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Normal pressure hydrocephalus (NPH) is a neurological disorder characterized by altered cerebrospinal fluid accumulation in the brain’s ventricles, leading to symptoms such as gait disturbance and cognitive impairment. Artificial intelligence (AI), including machine learning (ML) and deep learning (DL), shows promise in diagnosing NPH using medical images. In this systematic review, we examined 21 papers on the use of AI in detecting NPH. The studies primarily focused on differentiating NPH from other neurodegenerative disorders, such as Parkinson’s disease and Alzheimer’s disease. We found that traditional ML methods like Support Vector Machines, Random Forest, and Logistic Regression were commonly used, while DL methods, particularly Deep Convolutional Neural Networks, were also widely employed. The accuracy of these approaches varied, ranging from 70% to 95% in differentiating NPH from other conditions. Feature selection techniques were used to identify relevant parameters for diagnosis. MRI scans were more frequently used than CT scans, but both modalities showed promise. Evaluation metrics like Dice similarity coefficients and ROC-AUC were the most typical metrics of model performance. Challenges in implementing AI in clinical practice were identified, and the authors suggested that a hybrid deep-traditional ML framework could enhance NPH diagnosis. Further research is needed to maximize the benefits of AI while addressing limitations.

Cerebral white matter hyperintensities (WMHs) and cognitive impairment are common in elderly hypertensive patients, and more needs to be learned about their prevention and treatment. Our aim was to investigate the effect of low-dose statins on WMH and cognitive function in elderly patients undergoing antihypertensive treatment. A total of 732 elderly hypertensive patients taking hydrochlorothiazide as their baseline medication were randomized using a 2 × 2 factorial design with antihypertensive (telmisartan vs. placebo) and lipid-modulating (low-dose rosuvastatin vs. placebo) arms. Brain magnetic resonance imaging (MRI) and cognitive function data were obtained. After a mean follow-up time of 59.8 (range 12-65) months, there were no differences in WMH progression and cognitive function decline over time between the groups in the antihypertensive arm. The risks of new-incident WMH Fazekas scale scores ≥ 2 and the incidence of cognitive impairment did not differ between the telmisartan and placebo groups. Rosuvastatin use was associated with lower risks of new-incident Fazekas scale scores ≥2 (hazard ratio = 0.500; 95% confidence interval: 0.34-0.74) and cognitive impairment (hazard ratio = 0.54; 95% confidence interval: 0.36-0.80). Telmisartan interacted with rosuvastatin on reducing WMH progression and cognitive function decline. Findings suggest that low-dose rosuvastatin could reduce WMH progression and cognitive function decline in antihypertensive patients, as demonstrated by the interaction between telmisartan and low-dose rosuvastatin to this effect.

Background Statins have been recommended by several guidelines as the primary prevention medication for cardiovascular diseases. However, the benefits of statin therapy for cerebral small vessel disease (CSVD), particularly in adults ≥75 years of age, have not been fully evaluated. Methods We analyzed the data from a prospective population-based cohort study and a randomized, double-blind, placebo-controlled clinical trial to determine whether statin therapy might aid in slowing the progression of CSVD in adults ≥75 years of age. For the cohort study, 827 participants were considered eligible and were included in the baseline analysis. Subsequently, 781 participants were included in follow-up analysis. For the clinical trial, 227 participants were considered eligible and were used in the baseline and follow-up analyses. Results The white matter hyperintensities (WMH) volume, the WMH-to-intracranial volume (ICV) ratio, the prevalence of a Fazekas scale score ≥ 2, lacunes, enlarged perivascular spaces (EPVS), and microbleeds were significantly lower in the statin group than the non-statin group at baseline in the cohort study (all P  < 0.05). During the follow-up period, in both the cohort and clinical trial studies, the WMH volume and WMH-to-ICV ratio were significantly lower in the statin/rosuvastatin group than the non-statin/placebo group (all P  < 0.001). Statin therapy was associated with lower risk of WMH, lacunes, and EPVS progression than the non-statin therapy group after adjustment for confounders (all P  < 0.05). There was no statistically significant difference in the risk of microbleeds between the statin and non-statin therapy groups (all, P  > 0.05). Conclusions Our findings indicated that statin therapy alleviated the progression of WMH, lacunes, and EPVS without elevating the risk of microbleeds. On the basis of the observed results, we concluded that statin therapy is an efficient and safe intervention for CSVD in adults ≥75 years of age. Trial registration Chictr.org.cn: ChiCTR-IOR-17013557 , date of trial retrospective registration November 27, 2017 and ChiCTR-EOC-017013598 , date of trial retrospective registration November 29, 2017.

