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Feng T, Zhao C, Rao JS, Guo XJ, Bao SS, He LW, Zhao W, Liu Z, Yang ZY, Li XG. Different macaque brain network remodeling after spinal cord injury and NT3 treatment. iScience 2023; 26:106784. [PMID: 37378337 PMCID: PMC10291247 DOI: 10.1016/j.isci.2023.106784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 03/08/2023] [Accepted: 04/26/2023] [Indexed: 06/29/2023] Open
Abstract
Graph theory-based analysis describes the brain as a complex network. Only a few studies have examined modular composition and functional connectivity (FC) between modules in patients with spinal cord injury (SCI). Little is known about the longitudinal changes in hubs and topological properties at the modular level after SCI and treatment. We analyzed differences in FC and nodal metrics reflecting modular interaction to investigate brain reorganization after SCI-induced compensation and neurotrophin-3 (NT3)-chitosan-induced regeneration. Mean inter-modular FC and participation coefficient of areas related to motor coordination were significantly higher in the treatment animals than in the SCI-only ones at the late stage. The magnocellular part of the red nucleus may reflect the best difference in brain reorganization after SCI and therapy. Treatment can enhance information flows between regions and promote the integration of motor functions to return to normal. These findings may reveal the information processing of disrupted network modules.
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Affiliation(s)
- Ting Feng
- School of Biological Science and Medical Engineering, Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, PR China
| | - Can Zhao
- Institute of Rehabilitation Engineering, China Rehabilitation Science Institute, Beijing, PR China
| | - Jia-Sheng Rao
- School of Biological Science and Medical Engineering, Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, PR China
| | - Xiao-Jun Guo
- School of Biological Science and Medical Engineering, Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, PR China
| | - Shu-Sheng Bao
- School of Biological Science and Medical Engineering, Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, PR China
| | - Le-Wei He
- School of Biological Science and Medical Engineering, Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, PR China
| | - Wen Zhao
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, PR China
| | - Zuxiang Liu
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, PR China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, PR China
- Department of Biology, College of Life Sciences, University of Chinese Academy of Sciences, Beijing, PR China
| | - Zhao-Yang Yang
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, PR China
| | - Xiao-Guang Li
- School of Biological Science and Medical Engineering, Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, PR China
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Rao JS, Zhao C, Wei RH, Feng T, Bao SS, Zhao W, Tian Z, Liu Z, Yang ZY, Li XG. Neural regeneration therapy after spinal cord injury induces unique brain functional reorganizations in rhesus monkeys. Ann Med 2022; 54:1867-1883. [PMID: 35792748 PMCID: PMC9272921 DOI: 10.1080/07853890.2022.2089728] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
PURPOSE Spinal cord injury (SCI) destroys the sensorimotor pathway and induces brain plasticity. However, the effect of treatment-induced spinal cord tissue regeneration on brain functional reorganization remains unclear. This study was designed to investigate the large-scale functional interactions in the brains of adult female Rhesus monkeys with injured and regenerated thoracic spinal cord. MATERIALS AND METHODS Resting-state functional magnetic resonance imaging (fMRI) combined with Granger Causality analysis (GCA) and motor behaviour analysis were used to assess the causal interaction between sensorimotor cortices, and calculate the relationship between causal interaction and hindlimb stepping in nine Rhesus monkeys undergoing lesion-induced spontaneous recovery (injured, n = 4) and neurotrophin-3/chitosan transplantation-induced regeneration (NT3-chitosan, n = 5) after SCI. RESULTS The results showed that the injured and NT3-chitosan-treated animals had distinct spatiotemporal features of brain functional reorganization. The spontaneous recovery followed the model of "early intra-hemispheric reorganization dominant, late inter-hemispheric reorganization dominant", whereas regenerative therapy animals showed the opposite trend. Although the variation degree of information flow intensity was consistent, the tendency and the relationship between local neuronal activity properties and coupling strength were different between the two groups. In addition, the injured and NT3-chitosan-treated animals had similar motor adjustments but various relationship modes between motor performance and information flow intensity. CONCLUSIONS Our findings show that brain functional reorganization induced by regeneration therapy differed from spontaneous recovery after SCI. The influence of unique changes in brain plasticity on the therapeutic effects of future regeneration therapy strategies should be considered. Key messagesNeural regeneration elicited a unique spatiotemporal mode of brain functional reorganization in the spinal cord injured monkeys, and that regeneration does not simply reverse the process of brain plasticity induced by spinal cord injury (SCI).Independent "properties of local activity - intensity of information flow" relationships between the injured and treated animals indicating that spontaneous recovery and regenerative therapy exerted different effects on the reorganization of the motor network after SCI.A specific information flow from the left thalamus to the right insular can serve as an indicator to reflect a heterogeneous "information flow - motor performance" relationship between injured and treated animals at similar motor adjustments.
