ABSTRACT
Objective To study changes in bone microstructure of osteoporotic rats by multiscale analysis. Methods A total of 20 5-month-old female SD rats were randomly divided into two groups, i.e., ovariectomy (OVX) group (n=12) and the SHAM group (n=8), respectively. The rats in OVX group were subjected to bilateral ovariectomy and became osteoporosis models after 8 weeks, while sham operation was performed for the SHAM group. Changes in microstructure of cortical bone and cancellous bone at tissue scale, and osteocyte lacunar-canalicular network (LCN) and extracellular matrix (ECM) at cell scale were quantitatively analyzed using Micro-CT and SR-Nano-CT. Results At tissue scale, the cross-sectional area of cortical bone in OVX group was significantly higher than that in SHAM group (P<0.05), and the bone mineral density (BMD) and thickness of cortical bone were not significantly different from those in SHAM group. The trabecular BMD, bone volume fraction, trabecular thickness and trabecular number in OVX group were significantly decreased in comparison with SHAM group (P<0.01), while the trabecular separation was significantly increased (P<0.01). At cell scale, there was no significant difference in the semiaxes of lacunae between OVX group and SHAM group, but the thickness of lacunae and the diameter of canaliculi in OVX group were significantly increased in comparison with SHAM group (P<0.05). At the same time, the porosity of cortical bone in OVX group was significantly higher than that in SHAM group at cell scale (P<0.05). Conclusions The bone microstructure in OVX group varied to different extents at tissue and cell scales. At tissue scale, the cancellous bone loss was severe, while the cortical bone had fewer changes. At cell scale, porosity of the lacunar-canalicular network significantly increased, which directly affected the BMD and strength of cortical bone. Multiscale analysis on changes in bone microstructure of OP rats has potential application value for clinical diagnosis and pathological analysis of osteoporosis.
ABSTRACT
The modern concept of lacunar infarct is largely based on the meticulous postmortem work of Fisher from the 1950s to 1970s, which forms the basis of the"lacunar hypothesis". Along with the application of CT or MRI techniques and classification of ischemic stroke subtypes, the lacunar infarct was endowed with the profile of imaging diagnosis and stroke subtypes. Thus, the concept of lacunar infarct has far expanded the initial pathological meanings and the terminology and definitions for lacunar infarct vary widely. In this review, the historical pathological findings and the term evolution of lacunar infarct were systemically reviewed, with a focus toward future directions in the complex entity of lacunar infarct.
ABSTRACT
Stroke is one among such diseases which needs immediate care and attention as it causes death and disabilities in the person, hence considered as a major burden in developing countries like India. The estimated adjusted prevalence rate of stroke in India ranges from 84-262/1,00,000 in rural and 334-424/1,00,000 in urban areas. The incidence rate is 119-145/1,00,000 based on the recent population-based study. The nearest clinical entity for stroke is Pakshaghata. Methodology: A 51yrs old male patient who is a known case of DM since 6years under regular medication approached to OPD of SKAMCH & RC Bangalore, with a Lakshana of loss of function, sensation, speech etc where mainly right half of the body was affected. Based on the clinical presentation and Ayurvedic parameters, the condition was diagnosed as Pakshaghata with special reference to ischemic stroke with possible multiple lacunar infarcts and Chikitsa was adopted keeping Dhatukshayajanya pathology as base. The treatment such as Sarvanga Abhyanga, Sarvanga Nadi swda, Sarvanga shashtika shali pinda sweda and Basti with oral medications like Suvarna sameerapannaga rasa, Vidaryadi Kashaya, ashtavarga Kashaya, balarishta and Cap. Palsineuron were prescribed. Result: There were drastic improvements seen in the Lakshanas. Overall fruitful result was achieved even follow up were maintained. Discussion: This article is a discussion about a case of ischemic stroke of brain which was successfully treated with Ayurvedic approach. The disease Pakshaghata with its Lakshanas, Nidana, Samprapti, Sampraptivighatana of Chikitsa given, along with the approach to conclude its possible modern co-relation as Ischemic stroke of brain were the main points Sampraptivighatana, chikitsa given, consideration. Conclusion: The above-described sets of Panchakarma treatment along with Shamanoushadhi has shown significant result clinically with speedy recovery within a month in the patient in the present study.
