ABSTRACT
Objective To explore the features of resting state functional magnetic resonance imaging (rs-fMRI) in the patients with mild cognitive impairment (MCI) after during the process of converting to Alzheimer's disease (AD) dementia. To study the correlation of the brain function imaging and neuropsychological scores in converted MCI subjects with the purpose of finding the potential functional biomarkers which may predict the conversion of MCI to AD dementia in short term using resting state functional MRI. Methods Twenty-seven patients with MCI and 31 age, gender and years of education matched normal controls (NC) were enrolled in this study and neuropsychological assessment and rs-fMRI data were acquired respectively at the baseline and follow-up. Functional connectivity strength (FCS) analyses were used to assess the functional differences among the groups of MCI-converters (MCI-c) , MCI-non converters (MCI-nc) and NC. Variance analyses were used to compare the group differences in age, years of education and each neuropsychological assessment. In addition, Chi-squared test was used to compare group differences in gender. Then, Kruskal-Wallis test was used to compare group differences in the interval time of twice data collection. Group differences in FCS values were analyzed by general linear model. Finally, correlation analyses were used to evaluate the relationships between the FCS values of the brain regions with group differences and neuropsychological assessment scores in MCI patients. Results (1) Significant group differences of FCS among the MCI-c, MCI-nc and NC groups were observed in bilateral angular gyri, bilateral orbitofrontal cortex, right precentral gyrus, left paracentral lobule, left precuneus, right fusiform, right middle occipital gyrus, right superior occipital gyrus, left cerebellum. (2) The MCI-c showed decreased FCS in bilateral angular gyri, right middle occipital gyrus, right superior occipital gyrus, right inferior occipital gyrus, right fusiform, left precuneus, and left paracentral lobule, as compared to MCI-nc, the cluster was 149, 114, 186, 56, 48, 33, 38 and 102 voxels, respectively;P<0.05, respectively. The correlation analysis showed that the FCS values of the right angular gyrus were negative correlated with the MMSE scores (r=-0.561, P=0.017) . Conclusions This study revealed that the comparison of rs-fMRI imaging data between MCI-c and MCI-nc at baseline is of great benefits in analysing the imaging characteristics of patients during converting from MCI to AD. The feature of FCS in rs-fMRI in right angular gyrus might serve as early indicators for the dysfunction and progression from MCI to AD.
ABSTRACT
Objective To explore the features of resting state functional magnetic resonance imaging (rs-fMRI) in the patients with mild cognitive impairment (MCI) after during the process of converting to Alzheimer's disease (AD) dementia. To study the correlation of the brain function imaging and neuropsychological scores in converted MCI subjects with the purpose of finding the potential functional biomarkers which may predict the conversion of MCI to AD dementia in short term using resting state functional MRI. Methods Twenty-seven patients with MCI and 31 age, gender and years of education matched normal controls (NC) were enrolled in this study and neuropsychological assessment and rs-fMRI data were acquired respectively at the baseline and follow-up. Functional connectivity strength (FCS) analyses were used to assess the functional differences among the groups of MCI-converters (MCI-c) , MCI-non converters (MCI-nc) and NC. Variance analyses were used to compare the group differences in age, years of education and each neuropsychological assessment. In addition, Chi-squared test was used to compare group differences in gender. Then, Kruskal-Wallis test was used to compare group differences in the interval time of twice data collection. Group differences in FCS values were analyzed by general linear model. Finally, correlation analyses were used to evaluate the relationships between the FCS values of the brain regions with group differences and neuropsychological assessment scores in MCI patients. Results (1) Significant group differences of FCS among the MCI-c, MCI-nc and NC groups were observed in bilateral angular gyri, bilateral orbitofrontal cortex, right precentral gyrus, left paracentral lobule, left precuneus, right fusiform, right middle occipital gyrus, right superior occipital gyrus, left cerebellum. (2) The MCI-c showed decreased FCS in bilateral angular gyri, right middle occipital gyrus, right superior occipital gyrus, right inferior occipital gyrus, right fusiform, left precuneus, and left paracentral lobule, as compared to MCI-nc, the cluster was 149, 114, 186, 56, 48, 33, 38 and 102 voxels, respectively;P<0.05, respectively. The correlation analysis showed that the FCS values of the right angular gyrus were negative correlated with the MMSE scores (r=-0.561, P=0.017) . Conclusions This study revealed that the comparison of rs-fMRI imaging data between MCI-c and MCI-nc at baseline is of great benefits in analysing the imaging characteristics of patients during converting from MCI to AD. The feature of FCS in rs-fMRI in right angular gyrus might serve as early indicators for the dysfunction and progression from MCI to AD.
