HIV-associated neurocognitive disorders (HAND) are chronic complications of HIV infection in the central nervous system. Clinical presentations include asymptomatic neurocognitive impairment (ANI), mild neurocognitive...HIV-associated neurocognitive disorders (HAND) are chronic complications of HIV infection in the central nervous system. Clinical presentations include asymptomatic neurocognitive impairment (ANI), mild neurocognitive impairment (MND), and HIV-associated dementia (HAD). In the era of combination antiretroviral therapy (cART), the prevalence of HAD has significantly decreased, but the rates of ANI and MND have increased, impairing patients’ daily functioning, medical adherence, employment, driving abilities, risk of HIV transmission, overall quality of life, and posing challenges to society, economy, families, and public health. This article reviews the latest research findings regarding the pathogenesis, clinical diagnosis and treatment, neuroimaging, and neuropsychological assessment of HAND, aiming to provide insights into the prevention and management of HAND.展开更多
Objective:According to the World Health Organization,the number of infected people with human immunodeficiency virus(HIV)in 2019 was about 38 million.Using combinational antiretroviral therapy in recent years has incr...Objective:According to the World Health Organization,the number of infected people with human immunodeficiency virus(HIV)in 2019 was about 38 million.Using combinational antiretroviral therapy in recent years has increased life expectancy in these people and HIV has been changed from a deadly disease to a chronic one.HIV-associated neurological disorders(HAND)include asymptomatic neurological disorders,Motor neurological disorders,and HIV-associated dementia.Methods:We searched 3 databases(PubMed,Science Direct and Scopus databases)from January 2015 to March 2021 for the keywords;HIV associated with a neurocognitive disorder,HAND and combinational antiretroviral therapy to provide careful consideration of various aspects of these disorders,including;risk factors,their diagnostic methods,their epidemiology,and finally the treatment of HAND.Results:In the initial search,we came across 1351 articles.Three authors did the title-abstract screening,and 270 articles were entered into full-text screening from the previous step.Four authors did the full-text screening,and the screening outcome was 21 articles.We categorized the results of our study into sub-categories,including:risk factors,pathogenicity,clinical manifestations,diagnosis,and epidemiology of HAND.Conclusions:Although the HAND subheading has made great strides,many questions about the disease remain unanswered,and many of the diagnosing established methods are not 100%accurate and as a result of that,this epidemy can’t be fully endured yet.We hope to find and apply further advances and more definitive solutions in the coming decades.展开更多
The intravenous use of nalmefene has been found to exert neuroprotective effect in patients with severe traumatic brain injury and acute cerebral infarction;nonetheless,it is unknown whether nalmefene alleviates delay...The intravenous use of nalmefene has been found to exert neuroprotective effect in patients with severe traumatic brain injury and acute cerebral infarction;nonetheless,it is unknown whether nalmefene alleviates delayed neurocognitive recovery.Our purpose of the current research was to clarify the impact of nalmefene on delayed neurocognitive recovery in aged patients experiencing video-assisted thoracic surgery(VATS)with intraoperative use of one lung ventilation(OLV).The present study involved 120 paticents undergoing selective VATS,randomized to accept low-dose nalmefene(N1 group,n=40),high-dose nalmefene(N2 group,1n=40)or equal volume of physiologic saline(control group,1=40).A battery of neuropsychological tests were used to estimate cognitive function I day before surgery(o)and 10 days after surgery or before discharge(t).Regional cerebral oxygen saturation(rSO2)was detected 5 min before induction(t),5 min after induction(1),15 and 60 min after onset of OLV(62 and 13),and 15 min after termination of OLV(4).The plasma values of interleukin(IL)-1β,IL-6,tumor necrosis factor(TNF)-a1 and adiponectin(ADP)were also detected prior to induction of anesthesia(T0),1 h,2 h and 6 h after surgery(TI,T2,T3).On 1,delayed neurocognitive recovery occurred in 5/40(12.5%)patients of NI group,in 5/40(12.5%)patients of N2 group and in 13/40(32.5%)patients of control group(P<0.05).There were no statistical differences in rSO2 among three groups at different time points.At Tl,T2 and T3,IL-1β,IL-6 and TNF-a values significantly increased and ADP value significantly decreased(P<0.05)in control group.In contrast,at TI,T2 and T3,IL-1β,IL-6 and TNF-a values decreased and ADP value decreased less in N1 and N2 groups(P<0.05).At TI,T2 and T3,IL-1β,IL-6 and TNF-a concentrations presented a trend of N2 group<N1 group<control group and ADP presented a trend of N2 group>Nl group>control group(P<0.05).The result of our present research supports the hypothesis that the perioperative intravenous treatment with nalmefene to VATS with OLV ameliorates postoperative cognitive function and decreases the incidence of delayed neurocognitive recovery,most likely by suppression of inflammatory responses.