Lacunar Cerebral Infarction Research Articles

Local carotid stiffness, hemodynamic forces and blood viscosity in patients with cerebral lacunar infarctions.

The carotid stiffness is an important factor in the pathogenesis of cerebrovascular small vessel disease. Our study aimed to evaluate the relation of the local arterial stiffness of the common carotid artery (CCA) to the hemodynamic forces and blood viscosity in patients with cerebral lacunar infarctions (LI). Twenty-two patients with chronic LI and 15 age-matched controls were examined. An ultrasound examination of the CCA intima-media thickness (IMT), the parameters of local CCA stiffness: distensibility (DC) and compliance coefficients (CC), α and β stiffness indices and pulse wave velocity (PWV) was performed. The local hemodynamic forces were calculated: circumferential wall tension (CWT) and wall shear stress (WSS). Whole blood viscosity (WBV) and shear stresses at shear rates of 0.277 s-1 to 94.5 s-1 were measured in patients and controls. Higher values of IMT, a significant decrease of DC and CC and an increase of α and β stiffness indices and PWV in the LI patients compared to the controls were obtained. A parallel significant increase in CWT and a decrease in WSS was found. An increase in WBV and a significant increase in shear stresses were detected. In the LI patients, the increased stiffness indices were associated with an increase in age, cholesterol and WBV at higher shear rates in the left CCA. In the controls, the IMT and stiffness indices correlated significantly with the hemodynamic factors and WBV in both CCAs, while the stiffness indices correlated with the hemodynamic forces in the left CCA. The results of the present study demonstrate different associations of the local carotid stiffness indices with the hemodynamic forces and WBV in patients with LI and controls.

Diffusion tensor imaging and gray matter volumetry to evaluate cerebral remodeling processes after a pure motor stroke: a longitudinal study

Background and objectivesClinical factors are not sufficient to fix a prognosis of recovery after stroke. Pyramidal tract or alternate motor fiber (aMF: reticulo-, rubrospinal pathways and transcallosal fibers) integrity and remodeling processes assessable by diffusion tensor MRI (DTI) and voxel-based morphometry (VBM) may be of interest. The primary objective was to study longitudinal cortical brain changes using VBM and longitudinal corticospinal tract changes using DTI during the first 4 months after lacunar cerebral infarction. The second objective was to determine which changes were correlated to clinical improvement.MethodsTwenty-one patients with deep brain ischemic infarct with pure motor deficit (NIHSS score ≥ 2) were recruited at Purpan Hospital and included. Motor deficit was measured [Nine peg hole test (NPHT), dynamometer (DYN), Hand-Tapping Test (HTT)], and a 3T MRI scan (VBM and DTI) was performed during the acute and subacute phases.ResultsWhite matter changes: corticospinal fractional anisotropy (FACST) was significantly reduced at follow-up (approximately 4 months) on the lesion side. FAr (FA ratio in affected/unaffected hemispheres) in the corona radiata was correlated to the motor performance at the NPHT, DYN, and HTT at follow-up. The presence of aMFs was not associated with the extent of recovery. Grey matter changes: VBM showed significant increased cortical thickness in the ipsilesional premotor cortex at follow-up. VBM changes in the anterior cingulum positively correlated with improvement in motor measures between baseline and follow-up.DiscussionTo our knowledge, this study is original because is a longitudinal study combining VBM and DTI during the first 4 months after stroke in a series of patients selected on pure motor deficit. Our data would suggest that good recovery relies on spared CST fibers, probably from the premotor cortex, rather than on the aMF in this group with mild motor deficit. The present study suggests that VBM and FACST could provide reliable biomarkers of post-stroke atrophy, reorganization, plasticity and recovery.ClinicalTrials.gov IdentifierNCT01862172, registered May 24, 2013

Minimally invasive elective gastrectomy after preoperative chemotherapy in a patient with frailty who presented with locally far advanced-stage gastric cancer: a case report

