A resting-state functional magnetic resonance imaging study of functional connectivity in patients with leukoaraiosis / 中华行为医学与脑科学杂志

Objective:To investigate the alterations of brain resting-state functional connectivity in patients with leukoaraiosis(LA), and to explore its neuropathological mechanism of cognitive dysfunction.Methods:From August 2022 to February 2023, 28 patients with LA(LA group) and 30 gender, age and education level matched normal controls(NC group) in Jiangsu Shengze Hospital affiliated to Nanjing Medical University were prospectively recruited.Mini mental state examination, trail-making test, and Stroop color-word test were used to evaluate the cognitive function of participants, rs-fMRI images were processed by DPABI V6.1 based on MATLAB R2022a.Voxel-mirrored homotopic connectivity(VMHC) values were calculated and two-sample t test were performed to compare the differences in local brain activity between the two groups.The brain regions with significant differences were selected as the seeds to calculate the functional connectivity(FC) values of the whole brain, and Pearson correlation analyses were performed to evaluate the correlation between the FC values and neuropsychological scores. Results:The VMHC values of the calcarine fissure and surrounding cortex(CAL) (x=±18, y=-63, z=15), postcentral gyrus(PoCG) (x=±39, y=-27, z=48), lingual gyrus(LING) (x=±12, y=-51, z=-6), middle occipital gyrus(x=±27, y=-75, z=24) and insula(x=±36, y=6, z=3) in the LA group were lower than those in the NC group( P<0.05). The seed points FC results showed, FC values between right CAL(CAL.R) and bilateral precuneus(PCUN), right dorsolateral prefrontal cortex(DLPFC.R) and right temporal_mid were reduced in the LA group( P<0.05); FC values between PoCG.R and left CAL, left temporal_mid and right LING were reduced too( P<0.05). Additionally, the FC value in the LA group between CAL.R and DLPFC.R was negatively correlated with the Stroop C score( r=-0.39, P<0.05). The FC value in LA group and NC group between CAL.R and DLPFC.R was negatively correlated with the Stroop C score( r=-0.48, P<0.001)and also negatively correlated with the trail making test B(TMT-B) score( r=-0.40, P<0.01), and the FC value between CAL.R and PCUN.L was negatively correlated with the TMT-B score( r=-0.45, P<0.001). Conclusion:Desynchronized interhemispheric functional connectivity and abnormal cortical circuit functional connectivity were probably associated with the underlying neural mechanisms of cognitive impairment in LA.

The effects of butylphthalide soft capsule on the expression of uric acid and the pathological changes of white matter in patients with moderate and severe leukoaraiosis / 中国药师

Objective To investigate the effects of butylphthalide soft capsule on the expression of uric acid and the pathological changes of white matter in patients with moderate and severe leukoaraiosis.Methods A total of 60 patients with moderate to severe leukoosteoporosis admitted to the department of neurology of People's Hospital of Hai'an City,Jiangsu province from May 2021 to November 2022 were selected and divided into a study group and a control group by random number table method.The control group was treated with conventional basic treatment,and the study group was treated with butylphthalein softgel based on the control group.The score of mini-mental state examination(MMSE)scale,montreal cognitive assessment(MoCA)scale,hachinski ischemia score(HIS)scale,total decline scale(GDS),the levels of plasma factors[homocysteine(Hcy),total cholesterol(TC),central nervous specific protein(S100β)and uric acid(UA)]and improvement in leukoencephalopathy[as measured by arterial flow velocity at peak systolic flow rate(Vs),end-diastolic peak flow rate(Vd),and mean peak flow rate(Vm)]before and after treatment were compared between the two groups.Results A total 60 patients with leukoaraiosis were included,with 30 cases in the study group and 30 cases in the control group,respectively.Before treatment,there were no significant differences in scores of MMSE,MoCA,HIS and GDS,levels of Hcy,TC,S100β and UA,Vs,Vd,and Vm between the two groups(P＞0.05).After treatment,the scores of MMSE and MoCA scores,Vs,Vd,and Vm on both sides were significantly higher than those before treatment(P＜0.05),and those in the study group was significantly higher than those in the control group(P＜0.05);the scores of HIS and GDS,and the levels of Hcy,TC,S100β and UA were significantly lower than those before treatment(P＜0.05),and those in the study group was significantly lower than those in the control group(P＜0.05).Conclusions Butylphthalide soft capsule in the treatment of moderate and severe leukoaraiosis can effectively reduce the cognitive impairment,restore the cognitive function,reduce the levels of plasma factors,improve the cerebral blood flow,and improve the condition of leukoaraiosis.

Correlation between lesion volume ratio and cognitive function in ischemic leukoaraiosis / 中国医师进修杂志

Objective:To investigate the relationship between the volume ratio of ischemic leukoaraiosis (LA) and cognitive level and arterial perfusion.Methods:Fifty-four patients, who was hospitalized in Dalian Central Hospital and diagnosed as LA clinically during the time of March to December in 2012, were selected to collect the information of the volume ratio of white matter disease, MoCa score and the average flow rate of carotid artery. The correlation between the volume ratio of white matter disease and MoCa score, cognitive impairment and the average flow rate of carotid artery were analyzed.Results:The volume ratio of LA lesions was negatively correlated with MOCA score ( r = -0.59, P<0.01); the volume ratio of LA lesions was negatively correlated with the mean flow rate of internal carotid artery ( r = -0.37, P<0.01). Quantity order of the area under receiver operating characteristic (ROC) curve of MoCA cognitive subgroup was as following: delayed memory (1.000)> visual space/executive function (0.970) = abstract force (0.970)> language ability (0.960)> attention (0.888). Conclusions:The larger the volume ratio of leukopathy in LA patients, the more serious the cognitive impairment, especially the cognitive impairment of impairment of memory delay, visual space/executive function, abstract ability and language ability.

