The brainstem houses numerous nuclei and tracts that serve vital functions. Genome-wide associations with brainstem substructure volumes have been explored in European individuals, yet other ancestries remain under-represented. Here, we conduct cross-ancestry genome-wide association meta-analyses in 103,098 individuals for brainstem and 78,062 individuals for eight substructure volumes, including 7094 Chinese Han individuals. We identify 713 locus-trait associations with brainstem and substructure volumes at P < 5.56 ×10−9, comprising 569 new associations. Two associations show different effect sizes, while 496 associations have similar effect sizes between ancestries. We prioritize 186 genes associated with brainstem volumetric traits. We find both shared and distinct genetic loci, genes, and pathways for midbrain, pons, and medulla volumes, along with the shared genetic architectures related to disease phenotypes and physiological functions. The results provide new insights into the genetic architectures of brainstem and substructure volumes and their genetic associations with brainstem physiologies and pathologies. A cross-ancestry GWAS meta-analyses of brainstem structures identify 713 associations. It reveals shared/distinct genetic architectures across ancestries/substructures and overlaps with neuropsychiatric disorders and physiological functions.

We aimed to develop a prognostic model for primary pontine hemorrhage (PPH) patients and validate the predictive value of the model for a good prognosis at 90 days. A total of 254 PPH patients were included for screening of the independent predictors of prognosis, and data were analyzed by univariate and multivariable logistic regression tests. The cases were then divided into training cohort (n=219) and validation cohort (n=35) based on the two centers. A nomogram was developed using independent predictors from the training cohort to predict the 90-day good outcome and was validated from the validation cohort. Glasgow Coma Scale score, normalized pixels (used to describe bleeding volume), and mechanical ventilation were significant predictors of a good outcome of PPH at 90 days in the training cohort (all P<0.05). The U test showed no statistical difference (P=0.892) between the training cohort and the validation cohort, suggesting the model fitted well. The new model showed good discrimination (area under the curve=0.833). The decision curve analysis of the nomogram of the training cohort indicated a great net benefit. The PPH nomogram comprising the Glasgow Coma Scale score, normalized pixels, and mechanical ventilation may facilitate predicting a 90-day good outcome.

Cognitive impairment (CI) has been reported in 29 - 70% of patients with neuromyelitis optica spectrum disorder (NMOSD). Abnormal white matter (WM) functional networks that correlate with cognitive functions have not been studied well in patients with NMOSD. The aim of the current study was to investigate functional connectivity (FC), spontaneous activity, and functional covariance connectivity (FCC) abnormalities of WM functional networks in patients with NMOSD and their correlation with cognitive performance. Twenty-four patients with NMOSD and 24 healthy controls (HCs) were included in the study. Participants underwent brain resting-state functional magnetic resonance imaging (fMRI) and the Montreal Cognitive Assessment (MoCA). Eight WM networks and nine gray matter (GM) networks were created. In patients, WM networks, including WM1 - 4, WM1 - 8, WM2 - 6, WM2 - 7, WM2 - 8, WM4 - 8, WM5 - 8 showed reduced FC (P < 0.05). All WM networks except WM1 showed decreased spontaneous activity (P < 0.05). The major GM networks demonstrated increased/ decreased FC (P < 0.05), whereas GM7-WM7, GM8-WM4, GM8-WM6 and GM8-WM8 displayed decreased FC (P < 0.05). The MoCA results showed that two-thirds (16/24) of the patients had CI. FC and FCC in WM networks were correlated negatively with the MoCA scores (P < 0.05). WM functional networks are multi-layered. Abnormal FC of WM functional networks and GM functional networks may be responsible for CI.

