Objective To analyze the whole-brain structural-functional coupling imaging characteristics of patients with cerebral small vessel disease(CSVD)based on multiparametric functional and structural MRI,and to explore their correlation with cognitive function.Methods A prospective,consecutive study enrolled 60 CSVD patients from the Department of Neurology,the Second Affiliated Hospital of Anhui Medical University,between May 2021 and December 2023,and 47 controls matched for age,sex,education level,and handedness recruited from the community during the same period.Baseline data,including demographic information(age,sex,education),cognitive function,and imaging data,were collected for both groups.All participants underwent standardized neuropsychological assessments in a quiet environment.Emotional function was assessed using the patient health questionnaire-9(PHQ-9).Global cognitive function was screened using the Montreal cognitive assessment scale(MoCA)and Alzheimer's disease 8-item questionnaire(AD-8).Executive function was evaluated using the trail making test-B(TMT-B),the TMT time difference(TMT-B time minus TMT-A time),and the verbal fluency test(VFT).Attention and processing speed were assessed using TMT-A and the digit span test(DS).Memory function was evaluated using the Chinese auditory verbal learning test(AVLT),including learning,immediate recall,and delayed recall.Multimodal brain functional and structural MRI images were acquired for all participants.Fractional amplitude of low-frequency fluctuations(fALFF)and gray matter volume(GMV)were calculated using the DPABI software.A structure-function coupling index was computed by integrating the fALFF and GMV values of corresponding voxels.Structural-function coupling changes in CSVD patients and controls were assessed,and the correlations between fALFF,GMV,fALFF/GMV and cognitive function were explored.Results(1)Compared to the control group,CSVD patients showed significant lower scores in MoCA score(21.5[20.0,24.0]vs.24.3[23.0,26.0],Z=-4.094),higher PHQ-9 score(5.4±5.0vs.2.1±2.2,t=4.150),less VFT(15.5±3.8 vs.17.2±4.3,t=-3.258),increased TMT-B time([164.4±72.7]s vs.[123.6±45.7]s,t=3.307),TMT-A time([83.8±34.3]s vs.[62.9±22.7]s,t=3.704),and less DS forward span(6.3[5.0,8.0]vs.7.4[6.0,8.0],Z=-3.679),DS backward span(3.7±1.2 vs.4.5±1.4,t=-3.119),AVLT-learning(7.0±1.8 vs.8.7±1.9,t=-4.523),A VLT-immediate recall(7.2[6.0,9.0]vs.9.6[7.2,11.8],Z=-4.105),AVLT-delayed recall(6.9±3.1 vs.9.6±3.0,t=-4.310;all P＜0.01).No significant differences were observed in age,education,sex,AD-8 score,or TMT time difference(all P＞0.05).(2)CSVD patients showed decreased fALFF values in the right anterior cingulate gyrus(1.00±0.06 vs.1.07±0.06,t=-4.66)and increased fALFF values in the left superior parietal lobule(1.14±0.07 vs.1.07±0.07,t=5.68)and the right postcentral gyrus(1.08±0.05 vs.1.01±0.05,t=5.22;both P＜0.01).CSVD patients had increased GMV in the bilateral caudate nucleus(right:[0.27±0.06]mm3 vs.[0.21±0.04]mm3,t=6.12,left:[0.27±0.05]mm3 vs.[0.22±0.04]mm3,t=6.67;both P＜0.01)but decreased fALFF/GMV in the bilateral caudate nucleus(left:6.27±0.97 vs.7.75±1.70,t=-7.33;right:3.12±0.97 vs.4.18±0.95,t=-5.96)and the right globus pallidus(14.11±4.14 vs.19.99±4.03,t=-6.36;all P＜0.01).(3)Right anterior cingulate gyrus fALFF positively correlated with DS backward scores(R=0.348,P=0.013).Left superior parietal lobule fALFF negatively correlated with PHQ-9 scores(R=-0.308,P=0.029)and TMT time difference(R=-0.360,P=0.012).Right postcentral gyrus fALFF negatively correlated with TMT-A time(R=-0.419,P=0.003).Right caudate nucleus GMV positively correlated with TMT time difference(R=0.293,P=0.042),while left caudate nucleus GMV negatively correlated with AD-8 score(R=-0.284,P=0.043).fALFF/GMV in the right caudate nucleus(R=0.288,P=0.046)and right globus pallidus(R=0.290,P=0.045)positively correlated with VFT.After multiple comparison corrections,only the negative correlation between right postcentral gyrus fALFF and TMT-A time remained significant(P(alse discovery rate adjusted=0.024).Conclusions CSVD patients exhibit significant structure-function decoupling values in bilateral caudate nucleus and right globus pallidus are reduced,and this reduction is associated with a decline in verbal fluency.The results of this study still need to be further validated in larger sample size studies.

