and sites found to affect decision-making when applied bilaterally. Unilateral inactivation reduced normalized task-related responses in the ipsilateral mPFC without disrupting behavior needed to characterize event-related neuronal activity. Our results extend earlier findings that focused on delay-related activity by showing that central thalamic inactivation interferes with responses related to actions and outcomes that occur outside the period of memory delay. These findings are consistent with the broad effects of central thalamic lesions on behavioral measures of reinforcement-guided responding. Most (7/8) of the prefrontal response types affected by thalamic inactivation have also been observed in MD during dDNMTP. These results support the hypothesis that MD and IL act as transthalamic gates: monitoring prefrontal activity through corticothalamic inputs; integrating this information with signals from motivational and sensorimotor systems that converge in thalamus; and acting through thalamocortical projections to enhance expression of neuronal responses in the PFC that support adaptive goal-directed behavior.
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Affiliation(s)
- Miranda J Francoeur
- Department of Psychology, University of New Hampshire, Durham, New Hampshire
| | - Benjamin A Wormwood
- Department of Psychology, University of New Hampshire, Durham, New Hampshire
| | - Brett M Gibson
- Department of Psychology, University of New Hampshire, Durham, New Hampshire
| | - Robert G Mair
- Department of Psychology, University of New Hampshire, Durham, New Hampshire
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Overbeek BUH, Eilander HJ, Lavrijsen JCM, Koopmans RTCM. Are visual functions diagnostic signs of the minimally conscious state? an integrative review. J Neurol 2018; 265:1957-1975. [PMID: 29492651 PMCID: PMC6132665 DOI: 10.1007/s00415-018-8788-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 12/22/2022]
Abstract
Visual pursuit (VP) and visual fixation (VF) have been recognized as the first signs of emerging consciousness and, therefore, are considered indicative of the minimally conscious state (MCS). However, debate exists about their status as they are considered either conscious reactions or reflexes. The aim of this study is to review the evidence of the definition, operationalization, and assessment of VP and VF in unconscious patients. PubMed and EMBASE were searched for relevant papers between May 26, 1994 and October 1, 2016. In addition, an internet search was done to identify other relevant papers, reports and manuals of assessment methods. Papers were included if the definition, operationalization, or assessment method of VP and VF was discussed in patients with disorders of consciousness. We identified 2364 articles, of which 38 were included. No uniform definitions of VP and VF were found. VP and VF were operationalized differently, depending on which scale was used. The Coma Recovery Scale-revised and the Sensory Tool to Assess Responsiveness were the only diagnostic scales found; the other scales were developed to monitor DOC patients. The use of a mirror was the most sensitive method for detecting VP and VF. The literature about the importance VP and VF in relation with consciousness is controversial. This integrative review shows a lack of consensus regarding the definition, operationalization, and assessment of VP and VF. International consensus development about the definition, operationalization, and assessment of VP and VF is recommended.
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Affiliation(s)
- Berno U H Overbeek
- Department of Primary and Community Care, Centre of Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Azora, PO Box 30, 7060 AA, Terborg, The Netherlands. .,Kalorama, PO Box 85, 6573 ZH, Beek, The Netherlands.
| | - Henk J Eilander
- Department of Primary and Community Care, Centre of Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Jan C M Lavrijsen
- Department of Primary and Community Care, Centre of Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Centre of Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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Abstract
In the 2015 David Kopf Lecture on Neuroethics of the Society for Neuroscience, Dr. Joseph Fins presents his work on neuroethics and disorders of consciousness through the experience of Maggie and Nancy Worthen, a young woman who sustained a severe brain injury and her mother who cared for her. The central protagonists in his book, Rights Come to Mind: Brain Injury, Ethics and the Struggle for Consciousness (Cambridge University Press, 2015), their experience is emblematic of the challenges faced by families touched by severe brain injury and the possibility for improved diagnosis and treatment offered by progress in neuroscience. By telling their story, and those of other families interviewed as part of the research for Rights Come to Mind, Fins calls for improved care for this population arguing that this is both an access to care issue and a civil and disability rights issue worthy of greater societal attention.
