Objective:To investigate the impact of different etiologies on the spatial distribution pattern of infarcts and the mapping pattern of focal symptoms in acute ischemic stroke (AIS) using a population-based standardized spatial analysis of MRI.Methods:This was a cross-sectional study. Clinical [age, sex distribution, admission National Institutes of Health Stroke Scale (NIHSS) score and 90-day modified Rankin Scale (mRS) score at discharge, etc.] and imaging data of 2 610 patients with AIS attending 9 Medical Centers from January 2015 to December 2021 were retrospectively analyzed. All patients were categorized into 1 718 cases of large artery atherosclerosis (LAA) type, 335 cases of cardioembolism (CE) type, and 557 cases of small artery occlusion (SAO) type according to TOAST typing. All patients underwent diffusion-weighted imaging, and the detected infarct lesions were segmented and aligned to the standardized space using artificial intelligence-assisted methods, and the spatial distribution frequency heatmaps of lesion locations in patients with different TOAST subtypes were plotted and compared with each other by χ2 test. Lesion-symptom image brain maps with different clinical symptoms were further plotted, and differences of lesion-symptom image relationships among different TOAST subtypes were observed and compared with each other by interaction effect. Results:In all patients, the favored sites of infarct lesions were the bilateral middle cerebral artery region in the anterior circulation and the occipital and brainstem regions in the posterior circulation. Compared with the LAA type, the CE type lesions were more likely to occur in the anterior cerebral artery region, the occipital lobe, and the cerebellum posterior, while the SAO type lesions were more likely to occur in the perforator artery supply area. The lesion-symptom mapping results showed that AIS patients with infarct lesions in the frontoparieto-temporal region in the presence of a left middle cerebral artery supply had higher admission NIHSS scores and higher discharge 90-day mRS scores for the LAA type than for the CE type( P<0.05); AIS patients with infarcted lesions in the brainstem region and some cerebellar regions in the presence of vertebrobasilar artery supply had higher admission NIHSS scores and higher discharge 90-day mRS scores for the CE type than for the LAA type( P<0.05). Conclusion:At the population level, brain mapping reveals specific infarct distribution patterns and differences in lesion-symptom mapping patterns of different etiologies AIS patients, providing imaging evidence for the understanding of AIS pathogenetic mechanisms and clinical management.

Objective:To investigate whether escin(ESC)and dextromethorphan(DEX)have the protective effects on the progression and symptoms of Alzheimer disease(AD).Methods:The AD model of Caenorhabditis elegans(C.elegans)was established by transgenic amyloid β-protein(Aβ protein).Different concentrations of ESC or DEX or 50 μmol/L memantine(MEM)were used to treat the AD model worms,and their lifespan was detected.The movement ability of AD model C.elegans was evalua-ted by body bending frequency and head swinging frequency.The changes in cognitive functions of AD model C.elegans before and after treatment were detected by chemotaxis experiments.The changes in A βprotein and reactive oxygen species(ROS)content in C.elegans were detected.The changes in gene pathways related to oxidative stress were detected by Real-time quantitative polymerase chain reaction(RT-qPCR).Results:At high dose 1 000 μmol/L,ESC or DEX treatment showed no significant effects on the activity of C.elegans.Compared with untreated worms,the survival time of AD model C.elegans in the 20 μmol/L ESC and 60 μmol/L DEX intervention groups was significantly extended.In the middle stage of AD progression,the body bending frequency and head swinging frequency of AD model worms after ESC or DEX treatment was significantly increased compared with the untreated control group with DEX being more effective in the recovery of head swinging frequency.For the early cognitive function tests,the chemotaxis index of ESC or DEX treated worms was significantly higher than that of the untreated worms,which correlated with marked reductions in the Aβ protein levels.The reactive oxygen species content in the drug intervention group was also lower than that in the control group.RT-qPCR results showed that ESC could inhibit oxidative stress in the AD model C.elegans by a 2-fold upregulation of skn1 expression.Conclusion:ESC and DEX could improve the reductions of movement ability and cognitive function in the AD model worms and delay the aggravation of AD-related symptoms.ESC delays the progression of AD pos-sibly by activating the SKN-1/Nrf2 pathway to protect against oxidative injury in the AD model.