Objective To analyze the whole-brain structural-functional coupling imaging characteristics of patients with cerebral small vessel disease(CSVD)based on multiparametric functional and structural MRI,and to explore their correlation with cognitive function.Methods A prospective,consecutive study enrolled 60 CSVD patients from the Department of Neurology,the Second Affiliated Hospital of Anhui Medical University,between May 2021 and December 2023,and 47 controls matched for age,sex,education level,and handedness recruited from the community during the same period.Baseline data,including demographic information(age,sex,education),cognitive function,and imaging data,were collected for both groups.All participants underwent standardized neuropsychological assessments in a quiet environment.Emotional function was assessed using the patient health questionnaire-9(PHQ-9).Global cognitive function was screened using the Montreal cognitive assessment scale(MoCA)and Alzheimer's disease 8-item questionnaire(AD-8).Executive function was evaluated using the trail making test-B(TMT-B),the TMT time difference(TMT-B time minus TMT-A time),and the verbal fluency test(VFT).Attention and processing speed were assessed using TMT-A and the digit span test(DS).Memory function was evaluated using the Chinese auditory verbal learning test(AVLT),including learning,immediate recall,and delayed recall.Multimodal brain functional and structural MRI images were acquired for all participants.Fractional amplitude of low-frequency fluctuations(fALFF)and gray matter volume(GMV)were calculated using the DPABI software.A structure-function coupling index was computed by integrating the fALFF and GMV values of corresponding voxels.Structural-function coupling changes in CSVD patients and controls were assessed,and the correlations between fALFF,GMV,fALFF/GMV and cognitive function were explored.Results(1)Compared to the control group,CSVD patients showed significant lower scores in MoCA score(21.5[20.0,24.0]vs.24.3[23.0,26.0],Z=-4.094),higher PHQ-9 score(5.4±5.0vs.2.1±2.2,t=4.150),less VFT(15.5±3.8 vs.17.2±4.3,t=-3.258),increased TMT-B time([164.4±72.7]s vs.[123.6±45.7]s,t=3.307),TMT-A time([83.8±34.3]s vs.[62.9±22.7]s,t=3.704),and less DS forward span(6.3[5.0,8.0]vs.7.4[6.0,8.0],Z=-3.679),DS backward span(3.7±1.2 vs.4.5±1.4,t=-3.119),AVLT-learning(7.0±1.8 vs.8.7±1.9,t=-4.523),A VLT-immediate recall(7.2[6.0,9.0]vs.9.6[7.2,11.8],Z=-4.105),AVLT-delayed recall(6.9±3.1 vs.9.6±3.0,t=-4.310;all P＜0.01).No significant differences were observed in age,education,sex,AD-8 score,or TMT time difference(all P＞0.05).(2)CSVD patients showed decreased fALFF values in the right anterior cingulate gyrus(1.00±0.06 vs.1.07±0.06,t=-4.66)and increased fALFF values in the left superior parietal lobule(1.14±0.07 vs.1.07±0.07,t=5.68)and the right postcentral gyrus(1.08±0.05 vs.1.01±0.05,t=5.22;both P＜0.01).CSVD patients had increased GMV in the bilateral caudate nucleus(right:[0.27±0.06]mm3 vs.[0.21±0.04]mm3,t=6.12,left:[0.27±0.05]mm3 vs.[0.22±0.04]mm3,t=6.67;both P＜0.01)but decreased fALFF/GMV in the bilateral caudate nucleus(left:6.27±0.97 vs.7.75±1.70,t=-7.33;right:3.12±0.97 vs.4.18±0.95,t=-5.96)and the right globus pallidus(14.11±4.14 vs.19.99±4.03,t=-6.36;all P＜0.01).(3)Right anterior cingulate gyrus fALFF positively correlated with DS backward scores(R=0.348,P=0.013).Left superior parietal lobule fALFF negatively correlated with PHQ-9 scores(R=-0.308,P=0.029)and TMT time difference(R=-0.360,P=0.012).Right postcentral gyrus fALFF negatively correlated with TMT-A time(R=-0.419,P=0.003).Right caudate nucleus GMV positively correlated with TMT time difference(R=0.293,P=0.042),while left caudate nucleus GMV negatively correlated with AD-8 score(R=-0.284,P=0.043).fALFF/GMV in the right caudate nucleus(R=0.288,P=0.046)and right globus pallidus(R=0.290,P=0.045)positively correlated with VFT.After multiple comparison corrections,only the negative correlation between right postcentral gyrus fALFF and TMT-A time remained significant(P(alse discovery rate adjusted=0.024).Conclusions CSVD patients exhibit significant structure-function decoupling values in bilateral caudate nucleus and right globus pallidus are reduced,and this reduction is associated with a decline in verbal fluency.The results of this study still need to be further validated in larger sample size studies.

