Automated Brain MRI Volumetry Differentiates Early Stages of Alzheimer's Disease From Normal Aging.

As an enrichment strategy supplemented by the diagnostic framework of subjective cognitive decline (SCD), SCD plus identifies features that may increase the likelihood of including future-Alzheimer's disease (AD) patients. This study aimed to identify the shared and distinct atrophy patterns between patients specified by SCD plus and amnestic mild cognitive impairment (aMCI, a prodromal stage of AD) and to investigate the extent that automated brain magnetic resonance imaging (MRI) volumetry can differentiate patients with SCD from normal control (NC) participants and patients with aMCI. We acquired structural MRI brain scans from 44 patients with aMCI, 40 patients with SCD (who met the major criteria of SCD plus), and 48 NC participants. Automatic brain segmentation was performed to quantify the volumetric measures of cognitive-relevant areas. These volumetric measures were compared across the 3 groups with analysis of variance. In addition, we performed support vector machine analyses using volumetric measures of single regions or multiple regions to further evaluate the sensitivity of automated brain volumetry in differentiating a specific group from another. The atrophy patterns in patients with aMCI and SCD were similar. Using the regional volumetric measures, we achieved high performance in differentiating aMCI and SCD from NCs (average classification accuracy [ACC] > 90%). However, the performance was not ideal when differentiating aMCI from SCD (ACC < 63%). In conclusion, patients with SCD specified by SCD plus presented similar atrophy patterns as patients with aMCI, which was distinguishable from NC participants. Future studies should aim to associate the atrophy patterns of SCD with possible conversion to aMCI or AD in a longitudinal design.

Topological Properties of Large-Scale Cortical Networks Based on Multiple Morphological Features in Amnestic Mild Cognitive Impairment.

Previous studies have demonstrated that amnestic mild cognitive impairment (aMCI) has disrupted properties of large-scale cortical networks based on cortical thickness and gray matter volume. However, it is largely unknown whether the topological properties of cortical networks based on geometric measures (i.e., sulcal depth, curvature, and metric distortion) change in aMCI patients compared with normal controls because these geometric features of cerebral cortex may be related to its intrinsic connectivity. Here, we compare properties in cortical networks constructed by six different morphological features in 36 aMCI participants and 36 normal controls. Six cortical features (3 volumetric and 3 geometric features) were extracted for each participant, and brain abnormities in aMCI were identified by cortical network based on graph theory method. All the cortical networks showed small-world properties. Regions showing significant differences mainly located in the medial temporal lobe and supramarginal and right inferior parietal lobe. In addition, we also found that the cortical networks constructed by cortical thickness and sulcal depth showed significant differences between the two groups. Our results indicated that geometric measure (i.e., sulcal depth) can be used to construct network to discriminate individuals with aMCI from controls besides volumetric measures.

Machine learning based on the EEG and structural MRI can predict different stages of vascular cognitive impairment.

Background: Vascular cognitive impairment (VCI) is a major cause of cognitive impairment in the elderly and a co-factor in the development and progression of most neurodegenerative diseases. With the continuing development of neuroimaging, multiple markers can be combined to provide richer biological information, but little is known about their diagnostic value in VCI. Methods: A total of 83 subjects participated in our study, including 32 patients with vascular cognitive impairment with no dementia (VCIND), 21 patients with vascular dementia (VD), and 30 normal controls (NC). We utilized resting-state quantitative electroencephalography (qEEG) power spectra, structural magnetic resonance imaging (sMRI) for feature screening, and combined them with support vector machines to predict VCI patients at different disease stages. Results: The classification performance of sMRI outperformed qEEG when distinguishing VD from NC (AUC of 0.90 vs. 0,82), and sMRI also outperformed qEEG when distinguishing VD from VCIND (AUC of 0.8 vs. 0,0.64), but both underperformed when distinguishing VCIND from NC (AUC of 0.58 vs. 0.56). In contrast, the joint model based on qEEG and sMRI features showed relatively good classification accuracy (AUC of 0.72) to discriminate VCIND from NC, higher than that of either qEEG or sMRI alone. Conclusion: Patients at varying stages of VCI exhibit diverse levels of brain structure and neurophysiological abnormalities. EEG serves as an affordable and convenient diagnostic means to differentiate between different VCI stages. A machine learning model that utilizes EEG and sMRI as composite markers is highly valuable in distinguishing diverse VCI stages and in individually tailoring the diagnosis.