ABSTRACT
Objective:To investigate the incidence, neuroimaging features, and related factors for asymptomatic cerebral small vessel disease(CSVD)in the elderly population.Methods:A total of 201 elderly people with no neurological disease history who had undergone brain magnetic resonance imaging(MRI)examination from October 2019 to August 2020 were enrolled.We calculated the total CSVD score for each participant based on lacunar infarcts(LIs), white matter hyperintensities(WMH), enlarged perivascular spaces(EPVS), and cerebral microbleeds(CMBs)(0-4 points).CSVD neuroimaging features and the correlation between CSVD markers and clinical variables were analyzed.Results:In this study, 133 cases(66.2%)showed MRI features consistent with CSVD.Of whom, LIs were present in 44(21.9%), high-grade PVWMH in 88(43.8%), high-grade DWMH in 30(14.9%), basal ganglia EPVS in 61(30.3%), and CMBs in 92(45.8%).Total CSVD burden score( OR=1.876, 95% CI: 1.045-3.364, χ2=4.441, P=0.035), PVWMH( OR=2.821, 95% CI: 1.517-5.244, χ2=10.752, P=0.001), DWMH( OR=2.130, 95% CI: 1.108-4.092, χ2=5.145, P=0.023), and EPVS( OR=3.258, 95% CI: 1.675-6.334, χ2=12.129, P=0.000)were associated with hypertension.Total CSVD burden score, PVWMH, DWMH, EPVS, and CMB were correlated with increasing age( P<0.05).LIs was positively correlated with PVWMH( b=0.231, P=0.001), DWMH( b=0.247, P=0.000)and EPVS( b=0.215, P=0.001).There was a positive relationship between PVWMH and DWMH( b=0.546, P=0.000)as well as EPVS( b=0.388, P=0.000).DWMH was also positively correlated with EPVS( b=0.357, P=0.000)and CMB( b=0.177, P=0.009). Conclusions:The incidence of asymptomatic CSVD is high in the elderly population.The total CSVD score is a useful measure to evaluate asymptomatic cerebral small vessel disease in the elderly population.Neuroimaging features of asymptomatic CSVD are mainly correlated with age and hypertension.
ABSTRACT
Objective:To investigate the relationship between cognitive function and brain event-related potential in patients with lacunar cerebral infarction.Methods:A total of 464 patients with lacunar cerebral infarction admitted to the Department of Neurology, Kailuan General Hospital from 2014 to 2019 were prospectively selected as observation subjects (case group). According to mini-mental state examination (MMSE) score, the patients in the case group were divided into 352 cases of lacunar cerebral infarction with normal cognition and 112 cases of mild cognitive impairment. At the same time, 100 healthy volunteers were selected as the control group. All subjects were assessed by simple intelligent mental state, Zung self-rating anxiety scale, Zung self-rating depression scale and brain event-related potential P3a and P3b. The measurement data of normal distribution adopts one-way ANOVA, the measurement data of non normal distribution adopts Kruskal Wallis H test, and the counting data adopts χ2. Multivariate statistical analysis was performed by unconditional Logistics (stepwise method). Results:The proportions of smokers in control group, lacunar cerebral infarction cognitive normal group and lacunar cerebral infarction mild cognitive impairment group were 20.00% (20/100), 38.07% (134/352) and 46.42% (52/112), respectively. The proportions of drinkers were 18.00% (18/100), 33.24% (117/352), 33.93% (38/112), respectively. The proportions of hypertension were 38.00% (38/100), 58.24% (205/352), 59.82% (67/112), respectively. The proportions of hyperhomocysteinemia were 19.00% (19/100), 34.00% (120/352) and 68.75% (77/112), respectively, and the differences among the three groups were statistically significant ( χ2 values were 15.66, 7.91, 11.86 and 54.57, respectively; P<0.001, 0.019, 0.003, <0.001). The peak latency CZ leads of visual P3b wave group N2 were (271.48±40.65), (285.67±44.08) and (290.57±68.41) ms, respectively. PZ leads were (276.70±50.92), (287.86±43.28) and (312.16±62.75) ms. P3b peak latency FZ leads were (392.67±42.50), (405.82±52.43) and (410.34±64.27) ms. CZ leads were (395.04±42.44), (412.51±55.86) and (433.28±66.32) ms. PZ leads were (398.24±40.93), (411.17±49.48) and (435.78±67.69) ms. N2 amplitude CZ leads were (-3.99±2.81), (-3.60±3.00) and (-2.70±2.37) μV, PZ leads were (-3.18±2.69), (-2.91±2.62) and (-1.87±2.89) μV, respectively. Leads P3b amplitude of FZ were 5.27 (3.27, 7.40), 4.21 (2.31, 6.49) and 3.12 (1.61, 5.08) μV. CZ leads were 4.81 (2.78, 6.71), 4.15 (2.76, 6.16) and 3.51 (1.75, 5.15) μV. PZ leads were 5.17 (3.03, 6.97), 4.40 (2.89, 6.12) and 3.43 (1.52, 5.34) μV. There were statistically significant differences among the 3 groups ( F=3.29, 14.49, 3.95, 11.73, 14.06, 5.66 and 3.57, H=18.23, 