Background Visual rating scales are still the most popular tools in assessing atrophy degrees of whole brain and lobes. However, the false negative rate of the previous cutoff score of visual rating scales was relatively high for detecting dementia of Alzheimer’s type (DAT). This study aimed to evaluate the diagnostic value of new cutoffs of visual rating scales on magnetic resonance imaging for discriminating DAT in a Chinese population. Methods Out of 585 enrolled subjects, 296 participants were included and diagnosed as normal cognition (NC)( n = 87), 138 diagnosed as amnestic mild cognitive impairment (aMCI), and 71 as dementia of Alzheimer’s type (DAT). Receiver operating characteristic (ROC) curve analyses were used to calculate the diagnostic value of visual rating sales (including medial temporal atrophy (MTA), posterior atrophy rating scale (PA),global cortical atrophy scale (GCA) and medial temporal-lobe atrophy index (MTAi))for detecting NC from DAT . Results Scores of MTA correlated to age and Mini-mental state examination score. When used to detect DAT from NC, the MTA showed highest diagnostic value than other scales, and when the cutoff score of 1.5 of MTA scale, it obtained an optimal sensitivity (84.5%) and specificity (79.1%) respectively, with a 15.5% of false negative rate. Cutoff scores and diagnostic values were calculated stratified by age. For the age ranges 50–64, 65–74, 75–84 years, the following cut-offs of MTA should be used, ≥1.0(sensitivity and specificity were 92.3 and 68.4%), ≥1.5(sensitivity and specificity were 90.4 and 85.2%), ≥ 2.0(sensitivity and specificity were 70.8 and 82.3%) respectively. All of the scales showed relatively lower diagnostic values for discriminating aMCI from NC. Conclusions The new age-based MTA cutoff showed better diagnostic accuracy for detecting DAT than previous standard, the list of practical cut-offs proposed here might be useful in clinical practice.

Background: Acupuncture is safe and effective for improving the motor function of poststroke hemiplegic patients, but there still exists a certain gap between clinical practice and its neural mechanisms. The cerebral functional reconstruction after unilateral motor pathway injury exhibits a bilateral tendency, however current studies seldom pay attention to it. Hence, based on bilateral cerebral connections, the underlying mechanism of acupuncture in stroke rehabilitation remains research space to date. Methods: This is a single-center, randomized controlled, paralleled neuroimaging trial, with patients, outcome assessors, and data statisticians blinded. Stroke patients with motor dysfunction meeting the inclusion criteria will be randomly assigned (2:1) to receive either true acupoints treatment or sham acupoints treatment (5 sessions per week for 2 weeks). All the patients will receive conventional treatment and rehabilitation. Participants will undergo the neuroimaging scanning before and after the entire acupuncture treatment. The clinical primary outcomes are Fugl-Meyer assessments (FMA) and the National Institutes of Health stroke scales (NIHSS). The secondary outcome is Needle Sensation Assessment Scale (NSAS). The neuroimaing outcomes are voxel-mirrored homotopic connectivity (VMHC), fractional anisotropy (FA) and gray matter volume (GMV). The correlation analysis will be explored between the neuroimage indicators and clinical motor assessments. Discussion: From the perspective of bilateral connection, this trial will investigate the cerebral influence of acupuncture treatment on poststroke patients with motor dysfunction, promoting application of acupuncture in stroke rehabilitation. Trial registration: Chinese Clinical Trials Registry, ChiCTR 1800016263. Registered on 22 May, 2018.

Background Chronic inflammation is the major pathological feature of Atherosclerosis(As). Inflammation may accelerate plaque to develop, is a key factor resulting in the thinning of fibrous cap and the vulnerable rupture of plaque. Presently, clinical treatments are still lacking. It is necessary to find a safe and effective treatment for As inflammation. Simiaoyongan Decoction (SMYA) has potential anti-inflammatory and plaque protection effects. This protocol aims to evaluate the efficacy, safety,and mechanism of SMYA for patients with carotid atherosclerotic plaque. Methods/design The assess of SMYA clinical trial is designed as a randomized, double-blind, placebo-controlled study. The sample size is 86 cases in total, and there are 43 participants in the intervention group and the control group respectively. The intervention group takes SMYA, while the control group takes SMYA placebo. The medication lasts for 14 days every 10 weeks, with a total of 50 weeks. We will use carotid artery high resolution magnetic resonance imaging (HR-MRI) to measure plaque. The plaque minimum fiber cap thickness (PMFCT) is adopted as the primary outcome. The secondary outcomes include plaque fiber cap volume, volume percentage of fiber cap, lipid-rich necrotic core (LRNC) volume, volume percentage of LRNC, internal bleeding volume of plaque, internal bleeding volume percentage of plaque, plaque calcification volume, volume percentage of plaque calcification, lumen stenosis rate, average and maximum of vessel wall thickness, vessel wall volume, total vessel wall load, carotid atherosclerosis score, hs-CRP, IL-1β and IL-6, the leve of lipid profiles and blood glucose, blood pressure and body weight. Discussion We anticipate that patients with As plaque will be improved from SMYA by inhibiting inflammation to enhance plaque stability. This study analyzes plaque by using HR-MRI to evaluate the clinical efficacy and safety of SMYA. Moreover, we conduct transcriptome analysis, proteomic analysis and metagenomic analysis of blood and stool of participants to study the mechanism of SMYA against As plaque. This is the first prospective TCM trial to directly observe and treat As plaque by inhibiting inflammatory reaction. If successful, the finding will be valuable in the treatment of As plaque and drug development, especially in the “statin era”. Trial registration number Chinese Clinical Trial Registry ChiCTR2000039062; Registered on 1st November 2020.

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