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Vanhoecke J, Hariz M. Deep brain stimulation for disorders of consciousness: Systematic review of cases and ethics. Brain Stimul 2017; 10:1013-1023. [PMID: 28966051 DOI: 10.1016/j.brs.2017.08.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/24/2017] [Accepted: 08/21/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A treatment for patients suffering from prolonged severely altered consciousness is not available. The success of Deep Brain Stimulation (DBS) in diseases such as Parkinson's, dystonia and essential tremor provided a renewed impetus for its application in Disorders of Consciousness (DoC). OBJECTIVE To evaluate the rationale for DBS in patients with DoC, through systematic review of literature containing clinical data and ethical considerations. METHODS Articles from PubMed, Embase, Medline and Web of Science were systematically reviewed. RESULTS The outcomes of 78 individual patients reported in 19 articles from 1968 onwards were pooled and elements of ethical discussions were compared. There is no clear clinical evidence that DBS is a treatment for DoC that can restore both consciousness and the ability to communicate. In patients who benefitted, the outcome of DBS is often confounded by the time frame of spontaneous recovery from DoC. Difficult ethical considerations remain, such as the risk of increasing self-awareness of own limitations, without improving overall wellbeing, and the issues of proxy consent. CONCLUSION DBS is far from being evident as a possible future therapeutic avenue for patients with DoC. Double-blind studies are lacking, and many clinical and ethical issues have to be addressed. In the rare cases when DBS for patients with DoC is considered, this needs to be evaluated meticulously on a case by case basis, with comprehensive overall outcome measures including psychological and quality-of-life assessments, and with the guidance of an ethical and interdisciplinary panel, especially in relation to proxy consent.
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Affiliation(s)
- Jonathan Vanhoecke
- Unit of Functional Neurosurgery, Institute of Neurology, University College London, Queen Square, WC1N 3BG, London, UK.
| | - Marwan Hariz
- Unit of Functional Neurosurgery, Institute of Neurology, University College London, Queen Square, WC1N 3BG, London, UK; Department of Clinical Neuroscience, Umeå University, SE-901 87, Umeå, Sweden.
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Weng L, Xie Q, Zhao L, Zhang R, Ma Q, Wang J, Jiang W, He Y, Chen Y, Li C, Ni X, Xu Q, Yu R, Huang R. Abnormal structural connectivity between the basal ganglia, thalamus, and frontal cortex in patients with disorders of consciousness. Cortex 2017; 90:71-87. [PMID: 28365490 DOI: 10.1016/j.cortex.2017.02.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/28/2016] [Accepted: 02/20/2017] [Indexed: 12/17/2022]
Abstract
Consciousness loss in patients with severe brain injuries is associated with reduced functional connectivity of the default mode network (DMN), fronto-parietal network, and thalamo-cortical network. However, it is still unclear if the brain white matter connectivity between the above mentioned networks is changed in patients with disorders of consciousness (DOC). In this study, we collected diffusion tensor imaging (DTI) data from 13 patients and 17 healthy controls, constructed whole-brain white matter (WM) structural networks with probabilistic tractography. Afterward, we estimated and compared topological properties, and revealed an altered structural organization in the patients. We found a disturbance in the normal balance between segregation and integration in brain structural networks and detected significantly decreased nodal centralities primarily in the basal ganglia and thalamus in the patients. A network-based statistical analysis detected a subnetwork with uniformly significantly decreased structural connections between the basal ganglia, thalamus, and frontal cortex in the patients. Further analysis indicated that along the WM fiber tracts linking the basal ganglia, thalamus, and frontal cortex, the fractional anisotropy was decreased and the radial diffusivity was increased in the patients compared to the controls. Finally, using the receiver operating characteristic method, we found that the structural connections within the NBS-derived component that showed differences between the groups demonstrated high sensitivity and specificity (>90%). Our results suggested that major consciousness deficits in DOC patients may be related to the altered WM connections between the basal ganglia, thalamus, and frontal cortex.