Background It is unclear whether excessive salt intake accelerates the progression of cerebral small vessel disease (CSVD). The major objective of this study was to investigate the harmful effect of excessive salt intake on the progression of CSVD in older individuals. Methods Between May 2007 and November 2010, 423 community-dwelling individuals aged 60 years and older were recruited from the Shandong area, China. Salt intake was estimated using 24-hour urine collection for 7 consecutive days at baseline. Participants were classified into low, mild, moderate and high groups according to the salt intake estimation. CSVD including white matter hyperintensities (WMHs), lacunes, microbleeds and an enlarged perivascular space (EPVS) were determined using brain magnetic resonance imaging. Results During an average of five years of follow-up, the WMH volume and WMH-to-intracranial ratio were increased in the four groups. However, the increasing trends in the WMH volume and WMH-to-intracranial ratio were significantly faster in the higher salt intake groups compared with the lower salt intake groups ( P adjusted < 0.001). The cumulative hazard ratios of new-incident WMHs (defined as those with Fazekas scale scores ≥ 2), new-incident lacunes, microbleeds or an EPVS, as well as composites of CSVD, were respectively 2.47, 2.50, 3.33, 2.70 and 2.89 for the mild group; 3.72, 3.74, 4.66, 4.01 and 4.49 for the moderate group; and 7.39, 5.82, 7.00, 6.40 and 6.61 for the high group, compared with the low group after adjustment for confounders ( P adjusted < 0.001). The risk of new-incident WMHs, lacunes, microbleeds or an EPVS, and composites of CSVD was significantly increased with each 1-standard-deviation increment in salt intake ( P adjusted < 0.001). Conclusion Our data indicates that excessive salt intake is an important and independent contributor to the progression of CVSD in older adults.

This study aimed to investigate the relationship between cerebral small vessel disease (CSVD) and orthostatic hypotension (OH) using self-measured blood pressure at home in community-dwelling older subjects. Between May 2016 and October 2018, 663 community-dwelling adults aged ≥60 years were enrolled in Shandong, China. CSVD, including white matter hyperintensities (WMHs), lacunes, enlarged Virchow–Robin spaces (EVRS) and microbleeds, was assessed using brain magnetic resonance imaging. After receiving appropriate training, the subjects participated in “home-measured (H)OH” by themselves for three consecutive days. Participants were classified into no-HOH, 1 HOH, and ≥2 HOH episode groups according to the presence of HOH episodes. The WMH volume, WMH-to-total intracranial volume (TIV) ratio, total numbers of lacunes and EVRS, and prevalence of Fazekas scale score ≥2, lacunes, and EVRS were elevated in the 1 and ≥2 HOH episode groups compared with the no-HOH episode group (P < 0.05). The prevalence and total number of microbleeds were significantly higher in the ≥2 HOH episodes group than in the no-HOH and 1 HOH episode groups (P < 0.05). HOH episodes were significantly associated with WMH volume, WMH-to-TIV ratio, and the total numbers of lacunes, EVRS, and microbleeds after adjustment for confounders (P < 0.05). The risks of Fazekas scale score ≥2, lacunes, EVRS, and microbleeds were 2.123-, 1.893-, 2.162-, and 1.656-fold higher in the 1 HOH episode group and 4.910-, 5.359-, 3.048-, and 2.418-fold higher in the ≥2 HOH episodes group, respectively, than those in the no-HOH group. The presence of HOH episodes was an independent risk factor for CSVD in the community-based older population.

