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Zheng R, Bu C, Chen Y, Wei Y, Zhou B, Jiang Y, Zhu C, Wang K, Wang C, Li S, Han S, Zhang Y, Cheng J. Decreased intrinsic neural timescale in treatment-naïve adolescent depression. J Affect Disord 2024; 348:389-397. [PMID: 38160888 DOI: 10.1016/j.jad.2023.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/25/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) is mainly characterized by its core dysfunction in higher-order brain cortices involved in emotional and cognitive processes, whose neurobiological basis remains unclear. In this study, we applied a relatively new developed resting-state functional magnetic resonance imaging (rs-fMRI) method of intrinsic neural timescale (INT), which reflects how long neural information is stored in a local brain area and reflects an ability of information integration, to investigate the local intrinsic neural dynamics using univariate and multivariate analyses in adolescent depression. METHOD Based on the rs-fMRI data of sixty-six treatment-naïve adolescents with MDD and fifty-two well-matched healthy controls (HCs), we calculated an INT by assessing the magnitude of autocorrelation of the resting-state brain activity, and then compared the difference of INT between the two groups. Correlation between abnormal INT and clinical features was performed. We also utilized multivariate pattern analysis to determine whether INT could differentiate MDD patients from HCs at the individual level. RESULT Compared with HCs, patients with MDD showed shorter INT widely distributed in cortical and partial subcortical regions. Interestingly, the decreased INT in the left hippocampus was related to disease severity of MDD. Furthermore, INT can distinguish MDD patients from HCs with the most discriminative regions located in the dorsolateral prefrontal cortex, angular, middle occipital gyrus, and cerebellar posterior lobe. CONCLUSION Our research aids in advancing understanding the brain abnormalities of treatment-naïve adolescents with MDD from the perspective of the local neural dynamics, highlighting the significant role of INT in understanding neurophysiological mechanisms. This study shows that the altered intrinsic timescales of local neural signals widely distributed in higher-order brain cortices regions may be the neurodynamic basis of cognitive and emotional disturbances in MDD patients, and provides preliminary support for the suggestion that these could be used to aid the identification of MDD patients in clinical practice.
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Affiliation(s)
- Ruiping Zheng
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, PR China
| | - Chunxiao Bu
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, PR China
| | - Yuan Chen
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, PR China
| | - Yarui Wei
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, PR China
| | - Bingqian Zhou
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, PR China
| | - Yu Jiang
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, PR China
| | - Chendi Zhu
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Henan University of Chinese Medicine, PR China
| | - Kefan Wang
- Department of Psychiatry, the First Affiliated Hospital of Zhengzhou University, PR China
| | - Caihong Wang
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, PR China
| | - Shuying Li
- Department of Psychiatry, the First Affiliated Hospital of Zhengzhou University, PR China
| | - Shaoqiang Han
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, PR China.
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, PR China.
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, PR China.
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Luo W, Du R, Li Y, Zhang H, Li W, Luo X, Chen Y, Yuan X, Deng J. Identification of genetic features that are associated with amplitude of low-frequency fluctuation changes in schizophrenia using omics analysis. J Neurosci Res 2024; 102:e25297. [PMID: 38361412 DOI: 10.1002/jnr.25297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/14/2023] [Accepted: 01/14/2024] [Indexed: 02/17/2024]
Abstract
Genetic risk for schizophrenia is thought to trigger variation in clinical features of schizophrenia, but biological processes associated with neuronal activity in brain regions remain elusive. In this study, gene expression features were mapped to various sub-regions of the brain by integrating low-frequency amplitude features and gene expression data from the schizophrenia brain and using gene co-expression network analysis of the Allen Transcriptome Atlas of the human brain from six donors to identify genetic features of brain regions and important associations with neuronal features. The results indicate that changes in the dynamic amplitude of low-frequency fluctuation (dALFF) are mainly associated with transcriptome signature factors such as cortical layer synthesis, immune response, and expanded membrane transport. Further modular disease enrichment analysis revealed that the same set of signature genes associated with dALFF levels was enriched for multiple neurological biological processes. Finally, genetic profiling of individual modules identified multiple core genes closely related to schizophrenia, also potentially associated with neuronal activity. Thus, this paper explores genetic features of brain regions in the schizophrenia closely related to low-frequency amplitude ratio levels based on imaging genetics, which suggests structural endophenotypes associated with schizophrenia.