Objective:To investigate the effects of white matter hyperintensity (WMH) of different lesion areas and severities on early neurological deterioration (END) in acute ischemic stroke (AIS) patients after intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis.Methods:Three hundred and seventy-three AIS patients, admitted to our hospital from April 2019 to July 2021, were chosen in our study. These patients were treated with intravenous rt-PA thrombolysis within 4.5 h of onset. According to the presence or absence of END, these patients were divided into END group ( n=89) and non-END group ( n=284). Fazekas scale was used to assess the periventricular WMH (PVWMH) and subcortical WMH (SCWMH): none-mild PVWMH/SCWMH was defined at 0-1 score and moderate to severe PVWMH/SCWMH was defined at 2-3 scores; the sum scores of the two sites were calculated, and none-mild WMH was defined at 0-2 scores and moderate-severe WMH was defined at 3-6 scores. Univariate analysis was used to compare the baseline data of the two groups, and multivariate Logistic regression was used to determine the correlations of END with WMH lesion areas and severities. Results:Univariate analysis showed that there was significant difference between the END group and non-END group in age, baseline blood glucose, baseline National Institutes of Health Stroke Scale (NIHSS) scores, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, hemorrhagic transformation after thrombolysis, and PVWMH, SCWMH, and WMH scores ( P<0.05). Multivariate Logistic analysis showed that only baseline NIHSS scores ( OR=1.064, 95%CI: 1.019-1.111, P=0.005), hemorrhagic transformation after thrombolysis ( OR=3.931, 95%CI: 2.007-7.701, P=0.000), moderate-severe WMH ( OR=4.736, 95%CI: 2.737-8.195, P=0.000), and moderate-severe SCWMH ( OR=5.557, 95%CI: 3.156-9.783, P=0.000) were independently related to the occurrence of END. Conclusion:Patients with moderate-severe SCWMH, moderate-severe WMH, or high NIHSS scores after thrombolysis trend to have END.

Objective:To examine the clinical efficiency of laparoscopic gastroduodenostomy with BillrothⅠanastomosis with manual suture.Methods:The clinic data of 36 patients with gastric cancer who underwent laparoscopic gastroduodenostomy with Billroth Ⅰ anastomosis from November 2017 to September 2019 in Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People′s Hospital were analyzed retrospectively.There were 22 males and 14 females, aged (64.3±9.3) years(range: 43 to 80 years), underwent complete laparoscopic gastroduodenostomy. The laparoscopic manual suture was used for Billroth Ⅰ anastomosis.Results:All the laparoscopic radical gastrectomy and manual suturing gastroduodenostomy were successfully performed. The operation time was (226.7±40.4) minutes (range: 180 to 320 minutes), including (24.8±7.1) minutes (range: 15 to 48 minutes) for gastroduodenostomy.There was (3.8±0.9) days (range: 2 to 6 days) for anal exhaust, (5.7±2.0) days (range: 3 to 13 days) for extubation of gastric tube, and (10.3±3.1) days (range: 7 to 19 days) for hospitalization. There was no death in perioperative period. Postoperative pathological report showed 3 cases of highly differentiated adenocarcinoma, 5 cases of moderately differentiated adenocarcinoma, 22 cases of poorly differentiated adenocarcinoma and 6 cases of signet ring cell carcinoma, including 27 cases in T1 stage and 9 cases in T2 stage. The number of lymph nodes harvested was 36.4±8.9 (range: 23 to 60). Lymph node metastasis was positive in 7 cases and negative in 29 cases. TNM stage included 24 cases in ⅠA stage, 8 cases in ⅠB stage and 4 cases in Ⅱ stage. After the operation, the upper digestive tract radiography showed that the anastomosis opening was unobstructed without complications such as anastomotic stenosis.Conclusion:Laparoscopic gastroduodenostomy with Billroth Ⅰ anastomosis with manual suture is safe and feasible, has a good short-term effect.

