Predicting the efficacy of donepezil intervention in Alzheimer's disease patients using regional homogeneity in the inferior orbitofrontal cortex.

BACKGROUND: Although donepezil is a commonly used drug for treating Alzheimer's disease (AD), the mechanisms by which it affects patients' functional brain activity, and thus modulates clinical symptoms, remain unclear. METHODS: In the present study, we used resting-state functional magnetic resonance imaging (MRI) and regional homogeneity (ReHo) to investigate the effects of donepezil on local brain activity in AD patients. Resting-state functional MRI data were collected from 32 subjects: 16 healthy controls and 16 AD patients. All 16 AD patients underwent 6 months of donepezil treatment and received two MRI scans (pre- and post-intervention). Analysis of covariance and post hoc analyses were used to compare ReHo differences among the healthy controls, pre-intervention AD patients, and post-intervention AD patients. Pearson correlation analysis was used to examine relationships between ReHo values in differential brain regions and clinical symptoms. RESULTS: Compared with healthy controls, post-intervention AD patients had reduced ReHo in the orbital part of the inferior frontal gyrus, and pre-intervention AD patients had reduced ReHo in the orbital part of the right inferior frontal gyrus. Pattern recognition models revealed that pre-intervention ReHo values in abnormal brain regions of AD patients were 76% accurate for predicting the efficacy of donepezil on cognitive function and 65% accurate for predicting its efficacy on depressive symptoms. CONCLUSIONS: These findings deepen our understanding of the brain mechanisms underlying the clinical efficacy of donepezil in AD patients, and provide a novel way to predict its clinical efficacy in such patients.

The increased effective connectivity from left middle occipital gyrus to right medial septum/diagonal bands in AD patients after donepezil intervention.

Introduction: Donepezil enhances the function of cholinergic nerves by increasing the concentration of acetylcholine, thereby improving clinical symptoms in patients with Alzheimer's disease (AD). However, the neural mechanisms of how donepezil modulates the effective connectivity (EC) network of cholinergic system in AD patients remain unknown. We speculated that the effective network of the cholinergic system changes in AD patients after donepezil intervention. Methods: We employed resting-state functional magnetic resonance imaging and Granger causality analysis approach to explore changes in the effective connectivity network of the basal forebrain in AD patients before and after donepezil intervention. This study included 32 participants, including 16 healthy controls (HCs) and 16 AD patients. In a 3T MRI scanner, the 16 AD patients were scanned before and after the donepezil intervention. To compare EC differences between the three groups of participants, ANOVA and post-hoc t-tests analysis were employed. Results: Compared to baseline status, AD patients after donepezil intervention had an increased EC from left middle occipital gyrus to right medial septum/diagonal bands. Compared to HCs, AD patients after donepezil intervention had an increased EC from right inferior frontal gyrus/orbit part to right medial septum/diagonal bands, AD patients before donepezil intervention had a reduced EC from right precuneus to right medial septum/diagonal bands. A significant positive correlation was found between EC values in right precuneus and Mini-Mental State Examination in pre-intervention AD patients (r = 0.7338, p = 0.0012). Discussion: Our study showed that effective connectivity of brain regions associated with the default mode network in the cholinergic pathway was enhanced after donepezil intervention. The results of this study will help us to better understand the neural mechanisms of donepezil intervention in AD and to find clinical targets for intervention.

Abnormal functional connectivity of the habenula in mild cognitive impairment patients with depression symptoms revealed by resting-state functional magnetic resonance imaging.