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Affiliation(s)
- Wei Luo
- College of Mathematics and Informatics, South China Agricultural University, Guangzhou, China
- Pazhou Lab, Guangzhou, China
| | - Ruolan Du
- College of Mathematics and Informatics, South China Agricultural University, Guangzhou, China
- Pazhou Lab, Guangzhou, China
| | - Ying Li
- College of Information Engineering, Shanghai Maritime University, Shanghai, China
| | - Hua Zhang
- College of Information Engineering, Shanghai Maritime University, Shanghai, China
| | - Weixin Li
- College of Mathematics and Informatics, South China Agricultural University, Guangzhou, China
| | - Xiaoqi Luo
- College of Mathematics and Informatics, South China Agricultural University, Guangzhou, China
| | - Yunying Chen
- College of Mathematics and Informatics, South China Agricultural University, Guangzhou, China
| | - Xinying Yuan
- College of Mathematics and Informatics, South China Agricultural University, Guangzhou, China
| | - Jin Deng
- College of Mathematics and Informatics, South China Agricultural University, Guangzhou, China
- Pazhou Lab, Guangzhou, China
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Lu F, Cui Q, Zou Y, Guo Y, Luo W, Yu Y, Gao J, Cai X, Fu L, Yuan S, Huang J, Zhang Y, Xie J, Sheng W, Tang Q, Gao Q, He Z, Chen H. Effects of rTMS Intervention on Functional Neuroimaging Activities in Adolescents with Major Depressive Disorder Measured Using Resting-State fMRI. Bioengineering (Basel) 2023; 10:1374. [PMID: 38135965 PMCID: PMC10740826 DOI: 10.3390/bioengineering10121374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/10/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex (L-DLPFC) is commonly used for the clinical treatment of major depressive disorder (MDD). The neuroimaging biomarkers and mechanisms of rTMS are still not completely understood. This study aimed to explore the functional neuroimaging changes induced by rTMS in adolescents with MDD. A total of ten sessions of rTMS were administrated to the L-DLPFC in thirteen adolescents with MDD once a day for two weeks. All of them were scanned using resting-state functional magnetic resonance imaging at baseline and after rTMS treatment. The regional homogeneity (ReHo), amplitude of low-frequency fluctuation (ALFF), and the subgenual anterior cingulate cortex (sgACC)-based functional connectivity (FC) were computed as neuroimaging indicators. The correlation between changes in the sgACC-based FC and the improvement in depressive symptoms was also analyzed. After rTMS treatment, ReHo and ALFF were significantly increased in the L-DLPFC, the left medial prefrontal cortex, bilateral medial orbital frontal cortex, and the left ACC. ReHo and ALFF decreased mainly in the left middle occipital gyrus, the right middle cingulate cortex (MCC), bilateral calcarine, the left cuneus, and the left superior occipital gyrus. Furthermore, the FCs between the left sgACC and the L-DLPFC, the right IFGoper, the left MCC, the left precuneus, bilateral post-central gyrus, the left supplementary motor area, and the left superior marginal gyrus were enhanced after rTMS treatment. Moreover, the changes in the left sgACC-left MCC FC were associated with an improvement in depressive symptoms in early improvers. This study showed that rTMS treatment in adolescents with MDD causes changes in brain activities and sgACC-based FC, which may provide basic neural biomarkers for rTMS clinical trials.