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Affiliation(s)
- Jia-Sheng Rao
- School of Biological Science and Medical Engineering, Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, PR China
| | - Can Zhao
- Institute of Rehabilitation Engineering, China Rehabilitation Science Institute, Beijing, PR China
| | - Rui-Han Wei
- School of Biological Science and Medical Engineering, Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, PR China
| | - Ting Feng
- School of Biological Science and Medical Engineering, Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, PR China
| | - Shu-Sheng Bao
- School of Biological Science and Medical Engineering, Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, PR China
| | - Wen Zhao
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, PR China
| | - Zhaolong Tian
- Department of Anesthesiology, Xuanwu Hospital Capital Medical University, Beijing, PR China
| | - Zuxiang Liu
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, PR China.,Hefei Comprehensive National Science Center, Institute of Artificial Intelligence, Hefei, PR China.,Department of Biology, College of Life Sciences, University of Chinese Academy of Sciences, Beijing, PR China
| | - Zhao-Yang Yang
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, PR China
| | - Xiao-Guang Li
- School of Biological Science and Medical Engineering, Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, PR China
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Cerebral blood flow and cardiovascular risk effects on resting brain regional homogeneity. Neuroimage 2022; 262:119555. [PMID: 35963506 PMCID: PMC10044499 DOI: 10.1016/j.neuroimage.2022.119555] [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: 06/09/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 11/22/2022] Open
Abstract
Regional homogeneity (ReHo) is a measure of local functional brain connectivity that has been reported to be altered in a wide range of neuropsychiatric disorders. Computed from brain resting-state functional MRI time series, ReHo is also sensitive to fluctuations in cerebral blood flow (CBF) that in turn may be influenced by cerebrovascular health. We accessed cerebrovascular health with Framingham cardiovascular risk score (FCVRS). We hypothesize that ReHo signal may be influenced by regional CBF; and that these associations can be summarized as FCVRS→CBF→ReHo. We used three independent samples to test this hypothesis. A test-retest sample of N = 30 healthy volunteers was used for test-retest evaluation of CBF effects on ReHo. Amish Connectome Project (ACP) sample (N = 204, healthy individuals) was used to evaluate association between FCVRS and ReHo and testing if the association diminishes given CBF. The UKBB sample (N = 6,285, healthy participants) was used to replicate the effects of FCVRS on ReHo. We observed strong CBF→ReHo links (p<2.5 × 10-3) using a three-point longitudinal sample. In ACP sample, marginal and partial correlations analyses demonstrated that both CBF and FCVRS were significantly correlated with the whole-brain average (p<10-6) and regional ReHo values, with the strongest correlations observed in frontal, parietal, and temporal areas. Yet, the association between ReHo and FCVRS became insignificant once the effect of CBF was accounted for. In contrast, CBF→ReHo remained significantly linked after adjusting for FCVRS and demographic covariates (p<10-6). Analysis in N = 6,285 replicated the FCVRS→ReHo effect (p = 2.7 × 10-27). In summary, ReHo alterations in health and neuropsychiatric illnesses may be partially driven by region-specific variability in CBF, which is, in turn, influenced by cardiovascular factors.
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Bao SS, Zhao C, Chen HW, Feng T, Guo XJ, Xu M, Rao JS. NT3 treatment alters spinal cord injury-induced changes in the gray matter volume of rhesus monkey cortex. Sci Rep 2022; 12:5919. [PMID: 35396344 PMCID: PMC8993853 DOI: 10.1038/s41598-022-09981-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/01/2022] [Indexed: 11/18/2022] Open
Abstract
Spinal cord injury (SCI) may cause structural alterations in brain due to pathophysiological processes, but the effects of SCI treatment on brain have rarely been reported. Here, voxel-based morphometry is employed to investigate the effects of SCI and neurotrophin-3 (NT3) coupled chitosan-induced regeneration on brain and spinal cord structures in rhesus monkeys. Possible association between brain and spinal cord structural alterations is explored. The pain sensitivity and stepping ability of animals are collected to evaluate sensorimotor functional alterations. Compared with SCI, the unique effects of NT3 treatment on brain structure appear in extensive regions which involved in motor control and neuropathic pain, such as right visual cortex, superior parietal lobule, left superior frontal gyrus (SFG), middle frontal gyrus, inferior frontal gyrus, insula, secondary somatosensory cortex, anterior cingulate cortex, and bilateral caudate nucleus. Particularly, the structure of insula is significantly correlated with the pain sensitivity. Regenerative treatment also shows a protective effect on spinal cord structure. The associations between brain and spinal cord structural alterations are observed in right primary somatosensory cortex, SFG, and other regions. These results help further elucidate secondary effects on brain of SCI and provide a basis for evaluating the effects of NT3 treatment on brain structure.