BACKGROUND: Recent research suggests that abnormalities in the habenula (HB), a core area of the brain that transmits reward information, may be a determinant of depression. However, it is not clear whether the functional connectivity (FC) pattern of the mild cognitive impairment (MCI) with and without depression symptoms is abnormal. METHODS: In this study, we used resting-state functional magnetic resonance imaging (fMRI) to examine the FC pattern of the HB in MCI patients with depression symptoms (D-MCI). We acquired fMRI data from 54 subjects on a 3T MRI. Subjects collected included 16 patients with D-MCI, 18 patients with MCI with no depression, and 20 healthy controls. One way ANCOVA and post hoc t-test were used to compare the difference in FC strength between the three groups. RESULTS: The D-MCI group had altered FC between the left HB and the right superior temporal gyrus, right inferior frontal gyrus/opercular part, and right middle frontal gyrus. The D-MCI group had increased FC between the right HB and precuneus. CONCLUSIONS: These results suggest that the dysfunction of the HB-Default model network might be involved in the neural mechanism underlying depression in MCI.

Differentiation of lipid-poor adenoma from pheochromocytoma on biphasic contrast-enhanced CT.

PURPOSE: To evaluate the diagnostic performance of biphasic contrast-enhanced CT in differentiation of lipid-poor adenomas from pheochromocytomas. METHODS: 129 patients with 132 lipid-poor adenomas and 93 patients with 97 pheochromocytomas confirmed by pathology were included in this retrospective study. Patients underwent unenhanced abdominal CT scan followed by arterial and venous phase. Quantitative and qualitative imaging features were compared between the two groups using univariate analysis. Risk factors for pheochromocytomas were evaluated by multivariate logistic regression analysis and a diagnostic scoring model was established based on odd ratio (OR) of the risk factors. RESULTS: Pheochromocytomas were larger and showed cystic degeneration more frequently compared with lipid-poor adenomas (p < 0.01). No significant difference was found in peak enhancement phase between the two groups (p = 0.348). Attenuation values on unenhanced phase (CTU), arterial phase (CTA), and venous phase (CTV) of pheochromocytomas were significantly higher than that of lipid-poor adenomas while enhancement ratio on arterial and venous phase (ERA, ERV) of pheochromocytomas was significantly lower than that of lipid-poor adenomas (all p < 0.05). Multivariate analysis revealed lesion size > 29 mm (OR: 5.74; 95% CI 2.51-13.16; p < 0.001), CTA > 81 HU (OR: 2.54; 95% CI 1.04-6.17; p = 0.04), CTV > 97 HU (OR: 11.19; 95% CI 3.21-38.97; p < 0.001), ERV ≤ 1.5 (OR: 20.23; 95% CI 6.30-64.87; p < 0.001), and the presence of cystic degeneration (OR: 6.22, 95% CI 1.74-22.25; p = 0.005) were risk factors for pheochromocytomas. The diagnostic scoring model yielded an area under the curve (AUC) of 0.911. CONCLUSIONS: Biphasic contrast-enhanced CT showed good diagnostic performance in differentiation of lipid-poor adenomas from pheochromocytomas.

Comparing the diagnostic value of 18F-FDG-PET/CT versus CT for differentiating benign and malignant solitary pulmonary nodules: a meta-analysis.

BACKGROUND: This quantitative meta-analysis was conducted to provide an indirect comparison of the diagnostic value of computed tomography (CT) with positron emission tomography (PET)/CT for differentiating benign and malignant solitary pulmonary nodules (SPNs). METHODS: PubMed, Embase, and the Cochrane Library were searched to identify eligible studies throughout November 2018, which differentiated benign and malignant SPNs using CT or PET/CT. The summary sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR), diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) were calculated using bivariate generalized linear mixed model and random-effects model. The diagnostic value of CT with PET/CT was indirectly evaluated using the ratio for diagnostic parameters. RESULTS: The sensitivity, specificity, PLR, NLR, DOR, and AUC for CT were 0.94 [95% confidence interval (CI): 0.87-0.97], 0.73 (95% CI: 0.64-0.80), 3.45 (95% CI: 2.60-4.58), 0.09 (95% CI: 0.04-0.17), 32.01 (95% CI: 15.10-67.86), and 0.89 (95% CI: 0.86-0.91), respectively. The pooled sensitivity, specificity, PLR, NLR, DOR, and AUC for PET/CT were 0.89 (95% CI: 0.85-0.92), 0.78 (95% CI: 0.66-0.86), 3.97 (95% CI: 2.57-6.13), 0.15 (95% CI: 0.10-0.20), 24.04 (95% CI: 12.71-45.48), and 0.91 (95% CI: 0.89-0.94), respectively. No significant differences were observed between CT and PET/CT for sensitivity, specificity, PLR, NLR, DOR, and AUC. CONCLUSIONS: This study used both CT and PET/CT with a moderate-to-high diagnostic value for differentiating benign and malignant SPNs and showed no significant differences in diagnostic parameters between CT and PET/CT.

