Accelerated aging of selective brain structures in human immunodeficiency virus infection: a controlled,longitudinal magnetic resonance imaging study

Advances in treatment have transformed human immunodeficiency virus (HIV) infection from an inexorable march to severe morbidity and premature death to a manageable chronic condition, often marked by good health. Thus, infected individuals are living long enough that there is a potential for interaction with normal senescence effects on various organ systems, including the brain. To examine this interaction, the brains of 51 individuals with HIV infection and 65 uninfected controls were studied using 351 magnetic resonance imaging and a battery of neuropsychological tests collected 2 or more times over follow-up periods ranging from 6 months to 8 years. Brain tissue regions of interest showed expected age-related decrease in volume; cerebrospinal fluid-filled spaces showed increase in volume for both groups. Although HIV-infected individuals were in good general health, and free of clinically-detectable dementia, several brain regions supporting higher-order cognition and integration of functions showed acceleration of the normal aging trajectory, including neocortex, which extended from the frontal and temporal poles to the parietal lobe, and the thalamus. Beyond an anticipated increase in lateral ventricle and Sylvian fissure volumes and decrease in tissue volumes (specifically, the frontal and sensorimotor neocortices, thalamus, and hippocampus) with longer duration of illness, most regions also showed accelerated disease progression. This accelerated loss of cortical tissue may represent a risk factor for premature cognitive and motor compromise if not dementia. On a more promising note, HIV-infected patients with increasing CD4 counts exhibited slower expansion of Sylvian fissure volume and slower declines of frontal and temporoparietal cortices, insula, and hippocampus tissue volumes. Thus, attenuated shrinkage of these brain regions, likely with adequate pharmacologic treatment and control of further infection, has the potential of abating decline in associated higher-order functions, notably, explicit memory, executive functions, self-regulation, and visuospatial abilities.     

阿托伐他汀对扩张型心肌病心室重构和心功能的影响

目的 观察阿托伐他汀对扩张型心肌病（DCM）患者心室重构和心功能的影响，以及在心力衰竭患者中用药的安全性。方法 选择66例DCM患者，随机分为干预组（31例）及对照组（35例），前者在常规治疗基础上合用阿托伐他汀10mg／d。于干预前及干预后1、3、6个月时，分别检测肝功能、肾功能、肌酸激酶（CK）及各项心功能指标。结果 干预治疗前后比较，两组内CK指标均无明显改变，但肝功能指标均明显好转，差异有统计学意义（P〈0．01）；两组间同期比较差异无统计学意义（P〉0．05）。两组内各项心功能指标均有明显改善，差异有统计学意义（P〈0．01）；两组间同期比较，干预组比对照组疗效更好，但差异无统计学意义（P〉0．05）。结论 阿托伐他汀治疗DCM有改善心功能、逆转心室重构及缩小心脏的趋势，但与对照相组比无统计学上的差异。阿托伐他汀10mg在DCM中应用是安全的。     

Effect of partial left ventriculectomy on left and right ventricular volumes and function as assessed with electron beam tomography: preliminary results

Our objective was to determine if left ventricular reduction surgery affects left and right ventricular volumes and function. Twenty-three patients with end-stage heart failure underwent contrast-enhanced electron beam tomographic function studies before and twice after partial left ventriculectomy (PLV). The PLV was combined with other cardiosurgical procedures in 20 of 23 patients. Left and right ventricular enddiastolic volume (LVEDV, RVEDV), stroke volume (LVSV, RVSV), ejection fraction (LVEF, RVEF), and enddiastolic diameter (LVEDD, RVEDD) were determined by manual tracing of endo- and epicardial borders at enddiastole and endsystole. Patients were scanned 31 days (±34) before and 18 days (±13) and 8 months (±4) after PLV. Mean pre- and early and late postoperative values for LVEDV, LVSV, LVEF, and LVEDD were 387.9 ml (±125.5 ml), 255.6 ml (±79.3 ml; p<0.01), and 253.7 ml (±97.8 ml; p<0.05), 79.7 ml (±25.2 ml), 74.8 ml (±17.9; n.s.), and 79.1 ml (±26.5 ml; n.s.), 21.6% (±7.3%), 31.9% (±13.4%; p<0.05), and 34.1% (±14.1%; p<0.05), and 72.0 mm (±10.6 mm), 64.3 mm (±8.5 mm; p<0.05), and 63.5 mm (±9.4 mm; p<0.05), respectively. Mean pre- and postoperative values for RVEDV, RVSV, RVEF, and RVEDD were 177.7 ml (±72.8 ml), 172.4 ml (±59.2 ml; n.s.), and 178.9 ml (±60.8 ml; n.s.), 60.3 ml (±21.6 ml), 68.8 ml (±19.9 ml; n.s.), and 78.3 ml (±25.3 ml; n.s.), 38.1% (±15.4%), 43.7% (±16.3%; p<0.05), and 45.1% (±11.2%; n.s.), and 50.4 mm (±10.9 mm), 48.1 mm (±8.7 mm; n.s.), and 48.5 mm (±9.8 mm; n.s.), respectively. The PLV may induce a significant early reduction of left ventricular volumes and improvement of biventricular function; however, our results must be judged carefully as the majority of patients in this study underwent additional cardiosurgical procedures, the contributory effect of which on the overall outcome remains unclear. Electronic Publication     