展开更多
Objective:This study aimed to identify microRNAs(miRNAs)involved in the development of perioperative neurocognitive disorders(PND).Methods:Plasma exosomal miRNA expression was examined in patients before and after car...Objective:This study aimed to identify microRNAs(miRNAs)involved in the development of perioperative neurocognitive disorders(PND).Methods:Plasma exosomal miRNA expression was examined in patients before and after cardiopulmonary bypass(CPB)using microarray and qRT-PCR and these patients were diagnosed as PND later.Elderly rats were subjected to CPB,and the cognitive functions were examined.Bioinformatics analysis was conducted to predict the targets of miR-214-3p.Rats were administered rno-miR-214-3p agomir before or after CPB to investigate the role of miR-214-3p in PND development.Results:We identified 76 differentially expressed plasma exosomal miRNAs in PND patients after surgery(P<0.05,|log2FC|>0.58),including the upregulated hsa-miR-214-3p(P=0.002399392).Prostaglandin-endoperoxide synthase 2(PTGS2)was predicted as a miR-214-3p target.In rats,CPB reduced the platform crossing numbers and target quadrant stay time,accompanied with hippocampal neuronal necrosis.The rno-miR-214-3p level was significantly increased in plasma exosomes but decreased in rat hippocampus after surgery,exhibiting a negative correlation(P<0.001,r=-0.762).A negative correlation between miR-214-3p and PTGS2 protein expression was also observed in the hippocampus after surgery.Importantly,rno-miR-214-3p agomir treatment,before or after surgery,significantly increased the platform crossing numbers(P=0.035)and target quadrant stay time(P=0.029)compared with negative control.Hippocampal PTGS2 protein level was increased in the untreated surgery group and decreased in response to rno-miR-214-3p agomir treatment before or after surgery(both P<0.05 vs.negative control).Conclusion:These data suggest that miR-214-3p/PTGS2 signaling contributes to the development of PND,serving as a potential therapeutic target for PND.展开更多
Objectives:Although effective antiretroviral therapy(ART)has been used for more than two decades,HIV-associated neurocognitive disorder remains prevalent.Thus,whether ART can improve neurocognitive impairment is contr...Objectives:Although effective antiretroviral therapy(ART)has been used for more than two decades,HIV-associated neurocognitive disorder remains prevalent.Thus,whether ART can improve neurocognitive impairment is controversial.This review aims to explore the effects of ART on cognitive impairment in people living with HIV(PLWH).Methods:A systematic literature search was conducted in eight databases(PubMed,Embase,Web of Science,Cochrane Library,CNKI,VIP,China Biology Medicine disc,and WanFang)to identify studies that compare cognitive function between study groups who are administered and not administered ART.We searched for articles published up to April 2019.Article evaluation and data extraction were independently conducted by two reviewers.Results:Sixteen articles(6,694 participants)-14 cross-sectional studies and 2 cohort studies—were included in this meta-analysis.The cross-sectional studies demonstrated that ART group did not perform better than the non-ART group(OR=1.16;95%CI,1.03-1.30).However,the cohort studies reported a significant improvement in cognitive function at three months(OR=4.01;95%CI,2.35-6.85)and six months(OR=9.24;95%CI,1.71-49.96)after ART initiation compared with the baseline data.No significant cognitive improvement was found in participants younger than 55 years old,but the two crosssectional studies showed that ART may improve cognitive function in PLWH under 65 years old with poor physical condition and immune status.Conclusions:ART could improve cognitive function in PLWH with poor physical condition and immune status,but it does not considerably improve cognition in the entire PLWH population.展开更多
