Objective:To explore the correlation between levels of serum cold-inducible RNA-binding protein(CIRBP), cystatin C(CysC) and cognitive impairment in patients with cerebral small vessel disease(CSVD), as well as the diagnostic value of CI in CSVD.Methods:A total of 90 CSVD patients admitted to the Neurology Department of Zhengzhou People's Hospital from January 2024 to December 2024 were consecutively selected. According to the mini-mental state examination(MMSE) and Montreal cognitive assessment(MoCA), they were divided into non cognitive impairment group(NCI group, n=47) and cognitive impairment group(CI group, n=43). The general clinical data of patients were collected.Fasting venous blood was collected in the morning on the second day of admission to measure serum CIRBP, CysC, homocysteine(Hcy) and high-sentivity C-reactive protein(hs-CRP) levels.A multiple-factor Logistic regression model was applied to identify independent risk factors for CI in CSVD patients, the predictive performance of the model was evaluated by receiver operating characteristic(ROC) curves, and the area under the curve(AUC) value was calculated to quantify the diagnostic accuracy of the model. Results:The levels of Hcy((13.01±4.22)μmol/L vs (11.44±3.00)μmol/L), hs-CRP((2.84±3.01)mmol/L vs (1.81±1.32)mmol/L), CIRBP((2 412.40±967.78)pg/mL vs (1 715.13±971.98)pg/mL), and CysC((1.93±1.08)mg/L vs (1.24±0.87)mg/L) in the CI group were significantly higher than those in the NCI group(all P<0.05). Multiple Logistic regression analysis showed that both CIRBP( OR=1.001, 95% CI=>1.000-1.002, P=0.011) and CysC( OR=1.833, 95% CI=1.056-3.181, P=0.031) were independently influencing factors of the occurrence of CI in CSVD patients(all P<0.05). ROC curve analysis showed that the optimal cutoff values for serum CIRBP and CysC levels to evaluate CI were 1 875.50 pg/mL and 1.42 mg/L, respectively. The AUC (95% CI) were 0.805(95% CI=0.713-0.897, P<0.001) and 0.716(95% CI=0.607-0.825, P<0.001), respectively.The AUC(95% CI) of combined detection of CIRBP+ CysC was 0.820(95% CI=0.733-0.907, P<0.001), with specificity and sensitivity of 89.4% and 67.4%. Conclusion:The serum CIRBP and CysC levels can serve as independent predictors of CI in CSVD patients. Combined testing can improve the accuracy of patient condition assessment and may assist in the diagnosis and prediction of cognitive impairment in CSVD.

Objective To analyze the clinical and imaging features of adrenomyeloneuropathy(AMN).Methods A retrospective analysis was conducted on the clinical data of one patient diagnosed with AMN through genetic testing.Results This patient was a young male with insidious onset,chronic course and progressive aggravation.The main clinical manifestations were speech,choking cough when drinking water,weakness of both lower limbs,unstable walking and urinary incontinence.Physical examination showed dysarthria,bilateral pyramidal tract,sphincter dysfunction,combined with systemic skin blackening,skin and mucosal pigmentation.MRI showed symmetrical abnormal high signal of bilateral corticospinals,significant atrophy of cerebellum,brainstem and cervical and thoracic spinal cord.Lumbar puncture CSF IL-6,IL-8 slightly high,serum myelin oligodendrocyte glycoprotein(MOG)antibody positive(1∶32).The localization diagnosis was adrenal cortex cerebellum bilateral corticospinal tracts peripheral nerve,and the qualitative diagnosis considered hereditary metabolic diseases,MOG antibody-related diseases could not be excluded.But the patient had a chronic course,atrophy of cerebellum,brainstem,cervical and thoracic spinal cord,and considered that the serum MOG antibody might be false positive,so the qualitative diagnosis hereditary metabolic diseases were more likely.Because of the limited technical conditions in our hospital,we could not detect plasma very long-chain fatty acids,while the completion of gene detection showed ABCD1 gene mutation:c.1628C＞T(p.Pro543Leu)variant,so the diagnosis of AMN was clear.Conclusions AMN is an X-linked recessive genetic disorder.Its clinical manifestations primarily include impairment of neural conduction tracts(spastic paraplegia,sphincter dysfunction,and deep sensory disturbances),adrenal cortical insufficiency(skin and mucosal hyperpigmentation,sparse hair),and cerebral symptoms(dysgraphia,visual/hearing impairment,cognitive dysfunction,and personality changes).Imaging findings mainly show demyelination of the brain white matter in the bilateral corticospinal tract regions and degenerative spinal cord atrophy.Elevated levels of very long-chain fatty acids(VLCFAs)and mutations in the ABCD1 gene can confirm the diagnosis of AMN.

