Role of lipoprotein (a) in ischemic stroke / 中国脑血管病杂志

Lipoprotein (a) (Lp [a]) is an low density lipoprotein-like particle with constant individual concentration through life determined mainly by LPA gene variations and racial difference. Previous studies had proved the causal relationship between Lp (a) and cardiovascular disease due to potential pathogenic mechanisms including proatherogenic and prothrombotic effect. Lp (a) had been reported to be associated with ischemic stroke by many studies, especially among young people, but the conclusions remain controversial. Traditional lipid-lowering therapies, such as statins or fibrates do not effectively reduce Lp (a) levels. Possible treatment options consist of proprotein convertase subtilisin/kexin type 9 inhibitors,cholesteryl ester transfer protein,antisense oligonucleotide and apheresis.but their clinical benefits need to be confirmed by further trials. In this review,aspects of Lp (a) including the structure properties,correlation with ischemic stroke,probable pathophysiological mechanisms and recent advances in lowering Lp (a) are summarized.

Diffusion tensor imaging studies of amyotrophic lateral sclerosis patients with various levels of cognitive impairment / 中华神经科杂志

Objective To characterize the brain microstructure changes of amyotrophic lateral sclerosis (ALS) patients with various levels of cognitive impairment as measured by diffusion tensor imaging (DTI).Methods A total of 55 ALS patients and 20 healthy controls (HC) were enrolled in the Department of Neurology of Peking Union Medical College Hospital From September 2013 to March 2017,and all participants underwent neuropsychological assessments and DTI scans.According to their cognitive performance,ALS patients were further subclassified into ALS with normal cognition (ALS-Cn,n =27),ALS with cognitive impairment (ALS-Ci,n =17) and ALS-frontotemporal dementia (ALS-FTD,n =11)subgroups.Comparisons of voxel-based and atlas-based fractional anisotropy (FA) and mean diffusivity (MD) data were conducted among the four subgroups.Results In the voxel-based analyses,the FA showed significant differences in cingulate gyms,corpus callosum,brain stem and cerebellum,and MD showed significant differences in bilateral frontal lobe,temporal lobe,cingulate gyms,corpus callosum,and cerebellum among the four subgroups.Besides,when compared to ALS-Ci,ALS-Cn and HC groups in the order,the areas of involvement were larger and differences were more significant in ALS-FTD group.In the atlas-based analyses,the FA and MD of the corticospinal tracts revealed no difference within the patients groups,but decreased FA and increased MD were found compared to HC group.The ALS-IFD patients manifested widespread white matter fiber integrity damage and microstructure impairment in the extramotor areas compared to other three groups.Conclusion The brain white matter structural patterns of ALS patients correlate with their cognitive function,and there is a gradient of alterations across the ALS-Cn,ALS-Ci and ALS-FTD continuum.