Objective:To investigate whether escin(ESC)and dextromethorphan(DEX)have the protective effects on the progression and symptoms of Alzheimer disease(AD).Methods:The AD model of Caenorhabditis elegans(C.elegans)was established by transgenic amyloid β-protein(Aβ protein).Different concentrations of ESC or DEX or 50 μmol/L memantine(MEM)were used to treat the AD model worms,and their lifespan was detected.The movement ability of AD model C.elegans was evalua-ted by body bending frequency and head swinging frequency.The changes in cognitive functions of AD model C.elegans before and after treatment were detected by chemotaxis experiments.The changes in A βprotein and reactive oxygen species(ROS)content in C.elegans were detected.The changes in gene pathways related to oxidative stress were detected by Real-time quantitative polymerase chain reaction(RT-qPCR).Results:At high dose 1 000 μmol/L,ESC or DEX treatment showed no significant effects on the activity of C.elegans.Compared with untreated worms,the survival time of AD model C.elegans in the 20 μmol/L ESC and 60 μmol/L DEX intervention groups was significantly extended.In the middle stage of AD progression,the body bending frequency and head swinging frequency of AD model worms after ESC or DEX treatment was significantly increased compared with the untreated control group with DEX being more effective in the recovery of head swinging frequency.For the early cognitive function tests,the chemotaxis index of ESC or DEX treated worms was significantly higher than that of the untreated worms,which correlated with marked reductions in the Aβ protein levels.The reactive oxygen species content in the drug intervention group was also lower than that in the control group.RT-qPCR results showed that ESC could inhibit oxidative stress in the AD model C.elegans by a 2-fold upregulation of skn1 expression.Conclusion:ESC and DEX could improve the reductions of movement ability and cognitive function in the AD model worms and delay the aggravation of AD-related symptoms.ESC delays the progression of AD pos-sibly by activating the SKN-1/Nrf2 pathway to protect against oxidative injury in the AD model.

Objective:To investigate the impact of different etiologies on the spatial distribution pattern of infarcts and the mapping pattern of focal symptoms in acute ischemic stroke (AIS) using a population-based standardized spatial analysis of MRI.Methods:This was a cross-sectional study. Clinical [age, sex distribution, admission National Institutes of Health Stroke Scale (NIHSS) score and 90-day modified Rankin Scale (mRS) score at discharge, etc.] and imaging data of 2 610 patients with AIS attending 9 Medical Centers from January 2015 to December 2021 were retrospectively analyzed. All patients were categorized into 1 718 cases of large artery atherosclerosis (LAA) type, 335 cases of cardioembolism (CE) type, and 557 cases of small artery occlusion (SAO) type according to TOAST typing. All patients underwent diffusion-weighted imaging, and the detected infarct lesions were segmented and aligned to the standardized space using artificial intelligence-assisted methods, and the spatial distribution frequency heatmaps of lesion locations in patients with different TOAST subtypes were plotted and compared with each other by χ2 test. Lesion-symptom image brain maps with different clinical symptoms were further plotted, and differences of lesion-symptom image relationships among different TOAST subtypes were observed and compared with each other by interaction effect. Results:In all patients, the favored sites of infarct lesions were the bilateral middle cerebral artery region in the anterior circulation and the occipital and brainstem regions in the posterior circulation. Compared with the LAA type, the CE type lesions were more likely to occur in the anterior cerebral artery region, the occipital lobe, and the cerebellum posterior, while the SAO type lesions were more likely to occur in the perforator artery supply area. The lesion-symptom mapping results showed that AIS patients with infarct lesions in the frontoparieto-temporal region in the presence of a left middle cerebral artery supply had higher admission NIHSS scores and higher discharge 90-day mRS scores for the LAA type than for the CE type( P<0.05); AIS patients with infarcted lesions in the brainstem region and some cerebellar regions in the presence of vertebrobasilar artery supply had higher admission NIHSS scores and higher discharge 90-day mRS scores for the CE type than for the LAA type( P<0.05). Conclusion:At the population level, brain mapping reveals specific infarct distribution patterns and differences in lesion-symptom mapping patterns of different etiologies AIS patients, providing imaging evidence for the understanding of AIS pathogenetic mechanisms and clinical management.