Objective To analyze the clinical and imaging features of adrenomyeloneuropathy(AMN).Methods A retrospective analysis was conducted on the clinical data of one patient diagnosed with AMN through genetic testing.Results This patient was a young male with insidious onset,chronic course and progressive aggravation.The main clinical manifestations were speech,choking cough when drinking water,weakness of both lower limbs,unstable walking and urinary incontinence.Physical examination showed dysarthria,bilateral pyramidal tract,sphincter dysfunction,combined with systemic skin blackening,skin and mucosal pigmentation.MRI showed symmetrical abnormal high signal of bilateral corticospinals,significant atrophy of cerebellum,brainstem and cervical and thoracic spinal cord.Lumbar puncture CSF IL-6,IL-8 slightly high,serum myelin oligodendrocyte glycoprotein(MOG)antibody positive(1∶32).The localization diagnosis was adrenal cortex cerebellum bilateral corticospinal tracts peripheral nerve,and the qualitative diagnosis considered hereditary metabolic diseases,MOG antibody-related diseases could not be excluded.But the patient had a chronic course,atrophy of cerebellum,brainstem,cervical and thoracic spinal cord,and considered that the serum MOG antibody might be false positive,so the qualitative diagnosis hereditary metabolic diseases were more likely.Because of the limited technical conditions in our hospital,we could not detect plasma very long-chain fatty acids,while the completion of gene detection showed ABCD1 gene mutation:c.1628C＞T(p.Pro543Leu)variant,so the diagnosis of AMN was clear.Conclusions AMN is an X-linked recessive genetic disorder.Its clinical manifestations primarily include impairment of neural conduction tracts(spastic paraplegia,sphincter dysfunction,and deep sensory disturbances),adrenal cortical insufficiency(skin and mucosal hyperpigmentation,sparse hair),and cerebral symptoms(dysgraphia,visual/hearing impairment,cognitive dysfunction,and personality changes).Imaging findings mainly show demyelination of the brain white matter in the bilateral corticospinal tract regions and degenerative spinal cord atrophy.Elevated levels of very long-chain fatty acids(VLCFAs)and mutations in the ABCD1 gene can confirm the diagnosis of AMN.

Objective:To explore the correlation between levels of serum cold-inducible RNA-binding protein(CIRBP), cystatin C(CysC) and cognitive impairment in patients with cerebral small vessel disease(CSVD), as well as the diagnostic value of CI in CSVD.Methods:A total of 90 CSVD patients admitted to the Neurology Department of Zhengzhou People's Hospital from January 2024 to December 2024 were consecutively selected. According to the mini-mental state examination(MMSE) and Montreal cognitive assessment(MoCA), they were divided into non cognitive impairment group(NCI group, n=47) and cognitive impairment group(CI group, n=43). The general clinical data of patients were collected.Fasting venous blood was collected in the morning on the second day of admission to measure serum CIRBP, CysC, homocysteine(Hcy) and high-sentivity C-reactive protein(hs-CRP) levels.A multiple-factor Logistic regression model was applied to identify independent risk factors for CI in CSVD patients, the predictive performance of the model was evaluated by receiver operating characteristic(ROC) curves, and the area under the curve(AUC) value was calculated to quantify the diagnostic accuracy of the model. Results:The levels of Hcy((13.01±4.22)μmol/L vs (11.44±3.00)μmol/L), hs-CRP((2.84±3.01)mmol/L vs (1.81±1.32)mmol/L), CIRBP((2 412.40±967.78)pg/mL vs (1 715.13±971.98)pg/mL), and CysC((1.93±1.08)mg/L vs (1.24±0.87)mg/L) in the CI group were significantly higher than those in the NCI group(all P<0.05). Multiple Logistic regression analysis showed that both CIRBP( OR=1.001, 95% CI=>1.000-1.002, P=0.011) and CysC( OR=1.833, 95% CI=1.056-3.181, P=0.031) were independently influencing factors of the occurrence of CI in CSVD patients(all P<0.05). ROC curve analysis showed that the optimal cutoff values for serum CIRBP and CysC levels to evaluate CI were 1 875.50 pg/mL and 1.42 mg/L, respectively. The AUC (95% CI) were 0.805(95% CI=0.713-0.897, P<0.001) and 0.716(95% CI=0.607-0.825, P<0.001), respectively.The AUC(95% CI) of combined detection of CIRBP+ CysC was 0.820(95% CI=0.733-0.907, P<0.001), with specificity and sensitivity of 89.4% and 67.4%. Conclusion:The serum CIRBP and CysC levels can serve as independent predictors of CI in CSVD patients. Combined testing can improve the accuracy of patient condition assessment and may assist in the diagnosis and prediction of cognitive impairment in CSVD.

