Exploring causal pathways linking cerebral small vessel diseases burden to poststroke depressive symptoms with structural equation model analysis

BACKGROUND

Cerebral small vessel diseases (SVD) are associated with poststroke depressive symptoms (PDS). The mechanisms underlying the association between SVD burden and PDS are unclear. This study investigated the clinical pathways linking SVD burden to PDS.

METHOD

A cohort of 563 patients with acute ischemic stroke were examined at three and fifteen months after stroke. PDS was measured with the 15-item Geriatric Depression Scale (GDS). Cognitive and physical functions were assessed with the Mini-Mental State Examination and the modified Rankin Scale, respectively. All patients received MRI scans at baseline. Infarct volumes and the four SVD markers (lacunae, white matter hyperintensities, cerebral microbleeds, and perivascular spaces) were assessed on magnetic resonance imaging. SVD burden was defined as a latent variable encompassing the information about all four SVD markers in structural equation modeling (SEM). SEM was further employed to examine the direct and indirect linking pathways between SVD burden, infarct volumes, stroke severity, poststroke cognitive and physical dysfunctions, and PDS.

RESULTS

The latent SVD burden was directly associated with more severe PDS at the 3-month follow-up (path coefficient=0.11), while SVD burden and PDS at the 15-month were mainly linked through PDS at the 3-month follow-up (path coefficient=0.48). The volume of acute infarcts and impaired physical functions predominantly mediated the association between SVD burden and PDS at 3-month follow-up. Physical and cognitive functions 15 months after stroke mainly bridged the link between SVD burden and the PDS at the 15-month follow-up.

LIMITATIONS

The study included patients with mild stroke, which reduced the generalizability of the findings.

CONCLUSIONS

SVD burden not only directly determines poststroke depressive symptoms, but also worsens acute stroke lesions, stroke severity, and poststroke neurological deficits, thereby contributing further to the development of PDS over the first 15 months after stroke.

[Optimization of delivering minimum Gd-DTPA at the posterior upper point on tympanic medial wall and hT2W-3D-FLAIR sequence for detecting endolymphatic hydrops]

Objective: To optimize delivery of gadolinium-diethylenetriamine pentaacetic acid(Gd-DTPA) at the posterior upper point on tympanic medial wall and heavily T2-weighted 3-dimensional fluid-attenuated inversion recovery (hT2W-3D-FLAIR) sequence, and to implement the technique of detecting endolymphatic hydrops using gadolinium-enhancement MRI. Methods: Thirteen patients with periphery vertigo, who visited Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Changhai Hospital during June and December of 2017, were enrolled in the study.0.10-0.20 ml of Gd-DTPA in various dilutions (10, 20, and 40-fold) were delivered at the posterior upper point on tympanic medial wall using a soft-tipped tympanic suction and drug-spraying needle through an artificially perforated tympanic membrane. Inner ear MRI was performed at 8, 24 h after Gd-DTPA administration using a 3T MR machine in combination with a 20-channel Tim 4G head/neck coil and the sequence of hT2W-3D-FLAIR to detect the gadolinium-enhancement signal within the inner ear and possible endolymphatic hydrops. The scanning time was either 8 min 35 s or 15 min 11 s. Results: Efficient inner ear uptake of Gd-DTPA was detected and induced high signal to noise ratio of MRI in patients receiving targeted delivery of 0.15-0.20 ml of 10-fold diluted contrast agent at the posterior upper point on tympanic medial wall. At 8 h after delivery, significant uptake was detected in the scala tympani and vestibuli of hook region and basal turn of the cochlea, and perilymhatic compartment of the vestibule. At 24 h after delivery, the distribution of Gd-DTPA became homogenous in each turn of the cochlea and perilymphatic compartment of the vestibule. However, obvious individual variance existed in the inner ear uptake when 0.10 ml of 40-fold diluted Gd-DTPA was delivered. Efficient inner ear uptake and high quality images that generated in patients receiving 0.10, 0.15, and 0.20 ml of 20-fold Gd-DTPA demonstrated endolymphatic hydrops with minor individual variance. There was insignificant difference in the enhancement signal of inner ear between 0.15 and 0.10 ml groups when Gd-DTPA was diluted at 20-fold except for the signal of semicircular canal of 0.15 ml group (190.00±53.95 vs 165.50±42.13, t=2.61, P<0.05). There was insignificant difference in the image quality between 8 min 35 s and 15 min 11 s canning time. Various degrees of endolymphatic hydrops were detected in 7 cochleae and 11 vestibule, and both simultaneous cochlear and vestibular endolymphatic hydrops were detected in 4 ears. Cochlear endolymphatic hydrops was detected in all the 3 patients with definite Meniere's disease, and 2 of them had combined cochlear and vestibular endolymphatic hydrops. Endolymphatic hydrops was not detected in patients with possible Meniere's disease nor with symptoms of superior semicircular canal dehiscence. Conclusion: Targeted delivery of 0.10 ml with 20-fold diluted Gd-DTPA (total dosage of 5 μmol) at the posterior upper point on tympanic medial wall in combination with 8 min 35 s scanning time hT2W-3D-FLAIR sequence for inner ear MRI in a 3T MR machine is a clinically practical method to detect endolymphatic hydrops, and reduce the requirement for MRI hardware.

Clinical characteristics and magnetic resonance imaging findings in nine patients with nonalcoholic Wernicke's encephalopathy: a retrospective study

PURPOSE

Wernicke's encephalopathy (WE) is a severe neurological disorder caused by thiamine deficiency. The most common cause of WE is alcoholism. However, there is a significant paucity of information in the existing literature relating to nonalcoholic WE. In this study, we investigated the clinical characteristics and neuroimaging findings of nine patients with nonalcoholic WE.

