Rationale and Objectives: The pathophysiology of fusiform intracranial aneurysm (FIA) involves inflammatory processes, and homocysteine plays a role in the inflammatory processes in the vessel wall. Moreover, aneurysm wall enhancement (AWE) has emerged as a new imaging biomarker of aneurysm wall inflammatory pathologies. To investigate the pathophysiological mechanisms of aneurysm wall inflammation and FIA instability, we aimed to determine the associations between the homocysteine concentration, AWE, and FIAs' related symptoms. Materials and Methods: We retrospectively reviewed the data of 53 patients with FIA who underwent both high-resolution magnetic resonance imaging and serum homocysteine concentration measurement. FIAs' related symptoms were defined as ischemic stroke or transient ischemic attack, cranial nerve compression, brainstem compression, and acute headache. The contrast ratio of the signal intensity of the aneurysm wall to the pituitary stalk (CRstalk) was used to indicate AWE. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were performed to determine how well the independent factors could predict FIAs' related symptoms. Predictors of CRstalk were also investigated. Spearman's correlation coefficient was used to identify the potential associations between these predictors. Results: Fifty-three patients were included, of whom 23 (43.4%) presented with FIAs' related symptoms. After adjusting for baseline differences in the multivariate logistic regression analysis, the CRstalk (odds ratio [OR] = 3.207, P = .023) and homocysteine concentration (OR = 1.344, P = .015) independently predicted FIAs' related symptoms. The CRstalk was able to differentiate between FIAs with and without symptoms (area under the ROC curve [AUC] = 0.805), with an optimal cutoff value of 0.76. The homocysteine concentration could also differentiate between FIAs with and without symptoms (AUC = 0.788), with an optimal cutoff value of 13.13. The combination of the CRstalk and homocysteine concentration had a better ability to identify symptomatic FIAs (AUC = 0.857). Male sex (OR = 0.536, P = .018), FIAs' related symptoms (OR = 1.292, P = .038), and homocysteine concentration (OR = 1.254, P = .045) independently predicted the CRstalk. Conclusion: A higher serum homocysteine concentration and greater AWE indicate FIA instability. Serum homocysteine concentration may be a useful biomarker of FIA instability; however, this needs to be verified in future studies.

Abstract Background Recognizing the predictors of poor short-term prognosis after first-line immunotherapy in patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is essential for individualized treatment strategy. The objective of this study was to ascertain the factors that forecast short-term prognosis in patients with anti-NMDAR encephalitis, develop a prognostic prediction model, and authenticate its efficacy in an external validation cohort. Further, all patients were followed-up long-term to assess the factors of long-term outcome and relapses. Methods A prospective enrollment of patients diagnosed with anti-NMDAR encephalitis was conducted across five clinical centers in China from June 2014 to Mar 2022. The enrolled patients were divided into the derivation and validation sets based on enrollment time. The short-term prognostic model was visualized using a nomogram. Further, all patients were followed-up long-term to assess the factors of long-term outcome. Results This study found that poor short-term prognosis was a risk factor for poor long-term outcome (6-month prognosis, OR 29.792, 95%CI 6.507-136.398, p < 0.001; 12-month prognosis, OR 15.756, 95%CI 3.384–73.075, p < 0.001; 24-month prognosis, OR 5.500, 95%CI 1.045–28.955, p = 0.044). Abnormal behavior or cognitive dysfunction (OR 8.57, 95%CI 1.48–49.79, p = 0.017), consciousness impairment (OR19.32, 95%CI 3.03-123.09, p = 0.002), autonomic dysfunction or central hypoventilation (OR 5.66, 95%CI 1.25–25.75, p = 0.025), CSF pleocytosis (OR 4.33, 95%CI 1.48–12.65, p = 0.007), abnormal EEG (OR 5.48, 95% CI 1.09–27.54, p = 0.039) were independent predictors for a poor short-term prognosis after first-line immunotherapy. A nomogram that incorporated those factors showed good discrimination and calibration abilities. The area under the curve (AUC) for the prognostic model were 0.866 (95%CI: 0.798–0.934) with a sensitivity of 0.761 and specificity of 0.869. Conclusion We established and validated a prognostic model that can provide individual prediction of short-term prognosis after first-line immunotherapy for patients with anti-NMDAR encephalitis. This practical prognostic model may help neurologists to predict the short-term prognosis early and potentially assist in adjusting appropriate treatment timely.