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Affiliation(s)
- Shu-Sheng Bao
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Can Zhao
- Institute of Rehabilitation Engineering, China Rehabilitation Science Institute, Beijing, 100068, China. .,School of Rehabilitation, Capital Medical University, Beijing, 100068, China.
| | - Hao-Wei Chen
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Ting Feng
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Xiao-Jun Guo
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Meng Xu
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, 100853, China.
| | - Jia-Sheng Rao
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China.
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Kim AR, Cha H, Kim E, Kim S, Lee HJ, Park E, Lee YS, Jung TD, Chang Y. Impact of fractional amplitude of low-frequency fluctuations in motor- and sensory-related brain networks on spinal cord injury severity. NMR IN BIOMEDICINE 2022; 35:e4612. [PMID: 34505321 DOI: 10.1002/nbm.4612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 06/13/2023]
Abstract
Spinal cord injury (SCI) can cause motor, sensory, and autonomic dysfunctions and may affect the cerebral functions. However, the mechanisms of plastic changes in the brain according to SCI severity remain poorly understood. Therefore, in the current study, we compared the brain activity of the entire neural network according to severity of SCI using fractional amplitude of low-frequency fluctuations (fALFF) analysis in resting-state functional magnetic resonance imaging (rs-fMRI). A total of 59 participants were included, consisting of 19 patients with complete SCI, 20 patients with incomplete SCI, and 20 healthy individuals. Their motor and sensory functions were evaluated. The rs-fMRI data of low-frequency fluctuations were analyzed based on fALFF. Differences in fALFF values among complete-SCI patients, incomplete-SCI patients, and healthy controls were assessed using ANOVA. Then post hoc analysis and two-sample t-tests were conducted to assess the differences between the three groups. Pearson correlation analyses were used to determine correlations between clinical measures and the z-score of the fALFF in the SCI groups. Patients with SCI (complete and incomplete) showed lower fALFF values in the superior medial frontal gyrus than the healthy controls, and were associated with poor motor and sensory function (p < .05). Higher fALFF values were observed in the putamen and thalamus, and were negatively associated with motor and sensory function (p < .05). In conclusion, alterations in the neural activity of the motor- and sensory-related networks of the brain were observed in complete-SCI and incomplete-SCI patients. Moreover, plastic changes in these brain regions were associated with motor and sensory function.
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Affiliation(s)
- Ae Ryoung Kim
- Department of Physical Medicine and Rehabilitation, Kyungpook National University School of Medicine, South Korea
- Department of Physical Medicine and Rehabilitation, Kyungpook National University Hospital, South Korea
| | - Hyunsil Cha
- Department of Medical & Biological Engineering, Kyungpook National University, South Korea
| | - Eunji Kim
- Department of Medical & Biological Engineering, Kyungpook National University, South Korea
| | - Seungho Kim
- Department of Medical & Biological Engineering, Kyungpook National University, South Korea
| | - Hui Joong Lee
- Department of Radiology, Kyungpook National University School of Medicine, South Korea
- Department of Radiology, Kyungpook National University Hospital, South Korea
| | - Eunhee Park
- Department of Physical Medicine and Rehabilitation, Kyungpook National University School of Medicine, South Korea
- Department of Physical Medicine and Rehabilitation, Kyungpook National University Hospital, South Korea
| | - Yang-Soo Lee
- Department of Physical Medicine and Rehabilitation, Kyungpook National University School of Medicine, South Korea
- Department of Physical Medicine and Rehabilitation, Kyungpook National University Hospital, South Korea
| | - Tae-Du Jung
- Department of Physical Medicine and Rehabilitation, Kyungpook National University School of Medicine, South Korea
- Department of Physical Medicine and Rehabilitation, Kyungpook National University Hospital, South Korea
| | - Yongmin Chang
- Department of Medical & Biological Engineering, Kyungpook National University, South Korea
- Department of Radiology, Kyungpook National University Hospital, South Korea
- The Department of Molecular Medicine, Kyungpook National University School of Medicine, South Korea
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Cao Y, Zhan Y, Du M, Zhao G, Liu Z, Zhou F, He L. Disruption of human brain connectivity networks in patients with cervical spondylotic myelopathy. Quant Imaging Med Surg 2021; 11:3418-3430. [PMID: 34341720 DOI: 10.21037/qims-20-874] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 03/08/2021] [Indexed: 02/05/2023]
Abstract
