Transcranial sonography image characteristics of substantia nigra in different Parkinson′s disease subtypes and their correlation with iron metabolism / 中华超声影像学杂志

Objective:To explore the pathological mechanism of SN hyperechogenicity by investigating the characteristics of substantia nigra (SN) hyperechogenicity on transcranial sonography (TCS) and serum iron metabolism parameters in the postural instability gait difficulty and tremor dominant subtypes of Parkinson′s disease (PD), and the correlation between them.Methods:A total of 155 PD patients recruited in Parkinson′s Disease Specialty in the Second Affiliated Hospital of Soochow University from January 2019 to December 2021 were divided into postural instability gait difficulty group( n=95) and tremor dominant group( n=60). Meanwhile, 49 healthy gender- and age-matched healthy individuals who sought for physical examination during the same period were included as the control group. All subjects underwent TCS and blood test, and the echo of SN between the postural instability gait difficulty group and tremor dominant group, serum iron metabolism parameters among the three groups were compared. The postural instability gait difficulty group and tremor dominant group were subdivided into with SN hyperechogenicity (SN+ )subgroup and without SN hyperechogenicity (SN-) subgroup respectively according to TCS results, and the differences in serum iron metabolism parameters between the subgroups were further compared. The association between SN hyperechogenicity and serum iron metabolism parameters of the postural instability gait difficulty group and tremor dominant group were further analyzed. Results:The total area of bilateral SN+ , the area of SN+ on the larger side, and the ratio of the total area of SN+ to the midbrain area (S/M) in postural instability gait difficulty group were larger than those in tremor dominant group (all P<0.001). The value of serum ceruloplasmin and transferrin in both postural instability gait difficulty group and tremor dominant group were lower than those in control group (all P<0.001), and compared with tremor dominant group and control group, the postural instability gait difficulty group had lower serum ferritin(all P<0.01). In both postural instability gait difficulty group and tremor dominant group, serum ceruloplasmin in SN+ subgroup was lower than that in SN-subgroup ( P=0.001, 0.032). Moreover, there was a negative correlation between serum transferrin and the area of SN hyperechogenicity in two subgroups(postural instability gait difficulty group: rs=-0.454, P<0.001; tremor dominant group: rs=-0.494, P<0.001). Conclusions:Compared with the tremor dominant patients, the postural instability gait difficulty patients have larger area of SN hyperechogenicity and lower serum ferritin level. The area of SN hyperechogenicity is significantly negatively correlated with serum transferrin level, indicating that the production of this imaging characteristics is related to iron metabolism.

Predictive value of transcranial doppler ultrasound for cerebral small vessel disease in elderly patients / Valor preditivo do ultrassom doppler transcraniano para doença de pequenos vasos em pacientes idosos

ABSTRACT Objective: To investigate the predictive value of transcranial Doppler (TCD) ultrasound for cerebral small vessel disease in elderly patients. Methods: Transcranial Doppler ultrasound and magnetic resonance imaging (MRI) were performed on 184 elderly patients with cerebral small vessel disease. The relationship of clinical characteristics and TCD ultrasound parameters with severe white matter lesions (WMLs) in MRI were investigated by univariate analysis and multivariate analysis. Results: The univariate analysis showed that age, left middle cerebral artery (MCA) mean flow velocity, right MCA mean flow velocity and mean MCA pulsatility index were significantly correlated with severe WMLs (p < 0.05). The multivariate logistic regression analysis showed that only age (odds ratio: 1.21; 95%CI: 1.10-1.36; p < 0.01) and MCA pulsatility index (dominance ratio: 1.13; 95%CI: 1.06-1.80; p = 0.02) were significantly correlated with severe WMLs. The analysis of TCD ultrasound parameters showed that when the cut-off for MCA pulsatility index was 1.04, it could identify severe WMLs. The area under the curve was 0.70 (95%CI: 0.60-0.80). The sensitivity and specificity were 63.0% and 72.0%, respectively. The positive and negative predictive values were 35.4% and 86.6%, respectively. Conclusion: The MCA pulsatility index in TCD ultrasound is significantly correlated with severe WMLs; and TCD ultrasound can guide selective MRI for the detection of WMLs.

RESUMO Objetivo: Investigar o valor preditivo do ultrassom de Doppler transcraniano (TCD) para doença de pequenos vasos (SVD) em pacientes idosos. Métodos: ultrassonografia de TCD e ressonância magnética (RM) foram realizadas em 184 idosos portadores de SVD cerebral. As relações das características clínicas e os parâmetros ultrassonográficos do TCD com lesão grave de substância branca (WML) no desempenho da RM foram investigados por análise univariada e análise multivariada. Resultados: A análise univariada mostrou que, a idade, a velocidade média de fluxo (MFV) da artéria média cerebral (MCA) esquerda, a MFV da MCA direita e o índice de pulsatilidade (PI) médio estiveram significativamente relacionados à WML grave (P <0,05). A análise de regressão logística multivariada mostrou que apenas a idade (razão de chances: 1,21; IC95%: 1,10-1,36; P <0,01) e o PI da MCA (razão de dominância: 1,13; IC 95%: 1,06-1,80; P = 0,02) estiveram significativamente relacionados a WML grave. A análise dos parâmetros ultrassonográficos do TCD mostrou que, quando o ponto de corte do IP do MCA foi 1,04, ele pôde identificar à WML grave. A área sob a curva foi de 0,70 (IC 95%: 0,60-0,80). A sensibilidade e especificidade foram de 63,0% e 72,0%, respectivamente. Os valores preditivos positivos e negativos foram de 35,4% e 86,6%, respectivamente. Conclusão: O PI da MCA na ultrassonografia do TCD está significativamente relacionado à WML grave. A ultrassonografia TCD pode orientar a ressonância magnética seletiva para detecção da WML.

