Risk of type 2 diabetes mellitus in catholic priests compared with general public.

AIMS: Although Catholic priests have a life of discipline with many responsibilities, there has been little research on the health effects of their lifestyle. Analysis of disease prevalence in priests will help elucidate the influence of religious life and occupational characteristics on the occurrence of diabetes. This retrospective study was performed to examine the differences in the prevalence of diabetes and prediabetes between Catholic priests and the general population. METHODS: The study population comprised 1845 Catholic priests aged 31-80 years who visited the health promotion centers of three university hospitals in Korea between 2010 and 2019. Controls consisted of 1801 adult non-clerics aged 31-80 years who underwent health checkups at the screening center during the same period. Logistic regression analysis was performed to compare the differences in the rates of diabetes and prediabetes between the priest and control groups. RESULT: Priests were younger and had lower rates of smoking, drinking alcohol, and hypertension compared with the control group. However, metabolic markers, such as BMI, waist circumference, body fat mass, insulin, HbA1c, and lipid profiles, were significantly higher in the priest group than the control group (all p < 0.05). After adjusting for covariates, the priest group had a significantly higher likelihood of having diabetes (OR = 1.651, 95% CI 1.146-2.379) or prediabetes (OR = 3.270, 95% CI 2.471-4.327) compared with the controls. CONCLUSIONS: This study showed that Catholic priests have higher risks of diabetes and prediabetes compared with the general population, and these risks increase with age. Further large-scale prospective studies are required to confirm these relationships.

Regional Brain Volume Changes in Catholic Nuns: A Cross-Sectional Study Using Deep Learning-Based Brain MRI Segmentation.

OBJECTIVE: Religious behaviors are considered as complex brain-based phenomena that may be associated with structural brain change. To identify the pattern of regional brain volume change in nuns, we investigated structural alterations in the brains of nuns using a fast processing automated segmentation method based on deep learning algorithms. METHODS: We retrospectively reviewed the medical records of the catholic sisters between the ages of 31 and 80 who are members of the charity of St. Vincent de Paul of Korea. A total of 193 asymptomatic subjects (86 nuns and 107 control subjects) received comprehensive health screening and underwent brain MRI scans. We compared cortical and sub-cortical volume between groups across multiple locations using our in-house U-Net++ deep learning-based automatic segmentation tool. RESULTS: Compared to the control group, the nun group displayed increased gray matter volume in the right lingual cortex, left isthmus-cingulate, posterior-cingulate, rostral-middle-frontal, superior-frontal, supramarginal, temporal-pole cortices, and bilateral pars-triangularis cortices after correction for multiple comparisons. On the other hand, the nun group showed reduced gray matter volume in the temporal and parietal regions relative to healthy controls. CONCLUSION: Our study suggests that spiritual practice may affect brain structure, especially in several frontal regions involved in a higher level of insight function.

Impact of a family history of cardiovascular disease on prevalence, awareness, treatment, control of dyslipidemia, and healthy behaviors: Findings from the Korea National Health and Nutrition Examination Survey.

BACKGROUND: Family history (FH) is one of important risk factors for cardiovascular disease (CVD). However, little is known about its impact on dyslipidemia prevalence and management status. Thus, we aimed to investigate the impact of FH of CVD on dyslipidemia prevalence, awareness, treatment, control, and healthy behaviors in Korean adults. METHODS: We conducted a cross-sectional study using representative data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2014-2018. A total of 22,024 participants aged ≥ 19 years without histories of CVDs were classified into two groups according to the presence of FH of CVD (with FH, n = 3,778; without FH, n = 18,246). FH of CVD was defined as having a first-degree relative with ischemic heart disease or stroke. Multivariate logistic regression analyses were performed to evaluate the association between FH of CVD and dyslipidemia prevalence, awareness, treatment, control, and healthy behaviors (weight control, non-smoking, non-risky drinking, sufficient physical activity, and undergoing health screening). RESULTS: FH of CVD was significantly associated with a higher dyslipidemia prevalence (adjusted odds ratio [aOR] 1.34, 95% confidence interval [CI] 1.18-1.51), better awareness (aOR 1.54, 95%CI 1.19-2.00), and treatment rates (aOR 1.34, 95%CI 1.12-1.60), but not control. Having an FH of CVD was not predictive of any healthy behaviors in dyslipidemia patients. For non-dyslipidemia patients, FH of CVD even showed significant association with smoking (aOR 1.18, 95%CI 1.02-1.36), and risky drinking (aOR 1.20, 95%CI 1.03-1.40) while it was predictive of receiving health screening (aOR 1.14, 95% CI 1.02-1.27). CONCLUSIONS: Having an FH of CVD might positively trigger dyslipidemia patients to start pharmacological intervention, but not non-pharmacological interventions. Therefore, physicians should make more efforts to educate and promote the importance of non-pharmacological behavioral modification in dyslipidemia patients with an FH of CVD.

