Chengqian Li

Aims: To better comprehend relationships between the analysis along the perivascular space (ALPS) index and glymphatic dysfunction, we assessed the spatiotemporal patterns of structural brain injury related to the ALPS index in a longitudinal study. Methods: We performed voxel/vertex‐wise analysis to explore the relationship between lower ALPS index and brain parenchymal injury. We also performed brain network connectivity analysis to investigate the relationship between white matter disruption and cortical atrophy. Results: The lower baseline ALPS index showed an association with drastic progression of disruption of white matter microstructural integrity, primarily located in the subcortical regions where association fibers are distributed. Brain network connectivity analysis revealed an association of the lower ALPS index with a disconnected sub‐network in the midline and right frontal lobe, where association fibers are widely distributed. The lower ALPS index also displayed a correlation with cortical atrophy in the projection areas of both association and projection fibers in cross‐sectional analysis. However, this correlation was nonsignificant in longitudinal analysis. Conclusion: The ALPS index could be considered a composite marker of perivascular dynamics and white matter microstructural integrity, shedding light on the spatial pattern of disruption of white matter integrity in community‐dwelling populations.

Background: The mechanisms underlying covert versus symptomatic acute infarcts in cerebral small vessel disease are unclear. Methods: Based on the multicenter Cerebral Small Vessel Disease Disability and Outcome Cohort Study, we consecutively enrolled patients presenting with an acute lacunar stroke within 30 days or patients without acute stroke symptoms but with moderate to severe white matter hyperintensities. Between August 2016 and June 2019, 1710 patients (mean age 61.87±11.28 years, 37.25% female) were recruited across 30 hospitals in China. We compared the clinical and imaging characteristics between individuals with incidental diffusion‐weighted imaging (DWI)‐positive lesions and those with recent small subcortical infarcts (RSSI). Results: The prevalence of incidental DWI‐positive lesions and RSSI was 2.28% and 31.64%. Patients with incidental DWI‐positive lesions were older, had lower blood pressure and lipid levels, and more prior lacunar stroke. Incidental DWI‐positive lesions were typically smaller and round/ovoid, more often involved the subcortical white matter and cerebral cortex. RSSI more frequently affected perforating artery territories, 39.9% of RSSI cases were consistent with branch atheromatous disease. Incidental DWI‐positive lesions patients had a higher risk of 90‐day recurrent stroke (hazard ratio [HR], 8.28 [95% CI, 1.96–34.90], log‐rank P <0.001). They also had lower Mini‐Mental State Examination scores after adjustment for age and sex. Conclusions: Atherosclerosis and branch atheromatous disease appear to be predominant causes of RSSI among Chinese patients with cerebral small vessel disease. Incidental DWI‐positive lesions likely reflecting intrinsic small vessel injury constitute a cerebral small vessel disease marker and carry prognostic value for stroke recurrence and cognitive decline.

Background: Cognitive decline and incident dementia in ageing populations have been linked to brain parenchymal injury and the ALPS index (ALPS-I). Objective: This investigation aimed to elucidate whether the baseline ALPS-I could predict incident dementia and cognitive decline in this population. Methods: In total, 973 dementia-free participants from the Shunyi Study (mean age, 57 years; 37% male) received MRI between 2013 and 2016 to quantify the ALPS-I. The longitudinal relationships between the ALPS-I and cognitive deterioration in various cognitive areas were evaluated via linear mixed models. Cox proportional hazard models were utilized to explore the link between the index and incident dementia. Mediation assessments were carried out to identify the potential mediating effects of brain parenchymal injury on the link between the ALPS-I and cognition. Results: The baseline ALPS-I predicted longitudinal changes in global cognition (Montreal Cognitive Assessment), language (verbal fluency test), visuospatial perception (block design subtest of Wechsler intelligence scale), and executive function (Trail Making Test). A lower score was markedly associated with a higher incident dementia risk. Mediation analysis revealed that fractional anisotropy mediated the associations between the ALPS-I and executive function (mediation effect: 21.9%) and visuospatial perception (mediation effect: 68.8%). The white matter hyperintensity fraction was found to mediate the link between the ALPS-I and global cognition (mediation effect: 55.0%). Conclusions: This longitudinal evidence supports a link between the ALPS-I and cognitive degeneration. Furthermore, the link is mediated by subcortical parenchymal injury.

Leiomyoma with bizarre nuclei (LBN), also known as symplastic leiomyoma, is a histological subtype of benign leiomyoma with bizarre cells and nuclear atypia. Differentiating LBN from other benign leiomyoma subtypes, uterine smooth muscle tumors of uncertain malignant potential (STUMP), or leiomyosarcoma (LMS) can be diagnostically challenging owing to overlapping features in clinical presentation and pathologic morphological analysis. The difficulty of distinguishing LBN from other lesions, especially from LMS, and the potential of LBN for subsequent malignant transformation make LBN an important topic of research. Herein, we review the definition, diagnosis, treatment, and prognosis of LBN. Histopathological examination is essential for distinguishing LBN from other diseases. Pathology sampling and morphological examination remain the key to diagnosis. The newly established ancillary immunohistochemical (IHC) and molecular genetic analysis can be useful tools for differential diagnosis. Furthermore, serum biomarkers and imaging examination may also be useful diagnostic tools. Attention should be paid to the differentiation between LBN and LMS because morphological diagnosis may still be challenging in some cases. Some IHC markers of LBN have been identified, which may be helpful for differential diagnosis. Furthermore, the use of IHC panels as diagnostic markers may be advocated. Molecular genetic studies suggest that some genes can aid with the differential diagnosis between LBN and LMS. However, increasing evidence support the idea that LBN and LMS are molecularly related, indicating that LBN may represent a potentially malignant stage of precancerous progression. At present, conservative treatment is recommended for primary LBN, especially for patients desiring to retain fertility, but close follow-up with imaging examinations is required.