Association Analysis of Gut Microbiota and Prognosis of Patients with Acute Ischemic Stroke in Basal Ganglia Region.

Previous studies have implied the potential impact of gut microbiota on acute ischemic stroke (AIS), but the relationships of gut microbiota with basal ganglia region infarction (BGRI) and the predictive power of gut microbiota in BGRI prognosis is unclear. The aim of this study was to ascertain characteristic taxa of BGRI patients with different functional outcomes and identify their predictive value. Fecal samples of 65 BGRI patients were collected at admission and analyzed with 16s rRNA gene sequencing. Three-month functional outcomes of BGRI were evaluated using modified Rankin Scale (mRS), and patients with mRS score of 0-1 were assigned to good-BGRI group while others were assigned to poor-BGRI group. We further identified characteristic microbiota using linear discriminant analysis effect size, and receiver operating characteristic (ROC) curve was used to determine the predictive value of differential bacteria. According to the mRS score assessed after 3 months of stroke onset, 22 patients were assigned to poor-BGRI group, while 43 patients were assigned to good-BGRI group. Short chain fatty acids-producing bacteria, Romboutsia and Fusicatenibacter, were characteristic microbiota of the good-BGRI group, while pro-inflammatory taxa, Acetanaerobacterium, were characteristic microbiota of the poor-BGRI group. Furthermore, the differential bacteria showed extensive associations with clinical indices. ROC curves, separately plotted based on Romboutsia and Fusicatenibacter, achieved area under the curve values of 0.7193 and 0.6839, respectively. This study identified the efficient discriminative power of characteristic microbiota in BGRI patients with different outcomes and provided novel insights into the associations of gut microbiota with related risk factors.

The effect of drilling and drainage based on spiral CT-guided on hematoma clearance and serum inflammatory factors levels in patients with basal ganglia region hypertensive cerebral hemorrhage / 中国医师进修杂志

Objective:To investigate the effect of drilling and drainage based on spiral CT-guided on hematoma clearance and serum inflammatory factors levels in patients with basal ganglia region hypertensive cerebral hemorrhage.Methods:A total of 112 patients with basal ganglia region hypertensive cerebral hemorrhage admitted to Lanling County People′s Hospital from May 2017 to February 2020 were selected as the research objects, and 56 patients performed traditional craniotomy(craniotomy group), and 56 patients used spinal CT to locate the hematoma area and puncture point before the surgery, and performed drilling and drainage according the scanning results (drilling group). The operation conditions, hematoma volume changes and hematoma clearance rate in two groups were compared. The levels of neuron-specific enolase (NSE), specific protein S100B, interleukin(IL)-17, IL-1β and C-reactive protein (CRP) in two groups before and after the treatment for 1 month were compared. The scores of National Institute of Health Stroke Scale (NIHSS) and Barthel Index Scale(BI) in two groups before and after the treatment for 3 months were compared.Results:The operative time, intraoperative blood loss, postoperative drainage volume in the drilling group were lower than those in the craniotomy group: (1.21 ± 0.28) h vs. (2.43 ± 0.37) h, (131.98 ± 39.51) ml vs. (231.64 ± 47.65) ml, (41.05 ± 5.68) ml vs. (62.93 ± 7.83) ml; the hematoma clearance rate in the drilling group was higher than that in the craniotomy group: (89.57 ± 6.15)% vs. (77.95 ± 5.92)%, there were statistical differences ( P<0.05). After treatment for 1 month, the levels of S100B, NES, IL-17, IL-1β, CRP in the drilling group were lower than those in the craniotomy group: (0.49 ± 0.18) μg/L vs. (0.67 ± 0.24) μg/L, (15.32 ± 1.67) μg/L vs. (17.61 ± 1.59) μg/L, (147.38 ± 14.86) ng/L vs. (172.59 ± 12.94) ng/L, (84.17 ± 10.48) ng/L vs. (107.43 ± 9.35) ng/L, (33.78 ± 4.77) mg/L vs. (47.01 ± 4.15) mg/L, there were statistical differences ( P<0.05). After treatment for 3 months, the scores of NIHSS in the drilling group was lower than that in the craniotomy group and the scores of BI in thedrilling group was higher than that in the craniotomy group: (3.57 ± 2.13) scores vs. (7.83 ± 2.96) scores, (84.56 ± 8.16) scores vs. (67.43 ± 6.95) scores, there were statistical differences ( P<0.05). The complication rate in the two groups had no statistically differences ( P>0.05). Conclusions:Compared with traditional craniotomy, the drilling and drainage based on spiral CT-guided on hematoma clearance has the advantages of shorter operation time, less injury, better regulation of inflammation and better improvement of neurological function.