10.33,18.25; P=0.027, <0.001, 0.025, <0.001, <0.001, 0.004, 0.042, <0.001, 0.006, <0.001). The peak latency FZ leads of visual P3a wave group N2 were 265.00 (256.00, 286.00), 277.00(260.00,300.00), 282.00(270.00,304.00) ms, respectively. CZ leads weres 274.00(255.00,305.00), 285.00(262.00,329.00), 293.50(270.00,346.00) ms. P3a peak latency FZ leads were (413.83±49.58), (429.83±55.38) and (449.04±54.79) ms, CZ leads were (441.53±61.78), (457.12±69.29) and (460.23±72.24) ms. PZ leads were (430.14±54.53), (462.31±69.2) and (470.02±74.92) ms. N2 amplitude FZ leads were (-6.34±3.13), (-5.72±2.96) and (-4.92±2.05) μV, respectively. Leads P3a amplitude of FZ were 4.00 (2.28, 5.55), 3.15 (2.14, 4.91) and 2.80 (2.19, 4.19) μV. CZ lead were 3.37 (1.98, 4.66), 2.73 (1.70, 3.97) and 2.41 (1.64, 3.45) μV. There were statistically significant differences among the three groups ( H=13.92, 8.65, 9.17, 10.02, F=8.18, 6.33, 10.73, 4.62, P =0.001,0.013,0.010,0.007, <0.001,0.002, <0.001,0.010). Logistic regression analysis showed that alcohol consumption, P3b peak latency and wave amplitude PZ lead, N1 wave amplitude of visual P3a group FZ lead were the influencing factors of MMSE ( OR=0.04, 1.01, 0.76, 1.51, 95% Cl were 0.00-0.30, 1.00-1.03, 0.59-0.97, 1.08-2.10, P=0.002,0.007,0.029,0.016). Conclusion:The peak latency and amplitude of endogenous psychological cognitive potentials N2, P3b and P3a of event-related potentials P3b and P3a in patients with lacunar cerebral infarction were prolonged and decreased. At the same time, with the occurrence of clinical cognitive impairment, the peak latency and amplitude of these cognitive potentials were further prolonged and decreased more significantly. Alcohol consumption, P3b peak latency and PZ lead of visual P3b wave group, and FZ lead of N1 wave of visual P3a wave group were the influencing factors of simple intelligent mental state.
ABSTRACT
Objective:To investigate the efficacy of the Mini-Mental State Scale (MMSE) versus the Montreal Cognitive Assessment Scale (MoCA) in screening cognitive impairment in patients with a lacunar cerebral infarction. Methods:138 eligible patients who received treatment in the Affiliated Hospital of Shanxi Datong University from January 2018 to October 2019 were recruited for this study. They received cognitive function evaluation by the MMSE and MoCA. These patients were grouped according to the median number of age or the median number of years of education. The sensitivity and consistency of the MMSE versus MoCA in screening cognitive impairment in patients with a lacunar cerebral infarction were analyzed using the χ2 test. The total cognitive scores of the MMSE and MoCA, and the scores of each cognitive domain such as memory, execution, visual space, attention, language, and orientation, were compared between groups using multiple linear regression analysis. Results:The sensitivity of MoCA in screening for cognitive impairment in low-age, high-age, low-year-education, and high-year-education groups and the whole population of patients with a lacunar cerebral infarction was 76.5%, 75.7%, 74.2%, 77.8%, 76.1%, respectively, which were significantly higher than those of MMSE (44.1%, 65.7%, 60.6%, 50.0%, 55.1%, χ2 = 12.17, 13.13, 9.33, 15.75, 23.86, all P < 0.01). The Kappa coefficients of low-age, high-age, low-year-education and high-year-education groups were 0.336, 0.391, 0.358, 0.389, and 0.373, respectively, all of which were less than 0.4 (all P < 0.01). These findings suggest that the consistency of the two scales in screening cognitive impairment is poor. The cognitive impairment detection rate by the MMSE was significantly higher in the high-age group than in the low-age group (65.7% vs. 44.1%, χ2 = 6.50, P < 0.05). The total cognitive scores of MMSE and MoCA and the scores of memory, execution, visual space, attention, language, and orientation in patients with a lacunar cerebral infarction were significantly lower in the high-age group or low-year-education group than in the low-age group ( tMMSE = 3.61, 2.49, 3.12, 4.26, 1.70, 3.69, 2.24, all P < 0.01; tMoCA = 3.83, 1.75, 3.28, 3.80, 2.21, 4.08, 2.52, all P < 0.05) or high-year-education group ( tMMSE = -2.87, -2.32, -0.85, -2.54, -0.73, -2.57, -2.96, all P < 0.01; tMoCA = -2.95, -1.12, -3.39, -1.54, -1.52, -3.09, -3.02, all P < 0.05). Conclusion:Combined application of MMSE and MoCA has a high clinical value in screening cognitive impairment in patients with a lacunar cerebral infarction. High-age patients with a lacunar cerebral infarction who receive low-year education have memory, execution, visual space, attention, language, and orientation impairments.
