Objective To explore the correlation between gait disorders and alterations in diffusion tensor imaging(DTI)parameters in different regions of interest(ROI)and associated white matter tracts in older patients with leukoaraiosis(LA).Methods A total of 108 elderly LA patients admitted in our department from July 2023 to May 2024 were enrolled,and based on the Fazekas scale,they were divided into normal(n=28),moderate(n=48),and severe groups(n=32).Tinetti Gait Scale(TGS)was used to evaluate the morbility and balance function,and Short Physical Performance Battery(SPPB)was employed to assess motor function.All participants underwent brain MRI and DTI scanning.Fractional anisotropy(FA)values were quantitatively measured in predefined ROIs and specific white matter tracts.Results The moderate and severe groups had significantly advanced age and higher homocysteine level,and lower total TGS score,Tinetti gait score,total SPPB score,and walking speed score than the normal group(P＜0.05).The severe group exhibited obviously lower education level,and decreased Tinetti balance score and standing score than the normal and moderate groups(P＜0.05).The FA values at the left pa-rietal lobe,the anterior horn of bilateral lateral ventricles,and the splenium of the left corpus cal-losum were notably lower,so were the FA values at the corpus callosum(left-right),left cortico-spinal tract(inferior segment),left anterior thalamic radiation(inferior segment),left inferior fronto-occipital fasciculus(inferior segment),and left superior longitudinal fasciculus(inferior segment)in the moderate group and the severe group than the normal group(P＜0.05).The se-vere group demonstrated lower FA values at the left and right parietal lobes than the other two groups(P＜0.05).Multivariate logistic regression analysis revealed that the anterior horn of the left lateral ventricle(β=-0.683,P=0.001)and the left inferior corticospinal tract(β=-0.742,P=0.001)were influencing factors for gait disorder in elderly LA patients.Conclusion In elderly LA patients,gait disorders are correlated with decreased FA values in specific ROI and white mat-ter tracts,with the decreased FA values in the anterior horn of the left lateral ventricle and the left inferior corticospinal tract demonstrating the most significant impact.

Objective To explore the correlation between gait disorders and alterations in diffusion tensor imaging(DTI)parameters in different regions of interest(ROI)and associated white matter tracts in older patients with leukoaraiosis(LA).Methods A total of 108 elderly LA patients admitted in our department from July 2023 to May 2024 were enrolled,and based on the Fazekas scale,they were divided into normal(n=28),moderate(n=48),and severe groups(n=32).Tinetti Gait Scale(TGS)was used to evaluate the morbility and balance function,and Short Physical Performance Battery(SPPB)was employed to assess motor function.All participants underwent brain MRI and DTI scanning.Fractional anisotropy(FA)values were quantitatively measured in predefined ROIs and specific white matter tracts.Results The moderate and severe groups had significantly advanced age and higher homocysteine level,and lower total TGS score,Tinetti gait score,total SPPB score,and walking speed score than the normal group(P＜0.05).The severe group exhibited obviously lower education level,and decreased Tinetti balance score and standing score than the normal and moderate groups(P＜0.05).The FA values at the left pa-rietal lobe,the anterior horn of bilateral lateral ventricles,and the splenium of the left corpus cal-losum were notably lower,so were the FA values at the corpus callosum(left-right),left cortico-spinal tract(inferior segment),left anterior thalamic radiation(inferior segment),left inferior fronto-occipital fasciculus(inferior segment),and left superior longitudinal fasciculus(inferior segment)in the moderate group and the severe group than the normal group(P＜0.05).The se-vere group demonstrated lower FA values at the left and right parietal lobes than the other two groups(P＜0.05).Multivariate logistic regression analysis revealed that the anterior horn of the left lateral ventricle(β=-0.683,P=0.001)and the left inferior corticospinal tract(β=-0.742,P=0.001)were influencing factors for gait disorder in elderly LA patients.Conclusion In elderly LA patients,gait disorders are correlated with decreased FA values in specific ROI and white mat-ter tracts,with the decreased FA values in the anterior horn of the left lateral ventricle and the left inferior corticospinal tract demonstrating the most significant impact.