INTRODUCTION We aim to assess the association between smoking behavior and intracranial aneurysms (IAs) and the effect of smoking cessation medications on IAs at the genetic level. METHODS Causal effects of four phenotypes: 1) age at initiation of regular smoking, 2) cigarettes smoked per day, 3) smoking cessation, and 4) smoking initiation on IAs, were analyzed using two-sample inverse-variance weighted Mendelian randomization analyses. The effects of genes interacting with the smoking cessation medications were analyzed using cis-expression quantitative trait loci genetic instruments on IAs using summary statistics-based Mendelian randomization analyses. Colocalization analyses were then used to test whether the genes shared causal variants with IAs. The role of confounding phenotypes as potential causative mechanisms of IAs at these gene loci was tested. RESULTS Cigarettes smoked per day (OR=2.89; 95% CI:1.85-4.51) and smoking initiation on IAs (OR=4.64; 95% CI: 2.64-8.15) were significantly associated with IA risk. However, age at initiation of regular smoking (OR=0.54; 95% CI: 0.10-2.8) and smoking cessation (OR=6.80; 95% CI: 0.01-4812) had no overall effect on IAs. Of 88 genes that interacted with smoking cessation medications, two had a causal effect on IA risk. Genetic variants affecting HYKK levels showed strong evidence of colocalization with IA risk. Higher HYKK levels in the blood were associated with a lower IA risk. CONCLUSIONS This study provides evidence supporting that smoking initiation on IAs and cigarettes/day may increase IA risk. Increased HYKK gene expression continuous abstinence and varenicline therapy on smoking cessation.

Vertigo is a common neurological complaint, which can result in significant morbidity and decreased quality of life. While pathology to peripheral and subtentorial brain structures is a well-established cause of vertigo, cortical lesions have also been linked to vertigo and may lend insight into relevant neuroanatomy. Here, we investigate the supratentorial lesion locations associated with vertigo and test whether they map to a common brain network. We performed a systematic literature search and identified 23 cases of supratentorial brain lesions associated with vertigo. We mapped the lesion locations to a standard brain template and computed the network of brain regions functionally connected to each lesion location, using a 'wiring diagram' of the human brain termed the human connectome (n = 1000). Sensitivity was assessed by identifying the most common connection to lesion locations associated with vertigo, and specificity was assessed through comparison with control lesions associated with symptoms other than vertigo (n = 68). We found that functional connectivity between lesion locations and the bilateral ventral posterior insula was both sensitive (22/23 lesions) and specific (voxel-wise family-wise error-corrected P < 0.05) for lesion-induced vertigo. We computed connectivity with this hub region to define a lesion-based vertigo network, which included regions in the bilateral insula, somatosensory cortex, higher-level visual areas, cingulate sulcus, thalamus and multiple cerebellar regions in the territory of the posterior inferior cerebellar artery. Next, we used stereo-electroencephalography (80 stimulation sites across 17 patients) to test whether stimulation sites associated with vertigo mapped to this same network. We found that 36/42 (86%) of stimulation sites eliciting vertigo fell within the lesion-based vertigo network in contrast to 16/39 (41%) of stimulation sites that did not elicit vertigo. Connectivity between stimulation sites and our lesion-based hub in the ventral posterior insula was also significantly associated with vertigo (P < 0.0001). We conclude that cortical lesions and direct electrical stimulation sites associated with vertigo map to a common brain network, offering insights into the causal neuroanatomical substrate of vertigo.

