Correlation between pre-stroke cognitive impairment and MRI markers in patients with minor acute ischemic stroke / 国际脑血管病杂志

Objective:To investigate the correlation between MRI markers of neurodegenerative diseases and vascular diseases and pre-stroke cognitive impairment (PSCI).Methods:Patients with minor acute ischemic stroke at first onset and aged ≥60 years admitted to the Department of Neurology, the Affiliated Hospital of Yangzhou University and the Department of Neurology, Linyi Jinluo Hospital from March 2019 to December 2021 were retrospectively enrolled. The imaging markers of cerebral small vessel disease and neurodegeneration were analyzed by dichotomy visual score. The former included cerebral white matter hyperintensities, vasogenic lacunar lesions, cerebral microbleeds, and enlarged perivascular space, and the latter included global cortical atrophy and medial temporal lobe atrophy. According to the score of Information Questionnaire on Cognitive Decline in the Elderly (IQCODE), the patients were divided into PSCI group (≥3.31 points) and non-PSCI group (<3.31 points). The clinical baseline data and MRI markers of both groups were compared. Multivariate logistic regression model was used to analyze the correlation between MRI markers and PSCI, and receiver operator characteristic (ROC) curve was used to analyze the predictive value of MRI markers to PSCI. Results:A total of 221 patients were enrolled in the study, including 77 patients (34.8%) in the PSCI group and 144 (65.2%) in the non-PSCI group. Univariate analysis showed that there were significant differences in age, years of education, pathological white matter hyperintensities, medial temporal lobe atrophy, and the proportion of patients with ≥1 abnormal MRI markers between the two groups (all P<0.05). Multivariate logistic regression analysis showed that older age (odds ratio [ OR] 1.089, 95% confidence interval [ CI] 1.034-1.146; P=0.001), years of education <6 years ( OR 3.134, 95% CI 1.534-6.401; P=0.002), medial temporal lobe atrophy ( OR 2.911, 95% CI 1.385-6.121; P=0.005), and presence of ≥1 abnormal MRI markers ( OR 2.823, 95% CI 1.305-5.938; P=0.007) were the independent risk factors for PSCI. ROC curve analysis showed that the area under the curve of medial temporal lobe atrophy and the presence of ≥1 abnormal MRI markers for predicting PSCI were both smaller (0.595 and 0.584 respectively), but the area under the curve was the largest when the two and years of education were combined (0.818, 95% CI 0.756-0.880; P<0.001), and its sensitivity and specificity for predicting PSCI were 79.9% and 71.4% respectively. Conclusions:The incidence of PSCI is high. Medial temporal lobe atrophy combined with other abnormal MRI markers has a certain predictive value for PSCI.

Correlation between serum miR-320b and carotid atherosclerosis in patients with acute ischemic stroke / 国际脑血管病杂志

Objective To investigate the correlation between serum miR-320b and carotid atherosclerosis in patients with acute ischemic stroke.Methods From January 2017 to December 2017,patients with acute ischemic stroke visited the Department of Neurology,the Affiliated Hospital of Yangzhou University were enrolled.According to the findings of carotid artery ultrasonography,they were divided into plaque group and plaque-free group.The baseline clinical data such as demographic data,vascular risk factors,and blood biochemical indicators were collected.Reverse transcription quantitative polymerase chain reaction was used to detect the expression level of serum miR-320b.Multivariatelogistic regression analysis was used to determine the independent risk factors for carotid atherosclerosis.Results A total of 135 patients with acute ischemic stroke were enrolled in this study,including 58 females and 77 males,aged 58.4 ± 10.6 years.There were 85 patients in the plaque group and 50 in the plaque-free group.The total cholesterol (t =5.523,P =0.023) and low-density lipoprotein cholesterol (t =4.415,P =0.044) in the plaque group were significantly higher than those in the plaque-free group,while high-density lipoprotein cholesterol (t =5.849,P=0.017) and serum miR-320b (t =4.331,P=0.039) were significantly lower than those in the plaque-free group.Multivariate logistic regression analysis showed that referring to the highest quartile group,the low serum miR-320b level might be an independent risk factor for carotid atherosclerosis (the first quartile group:odds ratio 2.701,95％ confidence interval 1.154-6.321,P =0.022;the second quartile group:odds ratio 2.521,95％ confidence interval 1.249-5.091,P =0.010;and the third quartile group:odds ratio 1.849,95％ confidence interval 1.041-3.283,P=0.036).Conclusion The low serum miR-320b level might be an independent risk factor for carotid atherosclerosis in patients with acute ischemic stroke.

Treatment of MRA-DWI mismatched patients with mild ischemic stroke caused by middle cerebral artery M1 segment occlusion: comparison of endovascular treatment and intravenous thrombolytic therapy / 国际脑血管病杂志