Brain connectomic associations with traditional Chinese medicine diagnostic classification of major depressive disorder: a diffusion tensor imaging study.

BACKGROUND: Major depressive disorder (MDD) is highly heterogeneous in pathogenesis and manifestations. Further classification may help characterize its heterogeneity. We previously have shown differential metabolomic profiles of traditional Chinese medicine (TCM) diagnostic subtypes of MDD. We further determined brain connectomic associations with TCM subtypes of MDD. METHODS: In this naturalistic study, 44 medication-free patients with a recurrent depressive episode were classified into liver qi stagnation (LQS, n = 26) and Heart and Spleen Deficiency (HSD, n = 18) subtypes according to TCM diagnosis. Healthy subjects (n = 28) were included as controls. Whole-brain white matter connectivity was analyzed on diffusion tensor imaging. RESULTS: The LQS subtype showed significant differences in multiple network metrics of the angular gyrus, middle occipital gyrus, calcarine sulcus, and Heschl's gyrus compared to the other two groups. The HSD subtype had markedly greater regional connectivity of the insula, parahippocampal gyrus, and posterior cingulate gyrus than the other two groups, and microstructural abnormalities of the frontal medial orbital gyrus and middle temporal pole. The insular betweenness centrality was strongly inversely correlated with the severity of depression and dichotomized the two subtypes at the optimal cutoff value with acceptable sensitivity and specificity. CONCLUSIONS: The LQS subtype is mainly characterized by aberrant connectivity of the audiovisual perception-related temporal-occipital network, whereas the HSD subtype is more closely associated with hyperconnectivity and microstructural abnormalities of the limbic-paralimbic network. Insular connectivity may serve a biomarker for TCM-based classification of depression.Trial registration Registered at http://www.clinicaltrials.gov (NCT02346682) on January 27, 2015.

Abnormal changes in functional connectivity between the amygdala and frontal regions are associated with depression in Alzheimer's disease.

PURPOSE: The aim of the present study was to investigate the functional connectivity (FC) of Alzheimer's disease patients with depression (D-AD) based on an amygdalar seed using resting-state functional magnetic resonance imaging (rs-fMRI). METHODS: Twenty-one non-depressed AD (nD-AD) patients and 21 D-AD patients underwent rs-fMRI. The Hamilton Depression Rating Scale and Neuropsychiatric Inventory were used to evaluate the severity of depression. The amygdala was used as the seed for FC analysis. The FC differences between the two groups were evaluated by two-sample t tests, and the correlation of FC changes with depressive severity was analyzed by Pearson correlational analysis. RESULTS: Compared with the nD-AD patients, D-AD patients had increased FC values between the amygdala and orbitofrontal cortex and decreased FC values among the amygdala, medial prefrontal cortex, and inferior frontal gyrus. CONCLUSION: These data suggest that abnormal amygdala-prefrontal FC may be an important characteristic of AD patients with depression.

microRNA-761 regulates glycogen synthase kinase 3ß expression and promotes the proliferation and cell cycle of human gastric cancer cells.