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Affiliation(s)
- Fengmei Lu
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Qian Cui
- School of Public Affairs and Administration, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Yang Zou
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Yuanhong Guo
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Wei Luo
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Yue Yu
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Jingjing Gao
- School of Information and Communication Engineering, University of Electronic Science and Technology of China, Chengdu 611731, China;
| | - Xiao Cai
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Linna Fu
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Shuai Yuan
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Juan Huang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Yajun Zhang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Jing Xie
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Wei Sheng
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Qin Tang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Qing Gao
- School of Mathematical Sciences, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Zongling He
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Huafu Chen
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
- MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, China
- High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu 611731, China
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Chen X, Chen H, Liu J, Tang H, Zhou J, Liu P, Tian Y, Wang X, Lu F, Zhou J. Functional connectivity alterations in reward-related circuits associated with non-suicidal self-injury behaviors in drug-naïve adolescents with depression. J Psychiatr Res 2023; 163:270-277. [PMID: 37244065 DOI: 10.1016/j.jpsychires.2023.05.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/26/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023]
Abstract
Non-suicidal self-injury (NSSI) behaviors are a major public health concern among adolescents with depression. Such behaviors may be associated with the reward system. However, the underlying mechanism in patients with depression and NSSI still remains unclear. A total of 56 drug-naïve adolescents with depression, including 23 patients with NSSI (the NSSI group) and 33 patients without NSSI (the nNSSI group), and 25 healthy controls (HCs) were recruited in this study. Seed-based functional connectivity (FC) was used to explore the NSSI-related FC alterations in the reward circuit. Correlation analysis was conducted between the altered FCs and clinical data. Compared with the nNSSI group, the NSSI group showed greater FC between left nucleus accumbens (NAcc) and right lingual gyrus and between right putamen accumbens and right angular gyrus (ANG). The NSSI group also had declined FC between right NAcc and left inferior cerebellum, between left cingulate gyrus (CG) and right ANG, between left CG and left middle temporal gyrus (MTG), and between right CG and bilateral MTG (voxel-wise p < 0.01, cluster-wise p < 0.05, Gaussian random field correction). The FC between right NAcc and left inferior cerebellum was found positively correlated with the score of addictive features of NSSI (r = 0.427, p = 0.042). Our findings indicated that the regions in the reward circuit with NSSI-related FC alterations included bilateral NAcc, right putamen and bilateral CG, which may provide new evidence on the neural mechanisms of NSSI behaviors in adolescents with depression.
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Affiliation(s)
- Xianliang Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Hui Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jiali Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Huajia Tang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jiawei Zhou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Peiqu Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Yusheng Tian
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Xiaoping Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Fengmei Lu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 611731, China.
| | - Jiansong Zhou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Lu F, Guo Y, Luo W, Yu Y, Zhao Y, Chen J, Cai X, Shen C, Wang X, He J, Yang G, Gao Q, He Z, Zhou J. Disrupted functional networks within white-matter served as neural features in adolescent patients with conduct disorder. Behav Brain Res 2023; 447:114422. [PMID: 37030546 DOI: 10.1016/j.bbr.2023.114422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/17/2023] [Accepted: 04/05/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Conduct disorder (CD) has been conceptualized as a psychiatric disorder associated with white-matter (WM) structural abnormalities. Although diffusion tensor imaging could identify WM structural architecture changes, it cannot characterize functional connectivity (FC) within WM. Few studies have focused on disentangling the WM dysfunctions in CD patients by using functional magnetic resonance imaging (fMRI). METHODS The resting-state fMRI data were first obtained from both adolescent CD and typically developing (TD) controls. A voxel-based clustering analysis was utilized to identify the large-scale WM FC networks. Then, we examined the disrupted WM network features in CD, and further investigated whether these features could predict the impulsive symptoms in CD using support vector regression prediction model. RESULTS We identified 11 WM functional networks. Compared with TDs, CD patients showed increased FCs between occipital network (ON) and superior temporal network (STN), between orbitofrontal network (OFN) and corona radiate network (CRN), as well as between deep network and CRN. Further, the disrupted FCs between ON and STN and between OFN and CRN were significantly negatively associated with non-planning impulsivity scores in CD. Moreover, the disrupted WM networks could be served as features to predict the motor impulsivity scores in CD. CONCLUSIONS Our results provided further support on the existence of WM functional networks and could extended our knowledge about the WM functional abnormalities related with emotional and perception processing in CD patients from the view of WM dysfunction.
