Serum Inflammatory Cytokine Levels in Herpes Zoster Patients and Their Association with Postherpetic Neuralgia: A Prospective Study.

BACKGROUND This study aimed to investigate the serum levels of inflammatory cytokines in patients with herpes zoster (HZ) and to assess their correlation with the development of postherpetic neuralgia (PHN). Understanding this relationship may offer insight into the mechanisms of PHN and provide avenues for targeted treatment. MATERIAL AND METHODS We selected 169 patients diagnosed with HZ and 43 healthy controls (HCs) for the study. Serum levels of inflammatory cytokines were measured in all participants. Pain severity was evaluated using the visual analog scale (VAS). Based on follow-up data, the 169 HZ patients were categorized into 2 groups: those who developed PHN (HZ-PHN) and those who did not (HZ-Con). We then analyzed the differences in cytokine levels and their correlation with PHN development. RESULTS Compared to the HCs group, HZ patients exhibited a significant decrease in TNF-a levels and an increase in IL-10 levels (P<0.05, P<0.01). The VAS score was negatively correlated with TNF-alpha levels and positively correlated with IL-10 levels in HZ patients (r=-0.3081, P<0.01; r=0.5619, P<0.01). Distinctive levels of TNF-alpha, IL-6, IL-8, and IL-10 were observed among different pain groups (P<0.05, P<0.01). The HZ-PHN group showed lower TNF-alpha and higher IL-10 levels compared to the HZ-Con group (P<0.05, P<0.01). IL-10 level was identified as an independent risk factor for PHN, with a sensitivity and specificity of 76.4% and 54.3%, respectively. CONCLUSIONS Abnormal levels of inflammatory cytokines are present in HZ patients, and the IL-10 level may serve as a valuable indicator for predicting the risk of developing PHN.

Hippocampal Metabolic Alterations and Cognitive Dysfunction in Varicella Zoster Virus Meningitis: A Single-Center Case Series Study.

BACKGROUND Meningitis has been found to be associated with dementia. Different pathogens of meningitis lead to different cognitive impairments. However, the change of cognitive function and cellular metabolism in the hippocampus in varicella zoster virus (VZV) meningitis has received little attention. We aimed to explore the cognitive function and changes of cellular metabolism in bilateral hippocampal regions in VZV meningitis. MATERIAL AND METHODS We used magnetic resonance spectroscopy to check the cellular metabolism in the bilateral hippocampal region in 23 VZV meningitis patients and 19 controls in our hospital from June 2020 to November 2022. Also, cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) scale, and the correlation between MoCA scores and cellular metabolism in the bilateral hippocampal region was analyzed. RESULTS Six (26.1%) of the 23 patients with VZV meningitis had cognitive decline. Compared with that of the control group, the MoCA scores of VZV meningitis patients was much impaired (25.88±2.31 vs 27.74±1.94, P<0.05), visual-spatial executive function and delayed recall were significantly decreased (P<0.05), and N-acetylaspartate (NAA)/creatine (Cr) ratios in the bilateral hippocampus of patients with VZV meningitis were significantly lower (P<0.05). NAA/Cr ratios in the left and right hippocampus were positively correlated with MoCA scores (r=0.4158, P=0.0385; r=0.5274, P=0.0010, respectively), and negatively correlated with white blood cell count (P<0.01) and protein content in cerebrospinal fluid (P<0.05). CONCLUSIONS Patients with VZV meningitis had cognitive dysfunction and altered cellular metabolism of bilateral hippocampal regions. The main cognitive abnormalities were visual-spatial executive function and delayed recall.

Factors Predictive of Varicella Zoster Virus Encephalitis/Meningitis: A Single-Center, Retrospective Study.