Background Brain functional plasticity and reorganization in patients with cervical spondylotic myelopathy (CSM) is increasingly being explored and validated. However, specific topological alterations in functional networks and their role in CSM brain functional reorganization remain unclear. This study investigates the topological architecture of intrinsic brain functional networks in CSM patients using graph theory. Methods Functional MRI was conducted on 67 CSM patients and 60 healthy controls (HCs). The topological organization of the whole-brain functional network was then calculated using theoretical graph analysis. The difference in categorical variables between groups was compared using a chi-squared test, while that between continuous variables was evaluated using a two-sample t-test. Nonparametric permutation tests were used to compare network measures between the two groups. Results Small-world architecture in functional brain networks were identified in both CSM patients and HCs. Compared with HCs, CSM patients showed a decreased area under the curve (AUC) of the characteristic path length (FDR q=0.040), clustering coefficient (FDR q=0.037), and normalized characteristic path length (FDR q=0.038) of the network. In contrast, there was an increased AUC of normalized clustering coefficient (FDR q=0.014), small-worldness (FDR q=0.009), and global network efficiency (FDR q=0.027) of the network. In local brain regions, nodal topological properties revealed group differences which were predominantly in the default-mode network (DMN), left postcentral gyrus, bilateral putamen, lingual gyrus, and posterior cingulate gyrus. Conclusions This study reported altered functional topological organization in CSM patients. Decreased nodal centralities in the visual cortex and sensory-motor regions may indicate sensory-motor dysfunction and blurred vision. Furthermore, increased nodal centralities in the cerebellum may be compensatory for sensory-motor dysfunction in CSM, while the increased DMN may indicate increased psychological processing in CSM patients.
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Affiliation(s)
- Yuan Cao
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China.,Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yaru Zhan
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, China
| | - Miao Du
- College of Electrical Engineering of Sichuan University, Chengdu, China
| | - Guoshu Zhao
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, China
| | - Zhili Liu
- Department of Orthopedic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fuqing Zhou
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, China
| | - Laichang He
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, China
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Liu M, Tan Y, Zhang C, He L. Cortical anatomy plasticity in cases of cervical spondylotic myelopathy associated with decompression surgery: A strobe-compliant study of structural magnetic resonance imaging. Medicine (Baltimore) 2021; 100:e24190. [PMID: 33530210 PMCID: PMC7850749 DOI: 10.1097/md.0000000000024190] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 12/12/2020] [Indexed: 11/25/2022] Open
Abstract
Using voxel-based morphometry (VBM), we studied cortical gray matter volume changes in patients with cervical spondylotic myelopathy (CSM) before and after cervical cord surgical decompression. We then discussed the structural damage mechanisms and the neural plasticity mechanisms involved in postsurgical CSM.Forty-five presurgical CSM patients, 41 of the same group followed-up 6 months after decompression surgery and 45 normal controls (NC) matched for age, sex and level of education underwent high-resolution 3-dimensional T1-weighted scans by 3.0 T MR. Then, VBM measurements were compared and cortical gray matter volume alterations were assessed among pre- or postsurgical CSM patients and NC, as well as correlations with clinical indexes by Pearson correlation.Compared with NC, presurgical CSM patients showed reduced gray matter volume in the left caudate nucleus and the right thalamus. After 6 months, postsurgical CSM patients had lower gray matter volume in the bilateral cerebellar posterior lobes but had higher gray matter volume in the brain-stem than did presurgical CSM patients. Postsurgical CSM patients had significantly lower gray matter volume in the left caudate nucleus but greater regional gray matter volume in the right inferior temporal gyrus, the right middle orbitofrontal cortex (OFC) and the bilateral lingual gyrus / precuneus /posterior cingulate cortex than did NC. Abnormal areas gray volume in presurgical CSM and postsurgical CSM patients showed no significant correlation with clinical data (P > .05).Myelopathy in the cervical cord may cause chronic cerebral structural damage before and after the decompression stage, markedly in outlier brain regions involving motor execution/control, vision processing and the default mode network and in areas associated with brain compensatory plasticity to reverse downstream spinal cord compression and respond to spinal cord surgical decompression.
