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A three-dimensional (3D) continuous pulse arterial spin labeling (ASL) technique was used to investigate cerebral blood flow (CBF) changes in patients with Alzheimer's disease (AD), amnestic mild cognitive impairment (aMCI), and age- and sex-matched healthy controls. Three groups were recruited for comparison, 24 AD patients, 17 MCI patients, and 21 age- and sex-matched control subjects. Three-dimensional ASL scans covering the entire brain were acquired with a 3.0 T magnetic resonance scanner. Spatial processing was performed with statistical parametric mapping 8. A second-level one-way analysis of variance analysis (threshold at P<0.05) was performed on the preprocessed ASL data. An average whole-brain CBF for each subject was also included as group-level covariates for the perfusion data, to control for individual CBF variations. Significantly increased CBF was detected in bilateral frontal lobes and right temporal subgyral regions in aMCI compared with controls. When comparing AD with aMCI, the major hyperperfusion regions were the right limbic lobe and basal ganglia regions, including the putamen, caudate, lentiform nucleus, and thalamus, and hypoperfusion was found in the left medial frontal lobe, parietal cortex, the right middle temporo-occipital lobe, and particularly, the left anterior cingulate gyrus. We also found decreased CBF in the bilateral temporo-parieto-occipital cortices and left limbic lobe in AD patients, relative to the control group. aMCI subjects showed decreased blood flow in the left occipital lobe, bilateral inferior temporal cortex, and right middle temporal cortex. Our results indicated that ASL provided useful perfusion information in AD disease and may be used as an appealing alternative for further pathologic and neuropsychological studies, especially of compensatory mechanisms for cerebral hypoperfusion.

Purpose. The aim of the present study was to evaluate the relationship of fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVH) with haemodynamic abnormality and severity of arterial stenosis in patients with transient ischemic attack (TIA) of the carotid artery system. Patients and Methods. Consecutive inpatients (N = 38) diagnosed with TIAs of the carotid system in a 4-year period (2014–2017) were retrospectively analysed in our study and divided into FVH-negative and FVH-positive groups based on the presence of FVH sign. Each inpatient had undergone magnetic resonance imaging (MRI) followed by computed tomography (CT) perfusion imaging studies. We investigated the degree of arterial stenosis, number of stenosis, watershed regions, and related CT perfusion indexes, including hypoperfusion regions, mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume (CBV). Spearman rank correlation was performed between FVHs score, the degree of arterial stenosis, and CT perfusion indexes with significant difference. Results. Thirty-one patients (81.6%) observed with FVH sign were assigned to the FVH-positive group. The hypoperfusion regions, MTT, and CBF values were significantly different between the FVH-negative group and FVH-positive groups. Spearman correlation analysis showed significant positive correlations between hypoperfusion regions, MTT, and FVHs scores (r = 0.755 and 0.674, respectively, p<0.01); a moderate negative correlation was found between CBF and FVHs scores (r = −0.525, p<0.01), whereas the degree of artery stenosis revealed no significant correlation with FVH scores (r = 0.253, p>0.05). Conclusion. Hyperintense vessels on FLAIR were closely associated with hypoperfused regions, MTT, and CBF values, which indicated that the presence of FVHs could be an important and convenient imaging marker of haemodynamic impairment in patients with TIA.