Cognitive function changes and their influential factors in patients with ischemic stroke and leukoaraiosis / 中国基层医药

Objective:To investigate cognitive function changes and their influential factors in patients with ischemic stroke and leukoaraiosis.Methods:A total of 500 patients with ischemic stroke who received treatment in Yiwu Central Hospital from January 2018 to October 2019 were included in this study. They were divided into simple ischemic stroke group ( n = 200) and ischemic stroke complicated by leukoaraiosis group (combination group, n = 300). The infarct location and the degree of leukoaraiosis in the combination group were analyzed. An additional 150 volunteers who concurrently underwent the Cognitive Function Test in the same hospital were selected as controls. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Patients in the combination group were divided into cognitive impairment group (MoCA score ≥ 26 points) and non-cognitive impairment group (MoCA score < 26 points) according to MoCA score. The risk factors of cognitive impairment in patients with ischemic stroke and leukoaraiosis were analyzed. Results:The scores of the MMSE, MoCA, Clock Drawing Test (CDT), Verbal Fluency Test (VFT), and Digit Span Test (DST) in the control group were (28.93 ± 2.70) points, (28.35 ± 2.74) points, (4.69 ± 1.14) points, (4.94 ± 0.42) points, and (14.33 ± 1.66) points respectively. They were (26.92 ± 2.18) points, (25.02 ± 3.52) points, (3.61 ± 1.60) points, (4.77 ± 0.46) points, and (11.73 ± 1.16) points, respectively in the simple ischemic stroke group and (24.91 ± 2.79) points, (20.70 ± 3.06) points, (2.87 ± 1.23) points, (4.07 ± 0.85) points, and (10.82 ± 0.93) points respectively in the combination group. There were significant differences in the scores of the MMSE, MoCA, CDT, VFT, and DST among the three groups ( F = 124.50, 318.50, 93.43, 112.60, 428.60, all P < 0.001). Significant differences in the scores of the MMSE, MoCA, CDT, VFT, and DST were observed between patients with different degrees of leukoaraiosis ( F = 69.09, 102.40, 20.98, 60.90, 57.00, all P < 0.001). Spearman correlation analysis results showed that the scores of the MMSE, MoCA, CDT, VFT, and DST were negatively correlated with the degree of leukoaraiosis ( r = -0.61, -0.69, -0.43, -0.56, -0.44, all P < 0.05). Logistic regression analysis results showed that age, history of smoking and drinking, history of diabetes, history of stroke, and infarct location were the independent risk factors for cognitive impairment in patients with ischemic stroke and leukoaraiosis. Education level was a protective factor against ischemic stroke and leukoaraiosis. Conclusion:The degree of cognitive impairment in patients with ischemic stroke and leukoaraiosis is related to the degree of leukoaraiosis. Age, history of smoking and drinking, history of diabetes, history of stroke, infarction location, and education level are the influential factors of cognitive impairment.

Correlation between white matter hyperintensity and early neurological deterioration after intravenous recombinant tissue plasminogen activator thrombolysis in acute ischemic stroke patients / 中华神经医学杂志

Objective:To investigate the effects of white matter hyperintensity (WMH) of different lesion areas and severities on early neurological deterioration (END) in acute ischemic stroke (AIS) patients after intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis.Methods:Three hundred and seventy-three AIS patients, admitted to our hospital from April 2019 to July 2021, were chosen in our study. These patients were treated with intravenous rt-PA thrombolysis within 4.5 h of onset. According to the presence or absence of END, these patients were divided into END group ( n=89) and non-END group ( n=284). Fazekas scale was used to assess the periventricular WMH (PVWMH) and subcortical WMH (SCWMH): none-mild PVWMH/SCWMH was defined at 0-1 score and moderate to severe PVWMH/SCWMH was defined at 2-3 scores; the sum scores of the two sites were calculated, and none-mild WMH was defined at 0-2 scores and moderate-severe WMH was defined at 3-6 scores. Univariate analysis was used to compare the baseline data of the two groups, and multivariate Logistic regression was used to determine the correlations of END with WMH lesion areas and severities. Results:Univariate analysis showed that there was significant difference between the END group and non-END group in age, baseline blood glucose, baseline National Institutes of Health Stroke Scale (NIHSS) scores, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, hemorrhagic transformation after thrombolysis, and PVWMH, SCWMH, and WMH scores ( P<0.05). Multivariate Logistic analysis showed that only baseline NIHSS scores ( OR=1.064, 95%CI: 1.019-1.111, P=0.005), hemorrhagic transformation after thrombolysis ( OR=3.931, 95%CI: 2.007-7.701, P=0.000), moderate-severe WMH ( OR=4.736, 95%CI: 2.737-8.195, P=0.000), and moderate-severe SCWMH ( OR=5.557, 95%CI: 3.156-9.783, P=0.000) were independently related to the occurrence of END. Conclusion:Patients with moderate-severe SCWMH, moderate-severe WMH, or high NIHSS scores after thrombolysis trend to have END.