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Affiliation(s)
| | - Yongming Tan
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Chenlei Zhang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Laichang He
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
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Park E, Cha H, Kim E, Min YS, Kim AR, Lee HJ, Jung TD, Chang Y. Alterations in power spectral density in motor- and pain-related networks on neuropathic pain after spinal cord injury. Neuroimage Clin 2020; 28:102342. [PMID: 32798908 PMCID: PMC7453139 DOI: 10.1016/j.nicl.2020.102342] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The mechanisms by which mobility function and neuropathic pain are mutually influenced by supraspinal plasticity in motor- and pain-related brain networks following spinal cord injury (SCI) remains poorly understood. OBJECTIVE To determine cortical and subcortical resting-state network alterations using power spectral density (PSD) analysis and investigate the relationships between these intrinsic alterations and mobility function and neuropathic pain following SCI. METHODS A total of 41 patients with incomplete SCI and 33 healthy controls were included. The degree of mobility and balance function and severity of neuropathic pain and depressive mood were evaluated. The resting-state functional magnetic resonance imaging data of low-frequency fluctuations were analyzed based on PSD. Differences in PSD values between patients with SCI and controls were assessed using the two-sample t-test (false discovery rate-corrected P < 0.05). The relationship between PSD values and mobility function and pain intensity was assessed using Pearson's correlation coefficient adjusted for the severity of depressive mood. RESULTS Compared with healthy controls, lower PSD values in supplementary motor and medial prefrontal areas (the anterior cingulate cortex, ventral medial prefrontal cortex, and superior orbito-prefrontal cortex) were associated with greater pain severity and poorer postural balance and mobility (P < 0.05) in patients with SCI, whereas higher PSD values in the primary motor cortex, premotor cortex, thalamus, and periaqueductal gray were associated with greater pain severity and poorer postural balance and mobility (P < 0.05). CONCLUSIONS Cortical and subcortical plastic alterations in intrinsic motor- and pain-related networks were observed in patients with SCI and were simultaneously associated with neuropathic pain intensity and degree of mobility function.
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Affiliation(s)
- Eunhee Park
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, 41944, Korea
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Hyunsil Cha
- Department of Medical & Biological Engineering, Kyungpook National University, Daegu, Korea
| | - Eunji Kim
- Department of Medical & Biological Engineering, Kyungpook National University, Daegu, Korea
| | - Yu-Sun Min
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, 41944, Korea
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Ae Ryoung Kim
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, 41944, Korea
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Hui Joong Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Radiology, Kyungpook National University Hospital, Daegu, Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, 41944, Korea
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Yongmin Chang
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, 41944, Korea
- Department of Radiology, Kyungpook National University Hospital, Daegu, Korea
- Department of Molecular Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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Whether Visual-related Structural and Functional Changes Occur in Brain of Patients with Acute Incomplete Cervical Cord Injury: A Multimodal Based MRI Study. Neuroscience 2018; 393:284-294. [PMID: 30326291 DOI: 10.1016/j.neuroscience.2018.10.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 01/01/2023]
Abstract
Visual-related cortex plays an important role in the process of movement. It is of great importance to clarify whether traumatic spinal cord injury (SCI), which is a typical disease that results in sensorimotor dysfunction, leads to the alteration of visual-related brain structure and function area. To address this issue, multimodality MRI was applied on eleven patients with acute incomplete cervical cord injury (ICCI) and eleven healthy controls (HCs) to explore possible structural and functional changes of the brain. Voxel-based morphometry (VBM) analysis was performed to investigate the changes in brain structure of ICCI patients. The fractional amplitude of low-frequency fluctuations (fALFF) was used to characterize changes in regional neural activities, and independent component analysis (ICA) was carried out to explore alterations in the resting-state networks (RSNs) after ICCI. We also investigated correlations among brain imaging metrics and between the metrics and clinical variables. Compared with HCs, ICCI patients exhibited significant gray matter atrophy in the left hippocampus and parahippocampal gyrus, right superior frontal gyrus (SFG), and middle frontal gyrus (MFG) and also a decrease in fALFF in the left orbitofrontal cortex (OFC). Moreover, ICCI patients exhibited decreased intra-network functional connectivity (FC) in the medial vision network (mVN). The mean fALFF value was correlated with clinical motor scores of the left extremities and the total motor scores. Our findings proved that ICCI can not only cause structural changes in visual-related brain regions, but also result in visual-related brain functional alterations, revealing the possible mechanism of the effects of visual feedback training in motor function rehabilitation of SCI patients.
