To analyze the evolution of white matter microstructural integrity in acute ischemic stroke (AIS) patients with impaired cognitive functions using diffusion tensor imaging (DTI) and post-processing method based on tract based spatial statistics (TBSS), and to explore imaging biomarkers for early prediction of post-stroke cognitive impairment (PSCI).
Methods
A prospective study was conducted on 55 patients with cognitive impairment within 3 d after AIS who were hospitalized or followed up in the Neurology Department of Wusong Branch, Zhongshan Hospital Affiliated to Fudan University from August 2021 to April 2023.DTI scans and cognitive assessments were performed on all patients before and 6 months after treatment.According to the cognitive scores after 6 months, patients were divided into PSCI group and post-stroke non-cognitive impairment (N-PSCI)group.By TBSS,horizontally analyzed the differences in fractional anisotropy (FA) and mean diffusivity (MD) between two groups, and vertically analyzed the changes in FA and MD values before and 6 months after treatment within the group.
Results
Among the 55 patients, 4 patients lost contact, 3 patients refused further participation,and 1 patient died,47 patients were enrolled,including 22 in the PSCI group and 25 in the N-PSCI group.Compared with baseline, cognitive performance improved in 33 patients and remained unchanged in 14 patients after 6 months of treatment.Horizontal analysis between groups showed that the FA value of right superior longitudinal fasciculus (SLF) in the PSCI group was lower than that in the N-PSCI group before treatment, and the difference was statistically significant (P＜0.05).Longitudinal analysis showed that the dispersion of multiple white matter tracts (SLF, anterior thalamic radiation, corticospinal tract, etc.)recorded after 6 months of treatment worsened than those recorded before treatment in both groups with statistically significant (P＜0.05).
Conclusion
Patients with baseline impaired cognitive functions still have white matter microstructural damages at 6 months, even if their cognitive function has improved or returned to normal, which may have a negative impact on long-term cognition.The change of FA value of the right SLF fiber bundle has a certain predictive effect on the occurrence of PSCI.
To explore the relationship between serum levels of soluble T cell immunoglobulin and mucin domain-3 (sTIM-3), and its ligand Galectin-9 (Gal-9) and carcinoembryonic antigen-related cell adhesion molecule-1 (CEACAM-1) in patients with traumatic brain injury (TBI) and the degree of brain injury and prognosis.
Methods
A total of 120 patients with TBI admitted to the Third Department of Neurosurgery of Handan Central Hospital from February 2022 to February 2023 were selected as the observation group, and 120 healthy subjects who underwent physical examination during the same period were selected as the control group.The levels of sTIM-3, Gal-9 and CEACAM-1 were compared between the two groups.The TBI patients were graded according to the preoperative GCS score (severe type, moderate type and mild type), and the differences of serum sTIM-3, Gal-9 and CEACAM-1 levels in patients with different TBI degrees were explored.After 1 month of treatment, the prognosis of TBI patients was evaluated according to the GOS score.Univariate and multivariate Logistic regression analysis was used to analyze the influencing factors of poor prognosis in TBI patients.The receiver operating characteristic (ROC) curve was used to analyze the predictive value of the influencing factors on the prognosis of TBI patients.
Results
In the observation group, there were 36 cases of severe type, 42 cases of moderate type and 42 cases of mild type.Compared with the control group, the levels of sTIM-3, Gal-9 and CEACAM-1 in the observation group increased, and the expression level increased with the increase of TBI degree, the differences were statistically significant (P＜0.05).After 1 month of treatment, 76 cases had good prognosis and 44 cases had poor prognosis.Univariate analysis showed that the levels of serum sTIM-3,Gal-9,CEACAM-1 and GCS score in patients with poor prognosis were higher than those in patients with good prognosis (P＜0.05).Multivariate Logistic regression analysis showed that sTIM-3, Gal-9, CEACAM-1 and GCS score were independent factors affecting the prognosis of TBI patients (P＜0.05).ROC analysis showed that the area under the curve (95%CI) of serum sTIM-3,Gal-9, CEACAM-1 and GCS score alone and in combination were 0.744, 0.706, 0.697, 0.739 and 0.823(0.724-0.921), respectively, the diagnostic efficiency of combined application was higher than that of each index alone (P＜0.05).
Conclusion
Serum sTIM-3 and its ligands Gal-9 and CEACAM-1 can be used as new and meaningful molecular markers to evaluate the severity and prognosis of TBI patients.
To investigate the clinical application of homocysteine(Hcy)and Alzheimerassociated neuronal thread protein (AD7c-NTP) in the diagnosis of Alzheimer's disease (AD) patients.