Objective:To examine the clinical efficiency of laparoscopic gastroduodenostomy with BillrothⅠanastomosis with manual suture.Methods:The clinic data of 36 patients with gastric cancer who underwent laparoscopic gastroduodenostomy with Billroth Ⅰ anastomosis from November 2017 to September 2019 in Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People′s Hospital were analyzed retrospectively.There were 22 males and 14 females, aged (64.3±9.3) years(range: 43 to 80 years), underwent complete laparoscopic gastroduodenostomy. The laparoscopic manual suture was used for Billroth Ⅰ anastomosis.Results:All the laparoscopic radical gastrectomy and manual suturing gastroduodenostomy were successfully performed. The operation time was (226.7±40.4) minutes (range: 180 to 320 minutes), including (24.8±7.1) minutes (range: 15 to 48 minutes) for gastroduodenostomy.There was (3.8±0.9) days (range: 2 to 6 days) for anal exhaust, (5.7±2.0) days (range: 3 to 13 days) for extubation of gastric tube, and (10.3±3.1) days (range: 7 to 19 days) for hospitalization. There was no death in perioperative period. Postoperative pathological report showed 3 cases of highly differentiated adenocarcinoma, 5 cases of moderately differentiated adenocarcinoma, 22 cases of poorly differentiated adenocarcinoma and 6 cases of signet ring cell carcinoma, including 27 cases in T1 stage and 9 cases in T2 stage. The number of lymph nodes harvested was 36.4±8.9 (range: 23 to 60). Lymph node metastasis was positive in 7 cases and negative in 29 cases. TNM stage included 24 cases in ⅠA stage, 8 cases in ⅠB stage and 4 cases in Ⅱ stage. After the operation, the upper digestive tract radiography showed that the anastomosis opening was unobstructed without complications such as anastomotic stenosis.Conclusion:Laparoscopic gastroduodenostomy with Billroth Ⅰ anastomosis with manual suture is safe and feasible, has a good short-term effect.

Objective To investigate the impact of carotid atherosclerotic plaque on short-term outcomes of cardioembolic stroke due to non-valvular atrial fibrillation (NVAF).Methods A total of 288 patients with acute cerebral embolism due to NVAF were recruited in this study.All patients underwent carotid ultrasonography screening to estimate carotid intima-medium thickness (IMT) and atherosclerotic plaque.The short-term outcomes were assessed.The correlation between carotid atherosclerotic plaque and short-term outcomes of cardioembolic stroke due to NVAF were determined by partial correlation analysis.Results Among the 288 patients,carotid atherosclerosis occurred in 202 cases (70.1％) of the patients,poor outcomes in 113 cases (39.1％),worsening neurological function in 43 cases(14.9％),and stroke recurrence in 24 cases(8.3％).Carotid atherosclerosis plaque was positively associated with neurological worsening (r =0.247,P =0.000) and poor outcomes (r=0.139,P=0.018).The use of aspirin was negatively correlated with both neurological worsening (r=-0.235,P=0.000) and recurrence of stroke (r=-0.177,P=0.003).The use of statin was negatively correlated with recurrence of stroke (r =-0.223,P =0.000),neurological worsening (r=-0.147,P=0.013) and poor outcomes (r=-0.286,P=0.000).Conclusions Carotid atherosclerotic plaque is an independent predictive factor for poor short-term outcomes of cardioembolic stroke due to NVAF,and the aggressive management for carotid plaque can improve the poor short-term outcomes.

As a direct vascular recanalization method, safety and efficacy of mechanical embolectomy in acute ischemic stroke have been controversial. This article reviews the safety and efficacy of mechanical embolectomy in acute ischemic stroke via summarizing the development process of mechanical devices and the latest clinical trial results of mechanical embolectomy.

