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1.
J Neurol Sci ; 399: 111-117, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30798108

RESUMO

BACKGROUND: We aimed to quantitatively assess the vessel morphology of middle cerebral artery (MCA) atherosclerosis and explore its value in discriminating plaque types. METHODS: Patients were selected from a high-resolution magnetic resonance imaging (HRMRI) study from January 2007 to December 2015. One hundred and three patients with acute cerebral infarcts due to MCA stenosis (>50%) and eighty-nine patients with asymptomatic MCA stenosis (>50%) were included. Quantitative measurements of MCA morphology, including lumen area, outer-wall and wall area at stenotic site and reference site, stenotic degree, plaque length, remodeling index and plaque eccentricity, were performed on HRMRI with observers blinded to clinical presentations. Firth's penalized logistic regression analysis was used to construct a symptomatic plaque score (SPS) model. Then, the HRMRI data of 39 patients prospectively enrolled from January 2016 to January 2017 were used to validate the SPS model. RESULTS: The HRMRI data of 103 patients with symptomatic MCA stenosis and 89 patients with asymptomatic MCA stenosis in the construction cohort were analyzed. Four main factors were found to be associated with symptomatic plaques: stenotic lumen area ≥ 2.28 mm2, stenotic wall area ≥ 8.88 mm2, plaque length and presence of an eccentric plaque. Summation of each logistic regression coefficient multiplying the corresponding score produced the SPS with an area under curve (AUC) of 0.890 on receiver operating characteristics analysis. Validation of the score of 39 plaques (19 symptomatic and 20 asymptomatic) revealed an AUC of 0.862, confirming the continued diagnostic ability. When the data were pooled in all 235 plaques, the optimal cutoff score of discriminating symptomatic and asymptomatic plaques was 2.79 (SPS ≥ 2.79 indicating a symptomatic plaque) with AUC = 0.886, sensitivity 81.1% and specificity 80.5%. CONCLUSIONS: The quantitative analysis of MCA morphology can independently and accurately discriminate plaque types, suggesting its close association with the underlying pathophysiology. Further prospective studies are required to verify whether the SPS model is clinically valuable in monitoring plaque progression and assessing the vulnerability.

2.
J Int Med Res ; : 300060518816834, 2019 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-30628508

RESUMO

OBJECTIVES: This study evaluated associations between methylenetetrahydrofolate reductase ( MTHFR) C677T polymorphisms and diabetic retinopathy (DR) susceptibility within the Chinese population. METHODS: Five databases (PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure) were used for literature searches of open access articles from inception through April 2017. RESULTS: Eight publications were identified involving 600 DR cases, 363 healthy controls, and 646 nondiabetic retinopathy (NDR) controls. There was a positive association between MTHFR C677T polymorphisms and DR risk within the Chinese population (DR with NDR controls: T vs. C, odds ratio (OR): 2.14, 95% confidence interval (CI): 1.55-2.97; TT vs. CC, OR: 4.19, 95% CI: 2.09-8.41; TT + CT vs. CC, OR: 2.83, 95% CI: 1.86-4.40; TT vs. CC + CT, OR: 2.48, 95% CI: 1.52-4.05. DR with healthy controls: T vs. C, OR: 2.48, 95% CI: 1.99-3.09; TT vs. CC, OR: 4.92, 95% CI: 3.18-7.62; TT + CT vs. CC, OR: 3.22, 95% CI: 2.32-4.48; TT vs. CC + CT, OR: 3.11, 95% CI: 1.83-5.28). The association was similar in South China and North China, when stratifying by geographic areas. CONCLUSION: MTHFR C677T polymorphisms increase DR risk within the Chinese population.

