Sequential treatment with tirofiban and argatroban in acute isolated pontine infarction caused by branch atheromatous disease / 国际脑血管病杂志

Objective:To investigate the efficacy and safety of sequential treatment with tirofiban and argatroban in acute isolated pontine infarction (AIPI) caused by branch atheromatous disease (BAD).Methods:Consecutive patients with AIPI caused by BAD within 48 h of onset and admitted to Zhengzhou Central Hospital from April 2021 to April 2022 were enrolled retrospectively. The patients were divided into sequential treatment group and tirofiban group according to their therapeutic modalities. In the tirofiban group, tirofiban was pumped intravenously within 48 h after admission, and dual antiplatelet therapy with aspirin and clopidogrel was added 4 h before tirofiban was discontinued. On the basis of tirofiban treatment, the sequential treatment group was followed by argatroban for 5 days when tirofiban is discontinued. The main outcome measure was the modified Rankin Scale (mRS) score at 3 months after the onset . A score of <2 was defined as a good outcome. The secondary outcome measure was all the adverse events during the treatment and follow-up. Multivariate logistic regression analysis was used to determine the independent factors of the outcomes. Results:A total of 64 patients with AIPI caused by BAD were enrolled, including 32 in the sequential treatment group and 32 in the tirofiban group. There was no statistical difference in baseline data between the two groups, but the rate of good outcomes at 3 months after onset in the sequential treatment group was significantly higher than that in the tirofiban group (78.1% vs. 50.0%; χ2=5.497, P=0.019). Multivariate logistic regression analysis showed that after adjusting for low-density lipoprotein cholesterol, the higher baseline National Institutes of Health Stroke Scale score was independently associated with the poor outcomes (odds ratio 2.067, 95% confidence interval 1.343-3.182; P=0.001), while the sequential treatment was independently associated with the good outcomes (odds ratio 0.248, 95% confidence interval 0.064-0.957; P=0.043). Conclusion:Early application of sequential treatment with tirofiban and argatroban in AIPI caused by BAD may effectively improve the outcomes of patients, and the safety is good.

Study on rapid eye movement sleep behavior disorder in patients with Parkinson disease psychosis / 中华行为医学与脑科学杂志

Objective To explore the sleep structure characteristics and risk factors in patients with Parkinson disease psychosis (PDP).Methods Fifty-one patients with Parkinson disease were enrolled.Sixteen cases met the diagnostic criteria of Parkinson disease psychosis were included in the PDP group,while the remaining 35 cases were included in the PD group as the control group.Sleep status was monitored by polysomnography.Neuropsychological assessment of patients with Parkinson disease was performed by Parkinson quality of life questionnaire,Montreal cognitive assessment(MoCA)and Hoehn-Yahr state (H-Y) of Parkinson disease.Results There were statistically significant differences in age of onset in PD group and PDP group (64.11±8.87,57.44±10.07,t=1.242),course of disease (2 (1,4),6 (4,7),Z=-3.888),HY stage (2 (1.5,2.5),3 (2,3),Z=-2.487)(all P＜0.05).The total sleep time in the PDP group was lower than that in the PD group ((344.06±26.39)min,(361.74± 17.16)min,P＜0.05).Compared with the PD group,the proportion of slow wave sleep phase Ⅰ in the PDP group was bigger ((42.88 ± 7.99) ％,(37.14±5.21) ％,t=-3.065),and the proportion of slow wave sleep phase Ⅱ in the PDP group was smaller ((31.19±5.92) ％,(37.51±5.70) ％,t=3.634) (P＜0.05).Single factor binary logistic regression analysis showed that the course of disease,age of onset,RBD,HY stage,PDQ-39 questionnaire score,total sleep time,slow wave sleep stage Ⅰ (％) and slow wave sleep stage Ⅱ (％) were the risk factors of PDP (P＜0.05).Multivariate binary logistic regression analysis showed that the course of disease and RBD were independent risk factors for patients with PDP (P＜ 0.05).Conclusion Sleep structure changes in patients with PDP,and RBD is the independent risk factor for patients with Parkinson's psychotic disorders.

Intracranial arterial dolichoectasia and cerebral small vessel disease / 国际脑血管病杂志

Intracranial arterial dolichoectasia, also known as dilated cerebral artery disease, is characterized by an increase in the length and diameter of at least one intracranial artery, and the involved intracranial arteries enlarge and dilate. Cerebral small vessel disease mainly refers to diseases caused by small vessel lesions in the brain. It is usually used to describe a series of imaging changes of white matter and subcortical gray matter, including recent subcortical small infarction, lacuna, white matter hyperintensity, enlarged perivascular space, cerebral microhemorrhage, and cerebral atrophy. Recently, more and more studies have shown that there is a certain correlation between intracranial arterial dolichoectasia and cerebral small vessel diseases.

Advances in pathogenesis of cerebral small vessel disease / 国际脑血管病杂志

With the development of imaging, molecular biology, and pathology, the pathogenesis of cerebral small vessel disease (CSVD) has been deeply understood, but the exact pathogenesis is still unclear. This article reviews the pathogenesis of CSVD, including oxidative stress, inflammatory reaction, amyloid beta amyloid deposition, vascular endothelial dysfunction, and blood-brain barrier damage.