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Wang Q, Hou C, Jiang X, Li H. Alterations of spontaneous brain activity in type 2 diabetes mellitus without mild cognitive impairment: a resting-state functional magnetic resonance study. Front Hum Neurosci 2024; 17:1305571. [PMID: 38273877 PMCID: PMC10808360 DOI: 10.3389/fnhum.2023.1305571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) has been demonstrated an increased risk factor of cognitive impairment or even dementia. Kinds of resting-state functional magnetic resonance imaging indices have been proposed and used to investigate the brain mechanism underlying diabetic cognitive impairment. This study aimed to explore the early changes in spontaneous neural activity among T2DM patients without cognitive impairment by means of multiple rs-fMRI indices. Methods T2DM patients without cognitive impairment and age-, sex-, and education matched control subjects were included in this study. Three rs-fMRI indices, namely amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo) and voxel-mirrored homotopic connectivity (VMHC) were computed after image pre-processing. The Montreal Cognitive Assessment (MoCA) was performed to distinguish normal cognition. Brain volume was also evaluated. Correlation analyses were conducted to explore any relationship among rs-fMRI indices and clinical characteristics. Results The T2DM patients were detected significantly decreased neural activity in right angular and left prefrontal gyrus including middle and superior frontal gyrus. Increased activities were also observed in left caudate and the supplementary motor area. No correlation between rs-fMRI indices and clinical characteristics was survived after multiple comparison correction. But we observed a significant, but decreased correlation between ALFF and ReHo values in the reported brain areas. Conclusion The combination of ALFF, ReHo and VMHC analyses demonstrated abnormal spontaneous neural activity in brain regions which were reported in T2DM patients without cognitive impairment. These results may enhance our understanding of the diabetic brain changes at the early stage.
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Affiliation(s)
| | | | | | - Hongjun Li
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
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Wang Y, Wen J, Kong C, Xu Z, Hu S, Li M, Wang X, Zhang H, Jia X, Ding Q, Wu J, Hou D. Regional homogeneity alterations in multifrequency bands in patients with extracranial multi-organ tuberculosis: a prospective cross-sectional study. Quant Imaging Med Surg 2023; 13:1753-1767. [PMID: 36915302 PMCID: PMC10006160 DOI: 10.21037/qims-22-229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 01/04/2023] [Indexed: 02/16/2023]
Abstract
Background This study aimed to clarify the spontaneous neural activity in the conventional frequency band (0.01-0.08 Hz) and 2 subfrequency bands (slow-4: 0.027-0.073 Hz; slow-5: 0.01-0.027 Hz) in patients with extracranial multi-organ tuberculosis (EMTB) through regional homogeneity (ReHo) analysis. Methods In all, 32 patients with EMTB and 31 healthy controls (HCs) were assessed by resting-state functional magnetic resonance imaging (rs-fMRI) scans to clarify the abnormal spontaneous neural activity through ReHo analysis in the conventional frequency band and 2 subfrequency bands. Results Compared with the HCs, the patients with EMTB exhibited decreased ReHo in the left postcentral gyrus [t=-4.79; 95% confidence interval (CI): -0.79 to -0.31] and the left superior cerebellum (t=-4.45; 95% CI: -0.54 to -0.21) in the conventional band. Conversely, increased ReHo was observed in the right middle occipital gyrus (t=3.94; 95% CI: 0.18-0.53). In the slow-4 band, patients with EMTB only exhibited decreased ReHo in the superior cerebellum (t=-4.69; 95% CI: -0.54 to -0.22); meanwhile, in the slow-5 band, these patients exhibited decreased ReHo in the right postcentral gyrus (t=-3.76; 95% CI: -0.74 to -0.21) and the left superior cerebellum (t=-5.20, 95% CI: -0.72 to -0.31). After Bonferroni correction, no significant correlation was observed between the ReHo values in clusters showing significant between-group differences and cognitive test scores. Conclusions ReHo showed abnormal synchronous neural activity in patients with EMTB in different frequency bands, which provides a novel understanding of the pathological mechanism of EMTB.