It has been well documented that aberrant expression of microRNAs (miRs) serves important roles in cancer progression. The present study investigated the roles of miR-761 on gastric cancer (GC) cell proliferation. Reverse transcription polymerase chain reaction indicated that miR-761 was frequently upregulated in GC tissues and cells. Overexpression of miR-761 promoted the cell proliferation, cell colony formation and cell cycle of GC cells. Bioinformatics analysis revealed that miR-761 might target the 3'-untranslated region of glycogen synthase kinase 3ß, and was confirmed by luciferase reporter assay and western blot analysis. Taken together, the results of the present study revealed miR-761 as a tumor promoter in GC, and that it could be considered as a novel therapeutic target for patients with GC.

Altered Intrinsic Coupling between Functional Connectivity Density and Amplitude of Low-Frequency Fluctuation in Mild Cognitive Impairment with Depressive Symptoms.

Neuroimaging studies have demonstrated that major depressive disorder increases the risk of dementia in older individuals with mild cognitive impairment. We used resting-state functional magnetic resonance imaging to explore the intrinsic coupling patterns between the amplitude and synchronisation of low-frequency brain fluctuations using the amplitude of low-frequency fluctuations (ALFF) and the functional connectivity density (FCD) in 16 patients who had mild cognitive impairment with depressive symptoms (D-MCI) (mean age: 69.6 ± 6.2 years) and 18 patients with nondepressed mild cognitive impairment (nD-MCI) (mean age: 72.1 ± 9.7 years). Coupling was quantified as the correlations between the ALFF values and their associated FCDs. The results showed that the ALFF values in the D-MCI group were higher in the left medial prefrontal cortex (mPFC) and lower in the right precentral gyrus (preCG), and the FCD values were higher in the left medial temporal gyrus (MTG) than those in the nD-MCI group. Further, correlation analyses demonstrated that, in the D-MCI group, the mPFC was negatively correlated with the MTG. These findings may relate to the characteristics of mood disorders in patients with MCI, and they offer further insight into the neuropathophysiology of MCI with depressive symptoms.

The Abnormal Functional Connectivity between the Hypothalamus and the Temporal Gyrus Underlying Depression in Alzheimer's Disease Patients.

Hypothalamic communication with the rest of the brain is critical for accomplishing a wide variety of physiological and psychological functions, including the maintenance of neuroendocrine circadian rhythms and the management of affective processes. Evidence has shown that major depressive disorder (MDD) patients exhibit increased functioning of the hypothalamic-pituitary-adrenal (HPA) axis. Neurofibrillary tangles are also found in the hypothalamus of Alzheimer's disease (AD) patients, and AD patients exhibit abnormal changes in the HPA. However, little is known of how the hypothalamus interacts with other brain regions in AD patients with depression (D-AD). Functional connectivity (FC) analysis explores the connectivity between brain regions that share functional properties. Here, we used resting-state (rs) magnetic resonance imaging (MRI) technology and the FC method to measure hypothalamic connectivity across the whole brain in 22 D-AD patients and 21 non-depressed AD patients (nD-AD). Our results showed that D-AD patients had reduced FC among the hypothalamus, the right middle temporal gyrus (MTG) and the right superior temporal gyrus (STG) compared with the FC of nD-AD patients, suggesting that the abnormal FC between the hypothalamus and the temporal lobe may play a key role in the pathophysiology of depression in AD patients.

Amelioration of Intestinal Barrier Dysfunction by Berberine in the Treatment of Nonalcoholic Fatty Liver Disease in Rats.

