Microbleeds in fronto-subcortical circuits are predictive of dementia conversion in patients with vascular cognitive impairment but no dementia

Cerebral small vessel disease(CSVD) is a common etiology of vascular cognitive impairment with no dementia(V-CIND). Studies have revealed that cerebral microbleeds(CMBs), a feature of CSVD, contribute to cognitive impairment. However, the association between CMBs and dementia conversion in individuals with V-CIND is still unclear. Here, we analyzed the predictive role of CMBs in the conversion from V-CIND to dementia in CSVD patients. We recruited and prospectively assessed 85 patients with CSVD and V-CIND. V-CIND was evaluated using a series of comprehensive neuropsychological scales, including the Chinese version of the Montreal Cognitive Assessment and the Clinical Dementia Rating. MRI assessments were used to quantify lacunar infarcts, white matter hyperintensities, CMBs, and medial temporal lobe atrophy. Eighty-two of the 85 patients completed the assessment for dementia conversion at a 1-year follow-up assessment. Multivariate logistic regression analyses were conducted to examine independent clinical and MRI variables associated with dementia conversion. Twenty-four patients(29.3%) had converted to dementia at the 1-year follow-up, and these individuals had significantly more CMBs in the fronto-subcortical circuits. Multivariate logistic regression analyses revealed that the patients with CMBs in the fronto-subcortical circuits(odds ratio = 4.4; 95% confidence interval: 1.602–12.081, P = 0.004) and 5 or more CMBs overall(odds ratio = 17.6, 95% confidence interval: 3.23–95.84, P = 0.001) had a significantly increased risk of dementia at the 1-year follow-up. These findings indicate that CMBs in the fronto-subcortical circuits may be predictive of dementia conversion in CSVD patients with V-CIND, and thus extend the clinical significance of CMBs.

Multiple hypointense vessels on susceptibility-weighted imaging predict early neurological deterioration in acute ischaemic stroke patients with severe intracranial large artery stenosis or occlusion receiving intravenous thrombolysis

background and purpose Early neurological deterioration(END)is a common feature in patients with acute ischaemic stroke(AIS)receiving thrombolysis.This study aimed to investigate whether the presence of multiple hypointense vessels(MHVs)on susceptibility-weighted imaging(SWI)could predict END in patients with the anterior circulation AIS treated with recombinant tissue plasminogen activator(r-tPA).Methods This was a retrospective study focusing on AIS patients suffering from symptomatic stenosis or occlusion of the middle cerebral artery or internal carotid artery with r-tPA treatment.We collected clinical variables and initial haematological and neuroimaging findings.MHVs were measured on SWI performed after intravenous thrombosis and were defined as the presence of a greater number of veins or veins of a larger diameter with greater signal loss on SWI than those of the contralesional haemisphere.The degree of hyperintensity of MHVs was classified into four grades:none,subtle,moderate and extensive.END was defined as an increase in the National Institutes of Health Stroke Scale score by 2 points during the first 48 hours after the onset of symptoms.Multivariate logistic regressions were conducted to investigate the predictors of END.results The study included 61 patients(51 males and 10 females)with a mean age of 62.4±12.6 years.Thirty-five(57.4%)patients presented with MHVs:8(13.1%)were graded as subtle MHVs,while 23(37.7%)and 4(6.6%)were graded as moderate or extensive MHVs,respectively.Twenty patients(32.8%)presented with END.Logistic regression analysis showed that compared with patients without MHVs,moderate MHVs(adjusted OR 5.446,95%CI 1.360 to 21.800;p=0.017)and extensive MHVs(adjusted OR 15.240,95%CI 1.200 to 193.544;p=0.036)were significantly associated with END.Conclusions MHVs might be a useful predictor of END in AIS patients with symptomatic large artery stenosis or occlusion after r-tPA treatment.

Correlation between virus persistent infection and cardic function in patients with dilated cardiomyopathy

In our study, 50 patients with dilated cardiomyopathy (DCM) were selected to investigate the correlation between virus persistent infection and cardic function. We found that 44% of patients with DCM were coxsackie virus B-RNA (CVB RNA) positive, significantly different from that (20%) of the normal control group (P<0.05). The expression levels of coxsackie adenovirus receptor (CAR) in patients with DCM were significantly higher than those in the normal control group (P<0.01). In CVB-RNA-positive patients, expression levels of CAR were significantly higher than those in CVB-RNA-negative patients (P<0.01). There was a positive correlation between CAR expression and brain natriuretic peptide (BNP) level in patients with DCM, but no significant correlations between the CAR expression level and left ventricular ejection fraction (LVEF) or left ventricular end diastolic diameter (LVEDd). These results showed that expression levels of CAR on the surface of white cells can be used as an indicator for detecting persistent virus infection. We found that expression levels of CAR and heart function in patients with DCM were highly correlated.