Artificial intelligence for healthcare and medical education: a systematic review.

BACKGROUND: Human society has entered the age of artificial intelligence, medical practice and medical education are undergoing profound changes. Artificial intelligence (AI) is now applied in many industries, particularly in healthcare and medical education, where it deeply intersects. The purpose of this paper is to overview the current situation and problems of "AI+medicine/medical" education and to provide our own perspective on the current predicament. METHODS: We searched PubMed, Embase, Cochrane and CNKI databases to assess the literature on AI+medical/medical education from 2017 to July 2022. The main inclusion criteria include literature describing the current situation or predicament of "AI+medical/medical education". RESULTS: Studies have shown that the current application of AI in medical education is focused on clinical specialty training and continuing education, with the main application areas being radiology, diagnostics, surgery, cardiology, and dentistry. The main role is to assist physicians to improve their efficiency and accuracy. In addition, the field of combining AI with medicine/medical education is steadily expanding, and the most urgent need is for policy makers, experts in the medical field, AI and education, and experts in other fields to come together to reach consensus on ethical issues and develop regulatory standards. Our study also found that most medical students are positive about adding AI-related courses to the existing medical curriculum. Finally, the quality of research on "AI+medical/medical education" is poor. CONCLUSION: In the context of the COVID-19 pandemic, our study provides an innovative systematic review of the latest "AI+medicine/medical curriculum". Since the AI+medicine curriculum is not yet regulated, we have made some suggestions.

Study of gray matter atrophy pattern with subcortical ischemic vascular disease-vascular cognitive impairment no dementia based on structural magnetic resonance imaging.

Objective: This study explored the structural imaging changes in patients with subcortical ischemic vascular disease (SIVD)-vascular cognitive impairment no dementia (VCIND) and the correlation between the changes in gray matter volume and the field of cognitive impairment to provide new targets for early diagnosis and treatment. Methods: Our study included 15 patients with SIVD-normal cognitive impairment (SIVD-NCI), 63 with SIVD-VCIND, 26 with SIVD-vascular dementia (SIVD-VD), and 14 normal controls (NC). T1-weighted images of all participants were collected, and DPABI and SPM12 software were used to process the gray matter of the four groups based on voxels. Fisher's exact test, one-way ANOVA and Kruskal-Wallis H test were used to evaluate all clinical and demographic data and compare the characteristics of diencephalic gray matter atrophy in each group. Finally, the region of interest (ROI) of the SIVD-VCIND was extracted, and Pearson correlation analysis was performed between the ROI and the results of the neuropsychological scale. Results: Compared to the NC, changes in gray matter atrophy were observed in the bilateral orbitofrontal gyrus, right middle temporal gyrus, superior temporal gyrus, and precuneus in the SIVD-VCIND. Gray matter atrophy was observed in the left cerebellar region 6, cerebellar crural region 1, bilateral thalamus, right precuneus, and calcarine in the SIVD-VD. Compared with the SIVD-VCIND, gray matter atrophy changes were observed in the bilateral thalamus in the SIVD-VD (p < 0.05, family-wise error corrected). In the SIVD-VCIND, the total gray matter volume, bilateral medial orbital superior frontal gyrus, right superior temporal gyrus, middle temporal gyrus, and precuneus were positively correlated with Boston Naming Test score, whereas the total gray matter volume, right superior temporal gyrus, and middle temporal gyrus were positively correlated with overall cognition. Conclusion: Structural magnetic resonance imaging can detect extensive and subtle structural changes in the gray matter of patients with SIVD-VCIND and SIVD-VD, providing valuable evidences to explain the pathogenesis of subcortical vascular cognitive impairment and contributing to the early diagnosis of SIVD-VCIND and early warning of SIVD-VD.

Effects of white matter lesion grading on the cognitive function of patients with chronic alcohol dependence.