BackgroundHerein, we report a case of gastric antrum cancer with multiple invasions to other organs that was completely cured with laparoscopic distal gastrectomy after preoperative chemotherapy in a patient with poor general condition.Case presentationAn 80-year-old male patient was diagnosed with anemia during follow-up for cerebral lacunar infarction at another hospital. He was diagnosed with advanced-stage gastric antrum cancer and was referred to our hospital. On esophagogastroduodenoscopy, type 2 advanced-stage gastric cancer was detected at the greater curvature of the antrum, and the biopsy results revealed tubular adenocarcinoma. Contrast-enhanced computed tomography scan revealed multiple invasions to other organs, thick gastric wall with contrast effect, and superior mesenteric vein tumor thrombus. However, there was no evidence of distant metastasis on positron emission tomography/computed tomography scan. The clinical diagnosis was stage IVA gastric cancer. Pancreatoduodenectomy with portal vein resection could be important at this point. However, preoperative chemotherapy with S-1 and oxaliplatin was administered instead of performing extended surgery because the patient had poor general condition (performance status score of 3). The patient received three cycles of preoperative chemotherapy at the hospital along with rehabilitation and nutritional management with oral nutritional supplements. After treatment, the performance status score of the patient improved from 3 to 1. Furthermore, in terms of clinical therapeutic effect, the patient achieved partial response. Hence, laparoscopic distal gastrectomy with D2 lymph node dissection and partial transverse colectomy was performed. After surgery, the patient was admitted for oral intake on postoperative day 6 and was discharged on postoperative day 21. Based on the histopathological examination, gastric cancer had disappeared, and there were no evident malignant findings. Therefore, gastric cancer was classified as grade 3 according to the histological treatment efficacy criteria. The patient did not present with recurrence at 2 years after surgery.ConclusionsBy actively administering preoperative chemotherapy, minimally invasive radical surgery with maximum preservation of the surrounding organs can be performed for locally far advanced-stage gastric cancer in older patients with poor general condition.

The influence of cerebellum on visual selective attention in patients with multiple lacunar cerebral infarction and its neuromodulatory mechanisms.

This study aims to investigate the influence of the cerebellum on visual selective attention function and its neuromodulatory mechanism in patients with multiple lacunar cerebral infarction (MLCI). A retrospective analysis was conducted on 210 patients admitted with MLCI from January 2016 to May 2022. Analyzed the electrophysiological characteristics of the P3a and P3b components of vision in both groups, as well as source reconstruction simulations of dipole activation in the brains of the two groups, and analyzed the brain regions with differences in activation strength between the two groups. This study found that there was no significant difference in peak amplitude between the two groups, but compared with the control group, the peak latency of the case group was significantly prolonged. Specifically, the P3a peak latency induced by the novel stimulus was longer than that induced by the target stimulus P3b peak latency. Source reconstruction results showed decreased and increased activation in several brain regions in the case group compared to the control group. The study suggests that the impairment of distracted attention capture is more pronounced in patients with MLCI. The cerebellum indirectly influences the ventral and dorsal frontoparietal attention networks by modulating the levels of excitation and inhibition within the cerebral cortex of the attention network. This may represent a potential mechanism through which the cerebellum regulates visual selective attention information in MLCI patients.

Simvastatin mitigates vascular cognitive impairment in rat’s hippocampus in lacunar cerebral infarction

Simvastatin is used to treat Alzheimer’s disease with impaired cognitive function through blocking of PI3K/Akt signaling to inhibit survival of new neurons and growth of neurons. This study investigated the potential of simvastatin on vascular cognitive impairment (VCI) caused by lacunar cerebral infarction (LCI) in the hippocampus of rats. After establishment of LCI models, rats were administered with NaOH solution (model group), simvastatin (simvastatin group), and PI3K/Akt pathway inhibitor (inhibitor group), respectively, and 10 healthy rats served as control group. Upon treatment, Y-maze and Morris water maze detected spatial cognition ability of rats; while cleaved caspase-3 staining was used to assess apoptosis in the hippocampus. Western blot analysis detected Akt and ERK1/2 phosphorylation levels and enzyme-linked immuno sorbent assay (ELISA) determined the content of brain-derived neurotrophic factor (BDNF). The Y maze Morris water maze confirmed impairment of long-term memory abilities in the LCI rats from the model group. Treatment with simvastatin significantly improved correct rate of arm alternates in rats and shorted the stage latency in the hidden platform experiment. The number of apoptotic cells increased in the hippocampal DG sub-granular area of rats with LCI, and BDNF level was significantly reduced. Administration of simvastatin suppressed cell apoptosis and increased BDNF level when improving phosphorylation level of Akt and ERK1/2 as well. Cerebral ischemia following LCI affects short and long-term memory, which leads to VCI. Simvastatin increases Akt and ERK1 in PI3K/Akt pathway, and hence up-regulates hippocampal BDNF levels, which promotes the regeneration of rat hippocampal nerve cells to relieve VCI.

Unlocking the Medicinal Mysteries: Preventing Lacunar Stroke with Drug Repurposing.

