med jhmi edu/) Regions of interest (ROI) were set in four locati Regions of interest (ROI) were set in four locations on the basis of the DTI color map atlas (Wakana et al. 2004) (Fig. 1): the middle cerebellar peduncle (MCP, 30 voxels; bilateral 15 voxels each), posterior limb of the internal capsule (PLIC,

14 voxels; bilateral seven voxels each), corpus callosum (CC, 40 voxels; splenium and genu 20 voxels each), and white matter of the parietal lobe (WMP, 30 voxels; bilateral 15 voxels). We calculated mean FA values of 10 times settings in each location except when the standard deviation was higher than 0.1. Figure 1 Regions of interest (ROI) on the fractional anisotropy (FA) color map are shown. MCP = middle cerebellar peduncle, gCC = genu of corpus callosum, Inhibitors,research,lifescience,medical sCC = splenium of corpus callosum, Inhibitors,research,lifescience,medical PLIC = posterior limb of the internal capsule, WMP = white matter of the … In addition, we performed multivoxel magnetic resonance spectroscopy (MRS) (TE = 144

msec, TR = 2000 msec, FOV = 80 × 80 mm2, voxel of interest (VOI) size = 65 × 65 mm2, matrix = 16 × 16, ST = 15 mm, voxel resolution = 5 × 5 × 15 mm3). Multivoxels were set on the section containing gyrus cinguli and centrum semiovale (frontoparietal white matter site) along with a reference (Doelken et al. 2009). As the Inhibitors,research,lifescience,medical parameter, N-acetyl aspartate (NAA), SAHA HDAC creatine (Cre), choline (Cho), lactate, and lipid were analyzed. We chose six voxels (three voxels on each side) in gyrus cinguli and centrum semiovale as ROI and calculated the mean NAA/Cre Inhibitors,research,lifescience,medical ratio and the mean Cho/Cre ratio in these regions (Fig. 2). Figure 2 In magnetic resonance spectroscopy (MRS) study, six voxels (three voxels on each side) in centrum semiovale (A = white boxes) and gyrus cinguli (B = white boxes) as region of interest. Spectrum of NAA, creatine, or choline is shown (C). In accordance with the ethical guidelines of the Declaration

of Helsinki, written informed consent was obtained from all participants’ guardians under protocols approved by the Institutional Inhibitors,research,lifescience,medical Review Board of Kobe University Graduate School of Medicine, Kobe, Japan. Results Neurological examinations Patient profiles and neurological findings are summarized in Table 1. Hearing loss is a common symptom in XP. Progressive intellectual deterioration disturbed accurate evaluation for sensation. Deep tendon reflexes (DTRs) were absent or diminished in L-NAME HCl all patients, and abnormal plantar reflex (Babinski sign) were positive in eight of 10 patients. Those neurological findings indicated that both upper and lower motor neuron involvement started from an early stage. Cerebellar ataxia was obvious after 6 years of age. In an 18-year-old patient, an extrapyramidal sign was observed in association with various neurological abnormalities. In patient No.10, severe contractures in all extremities resulted in impossible proper examination for the presence of ataxia or abnormal reflexes.

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