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Ji J, Liu YY, Wu GW, Hu YL, Liang CH, Wang XD. Changes in dynamic and static brain fluctuation distinguish minimal hepatic encephalopathy and cirrhosis patients and predict the severity of liver damage. Front Neurosci 2023; 17:1077808. [PMID: 37056312 PMCID: PMC10086246 DOI: 10.3389/fnins.2023.1077808] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
PurposeMinimal hepatic encephalopathy (MHE) is characterized by mild neuropsychological and neurophysiological alterations that are not detectable by routine clinical examination. Abnormal brain activity (in terms of the amplitude of low-frequency fluctuation (ALFF) has been observed in MHE patients. However, little is known concerning temporal dynamics of intrinsic brain activity. The present study aimed to investigate the abnormal dynamics of brain activity (dynamic ALFF; dALFF) and static measures [static ALFF; (sALFF)] in MHE patients and to strive for a reliable imaging neuromarkers for distinguishing MHE patients from cirrhosis patients. In addition, the present study also investigated whether intrinsic brain activity predicted the severity of liver damage.MethodsThirty-four cirrhosis patients with MHE, 28 cirrhosis patients without MHE, and 33 age-, sex-, and education-matched healthy controls (HCs) underwent resting-state magnetic resonance imaging (rs-fMRI). dALFF was estimated by combining the ALFF method with the sliding-window method, in which temporal variability was quantized over the whole-scan timepoints and then compared among the three groups. Additionally, dALFF, sALFF and both two features were utilized as classification features in a support vector machine (SVM) to distinguish MHE patients from cirrhosis patients. The severity of liver damage was reflected by the Child–Pugh score. dALFF, sALFF and both two features were used to predict Child–Pugh scores in MHE patients using a general linear model.ResultsCompared with HCs, MHE patients showed significantly increased dALFF in the left inferior occipital gyrus, right middle occipital gyrus, and right insula; increased dALFF was also observed in the right posterior lobe of the cerebellum (CPL) and right thalamus. Compared with HCs, noMHE patients exhibited decreased dALFF in the right precuneus. In contrast, compared with noMHE patients, MHE patients showed increased dALFF in the right precuneus, right superior frontal gyrus, and right superior occipital gyrus. Furthermore, the increased dALFF values in the left precuneus were positively associated with poor digit-symbol test (DST) scores (r = 0.356, p = 0.038); however, dALFF in the right inferior temporal gyrus (ITG) was negatively associated with the number connection test–A (NCT-A) scores (r = -0.784, p = 0.000). A significant positive correlation was found between dALFF in the left inferior occipital gyrus (IOG) and high blood ammonia levels (r = 0.424, p = 0.012). Notably, dALFF values yielded a higher classification accuracy than sALFF values in distinguishing MHE patients from cirrhosis patients. Importantly, the dALFF values predicted the Child–Pugh score (r = 0.140, p = 0.030), whereas sALFF values did not in the current dataset. Combining two features had high accuracy in classification in distinguishing MHE patients from cirrhotic patients and yielded prediction in the severity of liver damage.ConclusionThese findings suggest that combining dALFF and sALFF features is a useful neuromarkers for distinguishing MHE patients from cirrhosis patients and highlights the important role of dALFF feature in predicting the severity of liver damage in MHE.