Study on the Correlation between the Severity of Leukoaraiosis and the Prognosis of Acute Ischemic Stroke with Large Vessel Occlusion treated with Mechanical Thrombectomy / 中风与神经疾病杂志

@#To explore whether the severity of LA in patients with acute ischemic stroke（AIS）with large vessel occlusion（AIS-LVO） was related to the prognosis of MT treatment. Methods A total of 75 AIS-LVO patients who received intravenous thrombolysis（IVT） bridging MT or MT alone were selected in the stroke center of our hospital from April 2016 to October 2021.According to the Fazekas score scale，the severity of LA was divided into non-mild group（0-2 points，n=44） and moderate-severe group（3～6 points，n=31）. The baseline data and postoperative outcome of MT were compared between the two groups. The prognosis at 90 days after operation was evaluated by modified Rankin scale（mRS）. The results were divided into two groups：good prognosis group（0～2 points，n=32） and poor prognosis group（3～6 points，n=43）. Univariate analysis and multivariate Logistic regression analysis were used to determine whether LA was related to the prognosis of at 90 days after MT.Results Univariate analysis showed that compared with the non-mild LA group，the moderate-severe LA group had an older age［（73.77±8.25） vs（63.00±10.50） years old］，higher female proportion（58.1% vs 22.7%），higher proportion of atrial fibrillation（61.3% vs 36.4%），lower proportion of hyperlipidemia（9.7% vs 29.5%），higher incidence of postoperative hemorrhage transformation（38.7% vs 13.6%），higher incidence of sICH at 72 hours after operation（19.4% vs 2%），higher rate of futile recanalization（78.6% vs 39.0%），and higher incidence of 90-day poor prognosis after operation（80.6% vs 40.9%）. There were significant differences between two groups（all P<0.05）. Univariate analysis showed that compared with the good prognosis group，the poor prognosis group had an older age［69.0（63.0，77.0）vs 63.5（53.0，75.5）years old］，higher baseline NIHSS score ［（17.8±6.8） vs（12.3±4.9） points］，higher fasting blood glucose level［6.78（5.71，10.43） vs 5.88（5.29，6.95）］ mmol/L］，higher neutrophil to lymphocyte ratio（NLR） ［4.48（1.92，8.11） vs 2.4（1.43，3.06）］，higher proportion of diabetes（37.2% vs 12.5%），and higher proportion of moderate-severe LA（58.1% vs 18.8%）. There were significant difference between two groups（all P<0.05）.Multivariate Logistic regressionanalysis showed that moderate-severe LA（OR=6.796，95%CI 1.564～29.530，P=0.011）and baseline NIHSS score（OR=1.156，95%CI 1.015～1.317，P=0.029） were independent risk factors for poor 90-day functional prognosis after MT.Conclusion Moderate-severe LA can independently predict the poor prognosis of patients with AIS-LVO after MT.

White matter hyperintensities: repercussion on grey matter structures of the brain / Hiperintensidades da substância branca: repercussão em estruturas da substância cinzenta do cérebro

The extensive white matter of the brain, which comprises about one half of its volume, is constituted by an intricate and interwoven assemble of nerve fibers. The WMH (leukoaraiosis) represent the most frequent ischemic type of lesion of SVD, affecting the white matter. These lesions may be apparent or normal appearing on neuroimaging. In both cases such lesions may interrupt the affected white matter fibers, with consequent disconnection syndromes, and atrophy of the denervated grey matter structures. These conditions affect the structural neural networks (connectome), with functional repercussion on the cognitive and behavioral domains.

A extensa substância branca do cérebro, que compreende cerca da metade do seu volume, é constituída por um intricado e entrelaçado conjunto de fibras nervosas. As HSB (hiperintensidades da substância branca) (leucoaraiose) representam o mais frequente tipo de lesão isquêmica da DPV (doença dos pequenos vasos) que afeta a substância branca. Essas lesões podem ser aparentes ou de aparência normal na neuroimagem. Em ambos os casos tais lesões podem interromper essas fibras da substância branca, com consequente síndromes por desconexão e atrofia de estruturas de substância cinzenta desnervadas. Essas condições afetam as redes neurais estruturais (conectoma), com repercussão funcional nos domínios cognitivo e do comportamento.