IgG4-related diseases (IgG4-RD) are a group of chronic progressive autoimmune diseases of unknown etiology that are increasingly recognized as an important pathophysiological basis for a variety of systemic diseases. It is thought to involve almost any organ of the body, but the involvement of the central nervous system is relatively rare. We report the case of a 56-year-old male patient admitted to the hospital d recurrent dizziness and nausea for more than 3 months. The preoperative imaging was misdiagnosed as a meningioma, with this lesion demonstrated localized inhomogeneous thickening of the meninges in the left parietal region on T2-weighted and T2 fat suppression sequences with localized nodular changes. The patient's final pathologic diagnosis was IgG4-associated sclerosing thick encephalitis. The diagnosis of IgG4-associated hypertrophic pontine meningitis is challenging. Clinically, IgG4-associated sclerosing diseases usually present as mass-like lesions, which can be easily misdiagnosed as neoplastic lesions due to their similar appearance. These fundamentally recognized autoimmune disorders respond well to corticosteroid therapy. Therefore, accurate detection of IgG4-related disease is critical to prevent patients from undergoing unnecessary surgery.

Objective: To observe the radiological characteristics of Neuronal Intranuclear Inclusion Disease (NIID) on lesion locations and diffusion property using quantitative imaging analysis. Methods: Visual inspection and quantitative analyses were performed on MRI data from 31 retrospectively included patients with NIID. Frequency heatmaps of lesion locations on T2WI and DWI were generated using voxel-wise analysis. Gray matter volume (GMV), white matter volume (WMV) and diffusion property of apparent diffusion coefficient (ADC) values of patients were voxel-wisely compared with healthy controls. Moreover, the ADC values within the DWI-detected lesion were compared with those within the adjacent cortical gray matter and white matter. Voxel-based lesion symptom mapping (VLSM) techniques, were used to determine the relationship between DWI lesion location and disease durations. Results: By visual inspection on the imaging findings, we proposed an "cockscomb flower sign" for describing the radiological feature of DWI hyperintensity within the corticomedullary junction. A "T2WI-DWI mismatch of spatial distribution" pattern was also revealed with visual inspection and frequency heatmaps, for describing the feature of a wider lesion distribution covering white matter shown on T2WI than that on DWI. Voxelbased morphometry comparison revealed that wildly reduced GMV and WMV, both the lesion areas detected by DWI and T2WI demonstrated ADC increase in patients. Furthermore, the ADC values within the DWIdetected lesion were intermediate between the adjacent cortex and the deep white matter with highest ADC. VLSM analysis revealed that frontal lobe, parietal lobe and internal capsule damage were associated with higher NIID durations. Conclusion: NIID features with "cockscomb flower-like" DWI hyperintensity in area of corticomedullary junction, based on a "T2WI-DWI mismatch of spatial distribution" of lesion locations. The pathological substrate of corticomedullary junction hyperintensity on DWI, can not be explained as diffusion restriction. These typical radiological features of brain MRI would be helpful for diagnosis of NIID. (c) 2023 Elsevier Masson SAS. All rights reserved.

Nasopharyngeal tuberculosis is a rare extrapulmonary tuberculosis caused by Mycobacterium tuberculosis invading the nasopharynx. Early clinical symptoms are atypical, making the condition easy to overlook and misdiagnosed. We retrospectively reviewed the case of a 37-year-old man who visited the clinic in March 2023, presenting with enlarged cervical lymph nodes persisting for over a year. Computed tomography and magnetic resonance imaging showed the nasopharynx wall was thickened, and cervical multiple enlarged lymph nodes were visible, presenting bead-like appearance. The enhanced scan revealed the lesion uneven enhancement. He was diagnosed with nasopharyngeal carcinoma with lymph node metastasis based on the images. However, the histopathological examination finally confirmed that the nasopharyngeal and neck mass were tuberculous granulomas. Nasopharyngeal tuberculosis is easily misdiagnosed and mistreated, and it is especially difficult to differentiate from nasopharyngeal carcinoma. When diagnosing and treating neck masses, clinicians should consider the possibility of nasopharyngeal tuberculosis in patients with chronic nasopharyngeal symptoms. Nasopharyngoscope biopsy and histopathological examination have great value in the diagnosis of nasopharyngeal tuberculosis.

