Effect of infarct location and volume on cognitive dysfunction in elderly patients with acute insular cerebral infarction

BACKGROUND The aging of the population has become increasingly obvious in recent years,and the incidence of cerebral infarction has shown an increasing trend annually,with high death and disability rates.AIM To analyze the effects of infarct location and volume on cognitive dysfunction in elderly patients with acute insular cerebral infarction.METHODS Between January 2020 and December 2023,we treated 98 cases of elderly acute insula,patients with cerebral infarction in the cerebral infarction acute phase(3-4 weeks)and for the course of 6 months in Montreal Cognitive Assessment Scale(MoCA)for screening of cognition.Notably,58 and 40 patients were placed in the cognitive impairment group and without-cognitive impairment group,respec-tively.In patients with cerebral infarction,magnetic resonance imaging was used to screen and clearly analyze the MoCA scores of two groups of patients with different infarctions,the relationship between the parts of the infarction volume,and analysis of acute insula cognitive disorder in elderly patients with cerebral RESULTS The number of patients with cognitive impairment in the basal ganglia and thalamus was significantly higher than that without cognitive impairment(P<0.05).The total infarct volume in the cognitive impairment group was higher than that in the non-cognitive impairment group,and the difference was statistically significant(P<0.05).The infarct volumes at different sites in the cognitive impairment group was higher than in the non-cognitive impairment group(P<0.05).In the cognitive impairment group,the infarct volumes in the basal ganglia,thalamus,and mixed lesions were negatively correlated with the total MoCA score,with correlation coefficients of-0.67,-0.73,and-0.77,respectively.CONCLUSION In elderly patients with acute insular infarction,infarction in the basal ganglia,thalamus,and mixed lesions were more likely to lead to cognitive dysfunction than in other areas,and patients with large infarct volumes were more likely to develop cognitive dysfunction.The infarct volume in the basal ganglia,thalamus,and mixed lesions was significantly negatively correlated with the MoCA score.

Blockage of the habenular nucleus can eliminate dyspnea induced by electrostimulation of the insular cortex

BACKGROUND： The insular cortex and habenular nucleus may be a regulatory center for obstructive sleep apnea syndrome, and dyspnea may be caused by insular cortex activity. The insular cortex is a cortical representation of obstructive sleep apnea syndrome. The habenular nucleus is a station for descending insular cortex activity. OBJECTIVE： Through actively stimulating the rat insular cortex, to observe rat respiratory movement, myoelectric activities of genioglossus, arterial partial pressure of oxygen, partial pressure of carbon dioxide and acidity-alkalinity, and to verify a hypothesis that the insular cortex is a superior-position regulation center, and the habenular nucleus is an inferior-position nervous nuclei of the insular cortex in patients with obstructive sleep apnea syndrome. DESIGN, TIME AND SETTING： The randomized, controlled animal study was performed at the Laboratory of Electrophysiology, Department of Physiology, Norman Bathune College of Medicine, Jilin University, China from September 2004 to June 2008. MATERIALS： We used L-glutamic acid （Dingguo Biological Product Research Center, Beijing, China）, lidocaine hydrochloride （Seventh Pharmacy Co., Ltd., Wuxi, China）, electric stimulator （Nihon Kohden, Japan）, and an AVL-OPTI blood gas analyzer （AVL Scientific Co., Roswell, GA, USA）. METHODS： The insular cortex of healthy adult Wistar rats underwent electrostimulation and L-glutamic acid stimulation to record changes in the myoelectric activity of genioglossus and respiratory movement. Some rats were injected with lidocaine to block the habenular nucleus before electrostimulation or L-glutamic acid stimulation. L-glutamic acid and lidocaine were injected by microelectrodes embedded in nuclear groups. MAIN OUTCOME MEASURES： Myoelectric activities of genioglossus, arterial partial pressure of oxygen, partial pressure of carbon dioxide and acidity-alkalinity were measured following apnea in rats undergoing electrostimulation in the insular cortex and following blockade of the habenular nucleus. RESULTS： Following electrostimulation and L-glutamic acid stimulation, rats developed apnea or respiratory rhythm disorders. Simultaneously, the amplitude of myoelectric activity of the genioglossus was reduced （P 〈 0.01 ）, and the electromyogram integral was decreased （P 〈 0.01）. Arterial blood gas analysis showed arterial blood acidosis, a decrease in pH （P 〈 0.05）, and an increase in the negative value of alkaline reserve （P 〈 0.01）. Lidocaine in the habenular nuclear blocked respiratory and other index changes after insular cortex stimulation. CONCLUSION： Dyspnea induced by stimulating the insular cortex may require the habenular nucleus. Paralysis of the habenular nucleus can completely eliminate insular cortex stimulation-induced dyspnea.