BACKGROUND The outcomes of varicella zoster virus (VZV) encephalitis/meningitis vary from complete recovery to severe complications. This study aimed to investigate the predictive factors of encephalitis and meningitis caused by VZV reactivation. MATERIAL AND METHODS VZV encephalitis/meningitis patients (n=39) who were treated between January 2019 and December 2021 were included. Patients were followed up for 3 months after discharge and divided into a favorable outcome group (FO, n=18; 46.2%) and an unfavorable outcome group (UO, n=21; 53.8%) according to whether it affects quality of life. The clinical data were retrospectively analyzed and compared between groups. RESULTS As compared to the FO group, patients in the UO group were more likely to have higher body temperature (>38°C) at admission, longer interval from onset of CNS symptoms to initial of antiviral therapy, higher white blood cells (WBC) and adenosine deaminase (ADA) in the cerebrospinal fluid (CSF) and higher CRP in the blood (P<0.05 or P<0.01). Univariate logistic regression analysis showed CSF ADA (OR=1.279, 95% CI: 0.996~1.642) and interval from onset of CNS symptoms to initial of antiviral therapy (OR=1.299, 95% CI: 1.011~1.669) were independent risk factors for unfavorable outcomes (P<0.05). The sensitivity and specificity of combined CSF ADA and time interval from onset of CNS symptoms to initial of antiviral therapy were 78.8% and 95.2%, respectively, in predicting outcomes. CONCLUSIONS Higher CSF ADA and longer interval from onset of CNS symptoms to initial of antiviral therapy predict an unfavorable outcome, and the combination of both factors can achieve better performance.

Effects of Endovascular Stent-Assisted Angioplasty on Cellular Metabolism in the Hippocampus of Elderly Patients with Symptomatic Vertebrobasilar Artery Stenosis.

BACKGROUND Cerebral artery stenosis is closely related to cognitive function, and angioplasty can improve the cognitive function of elderly patients with vertebrobasilar artery stenosis. The specific mechanism, however, is not clear. This study explored the effect of angioplasty on cellular metabolism in the hippocampus of elderly patients with symptomatic vertebrobasilar artery stenosis. MATERIAL AND METHODS Eighteen elderly patients with symptomatic vertebrobasilar artery stenosis who underwent endovascular stent-assisted angioplasty (ESAA) in our department were studied. The changes in cellular metabolism (NAA / Cr, CHO / Cr, NAA / CHO) in bilateral hippocampal areas were detected by MRS before and at 6 months and 12 months after the ESAA. The Montreal Cognitive Assessment Scale (MoCA), Hamilton Depression Self-assessment Scale (HAMD), and Hamilton Anxiety Self-assessment Scale (HAMA) were also used to evaluate the cognition, depression, and anxiety of patients at different time points of the study, and analyzed the correlation between the changes of cellular metabolism in the hippocampus and the scores of MoCA, HAMD, and HAMA. RESULTS The levels of NAA/Cr in left/right hippocampal areas were significantly higher at 6 and 12 months after the ESAA than before (1.01±0.17/1.22±0.26 vs. 1.10±0.20/1.05±0.26 vs. 0.82±0.10/0.84±0.11, respectively) (P<0.01). MoCA scores were positively correlated with the levels of NAA/Cr in the left/right hippocampal areas (P<0.05 and P<0.01, respectively). CONCLUSIONS ESAA can improve cognitive function of patients by changing the cellular metabolism of the hippocampus in elderly patients with symptomatic vertebrobasilar artery stenosis.

The effect of Scutellaria baicalensis stem-leaf flavonoids on spatial learning and memory in chronic cerebral ischemia-induced vascular dementia of rats.

Flavonoids have been shown to improve cognitive function and delay the dementia progression. However, the underlying mechanisms remain elusive. In the present study, we examined the effect of Scutellaria baicalensis stem-leaf total flavonoids (SSTFs) extracted from S. baicalensis Georgi on spatial learning and memory in a vascular dementia (VaD) rat model and explored its molecular mechanisms. The VaD rats were developed by permanent bilateral occlusion of the common carotid artery. Seven days after recovery, the VaD rats were treated with either 50 or 100 mg/kg of SSTF for 60 days. The spatial learning and memory was evaluated in the Morris water maze (MWM) test. The tau hyperphosphorylation and the levels of the related protein kinases or phosphatases were examined by western blot analysis. In VaD rats, SSTF treatment at 100 mg/kg significantly reduced the escape latency in training trial in MWM test. In the probe trial, SSTF treatment increased the searching time and travel distance in the target quadrant. SSTF treatment inhibited the tau phosphorylation in both cortex and hippocampus in VaD rats. Meanwhile, SSTF reduced the activity of glycogen synthase kinase 3ß and cyclin-dependent kinase 5 in VaD rats. In contrast, SSTF treatment increased the level of the protein phosphatase 2A subunit B in VaD rats. SSTF treatment significantly improved the spatial cognition in VaD rats. Our results suggest that SSTF may alleviate tau-hyperphosphorylation-induced neurotoxicity through coordinating the activity of kinases and phosphatase after a stroke. SSTF may be developed into promising novel therapeutics for VaD.