OBJECTIVE: To investigate the effect of berberine (BBR) on intestinal barrier function in nonalcoholic fat liver disease (NAFLD) in rats. MATERIALS AND METHODS: Rats were divided into three groups: normal diet group (control group [CON group]), high-fat diet feeding group (HFD group), and HFD with BBR group. After 8 weeks of HFD feeding, rats in the BBR group were given BBR intragastrically at a dose of 150 mg/kg daily for 4 weeks. The same volume of normal saline was given to the CON and HFD groups. Liver index was detected, and Sudan black B staining was used to study fatty degeneration, also the expression level of occluding and intestinal flora was analyzed. RESULTS: BBR administration significantly reduced HFD-induced increase in body weight (CON group: 379.83 ± 61.51 g, HFD group: 485.24 ± 50.15 g, and BBR group: 428.60 ± 37.37 g). It obviously alleviated the HFD-induced liver fatty degeneration and histopathological changes of intestinal mucosa according to liver index low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, and total cholesterol (P < 0.05). The triglyceride, alanine transaminase, and aspartate aminotransferase levels were greatly elevated after BBR treatment (P < 0.05); while endotoxin, intestinal fatty acid-binding protein, and tumor necrosis factor-α were significantly reduced (P < 0.05). Moreover, we found that BBR could obviously elevate the level of occludin and decrease the level of Faecalibacterium prausnitzii and upregulate the level of bacteroides. CONCLUSION: BBR provides significant protection in NAFLD through ameliorating intestinal barrier function. SUMMARY: Berberine (BBR), an alkaloid that can be isolated from many plants, has been medically used for its wide range of antimicrobial and anti-inflammatory effectsThis is a study of BBR on liver function and intestinal barrier function in nonalcoholic fat liver disease (NAFLD)BBR treatment for NAFLD could significantly restore the liver function and provide significant protection in NAFLD through ameliorating intestinal barrier function. Abbreviations used: BBR: Berberine, NAFLD: Nonalcoholic fat liver disease, ALT: Alanine transaminase, AST: Aspartate aminotransferase, TG: Triglyceride, I-FABP: Intestinal-fatty acid-binding protein, IBD: Inflammatory bowel disease.

Treatment of acute intermittent porphyria during pregnancy and posterior reversible encephalopathy syndrome after delivery: A case report.

Acute intermittent porphyria (AIP) is a rare inherited disorder of heme metabolism. It has the ability to trigger posterior reversible encephalopathy syndrome (PRES), a rare acute neurologic condition that is characterized by acute neurological symptoms. Pregnancy may induce AIP attacks. The present report describes the case of a pregnant woman with AIP. The patient was treated with heme-arginate during pregnancy and successfully delivered a healthy baby. Following delivery, the patient presented with PRES and experienced generalized seizures. Treatment including arginine hemoglobin, calcium gluconate and sodium chloride was administered. The symptoms of epilepsy did not recur. Magnetic resonance imaging of the head demonstrated that the bilateral occipital lobe lesions were significantly reduced in size following the treatment. In the present report, it was demonstrated that administration of heme-arginate for AIP during pregnancy is safe. Timely administration of arginine hemoglobin, calcium gluconate and sodium chloride may more efficiently improve the clinical status in AIP patients diagnosed with PRES who experience generalized seizures.

Abnormal baseline brain activity in Alzheimer's disease patients with depression: a resting-state functional magnetic resonance imaging study.

PURPOSE: As one of the most common mental disorders and the most important precursor of suicide in Alzheimer's disease (AD), depression is associated with a decline in both well-being and daily functioning. At present, the diagnosis of AD patients with depression (D-AD) is largely dependent on clinical signs and symptoms, and the precise neural correlate underlying D-AD is still not fully understood. METHODS: The current study sought to investigate low-frequency oscillations at the voxel level in D-AD patients based on the amplitude of low-frequency fluctuations (ALFF) measured using resting-state functional magnetic resonance imaging. We examined 22 D-AD patients and 21 non-depressed AD (nD-AD) patients. RESULTS: The results revealed that D-AD patients exhibited increased ALFF values in the left caudate and thalamus and decreased ALFF values in the left middle temporal pole compared with nD-AD patients. CONCLUSION: These findings may provide further insight into the underlying neuropathophysiology of AD with depression.

Fractional amplitude of low-frequency fluctuations is disrupted in Alzheimer's disease with depression.