Value of diffusion tensor imaging in evaluating cognitive function of patients with leukoaraiosis at varying degrees / 中华神经医学杂志

Objective:To investigate the value of diffusion tensor imaging (DTI) in evaluating the cognitive function of patients with leukoaraiosis (LA).Methods:A prospective study was chosen. Sixty patients with LA admitted to our hospital from July 2019 to May 2021 were selected. All patients accepted brain MRI. According to Fazekas visual grading standards, these 60 LA patients were divided into mild LA group, moderate LA group, and severe LA group ( n=20). Mini-mental state examination (MMSE) was used to evaluate the cognitive function of these patients. Diffusion tensor imaging was used to analyze the fractional anisotropy (FA) values of 6 regions of interest, namely the frontal lobe, temporal lobe, occipital lobe, parietal lobe, anterior horn of lateral ventricle, and corpus callosum. The differences of general data, cognitive function and FA values among the 3 groups were compared. The cognitive functions were assessed based on FA values (FA scores), and compared with those evaluated by MMSE (clinical scores). Results:(1) Age and homocysteine (Hcy) level of patients in mild, moderate and severe LA groups were increased successively, with statistical differences ( P<0.05). As compared with that in the mild and moderate LA groups, the educational level of patients in the severe LA group was significantly lower ( P<0.05). (2) Memory scores of patients in mild LA group, moderate LA group and severe LA group decreased successively, with statistical differences ( P<0.05). As compared with mild LA group and moderate LA group, MMSE total scores and recall scores in severe LA group were statistically decreased ( P<0.05). (3) FA values of parietal lobe and corpus callosum were successively decreased in mild, moderate and severe LA groups, with significant differences ( P<0.05). As compared with those in the mild and moderate LA groups, the FA values of frontal lobe, temporal lobe, occipital lobe and anterior horn of lateral ventricle in severe LA group were significant decreased, ( P<0.05). (4) There were no significant differences in FA scores and clinical scores of cognitive function scores in mild LA group ( P>0.05), except for attention and counting scores. There were no significant differences in FA scores and clinical scores of cognitive function scores in moderate LA group ( P>0.05), except for language function scores and tMMSE otal scores. Except for scores of location orientation, attention and counting, FA scores and clinical scores of all cognitive function scores in the severe LA group were significantly different ( P<0.05). Conclusions:The LA severity is related to the patient's age, Hcy level, education level, and cognitive function. In patients with mild LA, the cognitive function can be assessed according to FA values in addition to attention and counting ability; in patients with moderate LA, cognitive function can be assessed according to FA values in addition to language function; the cognitive function of patients with severe LA cannot be assessed according to FA values.

Correlation between leukoaraiosis and hematoma expansion in early stage of spontaneous intracerebral hemorrhage / 中风与神经疾病杂志

@#Objective　To investigate the relationship between leukoaraiosis in spontaneous supratentorial intracerebral hemorrhage.Methods　Patients with spontaneous supratentorial intracerebral hemorrhage who were admitted to the Department of Neurology,the First Affiliated Hospital of China Medical University from October 2015 to October 2017 were enrolled retrospectively.The patients were required to complete the cranial CT within 12 hours after ICH symptoms onset and the follow-up cranial CT within 48 hours.Hematoma volume and the volume of perihematoma edema were measured with Image J.The Van Swieten scale was used to evaluate the severity of leukoaraiosis.The differences in clinical,imaging and laboratory data such as hematoma location,hematoma shape,and degree of leukoaraiosis between early hematoma expansion group and nonexpantion group were compared to determine whether leukoaraiosis is an independent risk factor for early hematoma expansion.Results　94 cases (33.3%) developed early hematoma expansion.Multivariate logistic regression analysis showed that VSS score (OR=1.358,95%CI 1.139~1.619,P=0.001) and smoking degree (OR=1.286,95%CI 1.029~1.606,P=0.027) are independent risk factors for early hematoma expansion in spontaneous supratentorial intracerebral hemorrhage.Conclusion　Leukoaraiosis is closely related to the early expansion of hematoma in spontaneous supratentorial intracerebral hemorrhage,that is,the more serious the degree of leukoarais,the higher the incidence of early hematoma expansion.

Claudin-1 and Claudin-3 as Molecular Regulators of Myelination in Leukoaraiosis Patients

OBJECTIVES: Leukoaraiosis is described as white matter lesions that are associated with cognitive dysfunction, neurodegenerative disorders, etc. Myelin depletion is a salient pathological feature of, and the loss of oligodendrocytes is one of the most robust alterations evident in, white matter degeneration. Recent studies have revealed that claudin proteins are aberrantly expressed in leukoaraiosis and regulate oligodendrocyte activity. However, the roles of claudin-1 and claudin-3 in oligodendrocytes and leukoaraiosis are still not well-defined. METHODS: Quantitative polymerase chain reaction was used to measure the expression of claudin-1 (CLDN1), claudin-3 (CLDN3), and myelinogenesis-related genes such as myelin basic protein (MBP), proteolipid protein (PLP), oligodendrocyte transcription factor 2 (OLIG2), and SRY-box transcription factor 10 (SOX10) in leukoaraiosis patients (n=122) and healthy controls (n=122). The expression of claudin-1 and claudin-3 was either ectopically silenced or augmented in Oli-neu oligodendrocytes, and colony formation, apoptosis, and migration assays were performed. Finally, the expression of myelin proteins was evaluated by western blotting. RESULTS: Our results revealed that in addition to SOX10, the expression levels of claudin-1, claudin-3, and myelinogenesis-related proteins were prominently downregulated in leukoaraiosis patients, compared to those in healthy controls. Furthermore, the growth and migration of Oli-neu cells were downregulated upon silencing claudin-1 or claudin-3. However, the overexpression of claudin-1 or claudin-3 resulted in the reduction of the degree of apoptosis in Oli-neu cells. In addition, claudin-1 and claudin-3 promoted the expression of MBP, OLIG2, PLP, and SOX10 at the translational level. CONCLUSION: Our data has demonstrated that the abnormal expression of claudin-1 and claudin-3 regulates the pathological progression of leukoaraiosis by governing the viability and myelination of oligodendrocytes. These findings provide novel insights into the regulatory mechanisms underlying the roles of claudin-1 and claudin-3 in leukoaraiosis.

