Background:White matter lesion(WML)is common in aging brain and is associated with cognitive impairment and dementia.However,recent studies reported an association between patent foramen ovale(PFO)and WML in migraineu...Background:White matter lesion(WML)is common in aging brain and is associated with cognitive impairment and dementia.However,recent studies reported an association between patent foramen ovale(PFO)and WML in migraineurs,especially in young,middle-aged migraineurs.Our retrospective,case-control study aims to describe the clinical characteristics of WML in this population and to explore potential risk factors.Methods:226 patients with migraine and PFO were consecutively initially screened.Relevant factors were selected by the least absolute shrinkage and selection operator(LASSO)regression and multivariable logistic regression model.A Nomogram was employed to visualize the prediction model conveniently.The discrimination and calibration abilities were evaluated using the Receiver Operating Characteristic(ROC)curve,the Hosmer-Lemeshow test,and calibration curves.Results:One hundred and nineteen participants were ultimately enrolled in our study,with a median age of 36.9±12.7 years and 80.7%of females.Brain magnetic resonance imaging MRI showed 67(56.3%)patients had WML,whereas 52(43.7%)patients were categorized into the non-WML group.LASSO regression screened out potential variables and subsequent multivariate analysisfinally identified age,mean platelet volume,andfibri-nogen(FIB)as independent predictive factors of WML.The area under the ROC curve(AUC)was 0.807.Hos-mer-Lemeshow test and calibration curve verified a consistency between the predicted and actual probability.Conclusion:The predictive nomogram established and validated in our study may assist clinicians in screening WML among young middle-aged migraineurs with PFO and developing individualized preventive and treatment strategies.展开更多
It is very common that increased carotid intima media thickness （CIMT） and carotid plaque coexist in a single subject in elderly patients with white matter lesions （WMLs）. In this study we inves- tigated whether t...It is very common that increased carotid intima media thickness （CIMT） and carotid plaque coexist in a single subject in elderly patients with white matter lesions （WMLs）. In this study we inves- tigated whether the coexistence of increased CIMT and carotid plaque is more strongly associated with the presence and extent of WMLs than either alone. All patients were classified into 1 of the following 4 groups： without either increased CIMT （I） or carotid plaque （P）： I（-）P（-）; with only increased CIMT： I（＋）P（-）; with only carotid plaque： I（-）P（＋）; and with both increased CIMT and carotid plaque： I（＋）P（＋） The presence and severity of periventricular WMLs （PWMLs） and deep WMLs （DWMLs） were as- sessed and the prevalence of MRI findings by the Cochran-Armitage trend test was calculated. The characteristics of subjects showed that the percentages of patients with increased CIMT and carotid plaque in the DWMLs group and the PWMLs group were significantly higher than those without WMLs group. Both DWMLs and PWMLs were strongly associated with age, carotid plaque and CIMT. Furthermore, the Cochran-Armitage trend test indicated that the prevalence of MRI findings of PWMLs and DWMLs increased in the order of I（-）P（-）〈 I（＋）P（-）〈 I（-）P（＋）〈 I（＋）P（＋） （P〈0.0001）. For the pa- tients with DWMLs, the grades of both I（＋）P（-） and I（＋）P（＋） were increased significantly compared to I（-）P（-） （P〈0.0025, P〈0.05, respectively） without such a difference found in patients with PWMLs. Our results suggested that the coexistence of increased CIMT and carotid plaque is most closely associated with WMLs, and that increased CIMT is associated with the severity of DWMLs, whereas carotid plaque is related to the presence of WMLs.展开更多