PATIENTS AND METHODS

We retrospectively collated clinical data from nine patients who had been diagnosed with WE in accordance with established criteria including age, gender, risk factors and clinical manifestations. We also collated initial hematological and neuroimaging findings.

RESULTS

The mean age of the nine patients was 54.0±17.1 years; four of these patients (44.4%) were male. All nine patients had a history of fasting (range, 5-47 days) prior to WE. Four of the nine patients (44.4%) exhibited the classical triad, and eight (88.9%) showed alterations in mental status. Magnetic resonance imaging (MRI) scans showed that all nine patients had symmetric lesions of the medial thalamus. MRI also revealed other WE-related lesions in mammillary bodies (22.2%), the periaqueductal region (55.6%), the tectal plate of the midbrain (77.8%), cranial nerve nuclei (77.8%) and in the symmetric subcortical white matter (11.1%).

CONCLUSION

Our analysis showed that fasting is a common cause of WE in nonalcoholic patients and that MRI is a useful tool for the diagnosis of WE. The most common MRI findings were symmetrical lesions of the medial thalamus lesions, followed by the tectal plate of the midbrain and cranial nerve nuclei.

Anxiety in Patients With Acute Ischemic Stroke: Risk Factors and Effects on Functional Status

Background: Anxiety is prevalent after a stroke. The pathophysiological mechanisms underlying the development of poststroke anxiety (PSA) remain unclear. The aim of this study was to investigate the clinical and neuroimaging risk factors for development of PSA and examine the effects of PSA on activities of daily living (ADL) and quality of life (QOL) in Chinese patients with ischemic stroke. Methods: Two hundred nineteen patients with acute ischemic stroke were recruited to the study. A series of comprehensive assessments, including Hamilton Anxiety Rating Scale (HARS), Hamilton Depression Rating Scale (HDRS), Lawton ADL Scale, and the Stroke-Specific Quality of Life (SSQOL) Scale, were conducted in the acute stage and 3 months after stroke. Magnetic resonance imaging assessment focused on evaluation of infarctions, white matter lesions, and brain atrophy. Results: In the acute stage and 3 months after stroke, 34 (16%) and 33 (15%) patients had PSA, respectively. Multiple logistic regression analysis indicated that HDRS (OR = 1.269, 95% CI = 1.182-1.364, P < 0.001) and acute infarcts in cerebral hemispheric white matter (CHWM; OR = 2.902, 95% CI = 1.052-8.007, P = 0.040) were significant correlates of PSA in the acute stage of stroke. Three months after stroke, these correlates remained significant predictors, along with male sex. Multiple linear regressions showed that age, NIHSS, HARS, and HDRS in the acute stage were significant predictors for both ADL and SSQOL at 3 months after stroke. Conclusion: Depressive symptoms are the major correlates of PSA while more severe PSA is associated with poorer ADL and health-related QOL. Acute lesions involving CHWM may correlate with PSA in ischemic stroke patients with mild-to-moderate neurologic deficits, supporting a lesion-location hypothesis in PSA.

Effect of cysteamine hydrochloride supplementation on the growth performance, enterotoxic status, and glutathione turnover of broilers fed aflatoxin B1 contaminated diets

This study aimed to investigate the effect of cysteamine hydrochloride (CSH) supplementation on the growth performance, opportunistic bacteria and enterotoxic markers, visceral lesions, glutathione turnover, and inflammatory factors of broilers fed diets contaminated with aflatoxin B1 (AFB1). One-day-old Arbor Acres broilers (n = 480) were randomly allocated to 4 treatments with 6 replicates of 20 chicks each for a 2 × 2 design with CSH (0 or 200 mg/kg) and AFB1 (0 or 40 μg/kg). The trial lasted for 42 d. Results showed that AFB1 negatively affected (P < 0.05) growth performance, opportunistic bacteria and enterotoxic markers, intestinal lesions, glutathione turnover, and inflammatory factors. The CSH increased (P < 0.05) feed intake and body weight gain. The enterotoxic status was relieved in the CSH treatments by reducing (P < 0.05) the populations of gut Escherichia coli, Gram-negative bacteria, serum diamine oxidase, and intestinal lesions. The CSH also increased (P < 0.05) serum reduced glutathione, glutathione s-transferases, and glutathione reductase, and decreased (P < 0.05) the mRNA levels of tumor necrosis factor-α, interleukin-6, and interleukin-1β. Significant interactions (P < 0.05) were found on Gram-negative bacteria, diamine oxidase, and glutathione s-transferases. The results suggest that the CSH can improve glutathione turnover and reduce the risk of enterotoxic disease induced by AFB1 in broilers.