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Affiliation(s)
- Yichuan Wang
- Department of Medical Imaging, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.,Department of Medical Imaging, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Jianjie Wen
- School of Teacher Education, Zhejiang Normal University, Jinhua, China.,Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Chengcheng Kong
- Department of Medical Imaging, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.,Department of Medical Imaging, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Zexuan Xu
- Department of Medical Imaging, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Su Hu
- School of Teacher Education, Zhejiang Normal University, Jinhua, China.,Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Mengting Li
- School of Teacher Education, Zhejiang Normal University, Jinhua, China.,Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Xinguang Wang
- School of Information Science and Electronic Technology, Jiamusi University, Jiamusi, China
| | - Hongqiang Zhang
- Department of Radiology, Changshu No. 2 People's Hospital, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, China
| | - Xize Jia
- School of Teacher Education, Zhejiang Normal University, Jinhua, China.,Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China.,Department of Radiology, Changshu No. 2 People's Hospital, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, China
| | - Qingguo Ding
- Department of Radiology, Changshu No. 2 People's Hospital, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, China
| | - Jili Wu
- Department of Medical Imaging, Fourth People's Hospital of Taiyuan, Taiyuan, China
| | - Dailun Hou
- Department of Medical Imaging, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.,Department of Medical Imaging, Beijing Chest Hospital, Capital Medical University, Beijing, China
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Zhang G, Liu T, Wei W, Zhang R, Wang H, Wang M. Evaluation of altered brain activity in type 2 diabetes using various indices of brain function: A resting-state functional magnetic resonance imaging study. Front Hum Neurosci 2023; 16:1032264. [PMID: 36699964 PMCID: PMC9870028 DOI: 10.3389/fnhum.2022.1032264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/05/2022] [Indexed: 01/11/2023] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) has been identified as a risk factor that increases the rate of cognitive decline. Previous studies showed that patients with T2DM had brain function alterations based on a single index of resting-state functional magnetic resonance imaging (rs-fMRI). The present study aimed to explore spontaneous brain activity in patients with T2DM by comparing various rs-fMRI indices, and to determine the relationship between these changes and cognitive dysfunction. Methods A total of 52 patients with T2DM and age- and sex-matched control participants were included in this study. The amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), and voxel-mirrored homotopic connectivity (VMHC) values were calculated to represent the status of spontaneous neural activity. The Montreal Cognitive Assessment (MoCA) was used for the rapid evaluation of cognition in all subjects. Pearson correlation and mediation analyses were conducted to investigate the relationship between rs-fMRI indices and clinical parameters such as fasting glucose, disease duration, and MoCA. Results Patients with T2DM had alterations of concordant spontaneous brain activity in brain areas including the bilateral cerebellum posterior lobe, the left inferior temporal gyrus (ITG.L), the parahippocampal gyrus, and the left supplementary motor area (SMA.L). The indices were significantly correlated to each other in most of the detected brain areas. Positive correlations were observed between fasting glucose and neural activity in the surrounding areas of the left insula and the inferior frontal gyrus. MoCA scores were negatively correlated with the ReHo values extracted from the left anterior occipital lobe and the superior cerebellar cortex and were positively correlated with VMHC values extracted from the left caudate and the precentral gyrus (PreCG). No significant mediation effect of abnormal brain activity was found in the relationship between clinical parameters and MoCA scores. Conclusion The current study demonstrated the functional concordance of abnormal brain activities in patients with T2DM by comparing ALFF, ReHo, and VMHC measurements. Widespread abnormalities mainly involved in motor and sensory processing functions may provide insight into examining T2DM-related neurological pathophysiology.