Ischemic stroke often elicits profound white matter lesions, which results in poor neurological outcomes and impairing the recovery in post-stroke. However, few studies have focused on white matter lesions caused by c...Ischemic stroke often elicits profound white matter lesions, which results in poor neurological outcomes and impairing the recovery in post-stroke. However, few studies have focused on white matter lesions caused by cerebral ischemia. The present study was aimed to investigate the effects of cornel iridoid glycoside(CIG), a main active component extracted from Cornus officinalis, on the white matter injury induced by ischemic stroke. CIG(60 and 120 mg·kg-1) were administered intragastrically 6 h after middle cerebral artery occlusion reperfusion(MCAO) surgery once a day for 7 d. A series of behavioral tests were carried out to evaluate the neurological function of MCAO rats. White matter structure was detected by luxol fast blue staining and transmission electron microscopy. Immunohistochemical staining was used to assess myelin loss, oligodendrocytes maturation and glial activation. Results showed that CIG remarkably decreased neurological deficit score, accelerated the recovery of somatosensory and motor functions, and ameliorated the memory deficit in MCAO rats. CIG alleviated white matter lesions and demyelination, increased myelin basic protein expression and the number of mature oligodendrocytes in the corpus callosum of MCAO rats. Besides, CIG inhibited the activation of microglia and astrocytes. Further data obtained by western blot analysis indicated that CIG increased the expression of brain-derived neurotrophic factor(BDNF)/p-Trk B, neuregulin-1/Erb B, and PI3 K p110α/p-Akt/p-m TOR in the corpus callosum of MCAO rats. Our findings demonstrated that CIG protected against white matter lesions induced by cerebral ischemia and the mechanisms were partially contributed to increasing BDNF and activating neuregulin-1/Erb B signaling and its downstream PI3 K/Akt/m TOR pathway in white matter.展开更多
Background： White matter lesions （WMLs） are common findings in brain magnetic resonance imaging （MRI） and are strongly associated with stroke incidence, recurrence, and prognosis. However, the relationship betwee...Background： White matter lesions （WMLs） are common findings in brain magnetic resonance imaging （MRI） and are strongly associated with stroke incidence, recurrence, and prognosis. However, the relationship between WMLs and transient ischemic attacks （TIAs） is not well established. This study aimed to determine the clinical significance of WMLs in patients with TIA. Methods： A total of 181 consecutive inpatients with first-ever TIA were enrolled. Brain MRls within 2 days of symptom onset were used to measure WML volumes. Recurrent vascular events within 1 year of TIA onset were assessed. The relationship between WMLs and recurrent risk of vascular events was determined by a multivariate logistic regression. Results： WMLs were identified in 104 patients （57.5%）. Age and ratio of hypertension were significantly different between patients with and without WMLs. The incidence of vascular events in patients with WMLs significantly increased in comparison to those without WMLs （21.15% vs. 5.19%, 95% confidence interval [CI]： 1.18-[ 5.20, P = 0.027） after controlling for cont／~unders. Furthermore, distributions of WML loads were found to be different between patients who developed vascular events and those who did not. WML volumes were demonstrated to be correlated with recurrent risks, and the fourth quartile of WML volumes led to an 8.5-fold elevation of recurrent risk of vascular events compared with the first quartile （95% CI： 1.52-47.65, P = 0.015） alier adjusting for hyperlipidemia. Conclusion： WMLs occur frequently in patients with T1A and are associated wiila the high risk of recurrent vascular events, suggesting a predictive neuroimaging marker for TIA outcomes.展开更多
Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease characterized by complex and various clinical manifestations. The study aimed to analyze clinical features and cerebral magnetic reson...Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease characterized by complex and various clinical manifestations. The study aimed to analyze clinical features and cerebral magnetic resonance imaging (MRI) changes of hyperintense white matter (WM) lesions in SLE patients.Methods: This was a retrospective study based on a consecutive cohort of 1191 SLE patients;273 patients for whom cerebral MRI data were available were enrolled to assess hyperintense WM lesions associated with SLE. Patients were assigned to two groups, ie, with or without hyperintense WM lesions. The MRI assessment showed that the hyperintense WM lesions could be classified into three categories: type A, periventricular hyperintense WM lesions;type B, subcortical hyperintense WM lesions;and type C, multiple discrete hyperintense WM lesions. The clinical and MRI characteristics were analyzed. Factors related to hyperintense WM lesions were identified by multivariate logistic regression analysis.Results: Among the 273 