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10
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Rao JS, Liu Z, Zhao C, Wei RH, Zhao W, Tian PY, Zhou X, Yang ZY, Li XG. Ketamine changes the local resting-state functional properties of anesthetized-monkey brain. Magn Reson Imaging 2017; 43:144-150. [PMID: 28755862 DOI: 10.1016/j.mri.2017.07.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/27/2017] [Accepted: 07/24/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Ketamine is a well-known anesthetic. 'Recreational' use of ketamine common induces psychosis-like symptoms and cognitive impairments. The acute and chronic effects of ketamine on relevant brain circuits have been studied, but the effects of single-dose ketamine administration on the local resting-state functional properties of the brain remain unknown. In this study, we aimed to assess the effects of single-dose ketamine administration on the brain local intrinsic properties. METHODS We used resting-state functional magnetic resonance imaging (rs-fMRI) to explore the ketamine-induced alterations of brain intrinsic properties. Seven adult rhesus monkeys were imaged with rs-fMRI to examine the fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo) in the brain before and after ketamine injection. Paired comparisons were used to detect the significantly altered regions. RESULTS Results showed that the fALFF of the prefrontal cortex (p=0.046), caudate nucleus (left side, p=0.018; right side, p=0.025), and putamen (p=0.020) in post-injection stage significantly increased compared with those in pre-injection period. The ReHo of nucleus accumbens (p=0.049), caudate nucleus (p=0.037), and hippocampus (p=0.025) increased after ketamine injection, but that of prefrontal cortex decreased (p<0.05). CONCLUSIONS These findings demonstrated that single-dose ketamine administration can change the regional intensity and synchronism of brain activity, thereby providing evidence of ketamine-induced abnormal resting-state functional properties in primates. This evidence may help further elucidate the effects of ketamine on the cerebral resting status.
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Affiliation(s)
- Jia-Sheng Rao
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China.
| | - Zuxiang Liu
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Can Zhao
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
| | - Rui-Han Wei
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
| | - Wen Zhao
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing 100069, China
| | - Peng-Yu Tian
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
| | - Xia Zhou
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
| | - Zhao-Yang Yang
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing 100069, China
| | - Xiao-Guang Li
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China; Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing 100069, China
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11
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Zhao C, Song W, Rao JS, Zhao W, Wei RH, Zhou X, Tian PY, Yang ZY, Li XG. Combination of kinematic analyses and diffusion tensor tractrography to evaluate the residual motor functions in spinal cord-hemisected monkeys. J Med Primatol 2017; 46:239-247. [PMID: 28543057 DOI: 10.1111/jmp.12276] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Spinal cord injury (SCI) causes loss of locomotor functions. Nowadays, the relationship between the residual locomotion after SCI and the diffusion tensor tractography (DTT) results still remains unclear. METHODS Four rhesus monkeys were suffered thoracic cord hemisection. Kinematic evaluation and DTT were performed prior- and post-SCI (6 and 12 weeks). The longitudinal changes of gait parameters and the DTT parameters were analyzed for the injury-contralateral hindlimb. The correlations between gaits and DTT parameters were also investigated. RESULTS Almost gait parameters significantly changed after SCI, meanwhile, the caudal-rostral connection rate of DTT showed negative correlation with all gait parameters, demonstrating that the locomotor changes of the injury-contralateral hindlimb were associated with the ratio of residual fibers. CONCLUSIONS The combinatory use of gait analysis and DTT has been demonstrated to be sensitive to locomotion changes after SCI, and may therefore have potential applications in the pre-clinical studies of SCI.
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Affiliation(s)
- Can Zhao
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Wei Song
- Rehabilitation Engineering Research Institute, China Rehabilitation Research Center, Beijing, China
| | - Jia-Sheng Rao
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Wen Zhao
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Rui-Han Wei
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xia Zhou
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Peng-Yu Tian
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Zhao-Yang Yang
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Xiao-Guang Li
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
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12
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Chen Q, Zheng W, Chen X, Wan L, Qin W, Qi Z, Chen N, Li K. Brain Gray Matter Atrophy after Spinal Cord Injury: A Voxel-Based Morphometry Study. Front Hum Neurosci 2017; 11:211. [PMID: 28503142 PMCID: PMC5408078 DOI: 10.3389/fnhum.2017.00211] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/11/2017] [Indexed: 01/15/2023] Open
Abstract
The aim of this study was to explore possible changes in whole brain gray matter volume (GMV) after spinal cord injury (SCI) using voxel-based morphometry (VBM), and to study their associations with the injury duration, severity, and clinical variables. In total, 21 patients with SCI (10 with complete and 11 with incomplete SCI) and 21 age- and sex-matched healthy controls (HCs) were recruited. The 3D high-resolution T1-weighted structural images of all subjects were obtained using a 3.0 Tesla MRI system. Disease duration and American Spinal Injury Association (ASIA) Scale scores were also obtained from each patient. Voxel-based morphometry analysis was carried out to investigate the differences in GMV between patients with SCI and HCs, and between the SCI sub-groups. Associations between GMV and clinical variables were also analyzed. Compared with HCs, patients with SCI showed significant GMV decrease in the dorsal anterior cingulate cortex, bilateral anterior insular cortex, bilateral orbital frontal cortex (OFC), and right superior temporal gyrus. No significant difference in GMV in these areas was found either between the complete and incomplete SCI sub-groups, or between the sub-acute (duration <1 year) and chronic (duration >1 year) sub-groups. Finally, the GMV of the right OFC was correlated with the clinical motor scores of left extremities in not only all SCI patients, but especially the CSCI subgroup. In the sub-acute subgroup, we found a significant positive correlation between the dACC GMV and the total clinical motor scores, and a significant negative correlation between right OFC GMV and the injury duration. These findings indicate that SCI can cause remote atrophy of brain gray matter, especially in the salient network. In general, the duration and severity of SCI may be not associated with the degree of brain atrophy in total SCI patients, but there may be associations between them in subgroups.