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Affiliation(s)
- Ge Zhang
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China,Department of Radiology, Bethune International Peace Hospital, Shijiazhuang, China
| | - Taiyuan Liu
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Wei Wei
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Rui Zhang
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Huilin Wang
- Department of Radiology, Bethune International Peace Hospital, Shijiazhuang, China,*Correspondence: Huilin Wang ✉
| | - Meiyun Wang
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China,Laboratory of Brian Science and Brain-Like Intelligence Technology, Institute for Integrated Medical Science and Engineering, Henan Academy of Sciences, Zhengzhou, China,Meiyun Wang ✉
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Tan SW, Cai GQ, Li QY, Guo Y, Pan YC, Zhang LJ, Ge QM, Shu HY, Zeng XJ, Shao Y. Altered Brain Activity in Strabismic Amblyopic Children as Determined by Regional Homogeneity: A Resting-State Functional Magnetic Resonance Imaging Study. Front Neurosci 2022; 16:879253. [PMID: 35720698 PMCID: PMC9201242 DOI: 10.3389/fnins.2022.879253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/13/2022] [Indexed: 11/22/2022] Open
Abstract
Objective Earlier research has determined that amblyopia or strabismus may cause remarkable brain anatomical and functional variations. Nonetheless, thus far, the spontaneous changes in brain activity in children with strabismus amblyopia (SA) remain unclear. The purpose of this study was to determine the association between abnormal brain activity in children with SA and its behavioral manifestations. Patients and Methods ?A total of 24 children with SA (10 male and 14 female children) as well as 24 healthy controls (HCs), including 10 male and 14 female children were closely matched in sex and age, and examined using resting-state functional magnetic resonance imaging (fMRI). The regional homogeneity (ReHo) technique was applied to evaluate spontaneous cerebral activity variations in children with SA and HCs. Moreover, associations between altered ReHo values in distinct cerebral areas and the degree of strabismus were assessed using Pearson correlation analysis. Results Remarkably increased ReHo values were observed in the right lingual, right superior frontal medial, bilateral superior parietal, and right inferior parietal gyri of children with SA compared with HCs. In contrast, mean ReHo values in children with SA were lower in the right cerebellum, left superior frontal gyrus, and left putamen nucleus. Furthermore, esotropia showed a positive correlation with ReHo values of the left putamen. Conclusion The anomalous spontaneous activity changes in several brain areas that are caused by SA may indicate neuropathologic mechanisms of visual deficits and oculomotor disorders in children with SA.
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Affiliation(s)
- Si-Wen Tan
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,The First Clinical Medical College, Nanchang University, Nanchang, China
| | - Guo-Qian Cai
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qiu-Yu Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yu Guo
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi-Cong Pan
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li-Juan Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qian-Min Ge
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hui-Ye Shu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xian-Jun Zeng
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Liu L, Fan J, Zhan H, Huang J, Cao R, Xiang X, Tian S, Ren H, Tong M, Li Q. Abnormal regional signal in the left cerebellum as a potential neuroimaging biomarker of sudden sensorineural hearing loss. Front Psychiatry 2022; 13:967391. [PMID: 35935421 PMCID: PMC9354585 DOI: 10.3389/fpsyt.2022.967391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/30/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE While prior reports have characterized visible changes in neuroimaging findings in individuals suffering from sudden sensorineural hearing loss (SSNHL), the utility of regional homogeneity (ReHo) as a means of diagnosing SSNHL has yet to be established. The present study was thus conducted to assess ReHo abnormalities in SSNHL patients and to establish whether these abnormalities offer value as a diagnostic neuroimaging biomarker of SSNHL through a support vector machine (SVM) analysis approach. METHODS Resting-state functional magnetic resonance imaging (rs-fMRI) analyses of 27 SSNHL patients and 27 normal controls were conducted, with the resultant imaging data then being analyzed based on a combination of ReHo and SVM approaches. RESULTS Relative to normal control individuals, patients diagnosed with SSNHL exhibited significant reductions in ReHo values in the left cerebellum, bilateral inferior temporal gyrus (ITG), left superior temporal pole (STP), right parahippocampal gyrus (PHG), left posterior cingulum cortex (PCC), and right superior frontal gyrus (SFG). SVM analyses suggested that reduced ReHo values in the left cerebellum were associated with high levels of diagnostic accuracy (96.30%, 52/54), sensitivity (92.59%, 25/27), and specificity (100.00%, 27/27) when distinguishing between SSNHL patients and control individuals. CONCLUSION These data suggest that SSNHL patients exhibit abnormal resting-state neurological activity, with changes in the ReHo of the left cerebellum offering value as a diagnostic neuroimaging biomarker associated with this condition.