OBJECTIVE: To explore brain activity in AD with depression (D-AD) based on fractional amplitude of low-frequency fluctuation (fALFF). METHODS: Twenty-two D-AD and 21 AD without depression patients (nD-AD) were examined by magnetic resonance imaging during resting state. Neuropsychiatric Inventory and Hamilton Depression Rating Scale were employed to assess the severity of depression. We analysed the characteristics of fALFF in D-AD differing from nD-AD. We also examined the correlation between fALFF and the depression severity. RESULTS: D-AD patients had higher fALFF in right fusiform gyrus, left caudate nucleus, and right middle temporal gyrus (MTG), meanwhile lower fALFF in supplementary motor area (SMA) than nD-AD patients. CONCLUSIONS: Abnormal fALFF changes in fusiform gyrus, caudate nucleus, MTG and SMA may be important neuropathophysiologic characteristics of depression in AD. SIGNIFICANCE: We have clarified the potential neuropathological changes of depression in AD based on fALFF method, which is crucial for effective intervention.

Efficacy and safety comparison of chemotherapies for advanced gastric cancer: A network meta-analysis.

OBJECTIVE: Chemotherapy is one of the commonly used therapies for advanced gastric cancer. In this study, we performed a network meta-analysis on the efficacy and safety of common treatments to give evidences of their relative benefits. RESULTS: 32 trials with 8550 patients and 20 regimens were included in this study. According to the results of primary outcomes, 5-FU plus OXA, 5-FU plus DOC, CAP plus CIS, CAP plus OXA, S-1 plus OXA and S-1 plus PAC performed well in improving OS and ORR. As for the adverse events, S-1 had a safer effect than other treatments, conversely, 5-FU plus CIS ranked the last. However, there was no regimen with outstanding performances in both efficacy and safety. MATERIALS AND METHODS: Studies were searched from database and screened with criteria. The Bayesian framework based network meta-analysis was performed with software R and STATA. Overall survival (OS) and overall response rate (ORR) were considered as primary outcomes while adverse events as secondary outcomes. The outcomes were represented by hazard ratios or odd ratios with 95% corresponding credible intervals, respectively. CONCLUSIONS: The network meta-analysis suggested that 5-FU plus OXA and 5-FU plus DOC were recommended when efficacy was stressed. S-1 was safest but poorly effective. A regimen, as an excellent combination of efficacy and safety, is still waiting to be discovered.

Efficacy and safety of different molecular targeted agents based on chemotherapy for gastric cancer patients treatment: a network meta-analysis.

Increasing numbers of reports have been published to demonstrate that molecular targeted agents are able to improve the efficacy of chemotherapy in gastric cancer. This network meta-analysis aimed to evaluate the efficacy and safety of different molecular targeted agents, which were divided into six groups based on the targets including hepatocyte growth factor receptor (c-MET), vascular endothelial factor and its receptor (VEGF/VEGFR), human epidermal growth factor receptor 2 (HER2), epidermal growth factor receptor (EGFR), mammalian target of rapamycin (mTOR) and tyrosine kinase inhibitor (TKI). These six groups of targeted agents were evaluated for their efficacy outcomes measured by overall survival (OS), progression-free survival (PFS) and overall response rate (ORR). While their safety was measured 7 adverse events, including fatigue, anaemia, vomiting, neutropenia, thrombocytopenia, diarrhea and nausea. A total of 23 articles were included after extensive searching and strict inclusion, HER2 and VEGF(R) turned out to be the two most effective targeted drugs for their outstanding performance in OS and PFS. However, they were associated with severe adverse events, including fatigue, neutropenia and diarrhea. Therefore, they should be used with caution during their application. In conclusion, VEGF(R) and HER2 have the potential to be the optimal target agents for their survival efficacy, while the adverse events associated with them should be paid attention in application.

Effect of toll-like receptor 3 agonist poly I:C on intestinal mucosa and epithelial barrier function in mouse models of acute colitis.