Effect of leukoaraiosis on prognoses and enlarged hematoma in patients with spontaneous supratentorial intracerebral hemorrhage / 中华神经医学杂志

Objective:To explore the effect of leukoaraiosis (LA) severity on prognoses and enlarged hematoma in patients with spontaneous supratentorial intracerebral hemorrhage.Methods:Three hundred and forty-five patients with spontaneous supratentorial intracerebral hemorrhage admitted to our hospital from January 2018 to February 2019 were chosen in our study. The van Swieten scale (vSS) was performed on baseline brain CT images to evaluate the LA severity; and according to the vSS scores, these patients were divided into absent-to-moderate LA group (0-2, n=288) and severe LA group (3-4, n=57); the percentage of patients with good prognosis (modified Rankin scale scores≤2 90 d after discharge) and incidence of enlarged hematoma (hematoma volume increased by 12.5 mL or >33% of original volume as compared with that at admission) were compared between the two groups 90 d after discharge. According to the prognoses and enlarged hematoma, these patients were further divided into good prognosis group ( n=161) and poor prognosis group ( n=184), and non-hematoma expansion group ( n=303) and hematoma expansion group ( n=42), respectively; univariate analysis, multivariate Logistics regression analysis, and multi-classification Logistic regression analysis were used to evaluate the influence of LA severity in prognoses, mRS scores, and enlarged hematoma. Results:As compared with the absent-to-moderate LA group, the severe LA group had significantly lower percentage of patients having good prognosis (50.0% vs. 29.8%) and significantly higher incidence of enlarged hematoma (9.4% vs. 26.3%, P<0.05). Multivariate Logistic regression analysis showed that severe LA was an independent risk factor for poor prognosis ( OR=0.390, 95%CI: 0.163-0.933, P=0.034). Multi-classification Logistic regression analysis showed that patients with severe LA had high mRS scores ( OR=3.243, 95%CI: 1.775-5.923, P=0.000). Multivariate Logistic regression analysis showed that severe LA was not an independent risk factor for enlarged hematoma ( P>0.05). Conclusion:The severity of LA affects the prognoses 90 d after discharge, but not increase the risk of enlarged hematoma in patients with spontaneous supratentorial intracerebral hemorrhage.

Correlations of moderate to severe leukoaraiosis with hemorrhagic transformation and prognoses of patients with acute ischemic stroke after intravenous thrombolysis / 中华神经医学杂志

Objective:To explore the correlations of moderate to severe leukoaraiosis (LA) with hemorrhagic transformation (HT) and prognoses of patients with acute ischemic stroke after intravenous thrombolysis.Methods:Clinical data of 144 patients with acute ischemic stroke who underwent intravenous thrombolysis in our hospital from August 2017 to November 2018 were retrospectively collected. Van Swieten scale (vSS) was used to determine the leukoaraiosis degrees in these patients based on CT findings of the head before treatment. According to the CT results of head re-examination within 24 h of treatment, HT appearance of the patients was judged. The prognoses of these patients were evaluated according to modified Rankin scale (mRS) scores 90 d after discharge. Multivariate Logistic regression analysis was performed to determine the independent risk factors for HT and prognoses of patients with acute ischemic stroke after intravenous thrombolysis.Results:Among 144 patients, 23 patients (15.97%) had HT and 121 (84.03%) had non-HT; 61 patients (42.36%) were with poor prognosis and 83 (57.64%) were with good prognosis. As compared with patients in the non-HT group, patients in the HT group had significantly higher proportion of patients with moderate to severe LA, D-dimer level and urine specific gravity ( P<0.05). Multivariate Logistic regression analysis showed that moderate to severe LA ( OR=0.281, 95%CI: 0.105-0.753, P=0.012) and D-dimer ( OR=1.654, 95%CI: 1.100-2.489, P=0.016) were independent risk factors for HT. As compared with the patients in the good prognosis group, the patients in the poor prognosis group had significantly advanced age, statistically higher baseline NIHSS scores and proportion of patients with HT and positive urine sugar, significantly higher levels of random blood glucose and D-dimer, significantly higher plasma fibrinogen content, significantly higher international normalized ratio, and significantly longer plasma prothrombin time before treatment ( P<0.05). The TOAST etiological types of patients between good prognosis group and poor prognosis group were significantly different ( P<0.05). Multivariate Logistic regression analysis showed that baseline NIHSS scores ( OR=1.395, 95%CI: 1.213-1.605, P=0.000) and white blood cell count ( OR=1.292, 95%CI: 1.040-1.606, P=0.021) were independent risk factors for poor prognosis. Conclusions:Acute ischemic stroke patients with moderate to severe LA and high D-dimer are prone to HT after intravenous thrombolysis. Acute ischemic stroke patients with higher baseline NIHSS scores and peripheral white blood cell count are prone to have poor prognosis.