[Developing a Chinese PI-RADS v2-based nomogram for predicting clinically significant prostate cancer in patients with a prior negative biopsy]

Objective: To develop a nomogram based on prostate imaging reporting and data system version 2 (PI-RADS v2) to predict clinically significant prostate cancer in patients with a prior negative prostate biopsy. Methods: The clinical and pathological data of 231 patients who underwent repeat prostate biopsy and multiparametric MRI (mpMRI) were reviewed. Based on PI-RADS v2, the mpMRI results were assigned as PI-RADS grade from 0 to 2. A Logistic regression nomogram for predicting the probabilities of clinically significant prostate cancer were constructed. The performances of the nomogram were assessed using area under the receiver operating characteristic (ROC) curve, calibrations and decision curve analysis. Results: Of the total 231 repeat prostate biopsy patients, clinically significant prostate cancer was detected in 59 cases(25.5%). In multivariate Logistic regression analysis, age, prostate specific antigen (PSA), prostate volume (PV), digital rectal examination (DRE) and mpMRI results were significant independent predictors of the diagnosis of clinically significant prostate cancer (P<0.05). The nomogram with super predictive accuracy were constructed (AUC=0.927, P<0.001), and exhibited excellent calibration. Decision curve analysis also demonstrated a high net benefit across a wide range of threshold probabilities . Conclusions: PI-RADS v2 combined with age, PSA, PV and DRE can predict the probability of clinically significant prostate cancer in patients with negative initial biopsies. The nomogram generated may help the decision-making process in patients with prior benign histology before the performance of repeat biopsy.

Effect of yeast cell wall on the growth performance and gut health of broilers challenged with aflatoxin B1 and necrotic enteritis

This study aimed to investigate the effect of yeast cell walls (YCW) on the growth performance, visceral lesions, intestinal integrity, enterotoxicity, and bacteria of broilers challenged with aflatoxin B1 (AF) and necrotic enteritis (NE) from 1 to 21 d of age. A total of 576 one-day-old broilers were assigned to a 2 × 2 × 2 design for diets containing AFB1 (0 or 40 μg/kg), NE (challenged or unchallenged), or YCW (0 or 500 mg/kg). The main effect analysis showed that AF depressed (P < 0.01) average daily feed intake (ADFI), average daily body weight gain (ADG), the mRNA profiles of polymeric Ig receptor (pIgR), claudin-1, and occludin, but increased (P < 0.001) liver lesion scores, serum endotoxin, and diamine oxidase (DAO). The NE challenge depressed (P < 0.01) ADFI, ADG, secretory IgA (sIgA), pIgR, claudin-1, occludin, and the populations of Lactobacilli and Bifidobacteria, but increased (P < 0.001) visceral lesions, endotoxins, and DAO. The main effect of YCW on growth performance, visceral lesions, and intestinal integrity was not significant, but decreased (P < 0.01) mortality, endotoxin, DAO, and C. perfringens, and increased (P < 0.05) the populations of Lactobacilli and Bifidobacteria. There were 3-way interactions (P < 0.05) on growth performance, intestinal lesions, integrity, and gut bacteria. Compared with the treatment with the dual challenges, there were pronounced effects (P < 0.05) of YCW on ADFI, ADG, lesions, DAO, pIgR, and Bifidobacteria. The results suggest that with the concurrent challenges of AF and NE, the YCW can partially protect the growth performance and intestinal health of broilers.

Cerebral Small Vessel Disease Burden Is Associated With Poststroke Depressive Symptoms: A 15-Month Prospective Study

Objective: All types of cerebral small vessel disease (SVD) markers including lacune, white matter hyperintensities (WMH), cerebral microbleeds, and perivascular spaces were found to be associated with poststroke depressive symptoms (PDS). This study explored whether the combination of the four markers constituting an overall SVD burden was associated with PDS. Methods: A cohort of 563 patients with acute ischemic stroke were followed over a 15-month period after the index stroke. A score of ≥7 on the 15-item Geriatric Depression Scale was defined as clinically significant PDS. Scores of the four SVD markers ascertained on magnetic resonance imaging were summed up to represent total SVD burden. The association between SVD burden and PDS was assessed with generalized estimating equation models. Results: The study sample had a mean age of 67.0 ± 10.2 years and mild-moderate stroke [National Institutes of Health Stroke Scale score: 3, interquartile, 1-5]. PDS were found in 18.3%, 11.6%, and 12.3% of the sample at 3, 9, and 15 months after stroke, respectively. After adjusting for demographic characteristics, vascular risk factors, social support, stroke severity, physical and cognitive functions, and size and locations of stroke, the SVD burden was associated with an increased risk of PDS [odds ratio = 1.30; 95% confidence interval = 1.07-1.58; p = 0.010]. Other significant predictors of PDS were time of assessment, female sex, smoking, number of acute infarcts, functional independence, and social support. Conclusion: SVD burden was associated with PDS examined over a 15-month follow-up in patients with mild to moderate acute ischemic stroke.

[Development of a Chinese nomogram based on muti-parametric magnetic resonance for predicting the probability of prostate cancer in patients after initial negative biopsy]

Objective: To develop a predictive nomogram based on multi-parametric magnetic resonance imaging (mpMRI) information to identify men more likely to have a cancer diagnosed on repeat prostate biopsy. Methods: The clinical data of 237 patients who received repeat prostate biopsy after initial negative biopsy from Department of Urology of Peking University First Hospital between January 2001 and August 2016 was reviewed. Patient age, body mass index (BMI), serum total prostate-specific antigen (PSA), percent free PSA (f/t), prostate volume (PV), PSA density (PSAD), PSA velocity (PSAV), digital rectal examination (DRE), transrectal ultrasound (TRUS)and mpMRI results were included in the univariate and multivariate analysis. A nomogram was developed using selected variables and the area under the receiver operating characteristic (ROC) curve was calculated as a measure of discrimination. Results: A total of 76 patients (32.07%) had prostate cancer (PCa) detected on repeat biopsy. Based on univariate and multivariate logistic regression analysis, the patient age, PSA, PV, DRE and mpMRI results were independent predictors for the diagnosis of PCa on repeat biopsy. The current nomogram performed well (AUC=0.910) and showed excellent calibration. Conclusions: Multi-parametric magnetic resonance imaging combined with age, PSA, PV and DRE can predict the probability of PCa in patients with initial negative biopsy. The nomogram might help in decision-making for men with prior benign histology before the performance of repeat biopsy.