Background Progressive supranuclear palsy (PSP) is a rare movement disorder with poor prognosis. This retrospective study aimed to characterize the natural history of PSP and to find predictors of shorter survival and faster decline of activity of daily living. Method All patients recruited fulfilled the movement disorder society (MDS) clinical diagnostic criteria for PSP (MDS-PSP criteria) for probable and possible PSP with median 12 years. Data were obtained including age, sex, date of onset, age at onset (AAO), symptoms reported at first visit and follow-up, date of death and date of institutionalization. Magnetic resonance imaging was collected at the first visit. Endpoints were death and institutionalization. Kaplan-Meier method and Cox proportional hazard model were used to explore factors associated with early death and institutionalization. Results Fifty-nine patients fulfilling MDS-PSP criteria were enrolled in our study. Nineteen patients (32.2%) had died and 31 patients (52.5%) were institutionalized by the end of the follow-up. Predictors associated with poorer survival were late-onset PSP and decreased M/P area ratio. Predictors associated with earlier institutionalization were older AAO and decreased M/P area ratio. Conclusion Older AAO and decreased M/P area ratio were predictors for earlier dearth and institutionalization in PSP. The neuroimaging biomarker M/P area ratio was a predictor for prognosis in PSP.

Background： This study was to investigate the relationship among aortic artery calcification （AAC）, cardiac valve calcification （CVC）, and mortality in maintenance hemodialysis （MHD） patients. Methods： All MHD patients in Shanghai Ruijin Hospital in July 2011 were included. To follow up tbr 42 months, clinical data, predialysis blood tests, echocardiography, and lateral lumbar X-ray plain radiography results were collected. Plasma FGF23 level was measured using a C-terminal assay. Results： Totally, 110 MHD patients were involved in this study. Of which, 64 （58.2%） patients were male, the mean age was 55.2 ± 1.4 years old, and the median dialysis duration was 29.85 （3.0-225.5） months. About 25.5% of the 110 MHD patients had CVC from echocardiography while 61.8% of the patients had visible calcification of aorta from lateral lumbar X-ray plain radiography. After 42 months follow-up, 25 （22.7%） patients died. Kaplan-Meier analysis showed that patients with AAC or CVC had a significant greater number of all-cause and cardiovascular deaths than those without. In multivariate analyses, the presence of AAC was a significant factor associated with all-cause±mortality （hazard ratio [HR]： 3.149, P = 0.025） in addition to lower albumin level and lower 25-hydroxy Vitamin D （25（OH）D） level. The presence of CVC was a significant factor associated with cardiovascular mortality （HR： 3.800, P - 0.029） in addition to lower albumin level and lower 25（OH）D level. Conclusion： Lateral lumbar X-ray plain radiography and echocardiography are simple methods to detect AAC and CVC in dialysis patients. The presence of AAC and CVC was independently associated with mortality in MHD patients. Regular follow-up by X-ray and echocardiography could be a useful method to stratify mortality risk in MHD patients.

BackgroundThe role of minimally invasive surgery using robotics versus laparoscopy in resectable gastric cancer patients with a high body mass index (BMI) remains controversial.MethodsA total of 482 gastric adenocarcinoma patients with BMI ≥ 25 kg/m2 who underwent minimally invasive radical gastrectomy between August 2016 and December 2019 were retrospectively analyzed, including 109 cases in the robotic gastrectomy (RG) group and 321 cases in the laparoscopic gastrectomy (LG) group. Propensity score matching (PSM) with a 1:1 ratio was performed, and the perioperative outcomes, lymph node dissection, and 3-year overall survival (OS) and disease-free survival (DFS) rates were compared.ResultsAfter PSM, 109 patients were included in each of the RG and LG groups, with balanced baseline characteristics. Compared with the LG group, the RG group had similar intraoperative estimated blood loss [median (IQR) 30 (20–50) vs. 35 (30–59) mL, median difference (95%CI) − 5 (− 10 to 0)], postoperative complications [13.8% vs. 18.3%, OR (95%CI) 0.71 (0.342 to 1.473)], postoperative recovery, total harvested lymph nodes [(34.25 ± 13.43 vs. 35.44 ± 14.12, mean difference (95%CI) − 1.19 (− 4.871 to 2.485)] and textbook outcomes [(81.7% vs. 76.1%, OR (95%CI) 1.39 (0.724 to 2.684)]. Among pathological stage II–III patients receiving chemotherapy, the initiation of adjuvant chemotherapy in the RG group was similar to that in the LG group [median (IQR): 28 (25.5–32.5) vs. 32 (27–38.5) days, median difference (95%CI) − 3 (− 6 to 0)]. The 3-year OS (RG vs. LG: 80.7% vs. 81.7%, HR = 1.048, 95%CI 0.591 to 1.857) and DFS (78% vs. 76.1%, HR = 0.996, 95%CI 0.584 to 1.698) were comparable between the two groups.ConclusionRG conferred comparable lymph node dissection, postoperative recovery, and oncologic outcomes in a selected cohort of patients with BMI ≥ 25 kg/m2.