Currently, only the general control of the risk factors is known to prevent lacunar cerebral infarction, but it is unknown which type of medication for controlling the risk factors has a causal relationship with reducing the risk of lacunar infarction. To unlock this medical mystery, drug-target Mendelian randomization analysis was applied to estimate the effect of common antihypertensive agents, hypolipidemic agents, and hypoglycemic agents on lacunar stroke. Lacunar stroke data for the transethnic analysis were derived from meta-analyses comprising 7338 cases and 254,798 controls. We have confirmed that genetic variants mimicking calcium channel blockers were found to most stably prevent lacunar stroke. The genetic variants at or near HMGCR, NPC1L1, and APOC3 were predicted to decrease lacunar stroke incidence in drug-target MR analysis. These variants mimic the effects of statins, ezetimibe, and antisense anti-apoC3 agents, respectively. Genetically proxied GLP1R agonism had a marginal effect on lacunar stroke, while a genetically proxied improvement in overall glycemic control was associated with reduced lacunar stroke risk. Here, we show that certain categories of drugs currently used in clinical practice can more effectively reduce the risk of stroke. Repurposing several drugs with well-established safety and low costs for lacunar stroke prevention should be given high priority when doctors are making decisions in clinical practice. This may contribute to healthier brain aging.

Thrombotic and Bleeding Events in Japanese Adolescent and Young Adult PV and ET: Results from Japanese Multicenter Retrospective Study

[Background] There were no large-scale retrospective studies about adolescent and young adult (AYA) polycythemia vera (PV) or essential thrombocythemia (ET) in Japan. The characteristics in AYA PV or ET in Asia are not well-reported, except for one retrospective study using the Health Insurance Review and Assessment Service database in Korea. To reveal the clinical features, especially with regard to thrombotic and bleeding events in Japanese AYA PV and ET, we decided to perform secondary data analysis of Japanese multicenter large registry data, JSH-MPN-R18. [Methods] Data of PV and ET aged 20 to 39 at the initial visit were extracted from registration data in JSH-MPN-R18 as AYA cohort, and were compared to non-AYA cohort over 40 years old. Differences among categorical and continuous variables were evaluated by chi-square test or Fisher's exact test, and by Mann-Whitney U test, respectively. [Results] 31 PV (median age; 33 years［range 26-39］, male/female; 19/12) and 141 ET (median age; 32 years［range 20-39］, male/female; 52/89) were identified as AYA cohort, which represented 5.2% and 12.2% of overall PV or ET cohort, respectively. Non-AYA cohort consisted of 565 PV and 1011 ET. Regarding laboratory parameters, neutrophil ratio and counts were lower in AYA PV than in non-AYA PV, whereas, leukocyte counts, neutrophil ratio and counts, LDH and D-dimer level were lower in AYA ET than in non-AYA ET. The frequency of JAK2 V617F-mutated patients was lower in AYA than in non-AYA PV and ET (PV; 61.2% vs.77.2%, p=0.05, ET; 46.0% vs. 57.8%, p<0.01). Regarding the treatment, antiplatelet or anticoagulant therapy was introduced into 61.3% of AYA PV and 51.8% of AYA ET patients. Cytoreductive therapy (CRT) was provided to eight (25.8%) AYA PV and 61 (43.3%) AYA ET. In 62.5% of AYA PV and 75.4% of AYA ET, who received CRT, CRT was adopted for the reasons except for the past or recent thrombotic events (TE)/bleeding events. AYA PV patients experienced only one pulmonary embolism before diagnosis and one lacunar cerebral infarction (CI) at diagnosis. There were no TE after diagnosis in AYA PV. In terms of bleeding events, AYA PV had one event (details unknown) before diagnosis and two events (gastrointestinal bleeding and details unknown) after diagnosis. The frequency of AYA PV patients with TE had a tendency to be lower than that of non-AYA PV (6.5% vs 19.1%, p=0.09), although there were no statistical differences between the numbers of bleeding events between AYA and non-AYA PV during all of the course. AYA ET had nine TE (3 CI, 2 deep vein thrombosis (DVT), 1 transient ischemic attack (TIA), 1 peripheral arterial disease (PAD), 2 details unknown) before diagnosis, six TE (3 DVT, 2 CI, 1 TIA) at diagnosis, and six TE (1 myocardial infarction, 1 CI, 1 PAD, 1 TIA, 2 details unknown) after diagnosis. Fewer TE occurred in AYA ET than in non-AYA ET before (6.4% vs 19.8%, p<0.01) and at diagnosis (4.3% vs 9.5%, p=0.04). However the frequency of TE was not different (4.3% vs. 6.7%, p=0.36) after diagnosis. AYA ET had experienced only one bleeding event (oral mucosal bleeding) before diagnosis. Bleeding events were never found at or after diagnosis. Fewer bleeding events were detected in AYA ET than non-AYA ET during all of the course (0.7% vs 8.6%, p<0.01). The percentage of venous TE in total TE was higher in AYA-MPN than in non-AYA MPN (26.1% vs 5.4%). [Conclusion] Our analysis is the first retrospective cohort which revealed clinical features related to TE and bleeding events in Asian AYA MPN from large multicenter registry data. Lower neutrophil ratio and absolute counts at diagnosis might be attributable to lower mutated JAK2 allele burden in AYA PV, and lower frequency of JAK2-mutated ET in AYA ET. Regarding bleeding events, fewer bleeding events were found in AYA ET than in non-AYA ET. However in PV, there were no statistical differences in bleeding events between AYA and non-AYA. About TE, AYA PV and ET had fewer TE than non-AYA PV and ET. The percentage of venous TE in total TE was higher in AYA MPN than in non-AYA MPN also in Japan, but it was much lower than those reported in previous European or US cohorts, in which venous TE were more common than arterial TE. Especially after diagnosis, venous TE were never detected in either AYA PV or ET in Japan. Considering that the frequency of venous TE in the Korean receipt data was as low as that in our cohort, fewer venous TE might be one of the specific characteristics in Asian AYA MPN different from European or US AYA MPN.