3.
Neurology ; 91(19): e1760-e1769, 2018 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-30291186

RESUMO

OBJECTIVE: We aimed to investigate the geometric features of the middle cerebral artery (MCA) and their relevance to plaque distribution and ischemic stroke. METHODS: We reviewed our institutional vessel wall imaging database. Patients with symptomatic MCA atherosclerosis, asymptomatic MCA atherosclerosis, or without MCA atherosclerosis were included. The MCA geometric features, including M1 segment shape and M1 curve orientation, were defined on magnetic resonance angiography. Plaque distribution and other plaque parameters were identified on vessel wall imaging. The association among MCA geometric features, plaque distribution, and ischemic stroke were analyzed. RESULTS: A total of 977 MCAs were analyzed (87 atherosclerotic symptomatic MCAs, 459 atherosclerotic asymptomatic MCAs, and 431 plaque-free MCAs). Overall, curved M1 segments were the predominant shape across all groups. In 91.1% of curved atherosclerotic MCAs, the plaque involved the inner wall of the curve. Plaque not involving the inner wall was shorter (p < 0.0001) and thinner (p = 0.005) compared to plaque involving the inner wall. Inferior plaque was observed in 39.9% of inferior-oriented M1 curves compared to 21.7% in non-inferior-oriented M1 curves (p < 0.0001). The absence of an inferior-oriented M1 curve (odds ratio 0.45, 95% confidence interval 0.27-0.77) and presence of superior plaque (odds ratio 2.67, 95% confidence interval 1.52-4.67) were independently associated with stroke after adjusting for plaque length and thickness, degree of stenosis, and remodeling ratio. CONCLUSIONS: MCA geometric features are associated with plaque distribution and stroke. Our findings provide insight into the vascular pathophysiology of MCA atherosclerosis.


Assuntos
Doenças das Artérias Carótidas/patologia , Arteriosclerose Intracraniana/patologia , Artéria Cerebral Média/patologia , Placa Aterosclerótica/patologia , Acidente Vascular Cerebral/patologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
4.
Arch Gynecol Obstet ; 298(5): 861-871, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30220024

RESUMO

OBJECTIVE: The aim of this meta-analysis is to explore the beneficial role of granulocyte colony-stimulating factor (G-CSF) on infertile women under artificial reproduction technology treatment. METHOD: Medline, Embase and ISI Web of Science databases were searched to identify relevant randomized control trials. Studies before July, 2017 were included for primary screening. Meta-analysis of the total and subgroup patients was conducted, and relative risks (RRs) and their 95% confidence intervals (95% CI) were calculated by a fixed-effect model if no heterogeneity (evaluated as I2 statistic) existed. Otherwise, a random-effects model was adopted. Subgroup analysis was performed by administrating route or clinical indication. Egger test and influence analysis were conducted to evaluate the publication bias and study power, respectively. RESULTS: The final selection enrolled 10 RCTs, involving 1016 IVF-ET cycles (521 distributed to the G-CSF group and 495 to the control). Compared with control group, G-CSF administration could significantly improve clinical pregnancy rate (CPR, RR 1.89, 95% CI 1.53-2.33), while it had no beneficial effect on embryo implantation rate (IR, RR 1.84, 95% CI 0.84-4.03). The subgroup analysis by administration route showed that both uterine infusion and subcutaneous injection can produce a substantial increase in CPR, with the pooled RRs (95% CI) 1.46 (1.04-2.05) and 2.23 (1.68-2.95), respectively. Nevertheless, most of included RCTs dealt with the RIF subjects, and the pooled analysis of this data showed a higher PR and IR in G-CSF group as compared to that in the control, with the RRs (95% CI) 2.07 (1.64-2.61) and 1.52 (1.08-2.14), respectively. Egger regression test did not demonstrate any significance for the publication bias. CONCLUSION: G-CSF administration has a beneficial role on the clinical outcome after embryo transfer by both routes of local infusion and systematic administration, especially for the cases with RIF. Further RCTs are needed to investigate the role of G-CSF in thin endometrium patients.


Assuntos
Transferência Embrionária/métodos , Fertilização In Vitro/métodos , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Infertilidade Feminina/tratamento farmacológico , Adulto , Feminino , Fator Estimulador de Colônias de Granulócitos/farmacologia , Humanos , Infertilidade Feminina/patologia , Gravidez
5.
BMC Neurol ; 18(1): 83, 2018 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-29895279