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Affiliation(s)
- Ling Weng
- Center for the Study of Applied Psychology, Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Institute of Brain Science and Rehabilitation, South China Normal University, Guangzhou 510631, PR China
| | - Qiuyou Xie
- Centre for Hyperbaric Oxygen and Neurorehabilitation, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, PR China
| | - Ling Zhao
- Center for the Study of Applied Psychology, Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Institute of Brain Science and Rehabilitation, South China Normal University, Guangzhou 510631, PR China
| | - Ruibin Zhang
- Department of Psychology, The University of Hong Kong, Hong Kong, PR China
| | - Qing Ma
- Centre for Hyperbaric Oxygen and Neurorehabilitation, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, PR China
| | - Junjing Wang
- Center for the Study of Applied Psychology, Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Institute of Brain Science and Rehabilitation, South China Normal University, Guangzhou 510631, PR China
| | - Wenjie Jiang
- Center for the Study of Applied Psychology, Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Institute of Brain Science and Rehabilitation, South China Normal University, Guangzhou 510631, PR China
| | - Yanbin He
- Centre for Hyperbaric Oxygen and Neurorehabilitation, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, PR China
| | - Yan Chen
- Centre for Hyperbaric Oxygen and Neurorehabilitation, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, PR China
| | - Changhong Li
- Center for the Study of Applied Psychology, Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Institute of Brain Science and Rehabilitation, South China Normal University, Guangzhou 510631, PR China
| | - Xiaoxiao Ni
- Centre for Hyperbaric Oxygen and Neurorehabilitation, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, PR China
| | - Qin Xu
- Center for the Study of Applied Psychology, Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Institute of Brain Science and Rehabilitation, South China Normal University, Guangzhou 510631, PR China
| | - Ronghao Yu
- Centre for Hyperbaric Oxygen and Neurorehabilitation, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, PR China.
| | - Ruiwang Huang
- Center for the Study of Applied Psychology, Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Institute of Brain Science and Rehabilitation, South China Normal University, Guangzhou 510631, PR China.
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Yao S, Song J, Gao L, Yan Y, Huang C, Ding H, Huang H, He Y, Sun R, Xu G. Thalamocortical Sensorimotor Circuit Damage Associated with Disorders of Consciousness for Diffuse Axonal Injury Patients. J Neurol Sci 2015; 356:168-74. [PMID: 26165776 DOI: 10.1016/j.jns.2015.06.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/16/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
Abstract
The relationship of structural and functional brain damage and disorders of consciousness (DOC) for diffuse axonal injury (DAI) is still not fully explored. We employed diffusion tensor imaging (DTI) and resting-state fMRI (RS-fMRI) to examine the changes of resting activations and white matter (WM) integrity for DAI with DOC. WM damages were observed in the body and genu of the corpus callosum, right external capsule (EC) and superior corona radiate (SCR), left superior cerebellar peduncle (SCP) and posterior thalamic radiation (PTR). The RS-fMRI revealed augmented amplitude of low-frequency fluctuation (ALFF) in the anterior cingulate cortex, hippocampus, insula, amygdala and putamen, and reduced ALFF in the precuneus, thalamus, pre-central and post-central gyri. Correlation analysis identified positive associations between the Glasgow Coma Scale (GCS) and activation of the precuneus and between GCS and DTI measurements in the left PTR and SCP, but a negative correlation was found between GCS and activation of the thalamus. Cross modality association analyses indicated that activations of the amygdala and postcentral gyrus were correlated with DTI measurements of the right EC and left PTR respectively. These results implicate that the WM damages in thalamocortical sensorimotor circuit and aberrant brain activity responding to self-awareness and sensation are critical factors to DOC, which expand the current understanding of the neural mechanisms underlying DAI.