SLE patients with available cerebral MRI scans, 35.9% (98/273) had hyperintense WM lesions associated with SLE. The proportions of types A, B, and C were 54.1% (53/98), 11.2% (11/98), and 92.9% (91/98), respectively. Fifty-one percents of the patients showed an overlap of two or three types. Type C was the most common subgroup to be combined with other types. Compared with those without hyperintense WM lesions, the patients with hyperintense WM lesions were associated with neuropsychiatric SLE (NPSLE), lupus nephritis (LN), hypertension, and hyperuricemia (P = 0.002,P = 0.018,P = 0.045, andP = 0.036, respectively). Significantly higher rates of polyserous effusions and cardiac involvement were found in the patients with hyperintense WM lesions (P = 0.029 andP = 0.027, respectively), and these patients were more likely to present with disease damage (P < 0.001). In addition, the patients with hyperintense WM lesions exhibited a higher frequency of proteinuria (P = 0.009) and higher levels of CD8+ T cells (P = 0.005). In the multivariate logistic analysis, hyperuricemia and higher CD8+ T cells percentages were significantly correlated with hyperintense WM lesions in SLE patients (P= 0.019;OR 2.129, 95% confidence interval [CI] 1.313-4.006 andP < 0.001;OR 1.056, 95% CI 1.023-1.098, respectively).Conclusions: Hyperintense WM lesions are common in SLE patients and significantly associated with systemic involvement, including NPSLE, LN, polyserous effusions, cardiac involvement, and disease damage. Hyperuricemia and a higher number of CD8+ T cells were independent factors associated with hyperintense WM lesions in SLE.展开更多
Objective To study the microscopic changes of white matter and the relationship between white matter changes and cognitive impairment in Alzheimer’s disease(AD)using voxel-based analysis of DTI.Methods Thirty-seven p...Objective To study the microscopic changes of white matter and the relationship between white matter changes and cognitive impairment in Alzheimer’s disease(AD)using voxel-based analysis of DTI.Methods Thirty-seven patients with probable AD,and 32 normal controls(NC)were all examined by MMSE scores,and un-展开更多
目的采用基于T1WI的病灶映射方法刻画新生儿局灶性脑白质损伤(punctate white matter lesions,PWML)的好发区域并探究其时空分布规律。材料与方法回顾性纳入PWML新生儿94例,其中轻度损伤60例(早产/足月:24/36),重度损伤34例(早产/足月:2...目的采用基于T1WI的病灶映射方法刻画新生儿局灶性脑白质损伤(punctate white matter lesions,PWML)的好发区域并探究其时空分布规律。材料与方法回顾性纳入PWML新生儿94例,其中轻度损伤60例(早产/足月:24/36),重度损伤34例(早产/足月:20/14)。基于T1WI手动标记病灶,与约翰霍普金斯大学新生儿T1WI模板配准后叠加图谱,最终生成PWML概率映射图并计算病灶在不同区域的分布概率。对轻重度PWML组间以及不同分组内早产与足月儿各脑叶病灶体积进行比较。结果轻度PWML的分布均以颞顶叶为主(病灶体积于颞顶叶>额叶>枕叶,P<0.008),尤其是丘脑后辐射、角回及缘上回;早产儿损伤范围较足月儿增加,且向额叶延伸。重度PWML主要分布于额颞顶叶(病灶体积于额颞顶叶>枕叶,P<0.008),早产与足月损伤分布范围较为一致,共同累及的区域包括丘脑后辐射、角回及上放射冠。结论基于T1WI的病灶概率映射于脑区水平细化了不同程度PWML病灶的时空分布特征,为深入理解PWML的病理生理机制及预后评估提供了解剖基础。展开更多
文摘Background:White matter lesion(WML)is common in aging brain and is associated with cognitive impairment and dementia.However,recent studies reported an association between patent foramen ovale(PFO)and WML in migraineurs,especially in young,middle-aged migraineurs.Our retrospective,case-control study aims to describe the clinical characteristics of WML in this population and to explore potential risk factors.Methods:226 patients with migraine and PFO were consecutively initially screened.Relevant factors were selected by the least absolute shrinkage and selection operator(LASSO)regression and multivariable logistic regression model.A Nomogram was employed to visualize the prediction model conveniently.The discrimination and calibration abilities were evaluated using the Receiver Operating Characteristic(ROC)curve,the Hosmer-Lemeshow test,and calibration curves.Results:One hundred and nineteen participants were ultimately enrolled in our study,with a median age of 36.9±12.7 years and 80.7%of females.Brain magnetic resonance imaging MRI showed 67(56.3%)patients had WML,whereas 52(43.7%)patients were categorized into the non-WML group.LASSO regression screened out potential variables and subsequent multivariate analysisfinally identified age,mean platelet volume,andfibri-nogen(FIB)as independent predictive factors of WML.The area under the ROC curve(AUC)was 0.807.Hos-mer-Lemeshow test and calibration curve verified a consistency between the predicted and actual probability.Conclusion:The predictive nomogram established and validated in our study may assist clinicians in screening WML among young middle-aged migraineurs with PFO and developing individualized preventive and treatment strategies.