Influence of stent-assisted angioplasty on cognitive function and affective disorder in elderly patients with symptomatic vertebrobasilar artery stenosis.

BACKGROUND: We aimed to investigate cognitive function and affective disorder in elderly patients with symptomatic vertebrobasilar artery stenosis (SVAS) after stent-assisted angioplasty (SAA) and to explore the potential mechanism. MATERIAL AND METHODS: The study subjects were 26 elderly SVAS patients who were non-responsive to pharmacotherapy and received SAA (study group) and 30 patients receiving intracoronary stent implantation (control group). Montreal cognitive assessment (MoCA), Hamilton depression rating scale (HAMD), and Hamilton anxiety rating scale (HAMA) were used. RESULTS: The total MoCA score, scores of line connection, copying cube, drawing clock, and delayed recall increased significantly in the study group after surgery (P<0.05, P<0.01). In addition, the MoCA score increased over time and the total MoCA score at 12 months was markedly higher than that at 1 month (P<0.05). The scores of HAMD and HAMA decreased dramatically after surgery compared with before surgery in these patients (P<0.01). A comparison at the corresponding period was performed between study group and control group, and it was found that the differences in total MoCA scores and scores of line connection, copying cube, drawing clock, and delayed recall before surgery and at 1 month after surgery were significant (P<0.05, P<0.01). CONCLUSIONS: SAA may improve the visuospatial/executive abilities and delayed recall, as well as the depression and anxiety in patients with SVAS. Larger and controlled trails are needed to investigate the effect of SAA on cognition and affection in these patients.

Influence of carotid artery stenting on cognition of elderly patients with severe stenosis of the internal carotid artery.

BACKGROUND: The aim of this study was to investigate the influence of carotid artery stenting (CAS) on the cognition and quality of life of elderly patients with severe stenosis of the internal carotid artery. MATERIAL/METHODS: 65 elderly patients with symptomatic severe stenosis of internal carotid artery were recruited into 2 groups: the pharmacotherapy group (n=29) and the CAS group (n=36). Before surgery and 1, 3, 6, and 12 months after surgery, Montreal cognitive assessment (MoCA) was used for the evaluation of cognition and WHOQOL-BREF was used for the assessment of quality of life. RESULTS: At 12 months after surgery, total MoCA score and WHOQOL-BREF score in the pharmacotherapy group was significantly reduced when compared with those before surgery (P<0.05). In the CAS group, the total MoCA score, scores of attention and delayed recall, and WHOQOL-BREF score increased significantly at different time points after surgery when compared with those before surgery (P<0.05). Moreover, in CAS group, the MoCA score and WHOQOL-BREF markedly increased gradually over time (P<0.05). Compared with the pharmacotherapy group, cognition and quality of life in the CAS group were improved dramatically during the follow-up period (P<0.05). CONCLUSIONS: Severe stenosis of the internal carotid artery is a cause of cognition impairment, and CAS may improve cognition and quality of life.

Effects of mind-regulating acupuncture on pain, negative emotion and sleep quality in patients with postherpetic neuralgia： a randomized controlled pilot trial. / è°ƒç¥žé’ˆæ³•å¯¹å¸¦çŠ¶ç–±ç–¹åŽé—ç¥žç»ç—›æ‚£è€ ç–¼ç—›ç¨‹åº¦ã€è´Ÿæ€§æƒ ç»ªå’Œç¡çœ è´¨é‡çš„å½±å“.