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Affiliation(s)
- Shun Yao
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Command, Wuhan 430070, China
| | - Jian Song
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Command, Wuhan 430070, China
| | - Lichen Gao
- Department of Radiology, Wuhan General Hospital of Guangzhou Command, Wuhan 430070, China
| | - Yan Yan
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Command, Wuhan 430070, China
| | - Cheng Huang
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Command, Wuhan 430070, China
| | - Huichao Ding
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Command, Wuhan 430070, China
| | - He Huang
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Command, Wuhan 430070, China
| | - Yuanzhi He
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Command, Wuhan 430070, China
| | - Ronghui Sun
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Command, Wuhan 430070, China
| | - Guozheng Xu
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Command, Wuhan 430070, China.
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Crone JS, Soddu A, Höller Y, Vanhaudenhuyse A, Schurz M, Bergmann J, Schmid E, Trinka E, Laureys S, Kronbichler M. Altered network properties of the fronto-parietal network and the thalamus in impaired consciousness. NEUROIMAGE-CLINICAL 2013; 4:240-8. [PMID: 24455474 PMCID: PMC3895618 DOI: 10.1016/j.nicl.2013.12.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/22/2013] [Accepted: 12/17/2013] [Indexed: 12/19/2022]
Abstract
Recovery of consciousness has been associated with connectivity in the frontal cortex and parietal regions modulated by the thalamus. To examine this model and to relate alterations to deficits in cognitive functioning and conscious processing, we investigated topological network properties in patients with chronic disorders of consciousness recovered from coma. Resting state fMRI data of 34 patients with unresponsive wakefulness syndrome and 25 in minimally conscious state were compared to 28 healthy controls. We investigated global and local network characteristics. Additionally, behavioral measures were correlated with the local metrics of 28 regions within the fronto-parietal network and the thalamus. In chronic disorders of consciousness, modularity at the global level was reduced suggesting a disturbance in the optimal balance between segregation and integration. Moreover, network properties were altered in several regions which are associated with conscious processing (particularly, in medial parietal, and frontal regions, as well as in the thalamus). Between minimally conscious and unconscious patients the local efficiency of medial parietal regions differed. Alterations in the thalamus were particularly evident in non-conscious patients. Most of the regions affected in patients with impaired consciousness belong to the so-called ‘rich club’ of highly interconnected central nodes. Disturbances in their topological characteristics have severe impact on information integration and are reflected in deficits in cognitive functioning probably leading to a total breakdown of consciousness. We investigated network properties in patients with a disorder of consciousness. Patients showed reduced global modularity. Alterations in regions of the rich club were related to impaired consciousness. These alterations have severe impact on information integration and segregation. Disturbances in overall integration may lead to breakdown of consciousness.
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Affiliation(s)
- Julia Sophia Crone
- Neuroscience Institute & Centre for Neurocognitive Research, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria ; Centre for Neurocognitive Research & Department of Psychology, University of Salzburg, Salzburg, Austria ; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Andrea Soddu
- Coma Science Group, Cyclotron Research Centre, University of Liège, Belgium ; Brain and Mind Institute, Physics & Astronomy Department, Western University, London, Ontario, Canada
| | - Yvonne Höller
- Centre for Neurocognitive Research & Department of Psychology, University of Salzburg, Salzburg, Austria ; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | | | - Matthias Schurz
- Centre for Neurocognitive Research & Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Jürgen Bergmann
- Neuroscience Institute & Centre for Neurocognitive Research, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Elisabeth Schmid
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Steven Laureys
- Coma Science Group, Cyclotron Research Centre, University of Liège, Belgium ; Neurology Department, CHU Sart Tilman Hospital, University of Liège, Belgium
| | - Martin Kronbichler
- Neuroscience Institute & Centre for Neurocognitive Research, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria ; Centre for Neurocognitive Research & Department of Psychology, University of Salzburg, Salzburg, Austria
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12
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Guldenmund P, Demertzi A, Boveroux P, Boly M, Vanhaudenhuyse A, Bruno MA, Gosseries O, Noirhomme Q, Brichant JF, Bonhomme V, Laureys S, Soddu A. Thalamus, brainstem and salience network connectivity changes during propofol-induced sedation and unconsciousness. Brain Connect 2013; 3:273-85. [PMID: 23547875 DOI: 10.1089/brain.2012.0117] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In this functional magnetic resonance imaging study, we examined the effect of mild propofol sedation and propofol-induced unconsciousness on resting state brain connectivity, using graph analysis based on independent component analysis and a classical seed-based analysis. Contrary to previous propofol research, which mainly emphasized the importance of connectivity in the default mode network (DMN) and external control network (ECN), we focused on the salience network, thalamus, and brainstem. The importance of these brain regions in brain arousal and organization merits a more detailed examination of their connectivity response to propofol. We found that the salience network disintegrated during propofol-induced unconsciousness. The thalamus decreased connectivity with the DMN, ECN, and salience network, while increasing connectivity with sensorimotor and auditory/insular cortices. Brainstem regions disconnected from the DMN with unconsciousness, while the pontine tegmental area increased connectivity with the insulae during mild sedation. These findings illustrate that loss of consciousness is associated with a wide variety of decreases and increases of both cortical and subcortical connectivity. It furthermore stresses the necessity of also examining resting state connectivity in networks representing arousal, not only those associated with awareness.