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Affiliation(s)
- Qian Chen
- Department of Radiology, Xuanwu Hospital, Capital Medical UniversityBeijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain InformaticsBeijing, China
| | - Weimin Zheng
- Department of Radiology, Xuanwu Hospital, Capital Medical UniversityBeijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain InformaticsBeijing, China.,Department of Radiology, Dongfang Hospital Beijing University of Chinese MedicineBeijing, China
| | - Xin Chen
- Department of Radiology, Xuanwu Hospital, Capital Medical UniversityBeijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain InformaticsBeijing, China
| | - Lu Wan
- Department of Radiology, Xuanwu Hospital, Capital Medical UniversityBeijing, China
| | - Wen Qin
- Department of Radiology, Tianjin Medical University General HospitalTianjin, China
| | - Zhigang Qi
- Department of Radiology, Xuanwu Hospital, Capital Medical UniversityBeijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain InformaticsBeijing, China
| | - Nan Chen
- Department of Radiology, Xuanwu Hospital, Capital Medical UniversityBeijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain InformaticsBeijing, China
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical UniversityBeijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain InformaticsBeijing, China
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13
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Kaushal M, Oni-Orisan A, Chen G, Li W, Leschke J, Ward BD, Kalinosky B, Budde MD, Schmit BD, Li SJ, Muqeet V, Kurpad SN. Evaluation of Whole-Brain Resting-State Functional Connectivity in Spinal Cord Injury: A Large-Scale Network Analysis Using Network-Based Statistic. J Neurotrauma 2017; 34:1278-1282. [DOI: 10.1089/neu.2016.4649] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Mayank Kaushal
- Department of Biomedical Engineering, Marquette University Milwaukee, Wisconsin
| | | | - Gang Chen
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wenjun Li
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jack Leschke
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - B. Douglas Ward
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Benjamin Kalinosky
- Department of Biomedical Engineering, Marquette University Milwaukee, Wisconsin
| | - Matthew D. Budde
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brian D. Schmit
- Department of Biomedical Engineering, Marquette University Milwaukee, Wisconsin
| | - Shi-Jiang Li
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Vaishnavi Muqeet
- Department of Physical Medicine and Rehabilitation, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | - Shekar N. Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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14
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Rao J, Liu Z, Zhao C, Wei R, Zhao W, Yang Z, Li X. Longitudinal evaluation of functional connectivity variation in the monkey sensorimotor network induced by spinal cord injury. Acta Physiol (Oxf) 2016; 217:164-73. [PMID: 26706280 DOI: 10.1111/apha.12645] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 12/07/2015] [Accepted: 12/15/2015] [Indexed: 01/06/2023]
Abstract
AIM Given the unclear pattern of cerebral function reorganization induced by spinal cord injury (SCI), this study aimed to longitudinally evaluate the changes in resting-state functional connectivity (FC) in the sensorimotor network after SCI and explore their relationship with gait performance. METHODS Four adult female rhesus monkeys were examined using resting-state functional magnetic resonance imaging during their healthy stage and after hemitransected SCI (4, 8 and 12 weeks after SCI), and the gait characteristics of their hindlimbs were recorded (except 4 weeks after SCI). Twenty sensorimotor-related cortical areas were adopted in the FC analysis to evaluate the functional network reorganization. Correlation analyses were then used to explore the relationship between functional network variations and gait characteristic changes. RESULTS Compared with that during the healthy stage, the FC strength during post-SCI period was significantly increased in multiple areas of the motor control network, including the primary sensorimotor cortex, supplementary motor area (SMA) and putamen (Pu). However, the FC strength was remarkably reduced in the thalamus and parieto-occipital association cortex of the sensory network 8 weeks after SCI. Most FC intensities gradually approached the normal level 12 weeks after the SCI. Correlation analyses revealed that the enhanced FC strength between Pu and SMA in the left hemisphere, which regulates motor functions of the right side, was negatively correlated with the gait height of the right hindlimb. CONCLUSION The cerebral functional network presents an adjust-recover pattern after SCI, which may help us further understand the cerebral function reorganization after SCI.