RESUMO

BACKGROUND: The plaques at the dorsal or lateral wall of basilar artery (BA) are associated with pontine infarcts. We sought to explore the correlations between vertebrobasilar artery geometry and BA plaque locations. METHODS: We retrospectively analyzed the imaging and clinical data of 84 patients with BA atherosclerosis. On three-dimensional time-of-flight images, a side to side diameter difference of bilateral vertebral artery (VA) and BA bending were assessed. The vertebrobasilar artery geometry was qualitatively classified into four basic configurations: Walking, Tuning Fork, Dominant-Lambda, and Hypoplasia-Lambda. On high-resolution magnetic resonance imaging, the plaques were categorized based on the involvement of the ventral, dorsal, or lateral sides of BA wall. The relationships between vertebrobasilar artery geometry parameters and plaque locations were analyzed. RESULTS: Left VA dominance was identified in 28(33%) patients, and right VA dominance in 22(26%) patients. BA bending were detected in 49 patients. There were no significant correlations between the diameter difference/ratio of VA diameters and plaque locations, or between BA bending and plaque locations. BA plaques were evenly distributed in the vertebrobasilar arteries with Tuning Fork and Dominant-Lambda configurations. In Hypoplasia-Lambda group, however, plaques were more frequently located at the dorsal wall (58.57%) than at the ventral (14.43%) and lateral wall (26.71%; P = 0.001). In Walking group, the plaques more likely occurred at the lateral (49.79%) and dorsal (35.07%) wall than at the ventral wall (14.86%, P = 0.02). CONCLUSIONS: The geometric configurations of vertebrobasilar artery strongly influence the BA plaque locations. Further prospective studies are warranted to testify whether Hypoplasia-Lambda and Walking configurations are independent risk factors for pontine infarcts.


Assuntos
Aterosclerose/patologia , Artéria Basilar/patologia , Imagem por Ressonância Magnética/métodos , Placa Aterosclerótica/patologia , Artéria Vertebral/patologia , Idoso , Aterosclerose/diagnóstico por imagem , Artéria Basilar/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico por imagem , Estudos Prospectivos , Estudos Retrospectivos , Artéria Vertebral/diagnóstico por imagem
6.
BMC Neurol ; 17(1): 216, 2017 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-29233158

RESUMO

BACKGROUND: In this retrospective study, we investigated the main pathogenesis of the two types of isolated pontine infarction: paramedian pontine infarcts (PPIs) and small deep pontine infarcts (SDPIs). METHODS: Acute ischemic stroke patients, comprising 117 PPI patients and 40 SDPI patients, were enrolled. High-resolution magnetic resonance imaging (HR-MRI) and routine MRI sequences were performed for each patient, and clinical data were collected. The following brain small vessel disease (SVD) features of the MRI scans were each rated (0 or 1) separately: asymptomatic lacunar infarcts, white matter lesions (WMLs), deep and infratentorial cerebral microbleeds (CMBs), and enlarged perivascular spaces in the basal ganglia. The ratings were also summed in an ordinal "SVD score" (range: 0-4). The difference in the SVD score between the PPI and SDPI groups was determined. The presence and location of basilar artery (BA) atherosclerotic plaques (based on HR-MRI) in the two groups was evaluated. RESULTS: There was a significant difference in the total SVD score and three of the four independent SVD features (asymptomatic lacunar infarcts, WMLs, and deep and infratentorial CMBs) between the two groups. The prevalence of BA plaques relevant to the infarcts in the PPI group was significantly higher than that in the SDPI group, whereas the prevalence of plaques irrelevant to the infarcts was similar between the two groups. The degree of BA stenosis was slightly higher in the PPI group than in the SDPI group. Diabetes mellitus was much more prevalent in the PPI group. The National Institute of Health Stroke Scale score was higher in the PPI group, which is in accordance with the larger infarct size in the PPI group. CONCLUSION: BA atherosclerosis may be the major cause of PPI, while SVD may be the main mechanism underlying SDPI. HR-MRI combined with the total SVD score should be helpful to explore the pathogenesis underlying isolated pontine infarctions, especially in cases involving low-grade BA stenosis.


