OBJECTIVE:To investigate the effect of ultrasound-guided stellate ganglion block (SGB) on cerebral oxygen metabolism and serum S100B during carotid endarterectomy (CEA).METHODS:Patients who were prospectively enrolled to receive CEA under elective general anesthesia were randomized into an SGB group and a control group (ChiCTR2000033385). Before anesthesia, the SGB group underwent ipsilateral SGB under ultrasound guidance, while the control group did not. Ultrasound-guided right subclavian internal jugular vein catheterization was performed under general anesthesia. Mean arterial pressure (MAP) and heart rate (HR) were monitored at various time points (T0-T4). Arterial and internal jugular venous bulb blood were collected for blood gas analysis, determining jugular venous oxygen saturation (SjvO2), arteriovenous oxygen difference (AVDO2), cerebral oxygen extraction ratio (COER), lactate production rate (LPR), and lactate-oxygen index (LOI). The serum concentration of S100B in the internal jugular venous bulb at each time point was measured.RESULTS:The results revealed significantly lower HR during anesthesia induction and surgery in the SGB group, with more stable MAP and HR during endotracheal intubation and surgery compared to the control group (P<0.05). The control group exhibited decreases at T3 and a slight increase at T4. SjvO2 was significantly higher in the SGB group, while AVDO2 and COER gradually decreased over time, but they were significantly higher in the control group (P<0.05). LPR and LOI in both groups peaked at T3 and were significantly different between T4 and T2 (P<0.05). Serum S100B levels in both groups rose and then decreased at each time point, but they were consistently lower in the SGB group (P<0.05).CONCLUSION:SGB before CEA effectively suppresses the stress response, maintains intraoperative hemodynamic stability, improves brain tissue oxygen supply, and demonstrates a neuroprotective effect.
Objective:To investigate the risk factors for ruptured saccular intracranial aneurysms in young adults.Methods:Young patients with saccular intracranial aneurysm admitted to the First People's Hospital of Kashgar Region from February 2017 to November 2022 were retrospectively included. The demographic and clinical data from patients were collected. Risk factors of ruptured intracranial aneurysm were determined by univariate and multivariate regression analysis.Results:A total of 151 young patients with saccular intracranial aneurysm were enrolled, including 94 in the ruptured group (62.2%) and 57 in the unruptured group (37.8%). There were 70 males (46.4%) and 81 females (53.6%), with a median age of 41 years (interquartile range, 36-42 years). Univariate analysis showed that there were statistically significant differences in the proportion of male and triglycerides level between the ruptured group and the unruptured group (all P<0.05). Multivariate logistic regression analysis showed that males (odds ratio [ OR] 5.546, 95% confidence interval [ CI] 1.946-15.807; P=0.001), lower triglycerides ( OR 0.244, 95% CI 0.219-0.511; P<0.001), and aneurysms located in the anterior cerebral artery/anterior communicating artery ( OR 4.207, 95% CI 1.361-13.004; P=0.013) and middle cerebral artery ( OR 3.277, 95% CI 1.091-9.848; P=0.034) were the independent risk factors for intracranial aneurysm rupture. Conclusions:Male and lower triglycerides are the risk factors for ruptured saccular intracranial aneurysms in young adults. In addition, intracranial aneurysms located in the anterior cerebral artery/anterior communicating artery and middle cerebral artery are more prone to rupture.
Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease characterized by excessive fat accumulation in the liver. More and more evidence suggests that NAFLD is a multisystem disease that affects multiple extra-hepatic organs. Recent studies have shown that NAFLD may be associated with the risk, severity, and outcome of ischemic stroke. The article provides a summary of these aspects.
The impact of plateau environment on cerebral venous thrombosis (CVT) is more complex and diverse than in plain areas. This article reviews the epidemiological characteristics, affected sites, and especially the pathogenesis of CVT in plateau areas.