Background Robotic gastrectomy (RG) has been widely used to treat gastric cancer. However, whether the short-term outcomes of robotic gastrectomy are superior to those of laparoscopic gastrectomy (LG) for elderly patients with advanced gastric cancer has not been reported. Methods The study enrolled of 594 elderly patients with advanced gastric cancer who underwent robotic or laparoscopic radical gastrectomy. The RG cohort was matched 1:3 with the LG cohort using propensity score-matching (PSM). Results After PSM, 121 patients were included in the robot group and 363 patients in the laparoscopic group. Excluding the docking and undocking times, the operation time of the two groups was similar ( P = 0.617). The RG group had less intraoperative blood loss than the LG group ( P < 0.001). The time to ambulation and first liquid food intake was significantly shorter in the RG group than in the LG group ( P < 0.05). The incidence of postoperative complications did not differ significantly between the two groups ( P = 0.14). Significantly more lymph nodes were dissected in the RG group than in the LG group ( P = 0.001). Postoperative adjuvant chemotherapy was started earlier in the RG group than in the LG group ( P = 0.02). Conclusions For elderly patients with advanced gastric cancer, RG is safe and feasible. Compared with LG, RG is associated with less intraoperative blood loss; a faster postoperative recovery time, allowing a greater number of lymph nodes to be dissected; and earlier adjuvant chemotherapy.

Background Visceral obesity has been increasingly recognized as a potential risk factor for surgical complications in gastric cancer surgery, yet its impact on lymphadenectomy during laparoscopic gastrectomy remains undefined. This study aimed to investigate the influence of visceral fat area (VFA) on intraoperative adverse events (iAEs) during lymphadenectomy in laparoscopic gastrectomy. Methods A post hoc analysis was performed using data from two previous prospective studies ([NCT02327481] and [NCT01609309]). The patients were divided into high and low VFA groups based on preoperative computed tomography images at the umbilical level. All iAEs were reviewed from the surgical videos and graded using ClassIntra. The factors influencing iAEs were identified, and predictive models for iAEs were constructed. Results This study included 490 patients, with 244 and 246 patients in the high and low VFA groups, respectively. Restricted cubic splines demonstrated a positive linear association between VFA and iAEs. Compared with the low VFA group, the high VFA group exhibited a significantly higher incidence of iAEs (29% vs. 12%, p  < 0.001), primarily in the infrapyloric (9.0% vs. 2.0%) and suprapancreatic (23.4% vs. 9.3%) regions and higher rates of ClassIntra I-III. Multivariate logistic regression identified high VFA as an independent risk factor for iAEs (hazard ratio [HR] 2.16, 95% confidence interval [CI]: 1.22 − 3.83). Based on the VFA, nomograms were developed to predict iAEs (training area under the curve [AUC] 0.722, validation AUC 0.730). Meanwhile, a web-based calculator was developed to facilitate clinical application. Conclusions High preoperative VFA is independently correlated with iAEs after laparoscopic gastrectomy for gastric cancer. Nomograms based on VFA showed potential in predicting iAEs, helping identify high-risk patients early and facilitating tailored perioperative management. Graphical abstract