OBJECTIVES: To observe the effect of mind-regulating acupuncture on pain intensity, sleep quality, negative emotion in patients with postherpetic neuralgia (PHN), and evaluate the clinical effect of mind-regulating acupuncture combined with surrounding needling and heavy moxibustion at Ashi points (Extra) in treatment of PHN. METHODS: The patients with PHN were randomly divided into a control group (35 cases, 2 cases dropped out) and a comprehensive therapy group (35 cases). The patients in the control group were treated with surrounding needling and heavy moxibustion at Ashi points. In the comprehensive therapy group, the mind-regulating acupuncture therapy was delivered besides the treatment as the control group. The treatment was given once daily, one course of treatment was composed of 6 days and 2 courses were required in the 2 groups. Before and after treatment, the pain conditions were assessed using pain rating index (PRI), visual analogue scale (VAS) and present pain intensity (PPI), the negative emotions were assessed using Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD), and the sleep quality with Pittsburgh sleep quality index (PSQI). One week before and one week after treatment, the average sleep time was recorded. The therapeutic effect of 2 groups was evaluated. The effective cases of 2 groups were followed up in 2 months after treatment completion and the recurrence of neuralgia was recorded. RESULTS: There were no statistical differences in the above indicators between the 2 groups before treatment. After 2 courses of treatment, the scores of PRI, VAS, PPI, HAMA, HAMD and PSQI were reduced when compared with those before treatment in the patients of the 2 groups (P<0.05), and the average sleep time was increased (P<0.05). The scores of PRI, VAS, PPI, HAMA, HAMD and PSQI in the comprehensive therapy group, as well as the average sleep time were all improved when compared with those of the control group (P<0.05). The total effective rate in the comprehensive therapy group (34/35, 97.14%) was higher than that of the control group (27/33, 81.82%, P<0.05) and the recurrence rate was lower (ï¼»2/34, 5.88%ï¼½vsï¼»8/27, 29.63%ï¼½, P<0.05). CONCLUSIONS: The combination of mind-regulating acupuncture with surrounding needling and heavy moxibustion at Ashi acupoint can effectively relieve PHN. Compared with the traditional surrounding acupuncture in pain area combined with moxibustion at Ashi points, this comprehensive therapy is more effective for ameliorating pain intensity, improving sleep quality and reducing negative emotions. It is also effective for declining the recurrence.

Immune changes and their relationship with prognosis in patients with varicella-zoster virus encephalitis/meningitis.

OBJECTIVES: This study aimed to investigate the immune changes in patients with varicella-zoster virus (VZV) encephalitis/meningitis and explored their relationships with prognosis. METHODS: A total of 129 patients with herpes zoster (HZ), 32 patients with VZV encephalitis/meningitis and 31 non-HZ and non-VZV people as healthy controls were included into the present study. The numbers of peripheral T lymphocytes and the serum levels of complements 3 (C3), complements 4 (C4) and immunoglobulin A (IgA), immunoglobulin G (IgG), and immunoglobulin M (IgM) were detected and compared among groups. In 32 patients with VZV encephalitis/meningitis, the immune related variables were compared between the favorable and the unfavorable prognosis group and their relationships with prognosis were further evaluated. RESULTS: There were marked differences in the peripheral CD3+, CD4+ and CD8+ cells and CD4+/CD8+ ratio in the three groups (P<0.05). As compared with HZ and control groups, the peripheral CD3+ and CD4+ cells were reduced dramatically in patients with VZV encephalitis/meningitis (P<0.05). In 32 patients with VZV encephalitis/meningitis, the absolute CD3+ and CD4+ cells in patients with favorable prognosis were significantly higher than in patients with unfavorable prognosis (P<0.05), and they were positively related to the prognosis of these patients (r=0.3852, P=0.0295; r=0.3719, P=0.0361). CONCLUSION: These immune changes were compromised in VZV encephalitis/meningitis. The peripheral CD3+ and CD4+ levels may be employed to predict prognosis.

Cerebrospinal fluid proteomics in meningitis patients with reactivated varicella zoster virus.