基金supported by the National Natural Science Foundation of China (No. 30970962)
文摘It is very common that increased carotid intima media thickness （CIMT） and carotid plaque coexist in a single subject in elderly patients with white matter lesions （WMLs）. In this study we inves- tigated whether the coexistence of increased CIMT and carotid plaque is more strongly associated with the presence and extent of WMLs than either alone. All patients were classified into 1 of the following 4 groups： without either increased CIMT （I） or carotid plaque （P）： I（-）P（-）; with only increased CIMT： I（＋）P（-）; with only carotid plaque： I（-）P（＋）; and with both increased CIMT and carotid plaque： I（＋）P（＋） The presence and severity of periventricular WMLs （PWMLs） and deep WMLs （DWMLs） were as- sessed and the prevalence of MRI findings by the Cochran-Armitage trend test was calculated. The characteristics of subjects showed that the percentages of patients with increased CIMT and carotid plaque in the DWMLs group and the PWMLs group were significantly higher than those without WMLs group. Both DWMLs and PWMLs were strongly associated with age, carotid plaque and CIMT. Furthermore, the Cochran-Armitage trend test indicated that the prevalence of MRI findings of PWMLs and DWMLs increased in the order of I（-）P（-）〈 I（＋）P（-）〈 I（-）P（＋）〈 I（＋）P（＋） （P〈0.0001）. For the pa- tients with DWMLs, the grades of both I（＋）P（-） and I（＋）P（＋） were increased significantly compared to I（-）P（-） （P〈0.0025, P〈0.05, respectively） without such a difference found in patients with PWMLs. Our results suggested that the coexistence of increased CIMT and carotid plaque is most closely associated with WMLs, and that increased CIMT is associated with the severity of DWMLs, whereas carotid plaque is related to the presence of WMLs.
文摘Ischemic stroke often elicits profound white matter lesions, which results in poor neurological outcomes and impairing the recovery in post-stroke. However, few studies have focused on white matter lesions caused by cerebral ischemia. The present study was aimed to investigate the effects of cornel iridoid glycoside(CIG), a main active component extracted from Cornus officinalis, on the white matter injury induced by ischemic stroke. CIG(60 and 120 mg·kg-1) were administered intragastrically 6 h after middle cerebral artery occlusion reperfusion(MCAO) surgery once a day for 7 d. A series of behavioral tests were carried out to evaluate the neurological function of MCAO rats. White matter structure was detected by luxol fast blue staining and transmission electron microscopy. Immunohistochemical staining was used to assess myelin loss, oligodendrocytes maturation and glial activation. Results showed that CIG remarkably decreased neurological deficit score, accelerated the recovery of somatosensory and motor functions, and ameliorated the memory deficit in MCAO rats. CIG alleviated white matter lesions and demyelination, increased myelin basic protein expression and the number of mature oligodendrocytes in the corpus callosum of MCAO rats. Besides, CIG inhibited the activation of microglia and astrocytes. Further data obtained by western blot analysis indicated that CIG increased the expression of brain-derived neurotrophic factor(BDNF)/p-Trk B, neuregulin-1/Erb B, and PI3 K p110α/p-Akt/p-m TOR in the corpus callosum of MCAO rats. Our findings demonstrated that CIG protected against white matter lesions induced by cerebral ischemia and the mechanisms were partially contributed to increasing BDNF and activating neuregulin-1/Erb B signaling and its downstream PI3 K/Akt/m TOR pathway in white matter.