BACKGROUND: Alcohol dependence has become a major problem that poses a serious threat to public health. Long-term heavy alcohol consumption can lead to brain functional disorders. This study aimed to investigate the relationship of the severity of cerebral white matter lesions (WMLs), serum neurofilament light (NfL) and inflammatory factors, tumour necrosis factor alpha (TNF-α) and Interleukin-1ß (IL-1ß), with the cognitive function of patients with alcohol dependence. METHODS: A total of 118 patients were enrolled in this prospective study, and divided into alcohol-dependent and non-alcohol-dependent groups. The severity of WMLs was assessed using the Fazekas scale based on magnetic resonance imaging analysis. The expression levels of NfL, TNF-α and IL-1ß in the serum of the subjects were measured by enzyme-linked immunosorbent assay. The cognitive function and psychological status of the patients were assessed using the Minimum Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA). The severity of WMLs and the expression levels of serum NfL, TNF-α and IL-1ß in alcohol-dependent patients were analysed for their influence on cognitive function. This clinical trial was approved by China Clinical Trials Registry, and the trial number is ChiCTR2200066057 (http://www.chictr.org.cn/searchproj.aspx). RESULTS: The score of Fazekas scale was higher, and the MMSE score and MoCA score were lower in the alcohol-dependent group than those in the non-alcohol-dependent group. Moreover, the Fazekas score of the alcohol-dependent group was negatively correlated with the MMSE and MoCA scores. The serum NfL, TNF-α and IL-1ß levels were higher in the alcohol-dependent group than in the non-alcohol-dependent group, and the serum NfL, TNF-α and IL-1ß levels in the alcohol-dependent group were negatively correlated with the MMSE and MoCA scores. CONCLUSION: Alcohol-dependent patients have more severe cerebral WMLs and significant cognitive impairment, particularly in visuospatial and executive functions, attention, calculation, abstraction, delayed recall and orientation. Serum NfL, TNF-α and IL-1ß may be used as biomarkers to assess alcohol related cognitive decline.

Study on the Interaction between the Characteristics of Retinal Microangiopathy and Risk Factors for Cerebral Small Vessel Disease.

Objective: This study was designed to explore the characteristics of retinal microangiopathy in patients with cerebral small vessel disease (CSVD) and clarify its interaction with the risk factors for CSVD. Methods: Sixty patients with CSVD and 15 healthy individuals were enrolled. Demographic data, risk factors, and medical history were recorded, and magnetic resonance imaging was performed to detect and analyze the characteristics of retinal microangiopathy in the two groups. The interaction among retinal microangiopathy, vascular risk factors, and total imaging load of CSVD was compared. Results: (1) Hypertension, standard deviation of systolic blood pressure (SBPSD), standard deviation of blood glucose (SDBG), and atherogenic index of plasma (AIP) were independent vascular risk factors for CSVD. (2) Statistically significant differences in hypertension, SBPSD, SDBG, and AIP were observed between the two groups in terms of the total imaging burden of CSVD (p < 0.05). (3) Multivariate logistic linear regression showed that CSVD was associated with a wider central retinal vein equivalent (CRVE) (p = 0.015), a smaller arteriole-to-venule ratio (AVR) (p = 0.001), and a higher incidence of vessel tortuosity (p = 0.027). (4) When the total imaging burden of CSVD ranges from 0 to 4 points, the CRVE is larger, the AVR is smaller, and the incidence of vascular tortuosity is higher, with a statistically significant difference (p < 0.05). (5) The characteristics of retinal microangiopathy were correlated with hypertension, SBPSD, SDBG, and AIP (p < 0.05). (6) An association was observed between the characteristics of retinal microangiopathy and vascular risk factors and the total imaging burden of CSVD (p < 0.05). Conclusions: (1) Hypertension, SBP variability, BG fluctuation, and AIP are independent vascular risk factors for CSVD. (2) Retinal microvessels are changed in patients with CSVD, and venous dilatation, decreased arteriovenous ratio, and vascular tortuosity are the main characteristics of the disease. (3) The characteristics of retinal microangiopathy are interactively correlated with the total imaging load and risk factors for CSVD and can be used as indicators of the severity of CSVD.

The Value of Brain Structural Magnetic Resonance Imaging Combined with APOE--ε4 Genotype in Early Diagnosis and Disease Progression of Senile Vascular Cognitive Impairment No Dementia.

