Cerebral microbleeds and cognitive decline in a hemodialysis patient: Case report and review of literature

Cerebral microbleeds (CMBs) are small hemosiderin deposits indicative of prior cerebral microscopic hemorrhage and previously thought to be clinically silent. Recent population‐based cross‐sectional studies and prospective longitudinal cohort studies have revealed association between CMB and cognitive dysfunction. In the general population, CMBs are associated with age, hypertension, and cerebral amyloid angiopathy. In the chronic kidney disease (CKD) population, diminished estimated glomerular filtration rate has been found to be an independent risk factor for CMB, raising the possibility that a uremic milieu may predispose to microbleeds. In the end‐stage renal disease (ESRD) population on hemodialysis, the incidence of microbleeds is significantly higher compared with a control group without history of CKD or stroke. We present an ESRD patient on chronic hemodialysis with a history of gradual cognitive decline and progressive CMBs. Through this case and literature review, we illustrate the need to develop detection and prediction models to treat this frequent development in ESRD patients.     

积极降压对脑小血管病防治策略的影响

2017年,美国心脏病学会和美国心脏协会提出将高血压诊断标准降为130/80 mm Hg (1 mm Hg=0. 133 kPa),这与其他指南有所不同。降压治疗的核心目标在于靶器官的保护,近年来降压治疗与脑小血管病预防的相关问题日益受到临床重视。目前研究结果表明,降压治疗对腔隙性卒中患者的二级预防以及白质病变进展的预防可能有一定积极意义,但确切的降压目标值并未确定。血压与临床结局可能呈现J型关系,血压过低或过高可能均有害,而取得最大获益的降压目标有待进一步探索。     

Hemispheric contributions to nonverbal abstract reasoning and problem solving.

Hemispheric involvement in reasoning abilities has been debated for some time, and it remains unclear whether the right hemisphere's involvement in problem solving is modality specific or dependent on the type of spatial reasoning required. In the current study, 2 types of nonverbal reasoning abilities were examined, spatial reasoning and proportional reasoning, in 109 patients with cerebrovascular disease that was confined to either the right or the left hemisphere or was diffuse in nature. Results indicated that no lateralizing effects were present based on type of spatial reasoning. Findings are consistent with the suggestion that higher order cognitive processes involved in nonverbal abstraction and problem solving are not strongly lateralized to the right hemisphere but rather are more generally distributed throughout the cortex. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interleukin 6 and Aneurysmal Subarachnoid Hemorrhage. A Narrative Review

Interleukin 6 (IL-6) is a prominent proinflammatory cytokine. Neuroinflammation in general, and IL-6 signaling in particular, appear to play a major role in the pathobiology and pathophysiology of aneurysm formation and aneurysmal subarachnoid hemorrhage (SAH). Most importantly, elevated IL-6 CSF (rather than serum) levels appear to correlate with delayed cerebral ischemia (DCI, “vasospasm”) and secondary (“vasospastic”) infarctions. IL-6 CSF levels may also reflect other forms of injury to the brain following SAH, i.e., early brain damage and septic complications of SAH and aneurysm treatment. This would explain why many researchers have found an association between IL-6 levels and patient outcomes. These findings clearly suggest CSF IL-6 as a candidate biomarker in SAH patients. However, at this point, discrepant findings in variable study settings, as well as timing and other issues, e.g., defining proper clinical endpoints (i.e., secondary clinical deterioration vs. angiographic vasospasm vs. secondary vasospastic infarct) do not allow for its routine use. It is also tempting to speculate about potential therapeutic measures targeting elevated IL-6 CSF levels and neuroinflammation in SAH patients. Corticosteroids and anti-platelet drugs are indeed used in many SAH cases (not necessarily with the intention to interfere with detrimental inflammatory signaling), however, no convincing benefit has been demonstrated yet. The lack of a robust clinical perspective against the background of a relatively large body of data linking IL-6 and neuroinflammation with the pathophysiology of SAH is somewhat disappointing. One underlying reason might be that most relevant studies only report correlative data. The specific molecular pathways behind elevated IL-6 levels in SAH patients and their various interactions still remain to be delineated. We are optimistic that future research in this field will result in a better understanding of the role of neuroinflammation in the pathophysiology of SAH, which in turn, will translate into the identification of suitable biomarkers and even potential therapeutic targets.     