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Affiliation(s)
- Jiang Ji
- Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, China
- Department of Radiology, The First Affiliated Hospital of Xinxiang Medical College, Xinxiang, China
| | - Yi-yang Liu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guo-Wei Wu
- Chinese Institute for Brain Research, Beijing, China
| | - Yan-Long Hu
- Department of Radiology, The First Affiliated Hospital of Xinxiang Medical College, Xinxiang, China
| | - Chang-Hua Liang
- Department of Radiology, The First Affiliated Hospital of Xinxiang Medical College, Xinxiang, China
- *Correspondence: Chang-Hua Liang,
| | - Xiao-dong Wang
- Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, China
- Xiao-dong Wang,
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Lu F, Chen Y, Cui Q, Guo Y, Pang Y, Luo W, Yu Y, Chen J, Gao J, Sheng W, Tang Q, Zeng Y, Jiang K, Gao Q, He Z, Chen H. Shared and distinct patterns of dynamic functional connectivity variability of thalamo-cortical circuit in bipolar depression and major depressive disorder. Cereb Cortex 2023:6987621. [PMID: 36642500 DOI: 10.1093/cercor/bhac534] [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: 11/23/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/17/2023] Open
Abstract
Evidence has indicated abnormalities of thalamo-cortical functional connectivity (FC) in bipolar disorder during a depressive episode (BDD) and major depressive disorder (MDD). However, the dynamic FC (dFC) within this system is poorly understood. We explored the thalamo-cortical dFC pattern by dividing thalamus into 16 subregions and combining with a sliding-window approach. Correlation analysis was performed between altered dFC variability and clinical data. Classification analysis with a linear support vector machine model was conducted. Compared with healthy controls (HCs), both patients revealed increased dFC variability between thalamus subregions with hippocampus (HIP), angular gyrus and caudate, and only BDD showed increased dFC variability of the thalamus with superior frontal gyrus (SFG), HIP, insula, middle cingulate gyrus, and postcentral gyrus. Compared with MDD and HCs, only BDD exhibited enhanced dFC variability of the thalamus with SFG and superior temporal gyrus. Furthermore, the number of depressive episodes in MDD was significantly positively associated with altered dFC variability. Finally, the disrupted dFC variability could distinguish BDD from MDD with 83.44% classification accuracy. BDD and MDD shared common disrupted dFC variability in the thalamo-limbic and striatal-thalamic circuitries, whereas BDD exhibited more extensive and broader aberrant dFC variability, which may facilitate distinguish between these 2 mood disorders.
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Affiliation(s)
- Fengmei Lu
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Yingmenkou Road, Jinniu District, 611731, PR China
| | - Yanchi Chen
- Glasgow College, University of Electronic Science and Technology of China, Chengdu, No. 2006, Xiyuan Ave, West Hi-Tech Zone, 611731, PR China
| | - Qian Cui
- School of Public Affairs and Administration, University of Electronic Science and Technology of China, Chengdu, No. 2006, Xiyuan Ave, West Hi-Tech Zone, 611731, PR China
| | - Yuanhong Guo
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Yingmenkou Road, Jinniu District, 611731, PR China
| | - Yajing Pang
- School of Electrical Engineering, Zhengzhou University, Zhengzhou, No. 100 Science Avenue, High-tech Zone, 450001, PR China
| | - Wei Luo
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Yingmenkou Road, Jinniu District, 611731, PR China
| | - Yue Yu
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Yingmenkou Road, Jinniu District, 611731, PR China
| | - Jiajia Chen
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Yingmenkou Road, Jinniu District, 611731, PR China
| | - Jingjing Gao
- School of Information and Communication Engineering, University of Electronic Science and Technology of China, Chengdu, No. 2006, Xiyuan Ave, West Hi-Tech Zone, 611731, China
| | - Wei Sheng
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Yingmenkou Road, Jinniu District, 611731, PR China
| | - Qin Tang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Yingmenkou Road, Jinniu District, 611731, PR China
| | - Yuhong Zeng