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Affiliation(s)
- Lei Liu
- Department of Otorhinolaryngology, Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Jun Fan
- Department of Otorhinolaryngology, Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Hui Zhan
- Department of Otorhinolaryngology, Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Junli Huang
- Department of Medical Imaging, Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Rui Cao
- Department of Otorhinolaryngology, Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Xiaoran Xiang
- Department of Otorhinolaryngology, Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Shuai Tian
- Department of Otorhinolaryngology, Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Hongwei Ren
- Department of Medical Imaging, Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Miao Tong
- Department of Stomatology, Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Qian Li
- Department of Otorhinolaryngology, Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, China
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Liu J, Li Y, Yang X, Xu H, Ren J, Zhou P. Regional Spontaneous Neural Activity Alterations in Type 2 Diabetes Mellitus: A Meta-Analysis of Resting-State Functional MRI Studies. Front Aging Neurosci 2021; 13:678359. [PMID: 34220486 PMCID: PMC8245688 DOI: 10.3389/fnagi.2021.678359] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/11/2021] [Indexed: 01/06/2023] Open
Abstract
Objective: Resting-state functional magnetic resonance imaging (rs-fMRI) studies have revealed inconsistent regional spontaneous neural activity alterations in patients with type 2 diabetes mellitus (T2DM). The aim of our meta-analysis was to identify concordant regional spontaneous neural activity abnormalities in patients with T2DM. Methods: A systematic search was conducted to identify voxel-based rs-fMRI studies comparing T2DM patients with healthy controls. The permutation of subject images seed-based d mapping (SDM) was used to quantitatively estimate the regional spontaneous neural activity abnormalities in patients with T2DM. Metaregression was conducted to examine the associations between clinical characteristics and functional alterations. Results: A total of 16 studies with 19 datasets including 434 patients with T2DM and 391 healthy controls were included. Patients with T2DM showed hypoactivity in the right medial superior frontal gyrus, right superior temporal gyrus, and left lingual gyrus, whereas hyperactivity in the right cerebellum. Metaregression analysis identified negative correlation between regional activity in the medial superior frontal and anterior cingulate gyri and illness duration of patients with T2DM. Conclusion: The patterns of regional spontaneous neural activity alterations, characterized by hypoactivity in the medial pre-frontal cortex, visual cortex, and superior temporal gyrus, whereas hyperactivity in the cerebellum, might represent the underlying neuropathological mechanisms of T2DM.
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Affiliation(s)
- Jieke Liu
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yong Li
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xi Yang
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hao Xu
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jing Ren
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Peng Zhou
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Zhang D, Wang M, Gao J, Huang Y, Qi F, Lei Y, Ai K, Yan X, Cheng M, Su Y, Lei X, Zhang X. Altered Functional Connectivity of Insular Subregions in Type 2 Diabetes Mellitus. Front Neurosci 2021; 15:676624. [PMID: 34220433 PMCID: PMC8242202 DOI: 10.3389/fnins.2021.676624] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/06/2021] [Indexed: 01/09/2023] Open
Abstract
Diabetes-related brain damage can lead to cognitive decline and increase the risk of depression, but the neuropathological mechanism of this phenomenon remains unclear. Different insular subregions have obvious functional heterogeneity, which is related to many aspects of type 2 diabetes mellitus (T2DM)-related brain damage. However, little is known about changes in functional connectivity (FC) in insular subregions in patients with T2DM. Therefore, we aimed to investigate FC between different insular subregions and clinical/cognitive variables in patients with T2DM. Fifty-seven patients with T2DM and 55 healthy controls (HCs) underwent a neuropsychological assessment and resting-state FC examination. We defined three insular subregions, including the bilateral dorsal anterior insula (dAI), bilateral ventral anterior insula (vAI), and bilateral posterior insula (PI). We examined differences in FC between insular subregions and the whole brain in patients with T2DM compared with HCs. A correlation analysis was performed to examine the relationship between FC and clinical/cognitive variables. Compared with HCs, patients with T2DM showed significantly decreased FC between the dAI and the right inferior frontal gyrus, right superior/middle temporal gyrus, right hippocampus, and right precentral gyrus. FC between the vAI and the right supramarginal gyrus, as well as the PI and the right precentral/postcentral gyrus, was reduced in the T2DM group compared with the control group. In the T2DM group, we showed a significant negative correlation between glycated hemoglobin concentration and FC in the dAI and right hippocampus (r = −0.428, P = 0.001) after Bonferroni correction. We conclude that different insular subregions present distinct FC patterns with functional regions and that abnormal FC in these insular subregions may affect cognitive, emotional, and sensorimotor functions in patients with T2DM.
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Affiliation(s)
- Dongsheng Zhang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Man Wang
- Department of Graduate, Xi'an Medical University, Xi'an, China
| | - Jie Gao
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Yang Huang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Fei Qi
- Department of Graduate, Xi'an Medical University, Xi'an, China
| | - Yumeng Lei
- Department of Graduate, Xi'an Medical University, Xi'an, China
| | - Kai Ai
- Department of Clinical Science, Philips Healthcare, Xi'an, China
| | - Xuejiao Yan
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Miao Cheng
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Yu Su
- Department of Graduate, Xi'an Medical University, Xi'an, China
| | - Xiaoyan Lei
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xiaoling Zhang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
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