The Xuming Decoction, which is recorded in the "Gu Jin Lu Yan" section of Zhang Zhongjing's Synopsis of the Golden Chamber, is a traditional Chinese medicine formula. Recent literature review and summary of the clinical application research progress have found that this formula is primarily used to treat diseases such as acute cerebral infarction, facial neuritis, multiple sclerosis, Guillain-Barre syndrome, and pulmonary distension. However, different medical practitioners and scholars hold diverse understandings of Xuming Decoction.

Objective To investigate the relationship between cerebral atrophy and total burden of cerebral small vessel disease in patients with recent small subcortical infarct(RSSI).Methods A total of 194 elderly RSSI patients admitted to Department of Neurology of Changzhou Second People's Hospital Affiliated to Nanjing Medical University from September 2021 to November 2022 were recruited in this study.All patients completed cranial MRI examination and were divid-ed into a non-mild group 1(97 cases)and a moderate to severe group 1(97 cases)based on the to-tal burden of cerebral small vessel diseases(CSVD)imaging.Visual assessment scale was used to assess the severity of brain atrophy in the whole brain and various regions of the brain.According to the global cortical atrophy scale(GCA)score,all patients were divided into a non-mild group 2(88 cases)and a moderate to severe group 2(106 cases).Brain atrophy in various regions,medial temporal lobe atrophy(MTA)score,frontal temporal lobe atrophy(FTA)score,and posterior cortical atrophy(PA)score were evaluated.Their general clinical and imaging data were collected,multivariate logistic regression analysis was employed to analyze the relationship between GCA score and total burden of CSVD imaging in RSSI patients,and Spearman correlation analysis was further adopted to explore the correlation of GCA score and different parts of brain atrophy with total burden of CSVD imaging.Results When compared with the non-mild group 1,the moderate to severe group 1 had significantly larger proportions of having GCA score of 2-3 points,PA score of 2-3 points,MTA score of 2-4 points and FTA score of 2-4 points(P＜0.01).The ra-tio of having 2-4 points in total imaging burden score of CSVD was obviously higher in the mod-erate to severe group 2 than the non-mild group 2(P＜0.01).Multivariate logistic regression anal-ysis showed that age and total burden of CSVD imaging were independent risk factors for brain atrophy in RSSI patients(OR=1.184,95％CI:1.099-1.276,P=0.000;OR=3.537,95％CI:1.664-7.518,P=0.001).Spearman correlation analysis revealed that the total burden score of CSVD imaging was positively correlated with GCA,MTA,FTA and PA scores in RSSI patients(r=0.518,r=0.382,r=0.471,r=0.388,P=0.000).Conclusion The total burden of CSVD is an independent risk factor for GCA in elderly RSSI patients.The more serious the total burden of CSVD is,the higher the grade of GCA is.The total burden of CSVD is related to the whole brain and brain atrophy in other different regions of the brain.

Quantitative susceptibility mapping (QSM) is a noninvasive MR post-processing technique that can quantitatively analyze tissue magnetic susceptibility, which has important value in early diagnosis and assessment of cerebral small vessel disease (CSVD). In recent years, QSM has gradually been applied in clinical neuroimaging both domestically and internationally, becoming a new hotspot. This review focuses on the principle and classification of QSM, application of QSM in the gray matter microstructure, white matter microstructure, venous oxygen saturation assessment, cerebral microhemorrhage and cognitive function assessment of CSVD, so as to provide new perspective for its neuroimaging evaluation.

Objective:To evaluate the visibility of deep medullary veins (DMVs) in patients with recent subcortical small infarction (RSSI), and explore the influence of DMVs visibility in RSSI with cognitive impairment.Methods:One hundred and sixty-four first-onset RSSI patients admitted to Department of Neurology, Third Affiliated Hospital of Nanjing Medical University from February 2023 to May 2024 were selected. According to Montreal cognitive assessment (MoCA), they were divided into normal cognitive function group (MoCA scores≥26, n=78) and cognitive impairment group (MoCA scores<26, n=86); DMVs visibility on amplitude map or minimum intensity projection map in susceptibility weighted imaging was evaluated by visual scoring method. Univariate analysis was used to compare the differences in general clinical data and DMVs visibility scores between two groups; multivariate Logistic regression analysis was used to identify the independent influencing factors for RSSI combined with cognitive impairment. Spearman rank correlation was used to analyze the correlations of DMVs visibility score with MoCA score and cognitive scores in various cognitive domains, while mediation analysis was used to explore the correlations of MoCA score with total white matter hyperintensity (WMH) volume and DMVs visibility score. Results:The DMVs visibility score, age, hypertension proportion, periventricular white matter hyperintensity (PWMH) volume, and total WMH volume in RSSI patients with cognitive impairment were significantly higher, while body mass index (BMI) was statistically lower than those in patients with normal cognitive function ( P<0.05). Multivariate Logistic regression analysis showed that age ( OR=1.069, 95% CI: 1.017-1.123, P=0.008), total WMH volume ( OR=1.845, 95% CI: 1.050-3.241, P=0.033), and DMVs visibility score ( OR=1.239, 95% CI: 1.057-1.454, P=0.008) were independent influencing factors for cognitive impairment in RSSI patients. Spearman rank correlation showed negative correlations between DMVs visibility score and MoCA score ( rs=-0.472, P<0.001), between DMVs visibility score and score of executive function and visual-spatial skills ( rs=-0.329, P<0.001), between DMVs visibility score and attention score ( rs=-0.491, P<0.001), between DMVs visibility score and delayed recall score ( rs=-0.516, P<0.001), and between DMVs visibility score and directional ability score ( rs=-0.162, P=0.039) in RSSI patients. Mediation analysis results showed that DMVs visibility score not only had a direct effect of 87.5% on MoCA score, but also had an indirect effect of 12.5% on MoCA score through total WMH volume. Conclusion:Cognitive impairment trend to appear in RSSI patients with high DMVs visibility score, and WMH volume plays a mediating role in the effect of DMVs visibility on RSSI with cognitive impairment.