ABSTRACT
Objective:To investigate the relationship between plasma beta-2 microglobulin(β2M)levels and the total magnetic resonance imaging(MRI)burden of cerebral small-vessel disease(CSVD)in elderly patients with lacunar stroke.Methods:A total of 93 elderly patients with lacunar stroke admitted to the Department of Neurology, Changzhou Second People's Hospital form August 2018 to August 2019 were enrolled retrospectively, all with complete records of cranial magnetic resonance imaging and plasma β2M measurement.According to the total MRI CSVD burden, which ranges from an ordinal score of 0 to 4, patients were divided into 5 groups.Single-factor analysis was used to compare clinical data between the 5 groups.The association between the plasma β2M level and total MRI CSVD burden was analyzed by ordered multiple Logistic regression models.Results:Among elderly patients with lacunar infarction, 19 had a CSVD score of 0, 19 had a score of 1, 23 had a score of 2, 21 had a score of 3, and 11 had a score of 4, with statistically significant differences in age, percentage with diabetes, systolic blood pressure, diastolic blood pressure, glycosylated hemoglobin, plasma β2M, and eGFR between the 5 groups( P<0.05). Spearman correlation analysis showed that plasma β2M level was significantly positively correlated with total MRI CSVD burden( r=0.687, P<0.001). In ordered multivariate logistic regression models, after adjustment for possible confounding factors such as age, sex and hypertension, the results demonstrated that plasma β2M level( OR=5.253, 95% CI: 2.350-11.740, P<0.001)was an independent risk factor for total MRI CSVD burden. Conclusions:In elderly lacunar stroke patients, the plasma β2M level is closely related to the total MRI CSVD burden and can be used as a marker for predicting the severity of lesions.
ABSTRACT
Objective:To explore the value of the age, atrial fibrillation, dysphagia, sex, stroke severity (A2DS2) score, the prestroke independence, sex, age, National Institutes of Health stroke scale (ISAN) score, acute ischemic stroke-associated pneumonia score (AIS-APS), and intracerebral hemorrhage associated pneumonia score without hematoma volume included (ICH-APS-A) in predicting risk of stroke-associated pneumonia (SAP).Methods:From January to June 2019, 304 patients with acute stroke who were hospitalized in the Lianyungang Hospital Affiliated to Xuzhou Medical University were analyzed retrospectively. There were 164 patients with acute ischemic stroke (AIS), including 82 patients with SAP. And there were 140 patients with intracerebral hemorrhage (ICH), including 70 patients with SAP. They were divided into SAP group (152 cases) and non-SAP group (152 cases) depending on whether they had SAP. The area under the receiver operating characteristic curve (AUC) was used to compare the predictive value of the four scores.Results:When predicting risk of SAP in patients with the stroke, the A2DS2 score had the largest AUC compared to the ISAN score, AIS-APS score, and ICH-APS-A score. When predicting risk of SAP in patients with AIS, the AUC (0.875, 95% CI 0.815 to 0.922) of the A2DS2 score was greater than the AIS-APS score and the ISAN score. When predicting risk of SAP in patients with ICH, the AUC (0.950, 95% CI 0.900 to 0.980) of the A2DS2 score was greater than the ICH-APS-A score and the ISAN score. When predicting risk of SAP in patients with AIS and ICH: 0.911 (95% CI 0.873 to 0.94) vs. 0.882 (95% CI 0.840 to 0.916), Z = 2.319, P = 0.020, the A2DS2 score was significantly better than the ISAN score ( P<0.05). When predicting risk of SAP in patients with AIS, the A2DS2 score, ISAN score, and AIS-APS score all have good predictive value ( P>0.05). When predicting SAP in patients with ICH, the A2DS2 score, ISAN score, and ICH-APS-A score all have good predictive value ( P>0.05). Conclusions:When predicting risk of SAP in patients, the A2DS2 score is a reliable prediction tool, with good predictive value.