Clinical application of 3D ASL in the evaluation of early cerebral hemodynamic changes in patients with leukoaraiosis / 中风与神经疾病杂志

@#Objective　To explore the clinical value of 3D artistic spin labeling technology in evaluating early perfusion changes of leukaraiosis.Methods　Ninety patients and 30 healthy volunteers with different degrees of LA who were examined by magnetic resonance imaging were collected from January 2018 to April 2020.According to the Fazekas scale,they were divided into LA0,LA1,LA2 and LA3 group,30 cases were included in each group.CBF values of cortical watershed and subcortical watershed were measured according to cerebral blood flow pseudocolor image,and cerebral perfusion differences in anterior,posterior,radial crown and semicircular center of cortical watershed in different LA grades were evaluated,and the characteristics of early hemodynamic changes of LA were analyzed.Results　The CBF values of LA2,LA3 were significantly lower than that of LA0.There was no significant difference between LA1 and LA0 (P>0.05),however,the CBF in subcortical watershed was slightly lower than LA0 (P<0.05).Conclusion　3D ASL perfusion imaging technology can be used to quantify the CBF in the watershed area,and can be used to monitor the state of cerebral perfusion in LA patients.The CBF response in the subcortical watershed area is more sensitive,which can be used to evaluate the early cerebral hemodynamic changes in LA.

Risk factors for white matter hyperintensities / 国际脑血管病杂志

White matter hyperintensities (WMHs) is a magnetic resonance imaging phenotype of cerebral small vessel disease,which is manifested as diffuse or confluent subcortical white matter.There is usually no clinical manifestation in the early stage of WMHs,and its pathophysiological mechanism has not been fully elucidated.Studies have shown that a variety of factors are associated with WMHs.The article reviews the risk factors for WMHs.

Relationship between 24 h ambulatory blood pressure and severity of white matter hyperintensities / 国际脑血管病杂志

Objective To investigate the correlation between 24 h ambulatory blood pressure monitoring (ABPM) parameters and white matter hyperintensities (WMHs).Methods A cross-sectional analysis was performed in patients who visited the Department of Neurology,Liaoning People's Hospital,and showed WMHs on the head MRI and completed 24 h ABPM in the same period of hospitalization from September 2016 to October 2018.Periventricular white matter hyperintensities (PVWMHs) and deep white matter hyperintensities (DWMHs) were evaluated using the modified Scheltens scale respectively,and the sum of the two was used as the overall severity score of WMHs.The enrolled patients were grouped according to the tertiles of the overall WMH score.Multivariate ordinal logistic regression analysis was used to investigate independent risk factors affecting overall WMH scores.Multivariate linear regression analysis was used to investigate the influencing factors of PVWMH and DWMH scores.Results A total of 201 patients were enrolled,aged (62.7 ± 10.3) years (range 45-88 years),82 males (40.8％),and 123 patients (61.2％) with hypertension.The total WMH scores were 1-27.According to the tertiles,64 patients (31.8％) were divided into lower tertile group (1-3),65 (32.3％) in the middle tertile group (4-8),and 72 (35.8％) in the higher tertile group (9-27).There was significant difference in age between any two WMH score groups,namely,the high tertile group ＞ middle tertile group ＞ low tertile group (69.5 ± 8.5 years vs.63.1 ±9.2 years vs.54.5 ±6.9 years;all P＜0.001).The proportion of hypertension in the middle tertile group (66.2％) and the higher tertile group (69.4％) were significantly higher than those in the lower tertile group (46.9％;all P＜0.05).The homocysteine in the higher tertile group was significantly higher than that in the lower tertile group (15.6 [12.7-19.7]μmol/Lvs.14.1[12.5-15.9]μmol/L;P ＜0.05).In terms of 24 h ABPM parameters,the 24 h mean systolic blood pressure (24 h SBP) in the higher tertile group was higher than that in the lower tertile group,and the nighttime mean systolic blood pressure (nSBP) level in the higher tertile group was higher than that in the lower and middle tertile groups,the SD of daytime systolic blood pressure (dSBPSD) and the SD of the nighttime systolic blood pressure (nSBPSD) in the higher tertile group were higher than those in the lower tertile group,and dSBPSD of the middle tertile group was higher than of the lower tertile group.The above differences were statistically significant (all P ＜0.05).Multivariate ordinal logistic regression analysis showed that the increased age (odds ratio[OR] 1.143,95％ confidence interval[CI] 1.104-1.185;P＜0.001),24 h SBP (OR 1.026,95％ CI 1.005-1.048;P =0.015),dSBP (OR 1.022,95％ CI 1.001-1.043;P =0.036),nSBP (OR 1.026,95％ CI 1.006-1.046;P=0.011),dSBPSD (OR 1.119,95％ CI 1.023-1.221;P=0.013),and nSBPSD (OR 1.107,95％ CI 1.022-1.200;P=0.013) were independently positively correlated with the overall WMH score.Multivariate linear regression showed that age (β=0.607,95％ CI 0.500-0.714;P＜0.001),24 h SBP (β=0.182,95％ CI 0.075-0.289;P=0.001),dSBP (β=0.156,95％ CI 0.049-0.264;P=0.004),and nSBP (β =0.200,95％ CI 0.092-0.307;P ＜0.001) were independently positively correlated with the PVWMH score;age (β =0.505,95％ CI 0.387-0.622;P ＜0.001),24 h SBP (β =0.132,95％ CI 0.015-0.248;P =0.027),dSBP (β =0.127,95％ CI0.011-0.243;P =0.032),nSBP (β =0.148,95％ CI 0.031-0.265;P =0.013),and nSBPSD (β =0.133,95％ CI 0.016-0.250;P=0.027) were independently positively correhted with the DWMH score.Conclusion The increased age,ambulatory systolic blood pressure level (24 h,daytime,nighttime) and systolic blood pressure variability level (dSBPSD and nSBPSD) were independently associated with the severity of WMHs.