Focal Ischemic Injury to the Early Neonatal Rat Brain Models Cognitive and Motor Deficits with Associated Histopathological Outcomes Relevant to Human Neonatal Brain Injury

Neonatal arterial ischemic stroke is one of the more severe birth complications. The injury can result in extensive neurological damage and is robustly associated with later diagnoses of cerebral palsy (CP). An important part of efforts to develop new therapies include the on-going refinement and understanding of animal models that capture relevant clinical features of neonatal brain injury leading to CP. The potent vasoconstrictor peptide, Endothelin-1 (ET-1), has previously been utilised in animal models to reduce local blood flow to levels that mimic ischemic stroke. Our previous work in this area has shown that it is an effective and technically simple approach for modelling ischemic injury at very early neonatal ages, resulting in stable deficits in motor function. Here, we aimed to extend this model to also examine the impact on cognitive function. We show that focal delivery of ET-1 to the cortex of Sprague Dawley rats on postnatal day 0 (P0) resulted in impaired learning in a touchscreen-based test of visual discrimination and correlated with important clinical features of CP including damage to large white matter structures.     

An effective deep learning model for grading abnormalities in retinal fundus images using variational auto-encoders

Diabetic retinopathy (DR) and Diabetic Macular Edema (DME) are severe diseases that affect the eyes due to damage in blood vessels. Computer-aided automated grading will help clinicians conduct disease diagnoses at ease. Experiments of automated image processing with deep learning techniques using CNN produce promising results, especially in the medical imaging domain. However, the disease grading tasks in retinal images using CNN struggle to retain high-quality information at the output. A novel deep learning model based on variational auto-encoder to grade DR and DME abnormalities in retinal images is proposed. The objective of the proposed model is to extract the most relevant retinal image features efficiently. It focuses on addressing less relevant candidate region generation and translational invariance present in images. The experiments are conducted in IDRID dataset and evaluated using accuracy, U-kappa, sensitivity, specificity and precision metrics. The results outperform compared with other state-of-art techniques.     

基于ARM9的便携脑血氧监测仪及其以太接口设计

介绍了一种应用双光源的便携嵌入式近红外脑血氧监测设备.该设备采用三星S3C2410A微控制器和以太网控制芯片DM9000A进行软硬件设计,可实现同时对双侧脑组织局部血、氧参数的监测.     

Dissociating Processes Supporting Causal Perception and Causal Inference in the Brain.

An understanding of relations between causes and effects is essential for making sense of the dynamic physical world. It has been argued that this understanding of causality depends on both perceptual and inferential components. To investigate whether causal perception and causal inference rely on common or on distinct processes, the authors tested 2 callosotomy (split-brain) patients and a group of neurologically intact participants. The authors show that the direct perception of causality and the ability to infer causality depend on different hemispheres of the divided brain. This finding implies that understanding causality is not a unitary process and that causal perception and causal inference can proceed independently. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

实验大鼠脑缺血模型的制作及效果评价

缺血性脑血管病是临床上常见的一类疾病，其致残率和死亡率均较高。采用一种线栓法，制备大鼠局灶性脑缺血再灌注模型，并从动物神经病学评分、鼠脑整体观、鼠脑切面氯化三苯四氮唑染色、鼠脑组织光镜下观察等进行评价，表明该模型达到脑缺血的效果。在此基础上可进行缺血性脑血管病的多种实验性研究。     

汽车驾驶员脑氧参数的振动响应特性分析

应用近红外光谱法,研究分析汽车驾驶员在振动状态下的脑部血氧参数变化,探讨车辆振动对脑氧参数的影响。实验过程中应用近红外光谱法监测试验人员脑氧参数。经方差分析发现实验人员经车辆振动后脑部各血氧参数有显著性变化。实验结果表明汽车振动对脑部血氧参数还原血红蛋白的浓度(c_Hb)、氧合血红蛋白的浓度(c_HbO2)、血红蛋白总量的浓度(c_tHb)有显著性影响,且不同频率振动的影响显著性不同,其中4.5Hz的振动对脑氧参数影响最大;但振动对脑部组织血氧饱和度(tissue oxygen index,TOI)的影响极小。