Objective: To explore the value of brain structure magnetic resonance imaging combined with APOE-ε4 genotype in the early diagnosis and disease progression of elderly patients with vascular cognitive impairment no dementia (VCIND). Methods: The first stroke patients admitted to our hospital from March 2017 to December 2018 were collected, including 130 cases of vascular cognitive impairment no dementia (VCIND group) and 50 cases of the control group (NC group). The basic information of all subjects was recorded, and APOE-ε4 alleles of all subjects were detected. The neuropsychological test scale evaluated the cognitive psychology of the subjects, and they were scanned by multi-parameter MRI. After follow-up, VCIND patients were divided into the dementia group and the nondementia group. MRI scans were again performed, and the risk factors of VCIND patients developing dementia were analyzed. Results: Compared with the NC group, patients in the VCIND group had shorter years of education, more patients with hypertension, higher levels of homocysteine (Hcy), and lower cognitive ability. Patients with White Matter Volume (WMV), White Matter Hyperintensity (WMH), Lacunar Infarction (LI), elevated Fazekas scores, and APOE-ε4 gene carriers are more likely to develop VCIND. After 12 months of follow-up, compared with the nondementia group, the number of WMV, WMH, Fazekas scores, and APOE-ε4 gene carriers in the dementia group was significantly increased. In addition, the progression-free survival rate of APOE-ε4 gene carriers was significantly lower than that of nonAPOE-ε4 gene carriers. Conclusion: Years of education, hypertension, high levels of Hcy, elevated WMV, WMH, LI, and Fazekas scores, and carrying the APOE-ε4 gene are risk factors for VCIND in stroke patients. Craniocerebral structural MRI combined with APOE-ε4 genotype has a diagnostic role in the early diagnosis and disease progression of elderly patients with VCIND.

Effect of transverse sinus variation on the clinical outcomes of atherosclerotic anterior circulation infarction.

Background: Hypoplasia of the transverse sinus (TS) is a common anatomical variation. The aim of this study was to investigate the effects of TS variation (i.e., TS hypoplasia) and no variation (i.e., TS symmetry) and their subgroups on the clinical outcomes of patients with atherosclerotic anterior circulation cerebral infarction (CI). Methods: A total of 75 patients were included in the study and were divided into the no TS variation group and the TS variation group. The TS variation group was further divided into the following subgroups: the TS variation with ipsilateral CI group and the TS variation with contralateral CI group. We retrospectively analyzed the correlations of the endpoint events of patients with large atherosclerotic anterior circulation infarction and TS no variant, and subgroups of TS variants. Results: We found that the diameter of the ipsilateral IJV in patients with TS variants were significantly smaller than those without TS variants, which was statistically significant (P<0.05). The differences in primary endpoint events, secondary endpoint events, and responsible vessel stenosis were not statistically significant when comparing the TS variant and no TS variant groups, and the TS variant subgroup (P>0.05). We found statistically significant differences in the National Institute of Health stroke scale (NIHSS) and Modified Rankin Scale (mRS) scores after 90 days of CI between the total anterior circulation infarct (TACI) TS variant group, the ipsilateral CI TS variant group, and the partial anterior circulation infarct (PACI) TS hypoplasia group and the ipsilateral CI TS variant group (P<0.05). There was a statistically significant difference (P<0.05) between the TS variant group with TACI, the TS variant group with ipsilateral CI, and the TS no variant group and the TS variant with contralateral CI group when comparing patients' mRS scores after 90 days of CI. Conclusions: The diameter of the internal jugular vein (IJV) ipsilateral to the TS variant was significantly smaller than that of the TS no variant. Patients with TACI in the TS variant group and one of its subgroups (the TS variant with ipsilateral CI group) had more severe clinical symptoms and a worse prognosis than patients in the same group with PACI.

Correlation between 24-Hour Ambulatory Blood Pressure Variability and White Matter Lesions in Patients with Cerebral Small Vascular Disease: A Cross-Sectional Study.

Objective: The goals of this study are to assess the correlation between 24-hour ambulatory blood pressure (BP) variability and white matter lesions (WML) in patients with cerebral small vascular disease (CSVD) and to provide guidance for the prevention of WML. Methods: A total of 136 patients diagnosed with CSVD and essential hypertension were recruited and divided into two groups. The Fazekas scale was used to quantify the severity of WML. The basic information, BP levels, BP variability, and circadian rhythm changes across these groups were recorded and compared. Results: The control group consisted of 40 subjects without WML (Fazekas score = 0), and the WML group was composed of 96 patients with WML (Fazekas score ≥ 1). Patients in the WML group were then divided into three subgroups: mild WML (n = 43, Fazekas score = 1), moderate WML (n = 24, Fazekas score = 2), and severe WML (n = 29, Fazekas score = 3-4). Age, history of diabetes, and serum uric acid levels were significantly increased between the WML and control groups (P < 0.05). The levels of 24-hour mean diastolic BP (F = 3.158, P = 0.026) and daytime mean systolic BP (F = 3.526, P = 0.017) were significantly increased between the control and WML groups. There was no significant difference in the rhythmic classification of BP among all groups (P > 0.05). An ordered multinomial logistic regression analysis revealed that age, triglyceride levels, and nondipper BP were independent risk factors in WML. Conclusion: Age, history of diabetes, serum uric acid levels, 24-hour mean systolic level, and daily mean systolic BP level were significantly increased between the WML and control groups. Age, triglyceride levels, and nondipper BP were independent risk factors in WML in patients with CSVD, while the 24-hour dynamic blood pressure standard deviation and 24-hour dynamic blood pressure coefficient of variation were not associated with the occurrence of WML.