Intraoperative diffusion tensor imaging predicts the recovery of motor dysfunction after insular lesions

Insular lesions remain surgically challenging because of the need to balance aggressive resection and functional protection. Motor function deficits due to corticospinal tract injury are a common complication of surgery for lesions adjacent to the internal capsule and it is therefore essential to evaluate the corticospinal tract adjacent to the lesion. We used diffusion tensor imaging to evaluate the corticospinal tract in 89 patients with insular lobe lesions who underwent surgery in Chinese PLA General Hospital from February 2009 to May 2011. Postoperative motor function evaluation revealed that 57 patients had no changes in motor function, and 32 patients suffered motor dysfunction or aggravated motor dysfunction. Of the affected patients, 20 recovered motor function during the 6-12-month follow-up, and an additional 12 patients did not recover over more than 12 months of follow-up. Following reconstruction of the corticospinal tract, fractional anisotropy comparison demonstrated that preoperative, intraoperative and follow-up normalized fractional anisotropy in the stable group was higher than in the transient deficits group or the long-term deficits group. Compared with the transient deficits group, intraoperative normalized fractional anisotropy significantly decreased in the long-term deficits group. We conclude that intraoperative fractional anisotropy values of the corticospinal tracts can be used as a prognostic indicator of motor function outcome.

Impairment of LTP in insular cortex is correlated to resilience and vulnerability to chronic stress for PTSD

OBJECTIVE Exposure to stressful events can be differently perceived by individuals depending on the level of stress resilience or vulnerability.The neural processes that underlie such clinical y and social y important differences are largely unknown.As insula cortex is important in emotional processing,we have examined whether the changes in synaptic plasticity in the insula cortex involved in stress resilience or vulnerability.METHODS Mice were divided into two groups:control and stress group.Stress group was treated by foot electric shock twice daily(0.8 mA,2 s,ten times in 1 min) in continuous two weeks.Then we used fear conditioning test to detect re-experiencing of traumatic experience,open field test to detect avoidance,pre-pulse inhibition experiment to detect hyper arousal.The changes of synaptic plasticity in the insular cortex were recorded by the multiple channels electrophysiology and whole cell patch.RESULTS According to the behavioral scores,it was divided into resilient and vulnerable group.In the fear conditioning test,the vulnerable group showed the significant freezing time decreased than that of the resilient group(P<0.01).In the open field test,the time that enter the center zone of vulnerable group is increased than that resilient group(P<0.01);In the pre-pulse inhibition experiment,there are not significant difference of PPI value in both groups(P=0.4239).And then electrophysiological experiments are performed to detect the synaptic plasticity of the insular cortex.Compared with the resilient group,the LTP level was decreased(P<0.05) and the mEPSC was increased(P<0.01) in vulnerable group.CONCLUSION The impairment of synaptic plasticity in the insular cortex may be one of the neural mechanisms for the vulnerability to chronic stress.

The Relation Between Tourism, Local Development and Insularity： Case Study of Southern Aegean, Greece

Greece as a significant tourist destination showed a considerable increase （5.1%） in tourist arrivals in 2016, despite intense geopolitical upheaval, especially in the area of South-East Aegean. It is noteworthy that the main volume of tourism proceeds in Greece was generated by its insular regions, despite the intense problems faced by insularity, and by the insular Region of Southern Aegean in particular, despite the heavy refugee flows due to its geopolitical position. However, how is insularity affected by the new hyper-taxation of the islands through the increase of value added tax in insular local development and tourism？ Is insular economy strong enough to withstand the increased and intensely varying international challenges？ In this paper, after realistically depicting the official and published national tourism results for 2016, it is presented the immediate policy, institutional and destination management actions required in the Region of Southem Aegean so that it might be able to respond adequately to the new European or global tourism challenges, and act as the steam engine of the Greek tourism, pulling the broader Greek tourism development forward.

