The perivascular space is formed by the pia mater around the blood vessels and participates in the fluid exchange and waste clearance in the brain. The enlarged perivascular space (EPVS) indicates the disorder of brain clearance mechanism, which is closely related to the occurrence and development of a variety of clinical diseases. In recent years, there are a lot of studies on the pathogenesis and influencing factors of EPVS. This article reviews its anatomy, neuroimaging, pathogenesis, and risk factors.

A large number of studies have shown that the elevated lipoprotein (a) is a risk factor for ischemic stroke, but the specific mechanism is still unclear. Therefore, this article reviews the role of elevated lipoprotein (a) in ischemic stroke, its mechanism, and intervention measures.

Post-stroke cognitive impairment (PSCI) directly affects the outcome of patients with stroke. Enlarged perivascular spaces (EPVS) suggest the impairment of brain clearance mechanism and may affect cognitive function. More and more studies have confirmed that the presence of EPVS will aggravate PSCI. This article reviews the relationship between EPVS and PSCI.

Objective To evaluate the effect of salicylic acid on skin barrier function and the efficacy of salicylic acid combined with flumetasone ointment for the treatment of atopic dermatitis (AD).Methods Sixtyfour patients with AD (including 31 males and 33 females) aged 18 to 58 years were recruited into the present study.Four lesional areas of similar size and severity were selected at the similar body sites of both sides of each patient,and randomly classified into four groups to be topically treated with compound flumetasone ointment (containing 0.02％ flumetasone and 3％ salicylic acid,compound flumetasone group),flumetasone 0.02％ ointment (flumetasone group),salicylic acid 3％ ointment (salicylic acid group) and vehicle (control group),respectively;two normal skin areas were chosen from apparently normal skin on the similar body sites of both sides of each patient and topically treated with salicylic acid 3％ ointment (salicylic acid group) and vehicle (control group) respectively.All of these preparations were applied twice a day for 3 weeks.Transepidermal water loss (TEWL) was measured by a Tewameter MPA580 (Courage & Khazaka,Germany) at the baseline as well as on week 1,2 and 3 after initiation of treatment.Symptom and sign scores were evaluated before and after the treatment.Meanwhile,two normal skin areas were selected on bilateral forearm of 30 healthy controls and treated with 3％ salicylic acid ointment (salicylic acid group) and vehicle (control group) respectively twice a day for 3 weeks,and TEWL was measured before treatment as well as on week 1 and 3 after initiation of treatment.Results In the healthy controls,TEWL value showed no significant difference between the salicylic acid group and control group at any of these time points.As far as the lesional skin was concerned,no statistical difference was observed in TEWL value at the baseline between the four groups ((34.26 ± 20.82) vs.(33.02 ±16.71) vs.(34.16 ± 18.03) vs.(33.81 ± 17.11) g· m-2· h-1,P ＞ 0.05),but significant difference was noted after treatment (repeated measurement data analysis of variance,F =39.57,P ＜0.01),with the TEWL value being (22.38 ± 16.16),(17.04 ± 12.74),and (15.34 ± 13.13) g·m-2·h-1 respectively in the compound flumetasone group on week 1,2 and 3,(24.63 ± 17.08),(20.37 ± 9.53),(19.06 ± 9.17) g·m-2·h-1 respectively in the flumetasone group,(26.49 ± 8.59),(21.91 ± 8.46),(21.20 ± 9.38) g·m-2·h-1 respectively in the salicylic acid group,and (29.80 ± 12.48),(26.16 ± 8.31),(25.52 ± 6.05) g·m-2·h-1 respectively in the control group.In detail,the decrease in TEWL value was stronger in the compound flumetasone group than in the flumetasone group on week 1,2,and 3 (all P ＜0.05),in the salicylic acid group than in the control group (P ＜0.05 or 0.01),but similar between the flumetasone group and salicylic acid group.In non-lesional skin,the salicylic acid group showed a more intense decrease in TEWL value compared with the control group on week 2 and 3 (both P ＜0.05).Both the cure rate and response rate were significantly higher in the compound flumetasone group than in the flumetasone group (53.1％ vs.34.4％,x2 =4.57,P＜0.05;83.1％ vs.64.1％,x2 =6.90,P＜0.01).Conclusions The salicylic acid 3％ ointment shows a reparative effect on skin barrier in patients with AD,and the compound flumetasone ointment is superior to the flumetasone ointment in the treatment of AD.