BACKGROUND Blink and masseter reflexes provide reliable,quantifiable data on the function of the central nervous system:Delayed latencies have been found in patients with neurocognitive disorder(ND)and type 2 diabetes...BACKGROUND Blink and masseter reflexes provide reliable,quantifiable data on the function of the central nervous system:Delayed latencies have been found in patients with neurocognitive disorder(ND)and type 2 diabetes mellitus(T2DM),but this has not been studied in patients with both pathologies.AIM To investigate if older adults with ND plus T2DM have prolonged latencies of blink and masseter-reflex and if they were associated with disease progression.METHODS This cross-sectional study included 227 older adults(>60 years)from Colima,Mexico.Neurocognitive disorder was identified by a neuropsychological battery test,and T2DM identified by medical history,fasting glucose,and glycosylated hemoglobin.Latencies in the early reflex(R1),ipsilateral late(R2),and contralateral late(R2c)components of the blink reflex were analyzed for all subjects,and 183 subjects were analyzed for latency of the masseter reflex.RESULTS In 20.7%of participants,ND was detected.In 37%,T2DM was detected.Latencies in R1,R2,and R2c were significantly prolonged for groups with ND plus T2DM,ND,and T2DM,compared with the control group(P<0.0001).The masseter reflex was only prolonged in older adults(regardless of T2DM status)with ND vs controls(P=0.030).In older adults with ND and without T2DM,the more the cognitive impairment progressed,the more prolonged latencies in R2 and R2c presented(P<0.01).CONCLUSION These findings suggest that blink and masseter reflexes could be used to evaluate possible changes in brainstem circuits in older adults with ND and T2DM.展开更多
Background: Traditionally, neurocognitive testing is performed weeks to months after head injury and is mostly performed on patients who continue to have symptoms or difficulties. In this study, we sought to determine...Background: Traditionally, neurocognitive testing is performed weeks to months after head injury and is mostly performed on patients who continue to have symptoms or difficulties. In this study, we sought to determine whether these tests, when administered acutely, could assist in predicting short-term outcomes after acute traumatic brain injury(TBI).Methods: This is an IRB-approved prospective study of adult patients who came to the emergency department of our Level-1 trauma center with TBI. Patients were enrolled prospectively after providing written informed consent and underwent three separate neurocognitive tests: the Galveston Orientation Amnesia Test(GOAT), the Rivermead PostConcussion Survey Questionnaire(RPCSQ), and the Mini Mental Status Examination(MMSE).Results: A lower GOAT score was significantly associated with hospitalization(P=0.0212) and the development of post-concussion syndrome(PCS) at late follow-up(P=0.0081). A higher RPCSQ score was significantly associated with hospital admission(P=0.0098), re-admission within 30 days of discharge(P=0.0431) and evidence of PCS at early follow-up(P=0.0004). A higher MMSE score was significantly associated with not being admitted to the hospital(P=0.0002) and not returning to the emergency department(ED) within 72 hours of discharge(P=0.0078). Lower MMSE was also significantly associated with bleeding or a fracture on the brain CT(P=0.0431).Conclusions: While neurocognitive testing is not commonly performed in the ED in the setting of acute head injury, it is both feasible and appears to have value in predicting hospital admission and PCS. These data are especially important in terms of helping patients understand what to expect, thus, aiding in their recovery.展开更多
Background Prevalence of neurocognitive disorder with Lewy bodies （NCDLB） is low in Asian populations, which may partially refect its diagnostic diffculty. The Mayo Fluctuations Scale, a short questionnaire that ev...Background Prevalence of neurocognitive disorder with Lewy bodies （NCDLB） is low in Asian populations, which may partially refect its diagnostic diffculty. The Mayo Fluctuations Scale, a short questionnaire that evaluates cognitive fuctuation, has been shown to signifcantly differentiate NCDLB from Alzheimer＇s disease.Aim This study aimed to develop the Mayo Fluctuations Scale-Thai version and assess its validity to screen NCDLB in an elderly population.Methods The Mayo Fluctuations Scale was translated into Thai. The process involved back-translation, cross-cultural adaptation, feld testing of the prefnal version, as well as fnal adjustments. From all patients attending the Psychiatric and Memory Clinic at Ramathibodi Hospital, 135 