Subcortical ischemic vascular disease (SIVD) is considered to be the most important and common cause of vascular cognitive impairment (VCI). If patients with subcortical ischemic vascular cognitive impairment (SIVCI) and subcortical vascular cognitive impairment (sVCI) can be found early, it is possible that vascular dementia (VaD) can be identified before occurrence and even reverse the process. Recent studies have shown that resting-state functional magnetic resonance imaging (rsfMRI) may provide the objective basis for the diagnosis of SIVCI. This article reviews the application of rsfMRI in the diagnosis of SIVCI.

Objective To investigate the correlation between serum cystatin-C (Cys-C) levels and cognitive impairment.Methods A perspective study involving 273 patients in our hospital was performed from 2013 to 2015.They were divided into the cognitive impairment group and the control group.Cys-C measurement results and cognitive impairment assessment scores were collected.Possible influence factors were adjusted,and the correlation between Cys-C levels and mild cognitive impairment was analyzed.Results The distribution of age,hypertension,diabetes mellitus,smoking,drinking,dyslipidemia,and creatinine showed significant differences between the groups at different Cys-C levels (all P＜0.05).There was a significant difference in the Cys-C level between the cognitive impairment group and the control group [(0.727±0.082) mg/L vs.(0.514±0.045)mg/L,t=23.68,P＜0.01].The Cys-C level was negatively correlated with the scores of mini-mental state examination (MMSE) and Montreal cognitive assessment (MOCA) in the cognitive impairment group (r =-0.318 and -0.572,P＜0.05).The incidence of cognitive impairment was elevated with increasing Cys-C levels (x2 =13.12,P＜0.01).Logistic regression analysis showed that high levels of Cys-C (OR=3.298,95％ CI:1.417-7.675,P=0.001),history of diabetes mellitus (OR=7.971,95％ CI:3.036-31.562,P =0.03),education level (OR =2.237,95 ％ CI:1.022-4.896,),smoking (OR =5.692,95 ％ CI:1.060-2.614),drinking (OR=1.227,95％ CI:0.083-1.228),and dyslipidemia (OR=2.267,95％ CI:1.177-4.366) are independent risk factors for cognitive impairment.Conclusions High serum cystatin C levels are closely correlated with the risk of cognitive impairment occurrence.

Perivascular spaces (PVS) are an important part of the glymphatic system of the brain.Enlarged PVS (EPVS) may be an early manifestation of brain microvascular diseases and brain clearance mechanism disorders.There is growing evidence that EPVS plays an important role in the development and progression of cognitive impairment and may be its early warning sign.This article reviews the relationship between EPVS and cognitive impairment.

A 49-year-old male patient presented with repeated oral erosions for 1 year,as well as cutaneous erythema and blisters for 1 month.According to histopathological examination and detection of specific antibodies of pemphigus,the patient was diagnosed with pemphigus vulgaris.After the treatment with oral prednisone and azathioprine for 1 month,the white blood cell count and segmented neutrophilic granulocyte count both decreased.After withdrawal of azathioprine,the patient was subcutaneously injected with 150 μg recombinant human granulocyte colony-stimulating factor for 1 session.Then,the white blood cell count became normal.Genotyping test revealed that the patient carried a heterozygous mutation in the NUDT15 gene (JZ274),and was homozygous for wild-type TPMT*2,TPMT*3C and ITPA genes.The patient was diagnosed with azathioprine-induced myelosuppression.

Vascular cognitive impairment(VCI) is a group of syndroms from mild cognitive impairment to dementia caused by cerebrovascluar disease.The preventable and therapeutic characteristics of VCI bring an opportunity for its effective treatment.Non-pharmaceutical interventions play a vital role on its treatment,which gradually becomes a research hotspots.A variety of interventions to improve VCI have been confirmed,and the pathophysiological mechanism is unique but also complementary to each other.And their synergistic action cannot be ignored.This review focuses on the research progress in the effects of non-pharmaceutical interventions:physical activity,cognitive training,transcranial stimulation and acupuncture on VCI,and the possible mechanisms,in order to open new doors for the early detection,prevention and treatment of VCI.

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.

Atherosclerosis (AS) is one of the pathological bases of ischemic stroke. AS caused by elevated low-density lipoprotein cholesterol levels is the main causative factor. However, recent studies have found that the traditional blood lipid indicators can not fully reflect the risk of stroke in high-risk populations. Non-traditional blood lipid parameters are developed from traditional blood lipid parameters, including remnant cholesterol (RC), non-high density lipoprotein cholesterol and a variety of blood lipid ratios, which may play a role in the prevention and treatment of cerebrovascular diseases. Among them, RC is increasingly recognized as a biomarker driving the residual risk of AS. It has been confirmed that RC is closely associated with the risk of cerebrovascular disease in the primary and secondary prevention studies of stroke.

As a multifunctional signal molecule, fibroblast growth factor 21 (FGF21) has been proved to have a variety of biological effects, including anti-inflammatory, antioxidant stress, and neuroprotection. This article reviews the latest research progress on the protective effect of FGF21 in ischemic stroke and its relationship with cognitive impairment.

Vascular cognitive impairment (VCI) is a syndrome from mild cognitive impairment to dementia caused by various vascular risk factors and cerebrovascular diseases. Early detection and definite diagnosis can significantly improve the outcomes of patients with VCI. This article reviews the evaluation and diagnosis of VCI.

Objective To observe clinical nurses′knowledge, attitude, and practice of evidence-based practice (EBP), and to explore its potential influencing factors, so as to provide targeted knowledge training for nurses.Methods The nurses′ information form and evidence-based practice questionnaire ( EBPQ) were used in this survey. Totally 140 nurses from a hospital in Beijing from June to July 2015 participated in this survey. Results The average score of practice, attitude, and knowledge on EBP were (22.94±7.32), (21.69±6.47) and (57.39±15.31). Statistically significant correlations were found among different nurses′ age, length of employment, educational background, job tittle and nurses′ practice, attitude, and knowledge score on EBP ( P<0.05) . Multivariate linear regression showed that the EBP of nurses was mainly decided by their knowledge level, attitude level, amount of literature reading, and endorsement related to EBP.Conclusions The status of nurses′knowledge and practice level related to EBP was low, and the attitude level was relatively positive. Knowledge training program should be established according to nurses′ age, length of employment, educational background, and job tittle, in order to raise the level of their knowledge, attitude and behavior on EBP. As well as the amount of literature reading and endorsement related to EBP are also primarily factors that influence the practice level.