Assuntos
Aterosclerose/complicações , Infartos do Tronco Encefálico/etiologia , Ponte/patologia , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/diagnóstico por imagem , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/patologia , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Ponte/diagnóstico por imagem , Estudos Retrospectivos , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/patologia
7.
Ann Transl Med ; 5(16): 319, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28861416

RESUMO

BACKGROUND: Using high-resolution magnetic resonance imaging (HRMRI), we sought to investigate the underlying etiology of intracranial stenosis in young patients. METHODS: We retrospectively studied 122 Chinese young adult patients (from 18 to 45 years old, mean age 36.2±7.5 years) with unilateral middle cerebral artery (MCA) stenosis based on a prospectively established HRMRI database. The eccentricity, degree of stenosis, and remodeling types of MCA lesions were analyzed. The MCA lesions were classified as eccentric (presumed atherosclerosis) or concentric stenosis (presumed non-atherosclerosis). The clinical data and vessel wall properties were compared between the patients >35 years old and the patients ≤35 years old. RESULTS: Eccentric stenosis was observed in 98 (80.3%) patients and concentric stenosis in 24 (19.7%) patients. The patients with eccentric stenosis were older (37.5±6.8 vs. 31.4±8.4 years old, P<0.001) and more likely had atherosclerosis risk factors (56.1% vs. 25.0%, P=0.006). The patients >35 years old had higher prevalence (90.1% vs. 66.7%, P=0.001) of eccentric stenosis and atherosclerosis factors (60.6% vs. 35.3%, P=0.006) than the patients ≤35 years old. Most of the patients with concentric stenosis were ≤35 years old (17/24, 70.8%) and were female (16/24, 66.7%). Binary Logistic analysis suggested smoking (OR =3.171; 95% CI, 1.210-8.314) and remodeling ratio (OR =1.625; 95% CI, 1.001-2.636) were independent predictive factors for symptomatic stenosis. CONCLUSIONS: Atherosclerosis is the most common cause of intracranial stenosis in Chinese young patients. Non-atherosclerosis disease is an important etiology in young female, especially in the patients aged 35 years old or younger.

8.
Chemosphere ; 181: 433-439, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28458218

RESUMO

Forty-eight surface sediments were collected from three mangrove wetlands in the Pearl River Estuary (PRE) of South China to investigate the distribution of organophosphorus flame retardants (OPFRs) and the relationship between OPFRs and microbial community structure determined by phospholipid fatty acid. Concentrations of ΣOPFRs in mangrove sediments of the PRE ranged from 13.2 to 377.1 ng g-1 dry weight. Levels of ΣOPFRs in mangrove sediments from Shenzhen and Guangzhou were significantly higher than those from Zhuhai, indicating that OPFRs were linked to industrialization and urbanization. Tris(chloropropyl)phosphate was the predominant profile of OPFRs in mangrove sediments from Shenzhen (38.9%) and Guangzhou (35.0%), while the composition profile of OPFRs in mangrove sediments from Zhuhai was dominated by tris(2-chloroethyl) phosphate (25.5%). The mass inventories of OPFRs in the mangrove sediments of Guangzhou, Zhuhai and Shenzhen were 439.5, 133.5 and 662.3 ng cm-2, respectively. Redundancy analysis revealed that OPFRs induced a shift in the structure of mangrove sediment microbial community and the variations were significantly correlated with tris(1,3-dichloro-2-propyl)phosphate and tris(2-butoxyethyl) phosphate.


Assuntos
Retardadores de Chama , Áreas Alagadas , Anticorpos Fosfo-Específicos/análise , China , Estuários , Retardadores de Chama/análise , Sedimentos Geológicos/química , Sedimentos Geológicos/microbiologia , Fenômenos Microbiológicos , Organofosfatos/análise , Compostos Organofosforados/análise
9.
BMC Neurol ; 17(1): 8, 2017 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-28068949