Introduction Inflammation plays a key role in the progression of intracranial aneurysms. Aneurysmal wall enhancement (AWE) correlates well with inflammatory processes in the aneurysmal wall. Understanding the potential associations between blood inflammatory indices and AWE may aid in the further understanding of intracranial aneurysm pathophysiology. Methods We retrospectively reviewed 122 patients with intracranial fusiform aneurysms (IFAs) who underwent both high-resolution magnetic resonance imaging and blood laboratory tests. AWE was defined as a contrast ratio of the signal intensity of the aneurysmal wall to that of the pituitary stalk ≥ 0.90. The systemic immune-inflammation (SII) index (neutrophils × platelets/lymphocytes) was calculated from laboratory data and dichotomized based on whether or not the IFA had AWE. Aneurysmal symptoms were defined as sentinel headache or oculomotor nerve palsy. Multivariable logistic regression and receiver operating characteristic curve analyses were performed to determine how well the SII index was able to predict AWE and aneurysmal symptoms. Spearman’s correlation coefficients were used to explore the potential associations between variables. Results This study included 95 patients, of whom 24 (25.3%) presented with AWE. After adjusting for baseline differences in neutrophil to lymphocyte ratios, leukocytes, and neutrophils in the multivariable logistic regression analysis, smoking history (P = 0.002), aneurysmal symptoms (P = 0.047), maximum diameter (P = 0.048), and SII index (P = 0.022) all predicted AWE. The SII index (P = 0.038) was the only independent predictor of aneurysmal symptoms. The receiver operating characteristic curve analysis revealed that the SII index was able to accurately distinguish IFAs with AWE (area under the curve = 0.746) and aneurysmal symptoms (area under the curve = 0.739). Discussion An early elevation in the SII index can independently predict AWE in IFAs and is a potential new biomarker for predicting IFA instability.

目的 总结抗体相关自身免疫性小脑性共济失调(ACA)15例的特点及潜在意义.方法 收集2015年1月至2021年12月在首都医科大学宣武医院神经内科患者住院治疗、自身免疫抗体阳性且以小脑性共济失调为主要临床表现的患者,整理统计患者的临床资料.结果 15例患者均以头晕、走路不稳伴或不伴构音障碍的神经系统症状为首发和主要表现,4例患者有眼震,有8例患者在之后的筛查中发现肿瘤.15例患者,男性3例,女性12例,年龄34～69岁,平均年龄(55.5±3.79)岁.抗Yo抗体阳性3例,抗Hu抗体阳性2例,抗Tr抗体阳性2例,抗Ri抗体阳性、抗Amphiphysin抗体阳性、抗GAD抗体阳性、抗SOX1抗体阳性、抗PNMA2抗体阳性各1例,有3例为多重抗神经元抗体阳性.15例抗体阳性中有9例脑脊液相应抗体阳性,15例血清抗神经元抗体全部阳性.15例脑脊液常规、生化均未见明显异常,7例脑脊液特异性寡克隆区带阳性(46.67％).7例寡克隆区带阳性中有5例脑脊液抗体阳性(阳性率71.42％).8例寡克隆区带阴性中只有4例脑脊液抗体阳性(阳性率50％).5例头颅MRI有小脑萎缩,均为双侧萎缩(阳性率33.33％).糖皮质激素或静脉注射免疫球蛋白治疗后MRS评分显示神经系统症状均有改善.结论 自身ACA调相关抗体以细胞内抗体为主.自身ACA以头晕、走路不稳、构音障碍、中枢性眼震等前庭小脑系统症状为首发和主要表现,眼震电图等前庭功能检查对前庭小脑系统功能的评估有重要意义.血清中检测抗神经抗体被认为足以诊断自身免疫性小脑性共济失调.脑脊液化验呈非特异性炎性表现,脑脊液寡克隆区带阳性与脑脊液神经元抗体阳性率的关系有待进一步扩大样本量研究确定.治疗应尽早开始,糖皮质激素或静脉注射免疫球蛋白治疗后MRS评分显示神经系统症状均有改善.

Background:Many studies have emphasized that selective resection of epileptic lesions in temoral lobe is associated with better preservation of cognition function; whether this applies to patients with refractory mesial temporal lobe epilepsy (MTLE) remains unknown. The objective of this study was to evaluate changes in cognitive functions, mood status, and quality of life after anterior temporal lobectomy in patients with refractory MTLE.Methods:This single-arm cohort study assessed cognitive function, mood status, and quality of life, as well as electroencephalography findings, in patients with refractory MTLE who underwent anterior temporal lobectomy at Xuanwu Hospital from January 2018 to March 2019. Pre- and post-operative characteristics were compared to evaluate the effects of surgery.Results:Anterior temporal lobectomy significantly reduced the frequencies of epileptiform discharges. The overall success rate of surgery was acceptable. Anterior temporal lobectomy did not result in significant changes in overall cognitive functions (P > 0.05), although changes in certain domains, including visuospatial ability, executive ability, and abstract thinking, were detected. Anterior temporal lobectomy resulted in improvements in anxiety and depression symptoms and quality of life.Conclusions:Anterior temporal lobectomy reduced epileptiform discharges and incidence of post-operative seizures as well as resulted in improved mood status and quality of life without causing significant changes in cognitive function.