Objective To investigate the influencing factors of hematoma enlargement after spontaneous intracerebral hemorrhage. Methods The patients with spontaneous intracerebral hemorrhage were enrolled retrospectively in the study. The demographics, vascular risk factors, and baseline clinical data of the patients were collected. Hematoma enlargement was defined as CT scan within 48 h showed that the increased hematoma volume was more than >1/3 of the baseline. The demographics, vascular risk factors, and baseline clinical data of the hematoma enlargement group and the non-hematoma enlargement group were compared. Multivariate logistic regression analysis was use to identify the risk factors for hematoma enlargement. Results A total of 121 patients with spontaneous intracerebral hemorrhage were enrolled, including 69 males and 52 females, their ages were 24 to 89 years (mean 59.16 ±12.68). Forty-five patients (37.2%) had combined hypertension, 5 (4.1%) had diabetes, and 11 (9.1%) had hyperlipoidemia. Thirty patients (24.79%) had hematoma enlargement within 48 h. The time from ictus to the first CT scan was 4.21 ±1.57 h and the time from ictus to CT scan again was 34.78 ±6.90 h. Univariate analysis showed that the proportion of patients drinking alcohol (46.7% vs.26.4%; χ2 =4.313, P =0.038), as well as systolic blood pressure (174.53 ±20.02 mmHg vs.160.63 ±19.79 mmHg, t = -3.327, P = 0.001; 1 mmHg = 0.133 kPa), fasting blood glucose (7.67[6.70-9.47]mmol/L vs.6.78[5.81- 7.79]mmol/L; Z = -2.266, P =0.023), National Institutes of Health Stroke Scale (NIHSS) score (10.00[8.00-12.00] vs.5.00[3.00-8.00]; Z = -5.468, P < 0.001) in the hematoma enlargement group were significantly higher than those in the non-hematoma enlargement group, while low-density lipoprotein cholesterol (2.60[2.10- 2.91]mmol/L vs.3.00[2.60-3.41]mmol/L; Z = -3.905, P <0.001) was significantly lower than that in the nonhematoma enlargement group. Multivariate logistic regression analysis showed that baseline systolic blood pressure (odds ratio [OR] 1.036, 95% confidence interval [CI] 1.007-1.065; P =0.014) and NIHSS score (OR 1.310, 95% CI 1.111-1.544; P =0.001) were the independent risk factors for hematoma enlargement, while low –density lipoprotein cholesterol (OR 0.279, 95% CI 10.105-0.742; P =0.011) was the independent protective factor for hematoma enlargement. Conclusions Systolic blood pressure and NIHSS score were the independent risk factors for hematoma enlargement after spontaneous intracerebral hemorrhage, while low -density lipoprotein cholesterol was the independent protective factor for hematoma enlargement.

Objective To investigate the episodic memory monitoring in patients with white matter lesions (WML) and explore the relevance of episodic memory disorder and memory monitoring and the possible mechanism.Methods The feeling of knowing-episodic memory (FOK-EM) paradigm was adopted and subsequently administered in 30 WML patients and 30 control participants who were matched in age and educational level.Results Compared with control group (cued recall 4.37 ± 1.59;recognition 8.73 ± 1.05),the episodic memories of WML patients were significantly impaired on the cued recall performance (3.30 ± 1.51,t =2.666,P ＜ 0.05) and recognition performance (7.23 ± 0.77,t =6.306,P ＜ 0.01).Furthermore,the accuracy of FOK judgment (-0.13 ± 0.31),the correct judgment and correct recognition of FOK-EM (23.16％ ±5.96％) and the correct judgment and false recognition of FOK-EM (34.26％ ± 7.65％) in the WML patients group were significantly different compared with the control group (the accuracy of FOK judgment:0.34 ± 0.27,t =6.280,P ＜ 0.01;the correct judgment and correct recognition:35.12％ ± 6.82％,t =7.234,P ＜ 0.01;the correct judgment and false recognition:19.27％ ±6.50％,t =-8.174,P ＜ 0.01).In addition,the correct judgment and false recognition performance were positively correlated with the severity of periventricular lesions and deep white matter lesions in the WMLpatients group (r=0.716,P＜0.01;r=0.598,P＜0.01).Conclusions The WML patients demonstrated an overestimation of their recognition ability of episodic memory.Moreover,this impairment of memory monitoring was correlated with the deficit of executive function caused by the damage of the prefrontal-subcortical circuit,indicating that this mechanism could be an influential factor of episodic memory disorder in WML.

Objective To investigate the way of inducing dendritic cells from precursor in human cord blood and its role in antitumor immunity.Methods Cord blood was collected under sterile condition and the cord blood mononuclear cells were separated by centrifugal in density gradient.CBMCs were cultured with GM-CSF+IL-4+TNF-?and cell phenotype was analyzed with CD1a、CD83 antibody by using indirect immunofluorescence assays.The effects of DCs pulsed with tumoral antigens on cytotoxic T lymphocytes(CTLs) inducement and growth inhibition of YTMLC cells were assayed.Results Our results indicated that DCs precursors in human cord blood can be induced to differentiate in the medium containing GM-CSF、IL-4 and TNF-?.The cells with typical morphological properties of DCs were observed at the 7th day.At that time,(20.8?1.62)%CD1a+ cells were obtained.After incubation with tumor cytolysis antigen,the DCs can activate the CTLs to become tumor specialized CTLs,which had shown significantly inhibition on growth of YTMLC tumor cell line.Conclusion The precursors in human cord blood can be induced to functional DCs which activate T lymphocyte to become tumor specialized CTLs.