ABSTRACT
Objective：Although prediction of functional recovery after lacunar infarction is challenging, quantitative evaluation of brain imaging may be promising. In this article, we investigate association of the amount of corticospinal tract (CST) injury on Computed Tomography (CT) and functional recovery of lacunar infarction in the corona radiata.Methods：In 24 patients with lacunar infarction of the corona radiata, we investigated association of the amount of virtual CST injury with upper and lower limb motor function at 90 days after the stroke onset. The optimal area of the virtual CST to predict motor function was also determined. Finally, we evaluated whether the quantitative CST injury predicted practical motor function regarding activities of daily living.Results：The amount of virtual CST injury, evaluated with Hounsfield unit value of CT, was significantly associated with upper and lower limb function at 90 days after stroke onset. Among them, 6 mm radius CST circle for upper limb had the highest regression coefficient to predict Brunnstrom stage for the upper extremity (R2＝0.69), grip strength (R2＝0.52) and Simple Test for Evaluating Hand function (R2＝0.75). Also, 7 mm radius CST circle for lower limb had the highest regression coefficient to predict Brunnstrom stage for the lower extremity (R2＝0.51), weight bearing index (R2＝0.53) and Berg Balance Scale (R2＝0.52). These virtual CSTs predicted practical function including practical upper limb and ambulation.Conclusion：Quantitative evaluation of CST on CT predicted functional recovery after lacunar infarction of the corona radiata.
ABSTRACT
Abstract Objectives: Depression is common after both lacunar stroke and non-lacunar stroke and might be associated with lesion locations as proven by some studies. This study aimed to identify whether lesion location was critical for depression after both lacunar and non-lacunar strokes. Methods: A cohort of ischemic stroke patients was assigned to either a lacunar stroke group or a non-lacunar stroke group after a brain MRI scan. Neurological deficits and treatment response was evaluated during hospitalization. The occurrence of depression was evaluated 3 months later. Logistic regressions were used to identify the independent risk factors for depression after lacunar and non-lacunar stroke respectively. Results: 83 of 246 patients with lacunar stroke and 71 of 185 patients with non-lacunar stroke developed depression. Infarctions in the frontal cortex, severe neurological deficits, and a high degree of handicap were identified as the independent risk factors for depression after non-lacunar stroke, while lesion location was not associated with depression after lacunar stroke. Conclusion: The main determinants for depression after lacunar and non-lacunar stroke were different. Lesion location was critical only for depression after non-lacunar stroke.
ABSTRACT
Objective:To investigate the clinical effects of lacunar closure-assisted internal fixation in the one-stage treatment of Morel-Lavallée injury complicated with pelvic fracture.Methods:The 32 patients were retrospectively analyzed who had been treated for Morel-Lavallée injury complicated with pelvic fracture at Department of Orthopedic Trauma, Honghui Hospital Affiliated to Xi'an Jiaotong University from May 2018 to November 2020. They were 21 males and 11 females, aged from 18 to 58 years (average, 40.5 years). The injury was located at a unilateral hip in 20 cases, at bilateral hips in 6 cases, at low back in 4 cases, and at posterior thigh in 2 cases. The pelvic fractures were treated by open reduction and internal fixation while the Morel-Lavallée injuries by lacunar closure at the same time. Their wound healing, pelvic function and complications were observed regularly.Results:The hospital stay of 32 patients ranged from 14 to 28 days, averaging 19.2 days. The patients were followed up for 6 to 18 months (mean, 9.3 months). The area of Morel-Lavallée injury healed after one lacunar closure in 23 patients who obtained fine skin survival and no soft tissue necrosis or other complications; the wounds in the Morel-Lavallée injury area healed well after secondary lacunae closure in 4 patients. Superficial sensation of the skin decreased around the Morel-Lavallée injury area after wound healing in 3 patients. Wound fat liquefaction was found in the Morel-Lavallée injury area but responded to symptomatic treatment in one patient. A small amount of wound secretion found in the Morel-Lavallée injury area was cured also by symptomatic treatment in another patient whose bacterial culture was negative. All the fractures healed after 3 to 6 months (average, 3.9 months). At the last follow-up, the Majeed scores for the pelvic function ranged from 65 to 100 points, averaging 84.5 points.Conclusion:For Morel-Lavallée injury complicated with pelvic fracture, lacunar closure-assisted internal fixation can result in a satisfactory one-stage treatment.
