The main cause of subcortical ischemic vascular dementia is small vessel disease, including lacunar state, strategic infarct dementia, and Binswanger' s syndrome. The clinical manifestations are subcortical syndrome and cognitive impairment. The positive diagnosis and treatment of subcortical ischemic vascular dementia may help to reduce the risk of cognitive impairment in the elderly.

Objective To study the relationship of MR diffusion tensor imaging for corpus callosum and cingulate bundles with cognitive impairment in subcortical ischemic vascular dementia (SIVD) patients.Methods Sixty elderly SIVD patients admitted to our hospital from July 2015 to June 2016 served as a SIVD group and 40 age-matched persons undergoing physical examination served as a control group in this study.The mean ADC and FA were calculated according to the MR diffusion tensor imaging parameters in region of interest.Relationship between fiber tract integraty and MMSE Scale score was compared between the two groups.Results The ADC was significantly higher while the FA was significantly lower for the genu of corpus callosum in SIVD group than in control group.However,no significant difference was found in ADC for the spenium of corpus callosum between the two groups (P＞0.05).The ADC was significantly higher while the FA was significantly lower for bilateral cingulate bundles (P＜0.05,P＜0.01).The FA for the genu of corpus callosum and bilateral cingulate bundles was positively related with the MMSE Scale score (r=0.511,r=0.469,r=0.457,P＜0.05).However,the FA for the splenium of corpus callosum was not related with the MMSE Scale score(r=0.364,P＞0.05).Conclusion Changes of MR diffusion tensor imaging parameters in corpus callosum and cingulate bundles contribute to the early prevention and treatment of cognitive impairment in SIVD patients.

Objective To investigate the phenotypes and genetics of an early-onset familial Alzheimer′s disease ( EO-FAD ) family.Methods The clinical manifestations , brain MRI results and neuropathological findings of the proband and pedigree members of the EO -FAD family were evaluated. Autopsy was performed in the proband . Results Fifteen members of this family had a presenilin 1 (PSEN1) p.G378E mutation and nine of them had clinical manifestations or the MRI changes of EO -FAD. Neuropathological findings from autopsy of the proband disclosed moderate cortical atrophy throughout the brain, especially in frontal lobe and temporal lobe .Neuronal loss with gliosis was observed in the cortices of the frontal, temporal and occipital lobes , as well as in parahippocampal gyrus .Numerous senile plaques and neurofibrillary tangles were present in the cerebral cortex .The proband′s younger sister showed similar clinical presentations and MRI changes , and other members of this family demonstrated progressive memory loss.Conclusion A p.G378E mutation in the PSENl gene was identified in a Chinese EO-FAD pedigree.

Patent foramen ovale (PFO) is a congenital heart disease that occurs in about 25% of healthy adults. In recent years, more and more studies have shown that PFO is closely associated with cryptogenic stroke (CS). Although it is currently believed that paradoxical embolism is one of the main mechanisms of the pathogenesis of CS, but the exact mechanism is still controversial. In addition, the treatment of CS in patients with PFO is also the focus of controversy. Recent clinical trials have shown that PFO occlusion is significantly better than drug therapy alone in preventing stroke recurrence, especially for patients with a large right-to-left shunt and atrial septal tumor. This article reviews the potential mechanisms and prevention strategies of CS in patients with PFO.

Objective:To explore the effects of behavior intervention on patients with ischemic cerebrovascular disease recurrence, carotid artery stenosis recurrence, and quality of life after carotid artery stenting implantation.Methods:Sixty patients with carotid stenosis who underwent stenting surgery between January 2017 and July 2018 in Affiliated Hospital of Jining Medical University were recruited.The subjects were randomly divided into behavioral intervention group and control group.The control group was routinely followed up after carotid artery stenting implantation.The behavioral intervention group added home visit, education, guidance of the control and detection of risk factors for cerebrovascular disease of stent implantation.Results:After 12 months of intervention, the incidence of ischemic cerebrovascular disease and the recurrence rate of carotid restenosis in the behavioral intervention group(6.7%, 3.3%) were significantly lower than those in the control group(30.0%, 20.0%) (both P<0.05). Six months after the intervention and 12 months after the intervention, the self-management ability score (intervention group: six months after the intervention (171.20±18.43), 12 months after the intervention (179.90±14.34); control group: six months after the intervention (160.77±13.43); 12 months after the intervention (164.27±14.85)) and quality of SS-QOL score (intervention group: 6 months after intervention (188.47±16.25), 12 months after intervention (203.17±13.84); control group: 6 months after intervention (170.67±15.82); 12 months after intervention (183.80±18.19)of the intervention group were higher than that of the control group, the difference is statistically significant (all P<0.05). Conclusion:Behavioral intervention after carotid artery stenting implantation can effectively reduce the incidence of stroke and the recurrence rate of carotid stenosis and improve the prognosis of patients.The mechanism may be related with that the behavioral intervention can improve the self-management ability and the quality of life of patients with carotid stenosis.

Objective:To investigate the evaluation value of optical coherence tomography (OCT) for carotid atherosclerotic plaques.Methods:Patients with carotid atherosclerotic stenosis underwent digital subtraction angiography (DSA) and OCT in the Affiliated Hospital of Jining Medical College from January 2020 to January 2022 were retrospectively enrolled. The demographics, baseline clinical data, DSA and OCT imaging data of the symptomatic group and the asymptomatic group were compared. Multivariate logistic regression analysis was used to determine the independent risk factors for symptomatic carotid atherosclerotic stenosis. Results:A total of 39 patients were enrollded, including 21 in the symptomatic group and 18 in the asymptomatic group. The detection rate of fibrous plaque in the symptomatic group was significantly lower than that in the asymptomatic group (38.1% vs. 77.78%; P=0.023), while the detection rate of plaque rupture (38.1% vs. 5.56%; P=0.023) and macrophage infiltration (42.86% vs. 11.11%; P=0.037) was significantly higher than that in the asymptomatic group. Multivariate logistic regression analysis showed that plaque rupture (odds ratio 6.982, 95% confidence interval 1.068-45.660; P=0.043) and macrophage infiltration (odds ratio 6.480, 95% confidence interval 1.009-41.625; P=0.049) were significantly independently associated with the symptomatic carotid atherosclerotic stenosis. Conclusions:OCT is of value in evaluating the plaque characteristics of carotid atherosclerotic stenosis. Plaque rupture and macrophage infiltration are the independent risk factors for symptomatic carotid atherosclerotic stenosis.

To explore the predictive value of liver function indexes on the clinical severity at nadir and prognosis of patients with Guillain-Barré Syndrome（GBS）. Methods The clinical data of 206 GBS patients hospitalized in the affiliated hospital of Jining Medical University from January 2010 to September 2016 were analyzed retrospectively. Multivariate logistic regression analysis was used to analyze the independent factors affecting the severity and prognosis of GBS patients. The receiver operator characteristic curve （ROC） was used to evaluate the predictive value of pretreatment liver function indexes on the severity at nadir and prognosis of GBS patients. Results Albumin，A/G ratio，GGT，and ball palsy were the risk factors that affected the severity of disease in GBS patients at the peak （all P<0.05）；albumin，GGT，and mechanical ventilation were the risk factors for prognosis of GBS patients （all P values<0.05）. Conclusion Albumin and GGT have potentials to predict clinical severity at nadir and outcome at 6 months in patients with GBS.