Glymphatic system (GS), also known as glial-lymphatic system, plays a vital role in maintaining brain homeostasis. Previous research has established a link between cerebral small vessel disease (CSVD) and GS dysfunction. Diffusion tensor image analysis along the perivascular space (DTI-ALPS), an emerging non-invasive neuroimaging technique, has made significant strides in assessing GS function in central nervous system diseases. This review examines the DTI-ALPS principles, and relations of DTI-ALPS index with glymphatic circulation, various imaging markers of CSVD, and CSVD-related cognitive impairment, aiming to facilitate the early diagnosis, progression, and prognoses of CSVD.

Objective To investigate the relationship between choroidal thickness and white matter hyperintensity(WMH)in patients with recent subcortical small infarct(RSSI).Methods A total of 83 RSSI patients hospitalized in our hospital from November 2021 to May 2023 were enrolled,and according to paraventricular WMH,they were divided into no to mild lesion group 1(46 cases)and moderate to severe lesion group 1(37 cases),and based on deep WMH,40 of them were assigned into no to mild lesion group 2 and 43 cases into moderate to severe lesion group 2.All patients underwent cranial MRI for paraventricular WMH and deep WMH,and optical coher-ence tomography to measure choroid thickness by semi-automatic segmentation.The relationship between choroidal thickness and WMH at paraventricular and deep parts was analyzed.Results Significant advanced age,higher proportions of smoking and hypertension,and larger volume of deep WMH,while obviously thinner choroid thickness were observed in the moderate to severe lesion group 2 than the no to mild lesion group 2(P＜0.05,P＜0.01).While the moder-ate to severe lesion group 1 had older age,higher smoking and hypertension ratios,and higher volume of paraventricular WMH when compared with the no to mild group 1(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that age(OR=1.170,95％CI:1.064-1.287,P=0.001),hypertension(OR=4.533,95％CI:1.215-16.914,P=0.024),and choroidal thickness(OR=0.953,95％CI:0.931-0.975,P=0.001)were independent risk factors for deep WMH grade.Conclusion Changes in choroidal thickness in RSSI patients are independent influ-encing factors for severity of deep WMH lesions.The more severe the deep WMH lesion is,the thinner the choroidal thickness.

Cerebral small vessel disease (CSVD) is one of the main causes of cognitive impairment and decreased the quality of daily life in the elderly. Researches have shown that CSVD is closely associated with autonomic nervous function. Patients with CSVD may be accompanied by cardiovascular, endocrine, gastrointestinal, urination, sleep disorders and other autonomic dysfunction.

Objective:To investigate the relationship between the degree and location of cerebral microbleeds (CMBs) and the early neurological deterioration (END) within 72 h after admissionin in patients with acute small artery occlusive stroke (SAO).Methods:Patients with first-onset SAO hospitalized in Changzhou Second People′s Hospital from July 2020 to January 2021 were retrospectively enrolled. All patients completed the head magnetic resonance imaging including susceptibility weighted imaging. Collected baseline data, and evaluated the National Institutes of Health Stroke Scale (NHISS) scores before admission and within 72 h after onset. Patients were divided into END group and no END group according to whether NIHSS scores increased by ≥3 within 72 h after admission. The baseline characteristics were compared between these two groups. Moreover, the correlation between the degree and location of CMBs and END were analyzed by multivariate Logistic regression.Results:A total of 163 first-episode SAO patients were enrolled. There were 47 patients (28.83%) with END. In END group, there were 35 patients (74.47%) with CMBs which was higher than those in non-END group [42 patients (36.21%)]. In END group, there were 21 patients (44.68%) with severe CMBs, 11 patients (23.41%) with basal ganglia CMBs, 16 patients (34.04%) with mixed CMBs, which were all higher than those in non-END group [5 patients (4.31%) with severe CMBs, 9 patients (7.76%) with basal ganglia CMBs, and 13 patients (11.21%) with mixed CMBs]. The difference was statistically significant ( P<0.05). After adjusting for triglyceride, location of infarcated lesions, and the degree of WMHs, further Logistic regression analysis revealed that severe CMBs ( OR = 6.139, 95% CI 1.377 - 27.375, P = 0.017), basal ganglia CMBs ( OR = 5.253, 95% CI 1.105 - 24.975, P = 0.037) and mixed CMBS ( OR = 5.098, 95% CI 1.197 - 21.704, P = 0.028) were independent risk factors of END in SAO patients. Conclusions:The location and degree of CMBs are closely related to the occurrence of END in patients with SAO. Severe CMBs, basal ganglia CMBs and mixed CMBs may be the effective predictors of END in patients with SAO.