AIM: To investigate potential effects of poly I:C on mucosal injury and epithelial barrier disruption in dextran sulfate sodium (DSS)-induced acute colitis. METHODS: Thirty C57BL/6 mice were given either regular drinking water (control group) or 2% (w/v) DSS drinking water (model and poly I:C groups) ad libitum for 7 d. Poly I:C was administrated subcutaneously (20 µg/mouse) 2 h prior to DSS induction in mice of the poly I:C group. Severity of colitis was evaluated by disease activity index, body weight, colon length, histology and myeloperoxidase (MPO) activity, as well as the production of proinflammatory cytokines, including tumor necrosis factor-α (TNF-α), interleukin 17 (IL-17) and interferon-γ (IFN-γ). Intestinal permeability was analyzed by the fluorescein isothiocyanate labeled-dextran (FITC-D) method. Ultrastructural features of the colon tissue were observed under electron microscopy. Expressions of tight junction (TJ) proteins, including zo-1, occludin and claudin-1, were measured by immunohistochemistry/immunofluorescence, Western blot and real-time quantitative polymerase chain reaction (RT-qPCR). RESULTS: DSS caused significant damage to the colon tissue in the model group. Administration of poly I:C dramatically protected against DSS-induced colitis, as demonstrated by less body weight loss, lower disease activity index score, longer colon length, colonic MPO activity, and improved macroscopic and histological scores. It also ameliorated DSS-induced ultrastructural changes of the colon epithelium, as observed under scanning electron microscopy, as well as FITC-D permeability. The mRNA and protein expressions of TJ protein, zo-1, occludin and claudin-1 were also found to be significantly enhanced in the poly I:C group, as determined by immunohistochemistry/immunofluorescence, Western blot and RT-qPCR. By contrast, poly I:C pretreatment markedly reversed the DSS-induced up-regulated expressions of the inflammatory cytokines TNF-α, IL-17 and IFN-γ. CONCLUSION: Our study suggested that poly I:C may protect against DSS-induced colitis through maintaining integrity of the epithelial barrier and regulating innate immune responses, which may shed light on the therapeutic potential of poly I:C in human colitis.

Common 1H-MRS Characteristics in Patients With Alzheimer's Disease and Vascular Dementia Diagnosed With Kidney Essence Deficiency Syndrome: A Preliminary Study.

Context • Traditional Chinese medicine (TCM) indicates that both Alzheimer's disease (AD) and vascular dementia (VD) should be categorized as dementia and that they have a common etiology and pathogenesis under TCM classification of syndromes, such as with kidney essence deficiency syndrome (KEDS). The pathological location is mainly in the brain. However, it remains unclear whether AD and VD patients with KEDS exhibit a metabolic commonality in the same region of the brain. Objective • The study intended to investigate the metabolic characteristics of the brain using proton magnetic resonance spectroscopy (1H-MRS) in patients with AD and VD who had been diagnosed with KEDS. Design • The research team designed a pilot study, with the participants being allocated to 3 groups: (1) an AD group, (2) a VD group, and (3) a control group. All data analysis was carried out by a trained radiologist who was blinded to each participant's diagnosis. Setting • The study took place at the Tongde Hospital of Zhejiang Province (Zhejiang Sheng, China). Participants • Participants were patients at the Tongde Hospital with mild AD or VD who had been diagnosed with KEDS. The normal controls were patients' spouses or guardians with normal cognitive function. Outcome Measures • All participants underwent 1H-MRS. The N-acetyl aspartate (NAA)/myo-inositol (mI), NAA/creatine (Cr), choline (Cho)/Cr, and mI/Cr ratios were bilaterally measured in the posterior cingulate gyrus (PCG) and anterior cingulate gyrus (ACG) by the Syngo spectroscopy postprocessing package. Demographic characteristics and 1H-MRS data were assessed across the AD, VD, and normal control groups. Results • Thirteen patients with mild AD with KEDS, 15 patients with mild VD with KEDS, and 18 normal controls were recruited from May 2013 through May 2014. The AD and VD groups did not significantly differ in the NAA/mI, NAA/Cr, Cho/Cr, and mI/Cr ratios in either the PCG or the ACG, with the exception being the Cho/Cr ratio in the right ACG, for which the ratio of the AD group was significantly lower when compared with that of the VD group (P < .05). Conclusions • Mild AD and VD with KEDS showed similar patterns for the 1H-MRS on the cingulate cortex, providing evidence for a common pathogenesis for the KEDS that is associated with AD and VD, providing a modern biological basis for the philosophy of providing the same treatment for different diseases.