Demonstration of periventricular brain motion during a Valsalva maneuver: description of technique, evaluation in healthy volunteers and first results in hydrocephalic patients

There has long been a need for a sensitive and predictive parameter in the evaluation of hydrocephalic patients. Our goal was to assess ventricular response to a Valsalva maneuver as a potential method of studying patients with hydrocephalus. Twenty-five healthy volunteers and 5 patients with communicating hydrocephalus were examined with an axial and 10 volunteers with an axial, coronal and sagittal true fast imaging steady precession (FISP) sequence in a 1.5-T clinical MR scanner (TR 4.8 ms, TE 2.3 ms, flip angle 70 degrees, slice thickness 5 mm, field of view 330 mm, 3 slices). Images were assessed both as dynamic images in cine mode and by measuring lateral ventricular size over time. All volunteers showed marked periventricular brain motion. The lateral ventricular area was reduced under the Valsalva maneuver by an average of 18% (SD 7) in healthy volunteers, while remaining practically constant in the patient group. Differences were statistically significant with a p<0.0001. The Valsalva maneuver leads to periventricular brain motion, which can be consistently detected by a true FISP sequence. Our method proved to be an easy and reliable method with a capacity to identify hydrocephalic patients.     

老年男性心室流出道室性早搏的临床特点及与冠心病的关系

目的探讨老年男性频发流出道室性早搏心电图特征及与冠心病的关系。方法回顾性分析111例检出频发室性早搏患者的24h动态心电图,分析起源于心室流出道室性早搏的QRS波群特征及所占比例。结果111例频发室性早搏中45例起源于心室流出道,41例为非流出道起源,25例为频发多源室性早搏,流出道室性早搏患者冠心病发生率明显低于其他两组（P〈0.05）。结论部分老年男性室性早搏起源于心室流出道,其电生理特性与普通心肌细胞不同,具有明显的自律性和电生理各向异性,起源于心室流出道的室性早搏与心肌缺血无相关性。     

重症丘脑出血破入脑室的外科治疗及其预后

目的：探讨重症丘脑出血破入脑室后的外科治疗和预后。方法：选６０ 例重症丘脑出血患者，根据丘脑出血向邻近结构扩散范围，将其分为三组：Ⅰ组采用脑室穿刺引流；Ⅱ组脑室引流＋ 立体定向抽吸；Ⅲ组开颅清除外侧部血肿。结果：本组６０ 例，死亡１２ 例（２０ ％ ） ，重残２４ 例（４０ ％ ） ，生活自理１９ 例（３１ ．７ ％ ） ，治愈５ 例（８ ．３ ％ ） 。结论：把 Ｇ Ｃ Ｓ计分作为判断预后重要指标和手术的主要指征，重症丘脑出血应采用手术及脑室外引流，清除具有占位效应的外侧部血肿，以改善脑脊液循环，降低颅内压。     