ABSTRACT
Based on a comprehensive literature review with long-term experiences of clinical practice and researches, the authors propose the following concepts of the diagnosis, treatment and research of acute cerebral small vessel disease: (1) Cerebral small vessel disease could be grouped into acute and non-acute categories. Acute cerebral small vessel disease indicates an acute stroke due to small vessel disease, including ischemic (ie. acute lacunar stroke) and hemorrhagic (hypertensive arteriopathy- and cerebral amyloid angiopathy-related intracerebral hemorrhage) stroke. (2) Acute ischemic cerebral small vessel disease, defined traditionally by the infarction size (lacunar stroke), is regarded as the syndrome caused by a variety of mechanisms recently, although mainly characterized by lipohyalinosis in the small arterioles. The understanding of pathological mechanisms has experienced a history from autopsy observation, to inference based on risk factors, and then to direct observation of arteriole morphology using high-resolution magnetic resonance angiography. The advancement in imaging technology has brought new opportunities for studies on pathological mechanisms of cerebral small vessel disease. (3) Acute cerebral small vessel disease is manifested as acute stroke, which could be with or without the non-acute symptoms or imaging markers. (4) Individualized treatment based on the pathogenesis is the future direction for practice and research of cerebral small vessel disease. Reducing the incidence, recurrence and major outcomes (death, disability and dementia) is the main target of prevention and treatment.
ABSTRACT
@#We describe a 52-year old woman who developed one- and-a-half syndrome with an ipsilateral trigeminal and facial nerve palsy from a lacunar infarct of the left paramedian pontine area likely involving the median-paramedian perforators of the basilar artery.
Subject(s)
Stroke, Lacunar , Brain StemABSTRACT
Objective To investigate the conduction behavior of fluid flow induced by physiological loads at different scales of bone. Method sThe multiscale bone models were established by using the COMSOL Multiphysics software, and the fluid behaviors were investigated at macro-, meso- and micro-scale. Results At macro-meso scale，the distribution of pore pressure and fluid velocity of osteon near the periosteum and endoosteum were different from that in other parts. Due to the different structure and material parameters at different layers, the loading and fluid pressure caused different biomechanical responses in the process of transferring from macro-scale to micro-scale. Conclusions The multi-scale layered modeling of bone structure-osteon-lacunae-bone canaliculi was established, which provided the theoretical reference for deeper understanding of fluid stimulation and mechanotransduction.
ABSTRACT
Objective: To explore the patterns of cerebral structural abnormalities and cognitive function alterations in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis, and the underlying correlative factors. Methods: Thirty-seven ESRD patients undergoing maintenance hemodialysis without prior stroke in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine were selected. All patients underwent brain magnetic resonance imaging (MRI) and assessment of cognitive function by using Mini-Mental State Examination (MMSE). Patients were divided into lacunar infarction group (n=33) and non-lacunar infarction group (n=4), or white matter hyperintensities (WMH) group (n=14) and non-WMH group (n=23). The difference of demographic characteristics, past history, blood parameter and dialysis adequacy between patients and their controls were analyzed by t test, Mann-Whitney U test, χ2 test and Fisher exact test. Spearman correlation analysis were performed to explore the relationship between clinical features, cerebral structural abnormalities and cognitive function. Results: Nineteen male and eighteen female patients participated in the study. The mean age was (59.4±12.3) years. The incidences of lacunar infarction and WMH were 89.2% and 37.8%, respectively. 24.3% of the participants were diagnosed as cognitive impairment. Patients with lacunar infarction were elder, who had lower level of hemoglobin, hematocrit, serum albumin and serum total protein, while parathyroid hormone (PTH), erythrocyte sedimentation rate, tumor necrosis factor-α and interleukin-6 were elevated. Patients with WMH were also significantly elder, lower in transferrin saturation and higher in PTH. The differences between the two groups were statistically significant (all P<0.05). Spearman correlation analysis showed MMSE score had a negative correlation with age (r=-0.471, P=0.003) and had positive correlations with education status (r=0.355, P=0.031) and hypertension (r=0.358, P=0.030). The study did not find the relationship among lacunar infarction, WMH and MMSE score; however, recall function was found negatively correlated with lacunar infarction (r=-0.357, P=0.030). Conclusion: ESRD patients undergoing maintenance hemodialysis have a high prevalence of cerebrovascular disease and cognitive impairment. Older age, anemia, inflammation status, chronic kidney disease-mineral and bone disorder may be the influencing factors of the cerebral structural abnormalities and cognition decline.
ABSTRACT
Cerebral small vessel disease (CSVD) is a common group of neurological conditions that confer a significant burden of morbidity and mortality worldwide. In most cases, CSVD is only recognized in its advanced stages once its symptomatic sequelae develop. However, its significance in asymptomatic healthy populations remains poorly defined. In population-based studies of presumed healthy elderly individuals, CSVD neuroimaging markers including white matter hyperintensities, lacunes, cerebral microbleeds, enlarged perivascular spaces, cortical superficial siderosis, and cerebral microinfarcts are frequently detected. While the presence of these imaging markers may reflect unique mechanisms at play, there are likely shared pathways underlying CSVD. Herein, we aim to assess the etiology and significance of these individual biomarkers by focusing in asymptomatic populations at an epidemiological level. By primarily examining population-based studies, we explore the risk factors that are involved in the formation and progression of these biomarkers. Through a critical semi-systematic review, we aim to characterize “asymptomatic” CSVD, review screening modalities, and draw associations from observational studies in clinical populations. Lastly, we highlight areas of research (including therapeutic approaches) in which further investigation is needed to better understand asymptomatic CSVD.