Weight change and mental health according to obesity in relatively healthy middle-aged Korean women: The Korea National Health and Nutrition Examination Survey 2014, 2016, 2018.

BACKGROUND: Obesity is a known risk factor for various chronic conditions, as well as mental health disorders. However, there have been few studies on weight change and mental health according to obesity. This study was performed to elucidate the association between weight changes and mental health according to obesity in middle-aged women. METHODS: Data from the Korean National Health and Nutrition Examination Survey (2014, 2016, 2018), which included 3953 women aged 40 to 59, were used in this study. After excluding those who had chronic conditions possibly affecting weight change, 2964 women were included in the study. The associations between weight changes and mental health, including perceived stress, depressed mood surveyed by the patient health questionnaire-9(PHQ-9), and current depressive disorder were analyzed. RESULTS: Weight change in non-obese and obese women was associated with poorer mental health, including perceived stress and depressed mood (p<0.05), although the significance disappeared in covariates-adjusted analysis in obese women. Both non-obese and obese women with weight gain had higher perceived stress than women with weight loss, while in the PHQ-9 scores, higher scores were observed in non-obese women with weight gain, and in obese women with weight loss. LIMITATIONS: Our study could not define causality because this was a cross-sectional study. And the information on body weight change was obtained by self-reported questionnaires. CONCLUSIONS: Our study suggested that in relatively healthy middle-aged Korean women, weight change was a significant factor associated with mental health, but obesity itself was not.

Prevalence and related factors of irregular menstrual cycles in Korean women: the 5th Korean National Health and Nutrition Examination Survey (KNHANES-V, 2010-2012).

INTRODUCTION: There have been few population-based studies reporting medical, lifestyle and psychological factors associated with irregular menstrual cycles. This study aimed to elucidate the prevalence and related factors of irregular menstrual cycles in Korean women. METHODS: Cross-sectional data from the 5th Korean National Health and Nutrition Examination Survey were used. Eligible women were 19-40 years old, not currently taking oral contraceptives or using intrauterine devices, and not currently pregnant or breast feeding, and had no medical history of hysterectomy, thyroid diseases, cancers or renal failure. Finally, 3194 premenopausal women were recruited in this study. The prevalence and related factors of irregular cycles were obtained using a general linear model and logistic regression analyses in a complex sampling design. RESULTS: The prevalence of irregular cycles was 14.3%. Age and high-education level were associated with lower odds ratios (ORs) for irregular cycles (OR 0.91, 95% confidence interval (95% CI) 0.87-0.96, and OR 0.58, 95% CI 0.38-0.88, respectively). The ORs of body mass index, perceived stress and depressive mood were 1.05 (95% CI 1.01-1.10), 1.46 (95% CI 1.11-1.92) and 2.07 (95% CI 1.18-3.63), respectively. CONCLUSIONS: Age, perceived stress, body mass index, depressive mood and education level, rather than obstetric factors or metabolic diseases were significant factors associated with irregular menstrual cycles in Korean women. Of these factors, perceived stress is the most significant factor associated with increased irregular menstrual cycles.

Great toenail dystrophy: a single-center experience and review of the literature.

BACKGROUND: There have been a few reported cases of congenital great toenail dystrophy (GTND), described as a congenital malalignment of the great toenails. However, acquired GTDN is rare, and has not been documented extensively. This study aimed to describe the clinical features of 21 patients with acquired GTND. METHODS: Twenty-one patients with acquired GTND who visited Yeouido St. Mary's Hospital between June 2005 and August 2012 were retrospectively reviewed. RESULTS: The mean patient age was 43.1 years (range, 17 to 88 years), and the cohort predominantly comprised women (18/21). In our experience, all acquired GTND patients presented with yellow or yellow-brownish chromonychia, onychotrophy, and onycholysis. Conservative treatment with tape methods and grinding, as well as nail extraction, was provided and yielded little improvement in any case. CONCLUSION: This study provides initial data on the nail changes affecting the great toenail, such as yellowish chromonychia, onychomadesis, and onycholysis. These data may help physicians to distinguish various nail disorders, including onychomycosis, congenital malalignment of the great toenails, and yellow nail syndrome.

