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Zhong S, Zhang L, Wang M, Shen J, Mao Y, Du X, Ma J. Abnormal resting-state functional connectivity of hippocampal subregions in children with primary nocturnal enuresis. Front Psychiatry 2022; 13:966362. [PMID: 36072465 PMCID: PMC9441761 DOI: 10.3389/fpsyt.2022.966362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Previous neuroimaging studies have shown abnormal brain-bladder control network in children with primary nocturnal enuresis (PNE). The hippocampus, which has long been considered to be an important nerve center for memory and emotion, has also been confirmed to be activating during micturition in several human imaging studies. However, few studies have explored hippocampus-related functional networks of PNE in children. In this study, the whole resting-state functional connectivity (RSFC) of hippocampus was investigated in children with PNE. Methods Functional magnetic resonance imaging data of 30 children with PNE and 29 matched healthy controls (HCs) were analyzed in our study. We used the seed-based RSFC method to evaluate the functional connectivity of hippocampal subregions defined according to the Human Brainnetome Atlas. Correlation analyses were also processed to investigate their relationship with disease duration time, bed-wetting frequency, and bladder volume. Results Compared with HCs, children with PNE showed abnormal RSFC of the left rostral hippocampus (rHipp) with right fusiform gyrus, right Rolandic operculum, left inferior parietal lobule, and right precentral gyrus, respectively. Moreover, decreased RSFC of the left caudal hippocampus (cHipp) with right fusiform gyrus and right supplementary motor area was discovered in the PNE group. There were no significant results in the right rHipp and cHipp seeds after multiple comparison corrections. In addition, disease duration time was negatively correlated with RSFC of the left rHipp with right Rolandic operculum (r = -0.386, p = 0.035, uncorrected) and the left cHipp with right fusiform gyrus (r = -0.483, p = 0.007, uncorrected) in the PNE group, respectively. In the Receiver Operating Characteristic (ROC) analysis, all the above results of RSFC achieved significant performance. Conclusions To our knowledge, this is the first attempt to examine the RSFC patterns of hippocampal subregions in children with PNE. These findings indicated that children with PNE have potential dysfunctions in the limbic network, sensorimotor network, default mode network, and frontoparietal network. These networks may become less efficient with disease duration time, inducing impairments in brain-bladder control, cognition, memory, and emotion. Further prospective research with dynamic observation of brain imaging, bladder function, cognition, memory, and emotion is warranted.
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Affiliation(s)
- Shaogen Zhong
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lichi Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Mengxing Wang
- College of Medical Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Jiayao Shen
- Department of Nephrology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Mao
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoxia Du
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Jun Ma
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Zhong S, Shen J, Wang M, Mao Y, Du X, Ma J. Altered resting-state functional connectivity of insula in children with primary nocturnal enuresis. Front Neurosci 2022; 16:913489. [PMID: 35928018 PMCID: PMC9343997 DOI: 10.3389/fnins.2022.913489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Primary nocturnal enuresis (PNE) is a common developmental condition in school-aged children. The objective is to better understand the pathophysiology of PNE by using insula-centered resting-state functional connectivity (rsFC). Methods We recruited 66 right-handed participants in our analysis, 33 with PNE and 33 healthy control (HC) children without enuresis matched for gender and age. Functional and structural MRI data were obtained from all the children. Seed-based rsFC was used to examine differences in insular functional connectivity between the PNE and HC groups. Correlation analyses were carried out to explore the relationship between abnormal insula-centered functional connectivity and clinical characteristics in the PNE group. Results Compared with HC children, the children with PNE demonstrated decreased left and right insular rsFC with the right medial superior frontal gyrus (SFG). In addition, the bilateral dorsal anterior insula (dAI) seeds also indicated the reduced rsFC with right medial SFG. Furthermore, the right posterior insula (PI) seed showed the weaker rsFC with the right medial SFG, while the left PI seed displayed the weaker rsFC with the right SFG. No statistically significant correlations were detected between aberrant insular rsFC and clinical variables (e.g., micturition desire awakening, bed-wetting frequency, and bladder volume) in results without global signal regression (GSR) in the PNE group. However, before and after setting age as a covariate, significant and positive correlations between bladder volume and the rsFC of the left dAI with right medial SFG and the rsFC of the right PI with right medial SFG were found in results with GSR in the PNE group. Conclusion To the best of our knowledge, this study explored the rsFC patterns of the insula in children with PNE for the first time. These results uncovered the abnormal rsFC of the insula with the medial prefrontal cortex without and with GSR in the PNE group, suggesting that dysconnectivity of the salience network (SN)-default mode network (DMN) may involve in the underlying pathophysiology of children with PNE. However, the inconsistent associations between bladder volume and dysconnectivity of the SN-DMN in results without and with GSR need further studies.