Subject(s)
Aged , Humans , Biomarkers , Cerebral Small Vessel Diseases , Epidemiology , Leukoaraiosis , Mass Screening , Mortality , Neuroimaging , Risk Factors , Siderosis , Stroke, Lacunar , White MatterABSTRACT
Objective To investigate the early warning effect of glomerular filtration rate on cerebralmicrobleeds (CMBs) in patients with lacunar infarction. Methods A retrospective study was performed. One hundred and sixty-eight patients with lacunar infarction from January 2015 to January 2018 were selected in Tai′an Central Hospital. The CMBs group and non-CMBs group were classified according to susceptibility weighted imaging. The estimated glomerular filtration rate (eGFR) was obtained. According to the MDRD formula, the indicators of renal dysfunction in patients with different degrees of cerebral microbleeds were compared, and the related risk factors of cerebral microbleeds were analyzed by single factor and multivariate analysis. Results The blood high sensitive C-reactive protein (hs-CRP) was significantly higher in CMBs group than that in non-CMBs group: (4.29 ± 3.86) mg/L vs. (2.58 ± 2.74) mg/L, P < 0.01. The proportion of patients with elevated eGFR in CMBs group was significantly higher than that in non-CMBs group: 40.7%(33/81) vs. 11.4%(10/88), P<0.01. There were significant differences in the proportion of hypertension history [83.3% (50/60) vs. 52.4% (11/21), χ2＝6.947,P＝0.008], serum creatinine(SCr) value[(113.75 ± 71.23) μmol/L vs. (75.38 ± 38.36) μmol/L, t＝－2.346,P＝0.021] and eGFR value [(91.58 ± 31.87) ml/(min·1.73 m2) vs. (109.95 ± 29.47) ml/(min·1.73 m2),t＝2.316,P＝0.023] between CMBs groups with different distribution (P < 0.05). Multivariate Logistic regression analysis showed that the history of hypertension ( OR＝5.408; 95% CI 1.518-19.267, P＝0.008) was the risk factor of CMBs in deep/ subtentorial group.The urea nitrogen (BUN)value increased (χ2＝28.150, P < 0.01), SCr value (χ2＝47.610, P < 0.01) increased, and eGFR value (χ2＝39.067,P<0.01) decreased with the severity of CMBs, and the differences were statistically significant. The proportion of CMBs in patients with eGFR decreased group(76.7% , 33/43) was significantly higher than that in normal eGFR group (38.1%, 48/126), and the difference was statistically significant (χ2＝19.188, P < 0.01). Logistic regression analysis of multiple factors affecting cerebral microbleeds showed that history of hypertension ( OR＝3.135; 95% CI 1.343-7.321, P＝0.008), elevated hs-CRP( OR＝1.233; 95% CI 1.098-1.385, P < 0.01), eGFR decreased ( OR＝1.025; 95% CI 1.002-1.048, P＝0.033) were risk factors for cerebral microbleeds. The area under the ROC curve of eGRF was 0.694 (P＝0.042). Conclusions A history of hypertension is a risk factor for deep/infratentorial CMBs. Decreased glomerular filtration rate is an independent risk factor for cerebral microbleeds. Therefore, reminding clinicians to actively diagnose and treat patients with glomerular filtration rate decline has important clinical significance for preventing the occurrence and development of cerebral microbleeds.