Objective:To investigate the efficacy and safety of intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS) who are currently using direct oral anticoagulants (DOACs).Methods:Patients with AIS admitted to the Stroke Center of Zhengzhou People's Hospital from January 2021 to December 2024 and had taken DOACs within 48 hours prior to onset were included retrospectively. The demographic characteristics, vascular risk factors, laboratory test results, baseline National Institutes of Health Stroke Scale (NIHSS) scores, and other clinical data were collected. The main outcome measure was the functional outcome evaluated using the modified Rankin Scale at 90 days after onset, with a score of 0-2 defined as good outcome. The secondary outcome measures were symptomatic intracranial hemorrhage (sICH) and any bleeding in any location occurring within 36 hours after onset. Multivariate logistic regression analysis was used to determine the independent influencing factors of the outcome. Results:A total of 153 patients were included, with 87 males (56.9%), aged (71.261±6.983) years. Seventy-four patients (48.4%) underwent IVT, and 59 (38.6%) had poor outcome. The good outcome rate in the IVT group was significantly higher than that in the non-IVT group (71.6% vs. 51.9%; χ2=6.274, P=0.012), but there was no significant difference in the incidence of sICH and any bleeding in any location. The baseline NIHSS score of the good outcome group was significantly lower than that of the poor outcome group (8.817±3.677 vs. 11.203±5.060; t=3.361, P<0.001), and the proportion of IVT was significantly higher than that of the poor outcome group (56.4% vs. 35.6%; χ2=6.274, P=0.012). Multivariate logistic regression analysis showed that previous history of stroke or transient ischemic attack (odds ratio [ OR] 3.964, 95% confidence interval [ CI] 1.611-9.753; P=0.003) and high baseline NIHSS score ( OR 1.129, 95% CI 1.034-1.233; P=0.007) were independently associated with the poor outcome, while IVT was independently associated with the good outcome ( OR 0.166, 95% CI 0.068-0.410; P<0.001). Conclusion:For patients with AIS who had taken DOACs within 48 hours before onset, IVT can significantly improve the outcome without increasing the risk of sICH.