脑淀粉样血管病（cerebral amyloid angiopathy, CAA）是由软脑膜、小动脉和毛细血管β淀粉样蛋白（amyloid-β, Aβ）异常沉积引起的颅内血管局部淀粉样变性，是老年人群自发性脑出血的常见原因 [1]。CAA相关炎症（CAA-related inflammation, CAA-ri）是CAA的一种罕见进展性亚型，被认为是机体对Aβ沉积的免疫应答所致 [2]，是一种常见的年龄相关脑病，多见于55岁以上且血压控制良好的患者。CAA-ri的临床表现包括亚急性脑病、头痛、癫痫和/或局灶性神经功能缺损。颅脑MRI通常显示不对称皮质-皮质下脑白质高信号、脑微出血、脑实质出血（即CCA相关脑出血）和/或脑皮质表面铁沉积等 [3]。与CAA-ri相比，单纯性CAA多见于老年人，且随着年龄增长发病率逐渐上升，中位发病年龄较大，病程为缓慢进展，影像学表现为弥漫对称性病灶 [4]。根据脑活检病理结果，CAA-ri可分为2种亚型 [4-5]：一种是非破坏性血管周围套状炎症，即炎性CAA（inflammatory CAA, ICAA），表现为血管周围淋巴细胞、单核细胞（包括巨噬细胞，有时为多核巨细胞）等炎症细胞浸润，但无明显血管破坏；另一种是淀粉样蛋白沉积血管的跨血管壁或血管壁内炎症，即Aβ相关血管炎（Aβ-related angitis, ABRA），常表现为肉芽肿性炎症。CAA-ri是一种潜在可治疗的疾病，但鉴于其临床异质性，极易误诊 [6]。本文报道了1例反复卒中样发作的CAA-ri患者的临床表现、脑脊液特征及影像学改变，并结合文献探讨其临床特点，旨在提高临床医生对CAA-ri的认识，减少误诊或漏诊。
弥散加权成像（diffusion-weighted imaging, DWI）病变的可逆性意味着并非所有DWI病变都代表永久性损伤组织。比利时鲁汶大学医院的Scheldeman等利用WAKE-UP（Efficacy and Safety of Magnetic Resonance Imaging-Based Thrombolysis in Wake-Up Stroke）试验的数据进行了一项回顾性分析，旨在探讨DWI的可逆性及其与溶栓、再灌注和功能转归的关联。
骨或软骨异常及其对脑供血动脉的影响是缺血性卒中的潜在结构性原因，可称之为骨性卒中。目前对其描述尚不多见，而且没有针对骨性卒中的标准化检查和治疗方案。因此，德国慕尼黑工业大学医学院的Haertl等通过回顾性提取一家综合性卒中治疗中心在2017年1月至2022年3月期间所有骨性卒中患者的诊断和治疗方案，对这种卒中类型进行了探讨。
Dual antiplatelet therapy has been widely used for the secondary prevention in patients with minor stroke and high-risk transient ischemic attack (TIA). Currently, the commonly used antiplatelet drugs are aspirin and clopidogrel. The therapeutic effect of antiplatelet drugs varies among individuals, namely platelet resistance. Among them, aspirin resistance is often caused by poor drug compliance, while clopidogrel resistance is often associated with CYP2C19 allele mutations. Patients with minor stroke and high-risk TIA carrying CYP2C19 loss-of-function alleles have poor preventive effects when using clopidogrel. Early screening of the CYP2C19 loss-of-function alleles and targeted measures can benefit such patients. This article reviews the research progress on the selection of antiplatelet therapy for minor stroke or high-risk TIA patients carrying the CYP2C19 loss-of-function alleles.
缺血性卒中和短暂性脑缺血发作（transient ischemic attack, TIA）的标准病因调查项目包括心电图（electrocardiogram, ECG）和延长心电监测（prolonged cardiac monitoring, PCM）。无论采用何种方法诊断，卒中后检测到的心房颤动（atrial fibrillation, AF）通常都被认为是单一实体。然而，加拿大韦仕敦大学的Alvarado-Bola?os等假设，ECG检测到的AF相关的卒中复发风险要高于14 d PCM检测到的AF，并在此基础上进行了一项回顾性队列研究。
急性缺血性卒中机械血栓切除术后经常观察到弥散加权成像病变逆转（diffusion-weighted imaging lesion reversal, DWIR），但对年龄相关的差异及其对转归的影响还知之甚少。法国里尔大学的Scopelliti等进行了一项回顾性研究，旨在比较<80岁和≥80岁患者成功再通对DWIR的影响以及DWIR对功能转归的影响。
Intracranial atherosclerotic disease is one of the main causes of ischemic stroke. Imaging evaluation plays an important role in the formulation of treatment strategies. More and more studies have shown that the changes in hemodynamics after stenosis may have higher predictive value for stroke onset/recurrence compared to the degree of stenosis. This article reviews the evaluation of cerebral hemodynamics in intracranial atherosclerotic diseases.