Factors Associated With the Occurrence and Evolution of Recent Small Subcortical Infarcts (RSSIs) in Different Locations.

Recent small subcortical infarcts (RSSIs) can occur in different brain regions. Distinct etiologies might be involved for RSSIs in different locations and could further affect RSSI cavitation and functional outcomes. In this study, we aim to analyze the baseline clinical and imaging characteristics associated with the occurrence and cavitation of RSSIs in different locations. We retrospectively include patients who presented with RSSIs from a database for cerebral small vessel disease. Detailed information, including demographic, clinical, laboratory, and radiological data, were collected. We identify baseline RSSIs on diffusion-weighted images and divide them into brainstem, subcortical white matter, and basal ganglia region groups. Cavitation is evaluated on follow-up T2 fluid-attenuated inversion recovery (FLAIR) images. Statistical analysis is performed to determine factors associated with the occurrence and cavitation of RSSIs in different locations. We find that patients with brainstem RSSIs have a higher proportion of diabetes (64.1%) compared to patients with subcortical white matter (27.3%, P < 0.001) and basal ganglia region RSSIs (35.2%, P = 0.006) and have higher levels of HbA1c (7.20%) compared to patients with subcortical white matter (6.10%, P = 0.001) and basal ganglia region RSSIs (6.20%, P = 0.003). In addition, patients with brainstem RSSIs have higher NIHSS scores than patients with subcortical white matter RSSIs (2 vs 0, P = 0.001). Patients with subcortical white matter RSSIs have higher a white matter hyperintensity (WMH) burden compared to patients with basal ganglia region RSSIs (21.64 cm3 vs 11.10 cm3, P = 0.004). Follow-up analysis demonstrates that basal ganglia region RSSIs are less likely to cavitate than subcortical white matter RSSIs (61.4% vs 83.6%, P = 0.010), and contacting with WMH is associated with the cavitation of subcortical white matter RSSIs (OR: 101.760, P = 0.003). Our study demonstrates that RSSIs in different locations are associated with different clinical and imaging characteristics. Furthermore, cavitation of RSSIs might be affected by local lesion features and the surrounding environment rather than general demographic and clinical factors.

Alterations of Iron Level in the Bilateral Basal Ganglia Region in Patients With Middle Cerebral Artery Occlusion.

Background and Purpose: The purpose of this study was to explore the changes of iron level using quantitative susceptibility mapping (QSM) in the bilateral basal ganglia region in middle cerebral artery occlusion (MCAO) patients with long-term ischemia. Methods: Twenty-seven healthy controls and nine patients with MCAO were recruited, and their QSM images were obtained. The bilateral caudate nucleus (Cd), putamen (Pt), and globus pallidus (Gp) were selected as the regions of interest (ROIs). Susceptibility values of bilateral ROIs were calculated and compared between the affected side and unaffected side in patients with MCAO and between patients with MCAO and healthy controls. In addition, receiver operating characteristic (ROC) curves were performed to evaluate the diagnostic capability of susceptibility values in differentiating healthy controls and patients with MCAO by the area under the curve (AUC). Results: The susceptibility values of bilateral Cd were asymmetric in healthy controls; however, this asymmetry disappeared in patients with MCAO. In addition, compared with healthy controls, the average susceptibility values of the bilateral Pt in patients with MCAO were increased (P < 0.05), and the average susceptibility value of the bilateral Gp was decreased (P < 0.05). ROC curves showed that the susceptibility values of the Pt and Gp had a larger AUC (AUC = 0.700 and 0.889, respectively). Conclusion: As measured by QSM, the iron levels of the bilateral basal ganglia region were significantly changed in patients with MCAO. Iron dyshomeostasis in the basal ganglia region might be involved in the pathophysiological process of middle cerebral artery stenosis and occlusion. These findings may provide a novel insight to profoundly address the pathophysiological mechanisms of MCAO.

Pediatric Basal Ganglia Region Tumors: Clinical and Radiologic Features Correlated with Histopathologic Findings.