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Affiliation(s)
- Shaogen Zhong
- Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiayao Shen
- Department of Nephrology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mengxing Wang
- College of Medical Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Yi Mao
- Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoxia Du
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Jun Ma
- Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Dang J, Tang Z. Pathogenesis and brain functional imaging in nocturnal enuresis: A review. Exp Biol Med (Maywood) 2021; 246:1483-1490. [PMID: 33715529 DOI: 10.1177/1535370221997363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nocturnal enuresis is a common and distressing developmental disease, which may cause various degrees of psychosocial stress and impairment to self-esteem in affected children as well as agitation to their parents or caregivers. Nevertheless, the etiology and pathogenesis of nocturnal enuresis are not understood. Currently, nocturnal enuresis is generally considered a multifactorial disease associated with a complex interaction of somatic, psychosocial, and environmental factors. A variety of postulations have been proposed to explain the occurrence and progression of nocturnal enuresis, including hereditary aberration, abnormal circadian rhythm of antidiuretic hormone secretion during sleep, bladder dysfunction, abnormal sleep, difficulties in arousal, neuropsychological disorders, and maturational delays of the brain. In recent decades, the introduction of functional neuroimaging technologies has provided new approaches for uncovering the mechanisms underlying nocturnal enuresis. The main neuroimaging modalities have included brain morphometry based on structural magnetic resonance imaging (MRI), task-based and event-related functional MRI (fMRI), and resting-state fMRI. The relevant studies have indicated that nocturnal enuresis is associated with functional and structural alterations of the brain. In this review, we briefly summarized the popular hypotheses regarding the pathogenesis of nocturnal enuresis and the current progress of functional neuroimaging studies in examining the underlying mechanisms thereof.
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Affiliation(s)
- Jiawen Dang
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.,Sichuan Clinical Research Center for Birth Defects, Luzhou 646000, China
| | - Zhanghua Tang
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.,Sichuan Clinical Research Center for Birth Defects, Luzhou 646000, China
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Huang HM, Wei J, Sharma S, Bao Y, Li F, Song JW, Wu HB, Sun HL, Li ZJ, Liu HN, Wu Q, Jiang HL. Prevalence and risk factors of nocturnal enuresis among children ages 5-12 years in Xi'an, China: a cross-sectional study. BMC Pediatr 2020; 20:305. [PMID: 32571248 PMCID: PMC7310244 DOI: 10.1186/s12887-020-02202-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/12/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Nocturnal enuresis (NE) has a negative impact on children's health and imposes a long-term burden on families. With economic development and cultural improvements, parents and medical professionals pay more attention to NE. The aim of this study was to investigate the prevalence and risk factors of NE among children ages 5-12 years in Xi'an, China. METHODS A stratified cluster sampling method was used to conduct a cross-sectional study of NE in 10 kindergartens and 20 primary schools in Xi'an. We used univariate analysis to compare the prevalences of characteristics such as gender, duration of disposable diaper (DD) use, toilet training onset time, daily living habits, academic performance, and family history of NE. Logistic regression analysis was used to calculate odds ratio and to determine risk factors of NE. RESULTS The study included 6568 children ages 5-12 years, of which 262 (3.99%) had NE. The prevalence rates of NE decreased with age, with the highest prevalence at age 5 (9.09% for boys; 6.03% for girls). However, the prevalence increased with duration of DD use. Children experienced more NE if they never accepted toilet training (7.83%) or if they drank sugary beverages during the day (5.36%). Sleep disorders, sweets intake, drinking low amounts of plain water during the day, and family history of NE, were statistically associated with NE. CONCLUSION NE was closely associated with a family history of NE, being male, long-term use of DD, delayed toilet training, drinking sugary beverages and/or consuming little plain water, and sleep disorders. A supportive parental attitude towards NE and timely medical treatment can improve the quality of life of enuretic children.
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Affiliation(s)
- Hui-Mei Huang
- Department of Epidemiology and Biostatistics, School of Public Heath, Xi'an Jiaotong University, No.76 West Yanta Road, Xi'an, 710061, Shaanxi, China.,Department of Renal Dialysis, The First Affiliated Hospital of Xi'an Jiaotong University, No.277 West Yanta Road, Xi'an, 710061, Shaanxi, China.,Department of Nephrology, The Affiliated Children Hospital of Xi'an Jiaotong University, No.69 Xijuyuan Lane, Xi'an, 710002, Shaanxi, China
| | - Jing Wei
- Department of Epidemiology and Biostatistics, School of Public Heath, Xi'an Jiaotong University, No.76 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Shristi Sharma
- Department of Epidemiology and Biostatistics, School of Public Heath, Xi'an Jiaotong University, No.76 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Ying Bao
- Department of Nephrology, The Affiliated Children Hospital of Xi'an Jiaotong University, No.69 Xijuyuan Lane, Xi'an, 710002, Shaanxi, China
| | - Fei Li
- Department of Breast Cancer, Shaanxi Tumor Hospital, No.309 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Jian-Wen Song
- Department of Dermatology, The Affiliated Children Hospital of Xi'an Jiaotong University, No.69 Xijuyuan Lane, Xi'an, 710002, Shaanxi, China
| | - Hai-Bin Wu
- Department of Pediatric intensive care unit, The Affiliated Children Hospital of Xi'an Jiaotong University, No.69 Xijuyuan Lane, Xi'an, 710002, Shaanxi, China
| | - Hong-Li Sun
- Shaanxi Institute of Pediatric Diseases, The Affiliated Children Hospital of Xi'an Jiaotong University, No.69 Xijuyuan Lane, Xi'an, 710002, Shaanxi, China
| | - Zhi-Juan Li
- Department of Nephrology, The Affiliated Children Hospital of Xi'an Jiaotong University, No.69 Xijuyuan Lane, Xi'an, 710002, Shaanxi, China
| | - Huan-Nan Liu
- Department of Epidemiology and Biostatistics, School of Public Heath, Xi'an Jiaotong University, No.76 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Qian Wu
- Department of Epidemiology and Biostatistics, School of Public Heath, Xi'an Jiaotong University, No.76 West Yanta Road, Xi'an, 710061, Shaanxi, China.
| | - Hong-Li Jiang
- Department of Renal Dialysis, The First Affiliated Hospital of Xi'an Jiaotong University, No.277 West Yanta Road, Xi'an, 710061, Shaanxi, China.
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