OBJECTIVE: This study investigated the proteomic characteristics of cerebrospinal fluid (CSF) in patients with varicella zoster virus (VZV) meningitis to understanding the pathogenesis of central nervous system (CNS) infection by reactivated VZV. METHOD: We used data-independent acquisition model to analyze the CSF proteomic differences of 28 patients with VZV meningitis and 11 herpes zoster (HZ) patients. According to the clinical manifestations at discharge, 28 VZV meningitis patients were divided into favorable outcome group and unfavorable outcome (UO) group and their differences in CSF proteome were also analyzed. RESULTS: Compared with the HZ group, the proteins (CXCL10, ELANE, IL-1RN, MPO, PRTN3, etc.) related to inflammation and immune cell activation were significantly upregulated in the VZV meningitis group (p < .01). The protein related to the nerve function and energy metabolism (CKMT1B, SLITRK3, Synaptotagmin-3, KIF5B, etc.) were significantly downregulated (p < .05). The levels of a pro-inflammatory factor, IL-18, in CSF were significantly higher in patients in the UO group as compared to patients with favorable prognosis (p < .05). CONCLUSION: Inflammatory immune response is an important pathophysiological mechanism of CNS infection by VZV, and the CSF IL-18 levels might be a potential prognostic indicator of the outcomes of VZV meningitis.

[Efficacy of Maixuekang capsule on reconvalescents of cerebral infarction and its impact on coagulation function].

OBJECTIVE: To observe the clinical efficacy of Maixuekang capsule in reconvalescents of cerebral infarction and its impact on coagulation function. METHOD: One hundred and twenty cases of reconvalescents of cerebral infarction were randomly divided into treatment and control groups. The 50 cases in the control group were provided with conventional therapy, while the 70 cases in the treatment group were provided with the combination of conventional therapy and Maixuekang capsule for 3 months. Their neurological function and prothrombin time (PT), activated partial thromboplastin time (APTT) clotting enzyme time (TT), fibrinogen (Fib) were measured before and after treatment. RESULT: After the treatment, PT, APTT and TT were prolonged compared with those before the treatment in the treatment group (P<0.05), whereas Fib, neurological deficit scores decreased (P<0.01) and significantly different from the control group (P<0.05). CONCLUSION: Maixuekang capsule is among safe and effective drugs in treatment of reconvalescents of cerebral infarction, and can improve the patient's coagulation state.

Cellular metabolism changes in bilateral hippocampi in patients with herpes zoster.

OBJECTIVES: Herpes zoster (HZ) has been found to be associated with arisk of developing dementia. However, changes of cellular metabolism in the hippocampus in HZ have received little attention. This study aimed to investigate the cellular metabolism changes in bilateral hippocampi in acute HZ. METHODS: 1H-MRS (magnetic resonance spectroscopy) was used to detect the cellular metabolism of bilateral hippocampi in 62 patients with acute HZ and 12 volunteers (control group) from July 2020 to December 2021. Mini-Mental State Examination (MMSE), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) and Numerical Rating Scale (NRS) were used to evaluate their cognitive function, depression, anxiety and pain intensity, as well as a the correlation between them. RESULTS: The MMSE score in patients with HZ was not significantly different from that of controls (P>0.05), while the scores of HAMD and HAMA were significantly higher (P<0.05) than those of controls. Also 12.9% and 21.0% of the patients with acute HZ had depression and anxiety disorders, respectively. The level of Cho/Cr in the left/right hippocampi of HZ patients was significantly lower than that of the control group (P<0.05). The level of Cho/Cr in the right hippocampus, duration of disease and NRS score in HZ patients with anxiety/depression were significantly higher than those without anxiety/depression, but the level of NAA/Cr in the right hippocampus was lower (P<0.05). The NRS score and duration of disease in HZ patients were positively correlated with the scores of HAMD and HAMA. CONCLUSION: The cellular metabolism of bilateral hippocampi in patients with acute HZ is altered. Those with longer duration of disease and severe pain are more likely to have depression and anxiety disorder, and the changes in cellular metabolism of hippocampi in those with depression and anxiety were more prominent.

Meningitis/meningoencephalitis caused by varicella zoster virus reactivation: a retrospective single-center case series study.