The construction and validation of prognostic prediction model for sudden sensorineural hearing loss in middle-aged and elderly people

ObjectiveIdiopathic sudden sensorineural hearing loss (ISSNHL), as an otologic emergency, is commonly encountered and its prevalence has been climbing every year recently. To our knowledge, the prognosis of middle-aged and elderly patients is worse than that of young patients. Previous researches mainly focused on the adult population, which was considered as prognostic models who performed hearing recovery in ISSNHL. However, few studies regarding the middle-aged and elderly population who are regarded as prognostic models have been reported. Therefore, we aim to construct and validate a nomogram-based prognostic prediction model, which can provide a reference for the prognostic assessment in the middle-aged and elderly patients with ISSNHL. MethodA total of 371 middle-aged and elderly ISSNHL patients who were admitted to the Department of Otolaryngology-Head and Neck Surgery, Yanbian Hospital, Yanbian University, from April 2018 to April 2023 were enrolled in the study. All subjects were randomly divided into two groups including training group (n = 263) and validation group (n = 108). Lasso regression and multi-factor logistic regression were jointly utilized to screen out prognosis-related independent risk factors and establish a nomogram-based risk prediction model. The accuracy and clinical application value of the model were evaluated by combining the Bootstrapping method and k-fold cross-validation, plotting the receiver operating characteristic (ROC) curve, calculating the area under the ROC curve (AUC), plotting the decision curve analysis (DCA), and the calibrating curve. ResultWe used the method of lasso regression combined with multivariate logistic regression and finally screened out eight predictors (including age, number of affected ears, degree of hearing loss, type of hearing curve, duration of disease, presence of vertigo, diabetes, and lacunar cerebral infarction) that were included into the nomogram. The C-index were 0.823 [95% CI (0.725, 0.921)] and 0.851 [95% CI (0.701, 1.000)], and the AUC values were 0.812 and 0.823 for the training and validation groups, respectively. The calibration curve for the validation group was approximately conformed to that for the modeling group, indicating favorable model calibration. The DCA results revealed the modeling group (3%-86%) and the validation group (2%-92%) showed significant net clinical benefit under the majority of thresholds. ConclusionThis study developed and validated a nomogram-based prognostic prediction model which based on the eight independent risk factors mentioned above. The predictors are conveniently accessible and may assist clinicians in formulating individualized treatment strategies.

The gut microbial signatures of patients with lacunar cerebral infarction

ABSTRACT Background Emerging evidence revealed that gut microbial dysbiosis is involved in the pathogenesis of multiple neurological diseases, but there is little available data on the relationship between gut microbiota and lacunar cerebral infarction (LCI). Methods Fecal samples from acute LCI patients (n = 65) and matched healthy controls (n = 65) were collected. The compositions and potential functions of the gut microbiota were estimated. Results The results showed that there were significant gut microbial differences between LCI and control groups. Patients with LCI had higher abundances of genus Lactobacillus, Streptococcus, Veillonella, Acidaminococcus, Bacillus, Peptoclostridium, Intestinibacter, Alloscardovia and Cloacibacillus but lower proportions of genus Agathobacter and Lachnospiraceae_UCG-004. Investigating further these microbes such as Lactobacillus and Veillonella were correlated with clinical signs. Moreover, we found that 9 gene functions of gut microbiota were different between LCI patients and controls, which were associated with amino acid metabolism and inflammatory signal transduction. Notably, four optimal microbial markers were determined, and the combination of Streptococcus, Lactobacillus, Agathobacter, Lachnospiraceae_UCG-004 and the three risk factors achieved an area under the curve (AUC) value of 0.854 to distinguish LCI from controls. Conclusion These findings revealed the characterizing of gut microbiota in LCI patients and provided potential microbial biomarkers for clinical diagnosis of LCI.