Objective: To investigate the effect of telmisartan, rosuvastatin, or their combination on dementia and to understand the impact of Apolipoprotein E (APOE) genotype on the effect of the medications in older patients with hypertension. Methods: This is a double-blind, randomized, and placebo-controlled trial using a 2-by-2 factorial design. Between April 2008 and November 2010, 1244 hypertensive patients aged ≥60 years without cognitive impairment were recruited from communities in six cities in Shandong area, China. Patients were randomized into telmisartan and rosuvastatin administration after a 2-week washout period. APOE genotype was identified at the baseline. Possible dementia was determined using the combination of the global cognitive function and Assessment of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Results: Over an average follow-up of 7 (IQR: 6.7–7.2) years, telmisartan and rosuvastatin significantly reduced the cognitive impairment progression and the incidence of dementia. There was a synergistic interaction between telmisartan and rosuvastatin to reduce the cognitive impairment and the incidence of dementia (Padjusted <0.001). The cognitive impairment progression and the risk of dementia were higher in the hypertensive patients with APOE ε4 allele than in those without APOE ε4 allele. Rosuvastatin medication significantly alleviated the cognitive impairment progression and the risks of dementia in patients with APOE ε4 allele. Conclusion: The combination of telmisartan and rosuvastatin might be an effective prevention and/or treatment strategy for cognitive impairment and dementia, especially in the hypertensive patients with APOE ε4 allele.

Background: The large-scale National Lung Cancer Screening Trial demonstrated an increased detection of early-stage lung cancers using low-dose computed tomography scan in the screening population. It also demonstrated a 20% reduction of lung cancer-related deaths in these patients. Aims: Although both solid and subsolid lung nodules are evaluated in studies, subsolid and partially calcified lung nodules are often overlooked. Materials and Methods: We reviewed transthoracic fine-needle aspiration (FNA) cases from lung nodule patients in our clinics and correlated cytological diagnoses with radiologic characteristics of lesions. A computer search of the pathology archive was performed over a period of 12 months for transthoracic FNAs, including both CT- and ultrasound-guided biopsies. Results: A total of 111 lung nodule cases were identified. Lesions were divided into three categories: solid, subsolid, and partially calcified nodules according to radiographic findings. Of 111 cases, the average sizes of the solid (84 cases), subsolid (22 cases), and calcified (5 cases) lesions were 1.952 ± 2.225, 1.333 ± 1.827, and 1.152 ± 1.984 cm, respectively. The cytological diagnoses of three groups were compared. A diagnosis of malignancy was made in 64.28% (54 cases) in solid, 22.72% (5 cases) in subsolid, and 20% (1 case) in partially calcified nodules. Among benign lesions, eight granulomatous inflammations were identified, including one case of solid, five cases of subsolid, and two cases of calcified nodules. Conclusions: Our study indicates that solid nodules have the highest risk of malignancy. Furthermore, the cytological evaluation of subsolid and partially calcified nodules is crucial for the accurate diagnosis and appropriate clinical management of lung nodule patients.

We tested the hypothesis that the negative functional effects of cyclic GMP (cGMP) would be greater after increasing cyclic AMP (cAMP), because of the action of cGMP-affected cAMP phosphodiesterases in cardiac myocytes and that this effect would be altered in left ventricular hypertrophy (LVH) produced by aortic valve plication. Myocyte shortening data were collected using a video edge detector, and O 2 consumption was measured by O 2 electrodes during stimulation (5 ms, 1 Hz, in 2 mM Ca 2+ ) from control (n = 7) and LVH (n = 7) dog ventricular myocytes. cAMP and cGMP were determined by a competitive binding assay. cAMP was increased by forskolin and milrinone (10 -6 M). cGMP was increased with zaprinast and decreased by 1H-[1,2,4]oxadiazolo[4,3-a]quinoxilin-1-one (ODQ) both at 10 -6 and 10 -4 M, with and without forskolin or forskolin + milrinone. Zaprinast significantly decreased percent shortening in control (9 ± 1 to 7 ± 1%) and LVH (10 ± 1 to 7 ± 1%) myocytes. It increased cGMP in control (36 ± 5 to 52 ± 7 fmol/10 5 myocytes) and from the significantly higher baseline value in LVH (71 ± 12 to 104 ± 18 fmol/10 5 myocytes). ODQ increased myocyte function and decreased cGMP levels in control and LVH myocytes. Forskolin + milrinone increased cAMP levels in control (6 ± 1 to 15 ± 2 pmol/10 5 myocytes) and LVH (8 ± 1 to 18 ± 2 pmol/10 5 myocytes) myocytes, as did forskolin alone. They also significantly increased percent shortening. There were significant negative functional effects of zaprinast after forskolin + milrinone in control (15 ± 2 to 9 ± 1%), which were greater than zaprinast alone, and LVH (12 ± 1 to 9 ± 1%). This was associated with an increase in cGMP and a reduction in the increased cAMP induced by forskolin or milrinone. ODQ did not further increase function after forskolin or milrinone in control myocytes, despite lowering cGMP. However, it prevented the forskolin and milrinone induced increase in cAMP. In hypertrophy, ODQ lowered cGMP and increased function after forskolin. ODQ did not affect cAMP after forskolin and milrinone in LVH. Thus, the level of cGMP was inversely correlated with myocyte function. When cAMP levels were elevated, cGMP was still inversely correlated with myocyte function. This was, in part, related to alterations in cAMP. The interaction between cGMP and cAMP was altered in LVH myocytes.Key words: second messengers, cyclic AMP, cyclic GMP, cardiac myocyte function, cyclic GMP dependent cyclic-AMP phosphodiesterases, left ventricular hypertrophy, dog.