Recent clinical studies showed that central nervous system (CNS) infection caused by varicella zoster virus (VZV) reactivation was more than previously reported. The clinical manifestations were often diverse and complex, and the outcome often varied among different patients. A systematic study is needed to provide clinical characteristics of the CNS VZV infection to help clinicians with clinical diagnosis and management. Toward that end, we retrospectively analyzed the clinical presentations, laboratory results, imaging findings, treatment and outcomes in74 patients with meningitis or meningoencephalitis caused by VZV reactivation in our center from August 2018 to December 2020. Fever, headache, cranial nerve involvement, cognitive changes, meningeal irritation, nausea, vomiting, and Ramsay-Hunt syndrome (RHS) were the most common clinical manifestations of VZV meningitis or meningoencephalitis. Brain MRI analysis showed no obvious abnormal manifestation. Compared to VZV meningoencephalitis, patients with VZV meningitis were younger (56.9±13.8 vs 66.1±8.5 years; P=0.01), and more likely to develope in winter (P=0.04), had lower cerebrospinal fluid (CSF) glucose content (3.68±0.79 vs 4.21±0.94 mmol/L, P=0.02), and a better outcome at discharge (P=0.00). The outcome at discharge was worse in male patients and when longer than 1.5 days passed between onset of the neurological symptoms to initiation of the antiviral treatment.Early intravenous antiviral treatment for VZV meningitis and meningoencephalitis is important and is expected for a good outcome.

CXCL13 concentration in latent syphilis patients with treatment failure.

We aimed to investigate the CXCL13 concentration of the serum and cerebral spinal fluid (CSF) in human immunodeficiency virus (HIV)-negative latent syphilis patients with treatment failure and explore the change in CXCL13 after treatment. Sixty-eight latent syphilis patients with treatment failure (failure group), 68 syphilis patients with successful treatment (seroconversion group) and 18 patients with non-inflammatory diseases of the nervous system (control group) were included and serum and CSF were collected. Enzyme-linked immunosorbent assay was employed to detect the CXCL13 in the serum and CSF. Results showed that the serum CXCL13 concentration was comparable among three groups, and the CSF leukocyte count, IgG index and CXCL13 concentration in the failure group were significantly higher than those in the seroconversion group and control group (P < 0.05, P < 0.01). CSF CXCL13 concentration in the failure group was positively related to the CSF leukocyte count (r = 0.3594, P < 0.001). Of the 68 patients in the treatment failure group, neurosyphilis was found in 17 (25.0%). In conclusion, involvement of nervous system is one of the reasons for the treatment failure in patients with latent syphilis. Detection of CSF CXCL13 concentration is helpful for the diagnosis and therapeutic evaluation of HIV-negative latent syphilis patients with treatment failure and neurosyphilis.

MicRNA-320 facilitates the brain parenchyma injury via regulating IGF-1 during cerebral I/R injury in mice.

PURPOSE: To investigate the protective effects of miR-320 on cerebral ischemia/reperfusion (I/R) injury in mice and PC12 cells. METHODS: miR-320 normal control (NC), inhibitor fragment and overexpression fragments were injected into mice lateral ventricles. Thereafter, the middle cerebral artery occlusion (MCAO) for left cerebrum method was employed in order to establish a cerebral I/R injury mice model. Apoptosis in the peripheral region of cerebral infarction and the volume of cerebral infarction and brain edema were tested as well. For simulating MCAO in vitro, the PC12 cells were subjected to oxygen-glucose deprivation. The lentivirus transfection technique was used to overexpress or inhibit miR-320. Furthermore, the effects of miR-320 on the survival and apoptosis of PC12 were monitored by MTT and TUNEL detection. RESULTS: A cerebral I/R injury mice model was successfully established. MiR-320 enhanced cell apoptosis of the injury side cortical infarcted peripheral zone and increased brain infarction volume and edema volume in MCAO/R mice. In addition, Insulin growth factor-1 (IGF-1) mRNA and protein expressions in MCAO/R mice were inhibited by miR-320 as well. Moreover, the results of cell studies were consist with the animal studies. CONCLUSIONS: miR-320 may be involved in the regulation of cerebral I/R for brain parenchyma injury by inhibition of IGF-1 pathway.

Seven years' follow-up of comparative study between stenting and medication for treatment of symptomatic vertebrobasilar artery stenosis.