patients accompanied by their primary caregivers were included. Caregivers were interviewed by research assistants using a four-item scale, and psychiatrists determined patients＇ diagnosis based on the diagnostic and statistical manual of mental disorders （DSM）-5 criteria. Evaluations performed by psychiatrists and research assistants were blinded.Results Seventeen participants had been diagnosed with major NCDLB. At a cut-off score of 2 or over, the Mayo Fluctuations Scale exhibited excellent performance to differentiate major NCDLB from other major neurocognitive disorders （NCDs）, with a sensitivity of 94.1% and a specifcity of 71.4%, and acceptable performance to differentiate mild NCDLB from other mild NCDs, with a sensitivity of 60% and a specifcity of 93.1%.Conclusion The Mayo Fluctuations Scale-Thai version is an excellent screening tool for major NCDLB and an acceptable tool that may be used with other additional tests for mild NCDLB. The tool is practical for use in memory and psychiatric clinics. Further validation studies in participants with other specifc clinical conditions are required.展开更多
The future of any population is children. Resource limited settings with a high prevalence of HIV infection notably also have an excessive burden of malnutrition. The advances in prevention of mother to child HIV tran...The future of any population is children. Resource limited settings with a high prevalence of HIV infection notably also have an excessive burden of malnutrition. The advances in prevention of mother to child HIV transmission programmes have led to very effective combination antiretroviral regimens resulting in growing numbers of HIV exposed but uninfected children. The mortality of HIV exposed but uninfected children below 5 years is high in resource limited settings. It is also important to pay particular attention to their longitudinal growth and neurodevelopmental outcomes. In these settings, the contribution of feeding practices, choice of complementary foods and micronutrient deficiencies, to health outcomes of HIV exposed uninfected children are not clearly defined. This review highlights some gaps in research that need to be addressed in areas with increasing numbers of HIV exposed but uninfected children. Interventions to reduce mortality, improve growth and neurodevelopmental outcomes in HIV exposed uninfected children from resource limited areas should be prioritized.展开更多
Infection with HIV is one of the deadliest epidemics of our time and its type is widespread in the Central African Republic. It is frequently accompanied by neurological complications. Objective: To contribute to a be...Infection with HIV is one of the deadliest epidemics of our time and its type is widespread in the Central African Republic. It is frequently accompanied by neurological complications. Objective: To contribute to a better understanding of neurocognitive disorders in patients living with HIV (PLHIV) in Bangui, and to identify associated factors using the International HIV Dementia Scale (IHDS) as a screening tool. We conducted a descriptive and analytical cross-sectional study from 1 December 2014 to 30 January 2015, in a cohort of patients seen on one of the supported sites in Bangui. A total of 400 patients were received in follow-up visit during the study period of which 244 met the inclusion criteria. The prevalence of neurocognitive disorders was 25%, 95% CI [19.70 - 30.92]. The mean age of subjects was 42.77 ± 9.58 with extremes ranging from 24 - 64 years. The sex ratio (F/M) was 4.5 in. The average score for different tests was 10.93 ± 1.13 with extremes of 7 and 12. The disorder was more about the gestural sequence. Determinants of neurocognitive disorders in the cohort were older age and lower educational level (p < 0.05). It is useful to conduct further studies to confirm these results by combining a battery of neuropsychological tests to recommend this test for all the support sites of PLHIV in the country.展开更多
Peri-operative neurocognitive disorders(PNDs)include postoperative delirium(POD)and postoperative cognitive dysfunction(POCD).Children and the elderly are the two populations most vulnerable to the development of POD ...Peri-operative neurocognitive disorders(PNDs)include postoperative delirium(POD)and postoperative cognitive dysfunction(POCD).Children and the elderly are the two populations most vulnerable to the development of POD and POCD,which results in both high morbidity and mortality.There are many factors,including neuroinflammation and oxidative stress,that are associated with POD and POCD.General anesthesia is a major risk factor of PNDs.However,the molecular mechanisms of PNDs are poorly understood.Dexmedetomidine(DEX)is a useful sedative agent with analgesic properties,which significantly improves POCD in elderly patients.In this review,the current understanding of anesthesia in PNDs and the protective effects of DEX are summarized,and the underlying mechanisms are further discussed.展开更多