Decreased functional connectivity between the dorsal anterior cingulate cortex and lingual gyrus in Alzheimer's disease patients with depression.

BACKGROUND: Depression is one of the most common psychiatric symptoms in Alzheimer's disease (AD), occurring in up to 40% of AD patients. It influences the cognitive function of patients and increases the burden on their caregivers. Currently, there are few effective medical treatments for reducing the symptoms of depression in AD patients. Understanding the underlying neurobiological mechanisms in AD patients with depression (D-AD) is crucial for developing effective interventions. The anterior cingulate cortex (ACC) is an important brain region involved in emotional and cognitive processing. Several functional magnetic resonance imaging studies have shown that patients with major depressive disorder have structural, functional, and metabolic abnormalities in the ACC. METHODS: We investigated the resting-state functional connectivity (FC) of ACC subregions in 15 D-AD patients and 17 non-depressed AD (nD-AD) patients, by parcellating the ACC into the rostral and dorsal ACC (dACC). RESULTS: Our results revealed that D-AD patients have decreased FC between the dACC and the right occipital lobe and right lingual gyrus, compared with nD-AD patients. CONCLUSIONS: Decreased FC between the dACC and the right occipital lobe and right lingual gyrus may play an important role in the neuropathophysiology of depression in AD.

Symptomatic adjacent segment disease after single-lever anterior cervical discectomy and fusion: Incidence and risk factors.

The purpose of this study was to determine the incidence and risk factors of symptomatic adjacent segment disease (ASD) following single-lever anterior cervical discectomy and fusion (ACDF) for cervical degenerative diseases.From January 2000 to December 2010, a total of 582 patients with cervical radiculopathy and myelopathy who had undergone single-lever ACDF surgery in the authors' institution were reviewed retrospectively. Patients who had a revision surgery for symptomatic ASD were selected for this study. The authors analyzed the incidence for ASD after single-lever ACDF. And univariate analysis and logistic regression analysis were performed to identify the risk factors of ASD.Among the 582 patients, 36 patients received subsequent surgical management for ASD after initial single-lever ACDF for an overall prevalence of 6.2%. The average onset time of ASD was 8.5 (2-15) years. The univariate analysis showed that there were no significant differences in sex, duration of disease, BMI, DM, smoking, operative levels, and follow-up period (P > .05) between the 2 groups with and without ASD. There were statistically significant differences in age at the time of operation (χ = 4.361, P = .037), and developmental canal stenosis (χ = 4.181, P = .041) between patients with and without ASD. The variables of age at the time of operation and developmental canal stenosis were included in a logistic regression model. The logistic regression analysis revealed that age at the time of operation ≤50 years (P = .045, OR = 3.015, 95% CI = 1.024-8.882) and developmental canal stenosis (P = .042, OR = 2.797, 95% CI = 1.039-7.527) were the risk factors for ASD after single-lever ACDF.In the present study, the incidence of symptomatic ASD after single-lever ACDF was 6.2%. And the age at the time of operation ≤50 years and developmental canal stenosis were the risk factors for ASD. The patients ≤50 years old at the time of operation or with developmental canal stenosis are more likely to develop ASD after surgery, and the risk of reoperation will increase.