RESUMO

BACKGROUND: The underlying pathophysiology of BA distribution is unclear and intriguing. Using high-resolution magnetic resonance imaging (HR-MRI), we sought to explore the plaque distribution of low-grade basilar artery (BA) atherosclerosis and its clinical relevance. METHODS: We retrospectively analyzed the imaging and clinical data of 61 patients with low-grade atherosclerotic BA stenosis (<50%). On HR-MRI, the plaques were categorized based on the involvement of the ventral, dorsal, or lateral sides of BA wall. A culprit plaque was defined if it was on the same slice or neighboring slices of symptomatic pontine infarcts and played a probable causal role (dorsal plaques with median pontine infarcts or lateral plaques with ipsilateral pontine infarcts). The relationships between plaque distribution and clinical presentations were analyzed. RESULTS: Twenty-five symptomatic and thirty-six asymptomatic BAs with 752 HR-MRI image slices were studied. The average length of BA atherosclerosis plaques was 12.16 ± 5.61mm (10.30 ± 6.44mm in symptomatic and 13.46 ± 7.03mm in asymptomatic patients, p = 0.079). The plaque distribution was similar at ventral (29.0%), dorsal (37.6%) and lateral walls (33.1%). The BA plaques in symptomatic patients were more frequently located at the dorsal (42.5%) and lateral (41.2%) walls than at the ventral walls (16.1%; P < 0.05). Compared with symptomatic patients, asymptomatic patients more likely had their plaques distributed at the ventral walls (P = 0.022). Culprit plaques were observed in 85.0% (17/20) pontine infarcts in symptomatic patients and only 14.3% (2/14) silent pontine infarcts in asymptomatic patients (p < 0.001). CONCLUSIONS: Low-grade BA atherosclerosis has a long distribution and evenly involves ventral, dorsal and lateral walls. The plaques at dorsal and lateral walls are associated with symptomatic pontine infarcts but not with silent infarcts.


Assuntos
Aterosclerose/patologia , Artéria Basilar/patologia , Placa Aterosclerótica/patologia , Insuficiência Vertebrobasilar/patologia , Idoso , Aterosclerose/diagnóstico por imagem , Artéria Basilar/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico por imagem , Ponte/patologia , Estudos Retrospectivos , Insuficiência Vertebrobasilar/diagnóstico por imagem
10.
J Neurol Sci ; 369: 181-184, 2016 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-27653886

RESUMO

INTRODUCTION: We sought to incorporate high-resolution magnetic resonance imaging (HRMRI) into the diagnostic process of intracranial atherosclerosis associated moyamoya syndrome in adult patients. METHODS: From March 2013 to March 2014, HRMRI was consecutively performed on adult patients with angiographic moyamoya. The patients were classified as moyamoya - plaques (MMD-P) if a plaque could be identified or as moyamoya - no plaques (MMD-NP) if a plaque could not be identified. The angiography, HRMRI findings and atherogenic risk factors of these patients were analyzed. RESULTS: Fifty-one patients (mean age 39±9, 20 males) were enrolled. On traditional angiography, probable intracranial atherosclerosis was identified in 5 patients, no definite diagnosis in 12 patients, and moyamoya disease in 34 patients. On HRMRI, 15 out of 32 patients with risk factors and 4 out of 19 patients without risk factors were found to have plaques and were diagnosed as MMD-P, while the other 32 patients were diagnosed as MMD-NP. The MMD-P patients were more likely to be older (P=0.033) and male (P=0.0353) and were less likely to have cerebral hemorrhage (P=0.0066) and a history of disease progression (P=0.0012). CONCLUSIONS: Our study suggests that HRMRI can help diagnose intracranial atherosclerosis more accurately in moyamoya disease patients with atherogenic risk factors. The distinct clinical features between MMD-P and MMD-NP patients suggest different underlying pathophysiology and therefore potentially different treatment strategies.


Assuntos
Aterosclerose/complicações , Aterosclerose/diagnóstico por imagem , Vasos Sanguíneos/diagnóstico por imagem , Doença de Moyamoya/complicações , Doença de Moyamoya/diagnóstico por imagem , Adulto , Angiografia Digital , Vasos Sanguíneos/patologia , Distribuição de Qui-Quadrado , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
11.
Neurology ; 86(21): 1957-63, 2016 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-27164677