孤立性大脑后动脉闭塞患者的最佳治疗方法尚不确定。美国波士顿医学中心的Nguyen等进行了一项多国病例对照研究，旨在对孤立性大脑后动脉闭塞患者的血管内治疗（endovascular therapy, EVT）和药物治疗（medical management, MM）的临床转归进行比较。
评估缺血改变范围是决定是否使用静脉溶栓或机械血栓切除术的重要步骤，但目前的标准方法——阿尔伯塔卒中项目早期CT评分为半定量性，不同评分者之间的一致性不高。日本京都大学医学研究生院的Nishi等进行了一项多中心回顾性研究，旨在创建和测试一种仅使用非增强CT扫描图像的基于机器学习的全自动化缺血核心分割模型。
推测血管源性白质高信号（white matter hyperintensities, WMH）是脑小血管病（cerebral small vessel disease, cSVD）最突出的影像学特征。既往研究表明，急性缺血性卒中患者的cSVD负荷与静脉溶栓后脑出血和功能转归不良相关。德国汉堡-埃彭多夫大学医学中心的Frey等对基于MRI的随机对照试验WAKE-UP进行了一项事后研究，旨在确定WMH负荷对发病时间不明卒中患者阿替普酶静脉溶栓的疗效和安全性的影响。
Objective:To investigate the correlation of probiotic consumption level with serum inflammatory cytokines, endotoxin and post-stroke depression (PSD) severity in patients with ischemic stroke.Methods:Patients with ischemic stroke visited the Department of Neurology, the Third Affiliated Hospital of Naval Medical University from May 2021 to June 2022 were prospectively included. At 6 months after discharge, the outpatient follow-up was conducted to investigate the consumption of probiotic products in the past six months, and depression was evaluated using the Self-rating Depression Scale (SDS). Multiple linear regression analysis was used to determine the correlation of consumption levels of probiotic products and serum inflammatory cytokines, endotoxin, and PSD severity.Results:A total of 168 patients with ischemic stroke were included, including 74 patients (44.0%) in the probiotic product high consumption group and 94 (56.0%) in the low consumption group. The incidence of PSD in the high consumption group was significantly lower than that in the low consumption group (22.97% vs. 38.30%; χ2=6.551, P=0.036). The serum pro-inflammatory cytokine interleukin-6 (IL-6) and endotoxin levels at the follow-up in the high consumption group were significantly lower than those in the low consumption group, while the anti-inflammatory cytokine IL-10 was significantly higher than that in the low consumption group (all P<0.05). Multiple linear regression analysis shows that the probiotic consumption level was significantly negatively correlated with the serum IL-6 ( β=-0.178, P=0.001) and endotoxin ( β=-0.107, P=0.035) at follow-up. PSD severity (SDS score) was negatively correlated with probiotic consumption level ( β=-0.309, P=0.001), and was positively correlated with IL-6 ( β=0.306, P=0.027) and endotoxin ( β=0.360, P=0.017) at follow-up. Conclusion:Probiotic products can reduce the severity of serum pro-inflammatory cytokines, endotoxin and PSD, and may be a non-drug treatment direction for PSD.
慢性肾脏病及其潜在病理状况、肾功能障碍和肾损伤与心血管转归的相关性目前尚不完全清楚。日本九州大学医学科学研究生院的Ueki等进行了一项研究，旨在确定肾功能障碍[估算肾小球滤过率（estimated glomerular filtration rate, eGFR）降低]和/或肾损伤（蛋白尿）是否与缺血性卒中后长期转归有关。
Obstructive sleep apnea (OSA) is a sleep disorder characterized by recurrent upper respiratory tract obstruction, sleep fragmentation, and hypoxia during sleep. This disease often leads to cognitive, emotional, and memory related neurological damage, and its mechanism is closely associated with the disruption of the blood-brain barrier (BBB). This article mainly discusses the relationship between BBB damage caused by OSA and vascular cognitive impairment (VCI), as well as the role of early prevention, intervention, and repairing BBB on reducing VCI.