Neuroanatomical phenotypes in the reeler mouse

The reeler mouse (Reln) has been proposed as a neurodevelopmental model for certain neurological and psychiatric conditions and has been studied by qualitative histochemistry and electron microscopy. Using magnetic resonance microscopy (MRM), we have quantitated for the first time the neuromorphology of Reln mice at a resolution of 21.5 microm. The neuroanatomical phenotypes of heterozygous and homozygous mutant Reln mice were compared to those of wild type (WT) littermates using morphometry and texture analysis. The cortical, hippocampal, and cerebellar phenotypes of the heterozygous and homozygous mutant Reln mice were confirmed, and new features were revealed. The Reln(rl/rl) mice possessed a smaller brain, and both Reln(rl/+) and Reln(rl/rl) mice had increased ventricles compared to WT controls. Shape differences were found between WT and Reln(rl/rl) brains, specifically in cerebellum, olfactory bulbs, dorsomedial frontal and parietal cortex, certain regions of temporal and occipital lobes, as well as in the lateral ventricles and ventral hippocampus. These findings suggest that certain brain regions may be more severely impacted by the Reln mutation than others. Gadolinium-based active staining demonstrated that layers of the hippocampus were disorganized in Reln(rl/rl) mice and differences in thickness of these layers were identified between WT and Reln(rl/rl) mice. The intensity distributions characteristic to the dorsal, middle, and ventral hippocampus were altered in the Reln(rl/rl), especially in the ventral hippocampus. These differences were quantified using skewness and modeling the intensity distributions with a Gaussian mixture. Our results suggest that structural features of Reln(rl/rl) brain most closely phenocopy those of patients with Norman-Roberts lissencephaly.     

Cardiovascular Parameters Correlated with Metabolic Syndrome in a Rural Community Cohort of Korea: The ARIRANG Study

Although metabolic syndrome (MetS) is associated with increased cardiovascular mortality and the development of atherosclerosis, consensus is still lacking on the status of cardiovascular function and geometry in MetS patients. We investigated the relation between MetS and left ventricle (LV) geometry and function, carotid intima-media thickness (IMT) and arterial stiffness in a community-based cohort of 702 adult subjects. Subjects were categorized into three groups according to the number of MetS components present, as defined by the Adult Treatment Panel III guidelines: 1) Absent (0 criteria), 2) Pre-MetS (1-2 criteria) or 3) MetS (≥3 criteria). In female subjects, LV mass, LV mass/height^2.7, deceleration time, and aortic pulse wave velocity increased, and E/A ration decreased in a stepwise manner across the three groups. These changes were not observed in male subjects. The mean carotid IMT was higher in the MetS group than in the other two groups. The degree of MetS clustering is found to be strongly correlated with geometric eccentricity of LV hypertrophy, diastolic dysfunction and arterial changes irrespective of age and blood pressure status, particularly in females. Waist circumference is found to have the most powerful effect on cardiovascular parameters.     

Fractone-associated N-sulfated heparan sulfate shows reduced quantity in BTBR T+tf/J mice: a strong model of autism

BTBR T+tf/J (BTBR) mice show abnormal social, communicatory, and repetitive/stereotyped behaviors paralleling many of the symptoms of autism spectrum disorders. BTBR also show agenesis of the corpus callosum (CC) suggesting major perturbations of growth or guidance factors in the dorsal forebrain [1]. Heparan sulfate (HS) is a polysaccaride found in the brain and other animal tissues. It binds to a wide variety of ligands and through these ligands modulates a number of biological processes, including cell proliferation and differentiation, migration and guidance. It is aggregated on fractal-like structures (fractones) in the subventricular zone (SVZ), that may be visualized by laminin immunoreactivity (LAM-ir), as well as by HS immunoreactivity (HS-ir). We report that the lateral ventricles of BTBR mice were drastically reduced in area compared to C57BL/6J (B6) mice while the BTBR SVZ was significantly shorter than that of B6. In addition to much smaller fractones for BTBR, both HS and LAM-ir associated with fractones were significantly reduced in BTBR, and their anterior-posterior distributions were also altered. Finally, the ratio of HS to LAM in individual fractones was significantly higher in BTBR than in B6 mice. These data, in agreement with other findings linking HS to callosal development, suggest that variations in the quantity and distribution of HS in the SVZ of the lateral ventricles may be important modulators of the brain structural abnormalities of BTBR mice, and, potentially, contribute to the behavioral pathologies of these animals.