The impact of cerebral small vessel disease burden on prognosis in patients with acute coronary syndrome

Background Acute coronary syndrome(ACS)presents with a variable prognosis,posing significant public health challenges.This study investigated the potential link between cerebral small vessel disease(CSVD)burden and outcomes in patients with ACS.Methods In this retrospective cohort study,ACS patients admitted to Beijing Friendship Hospital,Capital Medical Universi-ty,Beijing,China from January 2020 to October 2021,were analyzed.CSVD burden was assessed using magnetic resonance ima-ging markers,including white matter lesions,lacunar infarcts,cerebral microbleeds,and enlarged perivascular spaces.The correl-ation between CSVD burden and clinical outcomes,including major adverse cardiovascular and cerebrovascular events,myocar-dial infarction(MI),target vessel revascularization,stroke,and mortality was examined over a one-year follow-up.Results Out of 248 patients,216 patients were categorized into the low score group(LSG-CSVD)and 32 patients were categor-ized into the high score group(HSG-CSVD).Patients in the HSG-CSVD group exhibited significantly worse prognosis,with an el-evated risk of major adverse cardiovascular and cerebrovascular events,MI,and target vessel revascularization.After adjusting for age,sex,hypertension,troponin T,and estimated glomerular filtration rate,a significantly higher risk of MI was observed in the HSG-CSVD group(HR=4.51,95%CI:1.53-13.26,P=0.006).Subgroup analysis by age and sex consistently demonstrated in-creased adverse outcomes in the HSG-CSVD.Conclusions The study highlights a direct association between increased CSVD burden and poorer ACS outcomes,particular-ly in MI risk.These findings underscore the importance of considering CSVD burden as a crucial prognostic factor in ACS manag-ement,facilitating risk stratification and guiding personalized treatment strategies.

Fatal progressive ascending encephalomyelitis caused by herpes B virus infection:first case from China

Dear editor,Herpes B virus(BV),also known as Macacine herpesvirus 1(family:Herpesviridae,subfamily:Alphaherpesvirinae,genus:Simplexvirus),officially designated by the International Committee on the Taxonomy of Viruses,exhibits serologic cross-reactivity with other members of the genus Simplexvirus,namely HSV type 1(HSV-1),the causative agent of oral herpetic ulcers(cold sores)in humans and HSV type 2(HSV-2),the agent of human genital herpes.[1]

Priming of the Cells： Hypoxic Preconditioning for Stem Cell Therapy

Objective： Stem cell-based therapies are promising in regenerative medicine for protecting and repairing damaged brain tissues after injury or in the context of chronic diseases. Hypoxia can induce physiological and pathological responses. A hypoxic insult might act as a double-edged sword, it induces cell death and brain damage, but on the other hand, sublethal hypoxia can trigger an adaptation response called hypoxic preconditioning or hypoxic tolerance that is of immense importance for the survival of cells and tissues. Data Sources： This review was based on articles published in PubMed databases up to August 16, 2017, with the following keywords：＂stem cells,＂ ＂hypoxic preconditioning,＂ ＂ischemic preconditioning,＂ and ＂cell transplantation.＂Study Selection： Original articles and critical reviews on the topics were selected. Results： Hypoxic preconditioning has been investigated as a primary endogenous protective mechanism and possible treatment against ischemic injuries. Many cellular and molecular mechanisms underlying the protective effects of hypoxic preconditioning have been identified. Conclusions： In cell transplantation therapy, hypoxic pretreatment of stem cells and neural progenitors markedly increases the survival and regenerative capabilities of these cells in the host environment, leading to enhanced therapeutic effects in various disease models. Regenerative treatments can mobilize endogenous stem cells for neurogenesis and angiogenesis in the adult brain. Furthermore, transplantation of stem cells/neural progenitors achieves therapeutic benefits via cell replacement and/or increased trophic support. Combinatorial approaches of cell-based therapy with additional strategies such as neuroprotective protocols, anti-inflammatory treatment, and rehabilitation therapy can significantly improve therapeutic benefits. In this review, we will discuss the recent progress regarding cell types and applications in regenerative medicine as well as future applications.

Restless legs syndrome secondary to pontine infarction:Clinical analysis of five cases

Objective: Pontine infarction is a common type of stroke in the cerebral deep structures, resulting from occlusion of small penetrating arteries, may manifest as hemi-paralysis, hemi-sensory deficit, ataxia, vertigo, and bulbar dysfunction, but patients presenting with restless legs syndrome (RLS) are extremely rare. Herein, we reported five cases with RLS as a major manifestation of pontine infarction.Methods: Five cases of pontine infarction related RLS were collected from July 2013 to February 2016. The diagnosis of RLS was made according to criteria established by the International RLS Study Group (IRLSSG) in 2003. Neurological functions were assessed according to the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Severity of RLS was based on the International RLS Rating Scale (IRLS-RS). Sleep quality was assessed by Epworth Rating Scale (ERS), and individual emotional and psychological states were assessed by Hamilton Depression Scale (HDS) and Hamilton Anxiety Scale (HAS).Results: The laboratory data at the onset including hemoglobin, serum concentration of homocysteine, blood urea nitrogen (BUN), creatinine, electrolytes, and thyroid hormones were normal. The electroencephalogram (EEG), lower-extremity somatosensory evoked potential (SEP), and nerve conduction velocity (NCV) in four limbs were normal. The average period of follow-up was 34.60 ± 12.76 months. The MRI examination showed acute or subacute pontine infarction lesions, 3 cases in the rostral inner side, 1 case in the rostral lateral and inner side, and 1 case in rostral lateral side. The neurological deficits included weakness in 4 cases, contralateral sensory deficit in 1 case, and ataxia in 2 cases. All 5 patients presented with symptom of RLS at or soon after the onset of infarction and 4 patients experienced uncomfortable sensations in the paralyzed limbs contralateral to the ischemic lesion. Their neurological deficits improved significantly 2 weeks later, but the symptoms of RLS did not resolve. Among them, 3/5 patients were treated with dopaminergic drugs. At the end of the follow-up, RLS symptom eventually resolved in 3 patients but persisted in two. The IRLS-RS, NIHSS and mRS scores were significantly lower at the onset than those at the last follow-up (P=0.035, 0.024 and 0.049, respectively). However, there was no significant difference in the ERS, HDS and HAS scores (P=0.477, 0.226 and 0.778, respectively).Conclusion: RLS can be an onset manifestation of pontine infarction, clinicians should be aware of this potential symptom. RLS usually occurs in the paralyzed limbs contralateral to the infarction lesion. The pathogenesis still needs further investigation.