Performance of the walking trail making test in older adults with white matter hyperintensities

BACKGROUND Several studies have reported that the walking trail making test(WTMT)completion time is significantly higher in patients with developmental coordination disorders and mild cognitive impairments.We hypothesized that WTMT performance would be altered in older adults with white matter hyperintensities(WMH).AIM To explore the performance in the WTMT in older people with WMH.METHODS In this single-center,observational study,25 elderly WMH patients admitted to our hospital from June 2019 to June 2020 served as the WMH group and 20 participants matched for age,gender,and educational level who were undergoing physical examination in our hospital during the same period served as the control group.The participants completed the WTMT-A and WTMT-B to obtain their gait parameters,including WTMT-A completion time,WTMT-B completion time,speed,step length,cadence,and stance phase percent.White matter lesions were scored according to the Fazekas scale.Multiple neuropsychological assessments were carried out to assess cognitive function.The relationships between WTMT performance and cognition and motion in elderly patients with WMH were analyzed by partial Pearson correlation analysis.RESULTS Patients with WMH performed significantly worse on the choice reaction test(CRT)(0.51±0.09 s vs 0.44±0.06 s,P=0.007),verbal fluency test(VFT,14.2±2.75 vs 16.65±3.54,P=0.012),and digit symbol substitution test(16.00±2.75 vs 18.40±3.27,P=0.010)than participants in the control group.The WMH group also required significantly more time to complete the WTMT-A(93.00±10.76 s vs 70.55±11.28 s,P<0.001)and WTMT-B(109.72±12.26 s vs 82.85±7.90 s,P<0.001).WTMT-A completion time was positively correlated with CRT time(r=0.460,P=0.001),while WTMT-B completion time was negatively correlated with VFT(r=-0.391,P=0.008).On the WTMT-A,only speed was found to statistically differ between the WMH and control groups(0.803±0.096 vs 0.975±0.050 m/s,P<0.001),whereas on the WTMT-B,the WMH group exhibited a significantly lower speed(0.778±0.111 vs 0.970±0.053 m/s,P<0.001)and cadence(82.600±4.140 vs 85.500±5.020 steps/m,P=0.039),as well as a higher stance phase percentage(65.061±1.813%vs 63.513±2.465%,P=0.019)relative to controls.CONCLUSION Older adults with WMH showed obviously poorer WTMT performance.WTMT could be a potential indicator for cognitive and motor deficits in patients with WMH.

Effect of Shensong Yangxin on the Progression of Paroxysmal Atrial Fibrillation is Correlated with Regulation of Autonomic Nerve Activity

Background： Shensong Yangxin （SSYX）, a traditional Chinese herbal medicine, has long been used clinically to treat arrhythmias in China. However, the mechanism of SSYX on atrial fibrillation （AF） is unknown. In this study, we tested the hypothesis that the effect of SSYX on the progression of paroxysmal AF is correlated with the regulation of autonomic nerve activity. Methods： Eighteen mongrel dogs were randomly divided into control group （n = 6）, pacing group （n = 6）, and pacing ＋ SSYX group （n = 6）. The control group was implanted with pacemakers without pacing; the pacing group was implanted with pacemakers with long-term intermittent atrial pacing; the pacing ＋ SSYX group underwent long-term intermittent atrial pacing and SSYX oral administration. Results： Compared to the pacing group, the parameters of heart rate variability were lower after 8 weeks in the pacing ＋ SSYX group （low-frequency [LF] component： 20.85± 3.14 vs. 15.3±1.89 ms2, P =0.004; LF component/high-frequency component： 1.34 ± 0.33 vs. 0.77± 0.15, P 〈 0.001 ）. The atrial effective refractory period （AERP） was shorter and the dispersion of the AERP was higher after 8 weeks in the pacing group, while the changes were suppressed by SSYX intake. The dogs in the pacing group had more episodes and longer durations of AF than that in the pacing ＋ SSYX group. SSYX markedly inhibited the increase in sympathetic nerves and upregulation of tumor necrosis factor-alpha and interleukin-6 expression in the pacing ＋ SSYX group. Furthermore, SSYX suppressed the decrease of acetylcholine and α7 nicotinic acetylcholine receptor protein induced by long-term intermittent atrial pacing. Conclusions： SSYX substantially prevents atrial electrical remodeling and the progression of AF. These effects of SSYX may have association with regulating the imbalance of autonomic nerve activity and the cholinergic anti-inflammatory pathway.

A novel homozygous RAG1 mutation in a girl presenting with granulomas and alopecia capitis totalis

Recombination-activating gene 1(RAG1)mutations in humans vary in residual recombination activity and result in heterogeneous clinical phenotypes[1,2].In recent years,RAG deficiency with a milder clinical course and delayed presentation has been reported.These patients present with generalized granulomas,severe complications after viral infections,hypogammaglobulinemia,and various autoimmune manifestations(such as cytopenias,vitiligo,psoriasis,myasthenia gravis,and Guillain-Barre syndrome)[3-17].