Objective To identify the applicability of Traditional nutritional evaluation method,short-form mini-nutritional assessment (MNA-SF) and nutrition risk screening 2002 (NRS 2002) on screening malnutrition in elderly in-patients.Methods 100 elderly in-patients with malnutrition were screened by the above screening instruments.The evaluation effects of the 3 methods were compared by sensitivity,specificity and ROC curve.Results The detection rates of elderly in-patients with malnutrition by BMI,MNA-SF and NRS 2002 was 7％,58％ and 39％ respectively.Taking the human body measurement instrument as standard,the sensitivities of BMI,MNA-SF and NRS 2002 was 0.475,0.918 and 0.410respectively,the specificities was 0.615,0.103 and 0.641 respectively.3 tools series test sensitivity and specificities was 0.557 and 0.913 respectively,parallel test sensitivity and specificities was 0.929 and 0.435 respectively.Conclusions There is significant difference among the sensitivities of the 3 methods,NRS 2002 has the highest accuracy and is applicable to the screening of nutrition risks in elderly patients.Combined 3 kinds of tool can better improve the effect.

Objective To explore the pressure ulcer incidence and nutrition evaluation of 102 hospitalized super aging patients (80-90 year-old) by the subjective comprehensive nutrition evaluation method (SGA),the micro-nutrition evaluation method (MNA-SF),and nutritional risk screening 2002 (NRS 2002).Methods A total of 102 hospitalized super aging patients had been selected by the convenient sampling method and documented the incidence pressure ulcer according to three methods of nutritional screening from August 2012 to December 2014.We combined with the traditional measurement methods and laboratory index to compare the correlation between them,and combined with the ROC to evaluate the sensitivity and specificity of different pressure ulcers.The evaluation of the advantages and disadvantages were also discussed.Results In elderly patients,the incidence of pressure ulcers was 35.29％,the detection rate of MNA-SF,NRS 2002,SGA evaluation methods in malnutrition were 74.5％,54.9％ and 29.4％.The MNA-SF detection rate of malnutrition was higher than the other two methods.All three nutrition detection methods had negative correlation with traditional nutrition measurement and indexes results of laboratory (P ＜ 0.05),and had statistical significance at assessment of nutrition risk,malnutrition,normal nutrition with incidence rate of pressure ulcer (P ＞ 0.05).While we assessed the sensitivity of pressure ulcer,the MNA-SF was 86.1％,NRS 2002 61.0％,SGA 33.3％,and the three specificity were 68.2％,51.5％,27.3％.Conclusions MNA-SF has a better effect than SGA and NRS 2002 at detection of malnutrition and the effect of pressure ulcer.

Objective To explore the ideal positions for venous indwelling needle among elderly patients. Methods A total of 135 elderly patients, who required transfusion aged from 70 to 90 years old, were randomly divided into observation group (n=66) and control group (n=69). Patients of the observation group underwent the pricking of forearm vein whiles patients of the control group received the pricking of dorsal hand vein. We compared the indwelling length of venous indwelling needle, incidences of related complications, success rate of pricking at first time and the pain level of pricking. Results The indwelling time of observation group was (4. 45 ± 0. 75) d higher than (4. 16 ± 0. 85) d of the control group; the complications such as phlebitis, fluid exudation in the observation was 12. 1% lower than 27. 5% in the control group (t/χ2 =2. 136, 5. 010;P<0. 05). There was no statistical significance for pain level of pricking and success rate of pricking at first time [(4. 12 ± 1. 99) vs (3. 61 ± 1. 58) score; 86. 4% vs 89. 9%; t/χ2 =1. 652, 0. 394;P>0. 05]. Conclusions The venous indwelling needle in forearm vein has some priority, decreases the complications incidences during needle indwelling, and postpones the length of indwelling, which can be the first choice.