The correlation between the severity of cerebral microbleeds and serum HMGB1 levels and cognitive impairment in patients with cerebral small vessel disease.

The study investigated the correlation and predictive value between the severity of cerebral microbleeds (CMBs) and the level of serum High Mobility Group Protein B1 (HMGB1) and the occurrence of cognitive impairment in patients with cerebral small vessel disease (CSVD). A total of 139 patients with CSVD admitted to the Department of Neurology of the First Affiliated Hospital of Xinxiang Medical University from December 2020 to December 2022 were selected as study subjects. The Montreal Cognitive Assessment (MoCA) scale was used to assess the cognitive function and was divided into the cognitive impairment group and the cognitive normal group. Magnetic Resonance Imaging (MRI) and Susceptibility Weighted Imaging (SWI) were used to screen and assess the severity of CMBs. Serum HMGB1 levels of CSVD patients were measured by enzyme linked immunosorbent assay (ELISA). Multivariable logistic regression analysis was used to explore risk factors for cognitive impairment and CMBs. Pearson correlation analysis was used to investigate the correlation between HMGB1 and cognitive function. Receiver Operating Characteristics (ROC) curves were used to assess the predictive value of HMGB1 for the occurrence of cognitive impairment in patients with CMBs. High Mobility Group Protein B1, uric acid (UA), glycosylated hemoglobin (HbA1c), CMBs, lacunar cerebral infarction (LI), years of education, and history of hypertension were risk factors for cognitive impairment (P < 0.05); HMGB1 was significantly and negatively associated with total MoCA score, visuospatial/executive ability, and delayed recall ability (P < 0.05). HMGB1 was significantly and positively correlated with the number of CMBs (P < 0.05). The area under the ROC curve for HMGB1 predicting cognitive impairment in patients with CMBs was 0.807 (P < 0.001). Serum HMGB1 levels are associated with the development of cognitive impairment in CSVD patients, and serum HMGB1 levels have a high predictive value for the development of cognitive impairment in CSVD patients with combined CMBs, which can be used for early clinical identification and intervention of vascular cognitive impairment.

CLINICAL AND PATHOGENETIC FEATURES OF DAMAGE TO THE NERVOUS SYSTEM AT THE INITIAL CLINICAL STAGES OF HIV-INFECTION

The aim of the study – investigating the features of clinical symptoms in HIV-positive people in the early stages of the disease and their pathogenetic justification.&#x0D; The study used theoretical methods based on the analysis and synthesis of studying the information of the modern world from the PubMed and Scopus databases, clinical observations, as well as deductive-inductive methods.&#x0D; Conclusions. As a result of the war in Ukraine, the epidemiological control of infectious diseases on the territory of the country was violated. HIV-infection and the absence or atypicality of its clinical symptoms in infected patients deserve special attention, which is based on a detailed understanding of the pathological processes of neuroAIDS. Damage to astrocyte cells disrupts the connection of cells of the structural and functional complex of the brain with other cells and forms the fundamental basis for understanding clinical symptoms. Most often in the form of: neuropsychic, cognitive somatic and neurological disorders. The pathogenic effect of the virus contributes to spasm of cerebral microvessels, is the cause of local hypoxic lesions, microstrokes, and in late cases – lacunar cerebral infarcts. The active involvement of brain cells in the pathogenesis of HIV-infection has been confirmed by many studies. Along with standard diagnostic methods, it is advisable to use psychoneurological and cognitive tests and scales. &#x0D; A number of shortcomings have been identified that can reduce the reliability of diagnostic studies when establishing a diagnosis. &#x0D; Understanding the pathogenetic picture will allow choosing «indicators» for the general diagnostic scheme and increasing the probability of establishing the correct diagnosis, adjusting ART and predicting the further development of the disease.

STATE OF CEREBRAL HEMODYNAMICS IN PATIENTS WITH LACUNAR STROKE

This article discusses the state of cerebral hemodynamics in patients with lacunar stroke. To evaluate and compare the state of cerebral hemodynamics in patients with lacunar stroke and hemorrhagic stroke of the brain. Therefore, conducting a detailed study on the diagnosis and treatment of lacunar cerebral infarction against the background of arterial hypertension, taking into account its subtypes, remains extremely relevant and has not yet been solved.