A narrative review of multimodal imaging of white matter lesions in type-2 diabetes mellitus.

OBJECTIVE: To discuss the relevant studies about the structural and functional changes of the brain in patients with type-2 DM (T2DM) and white matter lesion (WML) in recent years, and to summarize them. BACKGROUND: T2DM is a common metabolic disease with increasing prevalence worldwide. This disease is closely related to central nervous system and vascular disease, and is considered a risk factor for white matter lesions in the brain. Compared to healthy individuals, WML patients with T2DM exhibit changes in brain perfusion, functional networks, nerve fiber structure, and brain tissue metabolism. METHODS: We analyzed recent studies related to structural and functional changes in the brain of patients suffering from T2DM and WML and summarized them. CONCLUSIONS: Multimodal magnetic resonance imaging (MRI) utilizes noninvasive and sensitive imaging techniques to provide multiparametric information in patients with T2DM to help in clinical practice. It features non-invasively and with high sensitivity assess the histomorphological and functional abnormalities of white matter in patients with T2DM using various parameters. We can use multimodal MRI methods to reflect the microscopic damage of neuromyelin structures and pathological changes of neuronal metabolic functions in WML in T2DM patients, and thus speculate the disease progression. This approach can be helpful for the early diagnosis and treatment of patients with such a disease who do not exhibit neurological deficit, to effectively improve their prognosis.

Is laparoscopic liver resection safe for intrahepatic cholangiocarcinoma? A meta-analysis.

BACKGROUND: The use of laparoscopic liver resection for curative surgery of intrahepatic cholangiocarcinoma (ICC) is not well established. Herein, we perform a meta-analysis to compare the differences between laparoscopic liver resection (LLR) and open liver resection (OLR) for ICC. METHODS: Multiple electronic databases were searched and 8 relevant studies containing 552 patients treated by LLR and 2320 treated by OLR were identified. The fixed effects and a random-effects model were used to perform a meta-analysis. RESULTS: Compared with OLR, LLR for ICC was associated with less blood transfusion (7.14% versus 17.11%; OR: 0.32; 95% CI 0.15 to 0.71; P < 0.05), higher R0 resection (85.63% versus 74.69%; OR: 1.48; 95% CI 1.13 to 1.95; P < 0.05), shorter length of stay (LOS) (SMD: -0.40; 95% CI -0.80 to 0.00; P = 0.05), less overall morbidities (20% versus 32.69%; OR: 0.50; 95% CI 0.33 to 0.78; P < 0.05), and less death due to tumor recurrence (22.39% versus 35.48%; OR: 0.50; 95% CI 0.29 to 0.86; P <0.05); but LLR was associated with smaller ICC, fewer major hepatectomies, less lymph node (LN) dissection rate, and inferior 5-year overall survival (OS) (P < 0.05). Duration of operation, blood loss, average LN retrieved, LN metastasis, major morbidities, mortality, tumor recurrence, 3-year OS and disease free survival (DFS), and 5-year DFS were comparable (P >0.05). CONCLUSION: LLR for ICC is in the initial phase of exploration. More evidence is necessary to validate LLR for ICC.

Exosomal miRNA-223-3p as potential biomarkers in patients with cerebral small vessel disease cognitive impairment.

