Spatiotemporal Dynamics of Cerebral Vascular Permeability in Type 2 Diabetes-Related Cerebral Microangiopathy

AimsDiabetes-related cerebral microangiopathy can manifest as cerebral small vessel disease (CSVD) and exhibit cognitive decline. To find the early change of function in advance, this study examined the spatiotemporal dynamics of cerebral vascular permeability (Ktrans) in the progression of type 2 diabetes mellitus (T2DM).MethodsKtrans was cross-sectionally measured in T2DM and non-diabetes groups with or without CSVD using dynamic contrast-enhanced MRI (DCE-MRI).ResultsIn all patients with T2DM, the Ktrans of white matter (WM) was increased, whereas the Ktrans of gray matter (GM) was increased only in T2DM with CSVD. The involvement of WM was earlier than GM and was before the CSVD features could be visualized on MRI. Among the commonly available four CSVD items of MRI, microbleeds were the most sensitive, indicating the increased permeability in all patients. Increased Ktrans in T2DM was more associated with moderate WM hyperintensity but less with the presence of lacunae or multiple perivascular spaces, in contrast to patients without diabetes. The differential correlation suggested distinct mechanisms underlying diabetes-related CSVD and other CSVDs.ConclusionsThis study highlights the early development of cerebral microangiopathy with increased BBB leakage in T2DM, before the CSVD features can be visualized on MRI. The results may increase the proactivity of clinicians in recognizing the subsequent neurological comorbidities.

Use of serious games in medicine: a literature revision

It is noticeable that more and more medical professionals have been searching for strategies to keep people engaged both in the recovery processes (cognitive or physical) and in the teaching part. It is possible to observe that the insertion of Serious Games has been offering this innovative possibility, which allows the development of new possibilities for several areas of knowledge. This study aims to carry out a review on the use of Serious Games in Medicine, exploring how the method has been used. The methodology used was a systematic review. Articles published from 2015 to 2020 in indexed in three databases such as IEEE, Scopus, Scielo, among others, were searched. If used correctly, the Serious Games can help in the rehabilitation process of patients affected by some sequelae caused by stroke (CVA - Cerebral Vascular Accident), and also in the rehabilitation process of people with degenerative problems. It was also possible to observe that SG can be used as motivating and engaging tools for medical students.

The adducin saga: Pleiotropic genomic targets for precision medicine in human hypertension; vascular, renal, and cognitive diseases

Hypertension is a leading risk factor for stroke, heart disease, chronic kidney disease, vascular cognitive impairment, and Alzheimer's disease. Previous genetic studies have nominated hundreds of genes linked to hypertension and renal and cognitive diseases. Some have been advanced as candidate genes by showing that they can alter blood pressure or renal and cerebral vascular function in knockout animals; however, final validation of the causal variants and underlying mechanisms have remained elusive. This review chronicles 40 years of work, from the initial identification of adducin (ADD) as an ACTIN-binding protein suggested to increase blood pressure in Milan hypertensive rats, to the discovery of a mutation in ADD1 as a candidate gene for hypertension in rats that were subsequently linked to hypertension in man. More recently, a recessive K572Q mutation in ADD3 was identified in Fawn-Hooded Hypertensive (FHH) and Milan Normotensive (MNS) rats that develop renal disease, which is absent in resistant strains. ADD3 dimerizes with ADD1 to form functional ADD protein. The mutation in ADD3 disrupts a critical ACTIN-binding site necessary for its interactions with actin and spectrin to regulate the cytoskeleton. Studies using Add3 knockout and transgenic strains, as well as a genetic complementation study in FHH and MNS rats, confirmed that the K572Q mutation in ADD3 plays a causal role in altering the myogenic response and autoregulation of renal and cerebral blood flow, resulting in increased susceptibility to hypertension-induced renal disease and cerebral vascular and cognitive dysfunction.

Twiglike MCA: A Not-So-Common Cerebral Vascular Anomaly

Congenital anomalies of the MCA are rare compared with the rest of the intracranial vasculature. An aplastic MCA, known as a twiglike MCA, is the result of replacement of MCA trunk by a plexiform network of small vessels. In this report, we aim to review the radiologic features of a twiglike MCA and its differential diagnosis, helping the reader differentiate this entity from more common pathologies to avoid unnecessary further investigation.