Association of degrees of leukoaraiosis severity with prognoses of patients with acute anterior circulation large-artery occlusive stroke after mechanical thrombectomy / 中华神经医学杂志

Objective To assess whether degrees of leukoaraiosis (LA) severity is associated with prognoses of patients with acute anterior circulation large-artery occlusive stroke after mechanical thrombectomy.Methods Clinical data of patients with acute anterior circulation large-artery occlusive stroke who underwent mechanical thrombectomy in our hospital from January 2016 to August 2017 were collected. The subjects were divided into non-to-moderate LA group and severe LA group according to preoperative degrees of LA severity; the baseline data, successful reperfusion rate, and symptomatic intracranial hemorrhage rate within 24 h of surgery, good prognosis rate 90 d after surgery (modified Rankin scale [mRS] scores≤2) and mortality 90 d after surgery were analyzed. According to the prognoses, the patients were divided into good prognosis group and poor prognosis group; univariate regression analysis and multivariate Logistic regression analysis were used to evaluate the relations of degrees of LA severity with prognoses 90 d after surgery.Results In these 146 patients, 100 patients were into the non-to-moderate LA group and 46 patients were into the severe LA group. As compared with patients in the non-to-moderate LA group, patients in the severe LA group had significantly older age (70.50 [59.75, 79.75] yearsvs. 79 [73, 82] years), significantly higher baseline NIHSS scores (20 [16, 25])vs. 22 [18, 28]), significantly higher rate of symptomatic intracranial hemorrhage 24 h after surgery (11.0％ [11/100])vs. 26.1％ [12/46]), statistically higher mortality rate 90 d after surgery (14.0％[14/100]) vs. 14.0％ [14/46]), significantly lower successful reperfusion rate (97.0％ [97/100]vs. 84.8％ [39/46]), and statistically lower good prognosis rate (54.0％ [54/100]vs. 21.7％ [10/46],P<0.05). Among the 146 patients, 64 had good prognosis and 82 had poor prognosis; univariate analysis showed that as compared with than those from the good prognosis group, patients from the poor prognosis group had significantly older age (70.50 [59.75, 79.75] years oldvs. 79 [73, 82] years old) and statistically higher baseline NIHSS scores (20 [16, 25]vs. 22 [18, 28]), and significantly higher proportion of central source embolism by TOAST etiology classification (68.8％ [44/64]vs. 76.8％[63/82]) and proportion of severe LA (15.6％ [10/64]vs. 43.9％ [36/82],P<0.05); multivariate Logistic regression analysis showed that severe LA (OR=3.109, 95％CI: 1.241-7.788,P=0.015), age, baseline NIHSS scores, and TOAST etiology classification were all independent risk factors for poor prognosis 90 d after surgery (P<0.05). ConclusionSevere LA may be associated with poor prognosis of patients with acute anterior circulation large-artery occlusive stroke after mechanical thrombectomy.

Influence of moderate to severe leukoaraiosis in prognoses of acute ischemic stroke patients after endovascular treatment / 中华神经医学杂志

Objective To investigate the influence of moderate to severe leukoaraiosis (LA) in prognoses of acute ischemic stroke patients after endovascular treatment.Methods From January 2017 to December 2018, 60 patients with acute ischemic stroke due to anterior circulation large vessel occlusion underwent endovascular treatment and obtained complete vessel recanalization in our hospital were evaluated for degrees of LA severity according to head CT scan and van Swieten scale (2-4 scores were defined as moderate-severe LA). According to modified Rankin scale (mRS) scores 90 d after treatment, the patients were divided into poor prognosis group and good prognosis group. Univariate analysis was used to compare the differences of influencing factors of the two groups. Multivariate Logistic regression analysis was further used to explore the influence of moderate to moderate-severe LA in poor prognosis of patients after endovascular treatment.Results Of the 60 patients, 18 did not have LA, 19 had mild LA, and 23 had moderate-severe LA; 32 had poor prognosis and 28 had good prognosis. Univariate analysis showed that the patients from the poor prognosis group had significantly higher proportion of moderate-severe LA (59. 4％ [19/32]vs. 14.3％ [4/28]), significantly higher baseline National Institutes of Health Stroke Scale (NIHSS) scores ([23.4±10.1]vs. [14.7±7.0]), significantly higher baseline diastolic blood pressure ([87.5±18.9] mmHgvs. [78.3±15.1] mmHg), significantly higherproportion of patients with hypertension history (68.8％ [22/32]vs. 42.9％ [12/28]), and statistically older age ([70.6±9.4] yearsvs. [61.3±12.5] years) than the patients from the good prognosis group (P<0.05). On multivariable Logistic regression analysis, the presence of moderate-severe LA (OR=5.032, 95％CI: 1.026-24.679,P=0.046) and baseline NIHSS scores were independent risk factors for poor prognosis of patients after endovascular treatment.Conclusion Patients with acute ischemic stroke accompanied with moderate-severe LA are more likely to have poor prognosis after endovascular treatment.

Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies / 대한뇌졸중학회지

Cerebral small vessel disease (CSVD) is a common group of neurological conditions that confer a significant burden of morbidity and mortality worldwide. In most cases, CSVD is only recognized in its advanced stages once its symptomatic sequelae develop. However, its significance in asymptomatic healthy populations remains poorly defined. In population-based studies of presumed healthy elderly individuals, CSVD neuroimaging markers including white matter hyperintensities, lacunes, cerebral microbleeds, enlarged perivascular spaces, cortical superficial siderosis, and cerebral microinfarcts are frequently detected. While the presence of these imaging markers may reflect unique mechanisms at play, there are likely shared pathways underlying CSVD. Herein, we aim to assess the etiology and significance of these individual biomarkers by focusing in asymptomatic populations at an epidemiological level. By primarily examining population-based studies, we explore the risk factors that are involved in the formation and progression of these biomarkers. Through a critical semi-systematic review, we aim to characterize “asymptomatic” CSVD, review screening modalities, and draw associations from observational studies in clinical populations. Lastly, we highlight areas of research (including therapeutic approaches) in which further investigation is needed to better understand asymptomatic CSVD.

Correlation between metabolic syndrome and cerebral artery stenosis in patients with subcortical ischemic vascular disease / 国际脑血管病杂志

Objective@#To investigate the effects of metabolic syndrome (MetS) and each component on cerebral artery stenosis in patients with subcortical ischemic vascular disease (SIVD).@*Methods@#From June 2017 to May 2019, patients with SIVD admitted to the Departments of Neurology, the First and Forth Affiliated Hospitals of Anhui Medical University were enrolled retrospectively. MetS was diagnosied using NCEP-ATP III criteria. The North American Symptomatic Carotid Endarterectomy Trial criteria were used to evaluate the degree of cerebral artery stenosis. Multivariate logistic regression analysis was used to determine the independent correlation between MetS and cerebral artery stenosis.@*Results@#A total of 460 patients with SIVD were enrolled, including 289 males (62.8%), 171 females (37.2%), and age 72.7±4.787 years; 278 (60.4%) in the MetS group, 182 (39.6%) in the non-MetS group; and 279 (60.7%) in the cerebral artery stenosis group, 181 (39.3%) in the non-stenotic group. The proportion of patients with cerebral artery stenosis in the MetS group was significantly higher than that in the non-MetS group (84.2% vs. 24.7%; χ2=162.876, P<0.001). Among them, the proportions of patients with middle cerebral artery, internal carotid artery, vertebral artery, basal artery, and multiple cerebral artery stenosis in the MetS group were significantly higher than those in the non-MetS group (all P<0.05), and the proportion of patients with moderate and severe cerebral arterial stenosis was also significantly higher than that in the non-MetS group (all P<0.05). Multivariate logistic regression analysis showed that after adjusting for confounding factors such as previous stroke or transient ischemic attack history, alcohol consumption, and low-density lipoprotein cholesterol levels, there was still a significant independent correlation between the number of MetS components and cerebral arterial stenosis; with the number of MetS components increaseing, especially 3 or more, the risk of cerebral artery stenosis increased (2 components: odds ratio [OR] 4.573, 95% confidence interval [CI] 1.388-15.068; 3 components: OR 452.450, 95% CI 115.505-1 772.310; 4 components: OR 452.503, 95% CI 117.664-1 740.191; 5 components: OR 411.356, 95% CI 96.975-1 744.911).@*Conclusions@#MetS is an independent risk factor for cerebral artery stenosis in patients with SIVD, and the correlation between them increases with the increase of MetS components.

Resting-state Neural Networks and Granger Causal Connectivity for Patients with Cognitive Impairment Associated with Leukoaraiosis / 中国康复理论与实践

Objective:To compare the difference in resting state networks among leukoaraiosis (LA) patients with or without mild cognitive impairment, and healthy controls, as well as the functional connectivity under Granger causality analysis (GCA). Methods:Subjects aged 40 to 80 years, including 34 LA-MCI patients, 15 LA patients with normal cognition and 33 healthy controls, accepted resting-state functional magnetic resonance imaging. Independent component analysis was used to separate functional brain networks, and difference of activation was determined with two sample t-test. GCA was used to analyze effective connectivity of these functional networks. Results:Eight resting state networks were obtained, including default mode network, motor network, medial visual network, lateral visual network, right-memory network, left-memory network, auditory network and executive network. Activation was different among three groups. Effective connectivity of RSNs was also different among three groups. Conclusion:Components of the resting state networks keep changing as LA progressing. Activation decreases as patients' cognition impaired. The direction and strength of connections remodel.