Methods
Eighty-two AD patients diagnosed and treated in Neurology Department of Pangang Group General Hospital from September 2021 to July 2022 were selected as the study group, and 82 healthy volunteers during the same period were selected as the control group.AD patients of the study group were divided into mild group (51 cases) and moderate to severe group (31 cases) according to the degree of cognitive impairment.The levels of plasma Hcy and urine AD7c-NTP were compared between the study group and the control group, as well as between the mild and moderate to severe groups.The binary Logistic regression analysis and receiver operating characteristic (ROC) curve were used to study the diagnostic value of plasma Hcy, urine AD7c-NTP, and their combination for AD.
Results
The plasma Hcy and urine AD7c-NTP levels in the study group were significantly higher than those in the control group (P＜0.05).The plasma Hcy and urine AD7c-NTP levels in the mild group were significantly lower than those in the moderate to severe group (P＜0.05).The ROC curve analysis showed that the area under the curve for diagnosing AD with plasma Hcy,urine AD7c-NTP,and their combination were 0.812,0.803,and 0.867, respectively; the optimal critical values were 19.5 μmol/L, 1.545 ng/mL, and 43.426,respectively;the Jordan index was 0.549,0.463,and 0.597,respectively.The sensitivity and specificity at the optimal critical points were 54.9%and 100.0%for Hcy,96.3%and 50.0%for AD7c-NTP,and 84.1%and 75.6%for the combination of the two.
Conclusion
The expression of plasma Hcy and urine AD7c-NTP is high in AD patients, and the more severe the cognitive impairment of AD patients, the higher the expression of plasma Hcy and urine AD7c-NTP; The combination of plasma Hcy and urine AD7c-NTP has high diagnostic value for AD.
To analyze the risk factors associated with 30-day mortality in patients with primary brainstem hemorrhage (PBSH).
Methods
A retrospective analysis was performed on the clinical data of 101 patients with PBSH who were admitted to the Neurosurgery Department of Rizhao People’s Hospital from June 2019 to December 2023, including gender, age, medical history, blood glucose levels, body mass index (BMI), GCS score at admission, volume of blood clot, surgical interventions undertaken,maximum transverse diameter of the blood clot on CT imaging,and instances of intracranial hemorrhage.According to whether the patients died within hospitalization and 30-day after discharge, all patients were divided into survival group and death group.The risk factors associated with 30-day mortality were evaluated using Kaplan-Meier survival curves and Cox regression analysis.
Results
Among the 101 patients, 66 (65.4%) were in the survival group and 35 (34.6%) were in the death group.The proportion of patients with admission GCS score＜8 scores, total hematoma volume≥5 mL, concomitant intraventricular hemorrhage, and the longest diameter of haematoma transected at the level of the largest CT dimension≥2.6 cm between the two groups showed statistically significant differences (P＜0.05).Cox’s multifactorial regression analysis showed that the longest diameter of haematoma transected at the level of the largest CT dimension≥2.6 cm(HR=3.37,95%CI:1.10-10.37,P=0.034), and GCS score ＜8 scores (HR=20.18, 95%CI: 2.53-160.80, P=0.005) were independent risk factors affecting the 30-day mortality of patients with PBSH.
Conclusion
The 30-day mortality rate was significantly higher in PBSH patients with lower GCS scores at admission and a longer maximal transverse diameter at the largest hematoma level on CT.The critical role of these two indicators in prognostic evaluation should be emphasized in clinical practice.
To investigate the feasibility of conducting clinical research on electroacupuncture treatment for Alzheimer's disease (AD).
Methods
From July to November 2021, 19 AD patients recruited and included in the Acupuncture and Moxibustion Encephalopathy Clinic,Geriatrics Clinic of Guang'anmen Hospital of China Academy of Chinese Medical Sciences, Neurology Clinic of Xuanwu Hospital Capital Medical University and Guang'anmen Hospital of Chinese Academy of Traditional Chinese Medicine through posters, advertisements, multimedia platforms and other means were selected as research subjects for a randomized controlled study.All subjects were randomly divided into an electroacupuncture group(10 cases)and a sham electroacupuncture group(9 cases)using a simple randomization method.After 12 weeks of treatment, the proportion of participants recruited through different methods, recruitment qualification rate, and compliance were analyzed, and the preliminary clinical efficacy of electroacupuncture treatment for AD was observed.
Results
The recruitment ratios for special clinics, hospital platform public accounts, general expert clinics and advertising page were 36.8%, 21.1%, 31.6%, 10.5% respectively.The recruitment qualification rate was 28.8%.The treatment compliance in both groups was high at 85.1%.After 12 weeks of treatment, there was no statistically significant difference between the two groups of patients in terms of the difference between the Alzheimer's disease assessment scale-cognition score, neuropsychiatric inventory score, nurse distress score, and clinician's interview based impression of change score and baseline (P＞0.05); the difference between activity of daily living score and baseline in the electroacupuncture group was lower than that in the sham electroacupuncture group, and the difference was statistically significant (P＜0.05).