Background Tungiasis,a neglected tropical parasitosis,disproportionately afects children.Few empirical studies have reported neurocognitive and mental health outcomes of children with ectoparasitic skin diseases like ...Background Tungiasis,a neglected tropical parasitosis,disproportionately afects children.Few empirical studies have reported neurocognitive and mental health outcomes of children with ectoparasitic skin diseases like tungiasis.Pathophysiology of tungiasis suggests it could detrimentally afect cognition and behaviour.This study pioneered the investigation of neurocognitive and mental health outcomes in children with tungiasis.Methods This was a multi-site cross-sectional study including 454 quasi-randomly sampled school-children aged 8-14 from 48 randomly selected schools in two counties in Kenya and a district in Uganda.The participants were stratifed into infected and uninfected based on the presence of tungiasis.The infected were further classifed into mild and severe infection groups based on the intensity of the infection.Adapted,validated,and standardized measures of cognition and mental health such as Raven Matrices and Child Behaviour Checklist were used to collect data.Statistical tests including a multilevel,generalized mixed-efects linear models with family link set to identity were used to compare the scores of uninfected and infected children and to identify other potential risk factors for neurocognitive and behavioural outcomes.Results When adjusted for covariates,mild infection was associated with lower scores in literacy[adjustedβ(aβ)=−8.9;95%confdence interval(CI)−17.2,−0.6],language(aβ=−1.7;95%CI−3.2,−0.3),cognitive fexibility(aβ=−6.1;95%CI−10.4,−1.7)and working memory(aβ=−0.3;95%CI−0.6,−0.1).Severe infection was associated with lower scores in literacy(aβ=−11.0;95%CI−19.3,−2.8),response inhibition,(aβ=−2.2;95%CI−4.2,−0.2),fne motor control(aβ=−0.7;95%CI−1.1,−0.4)and numeracy(aβ=−3;95%CI−5.5,−0.4).Conclusions This study provides frst evidence that tungiasis is associated with poor neurocognitive functioning in children.Since tungiasis is a chronic disease with frequent reinfections,such negative efects may potentially impair their development and life achievements.展开更多
General anesthetic agents can impact brain function through interactions with neurons and their effects on glial cells.Oligodendrocytes perform essential roles in the central nervous system,including myelin sheath for...General anesthetic agents can impact brain function through interactions with neurons and their effects on glial cells.Oligodendrocytes perform essential roles in the central nervous system,including myelin sheath formation,axonal metabolism,and neuroplasticity regulation.They are particularly vulnerable to the effects of general anesthetic agents resulting in impaired proliferation,differentiation,and apoptosis.Neurologists are increasingly interested in the effects of general anesthetic agents on oligodendrocytes.These agents not only act on the surface receptors of oligodendrocytes to elicit neuroinflammation through modulation of signaling pathways,but also disrupt metabolic processes and alter the expression of genes involved in oligodendrocyte development and function.In this review,we summarize the effects of general anesthetic agents on oligodendrocytes.We anticipate that future research will continue to explore these effects and develop strategies to decrease the incidence of adverse reactions associated with the use of general anesthetic agents.展开更多
The hypothalamic-pituitary-adrenal axis regulates the secretion of glucoco rticoids in response to environmental challenges.In the brain,a nuclear receptor transcription fa ctor,the glucocorticoid recepto r,is an impo...The hypothalamic-pituitary-adrenal axis regulates the secretion of glucoco rticoids in response to environmental challenges.In the brain,a nuclear receptor transcription fa ctor,the glucocorticoid recepto r,is an important component of the hypothalamicpituitary-a d renal axis's negative feedback loop and plays a key role in regulating cognitive equilibrium and neuroplasticity.The glucoco rticoid receptor influences cognitive processes,including glutamate neurotransmission,calcium signaling,and the activation of brain-derived neurotrophic factor-mediated