Investigating the relationship between intracranial atherosclerotic plaque remodelling and diabetes using high-resolution vessel wall imaging

BACKGROUND Intracranial atherosclerosis,a leading cause of stroke,involves arterial plaque formation.This study explores the link between plaque remodelling patterns and diabetes using high-resolution vessel wall imaging(HR-VWI).AIM To investigate the factors of intracranial atherosclerotic remodelling patterns and the relationship between intracranial atherosclerotic remodelling and diabetes mellitus using HR-VWI.METHODS Ninety-four patients diagnosed with middle cerebral artery or basilar artery INTRODUCTION Intracranial atherosclerotic disease is one of the main causes of ischaemic stroke in the world,accounting for approx-imately 10%of transient ischaemic attacks and 30%-50%of ischaemic strokes[1].It is the most common factor among Asian people[2].The adaptive changes in the structure and function of blood vessels that can adapt to changes in the internal and external environment are called vascular remodelling,which is a common and important pathological mechanism in atherosclerotic diseases,and the remodelling mode of atherosclerotic plaques is closely related to the occurrence of stroke.Positive remodelling(PR)is an outwards compensatory remodelling where the arterial wall grows outwards in an attempt to maintain a constant lumen diameter.For a long time,it was believed that the degree of stenosis can accurately reflect the risk of ischaemic stroke[3-5].Previous studies have revealed that lesions without significant luminal stenosis can also lead to acute events[6,7],as summarized in a recent meta-analysis study in which approximately 50%of acute/subacute ischaemic events were due to this type of lesion[6].Research[8,9]has pointed out that the PR of plaques is more dangerous and more likely to cause acute ischaemic stroke.Previous studies[10-13]have found that there are specific vascular remodelling phenomena in the coronary and carotid arteries of diabetic patients.However,due to the deep location and small lumen of intracranial arteries and limitations of imaging techniques,the relationship between intracranial arterial remodelling and diabetes is still unclear.In recent years,with the development of magnetic resonance technology and the emergence of high-resolution(HR)vascular wall imaging,a clear and multidimensional display of the intracranial vascular wall has been achieved.Therefore,in this study,HR wall imaging(HR-VWI)was used to display the remodelling characteristics of bilateral middle cerebral arteries and basilar arteries and to explore the factors of intracranial vascular remodelling and its relationship with diabetes.

One new species in the genus Bryophaenocladius Thienemann(Chironomidae:Diptera)from China

One new species Bryophaenocladius alpinus Deng&Zhang sp.nov.is described and illustrated based on adult males collected from China.The adult males can be distinguished by the third palpomere with a digitiform projection but without sensilla clavata,anal point broad triangular,inferior volsella sub-rectangular-shaped and covered with setae,gonostylus broad triangular,and crista dorsalis welldeveloped.

Surgical management of pituitary adenoma during pregnancy

BACKGROUND Although conservative treatment is typically recommended for pregnant patients with pituitary adenoma(PA),surgical treatment is occasionally necessary for those with acute symptoms.Currently,surgical interventions utilized among these patients is poorly studied.AIM To evaluate the surgical indications,timing,perioperative precautions and postoperative complications of PAs during pregnancy and to provide comprehensive guidance.METHODS Six patients with PAs who underwent surgical treatment during pregnancy at Peking Union Medical College Hospital between January 1990 and June 2021 were recruited for this study.Another 35 pregnant patients who were profiled in the literature were included in our analysis.RESULTS The 41 enrolled patients had acute symptoms including visual field defects,severe headaches or vision loss that required emergency pituitary surgeries.PA apoplexies were found in 23 patients.The majority of patients(55.9%)underwent surgery in the second trimester of pregnancy.A multidisciplinary team was involved in patient care from the preoperative period through the postpartum period.With the exception of 1 patient who underwent an induced abortion and 1 fetus that died due to a nuchal cord,39 patients delivered successfully.Among them,37 fetuses were healthy until the most recent follow-up.CONCLUSION PA surgery during pregnancy is effective and safe during the second and third trimesters.Pregnant patients requiring emergency PA surgery require multidisciplinary evaluation and healthcare management.

Symptomatic Rathke＇s Cleft Cyst with Rapid Enlargement Masquerading as Rathke＇s Cleft Cyst Apoplexy

To the Editor： A 35-year-old Chinese woman was admitted to our hospital complaining of a 1-year history of bilateral temporal chronic intermittent moderate headache which used to be alleviated by ibuprofen tablets or rest and had increased in intensity in the past 1 month. The patient also presented with the slow development of visual deficit. In January 2012, the patient presented with polyuria and polydipsia suggestive of central diabetes insipidus. Endocrine studies showed no clinically significant results.

Coagulation disorders in patients with abnormal serum cortisol level

To the Editor:Cortisol is closely related to hemostasis.[1]In patients with hyperadrenalism,that is,Cushing syndrome(CS),a reduction in the activated partial thromboplastin time(APTT),an increased level of coagulation factors,and an increased risk of thrombosis have been repeatedly reported.[1,2]However,no studies reported the hemostatic status of patients with hypoadrenalism which is commonly seen in patients with pituitary diseases.

Diabetes Insipidus as Initial Presentation of Rathke＇s Cleft Cyst

To the Editor： A 56-year-old Chinese man was referred to Peking Union Medical College Hospital because of polydipsia （9000 ml/24 h） and polyuria （7000 ml/24 h） for over 20 days accompanied with intermittent moderate headache in frontal and temporal areas of both sides for about 2 weeks. The patient underwent a brain magnetic resonance imaging （MRI） with contrast in a local healthy facility, revealing that there was an irregular pituitary lesion measuring 1.1 cm× 1.4 cm× 2.2 cm. Apparently, the diagnosis of central diabetes insipidus （DI） was made, but the pituitary lesion remained to be elucidated. The patient received desmopressin acetate tablets （1.2 mg, q.n.） to ameliorate polydipsia （5000 ml/24 h） and polyuria （4000 ml/24 h）.