Conclusion
Conducting large-scale, long-term clinical studies on electroacupuncture as a potential treatment for patients with AD is feasible.
To evaluate the therapeutic efficacy and safety of combined caudal part of the zona incerta (cZI)-deep brain stimulation (DBS) with ventral intermediate nucleus (Vim)-DBS for the treatment of essential tremor(ET).
Methods
A retrospective analysis of 11 patients with ET treated with dual-target DBS at Neurosurgery Department of Shengli Oilfield Central Hospital from January 2020 to June 2023 were conducted.Postoperatively, all patients underwent immediate cranial CT to confirm electrode placement and to rule out complications such as cerebral hemorrhage and infarction.The Fahn-Tolosa-Marin tremor rating scale(FTMTRS)was used to assess motor symptoms preoperatively,on the day of device activation, and at 1, 3, 6, and 12 months post-activation to calculate the rate of symptom improvement and to evaluate the effectiveness of the treatment.Additionally, adverse reactions related to stimulation to assess the safety of the treatment were recorded.
Results
All 11 patients (2 with unilateral and 9 with bilateral treatment) successfully completed the dual-target DBS procedure.Cranial CT scans showed that the electrode positions matched the preoperative planned targets, and all patients experienced a significant microlesion effect postoperatively.The median follow-up time was 26 months(ranging from 12 to 42 months), with no observed complications such as infarction, hemorrhage, infection,allergy, or rejection.At one month postoperatively, during the initial device activation, patients selected monopolar stimulation at contacts in the cZI nucleus, with 2 patients adjusting contacts to the Vim target during follow-up.Tremor symptoms in all patients showed significant improvement postoperatively, with improvement rates on the day of activation and at 1, 3, 6, and 12 months post-activation being 70.21%,61.34%, 67.28%, 72.04%, and 75.04%, respectively.Post - activation, adverse reactions included dysarthria in 1 case, ataxia in 2 cases, transient limb numbness in 3 cases, and lower limb weakness in 4 cases,all of which were resolved or tolerated after adjusting the contact points or parameters.
Conclusion
cZI-DBS can effectively improve the clinical symptoms of patients with ET.The combined use with Vim-DBS enhances the flexibility of programming and reduces the risk of a second surgery for electrode reimplantation.Moreover, the procedure has fewer surgical complications, demonstrating good safety and feasibility.
Neuropathic pain (NP) is a common chronic pain that seriously threatens the physical and mental health of patients,and there is currently no effective therapy.Bone marrow mesenchymal stem cells (BMSCs) can alleviate NP by inhibiting inflammation, immune regulation, neuroprotection, and suppressing glial cell activation, but the specific mechanism is still unclear.This article mainly explores the mechanism of BMSCs on NP,in order to provide new ideas for the prevention and treatment of NP.
Parkinson's disease (PD) is the second most common neurodegenerative disease after Alzheimer's disease.It is clinically characterized by bradykinesia, resting tremor, muscle rigidity, and changes in posture and gait.Gait changes can occur early in the disease,so gait analysis in PD is of great value in diagnosis, treatment, and rehabilitation.This article provides an overview of the application of gait analysis methods in the early diagnosis, treatment, and rehabilitation of PD in order to explore the potential value and development prospects of gait analysis in clinical practice.
Multiple system atrophy (MSA) is a type of atypical Parkinson's syndrome with rapid progression and poor prognosis.It brings a heavy burden to individuals, families and society.At present,symptomatic treatment is mainly adopted, but the results are not promising.In recent years, neural regulation technology has shown great potential in neurodegenerative diseases.This article mainly reviews the preliminary evidence and possibility of applying neural regulation technology to MSA treatment.
Alzheimer's disease (AD) is the most common cause of dementia.Early diagnosis is very important for improving the condition and delaying the progression of AD.However, the current clinical diagnosis requires invasive cerebrospinal fluid detection or expensive amyloid β (Aβ)/Tau-PET examination, which limits the clinical popularization.In recent years, with the application of hypersensitive detection techniques, it has been found that the concentrations of amyloid and phosphorylated Tau in blood correlate well with those in cerebrospinal fluid and the Aβ/Tau-PET scan results.In addition, blood biomarkers of neurodegeneration, such as neurofilament light chains and glial fibrillary acidic protein,can reflect early pathological damage in AD,which can be used to predict disease progression and monitor treatment response.Therefore, this article reviews the research progress of blood biomarkers for AD, in order to improve the understanding of blood biomarkers in the diagnosis and treatment of AD,and provide guidance for their application in the early diagnosis of AD.