pathways,through a combination of genomic and non-genomic mechanisms.Protein interactions within the central nervous system can alter the expression and activity of the glucocorticoid receptor,there by affecting the hypothalamic-pituitary-a d renal axis and stress-related cognitive functions.An appropriate level of glucocorticoid receptor expression can improve cognitive function,while excessive glucocorticoid receptors or long-term exposure to glucoco rticoids may lead to cognitive impairment.Patients with cognitive impairment-associated diseases,such as Alzheimer's disease,aging,depression,Parkinson's disease,Huntington's disease,stroke,and addiction,often present with dysregulation of the hypothalamic-pituitary-adrenal axis and glucocorticoid receptor expression.This review provides a comprehensive overview of the functions of the glucoco rticoid receptor in the hypothalamic-pituitary-a d renal axis and cognitive activities.It emphasizes that appropriate glucocorticoid receptor signaling fa cilitates learning and memory,while its dysregulation can lead to cognitive impairment.This provides clues about how glucocorticoid receptor signaling can be targeted to ove rcome cognitive disability-related disorders.展开更多
Delirium,a complex neurocognitive syndrome,frequently emerges following surgery,presenting diverse manifestations and considerable obstacles,especially among the elderly.This editorial delves into the intricate phenom...Delirium,a complex neurocognitive syndrome,frequently emerges following surgery,presenting diverse manifestations and considerable obstacles,especially among the elderly.This editorial delves into the intricate phenomenon of postoperative delirium(POD),shedding light on a study that explores POD in elderly individuals undergoing abdominal malignancy surgery.The study examines pathophysiology and predictive determinants,offering valuable insights into this challenging clinical scenario.Employing the synthetic minority oversampling technique,a predictive model is developed,incorporating critical risk factors such as comorbidity index,anesthesia grade,and surgical duration.There is an urgent need for accurate risk factor identification to mitigate POD incidence.While specific to elderly patients with abdominal malignancies,the findings contribute significantly to understanding delirium pathophysiology and prediction.Further research is warranted to establish standardized predictive for enhanced generalizability.展开更多
In this editorial,we comment on the article by Hu et al entitled“Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique”.We wan...In this editorial,we comment on the article by Hu et al entitled“Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique”.We wanted to draw attention to the general features of postoperative delirium(POD)as well as the areas where there are uncertainties and contradictions.POD can be defined as acute neurocognitive dysfunction that occurs in the first week after surgery.It is a severe postoperative complication,especially for elderly oncology patients.Although the underlying pathophysiological mechanism is not fully understood,various neuroinflammatory mechanisms and neurotransmitters are thought to be involved.Various assessment scales and diagnostic methods have been proposed for the early diagnosis of POD.As delirium is considered a preventable clinical entity in about half of the cases,various early prediction models developed with the support of machine learning have recently become a hot scientific topic.Unfortunately,a model with high sensitivity and specificity for the prediction of POD has not yet been reported.This situation reveals that all health personnel who provide health care services to elderly patients should approach patients with a high level of awareness in the perioperative period regarding POD.展开更多
Objective: Some studies have investigated the association between oral microbiome and mild cognitive impairment (MCI). However, there needs to be more narrative reviews synthesizing this evidence. This study aimed to ...Objective: Some studies have investigated the association between oral microbiome and mild cognitive impairment (MCI). However, there needs to be more narrative reviews synthesizing this evidence. This study aimed to bridge this gap in the current knowledge. Methods: A comprehensive search was conducted on PubMed (MEDLINE) to identify studies examining the association between the oral microbiome and MCI. Search parameters and inclusion criteria were clearly defined, encompassing terms related to the oral microbiome, MCI, and their association. Two authors independently selected relevant studies and performed data extraction. Result: Four studies were included. Two cohort studies and two case-control reported an association between the oral microbiome and MCI. Conclusion: Based on the evidence synthesized from the included studies, the review suggests an association between MCI and the oral microbiome. Specifically, all included studies identified significant differences in the abundance of specific microbial species between individuals with MCI and those with normal cognitive function, underscoring the potential role of these species in neuroinflammatory diseases.展开更多