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Yingmenkou Road, Jinniu District, 611731, PR China
| | - Kexing Jiang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Yingmenkou Road, Jinniu District, 611731, PR China
| | - Qing Gao
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Yingmenkou Road, Jinniu District, 611731, PR China.,School of Mathematical Sciences, University of Electronic Science and Technology of China, Chengdu, No. 2006, Xiyuan Ave, West Hi-Tech Zone, 611731, PR China
| | - Zongling He
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Yingmenkou Road, Jinniu District, 611731, PR China
| | - Huafu Chen
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Yingmenkou Road, Jinniu District, 611731, PR China.,MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, No. 2006, Xiyuan Ave, West Hi-Tech Zone, 611731, PR China
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8
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He Z, Lu F. Commentary: Aberrant dynamic functional connectivity of posterior cingulate cortex subregions in major depressive disorder with suicidal ideation. Front Neurosci 2022; 16:1012050. [PMID: 36188483 PMCID: PMC9523315 DOI: 10.3389/fnins.2022.1012050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/29/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Zongling He
- The Fourth People's Hospital of Chengdu, Chengdu, China
- Chengdu Mental Health Center, Chengdu, China
| | - Fengmei Lu
- The Fourth People's Hospital of Chengdu, Chengdu, China
- Chengdu Mental Health Center, Chengdu, China
- *Correspondence: Fengmei Lu
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9
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Yang Y, Zhao R, Zhang F, Bai R, Li S, Cui R, Liu S, Xu J. Dynamic changes of amplitude of low-frequency in systemic lupus erythematosus patients with cognitive impairment. Front Neurosci 2022; 16:929383. [PMID: 36081656 PMCID: PMC9447953 DOI: 10.3389/fnins.2022.929383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/01/2022] [Indexed: 11/21/2022] Open
Abstract
Background Cognitive dysfunction (CI) is frequently reported in patients with systemic lupus erythematosus (SLE), but the identification and assessment of SLE-related CI remain challenging. Previous studies have focused on changes in static brain activity, and no studies have investigated the characteristics of dynamic brain activity in SLE patients with CI. Objects We calculated the dynamic amplitude of low-frequency fluctuation (dALFF) by combining the ALFF with a sliding window method to assess the temporal variability of brain functional activity in SLE patients with and without CI. Methods Thirty-eight SLE with CI, thirty-eight SLE without CI, and thirty-eight healthy controls (HCs) were recruited. By comparing static ALFF (sALFF) and dALFF among the three groups, changes in brain activity intensity and its temporal variability were assessed in patients with SLE with or without CI. Spearman correlation coefficients were calculated between the brain function indicator and Mini-mental State Examination (MMSE) scores of SLE with CI. Results Subjects among the three groups exhibited significant sALFF differences in the right parahippocampal gyrus, left caudate nucleus, right putamen, and left cuneus. Compared to the SLE without CI, the right parahippocampal gyrus exhibited higher sALFF in the SLE with CI group. Compared to the HCs, the left caudate nucleus exhibited increased sALFF in the SLE with CI group. Participants in the three groups exhibited significant dALFF variability in the right parahippocampal gyrus, right lingual gyrus, and bilateral inferior occipital gyrus. Compared to the HCs, the right lingual gyrus exhibited reduced dALFF in the SLE without CI group. Compared to the HCs, the right parahippocampal gyrus exhibited increased dALFF, left calcarine fissure, and the surrounding cortex exhibited reduced dALFF in the SLE with CI group. There was no significant correlation between the MMSE score, sALFF, and dALFF in the SLE with CI group. Conclusion SLE patients with CI have abnormal brain activity intensity and stability. By analyzing the dynamics of intrinsic brain activity, it provides a new idea for evaluating SLE-related CI. However, more research and validation with multiple metrics are needed to determine the link between the severity of cognitive impairment (CI) and brain activity in patients with SLE.