PURPOSE: To summarize the clinical and radiologic features of pediatric basal ganglia region tumors (PBGRT) in correlation with their histopathologic findings to reduce inappropriate surgery and identify tumors that can benefit from maximal safe resection. METHODS: The records of 35 children with PBGRT treated in our hospital from December 2011 to December 2015 were analyzed retrospectively. The clinical and radiologic features of these tumors were summarized and correlated with their histopathologic diagnosis. RESULTS: Our series included 15 astrocytomas and 11 germ cell tumors (GCTs). Basal ganglia astrocytomas were characterized by various clinical presentations and an ill-circumscribed mass with the involvement of surrounding structures on neuroimaging and mostly occurred in the first decade of life (n = 10; 66.7%). Basal ganglia GCT mostly occurred in the second decade of life (n = 8; 72.7%) with hemiparesis as the most common symptom (n = 9; 81.8%). The tumors were located predominantly in the caput of caudate nucleus (n = 8; 72.7%) with hemiatrophy as the typical sign (n = 8; 72.7%). Occasionally, other tumors also could occur in this region, including primitive neuroectodermal tumor (n = 1), atypical teratoid/rhabdoid tumor (n = 1), anaplastic ependymoma (n = 1), lymphoma (n = 1), extraventricular neurocytoma (n = 1), gangliogliomas (n = 2), oligodendroglioma (n = 1), and dysembryoplastic neuroepithelial tumor (n = 1). CONCLUSIONS: Astrocytoma and GCT are the most common PBGRTs. Low-grade astrocytomas could benefit from maximal surgical resection, whereas GCTs merit neoadjuvant chemoradiation therapy followed by second-look surgery. We advocate routine testing of tumor markers and analysis of their clinical and radiologic features to optimize the therapeutic strategy.

Comparison of therapeutic effects of different surgery methods on early hypertensive intracerebral hemorrhage in basal ganglia region in elderly patients and their prognostic factors analysis / 中华老年医学杂志

Objective To explore the therapeutic effects of different surgery methods on early hypertensive intracerebral hemorrhage(HICH)in basal ganglia region in elderly patients and on prognostic factors analysis.Methods 89 elderly patients with early HICH were randomly divided into four groups according to surgery methods and whether their ICP was monitored.Group A(n=21)was given minimally invasive hematoma drainage,group B(n=23)was given small bone window for removal of hematoma,group C(n=21)and group D(n=24)was given ICP monitoring and corresponding management of ICP on the basis of group A and group B,respectively.The changes of intracranial pressure before and after operation,prognosis and post-operative complications were compared.Results The intracranial pressure was significantly decreased at 3rd day,7th day after operation in group C and D as compared with those in group A and B at the same time points(F=11.76,P<0.05),and the score of GCS was also higher in group C and D at 7th day after operation than in group A,B at the same time points(F=4.72,P<0.05).At 14th and 28th day after operation,the score of GCS was higher in group C than in group A and B(F=19.24,P<0.05),and higher in group C than in group D at 28th day after operation(F=22.26,P<0.05).The dosage of mannitol was significantly lower in group C and group D than in group A and group B(F=18.87,P<0.05).The incidence rate of post-operative complications was 14.3% in group C vs.28.6% in group A(P<0.05)and 20.8% in group D vs.47.8% in group B(χ2=7.04,P<0.05).The proportion of a good recovery and a light disability was significantly higher in group C and D(76.2% and 75.0%)than in group A and B(42.9% and 39.1%)respectively(χ2=14.99,all P<0.05).Conclusions Minimally invasive hematoma drainage shows the advantages of small trauma and a few complications for the treatment of elderly patients with early HICH,and its combination with ICP can early change intracranial pressure and further improves the prognosis.

Clinical efficiacy and method analysis of operation approach in lateral fissure for patients with HICH in basal ganglia region / 重庆医学

Objective To analyze clinical efficacy of operation approach in lateral fissure for patients with hypertensive intracerebral hemorrhage (HICH) in basal ganglia region.Methods Retrospectively analyzed 120 cases of patients with HICH in basal ganglia region in the department of neurosurgery in our hospital from 2012 to 2015.Among them,64 cases of patients were treated by surgery via lateral fissure-insular approach (lateral fissure group),the other 56 cases of patients were treated by surgery via the traditional trans-temporal cortex approach (temporal lobe group).The perioperative indicators and clinical efficacy were compared between the two groups.Results Compared with the temporal lobe group,the operative time in the lateral fissure group was decreased,and the hematoma clearance rate was increased,there were statistically significant differences(P＜0.05).No statistically significant difference was found in postoperative re-bleeding rate and rate of complications between the two groups(P＞0.05).The activity of daily living (ADL) Barthel index scores,1 month,3 months and 6 months after operation,in the lateral fissure group were significantly higher than those in the temporal lobe group(P＜0.05).In the lateral fissure group one patient died and in the temporal lobe group 2 patients died.The proportion of patients with good prognosis in the lateral fissure group (70.31％) was higher than that in the the temporal lobe group(51.78％,P＜0.05).Conclusion Patients with HICH in basal ganglia region treated by operation via lateral fissure-insular approach undergo a shorter operation time,hematoma is evacuated more thoroughly,and have better postoperative prognosis,compared with those patients treated by operation via traditional trans-temporal cortex approach.