文摘Background： White matter lesions （WMLs） are common findings in brain magnetic resonance imaging （MRI） and are strongly associated with stroke incidence, recurrence, and prognosis. However, the relationship between WMLs and transient ischemic attacks （TIAs） is not well established. This study aimed to determine the clinical significance of WMLs in patients with TIA. Methods： A total of 181 consecutive inpatients with first-ever TIA were enrolled. Brain MRls within 2 days of symptom onset were used to measure WML volumes. Recurrent vascular events within 1 year of TIA onset were assessed. The relationship between WMLs and recurrent risk of vascular events was determined by a multivariate logistic regression. Results： WMLs were identified in 104 patients （57.5%）. Age and ratio of hypertension were significantly different between patients with and without WMLs. The incidence of vascular events in patients with WMLs significantly increased in comparison to those without WMLs （21.15% vs. 5.19%, 95% confidence interval [CI]： 1.18-[ 5.20, P = 0.027） after controlling for cont／~unders. Furthermore, distributions of WML loads were found to be different between patients who developed vascular events and those who did not. WML volumes were demonstrated to be correlated with recurrent risks, and the fourth quartile of WML volumes led to an 8.5-fold elevation of recurrent risk of vascular events compared with the first quartile （95% CI： 1.52-47.65, P = 0.015） alier adjusting for hyperlipidemia. Conclusion： WMLs occur frequently in patients with T1A and are associated wiila the high risk of recurrent vascular events, suggesting a predictive neuroimaging marker for TIA outcomes.
基金National Natural Science Foundation of China(Nos. 81771743 and 81801619)Macao Science and Technology Development Fund(No. 0094/2018/A3)。
文摘Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease characterized by complex and various clinical manifestations. The study aimed to analyze clinical features and cerebral magnetic resonance imaging (MRI) changes of hyperintense white matter (WM) lesions in SLE patients.Methods: This was a retrospective study based on a consecutive cohort of 1191 SLE patients;273 patients for whom cerebral MRI data were available were enrolled to assess hyperintense WM lesions associated with SLE. Patients were assigned to two groups, ie, with or without hyperintense WM lesions. The MRI assessment showed that the hyperintense WM lesions could be classified into three categories: type A, periventricular hyperintense WM lesions;type B, subcortical hyperintense WM lesions;and type C, multiple discrete hyperintense WM lesions. The clinical and MRI characteristics were analyzed. Factors related to hyperintense WM lesions were identified by multivariate logistic regression analysis.Results: Among the 273 SLE patients with available cerebral MRI scans, 35.9% (98/273) had hyperintense WM lesions associated with SLE. The proportions of types A, B, and C were 54.1% (53/98), 11.2% (11/98), and 92.9% (91/98), respectively. Fifty-one percents of the patients showed an overlap of two or three types. Type C was the most common subgroup to be combined with other types. Compared with those without hyperintense WM lesions, the patients with hyperintense WM lesions were associated with neuropsychiatric SLE (NPSLE), lupus nephritis (LN), hypertension, and hyperuricemia (P = 0.002,P = 0.018,P = 0.045, andP = 0.036, respectively). Significantly higher rates of polyserous effusions and cardiac involvement were found in the patients with hyperintense WM lesions (P = 0.029 andP = 0.027, respectively), and these patients were more likely to present with disease damage (P < 0.001). In addition, the patients with hyperintense WM lesions exhibited a higher frequency of proteinuria (P = 0.009) and higher levels of CD8+ T cells (P = 0.005). In the multivariate logistic analysis, hyperuricemia and higher CD8+ T cells percentages were significantly correlated with hyperintense WM lesions in SLE patients (P= 0.019;OR 2.129, 95% confidence interval [CI] 1.313-4.006 andP < 0.001;OR 1.056, 95% CI 1.023-1.098, respectively).Conclusions: Hyperintense WM lesions are common in SLE patients and significantly associated with systemic involvement, including NPSLE, LN, polyserous effusions, cardiac involvement, and disease damage. Hyperuricemia and a higher number of CD8+ T cells were independent factors associated with hyperintense WM lesions in SLE.
