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Rongcui Sui,1– 3 Jie Li,4 Yunhan Shi,1– 3 Shizhen Yuan,1– 3 Huijun Wang,1– 3 Jianhong Liao,1– 3 Xiang Gao,1– 3 Demin Han,1– 3 Yanru Li,1– 3 Xingjun Wang4 1Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, People’s Republic of China; 3Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, People’s Republic of China; 4Department of Electronic Engineering, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, People’s Republic of ChinaCorrespondence: Demin Han; Yanru Li, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaominxiang, Dongcheng District, Beijing, People’s Republic of China, Email deminhan_ent@hotmail.com; liyanruru@aliyun.comPurpose: This study aimed to investigate the association between sleep spindle metrics and executive function in individuals with obstructive sleep apnea (OSA). Furthermore, we examined the association of age and education on executive function.Patients and Methods: A total of 230 (40.90 ± 8.83 years, F/M = 45/185) participants were enrolled. Overnight electroencephalogram (C3-M2) recording detected sleep spindles by a novel U-Net-type neural network that integrates temporal information with time-frequency images. Sleep spindle metrics, including frequency (Hz), overall density (events/min), fast density (events/min), slow density (events/min), duration (sec) and amplitude (μV), were measured. Executive function was assessed using standardized neuropsychological tests. Associations between sleep spindle metrics, executive function, and demographic factors were analyzed using multivariate linear regression.Results: In fully adjusted linear regression models, higher overall sleep spindle density (TMT-A, B=− 1.279, p=0.009; TMT-B, B=− 1.813, p=0.008), fast sleep spindle density (TMT-A, B=− 1.542, p=0.048; TMT-B, B=− 2.187, p=0.036) and slow sleep spindle density (TMT-A, B=− 1.731, p=0.037; TMT-B, B=− 2.449, p=0.034) were associated with better executive function. And the sleep spindle duration both during N2 sleep time (TMT-A, B=− 13.932, p=0.027; TMT-B, B=− 19.001, p=0.034) and N3 sleep time (TMT-B, B=− 29.916, p=0.009; Stroop-incongruous, B=− 21.303, p=0.035) was independently associated with better executive function in this population. Additionally, age and education were found to be highly associated with executive function.Conclusion: Specific sleep spindle metrics, higher overall density, fast density and slow density during N2 sleep time, and longer duration during N2 and N3 sleep time, are independent and sensitive indicators of better executive function in young adult and middle-aged patients with OSA. Further research is needed to explore the underlying mechanisms and clinical implications of these findings.Keywords: sleep spindle metrics, executive function, obstructive sleep apnea, young adults, middle-aged adults

Ling Zhang,1 Lei Zhang,2 Rubo Sui1 1Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, People’s Republic of China; 2College of Nursing, Jinzhou Medical University, Jinzhou, People’s Republic of ChinaCorrespondence: Lei ZhangCollege of Nursing, Jinzhou Medical University, No. 40, Section 3, Songpo Road, Guta District, Jinzhou, 121001, Liaoning Province, People’s Republic of ChinaEmail zhanglei7812713@163.comBackground: Post-stroke depression (PSD) is a common complication after stroke. Ganoderic acid A (GAA), one of the main bioactive Ganoderma triterpenoids, exerts preventive and therapeutic effects in many diseases. However, the function of GAA in PSD has not been well studied.Methods: PSD model was established via stimulating rats with chronic unpredictable mild stress stimulations (CUMS) after middle cerebral artery occlusion (MCAO). Rats were treated with GAA before CUMS. Depressive-like behaviors were investigated by body weight alteration, open field test (OFT), and sucrose preference test (SPT). Neuronal damage was evaluated by hematoxylin and eosin (HE) staining and Western blotting. Inflammation was detected by enzyme-linked immunosorbent assay (ELISA) and quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). Microglial polarization was analyzed via qRT-PCR and Western blotting. The extracellular signal-regulated kinase (ERK)/cAMP-response element-binding protein (CREB) pathway was analyzed by Western blotting, and inactivated by the inhibitor PD98059 (PD).Results: GAA attenuated PSD-induced depressive-like behaviors in rats. GAA mitigated PSD-induced neuronal damage and reduced BDNF and NGF levels in the cerebral hippocampus. GAA weakened PSD-induced inflammatory response in the cerebral hippocampus. GAA prevented pro-inflammatory (M1) polarization and promoted anti-inflammatory (M2) polarization, as indicated by decreased iNOS and CD86 levels and increased Arg-1 and CD206 levels. GAA restored the PSD-induced inactivation of the ERK/CREB pathway. GAA regulated M1/M2 microglial polarization by activating the ERK/CREB pathway.Conclusion: GAA alleviated the depressive-like behaviors and brain inflammation in PSD rats, indicating its potential for PSD therapy.Keywords: ganoderic acid A, post-stroke depression, neuronal damage, inflammation, microglial polarization, extracellular signal-regulated kinase