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Affiliation(s)
- Yifan Yang
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ruotong Zhao
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Fengrui Zhang
- Department of Magnetic Resonance Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ru Bai
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shu Li
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ruomei Cui
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shuang Liu
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jian Xu
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
- *Correspondence: Jian Xu,
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10
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Tian N, Liang L, Luo X, Hu R, Long W, Song R. More than just statics: Altered complexity of dynamic amplitude of low-frequency fluctuations in the resting brain after stroke. J Neural Eng 2022; 19. [PMID: 35594839 DOI: 10.1088/1741-2552/ac71ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/20/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Previous neuroimaging studies mainly focused on static characteristics of brain activity, and little is known about its characteristics over time, especially in post-stroke (PS) patients. In this study, we aimed to investigate the static and dynamic characteristics of brain activity after stroke using functional magnetic resonance imaging (fMRI). APPROACH Twenty ischemic PS patients and nineteen healthy controls (HCs) were recruited to receive a resting-state fMRI scanning. The static amplitude of low-frequency fluctuations (sALFF) and fuzzy entropy of dynamic ALFF (FE-dALFF) were applied to identify the stroke-induced alterations. MAIN RESULTS Compared with the HCs, PS patients showed significantly increased FE-dALFF values in the right angular gyrus (ANG), bilateral precuneus (PCUN), and right inferior parietal lobule (IPL) as well as significantly decreased FE-dALFF values in the right postcentral gyrus (PoCG), right dorsolateral superior frontal gyrus (SFGdor), and right precentral gyrus (PreCG). The ROC analyses demonstrated that FE-dALFF and sALFF possess comparable sensitivity in distinguishing PS patients from the HCs. Moreover, a significantly positive correlation was observed between the FE-dALFF values and the Fugl-Meyer Assessment (FMA) scores in the right SFGdor (r =0.547), right IPL (r =0.522), and right PCUN (r =0.486). SIGNIFICANCE This study provided insight into the stroke-induced alterations in static and dynamic characteristics of local brain activity, highlighting the potential of FE-dALFF in understanding neurophysiological mechanisms and evaluating pathological changes.
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Affiliation(s)
- Na Tian
- Sun Yat-Sen University, Higher Mega Education Center, Guangzhou, Guangdong, 510006, CHINA
| | - Liuke Liang
- School of Biomedical Engineering, Sun Yat-Sen University, Higher Mega Education Center, Guangzhou, Guangdong, 510006, CHINA
| | - Xuemao Luo
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, CN, Jiangmen, Guangdong, 529030, CHINA
| | - Rongliang Hu
- Department of Rehabilitation Medicine, Jiangmen Central Hospital, Jiangmen, Guangdong, CN, Jiangmen, Guangdong, 529030, CHINA
| | - Wansheng Long
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, CN, Jiangmen, Guangdong, 529030, CHINA
| | - Rong Song
- Biomedical Engineering, National Sun Yat-sen University, Higher Mega Education Center, Guangzhou, 510006, CHINA
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11
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Prefrontal-limbic-striatum dysconnectivity associated with negative emotional endophenotypes in bipolar disorder during depressive episodes. J Affect Disord 2021; 295:422-430. [PMID: 34507222 DOI: 10.1016/j.jad.2021.08.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/24/2021] [Accepted: 08/21/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND The prefrontal-limbic-subcortical network has been suggested as an important circuitry in the pathophysiology underlying bipolar disorder during depressive episodes (BDD). However, the relationships between disrupted prefrontal-limbic-subcortical connection and the emotional endophenotypes in BDD patients remain largely unclear. METHODS Forty-three BDD patients and 63 matched healthy controls (HCs) underwent the resting-state functional magnetic resonance imaging scan. The altered clusters were first identified by using a spatial pairwise clustering method and then were extracted as regions of interest to calculate the functional connectivity (FC). Group comparisons were conducted to identify the abnormal FCs. Classification analysis was employed to examine whether the altered FCs could distinguish BDD from HCs. The relationships between FC alterations and the emotional endophenotypes as measured by the Affective Neuroscience Personality Scales (ANPS) were further detected in BDD. RESULTS Compared with HCs, BDD patients showed abnormal FCs in the prefrontal-limbic-striatum circuit. Importantly, the altered FCs yielded 84.91% accuracy (p< 1/5000) with 93.65% sensitivity and 72.09% specificity in differentiating between BDD and HCs. Moreover, the decreased FCs in the prefrontal-striatum and prefrontal-limbic systems were positively correlated with negative emotional endophenotypes of Sadness and Fear scores. CONCLUSIONS The findings demonstrated that prefrontal-limbic-striatum disconnection may be identified as a potential effective biomarker for BDD, which could help further explain the neurobiological mechanisms underlying BDD.