Microbleeds in fronto-subcortical circuits are predictive of dementia conversion in patients with vascular cognitive impairment but no dementia

Cerebral small vessel disease (CSVD) is a common etiology of vascular cognitive impairment with no dementia (V-CIND). Studies have revealed that cerebral microbleeds (CMBs), a feature of CSVD, contribute to cognitive impairment. However, the association between CMBs and dementia conversion in individuals with V-CIND is still unclear. Here, we analyzed the predictive role of CMBs in the conversion from V-CIND to dementia in CSVD patients. We recruited and prospectively assessed 85 patients with CSVD and V-CIND. V-CIND was evaluated using a series of comprehensive neuropsychological scales, including the Chinese version of the Montreal Cognitive Assessment and the Clinical Dementia Rating. MRI assessments were used to quantify lacunar infarcts, white matter hyperintensities, CMBs, and medial temporal lobe atrophy. Eighty-two of the 85 patients completed the assessment for dementia conversion at a 1-year follow-up assessment. Multivariate logistic regression analyses were conducted to examine independent clinical and MRI variables associated with dementia conversion. Twenty-four patients (29.3%) had converted to dementia at the 1-year follow-up, and these individuals had significantly more CMBs in the fronto-subcortical circuits. Multivariate logistic regression analyses revealed that the patients with CMBs in the fronto-subcortical circuits (odds ratio = 4.4; 95% confidence interval: 1.602–12.081, P = 0.004) and 5 or more CMBs overall (odds ratio = 17.6, 95% confidence interval: 3.23–95.84, P = 0.001) had a significantly increased risk of dementia at the 1-year follow-up. These findings indicate that CMBs in the fronto-subcortical circuits may be predictive of dementia conversion in CSVD patients with V-CIND, and thus extend the clinical significance of CMBs. This trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800017077). Protocol version: 1.0.

Association of Cerebral Small Vessel Disease Burden and Health-Related Quality of Life after Acute Ischemic Stroke

Objective: Cerebral small vessel disease (SVD) is associated with increased mortality, disability and cognitive decline, depression in stroke survivors. This study examined the association between SVD burden, defined by a combination of SVD markers, and health-related quality of life (HRQoL) in acute ischemic stroke. Methods: Patients admitted with acute ischemic stroke of any etiology were prospectively screened between January 2010 to December 2014 and enrolled in the study if they met study entry criteria. HRQoL was evaluated with the 12-item Stroke Specific Quality of Life (SSQoL) at 3 months after the onset of acute ischemic stroke. SVD was ascertained by the presence of any of the SVD markers including lacune, white matter hyperintensities (WMH), cerebral microbleeds (CMB) and enlarged perivascular spaces (EPVS) in the basal ganglia or their combinations on brain magnetic resonance imaging (MRI). The presence of each individual marker scored 1 point and was summed up to generate an ordinal "SVD score" (0-4) capturing total SVD burden. Linear regression was used to determine the associations between SVD burden and HRQoL. Results: Of the743 acute ischemic stroke patients that formed he study sample (mean age: 66.3 ± 10.6 years; 41.7% women), 49.3%, 22.5%, 16.0%, 9.2% and 3.1% had SVD scores of 0, 1, 2, 3 and 4, respectively. After adjusting for demographic, clinical and imaging variables, the SVD score was independently associated with lower overall score of SSQoL (B = -1.39, SE = 0.56, p = 0.01), and its domains of mobility (B = -0.41, SE = 0.10, p < 0.001) and vision (B = -0.12, SE = 0.06, p = 0.03). Acute infract volume (B = -1.44, SE = 0.54, p = 0.01), functional independence (B = 5.69, SE = 0.34, p < 0.001) and anxious (B = -1.13, SE = 0.23, p < 0.001) and depressive symptoms (B = -3.41, SE = 0.22, p < 0.001) were also the significant predictors of the overall score of SSQoL. Conclusion: The brain's SVD burden predicts lower HRQoL, predominantly in domains of mobility and vision at 3 months after acute ischemic stroke. The evaluation of SVD burden could facilitate developing individual treatment strategies.

Enlarged perivascular spaces are associated with health-related quality of life in patients with acute ischemic stroke

AIMS

This study explored the association between enlarged perivascular spaces (EPVS) and the health-related quality of life (HRQoL) in patients with acute ischemic stroke.

METHODS

This was an observational study of consecutively screened patients with acute ischemic stroke from March 2010 to March 2015. EPVS were rated in the basal ganglia and the centrum semiovale with a validated scale. The HRQoL was assessed 3 months after the stroke onset using the Stroke-Specific Quality of Life (SSQoL). Linear regression models were used to study the association between EPVS and HRQoL.

RESULTS

The study included 648 patients (mean age 65.8 years; 40.0% women) with mild to moderately severe stroke (median NIHSS score 2), of whom 640 (98.8%) exhibited signs of small vessel disease. The median EPVS scores in the basal ganglia and the centrum semiovale were 1 each. In linear regression analysis, EPVS in the basal ganglia were associated with a lower total SSQoL score (P = 0.02) and lower mobility (P = 0.01), mood (P = 0.03), and self-care (P < 0.01). EPVS in the centrum semiovale were associated only with a lower SSQoL work/productivity subscore (P = 0.002).

CONCLUSIONS

EPVS are associated with lower HRQoL in patients with mild to moderate acute ischemic stroke. Early identification and intervention of EPVS may improve HRQoL in stroke survivors.

