The influence of cerebellum on visual selective attention in patients with multiple lacunar cerebral infarction and its neuromodulatory mechanisms.

Objective: This study aims to investigate the influence of the cerebellum on visual selective attention function and its neuromodulatory mechanism in patients with multiple lacunar cerebral infarction (MLCI). Methods: A retrospective analysis was conducted on 210 patients admitted with MLCI from January 2016 to May 2022. Analyzed the electrophysiological characteristics of the P3a and P3b components of vision in both groups, as well as source reconstruction simulations of dipole activation in the brains of the two groups, and analyzed the brain regions with differences in activation strength between the two groups. Results: This study found that there was no significant difference in peak amplitude between the two groups, but compared with the control group, the peak latency of the case group was significantly prolonged. Specifically, the P3a peak latency induced by the novel stimulus was longer than that induced by the target stimulus P3b peak latency. Source reconstruction results showed decreased and increased activation in several brain regions in the case group compared to the control group. Conclusion: The study suggests that the impairment of distracted attention capture is more pronounced in patients with MLCI. The cerebellum indirectly influences the ventral and dorsal frontoparietal attention networks by modulating the levels of excitation and inhibition within the cerebral cortex of the attention network. This may represent a potential mechanism through which the cerebellum regulates visual selective attention information in MLCI patients.

The gut microbial signatures of patients with lacunar cerebral infarction.

BACKGROUND: Emerging evidence revealed that gut microbial dysbiosis is involved in the pathogenesis of multiple neurological diseases, but there is little available data on the relationship between gut microbiota and lacunar cerebral infarction (LCI). METHODS: Fecal samples from acute LCI patients (n = 65) and matched healthy controls (n = 65) were collected. The compositions and potential functions of the gut microbiota were estimated. RESULTS: The results showed that there were significant gut microbial differences between LCI and control groups. Patients with LCI had higher abundances of genus Lactobacillus, Streptococcus, Veillonella, Acidaminococcus, Bacillus, Peptoclostridium, Intestinibacter, Alloscardovia and Cloacibacillus but lower proportions of genus Agathobacter and Lachnospiraceae_UCG-004. Investigating further these microbes such as Lactobacillus and Veillonella were correlated with clinical signs. Moreover, we found that 9 gene functions of gut microbiota were different between LCI patients and controls, which were associated with amino acid metabolism and inflammatory signal transduction. Notably, four optimal microbial markers were determined, and the combination of Streptococcus, Lactobacillus, Agathobacter, Lachnospiraceae_UCG-004 and the three risk factors achieved an area under the curve (AUC) value of 0.854 to distinguish LCI from controls. CONCLUSION: These findings revealed the characterizing of gut microbiota in LCI patients and provided potential microbial biomarkers for clinical diagnosis of LCI.

Application of machine learning model to predict lacunar cerebral infarction in elderly patients with femoral neck fracture before surgery.

BACKGROUND: Femoral neck fracture and lacunar cerebral infarction (LCI) are the most common diseases in the elderly. When LCI patients undergo a series of traumas such as surgery, their postoperative recovery results are often poor. Moreover, few studies have explored the relationship between LCI and femoral neck fracture in the elderly. Therefore, this study will develop a ML (machine learning)-based model to predict LCI before surgery in elderly patients with a femoral neck fracture. METHODS: Professional medical staff retrospectively collected the data of 161 patients with unilateral femoral neck fracture who underwent surgery in the Second Affiliated Hospital of Wenzhou Medical University database from January 1, 2015, to January 1, 2020. Patients were divided into two groups based on LCI (diagnosis based on cranial CT image): the LCI group and the non-LCI group. Preoperative clinical characteristics and preoperative laboratory data were collected for all patients. Features were selected by univariate and multivariate logistic regression analysis, with age, white blood cell (WBC), prealbumin, aspartate aminotransferase (AST), total protein, globulin, serum creatinine (Scr), blood urea nitrogen (Bun)/Scr, lactate dehydrogenase (LDH), serum sodium and fibrinogen as the features of the ML model. Five machine learning algorithms, Logistic regression (LR), Gradient Boosting Machine (GBM), Extreme Gradient Boosting (XGBoost), Random Forest (RF), and Decision tree (DT), were used in combination with preoperative clinical characteristics and laboratory data to establish a predictive model of LCI in patients with a femoral neck fracture. Furthermore, indices like the area under the receiver operating characteristic (AUROC), sensitivity, specificity, and accuracy were calculated to test the models' performance. RESULTS: The AUROC of 5 ML models ranged from 0.76 to 0.95. It turned out that the RF model demonstrated the highest performance in predicting LCI for femoral neck fracture patients before surgery, whose AUROC was 0.95, sensitivity 1.00, specificity 0.81, and accuracy 0.90 in validation sets. Furthermore, the top 4 high-ranking variables in the RF model were prealbumin, fibrinogen, globulin and Scr, in descending order of importance. CONCLUSION: In this study, 5 ML models were developed and validated for patients with femoral neck fracture to predict preoperative LCI. RF model provides an excellent predictive value with an AUROC of 0.95. Clinicians can better conduct multidisciplinary perioperative management for patients with femoral neck fractures through this model and accelerate the postoperative recovery of patients.