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Affiliation(s)
- J.S. Rao
- Department of Biomedical Engineering; School of Biological Science and Medical Engineering; Beihang University; Beijing China
| | - Z. Liu
- State Key Laboratory of Brain and Cognitive Science; Institute of Biophysics; Chinese Academy of Sciences; Beijing China
| | - C. Zhao
- Department of Biomedical Engineering; School of Biological Science and Medical Engineering; Beihang University; Beijing China
| | - R.H. Wei
- Department of Biomedical Engineering; School of Biological Science and Medical Engineering; Beihang University; Beijing China
| | - W. Zhao
- Department of Neurobiology; School of Basic Medical Sciences; Capital Medical University; Beijing China
| | - Z.Y. Yang
- Department of Biomedical Engineering; School of Biological Science and Medical Engineering; Beihang University; Beijing China
- Department of Neurobiology; School of Basic Medical Sciences; Capital Medical University; Beijing China
| | - X.G. Li
- Department of Biomedical Engineering; School of Biological Science and Medical Engineering; Beihang University; Beijing China
- Department of Neurobiology; School of Basic Medical Sciences; Capital Medical University; Beijing China
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15
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Shin YW, Choi YM, Kim HS, Kim DJ, Jo HJ, O'Donnell BF, Jang EK, Kim TY, Shong YK, Hong JP, Kim WB. Diminished Quality of Life and Increased Brain Functional Connectivity in Patients with Hypothyroidism After Total Thyroidectomy. Thyroid 2016; 26:641-9. [PMID: 26976233 PMCID: PMC4939446 DOI: 10.1089/thy.2015.0452] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Acute hypothyroidism induced by thyroid hormone withdrawal (THW) in patients with thyroid cancer after total thyroidectomy can affect mood and quality of life (QoL). While loss or dysregulation of thyroid hormone (TH) has these well-known behavioral consequences, the effects of TH alterations on brain function are not well understood. Resting state functional connectivity (FC) measured by functional magnetic resonance imaging (fMRI) allows non-invasive evaluation of human brain function. This study therefore examined whether THW affects resting state FC and whether changes in FC correlate with the mood or QoL of the patients with THW status. METHODS Twenty-one patients who had undergone total thyroidectomy for thyroid cancer were recruited. Resting state fMRI scanning of the brain, thyroid function tests, and administration of the 12-Item Short Form Health Survey (SF-12) and the Patient Health Questionnaire-9 (PHQ-9) were performed before and after two weeks of THW. Regional homogeneity (ReHo), one of the measures of resting state FC, was calculated, and each voxel was compared between before and after THW in 19 patients. The ReHo values were extracted from the regions of interest showing within-group differences in ReHo values after THW, and correlations of ReHo values with thyrotropin (TSH) levels, total score of the PHQ-9, and composite scores of the SF-12 were statistically evaluated. RESULTS Higher ReHo was observed after THW in the brain cortical regions across primary motor and sensory, visual, and association cortices. Among the regions, the ReHo values in the bilateral pre- and postcentral gyri, bilateral middle occipito-temporal cortices, the left precuneus, and the left lingual gyrus showed positive correlations with serum TSH levels after THW. Higher ReHo values in the bilateral pre- and postcentral gyri, the left middle temporo-occipital cortices, and the left ligual gyrus correlated with the lower mental component summary score from the SF-12, while higher ReHo values in the bilateral pre- and postcentral gyri correlated with higher total scores in the PHQ-9. CONCLUSIONS Local brain FC is increased in the acute hypothyroid state. Higher FC correlates with a poorer mental QoL and increased depression in the hypothyroid state.
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Affiliation(s)
- Yong-Wook Shin
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yun Mi Choi
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho Sung Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae-Jin Kim
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Hang Joon Jo
- Scientific and Statistical Computing Core, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Brian F. O'Donnell
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Eun Kyung Jang
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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