Objective To investigate the clinical characteristics of vestibular paroxysmia(VP):age distribution,triggers,accompanying symptoms,maximum frequency per day,nystagmus features during attacks,and neurovascular compression.Methods The clinical data of 70 patients with VP were collected to analyze their age distribution,triggers,accompanying symptoms,maximum frequency per day,nystagmus features during attacks,and neurovascular compres-sion by using descriptive statistical methods.Results Among the 70 patients with VP,30(42.86%)were elderly,23(32.86%)were young,and 17(24.29%)were middle-aged patients.The maximum frequency per day was 2-5 in 53 cases(75.71%),6-10 in 9 cases(12.86%),and>10 in 8 cases(11.43%).Thirty-six patients(51.43%)had triggers,including rapid walking,emotional excitement,driving,cycling,sexual intercourse,coughing or wheezing,speaking or chatting,bathing,defecation,drinking alcohol,and sound stimulation.Thirty-three patients(47.14%)had unilateral tin-nitus,bilateral tinnitus,and tinnitus with facial spasms;nystagmus during VP episodes met the characteristics of the head coordinate system,which was horizontal-torsional towards the affected side.Among 57 patients examined for the relation-ship between the vestibulocochlear nerve and vessels using magnetic resonance angiography,37 patients(64.91%)had contact between the vestibulocochlear nerve and the right anterior inferior cerebellar artery,15 patients(26.32%)had contact between the vestibulocochlear nerve and the left anterior inferior cerebellar artery,and 5 patients(8.77%)had contact between the vestibulocochlear nerve and the basilar artery.Conclusion VP is most prevalent in the elderly,then young and middle-aged people.Most patients with VP have a maximum frequency of 2-5 per day.VP can be triggered by anger,excitement,exercise,and various stimuli.VP attacks can be accompanied by tinnitus and facial spasms.Its nystag-mus is horizontal-torsional towards the affected side.The percentage of contact between the vestibulocochlear nerve and the right anterior inferior cerebellar artery is highest in patients with VP.

Objective Morphological risk factors for the rupture of intracranial vertebral artery dissecting aneurysms (IVADAs) have not been well characterized. In this study, we aim to identify morphological characteristics associated with IVADA rupture. Methods We conducted a retrospective study of 249 consecutive patients with single IVADAs (31 ruptured and 218 unruptured) admitted to Beijing Tiantan Hospital between January 2016 and December 2020. Various morphological parameters were measured using three-dimensional digital subtraction angiography images. Univariate and multivariate logistic regression analyses were performed to identify morphological characteristics associated with IVADA rupture. Results Univariate regression analysis revealed that the coexistence of significant proximal and distal stenosis and posterior inferior cerebellar artery (PICA) involvement were associated with IVADA rupture, while the origin from the dominant vertebral artery was inversely associated with the rupture. Multivariate regression analysis demonstrated that the coexistence of significant proximal and distal stenosis (OR 22.00, 95% CI 5.60 to 86.70, p<0.001) and PICA involvement (OR 4.55, 95% CI 1.36 to 15.20, p=0.014) were independently associated with IVADA rupture. Conclusion The coexistence of significant proximal and distal stenosis and PICA involvement were independently associated with IVADA rupture. These morphological characteristics may facilitate the assessment of rupture risk in patients with IVADAs.

Patients with autoimmune encephalitis (AE) often developed psychiatric features during the disease course. Many studies focused on the psychiatric characteristic in anti-NMDAR encephalitis (NMDAR-E), but anti-LGI1 encephalitis (LGI1-E) had received less attention regarding the analysis of psychiatric features, and no study compared psychiatric characteristic between these two groups. The clinical data of AE patients (62 NMDAR-E and 20 LGI1-E) who developed psychiatric symptoms were analyzed in this study. In NMDAR-E, the most common higher-level feature was “behavior changes” (60/62, 96.8