ABSTRACT
Objective To observe the effect of early using butylphthalide injection before and after thrombolytic therapy with intravenous recombinant tissue plasminogen activator (rt-PA) on the clinical prognosis of patients with ultra-early acute cerebral infarction (ACI). Methods A prospective study was conducted, 81 patients with ACI admitted to the Department of Neurology of Tangshan Worker's Hospital from September 2014 to March 2016 were enrolled, and they were divided into a control group (40 cases) and an observation group (41 cases) according to the random number table. Both groups were given routine treatments, such as drugs for lowering blood pressure and blood sugar, decreasing blood lipid to stabilize plaque, neuroprotection, activating blood circulation and removing blood stasis, etc. On the basis of conventional treatment, the control group was directly treated with rt-PA intravenous (IV) thrombolytic therapy according to the guidelines of thrombolytic therapy; in the observation group, the patients immediately underwent CT head examination after admission to decide whether the thrombolytic therapy was necessary, if the therapy was decided to be done, during doctors waiting for the laboratory results or transferring patients, IV drip of butylphthalide sodium chloride 100 mL. After IV drip thrombolytic therapy, if the disease condition was stabilized, the head CT was re-examined to exclude intracranial hemorrhage, if no such hemorrhage, IV drip of butylphthalide sodium chloride 100 mL was continuously given, twice daily for consecutive 14 days with the interval between the two times of IV drip being 7 hours daily. When patient's condition was changed, the re-examination of head CT could be done at any time; if the patient's condition was not changed, the head CT was routinely performed 24 hours after IV drip thrombolysis. After exclusion of intracranial hemorrhage, the patients in both groups were treated additionally by the platelet aggregation drug on the basis of their original treatment. The National Institutes of Health Stroke Scale (NIHSS) scores, Bartherl index (BI) scores were recorded before and after treatment, and the recovery situation of neurological function, hemorrhage conversion rate, mortality and adverse reactions were observed after thrombolysis. Results After treatment, the NIHSS scores were lower, and the BI index scores were higher than those before treatment in the two groups, and the change in the observation group after 14 days of treatment was more significant (NIHSS score: 3.87±3.46 vs. 7.37±4.18, BI score: 87.38±9.34 vs. 75.67±8.05, both P < 0.05); the total effective rate of the observation group was significantly higher than that of the control group [73.2% (30/41) vs. 55.0% (22/40), P < 0.05], the rate of bleeding conversion rate was lower than that of the control group [2.4% (1/41) vs. 7.5% (3/40), P < 0.05], the difference in fatality rate between the two groups was not statistically significant [2.4% (1/41) vs. 2.5% (1/40), P > 0.05]. Conclusion The clinical therapeutic effect of butylphthalide injection is relatively good for treatment of patients with ultra-early ACI.
ABSTRACT
Objective To observe the effect of early using butylphthalide injection before and after thrombolytic therapy with intravenous recombinant tissue plasminogen activator (rt-PA) on the clinical prognosis of patients with ultra-early acute cerebral infarction (ACI). Methods A prospective study was conducted, 81 patients with ACI admitted to the Department of Neurology of Tangshan Worker's Hospital from September 2014 to March 2016 were enrolled, and they were divided into a control group (40 cases) and an observation group (41 cases) according to the random number table. Both groups were given routine treatments, such as drugs for lowering blood pressure and blood sugar, decreasing blood lipid to stabilize plaque, neuroprotection, activating blood circulation and removing blood stasis, etc. On the basis of conventional treatment, the control group was directly treated with rt-PA intravenous (IV) thrombolytic therapy according to the guidelines of thrombolytic therapy; in the observation group, the patients immediately underwent CT head examination after admission to decide whether the thrombolytic therapy was necessary, if the therapy was decided to be done, during doctors waiting for the laboratory results or transferring patients, IV drip of butylphthalide sodium chloride 100 mL. After IV drip thrombolytic therapy, if the disease condition was stabilized, the head CT was re-examined to exclude intracranial hemorrhage, if no such hemorrhage, IV drip of butylphthalide sodium chloride 100 mL was continuously given, twice daily for consecutive 14 days with the interval between the two times of IV drip being 7 hours daily. When patient's condition was changed, the re-examination of head CT could be done at any time; if the patient's condition was not changed, the head CT was routinely performed 24 hours after IV drip thrombolysis. After exclusion of intracranial hemorrhage, the patients in both groups were treated additionally by the platelet aggregation drug on the basis of their original treatment. The National Institutes of Health Stroke Scale (NIHSS) scores, Bartherl index (BI) scores were recorded before and after treatment, and the recovery situation of neurological function, hemorrhage conversion rate, mortality and adverse reactions were observed after thrombolysis. Results After treatment, the NIHSS scores were lower, and the BI index scores were higher than those before treatment in the two groups, and the change in the observation group after 14 days of treatment was more significant (NIHSS score: 3.87±3.46 vs. 7.37±4.18, BI score: 87.38±9.34 vs. 75.67±8.05, both P < 0.05); the total effective rate of the observation group was significantly higher than that of the control group [73.2% (30/41) vs. 55.0% (22/40), P < 0.05], the rate of bleeding conversion rate was lower than that of the control group [2.4% (1/41) vs. 7.5% (3/40), P < 0.05], the difference in fatality rate between the two groups was not statistically significant [2.4% (1/41) vs. 2.5% (1/40), P > 0.05]. Conclusion The clinical therapeutic effect of butylphthalide injection is relatively good for treatment of patients with ultra-early ACI.