Objective:To investigate the relationship between the overall burden score of cerebral small vessel disease (CSVD) and sudden sensorineural hearing loss (SSNHL) and its severity.Methods:Patients with SSNHL admitted to Zhengzhou People’s Hospital from January 2019 to June 2022 were used as the case group, and age- and gender-matched patients with tension headache or benign positional vertigo were used as the control group. MRI was used to evaluate the phenotype of CSVD, including white matter hyperintensities (WMHs), cerebral microbleeds (CMBs), enlarged perivascular spaces (EPVS), and lacune of presumed vascular origin, and then the total burden score of CSVD was calculated. Multivariate logistic regression analysis was used to determine the independent factors of SSNHL. Ordinal logistic regression analysis was used to investigate the relationship between the overall burden of CSVD and the severity of hearing loss in patients with SSNHL. Results:A total of 86 patients with SSNHL and 90 age- and gender-matched controls were included. There were statistically significant differences in triglycerides, high-density lipoprotein cholesterol, fasting blood glucose levels, WMHs overall score classification, periventricular WMHs score classification, deep WMHs score classification, CMBs, moderate to severe EPVS, CSVD overall burden score and classification between the two groups (all P<0.05). Multivariate logistic regression analysis showed that after adjusting for high-density lipoprotein cholesterol, fasting blood glucose ≥6.1 mmol/L (odds ratio [ OR] 2.149, 95% confidence interval [ CI] 1.042-4.432; P=0.038), triglycerides ≥1.7 mmol/L ( OR 7.012, 95% CI 2.962-16.597; P=0.000), CSVD overall burden score >1 (compared to 0 point, 2 points: OR 4.095, 95% CI 1.364-12.291, P=0.012; 3 points: OR 5.776, 95% CI 1.888-17.614, P=0.002; 4 points: OR 7.900, 95% CI 2.526-24.706; P=0.000) were significantly independently correlated with SSNHL. Ordinal logistic regression analysis showed that after adjusting for age and fasting blood glucose, the flat decline type hearing loss ( OR 1.276, 95% CI 1.131-1.618; P=0.044) and total deafness type hearing loss ( OR 1.029, 95% CI 1.002-1.058; P=0.038), and the overall burden of CSVD being moderate ( OR 1.318, 95% CI 1.036-1.677; P=0.025) and severe ( OR 2.330, 95% CI 1.232-4.406; P=0.009) were significantly independent associated with the degree of hearing loss in patients with SSNHL. Conclusion:The CSVD total burden score of moderate to severe degree is independently associated with SSNHL and the degree of hearing loss.

Objective:To investigate the correlation between white matter hyperintensities (WMHs) and collateral circulation in patients with stroke caused by anterior circulation large vessel occlusion (aLVO).Methods:Patients with stroke caused by aLVO treated with endovascular mechanical thrombectomy in the Department of Neurology, Zhengzhou People's Hospital from December 2017 to April 2021 were retrospectively enrolled. Their demography, vascular risk factors, baseline clinical data and Fazekas scale score were collected. Multivariate logistic regression analysis was used to determine the independent correlation between WMHs and the collateral circulation status in patients with aLVO. Results:During the study, 166 patients with aLVO were included (77 males, 46.39%; aged 69.62±5.91 years). Their baseline National Institutes of Health Stroke Scale (NIHSS) score was 9.33±4.42. There were 120 patients (72.29%) in the good collateral circulation group and 46 (27.71%) in the poor collateral circulation group. Univariate analysis showed that there were significant differences in baseline NIHSS score, total Fazekas score and periventricular Fazekas score between the good collateral circulation group and the poor collateral circulation group (all P<0.05). Multivariate logistic regression analysis showed that total Fazekas score (odds ratio 2.583, 95% confidence interval 1.445-4.619; P=0.001) and periventricular Fazekas score (odds ratio 2.190, 95% confidence interval 1.022-4.692; P=0.044) were the independent risk factors for the poor collateral circulation. Conclusion:The severity of WMHs is associated with the poor collateral circulation in patients with aLVO.

Objective　To investigate the difference in collateral circulation and clinical prognosis between cervical carotid atherosclerosis and cardioembolism.Methods　We enrolled 318 adult endovascular patients with acute ischemic stroke due to anterior circulation occlusion between January 2014 and November 2020.132 patients with cervical carotid atherosclerosis and 186 with cardioembolism were included.The collateral score,the modified Rankin Scale (mRS) score,mortality at 90 days between patients with carotid artery stenosis and patients with cardiogenic embolism was compared.Results　Compared with stroke due to cardiac embolism,stroke due to carotid atherosclerosis had a higher incidence of the internal carotid artery end occlusion（P＜0.001）and a higher collateral-circulation score（OR=1.63）,a lower mRS scores before stroke（P＜0.001）,and a lower 90-day median MRS score（OR=1.93）.Conclusion　Compared with cardiogenic embolic stroke patients,carotid atherosclerotic stroke patients have better collateral circulation and slightly better median MRS at 90 days.