Extracellular Levels of 5HT and 5HIAA Increase after an Inflammatory Process in the Rat’s Insular Cortex

Serotonin (5HT) in the central nervous system has been associated with pain processing and modulation. The insular cortex (IC) plays an important role in the development and perception of the inflammatory and chronic pain. The role of the serotoninergic system in IC has not been completely studied. We used micro-dialysis in freely moving rats to determine the extracellular release of 5HT and its main metabolite (5HIAA) in the IC during an inflammatory process. Results showed an increase of extracellular levels of 5HT and 5HIAA in the IC during carrageenan-induced inflammation and this augmentation correlates with a decrease of behavioral mechanonociceptive response. Furthermore, the exogenous administration of 5HT and 5HIAA in the IC increases the nociceptive response. Our current data imply that the serotoninergic system in the IC participates in the long-term pain process.

Activation of Cannabinoid Receptor 1 in GABAergic Neurons in the Rostral Anterior Insular Cortex Contributes to the Analgesia Following Common Peroneal Nerve Ligation

The rostral agranular insular cortex(RAIC)has been associated with pain modulation.Although the endogenous cannabinoid system(eCB)has been shown to regulate chronic pain,the roles of eCBs in the RAIC remain elusive under the neuropathic pain state.Neuropathic pain was induced in C57BL/6 mice by common peroneal nerve(CPN)ligation.The roles of the eCB were tested in the RAIC of ligated CPN C57BL/6J mice,glutamatergic,or GABAergic neuron cannabinoid receptor 1(CB1R)knockdown mice with the whole-cell patch-clamp and pain behavioral methods.The E/I ratio(amplitude ratio between mEPSCs and mIPSCs)was significantly increased in layer V pyramidal neurons of the RAIC in CPN-ligated mice.Depolarization-induced suppression of inhibition but not depolarization-induced suppression of excitation in RAIC layer V pyramidal neurons were significantly increased in CPN-ligated mice.The analgesic effect of ACEA(a CB1R agonist)was alleviated along with bilateral dorsolateral funiculus lesions,with the administration of AM251(a CB1R antagonist),and in CB1R knockdown mice in GABAergic neurons,but not glutamatergic neurons of the RAIC.Our results suggest that CB1R activation reinforces the function of the descending pain inhibitory pathway via reducing the inhibition of glutamatergic layer V neurons by GABAergic neurons in the RAIC to induce an analgesic effect in neuropathic pain.

岛叶胶质瘤的外科治疗策略的研究进展

岛叶位于外侧沟底,借其周围的环状沟与额、颞、顶叶分界。岛叶的尖部称岛阈,藏于大脑外侧沟深部的脑叶被顶、额、颞叶覆盖,其深面分别为最外囊、屏状核、壳核、外囊、内囊前后肢等,是胶质瘤的好发部位之一。由于位置深在、毗邻重要功能区和血管,而且术中难以准确判断边界,因此,岛叶胶质瘤的手术治疗难度大。Yasargil于1992年首次报道边缘系统和旁边缘系统肿瘤的手术治疗,开启了岛叶肿瘤手术治疗的新篇章。近年来,随着术中辅助技术的进步,岛叶胶质瘤外科治疗的可行性和安全性取得了较大的提升。本文就岛叶胶质瘤的外科治疗手段、术中辅助技术研究进展进行综述,为临床提供参考。

