Folia neuropathologica最新文献

Introduction: There is no uniform classification standard for brain stem haemorrhage. On the basis of previous experience in the treatment of brainstem haemorrhage, this study explored and established a set of criteria for brainstem haemorrhage classification, risk-stratified such patients and guided the selection of treatment options so as to achieve accurate and standardized diagnosis and treatment.

Material and methods: Thirty patients with brainstem haemorrhage from April 2019 to May 2022 were included. According to the amount and location of the brain stem bleeding, it was divided into the following types: small haemorrhage type (type 1), medium haemorrhage type (lateral type 2a, dorsal type 2b, ventral type 2c), and large haemorrhage type (type 3), and the preoperative condition and postoperative outcome within 3 months were evaluated.

Results: The included 30 patients with brainstem haemorrhage were aged 53.2 ±13.8 years old, and 80% were men. Among them, 5 patients were type 1 (16.7%), 2 patients type 2a (6.7%), 7 patients type 2b (23.3%), 5 patients type 2c (16.7%) and 11 patients type 3 (36.7%). The prognosis among these subtypes was significantly different ( p < 0.001). All type 1 patients were cured, with the highest mortality rate in type 2c patients (100%). Compared with type 2b (5.5 ±3.5 days) and type 2c (3.4 ±2.5 days), type 3 patients tend to die within fewer days (2.9 ±2.7 days). The difference in NIHSS scores was significant among surviving patients ( p < 0.001). Type 1 is the lowest at 1.8 ±2.2 points; type 3 is the highest at 35.0 ±3.5 points.

Conclusions: Relying on the anatomical basis and treatment plan, we propose a different classification, which is conducive to quickly identifying the haemorrhage type and degree of disease, and putting forward an appropriate treatment plan, which is expected to improve the patient prognosis.

Introduction: Long non-coding RNAs (lncRNAs) participate in the process of neuropathic pain (NP). Herein, the goal of this research was to examine the roles of lncRNA five prime to XIST (FTX) in influencing chronic constriction injury (CCI)-induced NP.

Material and methods: We have established a rat CCI model to simulate NP in vivo. Reverse transcription-quantitative PCR (RT-qPCR) was used to detect mRNA levels of FTX, microRNA (miR)-320a, and runt-related transcription factor 2 (RUNX2) in the spinal cord. This was followed by subsequent regulation of FTX or miR-320a levels in vivo by intrathecal injection of overexpression FTX or miR-320a mimic lentivirus. The behaviour of rat NP the paw withdrawal threshold (PWT) and paw withdrawal latency (PWL). Enzyme-linked immunosorbent assay (ELISA) was used to assess the secretion of pro-inflammatory and anti-inflammatory factors in the spinal cord tissue. A correlation between FTX and miR-320a, and RUNX2 was validated by luciferase reporter.

Results: FTX levels were reduced in CCI rats ( p < 0.05), and miR-320a was a direct target of FTX. Overexpression of FTX typically reduced PWL and PWT as well as neuroinflammation thus alleviating NP ( p < 0.05). However, increasing miR-320a reversed the alleviation of FTX on NP, increased PWL and PWT, and promoted neuroinflammation ( p < 0.05). Additionally, RUNX2, which is a miR-320a target gene, was significantly repressed in CCI rats and its expression was increased by FTX, however, this increase was attenuated by elevated miR-320a ( p < 0.05).

Conclusions: In the CCI-induced NP rat model, FTX attenuates NP and neuroinflammation by regulating the miR-320a/RUNX2 axis. This provides a new vision for NP treatment.

Introduction: Inevitable disease progression in amyotrophic lateral sclerosis (ALS) forces patients and their caregivers (CGs) to reflect on end-of-life treatment. The CGs are often heavily burdened with their role of surrogate decision-makers. The aim of the study was to analyze attitudes of CGs and presumable attitudes of ALS patients from the CGs' perspective towards palliative care in advanced disease stages.

Material and methods: One hundred and sixty four CGs from Germany and Poland were interviewed regarding their own preferences and patients' ideational attitudes towards life-prolonging (invasive and non-invasive ventilation, tube feeding) and life-shortening methods (termination of measures, active measures if permitted by law). The data were correlated with patient- and CG-related factors: demographic and clinical data, care commitment, depression and quality of life (QoL).