ABSTRACT
Objective@#To investigate the correlation between β-fibrinogen (FGB) gene -455G/A polymorphism and plasma fibrinogen (Fg) level and lacunar infarction (LI).@*Methods@#From June 2018 to August 2019, consecutive subjects without cerebrovascular disease and dementia admitted to the Department of Neurology, the People's Hospital of Liaoning Province were enrolled prospectively. According to whether there was LI or white matter hyperintensities (WMHs) in brain MRI, the patients were divided into LI group, LI+ WMHs group and control group. Polymerase chain reaction and gene sequencing technology were used to detect FGB -455G/A polymorphism. The turbidimetry was used to measure plasma Fg level. Multivariate logistic regression analysis was used to determine the independent risk factors for LI and LI+ WMHs.@*Results@#A total of 202 subjects were included, including 48 in the LI group, 58 in the LI+ WMHs group, and 96 in the control group. The proportions of patients with hypertension, dyslipidemia, and hyperhomocysteinemia and plasma Fg levels in the LI and LI+ WMHs groups were significantly higher than those in the control group (all P<0.05). There was no statistical difference in FGB -455G/A genotype and allele frequency between the three groups. The plasma Fg level of AG+ AA genotype was significantly higher than that of GG genotype (P<0.001), and there was no significant difference in demography and other vascular risk factors. Regardless of the genotype, the plasma Fg level was highest in the LI+ WMHs group, followed by the LI group and the control group, and the differences between each pair were statistically significant (P<0.05). Multivariate logistic regression analysis showed that hypertension (odds ratio [OR] 2.289, 95% confidence interval [CI] 1.015-5.166, P=0.046; OR 2.457, 95% CI 1.021-5.913, P=0.045), dyslipidemia (OR 2.681, 95% CI 1.217-5.905, P=0.014; OR 3.061, 95% CI 1.296-7.233, P=0.011) and plasma Fg levels (OR 5.038, 95% CI 2.328-10.902, P<0.001; OR 20.198, 95% CI 8.143-50.097, P<0.001) were all the independent risk factors for LI and LI+ WMHs.@*Conclusions@#The increased plasma Fg level, dyslipidemia, and hypertension were the independent risk factors for LI and LI+ WMHs. Although FGB -455G/A polymorphism could affect plasma Fg level, it had no significant correlation with LI and LI+ WMHs.
ABSTRACT
Objective To study the predictive value of lipoprotein-associated phospholipase A2 ( Lp-PLA2)for early neurological deterioration (END) in patients with lacunar infarction. Methods Between January 2016 and July 2018,281 consecutive patients with first-ever acute lacunar infarction admitted to the Department of Neurology, the Second People's Hospital of Lianyungang were enrolled retrospectively. They were divided into END group (n = 75 ) and non-END group ( n = 206) depending on whether END occurred or not. The general data ( age, sex, body mass index,past medical history) ,clinical data (National Institute of Health stroke scale [ NIHSS score] ) , onset to admission time,imaging data (white matter lesion score,cerebral microhemorrhage score and branch atherosclerosis) , treatment methods and laboratory findings such as neutrophil to lymphocyte ratio, total cholesterol,low- density lipoprotein cholesterol, fasting blood glucose, hypersensitive C-reactive protein, homocysteine, and Lp-PLA2 were compared in patients between the two groups. Immunoturbidimetry was used to determine the level of Lp-PLA2 in blood. SPSS 22. 0 software was used to analyze and process the data. Multivariate logistic regression was used to analyze the risk factors for affecting the occurrence of END in patients with lacunar cerebral infarction. Receiver operating characteristic (ROC) curve was used to analyze the value of Lp-PLA2 in predicting the occurrence of END in lacunar infarction. Results Univariate analysis showed that NLR (2. 5 ± 0. 5 vs. 2. 3 ± 0. 5, t = 2. 996) , low-density lipoprotein cholesterol (2. 6 ± 0. 8 mmol/L vs. 2. 3 ± 0. 7 mmol/L, t = 3. 056), NIHSS score on admission ( 3.4 ± 1.5 vs. 3.0 ± 1.4, l = 2. 080), and the proportion of patients with branch atherosclerosis (21. 3% [ 16/75] vs. 7. 3% [ 15/206] #=1 1-061) in the END group were higher than those in the non-END group (240 ± 26 jxg/L vs. 180 ±23 p,g/L, I = 9. 032) ,and the difference was statistically significant (all P <0. 05). Multivariate logistic regression analysis showed that the increased level of NLR (0/,3.927,95% CI 2.918 -5.016,P = 0.020),Lp-PLA2 (OR, 1.026,95% 67 1.019-1.034, P <0.01), low-density lipoprotein cholesterol (OR, 2.715,95% CI 2.193 -3.273, P =0.025) , NIHSS score on admission (OR,2. 831 ,95% CI 2.412 -3. 197, P = 0.028) , and branch atherosclerosis ( OR,4. 552 ,95% CI 2. 934 -7. 017 , P = 0. 002) were the independent risk factors for lacunar infarction occurring END. Receiver operating characteristic ( ROC) curve analysis showed that the area under the curve of Lp-PLA2 predicting END was 0. 799 (95% CI 0. 728 -0. 833 ,P< 0. 01 ) ;the optimal cut-off value was 189 jtg/L, the sensitivity for predicting END was 92. 3% ,and the specificity was 55. 4%. Conclusion The increased level of serum I.p-PLA2 is an independent risk factor for lacunar infarction occurring END,and it has certain predictive value for END.