Objective Endovascular stent-assistant angioplasty (ESAA) is a valid treatment for symptomatic vertebrobasilar artery stenosis (SVAS), but the long-term effect and the improvement of condition compared with medication treatment are unknown. This study investigated the long-term efficacy of ESAA in patients with moderate and severe SVAS, and compared the efficacy with medication treatment. Materials and methods We conducted a retrospective analysis of clinical data of 43 patients with moderate and severe SVAS hospitalized in our department. According to different treatment methods they were divided into 29 cases in an ESAA group and 14 cases in a medication treatment group. During the follow-up period, the degree of vascular stenosis, vascular blood flow velocity, restenosis rate, recovery of neurological function and the incidence of cerebral ischemic events in the two groups were analyzed. Results The average clinical follow-up period was 89.4 ± 10.2 months. Before treatment, the stenosis rate and average blood flow velocity of the two groups were not statistically significant ( p > 0.05). During the follow-up period, both were significantly lower than the medication treatment group ( p < 0.01). In the ESAA group, three cases of stent stenosis, and three cases in the medication treatment group were completely occluded. The total ischemic events in ESAA group were three cases, compared with nine cases in the medication treatment group; the difference was statistically significant ( p < 0.05). Conclusion ESAA has a long-term effect in the treatment of symptomatic moderate and severe vertebrobasilar artery stenosis. It is superior to medication therapy in preventing posterior circulation ischemia (PCI), but a larger sample size is still needed to confirm the study.

[Clinical study of combined treatment with compound Reinhartdt and Sea Cumber Capsule and donepezil for vascular dementia].

OBJECTIVE: To study the efficacy and safety of the combined treatment with compound Reinhartdt and Sea Cumber Capsule (RSC, a Chinese medicinal preparation consisted mainly of Reinhartdt and Sea Cumber) and Donepezil for vascular dementia (VD), and its effect on thyroid function axis. METHODS: Sixty-three patients with VD were treated respectively with RSC, Donepezil and the combined treatment. MMSE, ADAS-Cog and ADL scales were used to evaluate the condition of patients before treatment as well as at 3 months and 6 months after treatment. Meanwhile, levels of thyroid hormones, including (TSH, FT3, FT4, TT3, TT4) were measured with radioimmunoassay. RESULTS: As compared with the baseline, MMSE score increased, ADAS-Cog score and ADL score decreased significantly in all the three groups after 3 months and 6 months of treatment (P <0.05, P<0.01), the improvement in the Donepezil group was more significant than that in the RSC group after 6 months of treatment (P < 0.05), but the combined treatment group showed the best efficacy (P < 0.01). After 3 months of treament, the levels of FT3 and FT4 in the combined treatment group increased, but showed no statistical significance (P >0.05). However, significant changes were found at 6 months after combined treatment (P < 0.01). No significant changes were seen at all in levels of TSH, TT3 and TT4 (P > 0.05). FT3, FT4 increased without statistical significance after 6 months Donepezil treatment, TSH, TT3 and TT4 also showed no significant difference in the Donepezil group and no other significant changes of thyroid hormones was seen in patients treated with RSC (P > 0.05). No obvious adverse reaction occurred in any of the three groups. CONCLUSION: Combined treatment of RSC and Donepezil was effective and safe on VD patient, with the efficacy much better than either of them alone. No significant adverse reaction was observed. The regulation on thyroid hormones may one of the mechanisms of the combined treatment in improving cognitive function.

[Clinical study of Reinhartdt and sea cucumber capsule combined with donepezil in treating Alzheimer's disease].

OBJECTIVE: To study the efficacy and safety of Reinhartdt and sea cucumber capsule (RSC) combined with donepezil in treating Alzheimer's disease (AD), and its effect on thyroid function axis. METHODS: Sixty-eight patients were randomly assigned to the RSC group, the Donepezil group and the combined treatment group, who were treated for 3 and 6 months with RSC, Donepezil and RSC combined with Donepezil, respectively. The curative effect was evaluated by scoring according to Mini-Mental State Examination (MMSE), ADAS-Cog and ADL chart, and the level of thyroid hormones, including TSH, FT3, FT4, TT3 and TT4, were measured with radioimmunoassay before treatment, 3 and 6 months after treatment respectively. RESULTS: As compared with the baseline, MMSE score increased, ADAS-Cog score and ADL score decreased significantly in all the three groups after 3 months and 6 months of treatment (P < 0.05 and P < 0.01), but the improvement in the combined treatment group was more significant than that in the other two groups (P < 0.01). After 6 months of treatment, the levels of FT3 and FT4 in the combined treatment group were significantly changed (P < 0.01), but no significant change in all the thyroid hormones was found in the other two groups. No obvious adverse reaction occurred in all the three groups. CONCLUSION: RSC combined with Donepezil in treating AD is effective and safe with no evident adverse reaction, better than single drug treatment, which may be through influencing the metabolism of thyroid hormones to improve the cognition function of AD patients.