Results: The CGs were mostly female spouses of ALS patients, with secondary/higher education. Nearly 70% (81% in Poland, 57% in Germany; p = 0.0001) reported positive attitudes towards life-prolonging methods, which positively correlated with religiousness and negatively with patients' age. Approximately 40% of CGs (25% and 51% respectively; p = 0.001) reported positive attitudes towards life-shortening methods. It positively correlated with time since diagnosis and negatively with the CG's QoL, religiosity and religious/spiritual faith as factors that significantly influenced end-of-life decisions. There was a strongly positive correlation between CGs' positive attitudes towards life-shortening methods and presumed positive patients' attitudes assessed by their CGs ( p < 0.000001).

Conclusions: Although attitudes towards treatment differed between countries, the CGs of ALS patients were generally positive towards life-prolonging treatment. A greater acceptance of life-shortening methods in the case of longer disease duration and poorer QoL may indicate worse coping with disease progression and weaker adaptation mechanisms in CGs compared to those previously reported in ALS patients. A close resemblance of the CGs' answers to probable patients' attitudes reported by the CGs indicates that many GCs might actually express their own culturally shaped attitudes towards end-of-life methods. In light of earlier-reported discrepancies between presumed opinions of the CGs and of patients themselves, a greater focus should be placed on thorough discussions on future treatment options with ALS patients in the presence of their CGs, to stay in line with the patient's authentic will.

Cerebral small vessel disease (cSVD) is a disease defined by clinical symptoms and neuroimaging, which often causes a series of pathophysiological changes, blood-brain barrier destruction, brain tissue ischemia and involves cerebral arterioles, capillaries and venules. The exact pathogenesis of cSVD is unclear and there is no specific prevention and treatment for this potentially high disability rate disease. This article reviewed the latest research progress of neuroimaging of cSVD in order to improve our understanding of cSVD's manifestation and potential mechanism. We introduced the neuroimaging markers which can be accurately identified by diffusion tensor imaging, including recent subcortical infarction, white matter lesions, brain atrophy, lacunar infarction, cerebral microhaemorrhage and other cSVD neuroimaging markers. Besides, we also interpreted the total load score of cSVD, which described a wide range of clinical, pathological and neuroimaging features, reflecting the acute and chronic damage of the whole brain. Combined with the neuroimaging methods, capturing the imaging features of early cSVD can improve the diagnostic ability of cSVD and provide strong support for the longitudinal study.

Introduction: Brain pathology in patients with congenital heart disease (CHD) is associated with neuro-developmental delay. Imaging studies support vascular etiology for both white and gray matter lesions. In this retrospective study, we described the pathological changes in the brains of patients with CHD.

Material and methods: Last twenty autopsy cases in pediatric patients with CHD at our institution were retrieved and autopsy reports were reviewed. Available hematoxylin-eosin, special, and immunostains were evaluated, and at least one section from each case was stained with anti-glial fibrillary acidic protein (GFAP), anti-amyloid precursor protein (APP), and anti-HLA-DR antibody. Staining pattern of these immunostains was compared to staining pattern in five control cases. Control cases comprised of 2 cases with no significant pathological changes, and 3 cases with telencephalic leukoencephalopathy. The following histological features were assessed: necrotic cells in cortex, hippocampus, and cerebellum, APP and GFAP staining pattern, and the presence of focal lesions and amphophilic globules. Twenty patients (10 males, 10 females) were identified, with age range between 2 weeks and 19 years.

Results: The pathological findings were as follows: 10 cases had changes consistent with acute global hypoperfusion, 8 cases showed features consistent with chronic global hypoperfusion, 4 cases presented focal white matter necrosis (2 with intra-vascular emboli), and 16 cases showed diffuse moderate to severe gliosis, including 7 cases with amphophilic globules. Subarachnoid hemorrhages were present in 5 cases, subdural hemorrhage in 4 cases, intra-ventricular hemorrhage in 2 cases, and germinal matrix hemorrhage in 1 case.

Conclusions: In conclusion, diffuse gliosis is the prominent pathological feature in CHD cases. Most of the pathological changes are known to occur in cerebral hypoperfusion regardless of primary cause. Better techniques to improve cerebral perfusion are warranted in the management of these patients.

Introduction: Alzheimer's disease (AD) is the most common cause of dementia and is characterized by a progressive deterioration in cognitive function, which typically begins with impairment in memory. Persian clover (Trifolium resupinatum) is an annual plant found in central Asia. Due to its contents (high flavonoid and isoflavones), extensive researches have been done on its therapeutic properties, such as multiple sclerosis (MS) treatment. In this study, we investigate the neuroprotective effects of this plant on Streptozotocin (STZ)-induced AD in rats.