Anaplastic lymphoma kinase-positive anaplastic large cell lymphoma arising in a patient with hypersensitivity to mosquito bites.

Hypersensitivity to mosquito bites is defined as the appearance of intense skin reactive lesions and systemic symptoms subsequent to mosquito bites. Most cases of hypersensitivity to mosquito bites reported thus far have been associated with chronic Epstein-Barr virus infection or natural killer cell leukemia/lymphoma. In this study, we describe the case of an 18-year-old Korean boy who had hypersensitivity to mosquito bites associated with primary systemic anaplastic lymphoma kinase-positive anaplastic large cell lymphoma. After a mosquito bite, the patient developed a progressive cutaneous nodule on his left lower leg and regional lymphadenopathy in the left inguinal area. The histopathological and immunohistochemical findings suggested anaplastic lymphoma kinase-positive anaplastic large cell lymphoma. Positron emission tomography-computed tomography revealed increased fluorodeoxyglucose uptake in the left T4 vertebrae, left external iliac lymph nodes, left inguinal lymph nodes, and lateral subcutaneous region of the left lower leg. According to the clinical, histopathological, and immunohistochemical findings, as well as the imaging data, the patient was diagnosed with primary systemic anaplastic lymphoma kinase-positive anaplastic large cell lymphoma. Consequently, the patient received a total of 6 cycles of cyclophosphamide + doxorubicin + vincristine + prednisolone chemotherapy at 3-week intervals, after which the lesions regressed.

Dietary magnesium intake and metabolic syndrome in the adult population: dose-response meta-analysis and meta-regression.

ncreasing evidence has suggested an association between dietary magnesium intake and metabolic syndrome. However, previous research examining dietary magnesium intake and metabolic syndrome has produced mixed results. Our objective was to determine the relationship between dietary magnesium intake and metabolic syndrome in the adult population using a dose-response meta-analysis. We searched the PubMed, Embase and the Cochrane Library databases from August, 1965, to May, 2014. Observational studies reporting risk ratios with 95% confidence intervals (CIs) for metabolic syndrome in ≥ 3 categories of dietary magnesium intake levels were selected. The data extraction was performed independently by two authors, and the quality of the studies was evaluated using the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS). Based on eight cross-sectional studies and two prospective cohort studies, the pooled relative risks of metabolic syndrome per 150 mg/day increment in magnesium intake was 0.88 (95% CI, 0.84-0.93; I(2) = 36.3%). The meta-regression model showed a generally linear, inverse relationship between magnesium intake (mg/day) and metabolic syndrome. This dose-response meta-analysis indicates that dietary magnesium intake is significantly and inversely associated with the risk of metabolic syndrome. However, randomized clinical trials will be necessary to address the issue of causality and to determine whether magnesium supplementation is effective for the prevention of metabolic syndrome.

Duplicate publication of articles used in meta-analysis in Korea.

With the increasing use of meta-analysis, duplicate publication of original research is particularly problematic. Duplicate publication can result in an inappropriate weighting of the study results. The purpose of our study was to assess the incidence and characteristics of duplicate publications in Korea, and to estimate the impact of duplicate publication on meta-analyses. The meta-analysis literature written by Korean authors was searched using the online search engines PubMed, KMbase, and KoreaMed. Duplication patterns were classified into the following 4 combinations: identical samples and identical outcomes (copy), identical samples and different outcomes (fragmentation), increased samples and identical outcomes (imalas), and decreased samples and identical outcomes (disaggregation). To estimate the multiple publication bias, we performed a meta-analysis with and without duplicated data. We estimated that 6 (6.9%) of the 86 analyzed meta-analyses included duplicate publications, and 6 of the 1,194 articles (0.5%) used in the meta-analyses were duplicate publications. In this study, duplicate publications were usually due to disaggregation and overlapping (imalas) publications. Of 6 duplicated articles, 1 was considered a copy (16.6%); 1, a fragmentation (16.6%); 2, imalas (33.3%); and 2, disaggregations (33.3%). There was an increase in the mean effect size and fail-safe number with duplicated data. Our study found only 6 instances of duplicate publication after analyzing 1,194 articles used in meta-analyses written by Korean authors. However, 6.9% of the meta-analyses included duplicate publications. Our findings suggest that meta-analyses should be interpreted cautiously, taking into account the possibility of duplicated studies.