Objective:To explore the correlation between enlarged perivascular spaces and other imaging markers of cerebrovascular disease in patients with ischemic stroke.Methods:Totally 287 patients with ischemic stroke hospitalized in neurology department from January 2018 to January 2019 were selected. According to the severity of EPVS in different parts of the brain, the correlations between the severity of EPVS in different parts of the brain and cerebral microbleeds (CMBs), white matter hyperintensity (WMH), lacunar infarcts (LIs) were analyzed. SPSS 22.0 software was used for analysis. Chi-square test, independent sample t-test, rank-sum test and non parametric Mann-Whitney U test were used for group comparison, and Logistic regression analysis was used for multivariate analysis. Results:EPVS was common and severe in patients with ischemic stroke. Periventricular white matter hyperintensity(PWMH)( β=1.604, P<0.001, OR=4.971, 95% CI=2.015-12.263), CMBs ( β=1.224, P=0.018, OR=3.339, 95% CI=1.232-9.383) and LIs ( β=0.626, P=0.047, OR=1.871, 95% CI=1.009-3.470) were independent risk factors for BG-EPVS. PWMH ( r=0.614), DWMH ( r=0.622), LIs ( r=0.532) were positively correlated with the severity of BG-EPVS (all P<0.01). Conclusion:The imaging makers of CSVD are related to BG-EPVS, which can affect the severity of brain BG-EPVS in patients with ischemic stroke.

Objective To investigate the relationships of nutritional status and length of stay(LOS)with phase angle(PA)in patients with severe craniocerebral injury.Methods A total of 100 patients[Glasgow Coma Scale(GCS)score ≤8 points]admitted outside the department of neurology were selected as study objects.Body composition analysis and blood samples were used to determine the intracellular and extracellular water content,skeletal muscle,PA,prognostic nutritional index(PNI)and LOS.Patients were divided into low PA group(n=42)and normal PA group(n=58)based on PA values.Body composition related indexes,PNI and LOS were compared between the two groups.The correlation between PA and each index was analyzed.The influencing factors of malnutri-tion were analyzed.The influencing factors of malnutrition were analyzed.Results Intracellular wa-ter,total body water,body cell content and PNI in the low PA group were significantly lower,and LOS was significantly longer than that in the normal PA group(P＜0.05).PA was positively correlated with intracellular water,extracellular water,total body water,skeletal muscle,body cell content,bone mineral content,basal metabolic rate and PNI(P＜0.05),while PA was negatively correlated with LOS(P＜0.05).PA(OR=5.441,P=0.001,95％CI,2.011 to 14.719)and LOS(OR=8.373,P＜0.001,95％CI,3.079 to 22.765)were the influential factors in the occurrence of malnutrition.Conclusion PA is significantly correlated with nutritional status and LOS in patients with severe craniocerebral injury.

Objective To investigate the relationships of nutritional status and length of stay(LOS)with phase angle(PA)in patients with severe craniocerebral injury.Methods A total of 100 patients[Glasgow Coma Scale(GCS)score ≤8 points]admitted outside the department of neurology were selected as study objects.Body composition analysis and blood samples were used to determine the intracellular and extracellular water content,skeletal muscle,PA,prognostic nutritional index(PNI)and LOS.Patients were divided into low PA group(n=42)and normal PA group(n=58)based on PA values.Body composition related indexes,PNI and LOS were compared between the two groups.The correlation between PA and each index was analyzed.The influencing factors of malnutri-tion were analyzed.The influencing factors of malnutrition were analyzed.Results Intracellular wa-ter,total body water,body cell content and PNI in the low PA group were significantly lower,and LOS was significantly longer than that in the normal PA group(P＜0.05).PA was positively correlated with intracellular water,extracellular water,total body water,skeletal muscle,body cell content,bone mineral content,basal metabolic rate and PNI(P＜0.05),while PA was negatively correlated with LOS(P＜0.05).PA(OR=5.441,P=0.001,95％CI,2.011 to 14.719)and LOS(OR=8.373,P＜0.001,95％CI,3.079 to 22.765)were the influential factors in the occurrence of malnutrition.Conclusion PA is significantly correlated with nutritional status and LOS in patients with severe craniocerebral injury.