There is increasing evidence that major trauma can adversely affect the brain and cognition. In some cases, trauma may lead to deficits in executive function (EF). The anterior insula may be a causal outflow hub acting to coordinate EF-related brain networks. To clarify the neural underpinnings of EF deficits (EFD) after trauma, we performed a resting-state functional magnetic resonance imaging (rs-fMRI) study of anterior insular subnetworks in adults who have lost their only child. A total of 167 participants completed various psychological and cognitive assessments to assess EF-related deficits. Correlations were computed between abnormal connectivity and cognitive/post-traumatic stress symptoms. The results showed abnormal anterior insular subregion connectivity in the default mode network (DMN), prefrontal lobe, and cerebellum lobe in participants with EFD. No correlation was found between abnormal connectivity and cognitive/post-traumatic stress symptoms in participants with EFD. These results suggest that excessive connections between the insula and DMN could contribute to EFD after trauma. Overall, this study provides novel references into the neural mechanisms of EF status after trauma exposure.

Epidural angiolipoma is a rare benign tumor consisting of mature adipocytes, blood sinuses, capillaries, and small blood vessels. It constitutes about 0.04%-1.2% of spinal axis tumors and about 2%-3% of extradural spinal tumors. We report a case of thoracic epidural angiolipoma and review the literature. We describe a 42-year-old woman who had weakness and numbness in her lower extremities prior to diagnosis and had an onset of approximately 10 months. The patient was misdiagnosed as schwannoma on preoperative imaging, possibly because neurogenous tumor is the most common intramedullary subdural tumor, and the lesion grew into bilateral intervertebral foramina. However, the lesion demonstrated high signal on the T2-weighted and T2 fat suppression sequences, and the linear low signal at the lesion edge was ignored, leading to misdiagnosis. The patient underwent posterior thoracic 4-6 laminectomy, pathectomy, and spinal decompression/vertebroplasty under general anesthesia. The final pathologic diagnosis was intradural epidural angiolipoma of the thoracic vertebra. Spinal epidural angiolipoma is a rare benign tumor that occurs frequently in middle-aged women and is mostly located on the dorsal side of the thoracic spinal canal. Magnetic resonance imaging findings of spinal epidural angiolipoma depend on the ratio of fat to blood vessels. Most angiolipomas show equal or high signal on T1-weighted images and high intensity on T2-weighted images, with significant enhancement after injection of gadolinium. The treatment of spinal epidural angiolipoma is complete surgical resection with good prognosis.

Objective. High-resolution multi-modal magnetic resonance imaging (MRI) is crucial in clinical practice for accurate diagnosis and treatment. However, challenges such as budget constraints, potential contrast agent deposition, and image corruption often limit the acquisition of multiple sequences from a single patient. Therefore, the development of novel methods to reconstruct under-sampled images and synthesize missing sequences is crucial for clinical and research applications. Approach. In this paper, we propose a unified hybrid framework called SIFormer, which utilizes any available low-resolution MRI contrast configurations to complete super-resolution (SR) of poor-quality MR images and impute missing sequences simultaneously in one forward process. SIFormer consists of a hybrid generator and a convolution-based discriminator. The generator incorporates two key blocks. First, the dual branch attention block combines the long-range dependency building capability of the transformer with the high-frequency local information capture capability of the convolutional neural network in a channel-wise split manner. Second, we introduce a learnable gating adaptation multi-layer perception in the feed-forward block to optimize information transmission efficiently. Main results. Comparative evaluations against six state-of-the-art methods demonstrate that SIFormer achieves enhanced quantitative performance and produces more visually pleasing results for image SR and synthesis tasks across multiple datasets. Significance. Extensive experiments conducted on multi-center multi-contrast MRI datasets, including both healthy individuals and brain tumor patients, highlight the potential of our proposed method to serve as a valuable supplement to MRI sequence acquisition in clinical and research settings.