Objective:To investigate the temporal trend of the mortality rate of intracerebral hemorrhage (ICH) among residents with different characteristics during the comprehensive prevention and control of hypertension in Tengzhou, Shandong Province from 2013 to 2021.Methods:Comprehensive prevention and control of hypertension was conducted in Tengzhou, Shandong Province from 2013 to 2021. ICH mortality rate was calculated from January 1, 2013 to December 31, 2021. ICH mortality monitoring data from Tengzhou, Shandong Province was used to analyze the temporal trend of ICH mortality among residents with different characteristics. The registered residence population came from the Public Security Bureau of Tengzhou, Shandong Province. The age and gender standardized mortality rate was calculated based on the data of China's seventh population census in 2020. The temporal and age trends of mortality were analyzed using Cochran Armitage Trend Tests.Results:From 2013 to 2021, the overall crude and standardized mortality rates of ICH in Tengzhou, Shandong Province decreased from 50.51/100 000 and 63.21/100 000 to 17.51/100 000 and 16.74/100 000, respectively ( Z=-11.013 and -15.426, P<0.001), with an average annual mortality rate decrease of 12.41% and 15.30%, respectively. The overall crude and standardized mortality rates in 2017 peaked compared to 2016, mainly due to an increase of 32.94% and 30.92% in male ICH crude and standardized mortality rates, respectively ( χ2=12.328 and 15.854, P<0.05). The mortality rate of ICH increased with age, and the decreasing trend over time became increasingly evident with age. The mortality rate of ICH in the ≥65 year old age group decreased by 77.94% over 9 years ( Z=-14.065, P<0.001). In 2017, the mortality rate of ICH in the male age group ≥65 years old and female 45-54 years old increased by 31.13% and 125.79% compared to 2016 respectively, there were statistically significant differences ( χ2=8.877 and 5.421, P<0.05). In 2021, the mortality rates of urban and rural ICH decreased by 93.22% and 46.40% compared to 2013, respectively ( Z=-13.279 and -5.393, P<0.001), with an average annual decrease of 28.56% and 7.50%, respectively. The ICH mortality rate in rural areas increased by 30.54% in 2017 compared to 2016 ( χ2=16.086, P<0.001); after 2018, the mortality rate of ICH began to be higher than that of urban areas ( χ2=33.400 and 67.305, P<0.001). Conclusions:The ICH mortality rate in Tengzhou, Shandong Province has shown a significant downward trend over time, with male mortality rate higher than female mortality rate and rural mortality rate higher than urban areas. This suggests that the key attention should be paid to both male and rural areas.
Vascular dementia is a severe cognitive impairment syndrome that can seriously affect the normal life of patients. In the context of the increasingly serious aging of the population, the incidence rate of vascular dementia remains high. However, the pathogenesis of vascular dementia has not yet been fully elucidated, and there are no specific therapeutic drugs or standard treatment methods available. Therefore, this article reviews the risk factors, pathogenesis, and treatment of vascular dementia, in order to provide reference for its treatment and rehabilitation.
Objective:To investigate the imaging characteristics and diagnosis of thalamic dementia caused by medial tentorial dural arteriovenous fistula (TDAVF).Methods:The clinical and imaging data of 4 patients with medial TDAVF diagnosed at Nanjing Brain Hospital from August 2022 to September 2023 were retrospectively collected, summarized and analyzed.Results:Four patients were all males, with an average age of 67 years. The duration of cognitive impairment varies from 13 days to 2 months, with an average of about 1 month. The average score on the Mini-Mental State Examination (MMSE) was 13, while the average score on the Montreal Cognitive Assessment (MoCA) was 15. One patient was unable to complete these tests. MRI showed bilateral thalamic swelling, with scattered microbleeding lesions on diffusion-weighted imaging and susceptibility-weighted imaging ( n=3). Enhanced scans showed patchy or clumpy enhancement of the bilateral thalamus. Magnetic resonance angiography showed abnormal blood vessels along the straight sinus area ( n=4), while magnetic resonance venography showed no straight sinus development ( n=4). Magnetic resonance spectroscopy showed neuronal swelling and damage ( n=3), with no increase in choline peak. Arterial spin labeling perfusion imaging showed decreased perfusion in the lesions. Digital subtraction angiography confirmed TDAVF with straight sinus thrombosis. Two patients underwent embolization, with significant improvement in postoperative memory impairment. One patient underwent surgical clipping, while the other was transferred to other hospital for treatment. Conclusions:Patients with medial TDAVF often present with thalamic dementia. Imaging examinations show typical bilateral thalamic swelling with microbleeds, and early visualization of vascular shadows, without development of straight sinus. These features would be beneficial for the early diagnosis of TDAVF.