经外侧裂-岛叶入路显微手术与经额叶入路血肿清除术对高血压性基底节区脑出血患者神经功能损伤的影响

目的探讨高血压性基底节区脑出血患者应用经外侧裂-岛叶入路显微手术与经额叶入路血肿清除术对神经功能损伤的影响。方法回顾性分析广西河池市人民医院2019-01—2022-12收治的121例高血压性基底节区脑出血患者的临床资料,分为A组61例(经外侧裂-岛叶入路显微手术)与B组60例(经额叶入路血肿清除术)。比较2组患者神经功能损伤指标水平及其他相关指标。结果2组患者手术时间、住院时间比较无统计学差异(P>0.05);A组术后意识恢复时间(5.11±0.89)h,短于B组的(6.03±0.73)h,术中出血量(37.21±4.27)mL,少于B组的(39.82±4.41)mL,48 h血肿清除率(90.06±3.44)%,大于B组的(88.69±4.02)%,差异均有统计学意义(t=6.178、3.299、2.017,P<0.05);A组临床总有效率98.36%(60/61),高于B组的86.67%(52/60)(χ^(2)=4.460,P=0.035);术后3 d,2组患者S-100β蛋白(S-100β)、神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)水平均较术前下降,且A组低于B组(P<0.05);2组患者术后并发症发生率比较无统计学差异(P>0.05);术后3个月,A组格拉斯哥预后量表(GOS)评分高于B组(P<0.05);2组患者术后6个月GOS评分比较无明显差异(P>0.05)。结论相比于经额叶入路血肿清除术,应用经外侧裂-岛叶入路显微手术可更有效促进高血压性基底节区脑出血患者神经功能损伤恢复,减少术中出血量,提高血肿清除率及临床疗效,且能够显著改善患者近期预后。

不同入路小骨窗开颅显微手术治疗基底节区高血压脑出血的效果比较

目的分析不同入路小骨窗开颅显微手术治疗基底节区高血压脑出血的效果。方法选取2019年1月至2022年3月丰城市人民医院收治的88例基底节区高血压脑出血患者作为研究对象,随机分为观察组与对照组,每组44例。两组均行小骨窗开颅显微手术,对照组采用经颞叶皮质入路手术治疗,观察组采用经侧裂下Rolandic点-岛叶入路手术治疗,比较两组手术情况、血肿清除率、再出血率、术后并发症、术后1个月格拉斯哥昏迷量表(Glasgow coma score,GOS)分级情况及术后1、3、6个月的美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分及世界卫生组织生存质量测定量表(World Health Organization on quality of life brief scale,WHOQOL-BREF)评分。结果两组手术时间、术中出血量、引流管放置时间、行大骨瓣减压例数、住院时间比较差异均无统计学意义;观察组开始手术至颅内压下降时间长于对照组,差异有统计学意义(P<0.05)。观察组术后24 h血肿清除率明显高于对照组,差异有统计学意义(P<0.05);两组再出血率比较差异无统计学意义。观察组术后1个月预后良好率为81.82%,高于对照组的61.36%,差异有统计学意义(P<0.05)。术后1、3、6个月,观察组NIHSS评分均低于对照组,WHOQOL-BREF评分均高于对照组,差异有统计学意义(P<0.05)。观察组术后并发症发生率为6.82%,低于对照组的25.00%,差异有统计学意义(P<0.05)。结论经侧裂下Rolandic点-岛叶入路小骨窗开颅显微手术治疗基底节区高血压脑出血的效果显著,有助于提升血肿清除率,减少术后并发症发生率,促进术后神经功能的恢复,提高患者预后生存质量。

围手术期护理在腓肠肌岛状穿支肌皮瓣修复胫骨远端骨折伴骨外露中的应用效果

目的:分析围手术期护理在腓肠肌岛状穿支肌皮瓣修复胫骨远端骨折伴骨外露中的应用效果。方法:选择2021年1月—2023年2月高州市人民医院收治的20例胫骨远端骨折伴骨外露患者,入院均提供腓肠肌岛状穿支肌皮瓣修复治疗,采用随机抽签法分为两组,各10例。对照组接受常规护理,观察组接受围手术期护理。对比两组术后皮瓣成活率、疼痛评分、踝关节功能及护理满意度。结果:研究组的皮瓣成活率高于对照组,但两组对比差异无统计学意义(P>0.05);术后1 d、术后3 d及随访2周,研究组的疼痛评分均明显低于对照组,差异有统计学意义(P<0.05);术后7 d、随访1个月、随访3个月,研究组的踝关节功能评分均明显高于对照组,差异有统计学意义(P<0.05);研究组的护理满意度明显高于对照组,差异有统计学意义(P<0.05)。结论:围手术期护理应用于腓肠肌岛状穿支肌皮瓣修复治疗的胫骨远端骨折伴骨外露患者,皮瓣成活率好,且可减轻疼痛,提高踝关节功能,提升护理满意度。