Coronary artery calcification (CAC) is an independent risk factor of major adverse cardiovascular events; however, the impact of CAC on in-hospital death and adverse clinical outcomes in patients with coronavirus disease 2019 (COVID-19) remains unclear. To explore the association between CAC and in-hospital mortality and adverse events in patients with COVID-19. This multicenter retrospective cohort study enrolled 2067 laboratory-confirmed COVID-19 patients with definitive clinical outcomes (death or discharge) admitted from 22 tertiary hospitals in China between January 3, 2020 and April 2, 2020. Demographic, clinical, laboratory results, chest CT findings, and CAC on admission were collected. The primary outcome was in-hospital death and the secondary outcome was composed of in-hospital death, admission to intensive care unit (ICU), and requiring mechanical ventilation. Multivariable Cox regression analysis and Kaplan–Meier plots were used to explore the association between CAC and in-hospital death and adverse clinical outcomes. The mean age was 50 years (SD,16) and 1097 (53.1%) were male. A total of 177 patients showed high CAC level, and compared with patients with low CAC, these patients were older (mean age: 49 vs. 69 years, P < 0.001) and more likely to be male (52.0% vs. 65.0%, P = 0.001). Comorbidities, including cardiovascular disease (CVD) ([33.3%, 59/177] vs. [4.7%, 89/1890], P < 0.001), presented more often among patients with high CAC, compared with patients with low CAC. As for laboratory results, patients with high CAC had higher rates of increased D-dimer, LDH, as well as CK-MB (all P < 0.05). The mean CT severity score in high CAC group was also higher than low CAC group (12.6 vs. 11.1, P = 0.005). In multivariable Cox regression model, patients with high CAC were at a higher risk of in-hospital death (hazard ratio [HR], 1.731; 95% CI 1.010–2.971, P = 0.046) and adverse clinical outcomes (HR, 1.611; 95% CL 1.087–2.387, P = 0.018). High CAC is a risk factor associated with in-hospital death and adverse clinical outcomes in patients with confirmed COVID-19, which highlights the importance of calcium load testing for hospitalized COVID-19 patients and calls for attention to patients with high CAC.

BackgroundResearch has been looking into neural pathophysiology of post-traumatic stress disorder (PTSD) and dynamic functioning connectivity (dFC) applying resting state functional magnetic resonance imaging (rs-fMRI). Previous studies showed that PTSD related impairments are associated with alterations distributed across different brain regions and disorganized functional connectivity, especially in Default Mode Network and the cerebellar area. In this study, we specifically looked into dFC on a whole brain level, and we focused on critical regions such as DMN and cerebellum. MethodsTo explore the characteristics of dFC among patients with PTSD, we collected rs-fMRI data from 27 PTSD patients and 30 healthy controls. The study also added a control group of 33 trauma-exposed individuals to further look into trauma impact. Utilizing group spatial independent component analysis (ICA), the dynamic properties on whole brain level were detected with sliding time window approach, and k-means clustering. ResultsTwo reoccurring FC “States” were identified, with connections being more concentrated on a within-network level in one state and more strongly inter-connected in the other state. Abnormalities in dFC were found within DMN, between DMN and cerebellum, and between DMN and visual network. ConclusionsThe findings were in accordance with the study hypothesis that PTSD patients demonstrated deficits in emotional modulation and dysfunctional self-referential thoughts, and the deficits could be indicated in dFC alterations. Abnormalities in dFC among PTSD patients could serve as appropriate indicators of PTSD symptoms including depression and anxiety, hypervigilance, as well as impaired cognitive functioning and self-referential information processing.