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12
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Zheng R, Chen Y, Jiang Y, Wen M, Zhou B, Li S, Wei Y, Yang Z, Wang C, Cheng J, Zhang Y, Han S. Dynamic Altered Amplitude of Low-Frequency Fluctuations in Patients With Major Depressive Disorder. Front Psychiatry 2021; 12:683610. [PMID: 34349681 PMCID: PMC8328277 DOI: 10.3389/fpsyt.2021.683610] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/14/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Major depressive disorder (MDD) has demonstrated abnormalities of static intrinsic brain activity measured by amplitude of low-frequency fluctuation (ALFF). Recent studies regarding the resting-state functional magnetic resonance imaging (rs-fMRI) have found the brain activity is inherently dynamic over time. Little is known, however, regarding the temporal dynamics of local neural activity in MDD. Here, we investigated whether temporal dynamic changes in spontaneous neural activity are influenced by MDD. Methods: We recruited 81 first-episode, drug-naive MDD patients and 64 age-, gender-, and education-matched healthy controls who underwent rs-fMRI. A sliding-window approach was then adopted for the estimation of dynamic ALFF (dALFF), which was used to measure time-varying brain activity and then compared between the two groups. The relationship between altered dALFF variability and clinical variables in MDD patients was also analyzed. Results: MDD patients showed increased temporal variability (dALFF) mainly focused on the bilateral thalamus, the bilateral superior frontal gyrus, the right middle frontal gyrus, the bilateral cerebellum posterior lobe, and the vermis. Furthermore, increased dALFF variability values in the right thalamus and right cerebellum posterior lobe were positively correlated with MDD symptom severity. Conclusions: The overall results suggest that altered temporal variability in corticocerebellar-thalamic-cortical circuit (CCTCC), involved in emotional, executive, and cognitive, is associated with drug-naive, first-episode MDD patients. Moreover, our study highlights the vital role of abnormal dynamic brain activity in the cerebellar hemisphere associated with CCTCC in MDD patients. These findings may provide novel insights into the pathophysiological mechanisms of MDD.
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Affiliation(s)
- Ruiping Zheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuan Chen
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu Jiang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengmeng Wen
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bingqian Zhou
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuying Li
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yarui Wei
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhengui Yang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Caihong Wang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shaoqiang Han
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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13
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Sun F, Liu Z, Yang J, Fan Z, Yang J. Differential Dynamical Pattern of Regional Homogeneity in Bipolar and Unipolar Depression: A Preliminary Resting-State fMRI Study. Front Psychiatry 2021; 12:764932. [PMID: 34966303 PMCID: PMC8710770 DOI: 10.3389/fpsyt.2021.764932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Bipolar depression (BD) and unipolar depression (UD) are both characterized by depressive moods, which are difficult to distinguish in clinical practice. Human brain activity is time-varying and dynamic. Investigating dynamical pattern alterations of depressed brains can provide deep insights into the pathophysiological features of depression. This study aimed to explore similar and different abnormal dynamic patterns between BD and UD. Methods: Brain resting-state functional magnetic resonance imaging data were acquired from 36 patients with BD type I (BD-I), 38 patients with UD, and 42 healthy controls (HCs). Analysis of covariance was adopted to examine the differential pattern of the dynamical regional homogeneity (dReHo) temporal variability across 3 groups, with gender, age, and education level as covariates. Post-hoc analyses were employed to obtain the different dynamic characteristics between any 2 groups. We further applied the machine-learning methods to classify BD-I from UD by using the detected distinct dReHo pattern. Results: Compared with patients with UD, patients with BD-I demonstrated decreased dReHo variability in the right postcentral gyrus and right parahippocampal gyrus. By using the dReHo variability pattern of these two regions as features, we achieved the 91.89% accuracy and 0.92 area under curve in classifying BD-I from UD. Relative to HCs, patients with UD showed increased dReHo variability in the right postcentral gyrus, while there were no dReHo variability differences in patients with BD-I. Conclusions: The results of this study mainly report the differential dynamic pattern of the regional activity between BD-I and UD, particular in the mesolimbic system, and show its promising potential in assisting the diagnosis of these two depression groups.
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Affiliation(s)
- Fuping Sun
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhening Liu
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jun Yang
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zebin Fan
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jie Yang
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
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