Dexmedetomidine displays multiple mechanisms of neuroprotection in ameliorating ischemic brain injury. In this study, we explored the beneficial effects of dexmedetomidine on blood-brain barrier (BBB) integrity and neuroinflammation in cerebral ischemia/reperfusion injury. Sprague-Dawley rats were subjected to middle cerebral artery occlusion (MCAO) for 1.5 h and reperfusion for 24 h to establish a rat model of cerebral ischemia/reperfusion injury. Dexmedetomidine (9 µg/kg) was administered to rats 30 min after MCAO through intravenous injection, and SB203580 (a p38 MAPK inhibitor, 200 µg/kg) was injected intraperitoneally 30 min before MCAO. Brain damages were evaluated by 2,3,5-triphenyltetrazolium chloride staining, hematoxylin-eosin staining, Nissl staining, and brain water content assessment. BBB permeability was examined by Evans blue staining. Expression levels of claudin-5, zonula occludens-1, occludin, and matrix metalloproteinase-9 (MMP-9) as well as M1/M2 phenotypes-associated markers were assessed using immunofluorescence, RT-qPCR, Western blotting, and gelatin zymography. Enzyme-linked immunosorbent assay was used to examine inflammatory cytokine levels. We found that dexmedetomidine or SB203580 attenuated infarct volume, brain edema, BBB permeability, and neuroinflammation, and promoted M2 microglial polarization after cerebral ischemia/reperfusion injury. Increased MMP-9 activity by ischemia/reperfusion injury was inhibited by dexmedetomidine or SB203580. Dexmedetomidine inhibited the activation of the ERK, JNK, and p38 MAPK pathways. Moreover, activation of JNK or p38 MAPK reversed the protective effects of dexmedetomidine against ischemic brain injury. Overall, dexmedetomidine ameliorated brain injury by alleviating BBB permeability and promoting M2 polarization in experimental cerebral ischemia/reperfusion injury model by inhibiting the activation of JNK and p38 MAPK pathways.

Objective:To analyze the differences of effectiveness of stenting for vertebral artery ostium severe stenosis via transradial access and transfemoral access. Methods:Sixty-three patients with vertebral artery ostium severe stenosis confirmed by cerebral angiography in our hospital from December 2017 to March 2022 were enrolled. Stent implantation via transradial access was performed in 30 patients (radial artery group) and stent implantation via transfemoral access was performed in 33 patients (femoral artery group). The radial artery group was divided into left and right subgroups according to the lesions of vertebral arteries; and according to the anatomical classification of vertebral arteries, radial artery group was divided into two subgroups: anatomical type I and anatomical type II. The baseline data and surgery-related data (success rate of stent implantation, time from sheath insertion to stent implantation, surgical time, exposure time, and incidence of surgical complications) of patients in the radial artery group and femoral artery group were compared and analyzed. The surgical data of patients in the subgroups of radial artery group were compared and analyzed. Results:There was no significant difference in the success rate of stent implantation or incidence of primary endpoint events 3 d after surgery between the radial artery group and femoral artery group ( P>0.05). The time from sheath insertion to stent implantation, surgical time, and exposure time in the radial artery group were statistically shorter than those in the femoral artery group ( P<0.05). The radial artery group had significantly lower incidence of complications (9.01% vs. 30.0%) and incidence of hematoma (3.03% vs. 20.05) at the puncture sites than the femoral artery group ( P<0.05). Time from sheath insertion to stent implantation, surgical time, and exposure time in the anatomical type I patients of radial artery group were significantly longer than those in the anatomical type II patients ( P<0.05); those in patients with left lesions of radial artery group were significantly shorter than those in patients with right lesions ( P<0.05). Conclusion:As compared with that via transfemoral access, the stenting via transradial access has almost the same success rate, without significant difference in incidence of perioperative serious complications, and stenting via transradial access has shorter surgical time, lower surgical difficulty, and lower incidence of complications; patients with anatomical type II or left lesions have better efficacy than those with anatomical type I or right lesions.