Background: The risk factors for adverse events of Coronavirus Disease-19 (COVID-19) have not been well described. We aimed to explore the predictive value of clinical, laboratory and CT imaging characteristics on admission for short-term outcomes of COVID-19 patients. Methods: This multicenter, retrospective, observation study enrolled 703 laboratory-confirmed COVID-19 patients admitted to 16 tertiary hospitals from 8 provinces in China between January 10, 2020 and March 13, 2020. Demographic, clinical, laboratory data, CT imaging findings on admission and clinical outcomes were collected and compared. The primary endpoint was in-hospital death, the secondary endpoints were composite clinical adverse outcomes including in-hospital death, admission to intensive care unit (ICU) and requiring invasive mechanical ventilation support (IMV). Multivariable Cox regression, Kaplan-Meier plots and log-rank test were used to explore risk factors related to in-hospital death and in-hospital adverse outcomes. Results: Of 703 patients, 55 (8%) developed adverse outcomes (including 33 deceased), 648 (92%) discharged without any adverse outcome. Multivariable regression analysis showed risk factors associated with in-hospital death included ≥ 2 comorbidities (hazard ratio [HR], 6.734; 95% CI; 3.239-14.003, p < 0.001), leukocytosis (HR, 9.639; 95% CI, 4.572-20.321, p < 0.001), lymphopenia (HR, 4.579; 95% CI, 1.334-15.715, p = 0.016) and CT severity score > 14 (HR, 2.915; 95% CI, 1.376-6.177, p = 0.005) on admission, while older age (HR, 2.231; 95% CI, 1.124-4.427, p = 0.022), ≥ 2 comorbidities (HR, 4.778; 95% CI; 2.451-9.315, p < 0.001), leukocytosis (HR, 6.349; 95% CI; 3.330-12.108, p < 0.001), lymphopenia (HR, 3.014; 95% CI; 1.356-6.697, p = 0.007) and CT severity score > 14 (HR, 1.946; 95% CI; 1.095-3.459, p = 0.023) were associated with increased odds of composite adverse outcomes. Conclusion: The risk factors of older age, multiple comorbidities, leukocytosis, lymphopenia and higher CT severity score could help clinicians identify patients with potential adverse events.

Purpose To develop a machine learning-based CT radiomics model is critical for the accurate diagnosis of the rapid spread Coronavirus disease 2019 (COVID-19). Methods In this retrospective study, a machine learning-based CT radiomics model was developed to extract features from chest CT exams for the detection of COVID-19. Other viral-pneumonia CT exams of the corresponding period were also included. The radiomics features extracted from the region of interest (ROI), the radiological features evaluated by the radiologists, the quantity features calculated by the AI segmentation and evaluation, and the clinical parameters including clinical symptoms, epidemiology history and biochemical results were enrolled in this study. The SVM model was built and the performance on the testing cohort was evaluated by the area under the receiver operating characteristic curve (AUC), sensitivity and specificity. Results For the SVM model that built on the radiomics features only, it reached an AUC of 0.688(95% CI 0.496 to 0.881) on the testing cohort. After the radiological features were enrolled, the AUC achieved 0.696(95% CI 0.501 to 0.892), then the AUC reached 0.753(95% CI 0.596 to 0.910) after the quantity features were included. Our final model employed all the features, reached the per-exam sensitivity and specificity for differentiating COVID-19 was 29 of 38 (0.763, 95% CI: 0.598 to 0.886]) and 12 of 13 (0.923, 95% CI: 0.640 to 0.998]), respectively, with an AUC of 0.968(95% CI 0.911 to 1.000). Conclusion The machine learning-based CT radiomics models may accurately detect COVID-19 and differentiate it from other viral pneumonia.

The abnormal brain activity is a pivotal condition for the occurrence of posttraumatic stress disorder. However, the dynamic time features of intrinsic brain activities still remain unclearly in PTSD patients. Our study aims to perform the resting-state lag analysis (RS-LA) method to explore potential propagated patterns of intrinsic brain activities in PTSD patients. We recruited 27 drug-naive patients with PTSD, 33 trauma-exposed controls (TEC), and 30 demographically matched healthy controls (HC) in the final data statistics. Both RS-LA and conventional voxel-wise functional connectivity strength (FCS) methods were employed on the same dataset. Then, Spearman correlation analysis was conducted on time latency values of those abnormal brain regions with the clinical assessments. Compared with HC group, the time latency patterns of PTSD patients significantly shifted toward later in posterior cingulate cortex/precuneus, middle prefrontal cortex, right angular, and left pre- and post-central cortex. The TEC group tended to have similar time latency in right angular. Additionally, significant time latency in right STG was found in PTSD group relative to TEC group. Spearman correlation analysis revealed that the time latency value of mPFC negatively correlated to the PTSD checklist-civilian version scores (PCL_C) in PTSD group (r = -0.578, P < 0.05). Furthermore, group differences map of FCS exhibited parts of overlapping areas with that of RS-LA, however, less specificity in detecting PTSD patients. In conclusion, apparent alterations of time latency were observed in DMN and primary sensorimotor areas of PTSD patients. These findings provide us with new evidence to explain the neural pathophysiology contributing to PTSD.