Oxidative stress after ischemia reperfusion can cause irreversible brain damage. Thus, it is vital to timely consume excessive reactive oxygen species (ROS) and conduct molecular imaging monitoring on the brain injury site. However, previous studies have focused on how to scavenge ROS while ignoring the mechanism of relieving the reperfusion injury. Herein, we reported a layered double hydroxide (LDH)-based nanozyme (denoted as ALDzyme), which was fabricated by the confinement of astaxanthin (AST) with LDH. This ALDzyme can mimic natural enzymes, which include superoxide dismutase (SOD) and catalase (CAT). Furthermore, the SOD-like activity of ALDzyme is 16.3 times higher than that of CeO2 (a typical ROS scavenger). Based on these enzyme-mimicking properties, this one -of-a-kind ALDzyme offers strong anti-oxidative properties as well as high biocompatibility. Importantly, this unique ALDzyme can establish an efficient magnetic resonance imaging platform, thus guiding the in vivo details. As a result, the infarct area can be reduced by 77% after reperfusion therapy, and the neurological impairment score can be lowered from 3-4 to 0-1. Density functional theory computations can reveal more about the mechanism of this ALDzyme's significant ROS consumption. These findings provide a method for unraveling the neuroprotection application process in ischemia reperfusion injury using an LDH-based nanozyme as a remedial nanoplatform.

目的 明确小脑性共济失调患者视频眼震电图特点,为早期诊断小脑性共济失调和鉴别前庭中枢性和周围性病变提供眼动异常依据.方法 收集2019年10月至2020年5月首都医科大学宣武医院神经内科住院诊治小脑性共济失调患者20例,对其视频眼震图各个项目包括自发性眼震、视动性眼震、平稳跟踪试验、扫视试验、凝视试验、位置试验和双温试验进行分析,总结各个项目的表现特点.结果 自发性眼震试验:7例(35％)出现各种类型眼震和扫视侵扰;视动性眼震:3例(15％)出现双侧慢相角速度不对称,19例(95％)出现增益异常;平稳追踪试验:18例(90％)出现Ⅲ型和Ⅳ型曲线,10例(50％)出现增益异常;凝视试验:10例(50％)出现异常眼动;扫视试验:13例(65％)出现峰速度下降、12例(60％)出现准确度异常和1例(5％)出现潜伏期异常;静态位置试验:15例(75％)出现异常眼动;前庭双温试验:1例(5％)出现半规管功能亢进.结论 视动性眼震的增益异常、平稳追踪试验曲线波形异常提示前庭中枢异常,是早期诊断小脑性共济失调的依据之一.

Objective:To preliminarily evaluate the efficacy and safety of Surpass Streamline flow diverting device (FD) in the treatment of intracranial aneurysms.Methods:A retrospective analysis was conducted on the clinical data of 46 patients with intracranial aneurysms treated with Surpass Streamline FD at the Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University from November 2020 to March 2021. There were 57 aneurysms in 46 patients. Among them, there were 28 ophthalmic segment aneurysms, 8 communicating segment aneurysms, 19 cavernous sinus segment aneurysms, 1 carotid segment aneurysm and 1 vertebral V4 segment aneurysm. The O′Kelly-Marotta (OKM) grading scale was used to assess the degree of embolization of aneurysms immediately after surgery and during follow-up. The modified Rankin scale (mRS) was used to evaluate the neurological function of patients during the perioperative period and during follow-up. At 6 months after surgery, digital subtraction angiography (DSA) or CT angiography (CTA) was performed to review the occlusion of the aneurysm.Results:A total of 46 FDs were implanted in 57 intracranial aneurysms in 46 patients. Among them, 42 FDs (91.3%) were successfully released at one time; the other 4 FDs were not successfully released at one time, but after bridging, overlapping and balloon dilation, satisfactory release effects were achieved. Forty-three patients were treated with FD implantation alone, and three patients were treated with FD combined with coiling. The DSA of 57 aneurysms immediately after the operation showed that the contrast agent was well filled in the aneurysm, and the OKM grades were grade A in 30 cases, grade B in 19, grade C in 5, and grade D in 3. After the operation, 43 patients (93.5%) had a good outcome (mRS ≤2 points); the remaining 3 patients (6.5%) had various degrees of ischemic complications. A total of 32 patients (37 aneurysms) underwent DSA or CTA follow-up, the follow-up time was 6.6±1.8 months (3-10 months), and 32 aneurysms (86.5%) were completely occluded (OKM grade D in all). At the last follow-up, 32 patients had no new ischemic or bleeding complications, and their mRS were all ≤2 points.Conclusions:The immediate effect of Surpass Streamline FD in the treatment of intracranial aneurysms is satisfactory. The aneurysm occlusion rate in the mid-term follow-up seems high and the incidence of complications is low. However, the long-term efficacy and safety need to be further observed.