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Affiliation(s)
- Pieter Guldenmund
- Coma Science Group, Cyclotron Research Center, University of Liège, Liège, Belgium.
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León-Domínguez U, Vela-Bueno A, Froufé-Torres M, León-Carrión J. A chronometric functional sub-network in the thalamo-cortical system regulates the flow of neural information necessary for conscious cognitive processes. Neuropsychologia 2013; 51:1336-49. [DOI: 10.1016/j.neuropsychologia.2013.03.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 03/13/2013] [Accepted: 03/21/2013] [Indexed: 01/28/2023]
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Shi C, Flanagan SR, Samadani U. Vagus nerve stimulation to augment recovery from severe traumatic brain injury impeding consciousness: a prospective pilot clinical trial. Neurol Res 2013; 35:263-76. [PMID: 23485054 PMCID: PMC4568744 DOI: 10.1179/1743132813y.0000000167] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Traumatic brain injury (TBI) has high morbidity and mortality in both civilian and military populations. Blast and other mechanisms of TBI damage the brain by causing neurons to disconnect and atrophy. Such traumatic axonal injury can lead to persistent vegetative and minimally conscious states (VS and MCS), for which limited treatment options exist, including physical, occupational, speech, and cognitive therapies. More than 60 000 patients have received vagus nerve stimulation (VNS) for epilepsy and depression. In addition to decreased seizure frequency and severity, patients report enhanced mood, reduced daytime sleepiness independent of seizure control, increased slow wave sleep, and improved cognition, memory, and quality of life. Early stimulation of the vagus nerve accelerates the rate and extent of behavioral and cognitive recovery after fluid percussion brain injury in rats. METHODS We recently obtained Food and Drug Administration (FDA) approval for a pilot prospective randomized crossover trial to demonstrate objective improvement in clinical outcome by placement of a vagus nerve stimulator in patients who are recovering from severe TBI. Our hypothesis is that stimulation of the vagus nerve results in increased cerebral blood flow and metabolism in the forebrain, thalamus, and reticular formation, which promotes arousal and improved consciousness, thereby improving outcome after TBI resulting in MCS or VS. DISCUSSION If this study demonstrates that VNS can safely and positively impact outcome, then a larger randomized prospective crossover trial will be proposed.