Study on inhibitory effect of GC-miR-143 inhibitor nanoparticles on D2 receptor-mediated neurological behavioral damage in lacunar infarction

Blocking the dopamine D2 receptor is a key link in anti-psychiatric disease. Knockdown of miR-143 improved neurological behavioral damage by regulating the D2 receptor signaling pathway. The risk of neurological behavior damage can be increased 20 times by 1–2 lacunar infarction lesions. Based on the fact that miR-143 can target and regulate the D2 receptor signaling pathway, this study focused on analyzing the inhibitory effect of GC-miR-143 inhibitor nanoparticles on neurological behavior damage in lacunar infarction. 60 SD rats were separated into sham operation, model, vehicle, vehicle+inhibitor, inhibitor, or D2 agonist group (n = 10). The vascular dementia (VD) model was made by ligating bilateral common carotid arteries. Morris water maze assessed rats behavioral changes. Quantitative Real-Time Reverse Transcription PCR (QRT-PCR) was applied to detect levels of miRNA-143. Proteins were extracted from the prefrontal cortex, and immunoblotting was performed to measure the downstream of signal proteins of Neuregulin 1 (NRG1) and D2 receptor signaling pathways, p-protein kinase B (AKT) and p-Glycogen Synthase Kinase 3β (GSK3β). On days 1 to 5 of the water maze experiment, the escape latency for the five groups of rats were longer than in sham group; while escape latency for vehicle+inhibitor group and inhibitor group was shorter. Compared to VD model rats, vehicle+inhibitor group and inhibitor group had significantly reduced escape latency. Cross-platform time number for five groups was decreased and it was increased in vehicle+inhibitor group and inhibitor group with decreased number for D2 agonist group w. Compared with D2 agonist group, the vehicle+inhibitor group and inhibitor group showed more cross-platform times. Compared to sham operation group, levels of NRG1, p-AKT/GSK3β in remaining five groups were significantly decreased. Their levels in vector+inhibition group and inhibitor group were dramatically up-regulated, and levels of the above-mentioned proteins in D2 agonist group were significantly decreased. Their levels in vector+inhibitor group and inhibitor group were up-regulated relative to D2 agonist group. The GC-miR-143 inhibitor nanoparticles can up-regulate the expression of NRG1 and antagonize the D2 receptor to weaken the inhibitory effect of D2 receptor-mediated signaling pathways and inhibit neurological behavioral damage in lacunar cerebral infarction.

Hubungan Strok dengan Gagal Ginjal Kronis: Laporan Kasus

Kidney problems can increase the risk of brain disorders. The researchers found a strong link between poor kidney function and decreased blood flow to the brain, resulting in a greater decrease in kidney function. A male, 47 years old, BW 50 kg, with a diagnosis of sinistra kidney tumor with end stage renal disease (ESRD), cerebral lacunar infarction, pleural effusion sinistra, asthma to be performed nephrectomy. History of routine hemodialysis since 8 months, stroke infarction 2 months ago without accompanied limb weakness, asthma with last exacerbation occurred 1 months ago. Induction with fentanyl, propofol, atracurium, intubation with endotracheal tube no. 7.5 spiral, and maintenance anesthesia with sevoflurane 2-3 vol% with 50% oxygen/N2O with the flank position. The operation lasted for 3 hours, with a total bleeding of 2000 cc, the patient got a transfusion of 1 PRC (189cc), crystalloid fluid 1000 cc, colloidal 500cc. Chest tube thoracostomy (CTT) installation is carried out after the patient is anesthetized. The patient was extubated in the operating room and transferred to the ICU and was care for 2 days before being transferred to the ward. Renal failure is a risk factor for stroke, which is the leading cause of morbidity and mortality. The risk of stroke is 5-30 times higher in patients with chronic kidney disease (CKD), especially on dialysis. The case fatality rate is also higher, reaching almost 90%. Therefore, it is important to understand the factors that influence stroke in this vulnerable population in order to better implement prevention strategies.

Retracted: Predictive Analysis of Serum NO, PGI2, and Ox-LDL Levels on Disease Progression in Patients with Lacunar Cerebral Infarction.

[This retracts the article DOI: 10.1155/2022/1221810.].