Aim： To study the effects of nine synthetic clausenamide with different stereo structures on liver glutathione （GSH） biosynthesis and glutathione S-transferase （GST） activity in mice. Methods： The nine test compounds were racemic mixtures and their ennatiomers of clausenamide, neoclausenamide and epineoclausenamide. Mice were administered clausenamide 250 mg/kg once daily for 3 consecutive days, ig, and were killed 24 h after the last dosing. The mouse liver cytosol GSH and GST were determined with related biochemical methods. Results： Nine clausenamides exhibited different effects on liver GSH and GST. Of nine clausenamides, only （＋） and （＋）clausenamide markedly increased liver cytosol GSH content. The mechanism of increasing liver GSH content of （＋）clausenamide is mainly due to stimulating the key limiting enzyme γ-glutamylcysteine synthetase （γ-GCS） activity for GSH biosynthesis. The other test clausenamides had no such effect on liver GSH. All of the nine clausenamides induced a significant increase of GST activity. Conclusion： The effects of clausenamide ennatiomers on liver GST and GSH varied with the alterations of their spatial structures. （＋）Clausenamide stimulated liver GSH biosynthesis through enhancing γ-GCS activity.

Regional cerebral blood volume (rCBV) and permeability surfaces (rPS) permit in vivo assessment of glioma microvasculature, which provides quite important pathophysiological information in grading gliomas. The aim of our study was to simultaneously examine rCBV and rPS in glioma patients to determine their correlation with histological grade using CT perfusion imaging. A total of 22 patients with gliomas underwent multislice CT perfusion imaging preoperatively. Low-grade and high-grade groups were categorized corresponding to WHO grade II gliomas and WHO grade III or IV gliomas, respectively, as determined by histopathological examination. rCBVs and rPSs were obtained from regions of maximal abnormality in tumor parenchyma on CBV and PS color perfusion maps. Perfusion parameters were compared using the Kruskal-Wallis test in order to evaluate the differences in relation to tumor grade. The Pearson coefficients of rCBV and rPS for each tumor grade were assessed using SPSS 13.0 software. rCBV and rPS provided significant P-value in differentiating glioma grade (low-grade gliomas 3.28+/-2.01 vs 2.12+/-3.19 ml/100 g/min, high-grade gliomas 8.87+/-4.63 vs 12.11+/-3.18 ml/100 g/min, P<0.05). Receiver operating characteristic (ROC) curves revealed better specificity and sensitivity in PS than in CBV for glioma grade. A significant correlation between rCBV and rPS was observed in high-grade gliomas (r=0.684). rCBVs in oligodendrogliomas were higher than in other low-grade gliomas, whereas their rPS values did not show a parallel difference. Perfusion CT provides useful information for glioma grading and might have the potential to significantly impact clinical management and follow-up of cerebral gliomas.

Background/Aims: To investigate if and where abnormal iron accumulation in white matter fibers occurs in patients with Alzheimer’s disease (AD) by phase imaging and to relate these findings to white matter tract degeneration assessed by diffusion tensor imaging. Methods: Twenty-five patients with AD and 20 normal controls underwent phase imaging and diffusion tensor imaging with a 3.0-tesla system. White matter fibers including fornix (Fx), genu of corpus callosum (GCC), splenium of corpus callosum (SCC), bilateral posterior cingulum (PC), superior longitudinal fasciculus (SLF), inferior longitudinal fasciculus (ILF) and frontal occipital fasciculus (IOF) were measured on a fractional anisotropy (FA) map, mean diffusivity (MD) map and phase map. Results: Significantly decreased phase values and FA values in the Fx and PC regions were found in the AD group. The phase value in Fx had a moderately positive correlation with the FA value (r = 0.666, p = 0.000) in the AD group. Meanwhile, phase values in PC showed positive correlation with FA values (right side: r = 0.436, p = 0.033; left side: r = 0.458, p = 0.022, respectively). Conclusion: Iron accumulation of Fx and PC regions was significantly positively correlated with FA value, indicating that abnormal iron deposition may be one of the causes of white matter disruption in AD.