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Affiliation(s)
- Chen Shi
- Department of Neurosurgery, New York University School of Medicine and NYU Langone Medical Center, 550 First Ave. New York, NY 10016
| | - Steven R. Flanagan
- Department of Rehabilitation Medicine, New York University School of Medicine and NYU Langone Medical Center, 240 E. 38 St. New York, NY 10016
| | - Uzma Samadani
- Department of Neurosurgery, New York University School of Medicine and NYU Langone Medical Center, 550 First Ave. New York, NY 10016
- Division of Neurosurgery, New York Harbor Healthcare System Manhattan Veterans Hospital, 423 E. 23 St. New York, NY 10010
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Central thalamic deep brain stimulation for support of forebrain arousal regulation in the minimally conscious state. HANDBOOK OF CLINICAL NEUROLOGY 2013; 116:295-306. [PMID: 24112903 DOI: 10.1016/b978-0-444-53497-2.00024-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This chapter considers the use of central thalamic deep brain stimulation (CT/DBS) to support arousal regulation mechanisms in the minimally conscious state (MCS). CT/DBS for selected patients in a MCS is first placed in the historical context of prior efforts to use thalamic electrical brain stimulation to treat the unconscious clinical conditions of coma and vegetative state. These previous studies and a proof of concept result from a single-subject study of a patient in a MCS are reviewed against the background of new population data providing benchmarks of the natural history of vegetative and MCSs. The conceptual foundations for CT/DBS in selected patients in a MCS are then presented with consideration of both circuit and cellular mechanisms underlying recovery of consciousness identified from empirical studies. Directions for developing future generalizable criteria for CT/DBS that focus on the integrity of necessary brain systems and behavioral profiles in patients in a MCS that may optimally response to support of arousal regulation mechanisms are proposed.
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Schiff ND. Moving toward a generalizable application of central thalamic deep brain stimulation for support of forebrain arousal regulation in the severely injured brain. Ann N Y Acad Sci 2012; 1265:56-68. [PMID: 22834729 DOI: 10.1111/j.1749-6632.2012.06712.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This review considers the challenges ahead for developing a generalizable strategy for the use of central thalamic deep brain stimulation (CT/DBS) to support arousal regulation mechanisms in the severely injured brain. Historical efforts to apply CT/DBS to patients with severe brain injuries and a proof-of-concept result from a single-subject study are discussed. Circuit and cellular mechanisms underlying the recovery of consciousness are considered for their relevance to the application of CT/DBS, to improve consciousness and cognition in nonprogressive brain injuries. Finally, directions for development, and testing of generalizable criteria for CT/DBS are suggested, which aim to identify neuronal substrates and behavioral profiles that may optimally benefit from support of arousal regulation mechanisms.
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Affiliation(s)
- Nicholas D Schiff
- Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, USA.
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Demertzi A, Schnakers C, Soddu A, Bruno MA, Gosseries O, Vanhaudenhuyse A, Laureys S. Neural plasticity lessons from disorders of consciousness. Front Psychol 2011; 1:245. [PMID: 21833298 PMCID: PMC3153849 DOI: 10.3389/fpsyg.2010.00245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Accepted: 12/24/2010] [Indexed: 11/20/2022] Open
Abstract
Communication and intentional behavior are supported by the brain's integrity at a structural and a functional level. When widespread loss of cerebral connectivity is brought about as a result of a severe brain injury, in many cases patients are not capable of conscious interactive behavior and are said to suffer from disorders of consciousness (e.g., coma, vegetative state/unresponsive wakefulness syndrome, minimally conscious states). This lesion paradigm has offered not only clinical insights, as how to improve diagnosis, prognosis, and treatment, but also put forward scientific opportunities to study the brain's plastic abilities. We here review interventional and observational studies performed in severely brain-injured patients with regards to recovery of consciousness. The study of the recovered conscious brain (spontaneous and/or after surgical or pharmacologic interventions), suggests a link between some specific brain areas and the capacity of the brain to sustain conscious experience, challenging at the same time the notion of fixed temporal boundaries in rehabilitative processes. Altered functional connectivity, cerebral structural reorganization as well as behavioral amelioration after invasive treatments will be discussed as the main indices for plasticity in these challenging patients. The study of patients with chronic disorders of consciousness may, thus, provide further insights not only at a clinical level (i.e., medical management and rehabilitation) but also from a scientific-theoretical perspective (i.e., the brain's plastic abilities and the pursuit of the neural correlate of consciousness).
