An Integrated Analysis of Risk Factors of Cognitive Impairment in Patients with Severe Carotid Artery Stenosis

Objective To investigate cognitive dysfunction in patients with carotid artery stenosis(CAS) and potential risk factors related to cognitive-especially memory-dysfunction. Methods Forty-seven patients with carotid artery stenosis were recruited into our study cohort. The Mini-Mental State Examination(MMSE) and the Montreal Cognitive Assessment(MoCA) were adopted to assess cognitive function, the Wechsler Memory Scale(WMS) to assess memory function, high-resolution MRI and enhanced ultrasound to evaluate carotid plaques, and computed tomography perfusion(CTP) imaging to evaluate intracranial blood perfusion. Single-factor analysis and multiple-factor regression analysis were used to analyze potential risk factors of cognitive impairment. Results Mini-Mental State Examination test results showed that 22 patients had cognitive impairment, and MoCA test results showed that 10 patients had cognitive impairment. Analysis of various risk factors indicated that the average memory quotient of female patients was higher than that of males(P = 0.024). The cognitive and memory performance of those with an educational background above high school were significantly better than those of participants with high school or lower(P = 0.045). Patients with abnormal intracranial perfusion performed worse on the MMSE test(P = 0.024), and their WMS scores were significantly lower(P = 0.007). The MMSE scores and the memory quotients were significantly lower in patients with a history of cerebral infarction(MMSE, P = 0.047, memory quotient score, P = 0.018). Conclusion A history of cerebral infarction and abnormal cerebral perfusion are associated with decline in overall cognitive function and memory in patients with carotid stenosis. Being female and having an educational background above high school may be protective factors in the development of cognitive dysfunction.

Cerebral small vessel disease or intracranial large vessel atherosclerosis may carry different risk for future strokes

Background The effect of cerebral small vessel disease(CSVD)and intracranial arterial stenosis(ICAS)on stroke outcomes remains unclear.Methods Data of 1045 patients with minor stroke or transient ischaemic attack(TIA)were obtained from 45 sites of the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events(CHANCE)trial.We assessed the associations of burdens of CSVD and ICAS with new strokes and bleeding events using multivariate Cox regression models and those with modified Rankin Scale(mRS)scores using ordinal logistic regression models.Results Among the 1045 patients,CSVD was present in 830 cases(79.4%)and ICAS in 460(44.0%).Patients with>1 ICAS segment showed the highest risk of new strokes(HR 2.03,95%CI 1.15 to 3.56,p=0.01).No association between CSVD and the occurrence of new strokes was found.The presence of severe CSVD(common OR(cOR)2.01,95%CI 1.40 to 2.89,p<0.001)and>1 ICAS segment(cOR 2.15,95%CI 1.57 to 2.93,p<0.001)was associated with higher mRS scores.Severe CSVD(HR 10.70,95%CI 1.16 to 99.04,p=0.04),but not ICAS,was associated with a higher risk of bleeding events.Six-point modified CSVD score improved the predictive power for bleeding events and disability.Interpretation CSVD is associated with more disability and bleeding events,and ICAS is associated with an increased risk of stroke and disability in patients with minor stroke and TIA at 3 months.CSVD and ICAS may represent different vascular pathologies and play distinct roles in stroke outcomes.

Expert consensus on clinical applications of high-frequency oscillations in epilepsy

Studies in animal models of epilepsy and pre-surgical patients have unanimously found a strong correlation between high-frequency oscillations(HFOs,>80 Hz)and the epileptogenic zone,suggesting that HFOs can be a potential biomarker of epileptogenicity and epileptogenesis.This consensus includes the definition and standard detection techniques of HFOs,the localizing value of pathological HFOs for epileptic foci,and different ways to distinguish physiological from epileptic HFOs.The latest clinical applications of HFOs in epilepsy and the related findings are also discussed.HFOs will advance our understanding of the pathophysiology of epilepsy.

Carotid endarterectomy for treatment of carotid in-stent restenosis:longterm follow-up results and surgery experiences from one single centre

Objective Few studies have reported the surgical treatment of carotid in-stent restenosis(ISR),more data and longer follow-up are needed.We describe the surgical treatment of ISR by standard carotid endarterectomy(CEA)with stent removal,including long-term follow-up in 10 patients from our centre.Methods Ten patients from our centre who underwent CEA with stent removal for ISR were retrospectively analysed,including nine symptomatic and one asymptomatic ISR of at least 70%with mean age 67.3,the median time between carotid artery stenting and CEA was 17 months(range,2-54 months).results Standard CEA with stent removal was performed in all 10 patients without much technical difficulty(9 male and 1 female,mean age 67.3).Two cases were performed in hybrid operation room.There were a total of three complications that happened in three patients(30%)respectively.An asymptomatic dissecting aneurysm was formed on the petrous internal carotid artery in one patient who was followed up without intervention.In the second case,dissection occurred in the arterial wall distal to the site of the stent after stent removal revealed by intraoperative angiography,and another stent was implanted.The patient sustained temporary hypoglossal nerve dysfunction postoperatively.The third patient suffered cerebral hyperperfusion with complete recovery when discharged.No neurological complications occurred in other seven patients.After follow-up of 25 months(range,11-54 months),one patient died of rectal cancer without ischaemic attack and restenosis 4 years postoperation;in one patient occurred recurrent symptomatic restenosis(90%)1 year later;all other patients remained asymptomatic and without recurrent restenosis(>50%)by follow-up carotid ultrasound or CT angiography.conclusion It seems that CEA with stent removal is a reasonable choice,by experienced hand,for symptomatic ISR with higher but acceptable complications.The indication of stent removal for asymptomatic ISR needs further observation.