Epicardial adipose tissue: relationship between measurement location and metabolic syndrome.

Epicardial adipose tissue (EAT) is a contributing factor of metabolic syndrome (MS) and coronary artery disease (CAD). However, it is still unclear which measurement location of EAT area best reflects its cardiometabolic risk. The purpose of our study was to investigate the distribution of EAT and its relationship to the total EAT volume and MS. To assess volume and cross-sectional areas of EAT, coronary CT angiography were obtained in 256 asymptomatic subjects. The EAT areas within the threshold range of -190 to -30 Hounsfield units were measured at six representative slices. Correlations between single slice EAT areas and total EAT volumes were high across all measurement locations (correlation coefficient r > 0.80). The receiver-operator characteristic curves demonstrated EAT area at left main coronary artery (LMCA) was well discriminative for MS (AUC 0.82, p < 0.001) and CAD (AUC 0.76, p < 0.001). EAT areas across all measurement locations were significantly increased linearly with increasing number of MS components. EAT areas were significantly associated with MS at all measurement locations; the highest odds ratio (OR) between EAT area and MS was at the LMCA level (OR 5.86, p < 0.001). The OR between EAT area and coronary artery calcium was also significant in LMCA locations (OR 1.56, p = 0.042). We demonstrated that the single-slice EAT area measurement is a simple and reliable method compared with time-consuming volumetric measurements. The EAT area at LMCA level was the best single slice representing the risk of metabolic syndrome and coronary atherosclerosis.

Comparison of the Bactec Fx Plus, Mycosis IC/F, Mycosis/F Lytic blood culture media and the BacT/Alert 3D FA media for detection of Candida species in seeded blood culture specimens containing therapeutic peak levels of fluconazole.

BACKGROUND: The performance of Bactec Fx Plus Aerobic/F (PA), Mycosis IC/F (MF), Myco/F Lytic (ML) media and BacT/Alert 3D FA (FA) media in detecting 15 Candida isolates in blood cultures to which fluconazole had been added was investigated. METHODS: PA with resin, MF, ML media (n = 360), and FAmedia (n = 120) were tested against Candida albicans, C. tropicalis, C. parapsilosis, and C. krusei. As the peak plasma concentration after single oral doses of fluconazole 100, 200, and 400 mg was equivalent to peak level of 1.9, 4.7, and 6.7 mg/l, respectively, corresponding fluconazole was added. Time to detection (TTD) was measured. RESULTS: Overall TTD (mean hour ± standard deviation) for PA, FA, MF, and ML was as follows: 24.5 ± 7.3, 27.0 ± 7.5, 31.9 ± 21.3, and 37.7 ± 30.1, respectively. TTD of PA was shorter compared to other media. The effect of fluconazole was limited in PA and FA, but MF and ML showed delayed TTD. Larger inoculum size showed shorter TTDin PA and FA. CONCLUSION: TTD of Bactec Fx Plus Aerobic/F was more than 2.5 hr faster among the tested media. As thus system and media are unaffected by added fluconazole, it could be used for the diagnosis of candidemia in the clinical settings including the patients who have been treated empirically with fluconazole at the time when blood cultures were drawn.

Efficacy and safety of human placental extract solution on fatigue: a double-blind, randomized, placebo-controlled study.

Introduction. Fatigue is a common symptom, but only a few effective treatments are available. This study was conducted to assess the efficacy and safety of the human placental extract solution, which has been known to have a fatigue recovery effect. Methods. A total of 315 subjects were randomly assigned to three groups: group 1 (with Unicenta solution administration), group 2 (with exclusively human placental extract administration, excluding other ingredients from the Unicenta solution), and the placebo group. Subsequently, solutions were administered for four weeks. Results. The fatigue recovery rate was 71.00% in group 1, 71.72% in group 2, and 44.21% in the placebo group, which show statistically significant differences between the group 1 and the placebo group (P value = 0.0002), and between group 2 and the placebo group (P value = 0.0001). Conclusion. The human placental extract solution was effective in the improvement of fatigue.

Serum magnesium level is negatively associated with fasting serum glucose level in Korean adults.