全球化浪潮中的一座孤岛--德国小说《账单待付》中的岛屿母题

“岛屿”母题在21世纪的德国哲学和文学中书写了浓墨重彩的篇章。德国著名哲学家彼得·斯洛特戴克回溯了人类文明中的三次全球化,并用“岛屿化”和“全球化”来隐喻人类自我保护和开拓疆域之间的关系。他笔下全球化的宏大“水晶宫”破碎之后,个体以“泡沫化”的生存形式寻求自我免疫。德国作家英格-玛丽亚·马尔克以2008年全球金融危机为背景构思的小说《账单待付》描写了一个在全球化浪潮中被推至城市边缘的生存孤岛。借助多重叙事技巧,马尔克不仅展现了一群在各自社会圈层中坠落的人们的悲喜,更是敏锐地透视了当代德国人泡沫式的“孤岛文化”,展开了一幅全球化时代德国现实主义的画卷。

脑梗死累及岛叶预示心源性栓塞性卒中风险

目的 探讨在大脑中动脉供血区脑梗死患者中,病灶累及岛叶是否与心源性栓塞性卒中存在相关性。方法 回顾性纳入2020年10月至2023年3月中山大学附属第一医院和广西医科大学第一附属医院卒中中心收治的发病7 d内的大脑中动脉供血区脑梗死患者。卒中病因分型分为心源性栓塞型和非心源性栓塞型。病灶是否累及岛叶主要通过磁共振弥散加权成像(DWI)进行确诊。采用单因素和多因素logistic回归分析探讨累及岛叶的脑梗死与心源性栓塞性卒中之间的相关性。结果 共纳入大脑中动脉供血区脑梗死患者1585例,其中心源性栓塞型173例(10.9%)和非心源性栓塞型1412例(89.1%)。脑梗死累及岛叶448例(28.3%),其中心源性栓塞组135例(78.0%)和非心源性栓塞组313例(22.2%)。单因素logistic回归分析提示累及岛叶的脑梗死与心源性栓塞性卒中存在相关性(未调整模型:OR=12.474, 95%CI 8.520~18.263,P<0.001)。在调整潜在混杂因素后,两者间仍存在显著相关性(模型3:OR=6.233, 95%CI 3.688~10.543;P<0.001)。此外,累及左侧(模型3:OR=4.977, 95%CI 2.757~8.987,P<0.001)和右侧岛叶的脑梗死(模型3:OR=4.998,95%CI 2.743~9.107,P<0.001)均与心源性栓塞性卒中存在相关性。结论 大脑中动脉供血区脑梗死累及岛叶可作为心源性栓塞性卒中的潜在影像学标志。

经外侧裂-岛叶切除岛叶胶质瘤手术入路的显微解剖学研究

目的 通过尸头标本模拟经外侧裂-岛叶入路的相关解剖结构,为临床医师进行岛叶胶质瘤手术提供参考,从而在提高肿瘤全切率的同时能最大程度保护脑组织功能。方法 在10例尸头标本上进行外侧裂、岛叶、大脑中动脉区域的解剖研究,拍照并观察各重要结构的关系及测量相关参数。结果 岛中央沟与大脑表面的中央沟相齐平,将岛叶分为前半部分和后半部分,前半部分为3~5个岛短回,后半部分由2个岛长回构成。岛叶前半部分被额下回三角部、盖部和中央前回覆盖;岛叶后半部分的上方被中央后回、缘上回覆盖,下方被赫氏勒回覆盖。岛叶被上纵束环绕,上纵束联系额颞顶枕叶,钩束在岛叶下方连接额叶和颞叶。经侧裂暴露到达上界沟区域、前岛点,额眶部至少需要牵拉2.0 cm,牵拉时要避免对Broca区的损伤。暴露岛叶下界沟则需要牵拉颞叶2.5 cm,牵拉压迫过程中应注意避免损伤颞横回。结论 经外侧颞-岛叶入路可充分暴露岛叶,适合切除纯岛叶胶质瘤。对于其他类型岛叶胶质瘤,前岛点和前界沟位置容易暴露,后岛点及下界沟暴露更为困难。