BackgroundOrbital cysticercosis is a common disease in the developing world. Although previous studies reported the spectrum of imaging findings of orbital cysticercosis and variable involvement of the extraocular muscles, the relationship between the lesion and the extraocular muscle (within the muscle or on the surface), as well as its distribution within the muscle (muscle belly or the tendinous insertion) was uncertain.PurposeTo characterize the predominant imaging findings of orbital cysticercosis on computed tomography (CT) and assess the relationship between orbital infection and extraocular muscles.Methods and MethodsA cohort of 35 patients with orbital cysticercosis was included in the analysis. All patients underwent CT examination, whereas 6 underwent magnetic resonance imaging.Results52 lesions were visualized on CT. The nodular calcified stage was rather common, followed by the colloidal vesicular or granular nodular stage and vesicular stage. Approximately, two-thirds of the lesions were presented as a cyst with/without an intramural nodule and the remaining as calcification. The extraocular muscle involvement consisted of a single, two, and three lesions, respectively; these were predominantly located within the extraocular muscles, whereas 12 lesions were attached to the extraocular muscles. The lesions were frequently within or adjacent to the muscle belly and less frequently associated with the tendinous insertion. The lateral rectus was frequently involved. The intracranial or extra-orbital involvement was found in 12 patients.ConclusionOrbital cysticercosis mainly presented as a cyst containing an intramural nodule and frequently residing within an extraocular muscle, with a predilection for the muscle belly.

Seventeen PBD adolescents in manic phase (male/female, 6/11) and remission phase (male/female, 8/9) and 17 age-, gender- and education matched normal adolescents (male/female, 5/12) were included in the study. The Stroop color-word test (SCWT), digit span test (DST), trail making test (TMT) and visual reproduction subtest (VR) were used to assess the cognitive function of the patients and the healthy controls (HCs). The amplitude of low-frequency fluctuations (ALFF) of the functional magnetic resonance imaging (fMRI) signals was evaluated to describe the resting-state brain activity. In the neuropsychological tests, the result of variance analysis showed values of SCWT, DST-B and VR of PBD patients were significantly decreased compared with those of the HCs (p < 0.05). Compared with the HCs (p < 0.01), significant increased ALFF values were found in left hippocampus (HIP) and right amygdala (AMYG) and decreased ALFF were found in right inferior temporal gyrus (ITG), left superior parietal lobule (SPL), left inferior occipital gyrus (IOG) and right calcarine fissure and surrounding cortex (CAL). Moreover, the mean ALFF of the right AMYG was positively correlated with the Young Mania Rating Scale (YMRS) score, the mean ALFF of the right ITG and right CAL were negatively correlated with the SCWT-B score and SCWT-C score respectively in PBD-mania patients (p < 0.05). PBD patients with manic phase and remission phase have broad impairment of cognitive functions, especially in executive function and visual perception. The abnormal resting-state neuronal activities of the AMYG, ITG and CAL may play a vital role in the cognitive impairment in PBD patients.