Purpose To analyze CT characteristics of primary clear cell carcinoma of the liver (PCCCL) and improve the current understanding and diagnose accuracy of the tumor. Methods Pre- and post-contrast CT images of 19 patients with pathology proven PCCCL were retrospectively analyzed. The clinical data and CT findings as well as relevant literature reports were reviewed. Results Thirteen patients were tested positive for HBsAg, and two patients were positive for HCVAb. The serum alpha-fetoprotein (AFP) levels of most tumors (14/19) were ≤20 ng/ml with 14 cases were associated with liver cirrhosis. All lesions were solitary intraparenchymal mass lesions which have well-defined boarders. On pre-contrast CT scans, 15 lesions appeared as hypo-attenuation and four lesions appeared as isointensity to the adjacent liver parenchyma. On post-contrast CT scans, 16 lesions showed avid enhancement on the hepatic arterial phase, of which 6 lesions were hypo-attenuation, and 10 lesions remained slightly hyper-attenuation or iso-attenuation on the portal venous phase images. Three lesions showed only mild enhancement on the hepatic arterial phase and hypo-attenuation on the portal venous phase. All lesions demonstrated hypointensity on the equilibrium phase. There are 12 lesions showed pseudocapsules. None of patients showed signs of portal vein thrombosis. There was no distal metastasis except only one patient had lymph node metastasis. Conclusion The characteristics of CT imaging of PCCCL, such as tend to form pseudocapsules and less involved with vascular invasion, could be useful in differentiating from common type hepatocellular carcinoma (CHCC). Some CT imaging characteristics of PCCCL are similar to CHCC, such as prone to occur in patients with liver cirrhosis and early enhancement pattern on the hepatic arterial phase as well as hypo-attenuation on the equilibrium phase. Those features could be useful in differentiating PCCCL from other liver tumors, such as hemangioma and hepatic metastases.

The hypotheses are can a diet, deficient in essential fatty acids (EFA) alter: (1) the lipid profile and the membrane fluidity of the membrane of ventricular myocyte isolated from both rat and a hibernator (Marmota flaviventris); (2) the kinetics of the membrane bound L-type calcium channels; (3) the hypothermia tolerance of these channels; and (4) the intracellular calcium homeostasis of the myocyte. Animals were maintained on an essential EFA deficient (EFAD) diet and single ventricular myocytes were then isolated enzymatically. Electrophysiological, lipid biochemical, and fluorescent spectrophotometrical methods were used in this two-part study. The first part of the study examines the lipids composition and the fluidity of these myocyte membranes. The second part looks at the L-type calcium current (I $\\sb{\\rm Ca}$ ) and intracellular calcium homeostasis. There were no significant differences in total myocyte membrane neutral and phospholipids of either rats or marmots between control and EFAD groups. However, unsaturated EFAs associated with both neutral lipids and phospholipids were significantly decreased in EFAD animals. The myocyte membrane fluidity for EFAD animals were greatly decreased, especially at low temperatures. The results of the study of I $\\sb{\\rm Ca}$show, in EFAD animals, that there are general slowing in the rate of decay of I $\\sb{\\rm Ca}$ , decreasing in the peak current amplitude, and shifting to more positive membrane potential of the voltage dependence of activation and steady-state inactivation of the I $\\sb{\\rm Ca}$ . The myocytes from these animals also had a prolonged action potential. The resting intracellular calcium concentration of these myocytes are also elevated. Nevertheless, the extent of all the above changes in marmot is significantly less than that seen in rat, particularly at low temperatures. These data suggest that dietary lipids can modify the composition and some physical properties of mammalian myocyte membrane. This alteration could significantly change the electrical properties of L-type calcium channel and other cellular functions, regardless of the species differences.