Insular Cortex is Critical for the Perception, Modulation,and Chronification of Pain

An increasing body of neuroimaging and electrophysiological studies of the brain suggest that the insular cortex（IC） integrates multimodal salient information ranging from sensation to cognitive-affective events to create conscious interoception. Especially with regard to pain experience, the IC has been supposed to participate in both sensory-discriminative and affective-motivational aspects of pain. In this review, we discuss the latest data proposing that subregions of the IC are involved in isolated pain networks： the posterior sensory circuit and the anterior emotional network. Due to abundant connections with other brain areas, the IC is likely to serve as an interface where cross-modal shaping of pain occurs. In chronic pain,however, this mode of emotional awareness and the modulation of pain are disrupted. We highlight some of the molecular mechanisms underlying the changes of the pain modulation system that contribute to the transition from acute to chronic pain in the IC.

Nestedness in insular floras:spatiotemporal variation and underlying mechanisms

Aims Nestedness is a characteristic of insular metacommunity structure.Relatively few studies,however,have attempted to evaluate temporal changes in nestedness,or elucidate the mechanisms underlying nestedness.I evaluated both spatial and temporal patterns of nestedness in the insular floras of four archipelagoes of small islands in the Bahamas and the potential underlying environmental gradients.Methods The NODF(a nestedness metric based on overlap and decreasing fill)and the matrix temperature measure,T,were used to quantify nestedness in insular floras on small islands near Abaco,Andros,Great Exuma and the Exuma Cays,Bahamas.Two different null models were employed for each nestedness measure.Six environmental variables were evaluated in relation to nestedness by ordering islands according to gradients and recalculating NODF scores.Important Findings All archipelagoes were significantly nested.Nestedness among sites contributed more to overall nestedness than did nestedness among species.NODF scores varied among archipelagoes,but were surprisingly constant over time.Ordering islands by vegetated area yielded the highest nestedness scores for three archipelagoes;ordering islands by protection from exposure yielded the highest nestedness score for one archipelago.Nestedness scores varied little over time even though species compositions changed,indicating that extinctions occurred in a deterministic manner.The relative importance of area suggests extinction is an important mechanism in producing nestedness.Attempting to determine the relative importance of immigrations or extinctions requires some assumptions,however,and both processes are likely cumulative in most cases.

Ictal semiology,functional anatomy and multimodal diagnostic in patients with insular epilepsies

Background:The insula is a hidden part in the cerebral cortex.Insular epilepsy is underrecognized and it bears a special risk for misdiagnosis with regard to nonepileptic seizures or wrong localization of epileptic seizures.Case presentations:The manuscript describes 2 cases with ictal semiology of paresthesia and pain followed by hyperkinetic movements,noninvasive findings of source localization and/or invasive SEEG exploration.Conclusion:Magnetic source imaging,ictal SPECT as noninvasive and invasive recordings with depth electrodes(SEEG)can provide important preoperative information for the involvement of insular and periinsular regions in focal pharmacoresistant epilepsies.The optimal use of these methods presupposes extensive knowledge of ictal semiology and other clinical characteristics.The clinical localization hypothesis can be optimally proofed by SEEG exploration.