Several studies have observed an inverse association between serum magnesium and fasting glucose levels. However, there have been sparse data on Koreans. The present study was designed to evaluate the association between serum magnesium and fasting serum glucose levels in Korean adults. A total of 949 Korean adults who visited an outpatient at a university hospital were included in this study. We compared mean values of clinical data according to the tertile of serum magnesium level using analysis of covariance. Association between serum magnesium and fasting glucose levels was evaluated using multiple regression analysis. Odds ratio (OR) was calculated to determine the association between hypomagnesemia and abnormal glucose metabolism. Fasting serum glucose levels decreased significantly from the lowest to the highest tertile of serum magnesium level (108.0±1.4, 106.5±2.1, 102.5±1.7 mg/dl, respectively, p=0.015), whereas blood pressure and lipid profile showed no significant associations. Serum magnesium level was negatively associated with fasting serum glucose level (ß=-0.114, p=0.001). Participants with hypomagnesemia had significantly higher OR for abnormal glucose metabolism compared to those with normomagnesaemia (OR=2.28, 95%CI 1.29-4.02). There was a negative association between serum magnesium and fasting glucose levels in Korean adults. In addition, hypomagnesemia was associated with abnormal glucose metabolism.

Dietary supplement use by South Korean adults: Data from the national complementary and alternative medicine use survey (NCAMUS) in 2006.

There has been little data on the prevalence of supplement use and the characteristics of the dietary supplement users in the Republic of Korea. This study presents the prevalence and the details of any dietary supplement use and the characteristics of the adults who use dietary supplements in the Republic of Korea. Between May 18 and June 16, 2006, nationwide and population-weighted personal interviews with 6,201 adult aged from 30 to 69 years were conducted and the final sample consisted of 3,000 people with a 49.8% response rate. We examined the prevalence and details of the use of dietary supplements and the characteristics of those who use the dietary supplement among adults. About sixty two percent of adults had taken any dietary supplement during the previous 12-month period in 2006. The most commonly reported dietary supplement was ginseng, followed by multivitamins, glucosamine, probiotics, and vitamin C. Female (versus male), an older age group, a higher family income, those living in metropolitan cities, those with marital experience, those with a higher level of education, and those having medical problems had a greater likelihood of reporting the use of any dietary supplements. The particular relationships differed depending on the type of supplement. The most Korean adults took one more dietary supplement and the dietary supplement users had different demographic and health characteristics compared to those of the nonusers. Research on diet supplements by the medical community is needed in the future.

Vitamin C attenuates ERK signalling to inhibit the regulation of collagen production by LL-37 in human dermal fibroblasts.

Vitamin C is used as an anti-ageing agent because of its collagen enhancing effects. The precise cellular signalling mechanism of vitamin C is not well known. Here, we investigate the profibrotic mechanism of vitamin C against LL-37. Antimicrobial peptide LL-37 decreases collagen expression at mRNA and protein levels in human dermal fibroblasts (HDFs). The ability of LL-37 to inhibit collagen expression is dependent on phosphorylation of extracellular signal-regulated kinase (ERK). HDFs and human keloid fibroblasts were treated with vitamin C followed by 2 h of LL-37 treatment. Collagen mRNA expression and total soluble collagen production inhibited by LL-37 was enhanced by treatment with 0.5 mm vitamin C. Vitamin C also decreased intracellular reactive oxygen intermediates (ROI) levels that were increased by LL-37. Furthermore, the phosphorylation of ERK was analysed by Western blot following treatment with vitamin C and LL-37. Vitamin C turned off phosphorylation of ERK that was induced by LL-37. Ets-1 transcriptional factor, which is involved in the regulation of collagen expression by LL-37, was also inhibited by vitamin C. This study shows that vitamin C enhances collagen production by inhibiting the ERK pathway induced by LL-37.

Associations of serum Ca and Mg levels with mental health in adult women without psychiatric disorders.