Lijun Deng,1 Rubo Sui,1 Lei Zhang2 1Department of Neurology, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, People’s Republic of China; 2School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, People’s Republic of ChinaCorrespondence: Rubo SuiDepartment of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, People’s Republic of ChinaTel +8613204525199Email 627079227@qq.comPurpose: To analyze the changes in white matter tracts in patients with post-stroke depression (PSD), and the correlation between these changes and the depressive state.Patients and Methods: The numbers of white matter tracts and corresponding fractional anisotropy (FA) in the acute phase (the onset time < 72 hours) were examined in each subject by diffusion tensor tractography (DTT). Diffusion tensor imaging (DTT), a new development of diffusion tensor imaging (DTI), enables visualization of white matter fiber tracts, which are thought to be closely related to the occurrence of PSD, According to the scores of Hamilton Depression Scale (HAMD) recorded at the 2nd week, 1st month, 3rd month, 6th month, and 12th month, forty patients were randomly selected and were classified into PSD group (n=20), non-depression post-stroke group (N-PSD, n=20), and control normal group (NORM, n=20), respectively. Correlations between the number of bundles (lines) in the white matter tract and corresponding FA, and HAMD score were finally assessed.Results: 1) FAs of the ipsilesional crossed corticocerebellar tract, the corticospinal tract, and the anterior thalamic radiation in PSD group were significantly lower than those in N-PSD and NORM groups (P< 0.01); 2) Lines in the three areas in the PSD group were significantly lower than those in the N-PSD and NORM groups (P< 0.01); and 3) FA and lines in the three areas of PSD patients were negatively correlated to HAMD scores (correlation coefficient=− 0.586, − 0.793, − 0.626, − 0.533, − 0.642, and − 0.524, respectively, all P< 0.05).Conclusion: FA and lines of the ipsilesional crossed corticocerebellar tract, the corticospinal tract, and the anterior thalamic radiation in PSD patients are significantly correlated to the depressive state. The crossed corticocerebellar tract, the corticospinal tract and the anterior thalamic radiation are involved in the development of PSD.Keywords: post-stroke depression, white matter tracts, diffusion tensor imaging, diffusion tensor tractography

Jialu Qiao,1 Rubo Sui,1 Lei Zhang,2 Jiannan Wang1 1Department of Neurology, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, People’s Republic of China; 2School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, People’s Republic of ChinaCorrespondence: Rubo SuiDepartment of Neurology, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, People’s Republic of ChinaTel +8618640605108Email 907052401@qq.comPurpose: This study aimed to develop a risk prediction model for post-stroke depression (PSD) based on magnetic resonance (MR) spectroscopy.Patients and Methods: Data of 61 patients hospitalized with stroke (November 2017–March 2019) were retrospectively analyzed. After 61 patients had been admitted to hospital for routine clinical information collection, when the patients were in stable condition, proton MR spectroscopy (1H-MRS) examinations were performed to measure the ratio of choline to creatine (Cho/Cr) and N-acetylaspartate to creatine (NAA/Cr) in brain regions related to emotion. From the second month to the sixth month after the onset, these 61 patients were assessed by the Hamilton Depression Scale once a month. Based on the scores, patients were divided into PSD and post-stroke non-depression (N-PSD) groups. Twenty-two characteristics were extracted from clinical data and the 1H-MRS imaging indexes. The least absolute shrinkage and selection operator (LASSO) regression was used for optimal feature selection and the nomogram prediction model was established. The model’s predictive ability was validated by a calibration plot and the area under the curve (AUC) of the receiver operating characteristic curve.Results: Two demographic characteristics (activities of daily living and initial National Institutes of Health Stroke Scale scores) and three 1H-MRS imaging characteristics (frontal-lobe Cho/Cr, temporal-lobe Cho/Cr, and anterior cingulated-cortex Cho/Cr) were screened out by LASSO regression. The consistency test through the calibration plot found that the predicted probability of the nomogram for PSD correlates well with the actual probability. The AUCs for internal validation and external validation were 0.8635 and 0.8851, respectively.Conclusion: The PSD risk model based on 1H-MRS may help guide early treatment of stroke and prevent progression to PSD.Keywords: PSD, 1H-MRS imaging, prediction model, nomogram

Rubo Sui, Lie Zang, Yanjuan BaiDepartment of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121001, Liaoning, People’s Republic of ChinaCorrespondence: Rubo SuiDepartment of Neurology, The First Affiliated Hospital of Jinzhou Medical University, 2 Renmin Road, Jinzhou 121000, Liaoning, People’s Republic of ChinaEmail yaanddoy@sina.comBackground: Cerebral ischemia/reperfusion injury (I/R injury) is an important pathological process for nervous system. The I/R injury usually causes cerebral hypoxia, infarct or stroke. This study aimed to evaluate effects of troxerutin and cerebroprotein hydrolysate injection (TC) on I/R injury in rat models.Methods: Middle-cerebral artery occlusion/reperfusion (MCAO/R) rat models were established. Rats were divided into normal control (NC), MCAO/R rat model (injecting saline) and MCAO/R rats administrating with TC group (injecting with TC at concentration of 2 mL/100 g body weight). Neurological scores were evaluated with Garcia scale. Magnetic resonance imaging (MRI) was employed to observe infarct area, contralateral area and apparent diffusion coefficient (ADC) values. Cerebral infarct size was examined and visualized by staining with 2,3,5-triphenyltetrazolium chloride (TTC). Western blotting assay was used to determine caspase-1, caspase-3 and caspase-8 expression.Results: The infarct size of mice in MCAO/R+TC group was smaller significantly compared to that in MCAO/R group (p