[Changes of macrophages in colitis-associated colonic carcinogenesis]

OBJECTIVE

To investigate the changes of quantity and phenotype of macrophages during the progress of colitis-associated carcinogenesis, and to identify the chemokines mediating macrophage recruitment.

METHODS

Colitis-associated cancer was induced by azoxymethane (AOM) combined with dextran sulfate sodium (DSS) in C57BL/6 mice. The three sequential developmental stages of colitis associated cancer in the mice were named AD1, AD2 and AD3, respectively. Colon tissues were collected and digested into single-cell suspension. The percentage and phenotype of macrophages in the colon tissues were determined by fluorescence activated cell sorter (FACS). Protein array and real-time polymerase chain reaction (PCR) were used to predict potential chemotatic factors of macrophages.

RESULTS

Colitis-associated cancer was effectively induced in C57BL/6 mice using AOM combined with DSS. The percentage of macrophages was gradually elevated in the AD1, AD2 and AD3 groups [(9.93±1.28)%, (15.42±1.15)%, (21.25±0.62)%], respectively, significantly higher than that of the control group [(2.39±0.54)%, P<0.01]. The macrophages infiltrating the colonic mucosa exhibited mainly a pro-inflammatory phenotype as CD206(-)CD86(+) MHCII(-). The positive rates of CD206 in the AD1, AD2 and AD3 groups were (15.03±1.54)%, (8.11±3.70)%, and (9.06±1.16)%, respectively, significantly lower than that of the control group [(19.43±7.31)%, P<0.01]. The positive rates of CD86 in the AD2 and AD3 groups were (46.73±6.58)% and (76.90±14.32)%, respectively, significantly higher than that of the control group [(19.37±9.69)%, P<0.01)]. The positive rates of MHCⅡ in the AD1, AD2 and AD3 groups were (31.10±2.69)%, (33.93±14.08)%, and (29.93±1.41)%, respectively, significantly lower than that of the control group [(50.30±6.58)%, P<0.01]. Protein array analysis and real-time PCR data revealed that G-CSF was the potential chemokine to recruit macrophages in the AOM-DSS mouse model.

CONCLUSION

Macrophages infiltrate increasingly during the carcinogenesis and development of colitis-associated cancer, which mostly express CD206(-)CD86(+) MHCII(-) and might be potentially recruited by G-CSF.

Pontine microbleeds and depression in stroke

OBJECTIVES

Depression is the most common affective disorder following stroke yet the neuroanatomical model of poststroke depression (PSD) remains unclear. This study examined the association between PSD and cerebral microbleeds (CMBs) and hypothesized that CMBs in specific regions would be associated with PSD.

METHODS

Of the 4766 patients with first ever or recurrent acute ischemic stroke admitted to the Acute Stroke Unit of the Prince of Wales Hospital between June 2004 and October 2010, 229 met the entry criteria and formed the study sample. Patients with a Geriatric Depression Scale score of 7 or above were classified as having PSD. The presence and location of CMBs were evaluated with magnetic resonance imaging.

RESULTS

Compared to the non-PSD group, patients with PSD were more likely to have pontine CMBs (32.0% vs 18.2%; P = .019). The presence of pontine CMBs remained an independent predictor of PSD in the multivariate analysis, with an odds ratio of 2.2 (P = .016).

CONCLUSION

The results suggest that pontine CMBs are associated with a higher risk of developing PSD.

Neuroimaging indicators of the performance of instrumental activities of daily living in Alzheimer's disease combined with cerebrovascular disease

OBJECTIVES

The aim of the present study was to explore the magnetic resonance imaging correlates of the performance of instrumental activities of daily living (IADL) in patients with Alzheimer's disease combined with cerebrovascular disease.

METHODS

A total of 66 patients with Alzheimer's disease combined with cerebrovascular disease formed the study sample. Two regression models were constructed to find correlates of IADL. Model 1 only included clinical variables and model 2 included both clinical and magnetic resonance imaging variables.

RESULTS

In model 1, with IADL as the dependent variable, the Mini-Mental State Examination (MMSE) score, Physical Self-Maintenance Scale score at baseline and age were significant correlates accounting for 40.1% of the variance of IADL at baseline. MMSE score and age were also significant correlates of IADL at 6 months, accounting for 38.1% of the variance of it. In model 2, severity of white matter lesions, MMSE and Physical Self-Maintenance Scale scores at baseline significantly correlated with IADL at baseline, accounting for 52.1% of the variance of the dependent variables; severity of white matter lesions and MMSE significantly correlated with IADL at 6 months, accounting for 41.5% of the variance of the dependent variables.

CONCLUSION

In patients with Alzheimer's disease combined with cerebrovascular disease, subcortical ischemic lesions might be significant contributor to the functional status.