Explore the correlation between cerebral vessel characteristics with cognitive impairment among elder individuals: a community study from China

Background Brain Magnetic Resonance Imaging (MRI) examination of cerebral small vessel disease (CSVD) may help screen vascular cognitive impairment. A recently estimated CSVD score system was suggested to capture the overall CSVD burden. The study aimed to detect the association between systemic evaluation score of cerebral vascular imaging parameters with cognitive functions. Methods This was a cross-sectional study in community settings. From October 2017 to September 2018, elder (≧60) residents were recruited through on-site visit in 6 communities from Shanghai, China. The participants underwent brain MRI, carotid ultrasound, laboratory tests of blood and urine samples. Cognitive function was evaluated using Mini-Mental State Examination (MMSE). MRI score of CSVD was calculated according to the 2012 standard for the evaluation of statistical changes in imaging. Results Total 171 subjects completed survey and examinations. There were 55 participants diagnosed with cognitive impairment, with a total percentage of 32.2%. Participants with and without cognitive impairment showed significant differences in age, BMI and education level. Cognitive impaired participant had more disease history/comorbidity of hypertension and chronic renal insufficiency, higher level of creatinine, as well as lower level of full blood count (FBC) and alanine aminotransferase (ALT). A significant difference was detected in CSVD score between participants with and without cognitive impairment. Results of linear regression analysis showed significant negative correlations between MMSE score and both left and right carotid artery peak systolic velocity (PSV), however the CSVD score was only borderline (P = 0.0566) positively correlated with MMSE. Multivariate linear correlation analysis including all collected risk factor data showed that left carotid artery PSV score was among the independent negative correlated factors of MMSE. Multivariate binary logistic analysis showed that age, education and history of hypertension were the only statistically associated factors of cognitive impairment. Conclusions The current study identified high prevalence of cognitive impairment in a Chinese community. In addition, correlations between cerebral vascular disease imaging status and cognitive functions were confirmed although the sample size limited the possibility of screening cognitive impairment with imaging technique.

Abstract 9114: Impact of the Number of Prehospital Defibrillation Attempts on Neurologically Intact Survival in Patients With Out-of-Hospital Cardiac Arrest and Shockable Rhythm

Background: Early return of spontaneous circulation (ROSC) leads to survival with a favorable neurologic outcome in patients with out-of-hospital cardiac arrest (OHCA). For the early ROSC, defibrillation plays a crucial role for OHCA with shockable rhythm. However, little is known about the relation between the number of prehospital defibrillation attempts or etiology of OHCA and neurologically intact survival. Methods: Using a nationwide OHCA registry database from 2005 to 2017 in Japan, a cohort of 1,527,447 patients with OHCA were retrospectively analyzed. We included the patients of witnessed OHCAs with initial shockable rhythm. The relation between early ROSC, defined as prehospital ROSC achieved with defibrillation ≤3 times without adrenaline, and a neurologically intact survival rate (cerebral performance category score of 1 or 2 at 1 month) was evaluated. We also analyzed factors related to the successful early ROSC, including etiology of OHCA. Results: A total of 75,342 patients were included. Among patients with OHCA and prehospital ROSC, neurologically intact survival rates were better in patients who achieved early ROSC than their counterpart (62% vs. 36%, p<0.001). Success in early ROSC was an independent predictor of neurologically intact survival after adjustment of multiple cofounders (Table). Multivariate analysis showed cerebral vascular disease as an etiology of OHCA was a predictor of early ROSC (odds ratio 1.15, 95% confidence interval 1.03-1.29, p=0.02), but was significantly associated with a poor neurologic outcome at 1 month (Table). Conclusions: Success in early ROSC was associated with neurologically intact survival in patients with OHCA and initial shockable rhythm. Patients with OHCA due to cerebral vascular disease were likely to be resuscitated from cardiac arrest by defibrillations but had a poor neurologic outcome.

Risk factors for ischemic stroke. The role of vitamin D

Introduction. The prevalence of cerebral vascular diseases is steadily increasing worldwide. Cerebral stroke represents the most serious of them, being one of the leading causes of mortality and disability of the population. Reduction of morbidity and mortality from stroke can be achieved by improving preventive measures aimed at the correction of risk factors. The review presents domestic and foreign literature data on the risk factors of ischemic stroke and the system of primary prevention of acute ischemic brain lesions. Materials and methods. Data from eLibrary, MedLine, Scopus, Springerlink, and the scientific electronic library «Cyberleninka» were analyzed. Results and Discussion. The authors give an overview of pathological conditions that can lead to the development of cerebral vascular accident. Methods of primary prevention of ischemic stroke are considered in accordance with the European guidelines on stroke management. Current views on the correction of modifiable risk factors (arterial hypertension, diabetes mellitus, hyperlipidemia, heart and vascular pathology, etc.) are presented. Recommendations on lifestyle and body weight reduction are given. In addition to the well-known information, the authors present the data of new studies on the role of vitamin D in the ischemic cascade and consider the possible pathogenetic mechanisms of this effect. The review also provides information on the association of vitamin D deficiency with other pathological conditions that are the causes of ischemic stroke and the effect of vitamin D on the volume of ischemic lesions, the severity of the outcome and the risks of repeated vascular accidents. Conclusion. The study of risk factors for ischemic stroke and the development of primary prevention methods is one of the priority areas of modern neurology, since it will improve the system of care for patients with cerebrovascular disease.