RESUMO

OBJECTIVE: In this study, we sought to examine the prevalence and clinical relevance of deep tiny flow voids (DTFV) in patients with steno-occlusive middle cerebral artery (MCA) disease on high-resolution MRI (HRMRI). METHODS: We retrospectively reviewed the HRMRI and clinical data of 477 patients with MCA steno-occlusive disease. The presence and distribution of DTFV, defined as 3 or more flow voids along the affected MCA on at least 2 consecutive T2-weighted image slices on HRMRI, were observed. The relationships among DTFV, the degree of stenosis (mild <50%, moderate 50%-70%, severe 70%-99%, and occlusion), and infarctions were analyzed. To clarify the difference between DTFV and moyamoya collaterals, we compared the HRMRI findings of the patients with DTFV and 102 patients with moyamoya disease. RESULTS: The prevalence of DTFV was 1.4% in mild stenosis, 12.8% in moderate stenosis, 40.6% in severe stenosis, and 50.7% in MCA occlusions. Of the 112 patients with DTFV, 57 (50.9%) had all 4 quadrants (superior, inferior, dorsal, and ventral sides) of the MCA involved. DTFV were more common in asymptomatic patients than in symptomatic patients with severe stenosis (49.3% vs 30.9%, p = 0.025) and occlusions (68.0% vs 41.7%, p = 0.033). Obvious flow voids in the basal ganglia region were observed in 58 patients (56.9%) with moyamoya disease but in none of the patients with DTFV (p < 0.001). CONCLUSIONS: DTFV are common in patients with severe steno-occlusive MCA disease, especially in asymptomatic patients. We hypothesize that DTFV originate from new vessel network formation in response to chronic cerebral ischemia.


Assuntos
Infarto da Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Angiografia Cerebral , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/epidemiologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Infarto da Artéria Cerebral Média/epidemiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doença de Moyamoya/diagnóstico por imagem , Doença de Moyamoya/epidemiologia , Variações Dependentes do Observador , Prevalência , Estudos Prospectivos , Estudos Retrospectivos
12.
Eur J Radiol ; 85(4): 803-7, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26971427

RESUMO

PURPOSE: To evaluate the feasibility of high-resolution 3D CUBE T1WI for intracranial vessel wall imaging. METHODS: High-resolution 3D CUBE T1 weighted intracranial vessel wall images (0.4 mm × 0.4 mm × 0.4 mm) of 50 patients were retrospectively evaluated. A 5-point scale (1 poor, 5 excellent) was used to score the imaging quality for displaying the vessel wall of every intracranial artery segments. The inter-observer and intra-observer reproducibility of identifying plaques, intraplaque hemorrhage/luminal thrombosis, and wall enhancement were calculated. RESULTS: Totally 893 artery segments were evaluated. 3D CUBE T1WI displayed the arteries wall and lumen clearly, with the highest score (4.920 ± 0.837) for the C6-7 segments and the lowest (3.370 ± 1.107) for the C3 segments of the internal carotid artery (ICA). Both intra-observer and inter-observer reproducibility were high for identification of normal walls (κ=0.928, 95% confidence interval [CI] 0.891-0.954; κ=0.911, CI 0.868-0.940), plaque (κ=0.924, CI 0.884-0.954; κ=0.907, CI 0.866-0.943), luminal thrombosis (κ=1.000, CI 1.000-1.000; κ=1.000, CI 1.000-1.000), and wall enhancement (κ=1.000, CI 1.000-1.000; κ=0.914, CI 0.863-0.961). CONCLUSIONS: High-resolution 3D CUBE T1WI displayed intracranial wall and lumen clearly, and detected intracranial artery abnormalities with high reproducibility.


Assuntos
Angiografia Cerebral/métodos , Imagem Tridimensional/métodos , Angiografia por Ressonância Magnética/métodos , Adulto , Idoso , Artéria Basilar/patologia , Artéria Carótida Interna/patologia , Estenose das Carótidas/diagnóstico , Angiografia Cerebral/estatística & dados numéricos , Meios de Contraste , Estudos de Viabilidade , Feminino , Gadolínio DTPA , Humanos , Aumento da Imagem/métodos , Processamento de Imagem Assistida por Computador/métodos , Processamento de Imagem Assistida por Computador/estatística & dados numéricos , Imagem Tridimensional/estatística & dados numéricos , Doenças Arteriais Intracranianas/diagnóstico , Trombose Intracraniana/diagnóstico , Angiografia por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neuroimagem/métodos , Neuroimagem/estatística & dados numéricos , Placa Aterosclerótica/diagnóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Artéria Vertebral/patologia
13.
Seizure ; 29: 1-3, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26076836