Human dental pulp stem cells derived from cryopreserved dental pulp tissues of vital extracted teeth with disease demonstrate hepatic-like differentiation

Reviewing the literature, hepatic differentiation of human dental pulp stem cells (hDPSCs) from cryopreserved dental pulp tissues of vital extracted teeth with disease has not been studied. This study is aimed to evaluate the hypothesis that hDPSCs from cryopreserved dental pulp tissues of vital extracted teeth with disease could possess potential hepatic differentiation. Forty vital extracted teeth with disease recruited for hDPSCs isolation, stem cell characterization and hepatic differentiation were randomly and equally divided into group A (liquid nitrogen-stored dental pulp tissues) and group B (freshly derived dental pulp tissues). Samples of hDPSCs isolated from groups A and B but without hepatic growth factors formed negative controls. A well-differentiated hepatocellular carcinoma cell line was employed as a positive control. All the isolated hDPSCs from groups A and B showed hepatic-like differentiation with morphological change from a spindle-shaped to a polygonal shape and normal karyotype. Differentiated hDPSCs and the positive control expressed hepatic metabolic function genes and liver-specific genes. Glycogen storage of differentiated hDPSCs was noted from day 7 of differentiation-medium culture. Positive immunofluorescence staining of low-density lipoprotein and albumin was observed from day 14 of differentiation-medium culture; urea production in the medium was noted from week 6. No hepatic differentiation was observed for any of the samples of the negative controls. We not only demonstrated the feasibility of hepatic-like differentiation of hDPSCs from cryopreserved dental pulp tissues of vital extracted teeth with disease but also indicated that the differentiated cells possessed normal karyotype and were functionally close to normal hepatic-like cells. Copyright © 2013 John Wiley & Sons, Ltd.

Location of infarcts and apathy in ischemic stroke

BACKGROUND

Apathy is common in stroke survivors. Unlike poststroke depression, apathy after stroke has not been extensively investigated and the significance of the location of infarcts in the development of apathy following a stroke is unknown. This study examined the association between poststroke apathy (PSA) and the location of infarcts.

METHODS

A cohort of 185 patients with acute ischemic stroke admitted to the Stroke Unit of a university-affiliated regional hospital in Hong Kong was recruited. Three months after the index stroke, a psychiatrist administered the Apathy Evaluation Scale (AES). PSA was defined as an AES score of 37 or above. The presence and location of infarcts were evaluated with magnetic resonance imaging.

RESULTS

Altogether 185 patients met the entry criteria and formed the study sample; 20 (10.8%) had PSA. PSA patients were older and had higher stroke severity and more depressive symptoms. The PSA group also had lower levels of physical and cognitive functioning. Compared with the non-PSA group, PSA patients were more likely to have acute pontine infarcts (35.0% vs. 11.5%; p = 0.011). They had a higher mean number (0.5 ± 0.7 vs. 0.1 ± 0.3; p = 0.003) and larger volume (0.6 ± 1.4 vs. 0.1 ± 0.3 ml; p = 0.002) of acute pontine infarcts. Six variables were entered into the predictive regression model: age, the presence, number and volume of acute pontine infarcts, the number of old infarcts and periventricular white matter hyperintensities scores. The volume of infarcts remained an independent predictor of PSA in the multivariate analysis, with an odds ratio of 3.9 (p = 0.007). The Geriatric Depression Scale, National Institutes of Health Stroke Scale, Barthel Index and Mini-Mental State Examination scores were also entered into the subsequent associative regression model; the volume of acute pontine infarcts remained a significant predictor (odds ratio = 3.8).

CONCLUSIONS

This is the first report of an association between pontine infarcts and the risk of PSA. The results suggest that pontine infarcts may play a role in the development of PSA. The importance of acute pontine infarcts in the pathogenesis of PSA warrants further investigation.

Atrophy of the left dorsolateral prefrontal cortex is associated with poor performance in verbal fluency in elderly poststroke women

This study aimed to investigate the association between atrophy in the prefrontal cortex with executive function and verbal fluency in elderly male and female patients poststroke. Thirty elderly female patients with non-aphasic ischemic stroke aged ≥ 60 years and 30 age-matched non-aphasic male patients with ischemic stroke were recruited. Automatic magnetic resonance imaging segmentation was used to assess the volume of the whole prefrontal cortex, along with its subdivisions: anterior cingulate cortex, orbitofrontal cortex and dorsolateral prefrontal cortex. The Semantic Verbal Fluency Test was administered at 3 and 15 months poststroke. At 3 months poststroke, left dorsolateral prefrontal cortex volume was significantly correlated with Verbal Fluency Test score in female patients only (partial coefficient = 0.453, P = 0.045), after controlling for age, education, diabetes, neurological deficit, white matter lesions volume, as well as the location and volume of infarcts. At 15 months poststroke, there remained a significant association between the left dorsolateral prefrontal cortex volume and Verbal Fluency Test (partial coefficient = 0.661, P = 0.001) and between the left prefrontal cortex volume and Verbal Fluency Test (partial coefficient = 0.573, P = 0.004) in female patients after the same adjustments. These findings indicate that atrophy of the left dorsolateral prefrontal cortex contributes to the impairment of verbal fluency in elderly female patients with stroke. Sex differences may be present in the neuropsychological mechanisms of verbal fluency impairment in patients with stroke.

Launching plasmonic Bloch waves with excited dye molecules

In this paper, we will demonstrate that excited dye molecules can be used to launch the plasmonic Bloch waves (PBWs) propagating at multi-metal-dielectric interfaces. The properties of the PBWs, such as wavevectors, propagating bands, the interface and grating period effect, were characterized by a leakage radiation microscope. Theoretical simulations were also carried out to reveal the properties of the PBWs and were consistent with the experimental results. What is more, experimental results reveal an interesting phenomenon: the PBWs launched by the excited dye molecules present different optical behaviors from those launched by far-field laser beams through attenuated total reflection. The mechanism of this difference was analyzed based on the energy conversion between the optical near-field and far-field. Our work provides a new way to launch the PBWs. Further, the coupling between the dye molecules and PBWs also demonstrates a new method to manipulate the fluorescence emission from random to controllable.

Poststroke fatigue is associated with caudate infarcts

OBJECTIVE

The caudate nucleus may be involved in the pathogenesis of the fatigue observed in neurological disorders. However, the significance of caudate lesions in poststroke fatigue (PSF) is unknown. This study examined the association between caudate infarcts and PSF.