急性脑梗死部位、体积与临床预后的关系

目的探讨老年(年龄60~70岁)急性岛叶梗死患者的梗死部位、梗死体积与临床预后的关系。方法选取2021年2~12月张家口市第一医院老年病科及全科医学科收治的100例老年急性岛叶梗死患者作为研究对象,受试者的脑梗死部位均运用核磁共振成像(magnetic resonance imaging,MRI)筛查并明确,按Pullicino公式计算其脑梗死体积。根据脑梗死体积大小分组,脑梗死体积<3 cm^(3)组(A组)61例,脑梗死体积≥3 cm^(3)组(B组)39例,利用美国国立卫生院卒中量表(national institutesof health stroke scale,NIHSS)、蒙特利尔认知评估量表(montreal cognitive assessment,MoCA)、脑卒中改良Rankin量表(modifed rankin scale,mRS)、日常生活能力评估量表(activity of daily living scale,ADL)和简易精神状况量表(mini-mental state examination,MMSE)分别评估所有受试者入院时、出院时、出院后的神经功能缺损程度、认知、功能恢复、日常生活能力及精神状态进行综合评估。用秩和检验、Spearman等级相关性检验NIHSS、MoCA、mRS、ADL、MMSE评分与梗死部位、梗死体积的相关性。结果组内比较,A、B组入院时NIHSS、mRS评分依次高于出院时,出院后3、6个月时,MoCA、ADL、MMSE评分及TST剩余值依次低于出院时(P<0.05)。组间比较,A组入院时、出院期(出院时,出院后3、6个月)NIHSS、mRS评分显著低于B组,MoCA、ADL、MMSE评分及TST剩余值显著高于B组(P<0.05)。A组梗死部位(基底核、皮质、脑干、小脑、丘脑、混合病变)的TST剩余值均高于B组(P<0.05)。急性岛叶梗死患者的TST剩余值、NIHSS评分、mRA评分与脑梗死体积呈负相关(rs=-0.358、-0.425、-5.06,P=0.003、0.06、0.09),MoCA、ADL、MMSE评分与脑梗死体积呈正相关(rs=0.547、0.614、0.548,P均<0.001)。结论老年急性岛叶梗死患者的脑梗死部位与神经功能缺损程度、功能恢复呈负相关,与认知、日常生活能力及精神状态呈正相关,其中脑梗死体积与肢体运动功能呈负相关。

Logistic回归与决策树模型对大面积急性岛叶梗死患者预后的预测价值

目的探讨Logistic回归模型和决策树模型对大面积急性岛叶梗死预后不良的预测价值。方法回顾性分析2019年1月—2022年12月收治的大面积急性岛叶梗死100例的临床资料,根据发病3个月后改良Rankin量表分为预后良好组和预后不良组。统计2组临床资料、实验室指标、疾病史等基线资料。构建Logistic回归模型、决策树模型分析预后不良影响因素。绘制受试者工作特征(ROC)曲线分析2种模型对预后不良的预测效能。结果发病3个月后失访3例,预后不良发生率为39.18%(38/97),预后良好率为60.82%(59/97)。Logistic回归分析显示,年龄、房颤、基线肌钙蛋白T(cTnT)、鸢尾素、闭锁蛋白(Occludin)是预后不良影响因素(P<0.01);决策树模型分析显示,年龄、房颤、基线cTnT及Occludin是预后不良影响因素;决策树模型预测预后不良的曲线下面积大于Logistic回归模型。结论年龄、房颤、基线cTnT、Occludin是大面积急性岛叶梗死患者预后不良影响因素,基于上述因素构建Logistic回归模型和决策树模型均具有良好应用价值,应结合2种模型优点,为临床诊治提供新思路。

美国岛屿案件发展探析

岛屿案件是一项具有重大意义的司法裁决,其深远影响体现在对美国领土政策的塑造上,并对美国领土治理方法的形成和持续演进产生了持久的影响。19世纪末和20世纪初,美西战争后,美国获得波多黎各、关岛和菲律宾等领土,岛屿案件随之出现。这些裁决建立了管理非相邻领土居民的政治地位、权利和义务的法律框架。在岛屿案的审理过程中,美国最高法院就美国主权如何延伸至其获取的领土,以及这些领土上居民所享有的基本权利的宪法解释问题进行了探讨,展示了领土主权和公民权概念的演变。岛屿案件裁决为管理获得的领土的复杂性和平衡国家利益与正义和民主原则提供了有价值的见解。