RESUMO

PURPOSE: Recently, a novel multi-model monitor has been available, which integrates real-time signals of transcranial Doppler (TCD) and video-EEG (vEEG) into one workstation. We sought to test the feasibility of this device in detecting neurovascular coupling in patients with epilepsy. METHOD: Cerebral blood flow velocity (CBFV) of bilateral middle cerebral arteries and vEEG during seizure episodes were recorded simultaneously in 12 patients (age 17-58 years) with partial epilepsies. The correlations between vEEG and CBFV findings were analyzed. RESULTS: Eleven seizure episodes were detected in 5 patients. Of them, bilateral CBFV increase with interhemispheric asymmetry was observed in 4 seizure episodes of 3 patients. EEG abnormalities preceded CBFV increase by 1-3s at the onset of a seizure. In a patient with bilateral middle cerebral artery stenosis, no apparent CBFV changes were detected during 2 of 3 seizure episodes. Another patient with previous frontal hemorrhage displayed CBFV increase without interhemispheric asymmetry during 4 seizure episodes. CONCLUSION: It is feasible to evaluate neurovascular coupling with good temporal correlation in patients with frequent seizure episodes by real-time TCD-vEEG monitoring.


Assuntos
Encéfalo/fisiopatologia , Eletroencefalografia/métodos , Epilepsia/fisiopatologia , Monitorização Neurofisiológica/métodos , Acoplamento Neurovascular/fisiologia , Ultrassonografia Doppler Transcraniana/métodos , Adolescente , Adulto , Hemorragia Cerebral/fisiopatologia , Constrição Patológica/fisiopatologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/fisiopatologia , Convulsões/fisiopatologia , Fatores de Tempo , Gravação em Vídeo/métodos , Adulto Jovem
15.
Ann Transl Med ; 2(8): 73, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25333048
16.
Ann Transl Med ; 2(8): 74, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25333049

RESUMO

BACKGROUND AND PURPOSE: Three dimensional (3D) printing techniques for brain diseases have not been widely studied. We attempted to 'print' the segments of intracranial arteries based on magnetic resonance imaging. METHODS: Three dimensional magnetic resonance angiography (MRA) was performed on two patients with middle cerebral artery (MCA) stenosis. Using scale-adaptive vascular modeling, 3D vascular models were constructed from the MRA source images. The magnified (ten times) regions of interest (ROI) of the stenotic segments were selected and fabricated by a 3D printer with a resolution of 30 µm. A survey to 8 clinicians was performed to evaluate the accuracy of 3D printing results as compared with MRA findings (4 grades, grade 1: consistent with MRA and provide additional visual information; grade 2: consistent with MRA; grade 3: not consistent with MRA; grade 4: not consistent with MRA and provide probable misleading information). If a 3D printing vessel segment was ideally matched to the MRA findings (grade 2 or 1), a successful 3D printing was defined. RESULTS: Seven responders marked "grade 1" to 3D printing results, while one marked "grade 4". Therefore, 87.5% of the clinicians considered the 3D printing were successful. CONCLUSIONS: Our pilot study confirms the feasibility of using 3D printing technique in the research field of intracranial artery diseases. Further investigations are warranted to optimize this technique and translate it into clinical practice.

17.
Ann Transl Med ; 2(8): 75, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25333050

RESUMO

BACKGROUND AND PURPOSE: High signals within occluded vessels on T1-weighted fat-suppressed images (HST1) are highly suggestive of luminal thrombosis. We sought to investigate the feasibility of in vivo identification of luminal thrombosis in middle cerebral artery (MCA) occlusions using high-resolution magnetic resonance imaging (HR-MRI). METHODS: We retrospectively reviewed the HR-MRI data of 25 patients with unilateral symptomatic MCA occlusion. HST1 were defined as an area of high signal within the cross-section of occluded MCA, the intensity of which was >150% of the signal of adjacent muscles. The prevalence of HST1 and their relationship to infarct sizes and infarct patterns were analyzed. RESULTS: The average time from stroke onset to HR-MRI examination was 9±6 days. There were 18 (72%) occluded vessels with HST1 on HR-MRI. HST1 were observed in 5/7 patients with a large territory infarct (≥1/3 MCA distribution) and 13/18 patients without (P=0.37). In the patients with non-large territory infarcts, the presence of HST1 was similar in those with and without border zone infarcts (9/13 vs. 4/5, P=0.42). CONCLUSIONS: It's feasible to in vivo identify luminal thrombosis in occluded MCA. HR-MRI is a potentially powerful tool for investigating the mechanisms of stroke due to MCA occlusions.