METHODS

Five hundred Chinese patients with acute ischemic stroke admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong participated in the study. All participants were assessed for PSF with the Fatigue Severity Scale (FSS) three months after their index stroke. PSF was defined as a mean FSS score of 4.0 or more. Physical functioning and depressive symptoms were measured by the Barthel Index (BI) and the Geriatric Depression Scale (GDS).

RESULTS

One hundred and twenty-five (25.0%) of the patients had PSF. Compared to the non-fatigue group, the PSF patients were more likely to be women and had hyperlipidemia, lower BI and higher GDS scores. Caudate (8.0% versus 1.3%, p=0.001) and putamen (19.2% versus 12.0%, p=0.043) acute infarcts were more common in the PSF group, whereas pons infarcts (13.6% versus 22.2%, p=0.038) were less common. Acute caudate infarcts remained an independent predictor of PSF in the multivariate analysis, with an odds ratio of 6.4.

CONCLUSIONS

The results suggest that patients with PSF are more likely to have caudate infarcts.

First Report of Cucumber mosaic virus in Desert Rose in Taiwan

Desert rose (Adenium obesum (Forssk.) Roem. & Schult, family Apocynaceae) is native to southeastern Africa, and is a perennial potted ornamental with colorful flowers that are popular in Taiwan. Symptoms of mosaic and chlorotic ringspots and line patterns on leaves were observed in July 2010, on all eight plants in a private garden in Potzu, Chiayi, Taiwan. Spherical virus particles with a diameter of approximately 28 nm were observed in crude sap prepared from symptomatic leaves. Virus culture was established by successive local lesion isolation in Chenopodium quinoa and was maintained in the systemic host Nicotiana tabacum van Hicks. The virus was mechanically transmissible to indicator plants and induced symptoms similar to those incited by Cucumber mosaic virus (CMV). Observed symptoms included local lesions on inoculated leaves of C. amaranticolor and systemic mosaic in Cucumis sativus, Lycopersicon esculentum, N. benthamiana, N. glutinosa, and N. rustica. On N. tabacum, necrotic ringspots developed on inoculated leaves followed by systemic mosaic. Serological tests using ELISA assays and western blotting indicated that the virus reacted positively to a rabbit antiserum prepared to CMV (4). Amplicons of an expected size (1.1 kb) were obtained in reverse transcription-PCR with primers specific to the 3'-half of CMV RNA 3 (3) using total RNA extracted from infected desert rose and N. tabacum. The amplified cDNA fragment was cloned and sequenced (GenBank Accession No. AB667971). Nucleotide sequences of the coat protein open reading frame (CP ORF) (657 nt) had 92 to 96% and 76 to 77% sequence identity to those of CMV in subgroups I (GenBank Accession Nos. NC_001440, D00385, M57602, D28780, and AB008777) and II (GenBank Accession Nos. L15336, AF127976, AF198103, and M21464), respectively. Desert roses infected by Tomato spotted wilt virus (TSWV) (1) and CMV (2) have been reported previously. In spite of the plants showing mosaic symptoms similar to that caused by CMV (2) and chlorotic ringspots and line patterns caused by TSWV (1), only CMV was detected in and isolated from these infected desert roses. However, the possibility of mixed infection of CMV and other viruses were not excluded in this research. To our knowledge, this is the first report of CMV infection in desert rose plants occurring in Taiwan. References: (1) S. Adkins and C. A. Baker. Plant Dis. 89:526, 2005. (2) C. A. Baker et al. Plant Dis. 87:1007, 2003. (3) Y. K. Chen et al. Arch. Virol. 146:1631, 2001. (4) Y. K. Chen and C. C. Yang. Plant Dis. 89:529, 2005.

Classification of probe-based confocal laser endomicroscopy findings in pancreaticobiliary strictures

BACKGROUND AND STUDY AIMS

The accurate diagnosis of indeterminate pancreaticobiliary strictures presents a clinical dilemma. Probe-based confocal laser endomicroscopy (pCLE) offers real-time in vivo microscopic tissue examination that may increase sensitivity for the detection of malignancy. the objective of this study was to develop and validate a standard descriptive classification of pcle in the pancreaticobiliary system.

PATIENTS AND METHODS

A total of 102 patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) with pCLE to assess indeterminate pancreaticobiliary strictures were enrolled in a multicenter registry; 89 of these patients were evaluable. Information and data on the following were collected prospectively: clinical, ERCP, tissue sampling, pCLE, and follow-up. A uniform classification of pCLE findings ("Miami Classification") was developed, consisting of a set of image interpretation criteria. Thereafter, these criteria were tested through blinded consensus review of 112 randomized pCLE videos from 47 patients, and inter-observer variability was assessed in 42 patients .

RESULTS

A consensus definition of the specific criteria of biliary and pancreatic pCLE findings for indeterminate strictures was developed. Single-image interpretation criteria did not have a high enough sensitivity for predicting malignancy. However, combining two or more criteria significantly increased the sensitivity and predictive values. The characteristics most suggestive of malignancy included the following: thick white bands (>20 µm), or thick dark bands (>40 µm), or dark clumps or epithelial structures. These provided sensitivity, specificity, positive predictive value, and negative predictive value of 97%, 33%, 80%, and 80% compared with 48%, 100%, 100%, and 41% for standard tissue sampling methods. Inter-observer variability was moderate for most criteria.

CONCLUSION

The Miami Classification enables a structured, uniform, and reproducible description of pancreaticobiliary pCLE. Combining individual characteristics improves the sensitivity for the detection of malignancy.