Objective:To investigate the correlation between serum proprotein convertase subtilisin/Kexin type 9 (PCSK9) level and white matter hyperintensities (WMHs) in healthy population.Methods:Consecutive healthy individuals underwent routine physical examinations at the Department of Neurology, Jinling Hospital Affiliated to Medical School of Nanjing University (April 2023 to December 2023) and Hexi Branch of Nanjing First Hospital (March 2024 to April 2024) were included prospectively. Enzyme-linked immunosorbent assay was used to detect serum PCSK9 level. The Fazekas scale was used to assess the severity of WMHs (total score 0-6) and they were divided into no or mild WMHs group (0-2) and moderate to severe WMHs group (3-6). Multivariate logistic regression analysis was used to determine the independent correlation between the serum PCSK9 level and the severity of WMHs. Results:A total of 177 subjects were enrolled, including 110 males (62.1%), aged 66.7±10.1 years. The median serum PCSK9 level was 203.9 ng/L. According to the Fazekas score, there were 102 patients (51.6%) in the no or mild WMHs group, and 75 (42.4%) in the moderate to severe WMHs group. One way analysis of variance showed that serum PCSK9 level significantly increased with the increase of WMHs total score ( P=0.001). The serum PCSK9 level in the moderate to severe WMHs group was significantly higher than that in the no or mild WMHs group (437.2±260.4 ng/L vs. 217.9±141.7 ng/L; P=0.001). Multivariate logistic regression analysis showed that after adjusting for age, gender, and other confounding factors, there was a significant independent correlation between higher serum PCSK9 level and moderate to severe WMHs (odds ratio 3.201, 95% confidence interval 2.107-5.082; P=0.001). Conclusion:Higher serum PCSK9 level is an independent risk factor for moderate to severe WMHs in healthy individuals.

【Objective】 To analyze the current situation of direct exemption of clinical blood fess for voluntary blood donors and their family members in Henan Province, in order to improve and fully implement the policy. 【Methods】 According to the policy on blood fees exemption issued by China and Henan Province in 2019,the data of hospitals in 18 prefecture-level cities in Henan from 2020 to 2021 were continuously collected from the system of clinical blood fees exemption,including the way of exemption,the number of people (times) of exemption,exemption amount, the proportion of blood fees exemption and the total exemption rate. The experience gained in the past two years after the implementation of the policy was summarized,and the existing problems and causes were analyzed. 【Results】 The rates of direct exemption of blood fees in Henan Province in 2020 and 2021 were 34.53% (8 709/25 221) and 71.68%(23 587/32 906) (P<0.05) ,respectively. In 2021, the direct exemption rate of blood fees in 18 cities was 6.20% (83/1 370) to 88.50% (1 332/1 505) [ (47.35±41.15)%],and increased month by month from 43.19% (1 183/2 507) in January to 83.15% (2 097/2 522) in August, then remained stable at a similar level to August from September to December, with 83.43% (2 744/3 289) in December as the highest for the year. 【Conclusion】 The implementation of the policy of blood fees exemption showed significant effectiveness, which has effectively promoted the development of voluntary blood donation in Henan. However, there is still room for improving the policy in some cities, which is expected to further increase the direct exemption rate of the city and the whole province.

Diffuse leptomeningeal glioneuronal tumor (DLGNT) is a rare, low-grade neoplasm, which is newly categorized into the neuronal and mixed neuro-glial tumor in 2016. The most characteristic imaging findings are diffuse leptomeningeal thickening and enhancement with multiple minor cysts. This article described a case with DLGNT mimicking meningitis, whose cystic lesions were not obvious, with swollen multiple lobes cortex, gyri form cortical calcification and enhanced meninges. Meningeal irritation sign repeated attacks and the clinical symptoms gradually improved after steroid pulse therapy. The biopsy and immunohistochemistry staining were diagnosed as DLGNT. The imaging features and clinical data of this case were analyzed to improve the understanding of the disease in clinical practice.