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Affiliation(s)
- Athena Demertzi
- Coma Science Group, Cyclotron Research Centre and Neurology Department, Sart Tilman, University and University Hospital of Liège Liège, Belgium
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Fins JJ, Schiff ND. Conflicts of Interest in Deep Brain Stimulation Research and the Ethics of Transparency. THE JOURNAL OF CLINICAL ETHICS 2010. [DOI: 10.1086/jce201021205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Memory enhancement with event-related stimulation of the rostral intralaminar thalamic nuclei. J Neurosci 2009; 28:14293-300. [PMID: 19109510 DOI: 10.1523/jneurosci.3301-08.2008] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The rostral intralaminar thalamic nuclei (ILn) are organized to activate pathways originating in medial prefrontal cortex (mPF) that mediate memory-guided responding during alert, wakeful states. Previous studies have shown that rostral ILn or mPF lesions produce deficits in delayed matching to position (DMTP). Here, we manipulated rostral ILn activity in rats by microinjecting drugs or applying electrical current and examined effects on DMTP. Inhibiting activity with the GABA(A) agonist muscimol impaired DMTP. Decreasing GABA(A) tone with FG-7142 (N-methyl-beta-carboline-3-carboxamide) improved DMTP at low but not high doses. Orexin A, which depolarizes thalamocortical neurons locally within the ILn, improved DMTP, whereas the cholinergic agonist carbachol impaired performance at the highest dose tested. These drug effects were unaffected by partial mPF lesions in a subset of animals. Microinjection results are consistent with an inverted-U relationship between thalamic activity and DMTP. This relationship was confirmed by event-related electrical stimulation, which produced improvement at low stimulation currents and impairment at higher currents. Electrical stimulation affected DMTP when applied at the start of the memory delay or choice response, but not earlier when trials began or the sample lever was presented. Our results are consistent with evidence that the rostral ILn play a role in retrieval, carrying response-related information across brief memory delays and facilitating memory-guided responding. They also provide evidence that treatments stimulating rostral ILn activity may be an effective means to enhance working memory and related cognitive processes and thus to treat disorders that affect these functions.
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Demertzi A, Vanhaudenhuyse A, Bruno MA, Schnakers C, Boly M, Boveroux P, Maquet P, Moonen G, Laureys S. Is there anybody in there? Detecting awareness in disorders of consciousness. Expert Rev Neurother 2009; 8:1719-30. [PMID: 18986242 DOI: 10.1586/14737175.8.11.1719] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The bedside detection of awareness in disorders of consciousness (DOC) caused by acquired brain injury is not an easy task. For this reason, differential diagnosis using neuroimaging and electrophysiological tools in search for objective markers of consciousness is being employed. However, such tools cannot be considered as diagnostic per se, but as assistants to the clinical evaluation, which, at present, remains the gold standard. Regarding therapeutic management in DOC, no evidence-based recommendations can be made in favor of a specific treatment. The present review summarizes clinical and paraclinical studies that have been conducted with neuroimaging and electrophysiological techniques in search of residual awareness in DOC. We discuss the medical, scientific and ethical implications that derive from these studies and we argue that, in the future, the role of neuroimaging and electrophysiology will be important not only for the diagnosis and prognosis of DOC but also in establishing communication with these challenging patients.
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Affiliation(s)
- Athena Demertzi
- Coma Science Group, Neurology Department, Cyclotron Research Centre, University of Liège, Liège, Belgium
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Deep Brain Stimulation. Neuromodulation 2009. [DOI: 10.1016/b978-0-12-374248-3.00010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Schiff ND. Deep Brain Stimulation for Cognitive Neuromodulation. Neuromodulation 2009. [DOI: 10.1016/b978-0-12-374248-3.00084-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fukushi T, Sakura O. Ethical challenges and clinical implications of molecular imaging of human consciousness. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2008; 8:23-24. [PMID: 18853377 DOI: 10.1080/15265160802412510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Tamami Fukushi
- Research Institute of Science and Technology for Society (RISTEX), Japan Science and Technology Agency (JST), Tokyo, Japan.
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