Application of machine learning model to predict lacunar cerebral infarction in elderly patients with femoral neck fracture before surgery

BackgroundFemoral neck fracture and lacunar cerebral infarction (LCI) are the most common diseases in the elderly. When LCI patients undergo a series of traumas such as surgery, their postoperative recovery results are often poor. Moreover, few studies have explored the relationship between LCI and femoral neck fracture in the elderly. Therefore, this study will develop a ML (machine learning)-based model to predict LCI before surgery in elderly patients with a femoral neck fracture.MethodsProfessional medical staff retrospectively collected the data of 161 patients with unilateral femoral neck fracture who underwent surgery in the Second Affiliated Hospital of Wenzhou Medical University database from January 1, 2015, to January 1, 2020. Patients were divided into two groups based on LCI (diagnosis based on cranial CT image): the LCI group and the non-LCI group. Preoperative clinical characteristics and preoperative laboratory data were collected for all patients. Features were selected by univariate and multivariate logistic regression analysis, with age, white blood cell (WBC), prealbumin, aspartate aminotransferase (AST), total protein, globulin, serum creatinine (Scr), blood urea nitrogen (Bun)/Scr, lactate dehydrogenase (LDH), serum sodium and fibrinogen as the features of the ML model. Five machine learning algorithms, Logistic regression (LR), Gradient Boosting Machine (GBM), Extreme Gradient Boosting (XGBoost), Random Forest (RF), and Decision tree (DT), were used in combination with preoperative clinical characteristics and laboratory data to establish a predictive model of LCI in patients with a femoral neck fracture. Furthermore, indices like the area under the receiver operating characteristic (AUROC), sensitivity, specificity, and accuracy were calculated to test the models’ performance.ResultsThe AUROC of 5 ML models ranged from 0.76 to 0.95. It turned out that the RF model demonstrated the highest performance in predicting LCI for femoral neck fracture patients before surgery, whose AUROC was 0.95, sensitivity 1.00, specificity 0.81, and accuracy 0.90 in validation sets. Furthermore, the top 4 high-ranking variables in the RF model were prealbumin, fibrinogen, globulin and Scr, in descending order of importance.ConclusionIn this study, 5 ML models were developed and validated for patients with femoral neck fracture to predict preoperative LCI. RF model provides an excellent predictive value with an AUROC of 0.95. Clinicians can better conduct multidisciplinary perioperative management for patients with femoral neck fractures through this model and accelerate the postoperative recovery of patients.

A Nomogram to Predict Delirium after Hip Replacement in Elderly Patients with Femoral Neck Fractures.

Postoperative delirium (POD) is a common complication, and clinical practitioners have taken measures to improve the quality of life after hip replacement surgery. We aim to establish a nomogram to predict POD in elderly patients with femoral neck fractures (FNFs) after hip replacement. A total of 384 elderly patients (267 females) with an average age of 75.8 years who underwent hip replacement from June 2010 to May 2020 were retrospectively reviewed. Patients were divided into delirium and non-delirium groups according to the confusion assessment method. The risk factors for POD were analyzed by multivariate logistic regression, and the nomogram was established based on the results. The incidence of POD was 33.33% (128/384). Univariate analysis showed that advanced age, diabetes, lacunar cerebral infarction, surgery type, intraoperative blood loss, electrolyte imbalance, and anemia were risk factors for POD (p< 0.05). Multivariate logistic regression revealed that the independent risk factors for POD were age (OR=1.332, 95% CI [1.224, 1.449], p< 0.01), surgery type (OR=0.351, 95% CI [0.137, 0.900], p= 0.029), electrolyte imbalance (OR=4.407, 95% CI [1.947, 9.977], p< 0.01), anemia (OR=10.819, 95% CI [4.573, 25.598], p< 0.01). The prediction equation was established; logistic (p)=-25.469 + 0.277*X1(age[value=years of age]) +1.293*X2(surgery[value=0 for "total hip replacement" or value=1 for "hemiarthroplasty"]) +1.510*X3(electrolyte imbalance[value=0 for "no" or value=1 for "yes"]) +2.157*X4(anemia[value=1 for "hemoglobin with < 120g/L in male and < 110g/L in female patients" ]) or 2.975*X5(anemia[value=1 for "hemoglobin with <90g/L"]). The area under the curve was 0.957 (95% CI [0.938, 0.976], p< 0.01). The incidence of POD in elderly patients with FNF after hip replacement is high. The nomogram incorporating age, surgery type, electrolyte imbalance, and anemia could provide an individualized prediction for POD among FNF patients after hip replacement, which may help the physician determine appropriate perioperative management.