Objective:To investigate the correlation between the lipocalin-2 (LCN-2) level and white matter hyperintensities (WMHs) in patients with ischemic stroke.Methods:Consecutive patients with ischemic stroke admitted to the Department of Neurology, Jinling Hospital, Medical School of Nanjing University from September 2021 to November 2021 and whose duration from onset to hospitalization <14 d were prospectively enrolled. Enzyme-linked immunosorbent assay was used to detect the serum LCN-2. Fazekas scale was used to assess the severity of periventricular and subcortical WMHs. A total WMHs score ≥3 was defined as severe WMHs. Multivariate logistic regression analysis was used to determine the correlation between serum LCN-2 level and WMHs. Results:A total of 179 patients were enrolled, including 122 males (68.2%), aged 64.7±11.6 years. The median serum LCN-2 level was 387.1 g/L, and 86 patients (48.0%) had severe WMHs. Serum LCN-2 in the severe WMH group was significantly higher than that in the non-severe WMH group (505.3±342.4 g/L vs. 367.8±224.5 g/L; t=3.110, P=0.002). Multivariable logistic regression analysis showed that after adjusting for the relevant confounding factors, there was a significant correlation between higher serum LCN-2 and severe WMHs (odds ratio 2.32, 95% confidence interval 1.17-4.63; P=0.017) and higher total WMHs score (odds ratio 1.62, 95% confidence interval 1.12-2.35; P=0.011). Conclusion:Higher serum LCN-2 level is associated with severe WMHs in patients with ischemic stroke.

Intracranial artery stenosis is the main cause of ischemic stroke in China. Because of the high recurrence rate of stroke in these patients, the selected patients may benefit from interventional therapy. Therefore, risk stratification and evaluation of intracranial artery stenosis are helpful to determine the clinical treatment plan. High resolution magnetic resonance imaging can clearly show the characteristics of intracranial vascular wall, which is helpful to comprehensively evaluate intracranial vessels. This article reviews the characteristics of vulnerable plaque of intracranial atherosclerosis, the pathogenesis of stroke and the clinical application of high-resolution magnetic resonance imaging in intracranial artery stenosis.

Objective:To investigate the correlation between obstructive sleep apnea (OSA) and triglyceride-glucose (TyG) indexin patients with ischemic stroke.Methods:Patients with ischemic stroke underwent sleep breathing monitoring in Nanjing Stroke Registry Program from August 2020 to August 2021 were retrospectively enrolled. According to apnea-hypopnea index (AHI), the patients were divided into no/mild OSA group (AHI≤15 events/h) and moderate to severe OSA group (AHI>15 events/h). The TyG index was calculated according to triglycerides and fasting blood glucose, and the patients were grouped by quartile. The relationship between moderate to severe OSA and TyG index was determined by ordinal multinomial logistic regression analysis. Pearson correlation analysis was used to evaluate the correlation between TyG index and AHI. Results:A total of 155 patients with ischemic stroke were enrolled in the study, including 66 patients in the no/mild OSA group, 89 in the moderate to severe OSA group; 39 in the Q1 group (TyG index ≤8.46), 39 in the Q2 group (TyG index 8.47-8.78), 39 in the Q3 group (TyG index 8.79-9.17), and 38 in the Q4 group (TyG index >9.17). Ordinal multinomial logistic regression analysis showed that after adjusting for potential confounding factors, higher fasting blood glucose (odds ratio 2.370, 95% confidence interval 1.745-3.222; P<0.001) and moderate to severe OSA (odds ratio 2.377, 95% confidence interval 1.217-4.646; P=0.011) had significant independent positive correlation with TyG index. Pearson correlation analysis showed that AHI was positively correlated with the TyG index in patients with ischemic stroke ( r=0.209, P=0.011). Conclusion:OSA is independently correlated with TyG index in patients with ischemic stroke.