Objective To explore the correlation between the total imaging burden of cerebral small vessel disease(CSVD)and heart rate variability(HRV)in elderly patients with hypertension.Methods A total of 256 elderly patients with hypertension admitted to Department of Neurolo-gy,Changzhou Second People's Hospital form September 2021 to December 2022 were consecu-tively recruited in this study.According to the total brain MRI burden,they were divided into scored 0-2 group(180 cases)and 3-4 group(76 cases).Their general clinical data and HRV parameters were compared between the two groups.Multivariate logistic regression analysis was used to analyze the relationship between HRV and total CSVD burden in these patients,and Spearman correlation analysis was employed used to analyze the correlation between HRV and to-tal CSVD burden,and between blood pressure variability and HRV.Results Older age,longer course of hypertension,and higher homocysteine level were observed in the group of scored 3-4 than the group of 0-2(P＜0.01).The former group had significantly lower SDNN,SDANN,ASDNN,rMSSD,PNN50,LF and HF when compared with the latter group(all P＜0.01).But there was no statistical difference in LF/HF ratio between the two groups(P＞0.01).Multivariate logistic regression analysis indicated that SDNN(OR=0.989,95％CI:0.979-0.999,P=0.034),SDANN(OR=0.988,95％CI:0.977-0.999,P=0.039)and rMSSD(OR=0.965,95％CI:0.938-0.994,P=0.016)were independent risk factors for total burden of severe CSVD in elderly hypertensive patients.Spearman correlation analysis showed that SDNN,SDANN,ASDNN,rMSSD,PNN50,LF and HF were negatively correlated with the total CSVD burden(P＜0.01);the standard deviation of 24-h SBP was negatively correlated with SDNN,SDANN and rMSSD(P＜0.01);the coefficient of variation of 24-h SBP was negatively correlated with SDNN,SDANN and rMSSD(P＜0.01).Conclusion HRV is an independent risk factor for total burden of severe CSVD in elderly hypertensive patients,and HRV parameters are negatively correlated with the to-tal CSVD burden.

Objective To explore the relationship between optic nerve tissue thickness and enlarged perivascular space(EPVS)in patients with recent small subcortical infarct(RSSI).Methods A total of 72 RSSI patients admitted to Department of Neurology of Changzhou Second People's Hospital affiliated to Nanjing Medical University from November 2021 to December 2022 were re-cruited in this study.All patients underwent cranial MRI,optical coherence tomography(OCT)and fundus photography.The thickness of retinal nerve fiber layer(RNFL)and ganglion cell-inner plexiform layer(GCL-IPL)were measured by software semi-automatic segmentation,and fundus lesions such as fundus hemorrhage and exudation were observed through fundus photography.The severity of EPVS was graded by visual quantitative evaluation,and then the patients were divided into no to mild EPVS group(32 cases)and moderate to severe EPVS group(40 cases).Basal gan-glia EPVS(BG-EPVS)and semioval center EPVS(CSO-EPVS)were further graded and grouped into no to mild BG-EPVS group(31 cases)and moderate and severe BG-EPVS group(41 cases),and no to mild CSO-EPVS group(39 cases)and moderate and severe CSO-EPVS group(33 cases).The clinical data of each group were compared separately.Results There were statistical differences in age,ratio of hypertension and thicknesses of RNFL and GCL-IPL between the no to mild EPVS group and the moderate to severe EPVS group(P＜0.05,P＜0.01),between the no to mild BG-EPVS and the moderate to severe BG-EPVS group(P＜0.01).Multivariate logistic re-gression analysis showed that age(OR=1.207,95％CI:1.028-1.416,P=0.021),hypertension(OR=7.264,95％CI:1.079-11.929,P=0.042),RNFL thickness(OR=0.753,95％CI:0.617-0.915,P=0.004)and GCL-IPL thickness(OR=0.848,95％CI:0.758-0.949,P=0.004)were independent factors of BG-EPVS grade.Spearman correlation analysis indicated that the thicknes-ses of RNFL and GCL-IPL were negatively correlated with BG-EPVS grade(r=-0.571,r=-0.649,P＜0.01).Conclusion RNFL and GCL-IPL thicknesses are independent factors for BG-EPVS grade and negatively correlated with BG-EPVS grade.OCT has important clinical value in assessing the severity of EPVS lesions in RSSI patients.