Clinical Transcranial Color Doppler Observations on Dynamic Moxibustion plus Acupuncture for the Treatment of Cervical Vertigo / 上海针灸杂志

Objective To evaluate the efficacy of dynamic moxibustion plus acupuncture in treating cervical vertigo by clinical observation of vertebrobasilar artery blood flow velocity using transcranial color Doppler before and after treatment. Method Sixty-one patients diagnosed with cervical vertigo were randomly allocated to two groups. The treatment group of 31 patients received dynamic moxibustion plus acupuncture and the control group of 30 patients, acupuncture alone. Vertebrobasilar artery blood flow velocity was observed using transcranial color Doppler before and after treatment. Result The total efficacy rate was 96.8% in the treatment group and 73.3% in the control group. Vertebrobasilar artery blood flow velocity was improved in both groups, but the effect was more marked in the treatment group (P<0.05). Conclusion Dynamic moxibustion plus acupuncture can more effectively improve vertebrobasilar artery blood flow velocity than acupuncture alone.

Effect of Auricular Point Sticking on Cerebrovascular Reactivity in Hypertension Patients Studied by Transcranial Doppler / 上海针灸杂志

Objective To study the effect of auricular point sticking on the cerebrovascular reactivity in hypertension patients of different stages by using Transcranial Doppler (TCD) technology.Method Three hundred hypertension patients were randomized into a treatment group (auricular point sticking) of 180 cases and a control group (medication) of 120 cases. The cerebral arterial hemodynamic indexes were observed and analyzed by TCD before and after intervention.Result In comparing the improvements of cerebral arterial hemodynamic indexes in stage 1-2 hypertension patients, the treatment group was significantly superior to the control group (P＜0.05,P＜0.01); in stage 3 hypertension patients, the improvements of cerebrovascular hemodynamics of the treatment group were significantly better than those in the control group (P＜0.05,P＜0.01).Conclusion Auricular point sticking can improve the cerebrovascular hemodynamics and effectively improve the cerebrovascular reactivity of hypertension patients. TCD can help observe and estimate the cerebral arterial function of hypertension patients, and prevent and intervene in cerebrovascular diseases.

Acupuncture Effects on Endocranial Hemodynamics of Patients with Takayasus Arteritis(Brachiocephalic Artery Type) / 针灸推拿医学（英文版）

Objective: To discuss the action mechanisms of Takayasus arteritis (brachiocephalic artery type) of acupuncture. Methods: We applied acupuncture therapy with the principle of warming Yang and supplementing Qi, removing obstruction in the meridians and recovering pulse, to treat patients with takayasus arteritis (brachiocephalic artery type). Before and after treatment, we detected the TCD (Transcranial Doppler) changes of the average velocity of blood flow (AVBF) and arterial pulsatility index (PI) of related arteris. Results: After treatment,acupuncture and moxibustion can regulate the abnormal blood flow rate in endocranial correlated arteries by two sides, in the AVBF while, elevate the elasticity of endocranial vessels.Conclusion: Acupuncture and moxibustion can regulate cerebrovascular function of patients with takayasus arteritis (brachiocephalic artery type), increase the perfusion of cerebral blood flow, and adjust abnormal state of endocranial hemodynamics. This is possibly the important action mechanisms acupuncture in treating this disorder.

Clinical Observations on the Treatment of Pseudobulbar Paralysis by Combined Scalp and Body Acupuncture / 针灸推拿医学（英文版）

Objective: To investigate the efficacy of scalp acupuncture in combination with body acupuncture for treating pseudobulbar paralysis. Methods: Eighty patients were randomly divided into treatment and control groups, 40 cases each. The control group was treated by the routine method of Western medicine and the treatment group by combined scalp and body acupuncture on the basis of the former. The curative effect was evaluated after treatment in both groups. The influence of the treatment on mean blood velocity(MBV) in anterior, middle and posterior cerebral arteries was observed by transcranial Doppler(TCD) in both groups. Results: The total efficacy rate was 97.5% in the treatment group and 12.5% in the control group. The recovery rate was 75% in the treatment group and 0% in the control group. There was a significant difference between the two groups(P＜ 0. 01). TCD showed that blood velocity in cerebral arteries was significantly increased and the unbalanced stasis of the right and left cerebral blood flow changed in the treatment group. A comparison of MBV between pretreatment and posttreatment showed P ＜ 0.01. Conclusion: Scalp acupuncture in combination with body acupuncture has a good effect on pseudobulbar paralysis.