Objective To investigate the effect of different treatment regimens guided by magnetic resonance angiography (MRA) and diffusion weighted imaging (DWI) mismatch on the outcomes of patients with mild ischemic stroke caused by acute middle cerebral artery (MCA) M1 segment occlusion. Methods From January 2013 to February 2018, the clinical data of patients with mild ischemic stroke caused by acute MCA M1 segment occlusion and admitted to the Department of Neurology, the Affiliated Hospital of Yangzhou University were analyzed retrospectively. Mild stroke was defined as the National Institutes of Health Stroke Scale (NIHSS) score ≤5, and the MRA-DWI mismatch was defined as MCA M1 segment occlusion confirmed by MRA and the DWI-Alberta Stroke Program Early Computed Tomography Score ≥6. According to the clinical decision, they were divided into endovascular treatment group and intravenous thrombolytic therapy group. The primary outcome measure was the modified Rankin Scale score at 90 days after onset, ≤2 was defined as good outcome. The secondary outcome measure was the incidence of symptomatic intracranial hemorrhage (sICH) within 7 days after treatment and the mortality rate at 90 d. Multivariate logistic regression analysis was used to determine the independent effects of different treatment regimens on outcomes. Results A total of 38 patients were enrolled, 19 (50. 00％) in the intravenous thrombolytic therapy group, and 19 in the endovascular treatment group (50. 00％, including 5 patients with intratracheal thrombectomy after intravenous thrombolysis); 27 patients had good outcomes (71. 05％) and 11 had poor outcomes (28. 95％). Except for total cholesterol level, there were no significant differences in demography, vascular risk factors, and all baseline clinical data between the endovascular treatment group and the intravenous thrombolytic therapy group. The rate of good outcome in the endovascular treatment group was significantly higher than that in the intravenous thrombolytic therapy group (89. 47％ vs. 2. 63％; P = 0. 029), and there was no significant difference between the incidence of sICH within 7 days (15. 79％ vs. 5. 26％; P = 0. 604) and 90-day mortality (0％ vs. 10. 53％; P = 0. 486). The proportion of patients who underwent endovascular treatment in the good outcome group was significantly higher than that in the poor outcome group (62. 96％ vs. 18. 18％; P = 0. 029). Multivariate logistic regression analysis showed that endovascular treatment was an independent predictor of good outcome (odds ratio 0. 103, 95％ confidence interval 0. 015-0. 714; P = 0. 021). Conclusion Endovascular treatment is an independent predictor of good outcome in patients with mild ischemic stroke caused by acute MCA M1 segment occlusion.

Dynamic changes of ATP binding cassette transporter A1 expression in perihematomal tissue of mouse cerebral hemorrhage model induced by collagenase / 国际脑血管病杂志

Objective To investigate the ATP binding cassette transporter A1 (ABCA1) expression in perihematomal tissue of mouse cerebral hemorrhage model induced by collagenase. Methods Stereotactic injection of type Ⅳ collagenase was used to induce a model of caudate putamen intracerebral hemorrhage in mice. The behavioral scores were use to assess neurological deficits at 24 h, 48 h and 72 h after model making. Neisserian staining was used to detect the morphology of neurons around hematomas.Immunohistochemical staining and Western blot analysis were used to detect the expression of ABCA1 around hematomas. Results Nissl bodies reduction, atrophy, necrosis of perihematomal neurons were observed and aggravated over time. Immunohistochemical staining and Western blot analysis showed that the expression level of ABCA1 in the perihematomal tissue was significantly higher than that in the sham operation group (all P < 0. 05), and the expression level increased significantly with time (all P < 0. 05 ).Conclusion ABCA1 was up-regulated after cerebral hemorrhage, suggesting that it might be involved in the pathological process of cerebral hemorrhage.

Cerebral white matter injury and repair after intracerebral hemorrhage / 国际脑血管病杂志

Animal experiments and clinical studies have shown that intracerebral hemorrhage may damage the white matter.The pathophysiology mechanisms of cerebral white matter injury and repair after intracerebral hemorrhage is very complicated.This article reviews the related clinical and experimental evidence,pathophysiological mechanisms,and possible intervention strategies of cerebral white matter injury after intracerebral hemorrhage.

Investigation of the incidences of non-motor symptoms in siblings and spouses of patients with Parkinson's disease / 中华神经科杂志

Objective Non-motor symptoms are important prodromal characteristics of Parkinson's disease (PD).The siblings and the spouses of PD patients do not have classic motor symptoms.This study aimed to investigate if they have PD prodromal symptoms.Methods A total of 98 PD patients from the Affiliated Hospital of Yangzhou University were recruited between January 2015 and August 2017;256 siblings of these patients were included in a siblings group,87 spouses of PD patients were included in a spouses group and 250 healthy individuals were included in a control group.Various scales were used to assess non-motor symptoms,including depression,anxiety,cognitive function,sleep status,constipation,daytime sleepiness,subjective olfactory disorder,rapid-eye-movement sleep behavior disorder (RBD),and restless legs syndrome (RLS).Results The incidence of anxiety (OR=3.06,95％CI 1.86-5.05,P＜0.01),depression (OR=2.16,95％CI 1.16-4.04,P=0.01),RBD (OR=3.83,95％CI 1.79-8.19,P＜0.01) and subjective olfactory disorder (OR=4.48,95％CI 2.02-9.90,P＜0.01) was higher in the siblings group than the control group.There were not statistically significant differences in constipation,cognitive impairment,sleep disorder,daytime sleepiness,and RLS between the two groups.There were not statistically significant differences in non-motor symptoms between the spouses group and the control group,except that the mild depression (OR=2.58,95％CI 1.07-6.20,P =0.03) in the spouses group was more obvious.Conclusions The siblings of PD patients are more likely to have PD prodromal symptoms compared with those without PD family history,perhaps because PD patients and their siblings have common pathogenic genetic factors and early living environment for neurodegeneration.There are no obvious non-motor symptoms in the spouses of PD patients.It can be concluded that the onset of PD is not related to the family life environment in adulthood.