脑健康服务(brain health services,BHSs)是一种个体化预防痴呆的新方法。本文将讨论痴呆或认知障碍与社会、文化和经济背景的关系,以及痴呆预防的社会背景相关领域的挑战,并基于此提出更有效的干预方式。首先,我们关注BHSs如何应对痴呆风险人群、如何识别痴呆的危险因素以及干预措施的效果;其次,我们强调BHSs本身的社会背景及其降低痴呆风险的能力;最后,我们详细阐述了如何满足或应对这些挑战。我们建议考虑这些挑战将有助于BHSs解决2个根本问题,即痴呆高风险个体化防治与基于人群的公共卫生预防之间的平衡,以及BHSs满足医疗公平伦理准则的能力。
目的探讨高分辨率磁共振成像（high-resolution magnetic resonance imaging, HR-MRI）评价有症状颈动脉狭窄患者斑块稳定性的价值以及不稳定斑块和血管重度狭窄的危险因素。方法纳入有症状颈动脉狭窄患者，通过HR-MRI评价有症状颈动脉狭窄患者颈动脉斑块成分判断斑块的稳定性。收集行颈动脉内膜切除术患者的颈动脉斑块进行病理学检查，比较术前HR-MRI与术后病理学检查结果的一致性。收集所有患者的临床资料，分析颈动脉斑块稳定性和血管狭窄程度的危险因素。结果共219例狭窄程度〉50%的有症状颈动脉狭窄患者接受HR-MRI检查。其中102例（46.6%）存在稳定斑块，117例（53.4%）患者存在不稳定斑块；118例（53.9%）中度狭窄，101例（46.1%）重度狭窄。35例患者接受颈动脉内膜切除术，其中19例（54.3%）HR-MRI显示斑块不稳定，20例（57.1%）病理学检查显示斑块不稳定，二者高度一致（κ＝0.942，P〈0.001）。不稳定斑块组男性（P＝0.007）、高脂血症（P＝0.013）、吸烟（P〈0.001）的患者构成比以及总胆固醇（P＝0.001）、低密度脂蛋白胆固醇（P〈0.001）和空腹血糖（P＝0.001）水平显著高于稳定斑块组。多变量logistic回归分析显示，男性[优势比（odds ratio, OR）2.33，95%可信区间（confidence interval, CI）1.08～5.04；P＝0.032]、吸烟（OR 3.45，95% CI 1.67～7.14；P＝0.001）和空腹血糖水平较高（OR 1.26，95% CI 1.07～1.48；P＝0.006）是斑块不稳定的独立危险因素。中度狭窄组与重度狭窄组患者的所有资料均未显示出显著性差异。结论HR-MRI能准确评估有症状颈动脉狭窄患者的斑块稳定性。性别、吸烟和空腹血糖增高是颈动脉不稳定斑块的独立危险因素。
Background:Brain consists of plenty of complicated cytoarchitecture.Gaussian-model based diffusion tensor imaging(DTI)is far from satisfactory interpretation of the structural complexity.Diffusion kurtosis imaging(DKI)is a tool to determine brain non-Gaussian diffusion properties.We investigated the network properties of DKI parameters in the whole brain using graph theory and further detected the alterations of the DKI networks in Alzheimer’s disease(AD).Methods:Magnetic resonance DKI scanning was performed on 21 AD patients and 19 controls.Brain networks were constructed by the correlation matrices of 90 regions and analyzed through graph theoretical approaches.Results:We found small world characteristics of DKI networks not only in the normal subjects but also in the AD patients;Grey matter networks of AD patients tended to be a less optimized network.Moreover,the divergent small world network features were shown in the AD white matter networks,which demonstrated increased shortest paths and decreased global efficiency with fiber tractography but decreased shortest paths and increased global efficiency with other DKI metrics.In addition,AD patients showed reduced nodal centrality predominantly in the default mode network areas.Finally,the DKI networks were more closely associated with cognitive impairment than the DTI networks.Conclusions:Our results suggest that DKImight be superior to DTI and could serve as a novel approach to understand the pathogenic mechanisms in neurodegenerative diseases.