BACKGROUND: Cerebrovascular disease is a common clinical illness. Many patients with cerebrovascular disease can be accompanied by cognitive impairment. The exosomal microRNA (miRNA)-223-3p is related to vascular endothelial injury, synaptic function, inflammatory response, and other mechanisms. In this study, we investigated the levels of plasma exosomal miRNA-223-3p in patients with cerebral small vessel disease (CSVD), in order to determine whether it could be used as a more accessible potential biomarker for the early diagnosis and treatment of CSVD. This study aimed to explore whether the development of cognitive impairment can be explained by differentially expressed miRNA-223-3p by detecting the level of miRNA-223-3p, which is abundant in peripheral blood exosomes related to cognitive impairment in CSVD. METHODS: The three groups of participants included 40 patients with CSVD cognitive impairment (CSVDCI), 38 patients with CSVD, and 35 normal controls (NC). The real-time polymerase chain reaction (RT-PCR) was used to detect the expression level of blood exosomal miRNA-223-3p. In addition, we also studied the relationship between exosomal miRNA-223-3p and blood Hcy and C-reactive protein (CRP). Receiver-operating characteristic (ROC) curve analysis was used to evaluate the diagnostic efficacy of plasma exosomal miRNA-223-3p. RESULTS: The expression of exosomal miRNA-223-3p in CSVD increased, and the expression of miRNA-223-3p increased significantly with the occurrence of cognitive impairment. Exosomal miRNA-223-3p was positively correlated with the expression levels of Hcy and CRP in the blood. CONCLUSIONS: The expression of plasma exosomal miRNA-223-3p is associated with the development of cognitive impairment in patients with CSVD. It may be involved in the pathogenesis of CSVD and cognitive impairment, and can be used as a sensitive predictive biomarker.

The role of laparoscopic surgery in the surgical management of gallbladder carcinoma: A systematic review and meta-analysis.

Previous studies have explored the role of laparoscopic surgery (LS) in the surgical management of gallbladder carcinoma (GBC) and obtained satisfactory outcomes versus conventional open surgery. However, most of them either included a small number of patients or mainly focused on the early-staged lesions. Therefore, their results were less statistical powerful and a more comprehensive evaluation on the role of LS in GBC is warranted. A thorough database searching was performed in PubMed, EMBASE and Cochrane Library for comparative studies between the laparoscopic and open approach in the surgical management of GBC and 18 comparative studies were finally identified. RevMan 5.3 and Stata 13.0 software were used for statistical analyses. Pooled results revealed that patients in the laparoscopic group recovered faster with less intraoperative hemorrhage and less postoperative morbidity. Comparable operative time, overall recurrence rate, R0 resection rate, lymph node yield, intraoperative gallbladder violation rate and postoperative survival outcomes were also acquired. Regarding the debating issue of port-site recurrence, a significantly higher incidence of port-site recurrence was observed in laparoscopic group. However, having excluded studies on incidental gallbladder carcinoma, the subsequent pooled result showed no significant difference. Considering the inherent inconsistency of the surgical indication between laparoscopic and open surgeries and the deficiency of advanced lesions, we drew a conclusion that laparoscopic surgery seems to be only safe and feasible for early- or middle-staged lesions. Upcoming random controlled trials or comparative studies with equivalent surgical indication focused on advanced lesions are warranted for further evaluation.

Application of Hydrogen Proton Magnetic Resonance Technology Combined with Brain Neurometabolite Analysis in the Treatment of Cognitive Impairment Caused by Type 2 Diabetes Mellitus.

This study used hydrogen proton magnetic resonance imaging to detect the changes of white matter and the medial cortex in the prefrontal cortex of patients with type 2 diabetes, analyzed its relationship with cognitive function and blood glucose level, and discussed the recognition of patients with type 2 diabetes from the perspective of brain metabolism. We discuss the neural mechanisms affected by the disorder. The experiment recruited 65 volunteers, including 32 control subjects and 33 patients with type 2 diabetes. All volunteers underwent clinical cognitive function and psychological evaluation, including a simple intelligent mental state examination scale, digital breadth test, Raven intelligence test, Flanker paradigm experiment, connection test, auditory word learning test, depression self-evaluation scale, and anxiety self-rating scale. All subjects underwent multivoxel proton magnetic resonance scanning, and the spectral data were processed and metabolite concentration analysis was completed by Functool software. The detected regions of interest included the bilateral prefrontal white matter and bilateral prefrontal cortex. This study found that the N-acetylaspartate (NAA) and NAA/myo-inositol (MI) of the right prefrontal cortex were reduced, the right prefrontal white matter choline-containing compounds increased, and the MI of the bilateral prefrontal cortex increased in the type 2 diabetes group compared with the control group. The NAA value of the right prefrontal cortex in the type 2 diabetes group was negatively correlated with the glycated hemoglobin concentration. The study found that the right prefrontal cortex NAA value of patients with type 2 diabetes was negatively correlated with the glycated hemoglobin concentration, reflecting that recent blood glucose levels can affect the changes of brain metabolites, and reasonable control of blood glucose can effectively delay brain neurons caused by diabetes.