First Report of Bidens mottle virus Causing Mosaic and Leaf Deformation in Garland Chrysanthemum and Lettuce in Taiwan

Garland chrysanthemum (Chrysanthemum coronarium) and lettuce (Lactuca sativa) are winter vegetables in Taiwan. Turnip mosaic virus (TuMV) and Lettuce mosaic virus (LMV) were potyviruses commonly isolated from garland chrysanthemum and lettuce, respectively (1). Symptoms of mosaic and deformation in leaves and stunting of plants have been observed in both Compositae crops in the fields since 2007 in the Chiayi area and with an increasing incidence in recent years (26 and 33% in garland chrysanthemum and lettuce, respectively). Filamentous virus particles (approximately 780 × 13 nm) in the crude sap and pinwheel inclusions in infected cells can be observed in the preparations of both diseased hosts with electron microscopy. However, TuMV, LMV, and other potyviruses (Bean yellow mosaic virus, Papaya ringspot virus, and Zucchini yellow mosaic virus) were not detectable in diseased samples by ELISA and western blotting tests, indicating a new potyvirus infection. Virus cultures were isolated from infected garland chrysanthemum and lettuce separately via mechanical inoculations in Chenopodium quinoa. Each isolate was mechanically inoculated to their original host individually and all caused symptoms similar to that observed in the field, indicating their pathogenicity to their original host. A cDNA fragment consisting of partial nuclear inclusion (NIb) and coat protein (CP) genes were amplified with potyvirus degenerate primers (forward: 5'-GGBAAYAATAGTGGNCAACC and reverse: 5'-GGGGAGGTGCCGTTCTCDATRCACCA) and was found to share 90% nucleotide sequence identity to that of Bidens mottle virus (BiMoV; GenBank Accession No. AF538686). The sequences of the CP gene and 3' untranslated region (3'-UTR) of tested viruses were further amplified with a specific primer of BiMoV CP and oligo-dT in reverse transcription-PCR. The amplified fragments were cloned, sequenced, and the combined cDNA sequences were deposited in GenBank (Accession No. AB491763 for isolate garland chrysanthemum and Accession No. AB491764 for isolate lettuce). Sequence analysis showed that both cloned sequences shared more than 97% nucleotide similarity to that of BiMoV. The amino acid sequence of the CP of both isolates shared a 99.3% identity and a 98.9 to 99.3% identity to that of other BiMoV isolates deposited in GenBank. BiMoV was first described to be infecting lettuce and Cichorium endivia in the United States (4) and was first reported in sunflower and calendula in Taiwan recently (2,3). To our knowledge, this is the first report of the occurrence of BiMoV in garland chrysanthemum and lettuce in Taiwan. References: (1) Y. K. Chen et al. Plant Pathol. Bull. 5:55,1996. (2) C.-H. Huang and F.-J. Jan. Plant Dis. 95:362, 2011. (3) J. Y. Liao et al. Arch. Virol. 154:723, 2009. (4) F. Youssef et al. Arch. Virol 153:227, 2008.

First Report of Group 16SrXII Phytoplasma Associated with Papaya Yellows in Taiwan

Phytoplasmas have been reported to cause various disorders in papaya (Carica papaya L.), including dieback, mosaic, and yellow crinkle in Australia, Nivun Haamir dieback in Israel, and bunchy top-like disease in Cuba (1). Papaya is an economically important crop in Taiwan, and therefore, is monitored for viral infections. In 2005, papaya plants showing chlorosis, yellows and shriveling of leaves, dieback and lateral growth of branches, bending of apical branches, latexosis of fruits, and brown necrosis in phloem tissues were observed in southern Taiwan. Examination by an electron microscope revealed the presence of pleomorphic phytoplasma cells in sieve tubes of the phloem of petioles and leaf veins of diseased plants. Total DNA was extracted individually from at least three diseased plants at each location with a commercial DNA preparation kit (Axygen Scientific, Union City, CA) and used for amplification of the phytoplasma 16S rRNA gene in PCR with universal primer pairs P1 and Tint (3). The full-length 16S rRNA gene has been amplified and cloned. Sequence analysis revealed that the fragment was 1,581 bp long (GenBank Accession No. AJ919994) and shared 99.6% sequence identity with that of the 'Candidatus Phytoplasma solani' reference strain (GenBank Accession No. AF248959). A virtual restriction fragment length polymorphism analysis of the 16S rDNA sequence amplified from the R16F2n/R16R2 primers (2) was performed with iPhyClassifier (4) and pDRAW32. In silico restriction analysis identified the studied papaya phytoplasma as a subgroup 16SrXII-A strain. The sequence had 97 to 98% sequence identity with papaya phytoplasmas of the 16SrXII group in Australia (GenBank Accession No. Y10095), Israel (GenBank Accession No. AY903951), and Cuba (GenBank Accession No. AY725234). The disease incidence was 30 to 35% during the 2006 to 2010 growing seasons, and field surveys indicated that the disease has spread to central Taiwan with sporadic occurrence in recent years. To our knowledge, this is the first report of phytoplasma associated with papaya yellows in Taiwan. References: (1) Y. Arocha et al. Int. J. Syst. Evol. Microbiol. 55:2451, 2005. (2) I. M. Lee et al. Int. J. Syst. Bacteriol. 48:1153, 1998. (3) C. D. Smart et al. Appl. Environ. Microbiol. 62:2988, 1996. (4) Y. Zhao et al. Int. J. Syst. Evol. Microbiol. 59:2582, 2009.