Correlation of iron deposition and change of gliocyte metabolism in the basal ganglia region evaluated using magnetic resonance imaging techniques: an in vivo study.

INTRODUCTION: We assessed the correlation between iron deposition and the change of gliocyte metabolism in healthy subjects' basal ganglia region, by using 3D-enhanced susceptibility weighted angiography (ESWAN) and proton magnetic resonance spectroscopy ((1)H-MRS). MATERIAL AND METHODS: Seventy-seven healthy volunteers (39 female and 38 male subjects; age range: 24-82 years old) were enrolled in the experiment including ESWAN and proton MRS sequences, consent for which was provided by themselves or their guardians. For each subject, the mean phase value gained by ESWAN was used to evaluate the iron deposition; choline/creatine (Cho/Cr) and mI/Cr ratios gained by (1)H-MRS were used to evaluate gliocyte metabolism in the basal ganglia region of both sides. The paired t test was used to test the difference between the two sides of the basal ganglia region. Linear regression was performed to evaluate the relation between mean phase value and age. Pearson's correlation coefficient was calculated to analyze the relationship between the result of ESWAN and (1)H-MRS. RESULTS: There was no difference between the two sides of the basal ganglia region in the mean phase value and Cho/Cr. But in mI/Cr the mean phase value of each nucleus in bilateral basal ganglia decreased with increasing age. There are 16 r-values between the mean phase value and Cho/Cr and mI/Cr in bilateral basal ganglia region. And each of all p-values is less than 0.001 (p < 0.001). CONCLUSIONS: Iron deposition in the bilateral basal ganglia is associated with the change of gliocyte metabolism with increasing age. Iron deposition in each nucleus of the basal ganglia region changes with age.

Influence of microsurgical operation through lateral fissure-insula lobe approach in the treatment of hyperten-sive cerebral hemorrhage in basal ganglia region / 局解手术学杂志

Objective To explore the impact of Microsurgical operation through lateral fissure-insula lobe approach in the treatment of hypertensive cerebral hemorrhage in basal ganglia region on the clinical curative effect.Methods Selected 90 cases of patients with hyper-tensive cerebral hemorrhage in basal ganglia region in our hospital from April 2013 to December 2015.According to the random number table method,they were divided into the observation group and the control group.Regarded the even numbers as the observation group while the odd numbers as the control group,with 45 cases in each group.Patients of the two groups were all performed general anaesthesia with tracheal in-tubation.And patients of the control group were given large trauma craniotomy,while patients of the observation group were treated by micro-surgical operation through lateral fissure-insula lobe approach.Recorded the situation of surgery and postoperative recovery of patients in the two groups.In addition,compared the postoperative complications and evaluated living conditions of the two groups through activity of daily living scale(ADL)half a year after surgery.Results The good rate of recovery in the observation group was 84.44% (38 /45),while it was 51.11%(23 /45)in the control group,and there was statistically significant difference between the two groups(χ2 =11.447,P =0.000).Be-sides,the mortality rate of the observation group was 0(0 /45)half a year after surgery,while it was 8.89%(4 /45)in the control group,and there was statistically significant difference between the two groups(χ2 =4.186,P =0.041).The operation time of observation group and the automatic opening time in the observation group were obviously shorter than that of the control group(P <0.05).Moreover,the hematoma clearance rate and GCS score of the observation group 1 week after operation were significantly higher than those of the control group (P <0.05).The incidence of postoperative complications of the observation group was 8.89%(4 /45),which was significantly lower than 31.11%(14 /45)in the control group,and there was significant difference(P <0.05).Conclusion It has many advantages such as shorter operative time,faster postoperative recovery,and higher hematoma clearance rate to apply microsurgical operation through lateral fissure-insula lobe approach in the treatment of hypertensive cerebral hemorrhage in basal ganglia region.Besides,it pays attention to protecting cerebral vascular of patients.The clinical treatment effect is ideal and safe.Therefore,it is worth popularizing in clinical application.