文摘Objective To study the microscopic changes of white matter and the relationship between white matter changes and cognitive impairment in Alzheimer’s disease(AD)using voxel-based analysis of DTI.Methods Thirty-seven patients with probable AD,and 32 normal controls(NC)were all examined by MMSE scores,and un-
文摘目的采用基于T1WI的病灶映射方法刻画新生儿局灶性脑白质损伤(punctate white matter lesions,PWML)的好发区域并探究其时空分布规律。材料与方法回顾性纳入PWML新生儿94例,其中轻度损伤60例(早产/足月:24/36),重度损伤34例(早产/足月:20/14)。基于T1WI手动标记病灶,与约翰霍普金斯大学新生儿T1WI模板配准后叠加图谱,最终生成PWML概率映射图并计算病灶在不同区域的分布概率。对轻重度PWML组间以及不同分组内早产与足月儿各脑叶病灶体积进行比较。结果轻度PWML的分布均以颞顶叶为主(病灶体积于颞顶叶>额叶>枕叶,P<0.008),尤其是丘脑后辐射、角回及缘上回;早产儿损伤范围较足月儿增加,且向额叶延伸。重度PWML主要分布于额颞顶叶(病灶体积于额颞顶叶>枕叶,P<0.008),早产与足月损伤分布范围较为一致,共同累及的区域包括丘脑后辐射、角回及上放射冠。结论基于T1WI的病灶概率映射于脑区水平细化了不同程度PWML病灶的时空分布特征,为深入理解PWML的病理生理机制及预后评估提供了解剖基础。
文摘目的:探讨脑白质病变(white matter lesions,WML)对帕金森病(Parkinson’s disease,PD)患者运动症状、认知功能和情绪的影响。方法:纳入2018年1月至2023年12月就诊于安徽医科大学第二附属医院神经内科PD患者123例,应用年龄相关的白质改变(age-related white matter changes,ARWMC)量表评估患者头颅MRI影像学的脑白质病变程度,根据评分结果将患者分为轻度WML组(46例),中重度WML组(77例);使用帕金森病统一评定量表第三部分、Hoehn&Yahr(H-Y)分级量表评定运动症状及疾病严重程度,简易精神状态检查(mini-mental state examination,MMSE)评估PD的认知功能,汉密尔顿抑郁量表,汉密尔顿焦虑量表评定情绪状态,Barthel指数评定患者日常生活功能状态。比较两组患者的运动症状、认知及情绪评分等差异,应用Logistic回归分析PD患者的WML与临床症状的关系。结果:中重度WML组的高血压发生率(41.6%vs.23.9%,P<0.05)高于轻度WML组。中重度WML组的H-Y分级高于轻度WML组[2.5(1.5,3.0)vs.2.0(1.5,2.5),P<0.05],UPDRS-Ⅲ评分高于轻度WML组[(34.0±16.5)vs.(24.09±11.04),P<0.01]。此外,中重度WML组的MMSE评分低于轻度WML组[24.0(18.5,27.0)vs.26.0(23.8,27.0),P<0.01],Barthel得分亦低于轻度WML组[(77.4±17.4)vs.(83.5±11.7),P<0.05],差异有统计学意义。相关分析显示,ARWMC总分与HY及UPDRS-Ⅲ得分呈正相关,与年龄亦呈正相关。ARWMC总分与MMSE得分及Barthel评分呈负相关。Logistic回归分析显示,重度WML损害与认知障碍有相关性(回归系数β=1.072,95%CI=1.078~7.918,P=0.035)。结论:WML与PD运动障碍、认知功能损害及生活质量下降相关。