18.
Ann Transl Med ; 2(8): 76, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25333051

RESUMO

BACKGROUND: Physicians' adherence to stroke guidelines is becoming a critical part of public stroke care system. The objective of this national survey was to examine Chinese physicians' awareness of the guidelines in secondary stroke prevention. METHODS: This is a non-commercial and no-incentive internet survey. Respondents were asked to perform a self-examination of 13 questions regarding their stroke practice. Their awareness of stroke guidelines, preference for Chinese traditional herbs (CTH), and patients' expense for stroke treatment were surveyed and compared between physicians from community and from tertiary hospitals using univariate analysis and logistic regression. RESULTS: A total of 8,581 physicians (70.1% from community hospitals) responded to the survey. Only 32.1% physicians considered risk factors control necessary for stroke. For the treatments of symptomatic carotid stenosis, only 10.4% physicians selected carotid endarterectomy and anti-platelet plus controlling stroke risk factors. Only 21.45% physicians selected warfarin anticoagulation for stroke patients with atrial fibrillation. In contrast, a high percentage (64.56%) of physicians had positive attitude towards CTH. Compared with those from tertiary hospitals, community physicians were more likely unaware of the guidelines and preferred CTH. Those who prescribed CTH reported more patients' cost (P<0.001, OR 1.78, 95% CI, 1.55-2.04) than who didn't. CONCLUSIONS: There is a very low awareness of stroke guidelines in Chinese community physicians. A well-organized continuing stroke-guidelines education should be an essential part of public stroke-care system in China. Also, more well-designed clinical trials are required to establish the safety and effectiveness of CTH.

19.
Ann Transl Med ; 2(8): 77, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25333052

RESUMO

OBJECTIVE: The aim of this study was to describe the clinical and radiological findings of patients with moyamoya syndrome and Graves' disease. Possible mechanisms predisposing these individuals to ischemic stroke are discussed. METHODS: We retrospectively analyzed 12 consecutive patients with both moyamoya syndrome and Graves' disease. Moyamoya vasculopathy was diagnosed by digital subtract angiography or magnetic resonance angiography (MRA). The clinical characteristics, laboratory data, vascular radiological characteristics and outcome were reported. RESULTS: All patients were female and mean age was 33.33±12.65 years. Stenosis or occlusion of bilateral terminal internal carotid artery and/or proximal anterior/middle cerebral arteries was found in nine patients. Among them, three patients displayed asymmetrical stenosis. In addition, there were three patients with probable unilateral moamoya syndrome. Eleven patients presented with ischemic stroke and/or transient ischemic attack (TIA) and one with dizziness. Thyroid function tests demonstrated elevated thyroid hormone levels and suppressed thyroid stimulating hormone levels in all the patients with ischemic events. All patients received anti-thyroid therapy and two had recurrent ischemic attack after drug withdrawal. CONCLUSIONS: Moyamoya syndrome associated Graves' disease often presented with asymmetric stenosis or occlusion. We hypothesize cerebrovascular hemodynamic changes due to thyrotoxicosis contribute to the ischemic events.

20.
Ann Transl Med ; 2(8): 78, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25333053

RESUMO

Large arteries are the upstream vessels of cerebral small vessels, through which blood flow is transported. Since structurally and functionally connected, large arteries and cerebral small vessels are physiologically correlated. However, large vessel diseases and small vessel diseases are investigated separately in old era. More and more evidence suggested they are inter-mingled and should be considered together. When a deep brain lacunar infarct occurs, it is of necessity to perform high-resolution magnetic resonance imaging to screen intracranial large artery atherosclerosis, which requires more intensified treatment. It may be the appropriate strategy to keep longitudinal monitoring of the trend of large artery stiffness and give intervention such as aggressive blood pressure control to prevent cerebral white matter lesions (WMLs) occurrence or progression. More data from cohort studies are required, especially the biomarkers of "diseased" artery stiffness. In the future, when randomized clinical trials are performed, the end points should take both large artery and small vessel damages into consideration. The two diseases are in the same "boat", i.e., the pan-vessel diseases. In order to save one, we have to save both.

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