Material and methods: This research aimed to evaluate the neuroprotective effect of Trifolium resupinatum on the spatial learning and memory, superoxide dismutase (SOD), expressions of β amyloid 1-42 (Ab 1-42 ), and b amyloid 1-40 (Ab 1-40 ) in the hippocampus of STZ-induced Alzheimer rats.

Results: Our data showed that Trifolium resupinatum extract administration for two weeks before and one week after AD induction significantly improves maze escape latency ( p = 0.027, 0.001 and 0.02 in 100, 200, and 300 mg of the extract, respectively) and maze retention time ( p = 0.003, 0.04 and 0.001 in 100, 200, and 300 mg of the extract, respectively). Also, the administration of this extract significantly increases the SOD levels from 1.72+0.20 to 2.31+0.45 ( p = 0.009), 2.48+0.32 ( p = 0.001) and 2.33+0.32 ( p = 0.007) and decreases the expressions of Ab 1-42 ) ( p = 0.001 in all concentrations of the extract) and Ab 1-40 ) ( p = 0.001 in all concentrations of the extract) in the rat's hippocampus.

Conclusions: This study suggests that the alcoholic extract of Trifolium resupinatum has anti-Alzheimer and neuroprotective effects on rats.

Introduction: The aim of the study was to investigate the pathogenesis of diabetic peripheral neuropathy (DPN) and the value of fibrinogen (FIB) in the early diagnosis of DPN.

Material and methods: A total of 121 patients with type 2 diabetes mellitus (T2DM) and DPN hospitalized in the Endocrinology Department of the 923 Hospital of the People's Liberation Army of China were randomly selected between May and October 2020 and divided into a T2DM asymptomatic (no peripheral neuropathy-related symptoms) group (66 cases) and a T2DM symptomatic group (55 cases) according to the presence or absence of clinical neurological symptoms and signs. Forty healthy volunteers were selected as a normal control group. In addition to plasma FIB and nerve electrophysiological tests, all included subjects were electrophysiologically tested for nerve conduction velocity (NCV), terminal motor latency (DML), sensory nerve action potential (SNAP) amplitude, and compound muscle action potential (CMAP) amplitude.

Results: Compared with the control group, NCV was slowed down in T2DM patients, DML was prolonged, and the amplitude of CMAP and SNAP were decreased. Compared with asymptomatic T2DM patients, symptomatic patients had slower NCV, longer DML, lower CMAP amplitude of median nerve, ulnar nerve and tibial nerve, and significantly lower SNAP amplitude of median nerve and ulnar nerve. CMAP amplitudes were decreased, and median and ulnar nerve SNAP amplitudes were also significantly decreased ( p < 0.05). The plasma FIB concentration of asymptomatic patients with T2DM was higher than that of the control group, and the plasma FIB concentration of symptomatic patients with T2DM was higher than that of asymptomatic patients with T2DM ( p < 0.01). The NCV and DML of asymptomatic patients with T2DM slowed down and prolonged as the FIB level increased; the NCV of T2DM symptomatic patients also slowed down as FIB increased, and median and ulnar nerve DML increased as FIB increased. There was no correlation between NCV and DML and the plasma FIB level in the control group. SNAP amplitudes of symptomatic and asymptomatic patients with T2DM decreased as plasma FIB increased, while CMAP amplitudes of the tibial nerve and the T2DM symptomatic ulnar nerve decreased as FIB increased in the control group.

Conclusions: FIB may be a contributing factor for diabetic neuropathy and could be used as an indicator in the early screening and diagnosis of peripheral neuropathy in patients with T2DM.

The 5th edition of World Health Organization (WHO) Central Nervous System (CNS) tumours classification has transformed the pathological diagnosis of gliomas from purely histological to the multilayered integrated one with molecular biomarkers necessary for proper classification, risk stratification, and prognostic-predictive clinical purposes. Because of deep and important changes in taxonomy and diagnostic approach to gliomas, this manuscript is a review of WHO CNS classification 5th edition with general testing guidance for pathologists and clinicians working in neuro-oncology.

Aphasia is a common consequence of stroke and repetitive transcranial magnetic stimulation (rTMS) may be a promising brain stimulation technique in the treatment of aphasia. However, there are few reports about the therapeutic effect of rTMS for Broca's area in patients with sensory aphasia. This study reported one stroke patient with sensory aphasia who received 6 treatment sessions of low-frequency rTMS before speech and language therapy. The target area was the Broca mirror area in the right hemisphere. After treatment, the auditory comprehension of the patient improved from 46 to 112, the naming improved from 18 to 32, and the AQ improved from 34.2 to 42.6. However, the level of functional language, spontaneous speech and repetition did not show obvious improvement.