CXCL13 and TH1/Th2 cytokines in the serum and cerebrospinal fluid of neurosyphilis patients.

Neurosyphilis is a chronic infectious disease with involvement of central nervous system infection by Treponema pallidum. This study was to investigate the contents of B lymphocyte chemokine 1 (BLC-1/chemokine [C-X-C motif] ligand 13), Th1 cytokines (Interleukin [IL]-2, IL-12, and Interferon [IFN]-γ), and Th2 cytokines (IL-6 and IL-10) in serum and cerebrospinal fluid (CSF) of HIV-negative patients with neurosyphilis before and after treatment, aiming to elucidate roles of CXCL13 and Th1/Th2 cytokines in immune response to and pathogenesis of neurosyphilis.Enzyme-linked immunosorbent assay was employed to detect the contents of CXCL13, IL-2, IL-12, IFN-γ, IL-6, and IL-10 in serum and CSF of 47 HIV-negative patients with neurosyphilis, 36 syphilis patients without neurological involvement and 23 controls (noninfectious intracranial disease) before, 3 and 12 months after treatment with high dose penicillin.Results showed that there was no significant difference in blood CXCL13 content among 3 groups (P > .05); CSF CXCL13 content in neurosyphilis patients was significantly higher than in other 2 groups (P < .001), and positively related to leucocyte count, protein concentration, and IgG index. IL-6 and IL-10 contents of the serum and CSF in neurosyphilis patients were markedly higher than in other 2 groups (P < .05 or .01), but IL-2, IL-12, and IFN-γ of the serum and CSF were significantly lower than in other 2 groups (P < .05 or .01). The IL-6, IL-10, IL-2, IL-12, and IFN-γ contents of the serum and CSF were comparable between control group and syphilis group (P > .05). CSF CXCL13 content was positively related with IL-6 and IL-10 content, while negatively related to IL-12 content in neurosyphilis patients. CSF IL-6 content was negatively related with IL-12 content. In neurosyphilis patients, the CSF CXCL13 content reduced significantly at 3 and 12 months (P < .001), the CSF IL-2 and IL-12 contents increased significantly at 12 months, and CSF IL-6 contents reduced significantly at 12 months after treatment (P < .05 or .01).It is concluded that neurosyphilis patients did not have normal immune function. CXCL13 and Th1/Th2 cytokines are involved in the immune response of neurosyphilis patients. CSF CXCL13 and Th1/Th2 cytokines contents may be used for the diagnosis and evaluation of therapeutic efficacy of neurosyphilis.

Glutamatergic and central cholinergic dysfunction in the CA1, CA2 and CA3 fields on spatial learning and memory in chronic cerebral ischemia-Induced vascular dementia of rats.

Chronic cerebral ischemia (CCI) is associated with cognitive decline in aging, vascular dementia and Alzheimer's disease. Substantial evidence has shown that chronic cerebral ischemia may cause cognitive impairment, but the underlying neurobiological mechanism is poorly understood so far. In the present study, we used a rat model of chronic cerebral ischemia by permanent bilateral common carotid artery occlusion (BCCAO) to investigate the alterations of glutamatergic and central cholinergic dysfunction, and their causal relationship with the cognitive deficits induced by chronic cerebral ischemia. We found that BCCAO rats exhibited spatial learning and memory impairments dysfunction 3 month after BCCAO. Meanwhile, vGluT levels as well as glutamatergic and central cholinergic positive neurons in the hippocampus CA1-3 field significantly decreased. The protection of glutamergic and cholinergic neurons or regulating glutamate and central cholinergic levels in hippocampal subregion may have beneficial effects on cognitive impairments associated with the possible mechanism in CCI-induced vascular dementia.