•Half patients with anti-mGluR5 encephalitis from publications developed seizures.•We report a case of anti-mGluR5 encephalitis presenting with focal motor seizures.•Isolated focal seizure highlights an unusual feature of anti-mGluR5 encephalitis.

BackgroundImmune-mediated cerebellar ataxias (IMCAs) are common in paraneoplastic cerebellar degeneration (PCD) but rarely occur in patients with neuronal surface antibodies (NSAbs). Although cerebellar ataxias (CAs) associated with anti-NMDAR and anti-CASPR2 have been reported in a few cases, they have never been studied systematically. This study aimed to analyze the characteristics of anti-NSAbs-associated CAs.MethodsA retrospective investigation was conducted to identify patients using the keywords IMCAs and NSAbs. We collected the clinical data of 14 patients diagnosed with anti-NSAbs-associated CAs.ResultsThe median age was 33 years (16-66), and the male-to-female ratio was 4:3. Nine were positive for NMDAR-Ab, two for LGI1-Ab, two for CASPR2-Ab, and one for AMPA2R-Ab. CAs were initial symptoms in three patients and presented during the first two months of the disease course (10 days on average) among the rest of the patients. After the immunotherapy, two cases were free from symptoms, and eight cases recovered satisfactorily (10/14, 71.4%). Compared with other causes of IMCAs, anti-NSAbs were more frequently associated with additional extra-cerebellar symptoms (85.7%), mostly seizures (78.6%) and mental abnormalities (64.3%). In the CSF analysis, pleocytosis was detected in ten patients (71.4%) and oligoclonal bands (OB) were observed in nine patients (64.3%). Moreover, compared with PCD and anti-GAD65-Ab-associated CAs, anti-NSAbs-associated CAs showed a better response to immunotherapy.ConclusionIMCAs are rare and atypical in autoimmune encephalitis with neuronal surface antibodies. Compared with other forms of IMCAs, more symptoms of encephalopathy, a higher rate of pleocytosis and positive OB in CSF, and positive therapeutic effect were the key features of anti-NSAbs-associated CAs.

目的 利用虚拟支架算法对真实血管内支架展开的状态进行模拟,同时对虚拟术后模型进行血流动力学参数的数值模拟,评估虚拟支架置入手术前后血流动力学参数的变化.方法 纳入2014年9月19日于首都医科大学附属北京天坛医院就诊的1例基底动脉瘤(动脉瘤直径10.93 mm)伴动脉瘤壁1级强化患者,对其动脉瘤增大(12.83 mm,动脉瘤壁2级强化)后的高分辨率磁共振成像进行重组,得到患者的特异性动脉瘤血管几何模型,对该模型进行分割与平滑处理.选用Pipeline密网支架,首先通过基于单纯性可变形网格的虚拟支架快速模拟仿真算法,对支架展开进行快速有效的模拟,得到展开后的支架位置与形态结构.同时,通过对支架进行实体化建模,及对虚拟支架置入术后的动脉瘤进行血流动力学仿真计算,对比术前术后可量化的血流动力学参数(包括时间平均壁面剪应力、振荡剪切指数、梯度震荡数、壁面剪应力梯度、压力、质量流量和流速).结果 动脉瘤壁内的时间平均壁面剪应力、壁面剪应力梯度、最大梯度振荡数等血流动力学参数较术前均有明显降低,压力和最大震荡剪切指数较术前增高.动脉瘤壁的时间平均壁面剪应力最大值从5.277 Pa下降至2.701 Pa,下降幅度为48.816％;壁面剪应力梯度最大值由16078.273 Pa/m下降至8995.226 Pa/m,降幅为44.054％;梯度振荡数的最大值由0.938降至0.919,降幅为2.026％.压力最大值由术前的13155.029 Pa增至术后的13247.047 Pa,增幅为0.699％;振荡剪切指数最大值从0.462增加至0.468,上升幅度为1.299％.通过瘤颈平面的质量流量从0.344 g/s明显下降至0.00025 g/s.右侧大脑后动脉出口质量流量由术前0.882 g/s增加至术后0.945g/s,增幅为7.143％;流速由术前1.243m/s增加至1.302m/s,增幅为4.747％.结论 虚拟支架算法与计算流体动力学模拟相结合可以为颅内动脉瘤介入治疗提供手术前后血流动力学参数变化,为医师手术评估提供重要的参考依据.