Relationship between cognitive function and brain event-related potentials in patients with lacunar cerebral infarction / 中国综合临床

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.

Correlation of serum uric acid, cystatin C and high-sensitivity C-reactive protein with cognitive impairment in lacunar cerebral infarction.

OBJECTIVE: To study the correlation of serum uric acid (UA), cystatin C (Cys-C) and high-sensitivity C-reactive protein (hs-CRP) with cognitive impairment in lacunar cerebral infarction. METHODS: Total 198 patients with lacunar cerebral infarction were selected and divided into 4 groups according to their cognitive function, with 65 cases in the normal group, 72 cases in the mild cognitive impairment group, 38 cases in the moderate cognitive impairment group and 23 cases in the severe cognitive impairment group. The hs-CRP, serum UA, Cys-C and Montreal Cognitive Assessment (MoCA) were measured upon admission. RESULTS: There were statistical differences in hs-CRP, UA and Cys-C among the four groups (all P<0.001). MoCA was negatively correlated with hs-CRP, UA and Cys-C (all P<0.001). Multivariate logistic regression analysis showed that elevated levels of hs-CRP, UA and Cys-C were the influencing factors of cognitive impairment in patients with lacunar cerebral infarction (all P<0.05). CONCLUSION: The levels of hs-CRP, UA and Cys-C in patients with lacunar cerebral infarction increase with the aggravation of cognitive impairment, and high hs-CRP, UA and Cys-C are independent risk factors of cognitive impairment in patients with lacunar cerebral infarction.

Clinical Observation of Argatroban in the Treatment of Progressive Stroke of Different Ischemic Ranges / 中国药房

OBJECTIVE:To study clinical effect of argatroban for progressive stroke patients of different cerebral ischemic ranges. METHODS:A total of 116 progressive stroke patients selected from neurology department of our hospital during Feb. 2015-May 2016 were divided into anterior circulation (ischemia) group (n=60),posterior circulation (ischemia) group (n=50) and lacunar(cerebral infarction)group(n=6)according to cerebral ischemic ranges. They all received routine treatment combined with argatroban,and given continuous intravenous infusion of argatroban 60 mg/d on the day and 2nd day of disease aggravation, and then continuous intravenous infusion of argatroban 5th day after relieving,3 h/time,bid,7 d as a treatment course. NIHSS scores,modified RANKIN (mRS) scores,APTT and ADR were compared among 3 groups. RESULTS:Forteen days after treat-ment,NIHSS scores and mRS scores of 3 groups were decreased significantly compared to before treatment,with statistical signifi-cance (P0.05). No obvious ADR was found in 3 groups. CONCLUSIONS:Argatroban shows significant therapeutic efficacy for progressive stroke of different ischemic ranges with good safety;especially for the patients with anterior circulation ischemics stroke,the effect is quick and anticoagulant effect is significant.

The curative effect observation of Danhong injection combined with atorvastatin calcium in the treatment of lacunar cerebral infarction of the elderly / 国际中医中药杂志

Objective To observe the clinical curative effect of Danhong injection combined with atorvastatin calcium in the treatment of lacunar cerebral infarction of the elderly.. Methods 125 elderly patients with lacunar cerebral infarction were randomly recruited into two groups, a control group(n=60 cases) was treated with atorvastatin calcium on the basis of conventional symptomatic treatment, and an observation group (n=65 cases) was treated with Danhong injection combined with atorvastatin calcium on the basis of conventional symptomatic treatment, the courses of two groups were 14 d. The clinical curative effect, the degree of nerve function defect score, the changes of hemorheology of two groups before and after the treatment were compared. Results The total effective rate of the observation group(89.2%)was significantly higher than that of the control group(71.7%)(P<0.05). The degree of nerve function defect score(16.24±4.63)of observation group after treatment improved significantly better than that of control group(22.17±7.38), P<0.05, and the whole blood viscosity(high), whole blood viscosity(low), plasma viscosity and fibrinogen [(3.62±0.64)mPa?s,(8.07±2.45)mPa?s, (1.61±0.30)mPa?s, (2.76±0.28)g/L]decreased significantly than that of the control group[(4.73±0.85)mPa?s, (9.86±3.26)mPa?s, (2.05±0.33)mPa?s,(3.94±0.35)g/L], P<0.05. Conclusion The treatment of Danhong injection combined with atorvastatin calcium for elderly lacunar cerebral infarction had a good therapeutic effect. It could improve nerve function defect degree and blood rheology indexes.