Analysis of post-traumatic growth status and its influencing factors in patients with facial palsy

Background:Facial nerve paralysis in patients occurs in varying degrees of self-image disorders,both physically and mentally,resulting in low self-esteem,anxiety,depression,and even suicide;however,there were few researches on psychological problems in facial palsy patients at home and abroad.This study's objective was to investigate post-traumatic growth(PTG)in facial nerve palsy patients and analyze its influencing factors.Methods:Using the convenience sampling method,a total of 47 patients with facial nerve paralysis were enrolled in the current study between June 1,2016,and May 31,2017.Post-traumatic growth rating scale was utilized to investigate the post-traumatic growth of these patients,and factors influencing patients'post-traumatic growth were analyzed through collecting the general sociological information,disease-related information,simple coping style questionnaire,and social support rating scale.Results:The total score of post-traumatic growth in patients with facial nerve paralysis was mean(M)=63.1,standard deviation(SD)=19.14.The ranking of five dimensional scores from high to low was as follows:new possibilities,personal strength enhancement,appreciation of life,mental changes,and improvement of relationships with others.Multiple linear regression analysis showed that six variables,namely,the personality type,duration with facial nerve paralysis,and four coping styles,consisting of three types of positive coping styles and one negative coping style,could explain 71.6%of the total post-traumatic growth score.Conclusions:Post-traumatic growth in facial nerve palsy patients is moderate.The personality type of patients,the disease duration,and the coping style are the primary influencing factors.Therefore,clinical staffs should perform personalized nursing protocol and psychological intervention for facial nerve palsy patients to reduce their negative mood,improve their compliance with treatment,and help them recover more rapidly.

Proteomic analysis of human frontal and temporal cortex using iTRAQ-based 2D LCMS/MS

Background:The human brain is the most complex organ in the body,and it is important to have a better understanding of how the protein composition in the brain regions contributes to the pathogenesis of associated neurological disorders.Methods:In this study,a comparative analysis of the frontal and temporal cortex proteomes was conducted by isobaric tags of relative and absolute quantification(iTRAQ)labeling and two-dimensional liquid chromatographytandem mass spectrometry(2D LC-MS/MS).Brain protein was taken from relatively normal tissue that could not be avoided of damage during emergent surgery of the TBI(traumatic brain injury)patients admitted in Beijing Tiantan Hospital from 2014 to 2017.Eight cases were included.Four frontal lobes and 4 temporal lobes proteome were analyzed and the proteins were quantitated.Gene Ontology(GO),Ingenuity Pathway Analysis(IPA),and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway analysis were used to analyze the biological function of identified proteins,unchanged proteins,and differentially expressed proteins(DEPs).Results:A total number of 2127 protein groups were identified in the frontal and temporal lobe proteomes.A total of 1709 proteins could be quantitated in both the frontal and temporal cortex.Among 90 DEPs,14 proteins were screened highly expressed in the temporal cortex,including MAPT,SNCG,ATP5IF1,GAP43,HSPE1,STMN1,NDUFS6,LDHB,SNCB,NDUFA7,MRPS36,EPDR1,CISD1,and RALA.In addition,compared to proteins expressed in the frontal cortex,14 proteins including EDC4,NIT2,VWF,ASTN1,TGM2,SSB,CLU,HBA1,STOM,CRP,LRG1,SAA2,S100A4,and VTN were a low expression in the temporal cortex.The biological process enrichment showed that unchanged proteins between the frontal and temporal cortex mainly take part in regulated exocytosis,axon guidance,and vesicle-mediated transport.The KEGG pathway analysis showed that unchanged proteins between the frontal and temporal cortex mainly take part in oxidative phosphorylation,carbon metabolism,Huntington’s disease,and Parkinson’s disease.Conclusions:The majority of proteins are unchanged between the frontal and temporal cortex,and unchanged proteins are closely related to its function.Among DEPs,MATP(tau)is upregulated in the temporal cortex,closely related to Alzheimer’s disease(AD),and is one of the targets for the treatment of AD.CLU is downregulated in the temporal cortex which functions as an extracellular chaperone that prevents aggregation of non-native proteins.It was suggested that the temporal lobe may not be the“functional dumb area”of the traditional view,but could be involved in important neural metabolic circuits.

An atypical pituitary adenoma with a high degree of malignancy: a case report

Background: Pituitary carcinoma is very rare and hard to diagnose. However, some atypical pituitary adenomas present with a high rate of proliferation and extensive invasion, suggesting a tumor with a high degree of malignancy. Case presentation: Here, we present a case study of this type of tumor. A 46 years old women was admitted for headaches and impaired vision, and MRI and CT revealed a sellar lesion. She underwent a transsphenoidal surgery followed by radiotherapy, but the tumor recurred only one month later. She decided to undergo a second and third operation. The final pathology showed a non-functioning adenoma that was approximately 80% ki-67-positive and extensively p53-positive. No metastasis was found. The tumor progressed extremely quickly, and the patient died 7 months after the initial diagnosis. Conclusions: A pituitary adenoma like this should be treated like a carcinoma, and early treatment may increase the likelihood of survival. A traditional diagnosis standard is unfit for this type of tumor.