Several lines of evidence from previous studies suggest that Calcium (Ca) and Magnesium (Mg) may be involved in intracellular and interneuronal processes associated with affective disorders. However, there have been inconsistent results on the effect of Ca and Mg on depressive mood disorder. This cross-sectional study was conducted to determine whether serum Ca and Mg levels, as well as serum Ca/Mg ratio, are associated with mental health in relatively healthy, adult women without psychiatric disorders. One hundred and twelve adult women were recruited from the outpatient clinic in a university hospital setting. Serum Ca and Mg levels were measured and indicators of mental health such as depression, anxiety, and stress were evaluated using two validated questionnaires; the Hospital Anxiety Depression Scale and the Modified Brief Encounter Psychosocial Instrument Stress Scale. After categorizing the serum Ca and Mg levels, and the Ca/Mg ratio into tertiles, the mean scores on each mental health scale were compared using analysis of covariance. The risk of depressive mood disorder according to the tertiles of serum Mg level and serum Ca/Mg ratio was assessed using logistic regression analysis. Women in the middle tertile of serum Ca/Mg ratio had significantly lower scores on depression and stress scales (p = 0.004 and p = 0.007, respectively) and a lower odds ratio (OR) for the risk of depressive mood disorder (OR = 0.31, CI(95%) 0.10-0.93) than those in the highest tertile. The OR for the risk of depressive mood disorder was higher in women in the lowest tertile of serum Mg than in those in the highest tertile (OR = 3.92, CI(95%) 1.11-13.83). Serum Mg level and serum Ca/Mg ratio may be involved in the mechanism for the progression of depressive mood or stress perception in relatively healthy, adult women.

The use of complementary and alternative medicine in a general population in South Korea: results from a national survey in 2006.

The purpose of this survey was to obtain information on the prevalence, costs, and patterns of use of complementary and alternative medicine (CAM) in a general population in the Republic of Korea. In 2006, we conducted nationwide and population-weighted personal interviews with 6,021 adults ranging from 30 to 69 yr of age; the final sample consisted of 3,000 people with a 49.8% response rate. In addition to their general socio-demographics, the respondents were asked about their use of CAM during the previous 12-month period, costs, sources of information, and reasons for use. The prevalence of use overall was 74.8%, while biologically based CAM therapies were the most likely type of use (65.4%). The median annual out-of-pocket expenditures for CAM therapies was about US$203. The primary reason for using CAM was for disease prevention and health promotion (78.8%). The main source of advice about CAM therapies use was most likely to be from family and friends (66.9%). Our study suggests that CAM use has been and continues to be very popular in South Korea. Conventional western medical doctors and governments should obtain more evidence and become more interested in CAM therapies.

Psychiatric disorder in two siblings with hallervorden-spatz disease.

Hallervorden-Spatz disease (HSD) is a rare autosomal-recessive hereditary disorder characterized by the early onset of progressive movement alterations, including dystonia, rigidity, choreoathetosis, and mental deterioration. HSD is also associated with a variety of psychiatric symptoms, primarily depression and mental deterioration. However, psychosis has rarely been reported as a major symptom of HSD. We report two siblings who presented psychiatric symptoms as major clinical presentations, accompanied by ataxic and spastic gait, dysarthria, and typical neuroimaging findings of HSD. A 14-year-old girl presented complex motor tics, stereotypic behavior and anxiety symptoms. Her older brother, a 16-year-old boy, presented prominent auditory hallucinations, persecutory delusions and social withdrawal symptoms. Psychiatric symptoms were improved after atypical antipsychotic treatment. HSD is a rare disease but should be carefully considered in the diagnosis of patients with both motor disorder and various psychiatric symptoms.

The segmented regional volumes of the cerebrum and cerebellum in boys with Tourette syndrome.

Neuropathological deficits are an etiological factor in Tourette syndrome (TS), and implicate a network linking the basal ganglia and the cerebrum, not a particular single brain region. In this study, the volumes of 20 cerebral and cerebellar regions and their symmetries were measured in normal boys and TS boys by brain magnetic resonance imaging. Brain magnetic resonance images were obtained prospectively in 19 boys with TS and 17 age-matched normal control boys. Cerebral and cerebellar regions were segmented to gray and white fractions using algorithm for semi-automated fuzzy tissue segmentation. The frontal, parietal, temporal, and the occipital lobes and the cerebellum were defined using the semiautomated Talairach atlas-based parcellation method. Boys with TS had smaller total brain volumes than control subjects. In the gray matter, although the smaller brain volume was taken into account, TS boys had a smaller right frontal lobe and a larger left frontal lobe and increased normal asymmetry (left>right). In addition, TS boys had more frontal lobe white matter. There were no significant differences in regions of interest of the parietal, temporal, or the occipital lobes or the cerebellum. These findings suggest that boys with TS may have neuropathological abnormalities in the gray and the white matter of the frontal lobe.