Objective:To analyze the differences of effectiveness of stenting for vertebral artery ostium severe stenosis via transradial access and transfemoral access. Methods:Sixty-three patients with vertebral artery ostium severe stenosis confirmed by cerebral angiography in our hospital from December 2017 to March 2022 were enrolled. Stent implantation via transradial access was performed in 30 patients (radial artery group) and stent implantation via transfemoral access was performed in 33 patients (femoral artery group). The radial artery group was divided into left and right subgroups according to the lesions of vertebral arteries; and according to the anatomical classification of vertebral arteries, radial artery group was divided into two subgroups: anatomical type I and anatomical type II. The baseline data and surgery-related data (success rate of stent implantation, time from sheath insertion to stent implantation, surgical time, exposure time, and incidence of surgical complications) of patients in the radial artery group and femoral artery group were compared and analyzed. The surgical data of patients in the subgroups of radial artery group were compared and analyzed. Results:There was no significant difference in the success rate of stent implantation or incidence of primary endpoint events 3 d after surgery between the radial artery group and femoral artery group ( P>0.05). The time from sheath insertion to stent implantation, surgical time, and exposure time in the radial artery group were statistically shorter than those in the femoral artery group ( P<0.05). The radial artery group had significantly lower incidence of complications (9.01% vs. 30.0%) and incidence of hematoma (3.03% vs. 20.05) at the puncture sites than the femoral artery group ( P<0.05). Time from sheath insertion to stent implantation, surgical time, and exposure time in the anatomical type I patients of radial artery group were significantly longer than those in the anatomical type II patients ( P<0.05); those in patients with left lesions of radial artery group were significantly shorter than those in patients with right lesions ( P<0.05). Conclusion:As compared with that via transfemoral access, the stenting via transradial access has almost the same success rate, without significant difference in incidence of perioperative serious complications, and stenting via transradial access has shorter surgical time, lower surgical difficulty, and lower incidence of complications; patients with anatomical type II or left lesions have better efficacy than those with anatomical type I or right lesions.

Objective:To investigate the value of diffusion tensor imaging (DTI) in evaluating the cognitive function of patients with leukoaraiosis (LA).Methods:A prospective study was chosen. Sixty patients with LA admitted to our hospital from July 2019 to May 2021 were selected. All patients accepted brain MRI. According to Fazekas visual grading standards, these 60 LA patients were divided into mild LA group, moderate LA group, and severe LA group ( n=20). Mini-mental state examination (MMSE) was used to evaluate the cognitive function of these patients. Diffusion tensor imaging was used to analyze the fractional anisotropy (FA) values of 6 regions of interest, namely the frontal lobe, temporal lobe, occipital lobe, parietal lobe, anterior horn of lateral ventricle, and corpus callosum. The differences of general data, cognitive function and FA values among the 3 groups were compared. The cognitive functions were assessed based on FA values (FA scores), and compared with those evaluated by MMSE (clinical scores). Results:(1) Age and homocysteine (Hcy) level of patients in mild, moderate and severe LA groups were increased successively, with statistical differences ( P<0.05). As compared with that in the mild and moderate LA groups, the educational level of patients in the severe LA group was significantly lower ( P<0.05). (2) Memory scores of patients in mild LA group, moderate LA group and severe LA group decreased successively, with statistical differences ( P<0.05). As compared with mild LA group and moderate LA group, MMSE total scores and recall scores in severe LA group were statistically decreased ( P<0.05). (3) FA values of parietal lobe and corpus callosum were successively decreased in mild, moderate and severe LA groups, with significant differences ( P<0.05). As compared with those in the mild and moderate LA groups, the FA values of frontal lobe, temporal lobe, occipital lobe and anterior horn of lateral ventricle in severe LA group were significant decreased, ( P<0.05). (4) There were no significant differences in FA scores and clinical scores of cognitive function scores in mild LA group ( P>0.05), except for attention and counting scores. There were no significant differences in FA scores and clinical scores of cognitive function scores in moderate LA group ( P>0.05), except for language function scores and tMMSE otal scores. Except for scores of location orientation, attention and counting, FA scores and clinical scores of all cognitive function scores in the severe LA group were significantly different ( P<0.05). Conclusions:The LA severity is related to the patient's age, Hcy level, education level, and cognitive function. In patients with mild LA, the cognitive function can be assessed according to FA values in addition to attention and counting ability; in patients with moderate LA, cognitive function can be assessed according to FA values in addition to language function; the cognitive function of patients with severe LA cannot be assessed according to FA values.