Objective: Although clinical trials have demonstrated that cathodal transcranial direct current stimula-tion (tDCS) is effective for seizure reduction, its long-term efficacy is unknown. This study aimed to deter-mine the long-term effects of repeated cathodal long tDCS sessions on seizure suppression in patients with refractory epilepsy. Methods: Patients were recruited to participate in an extended phase of a previous randomized, double-blind, sham-controlled, three-arm, parallel, multicenter study on tDCS. The patients were divided into an active tDCS group (20 min of tDCS per day) and an intensified tDCS group (2 x 20 min of tDCS per day). Each tDCS session lasted 2 weeks and the patients underwent repeated sessions at intervals of 2 to 6 months. The cathode was placed over the epileptogenic focus with the current intensity set as 2 mA. Seizure frequency reduction from baseline was analyzed using the Wilcoxon signed-rank test for two related samples. A generalized estimating equation model was used to estimate group, time, and inter-action effects. Results: Among the 19 patients who participated in the extended phase, 11 were in the active tDCS group and underwent 2-16 active tDCS sessions, and eight were in the intensified tDCS group and underwent 3-11 intensified tDCS sessions. Seizure reduction was significant from the first to the seventh follow-up, with a median seizure frequency reduction of 41.7%-83.3% (p < 0.05). Compared to the regular tDCS pro-tocol, each intensified tDCS session substantially decreased seizure frequency by 0.3680 (p < 0.05). One patient experienced an increase of 8.5%-232.8% in the total number of seizures during three treatment sessions and follow-ups. Conclusion: Repeated long cathodal tDCS sessions yielded significant and progressive long-term seizure reductions in patients with refractory focal epilepsy. (c) 2022 Published by Elsevier Inc.

目的 探讨抗SOX1抗体阳性副肿瘤性小脑变性的诊疗要素.方法 北京首都医科大学宣武医院神经内科报道1例抗SOX1抗体阳性副肿瘤性小脑变性患者,分析其诊治过程中的关键点和经验.结果 患者中年男性,急性起病,以小脑性共济失调为主要表现,肺部占位伴纵隔淋巴结肿大,PETCT代谢增高,血清副肿瘤抗体谱:抗SOX1抗体(+),左肺占位穿刺活检病理结果提示炎症性病变,发病第4个半月门诊随诊发现胃泌素释放肽前体(645.20pg·mL-1)、神经元特异性烯醇化酶(93.47 pg·mL-1)升高,超声引导下支气管镜下纵隔淋巴结组织活检,淋巴结活检病理证实为小细胞肺癌,确诊后给与阿替利珠单抗治疗过程中出现药物相关PD-L1相关脑炎,神经系统症状经类固醇联合免疫球蛋白治疗好转.结论 抗SOX1抗体阳性与小细胞肺癌关系密切,抗SOX1抗体阳性副肿瘤综合征可以以小脑变性为主要表现.肿瘤患者阿替利珠单抗等PD-L1抑制剂治疗过程中,需注意免疫相关不良反应,少数患者会出现PD-L1相关脑炎.

(1) Background: The purpose of this study was to investigate the efficacy and safety of transcutaneous vagus nerve stimulation (t-VNS) in the treatment of primary insomnia. (2) Methods: This is a single center, randomized, double-blind study. A total of 30 patients diagnosed with primary insomnia were randomly divided into two groups to receive 20 Hz t-VNS in either the auricular concha area (treatment group) or periauricular area (control group), twice a day for 20 min during a one-month study period. The effective rate of treatment, defined as a ≥50% reduction of the Pittsburgh Sleep Index Scale (PSQI) after treatment, was compared between the two groups as the primary outcome. Response rate (defined as ≥10% change in the PSQI score), and changes in the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) scores were also assessed. (3) Results: After one month of treatment, the PSQI score of the treatment group decreased significantly (p = 0.001). The effective rate of the treatment group (73% vs. 27%, p = 0.027) was significantly higher than that of the control group. No statistical differences in changes of HAMA and HAMD scores were detected between the two groups. There were no complications in all patients. (4) Conclusion: T-VNS appeared to be a safe and effective treatment for primary insomnia.