Post-traumatic stress disorder (PTSD) is associated with alterations in regional brain activation and remote functional connectivity (FC) in limbic and prefrontal cortex. However, little is known about local FC changes following a traumatic event. Resting-state functional magnetic resonance images were collected for typhoon survivors with (n = 27) and without PTSD (n = 33), and healthy controls (n = 30). Local FC was examined by calculating regional homogeneity (ReHo), and remote FC was investigated between regions showing significant ReHo group differences. The PTSD group showed ReHo changes in multiple regions, including the amygdala, parahippocampal gyrus, and prefrontal cortex relative to both control groups. Compared with healthy controls, typhoon survivors had increased ReHo in the insula/inferior frontal gyrus, middle and dorsal anterior cingulate cortex (MCC/dACC), as well as enhanced negative FC between the MCC/dACC and posterior cingulate cortex (PCC)/precuneus. The typhoon-exposed control group exhibited higher ReHo in the PCC/precuneus than the PTSD and healthy control groups. Furthermore, positive correlations were found between PTSD symptom severity and ReHo in several regions. Post-traumatic stress can influence local and remote FC, irrespective of PTSD diagnosis. Future studies are needed to validate the findings and to determine whether the alterations represent pre-existing or acquired deficits.

Nineteen manic adolescents (male/female, 7/12) with bipolar disorder and 18 age-and gender-matched normal adolescents (male/female, 6/12) were included in the study. The stroop color-word test (SCWT), visual reproduction test and trail making test (TMT) were used to assess the cognitive function of the patients and the healthy controls (HCs). The regional homogeneity approach was used to study the resting-state brain activity. Correlation between the resting-state brain activity and neuropsychological testing were analyzed. In the neuropsychological tests, the values of the test of SCWT, TMT-A and visual reproduction test of adolescents were significantly decreased compared with those of the HC group (p < 0.05). Compared with the control group (p < 0.05), the results of two-sample T-test showed that the brain areas with increased ReHo value included the left middle cingulate cortex (MCC_L) and decreased ReHo value included the left superior parietal gyrus (SPG_L), the inferior occipital gyrus (IOG), the right superior temporal gyrus (STG_R), the right superior occipital gyrus (SOG_R), the left precuneus (PCUN_L), the left supplementary motor area (SMA_L) and the left cerebelum_Crus2. Moreover, the mean ReHo values in the SOG_R were negatively correlated with the TMT-A scores and the mean ReHo values in the STG_R were negatively correlated with the Visual reproduction test scores. Pediatric bipolar disorder (PBD) patients have broad impairment of cognitive functions, including attention, spatial perception, memory and executive functions, which provides a new perspective for clarifying the pathophysiologic basis of cognitive impairment in patients with PBD.

BACKGROUND Betel quid dependence (BQD) patients have a cluster of cognitive, behavioral, and physiological symptoms which are associated with structural abnormalities in brain gray matter. However, so far there have neither been brain structural studies investigating the alterations related to BQD, nor studies assessing the brain structural changes with clinical indexes. METHODS 65 subjects were recruited including 33 'pure' BQD patients and another 32 gender and age matched in the control group. T1 structural voxel-based morphometry (VBM) was performed to investigate the gray matter (GM) volume alterations. In BQD patients, Pearson correlation analysis was performed to investigate the association between GM segmentations and clinical indexes, including BQD scores, illness duration, SAS and SDS. RESULTS Compared with that of the control group, the VBM of GM in BQD patients exhibited a significant decrease in volume (All P values > 0.05, AlphaSim correction) in the midbrain, right anterior cingulate cortex (rACC), bilateral dorsolateral prefrontal cortex (dlPFC) and right superior temporal gyrus (STG), and also there was an increased volume in right hippocampal and right precuneus. GM volumes of the left DLPFC and right rACC showed negative correlation with the duration of BQD, meanwhile, midbrain volumes were negative correlating with BQD scores (All P values > 0.05). CONCLUSIONS Our findings suggested that brain structural changes were present in BQD patients, and those may be a neurobiological basis for BQD patients. These findings may provide a new insight into the pathogenesis of BQD. Also, VBM is an effective tool for in vivo investigation of gray matter alterations in patients with BQD.