Assessment of the predictive value of carotid color Doppler ultrasound Crouse score combined with high‐sensitivity C‐reactive protein in elderly diabetics with cerebral infarction

Both the carotid Crouse score and high-sensitivity C-reactive protein (hs-CRP) levels are commonly used to evaluate atherosclerosis and vascular inflammatory response. This study was to investigate the correlation between the Crouse score and hs-CRP and cerebral infarction (CI) in elderly diabetics. We compared the carotid Crouse scores and hs-CRP levels between two groups of diabetic patients with and without CIs (n = 100 each) and the relationship between changes in these indices and CI. Between the four groups (control, diabetic with a large CI, diabetic with a small CI, and diabetic with a lacunar CI) there was a significant difference in the age, sex, Crouse scores and hs-CRP levels, as well as fasting blood glucose (FBG) and glycated haemoglobin (HbA1c) (all p < 0.05). Logistic regression analysis with CI as the dependent variable showed that the age (odds ratio [OR] = 1.114, 95% confidence interval [CFI]: 1.063-1.167, p = 0.000), FBG (OR = 1.260, 95% CFI: 1.102-1.570, p = 0.039), HbA1c (OR = 2.036, 95% CFI: 1.348-3.703, p = 0.001), Crouse score (OR = 2.721, 95% CFI: 1.800-4.114, p = 0.000) and hs-CRP level (OR = 3.364, 95% CFI: 2.185-5.180, p = 0.000) were risk factors for a CI in combination with diabetes mellitus. Significant differences were found in age, diastolic blood pressure, Crouse scores and hs-CRP levels between the male diabetic-non-CI subgroup, female diabetic-non-CI subgroup, male diabetic-CI subgroup and female diabetic-CI subgroup (All p < 0.05). The carotid Crouse score method has high reliability and reflects the severity of carotid atherosclerosis. The age, sex, fasting blood glucose, HbA1c, Crouse score, an elevated hs-CRP level, and the occurrence of CI in elderly with diabetes mellitus are closely related.

Risk factors and their correlation with severity of cerebral microbleed in acute large artery atherosclerotic cerebral infarction patients

ObjectiveRisk factors and prognosis of cerebral microbleeding (CMB) complicated acute large artery atherosclerotic cerebral infarction (ALAACI) patients was controversial. Present study aimed to investigate the risk factors and severity of CMB among ALAACI. MethodsTotally 256 ALAACI patients receiving treatment in Central Hospital of Wuhan between May 2020 and September 2021 were included into this analysis. There were 152 simple ALAACI without CMB patients (simple group) and 104 ones with CMB (combined group). Based on the number of CMB, there were 19 (CMB≥10) patients in severe group, 34 (CMB=5–9) in moderate group, and 51 (CMB=1–4) in mild group. Logistic regression was used to explore the risk factors of CMB. Spearman rank analysis was conducted to investigate association of risk factors and severity of CMB. ResultsThere was no difference of sex, drinking, and smoking among the severe, the moderate, the mild, and the simple groups (P > 0.05). Age, rate of hypertension, lacunar cerebral infarction and prior cerebral infarction were all increased with the severity of CMB among these groups (P < 0.05). Logistic regression showed that the risk factors of CMB were hypertension, history of cerebral infarction, total cholesterol, and homocysteine. Spearman rank analysis revealed that hypertension, history of cerebral infarction, and homocysteine were positively correlated with the severity of CMB in ALAACI patients (r = 0.389, 0.154, 0.563, P = 0.003, 0.006, 0.012, respectively), while total cholesterol was negatively correlated with CMB (r = −0.321, P = 0.008). ConclusionsHypertension, history of cerebral infarction. homocysteine were positively associated with severity of CMB, and total cholesterol was negatively correlated with it in ALAACI patients.

Simvastatin Alleviates Vascular Cognitive Impairment Caused by Lacunar Cerebral Infarction Through Protein Kinase B/Nuclear Factor Erythroid 2–Related Factor 2 (AKT/Nrf2) Signaling Pathway

Lacunar cerebral infarction (LACI) is one of the main causes of vascular cognitive impairment (VCI). Herein, this study explored the potential effect of Simvastatin (Sim) on VCI secondary to LACI and Akt/Nrf2 signaling transduction and apoptosis. We established a rat model of VCI and the animals were administered with Sim (40 mg/kg and 80 mg/kg) every day for 28 days. After that, the cognition and memory abilities of rats were assessed together with analysis of morphological changes of hippocampal neurons by immunohistochemistry staining and level of anti-apoptotic related proteins and Akt and Nrf2 signaling proteins by western blot. Compared with normal saline (control group), Sim administration significantly improved the capacity spatial learning and relieved the memory impairment with an improvement in morphological defects. Importantly, Sim treatment restored the p-Akt, t-Nrf2, n-Nrf2 and HO-1 expression along with up-regulation of Bcl-2 and down-regulation of Bax. In conclusion, Sim improves cognitive and morphological disorders induced by LACI possibly through regulating Akt/Nrf2 signaling pathway. These evidence might promote the development of Sim-based treatment for VCI and LACI.