Imaging Diagnosis of Central Nervous System Damage in Patients with T2DM.

This paper uses resting-state functional magnetic resonance imaging (rs-FMRI) to construct a whole-brain binary functional network through a complex brain network analysis theory based on graph theory to explore the functional network of patients with type 2 diabetes (T2DM). Changes in topological properties and their potential relationships with fasting blood glucose (FBG), glycated haemoglobin (HbAlc), and cognitive function scale, and further explore the diagnostic value of rs-FMRI technology for central nervous system damage in T2DM patients, for clinical diagnosis and treatment Provide objective radiological evidence. In the range of sparsity (Sp) of 0.05 to 0.50 and a step size of 0.01, compared with the random network, the resting brain functional networks in the T2DM group and the HC group have larger clustering coefficients and similar shortest paths. Length and small world index greater than 1, that is, both groups of resting brain functional networks have small world characteristics. The MoCA score of the T2DM group was positively correlated with the node degree (r = 0.400, p = 0.043) and the node efficiency (r = 0.452, p = 0.021) of the right straight back. FBG is positively correlated with the node degree of the left occipital gyrus (r = 0.422, p = 0.023); HbAlc is related to the node degree of the left occipital gyrus (r = 0.372, p = 0.043) and the node degree of the left occipital gyrus (r = 0.382, p = 0.037) was positively correlated with the node intermediary (r = 0.388, p = 0.034) at the back of the right cingulate gyrus. The topological properties of the resting brain function network of T2DM patients with negative MRI findings have changed compared with normal people, indicating that T2DM is an important factor leading to brain function damage, further explaining the rs-fMRI technology and complex brain networks based on graph theory Analysis theory can be used as an effective method to study the changes of brain function in T2DM patients.

Association between plasma exosome neurogranin and brain structure in patients with Alzheimer's disease: a protocol study.

INTRODUCTION: Neurogranin is known to be significantly elevated in patients with Alzheimer's disease (AD) and may be an effective clinical predictor of cognitive decline and neurodegeneration. Amnestic mild cognitive impairment (aMCI) is an intermediate disease state between normal cognitive ageing and dementia, the latter of which can easily revert to AD. There remains significant uncertainty regarding the conversion of aMCI to AD, and therefore, elucidating such progression is paramount to the field of cognitive neuroscience. In this protocol study, we therefore aim to investigate the changes in plasma neurogranin in the early stage of AD and the mechanism thereof regarding the cognitive progression towards AD. METHODS AND ANALYSIS: In this study, patients with aMCI and AD patients (n=70 each) will be recruited at the memory clinic of the Department of Neurology of Hongqi Hospital affiliated with the Mudanjiang Medical University of China. Healthy older controls (n=70) will also be recruited from the community. All subjects will undergo neuroimaging and neuropsychological evaluations in addition to blood collection at the first year and the third year. We hope to identify a new biomarker of cognitive decline associated with AD and characterise its behaviour throughout the progression of aMCI to AD. This work will reveal novel targets for the therapeutic prevention, diagnosis and treatment of AD. The primary outcome measures will be (1) neuropsychological evaluation, including Mini-Mental State Examination, Montreal Cognitive Assessment, Clinical Dementia Rating scale, Shape Trail Test-A&B, Auditory Verbal Learning Test-HuaShan version; (2) microstructural alterations and hippocampal features from MRI scans; and (3) neurogranin levels in the neuronal-derived exosomes from peripheral blood samples. ETHICS AND DISSEMINATION: The ethics committee of the Hongqi Hospital affiliated with the Mudanjiang Medical University of China has approved this study protocol. The results will be published in peer-reviewed journals and presented at national or international scientific conferences. TRIAL REGISTRATION NUMBER: ChiCTR2000029055.

Schwannoma in the hepatoduodenal ligament with portal vein invasion: A case report.