Analysis of prognostic factors of the elderly patients with lacunar infarction / 中国基层医药

Objective To explore the correlation between the recurrence rate of the elderly patients with lacunar infarction and the risk factors including blood pressure, blood glucose, total cholesterol, triglycerides,low density lipoprotein cholesterol values, high-density lipoprotein cholesterol and other. Methods 207 over 60 years old patients with lacunar infarction occurred the first time were included in the study. All patients were followed up two years to assess the relapse rate and the risk factors of the patients with lacunar infarction. Results 207 cases of elderly patients with lacunar infarction complicated with hypertension,type 2 diabetes and hyperlipidemia were 148 cases,22 cases,7 cases respectively, and the recurrence rates of three groups were 8.78%, 18.18%, 14.29% respectively;The patients complicated with hypertension and 2 type diabetes were 6 cases,and the recurrence rate was 34.62%;The patients without hypertension,type 2 diabetes and hyperlipidemia were 4 cases,and the recurrence rate was 0%. In two years,27 cases of lacunar infarction recurred,and the recurrence rate was 13.04%. Conclusion Hypertension,type 2 diabetes,hyperlipidemia could also be considered as the high-risk predictor factors for the recurrence rate of the elderly patients with lacunar infarction.

Observation on the effects of Danhong Injection on lacunar cerebral infarction / 国际中医中药杂志

Objective To observe the effects of Danhong Injection in the treatment of lacunar cerebral infarction, Methods 82 patients with lacunar cerebral infarction were randomly recruited into a treatment group (n=42) and a control group (n=40). The treatment group was treated with Danhong Injection, 30ml/d for once, while the control group was treated with Danshen Injection, i.v. 20ml/day for once. Both groups were treated for 14 days. Results The total effective rate was 97.62% and 77.50% in the treatment group and the control group respectively, showing significant difference (χ~2=4.65, P< 0.05) . Conclusion Danhong Injection is better than Danshen Injection in treatment of lacunar cerebral infarction.

Hemorrheological Changes in Lacunar Cerebral Infarction Patients With Arteriopathy of Small Artery / 广州中医药大学学报

【Objective】To observe the hemorrheological changes in lacunar cerebral infarction(LCI) patients with arteriopathy of middle and small arteries.【Methods】The hemorrheological changes of cerebral arteries in 85 LCI patients without arteriopathy of large artery confirmed by cervical vessels color ultrasonography and magnetic resonance image(MRI)were observed by transcranial Doppler ultrasonography(TCD).The correlation of the hemorrheological changes with age and blood pressure(BP) of arteries was investigated.The above indexes were compared with those in 25 healthy volunteers confirmed by encephalography in the same age group.【Results】The mean blood flow rates of cerebral middle,anterior and posterior artery in LCI patients were(62.09?16.90)cm?s~(-1),(50.42?13.11)(cm?s~(-1),)and(32.33?7.55)cm?s~(-1) respectively,lower than(69.65?19.20)cm?s~(-1),(57.75?16.75)cm?s~(-1),and(38.75?8.81)cm?s~(1) respectively in the healthy volunteers(P0.05).【Conclusion】The arteriopathy of small artery in LCI patients can cause the mild decrease of blood flow rate and the increase of pulsating index.There exists a correlation of pulsating index with age and arterial blood pressure.

Change of serum C-reactive protein levels in patients with acute cerebral infarction and acute cerebral infarction with multiple organ dysfunction syndrome / 临床神经病学杂志

Objective To investigate the change of serum C-reactive protein(CRP) levels in patients with acute cerebral infarction(ACI) and ACI with multiple organ dysfunction syndrome(MODS), and the relationship between serum CRP levels and incidence of MODS.Methods The serum CRP levels of 30 normal healthy people and 82 patients with ACI were detected by immune transmission turbidity method. The data from the patients with lacunar cerebral infarction(LCI), acute simple cerebral infarction(PACI) and ACI with MODS(ACI+MODS) were compared.Results The levels of serum CRP in patients with ACI significantly increased compared with the controls( P