RATIONALE: Schwannomas are mesenchymal tumors with low malignant potential that originate from Schwann cells. They can occur in most parts of the body, such as the head, neck, and extremities. Schwannoma in the hepatoduodenal ligament is extremely rare, and only four cases have been reported in the literature. PATIENT CONCERNS: Herein, we describe a 58-year-old female who presented with right epigastric pain for 10 days. Preoperative computed tomographic (CT) revealed a 4.5 cm × 3.8 cm tumor in the hepatic hilar area. DIAGNOSES: Schwannoma in the hepatoduodenal ligament with portal vein invasion. INTERVENTIONS: Intraoperative findings revealed that the tumor was identified in the hepatoduodenal ligament, and the left branch of the portal vein was compressed. Complete tumor resection with reparation of the portal vein was performed for the patient. Postoperative pathological examination confirmed the final diagnosis of benign schwannoma, characterized by abundant spindle-shaped cells and positive reactivity for S-100 protein. OUTCOMES: The patient had a good prognosis and had no recurrence after 37 months of follow-up. LESSONS: Our case of schwannoma in the hepatoduodenal ligament is unique owing to the portal vein invasion, aimed at helping recognize the difficulty of preoperative diagnosis.

Extended Lymphadenectomy Versus Regional Lymphadenectomy in Resectable Hilar Cholangiocarcinoma.

AIM: The aim of this study is to compare the effects of extended lymphadenectomy (E-LD) and regional lymphadenectomy (R-LD) on outcome after radical resection of hilar cholangiocarcinoma (HCCA). METHODS: Data of 290 patients who underwent radical resection of HCCA were retrospectively analyzed. Demographic characteristics, surgical variables, and tumor and LN characteristics were evaluated for association with survival. RESULTS: A total of 63 patients underwent E-LD. Patients who underwent E-LD were more likely to have portal vein embolization (14.3% vs. 5.7%), radical hepatectomy (36.2% vs. 26.0%), higher proportion of M1 patients (22.2% vs. 5.3%), more lymph nodes (LNs) retrieved (17 vs. 7), and positive common hepatic artery lymph nodes (21.4% vs. 12.6%) when compared with R-LD (all P < 0.05). The Kaplan-Meier curve of overall survival for patients who underwent E-LD indicated improvement over patients who underwent R-LD in M0 (33.39 vs. 21.31 months; P = 0.032) and R0 resection (32.97 vs. 21.02 months; P = 0.044) disease, but not observed in M1 disease (P > 0.05). After propensity score matching, E-LD was not associated with a significant improvement in overall survival (OS) even in all subgroup analysis (all P > 0.05). On multivariable analysis, E-LD was associated with improved overall survival, but not after propensity score matching. CONCLUSION: E-LD is more likely to be performed in higher stage tumors. E-LD significantly increases LN retrieval, thereby preventing under-staging and improving survival prediction. E-LD should not be adopted for HCCA patients with intraoperatively confirmed distant LN metastases. Future studies are required to further assess whether E-LD should be performed in negative celiac, superior mesenteric, and para-aortic lymph node in HCCA patients.

Trajectories of the Hippocampal Subfields Atrophy in the Alzheimer's Disease: A Structural Imaging Study.

BACKGROUND: The hippocampus and hippocampal subfields have been found to be diversely affected in Alzheimer's Disease (AD) and early stages of Alzheimer's disease by neuroimaging studies. However, our knowledge is still lacking about the trajectories of the hippocampus and hippocampal subfields atrophy with the progression of Alzheimer's disease. OBJECTIVE: To identify which subfields of the hippocampus differ in the trajectories of Alzheimer's disease by magnetic resonance imaging (MRI) and to determine whether individual differences on memory could be explained by structural volumes of hippocampal subfields. METHODS: Four groups of participants including 41 AD patients, 43 amnestic mild cognitive impairment (aMCI) patients, 35 subjective cognitive decline (SCD) patients and 42 normal controls (NC) received their structural MRI brain scans. Structural MR images were processed by the FreeSurfer 6.0 image analysis suite to extract the hippocampus and its subfields. Furthermore, we investigated relationships between hippocampal subfield volumes and memory test variables (AVLT-immediate recall, AVLT-delayed recall, AVLT-recognition) and the regression model analyses were controlled for age, gender, education and eTIV. RESULTS: CA1, subiculum, presubiculum, molecular layer and fimbria showed the trend toward significant volume reduction among four groups with the progression of Alzheimer's disease. Volume of left subiculum was most strongly and actively correlated with performance across AVLT measures. CONCLUSION: The trend changes in the hippocampus subfields and further illustrates that SCD is the preclinical stage of AD earlier than aMCI. Future studies should aim to associate the atrophy of the hippocampal subfields in SCD with possible conversion to aMCI or AD with longitudinal design.