Neuroscientists have recognized the importance of astrocytes in regulating neurological function and their influence on the release of glial transmitters.Few studies,however,have focused on the effects of general anes...Neuroscientists have recognized the importance of astrocytes in regulating neurological function and their influence on the release of glial transmitters.Few studies,however,have focused on the effects of general anesthetic agents on neuroglia or astrocytes.Astrocytes can also be an important target of general anesthetic agents as they exert not only sedative,analgesic,and amnesic effects but also mediate general anesthetic-induced neurotoxicity and postoperative cognitive dysfunction.Here,we analyzed recent advances in understanding the mechanism of general anesthetic agents on astrocytes,and found that exposure to general anesthetic agents will destroy the morphology and proliferation of astrocytes,in addition to acting on the receptors on their surface,which not only affect Ca^(2+)signaling,inhibit the release of brain-derived neurotrophic factor and lactate from astrocytes,but are even involved in the regulation of the pro-and anti-inflammatory processes of astrocytes.These would obviously affect the communication between astrocytes as well as between astrocytes and neighboring neurons,other neuroglia,and vascular cells.In this review,we summarize how general anesthetic agents act on neurons via astrocytes,and explore potential mechanisms of action of general anesthetic agents on the nervous system.We hope that this review will provide a new direction for mitigating the neurotoxicity of general anesthetic agents.展开更多
Neurocognitive deficits are frequently observed in patients with schizophrenia and major depressive disorder(MDD). The relations between cognitive features may be represented by neurocognitive graphs based on cognitiv...Neurocognitive deficits are frequently observed in patients with schizophrenia and major depressive disorder(MDD). The relations between cognitive features may be represented by neurocognitive graphs based on cognitive features, modeled as Gaussian Markov random fields. However, it is unclear whether it is possible to differentiate between phenotypic patterns associated with the differential diagnosis of schizophrenia and depression using this neurocognitive graph approach. In this study, we enrolled 215 first-episode patients with schizophrenia(FES), 125 with MDD, and 237 demographically-matched healthy controls(HCs). The cognitive performance of all participants was evaluated using a battery of neurocognitive tests. The graphical LASSO model was trained with aone-vs-one scenario to learn the conditional independent structure of neurocognitive features of each group. Participants in the holdout dataset were classified into different groups with the highest likelihood. A partial correlation matrix was transformed from the graphical model to further explore the neurocognitive graph for each group. The classification approach identified the diagnostic class for individuals with an average accuracy of 73.41% for FES vs HC, 67.07% for MDD vs HC, and 59.48% for FES vs MDD. Both of the neurocognitive graphs for FES and MDD had more connections and higher node centrality than those for HC. The neurocognitive graph for FES was less sparse and had more connections than that for MDD.Thus, neurocognitive graphs based on cognitive features are promising for describing endophenotypes that may discriminate schizophrenia from depression.展开更多
Background:Perioperative neurocognitive disorders(PND)are a series of severe complications in the perioperative and anesthetic periods with a decline in memory,execution ability,and information processing speed as the...Background:Perioperative neurocognitive disorders(PND)are a series of severe complications in the perioperative and anesthetic periods with a decline in memory,execution ability,and information processing speed as the primary clinical manifestation.This study aimed to evaluate the impact of edaravone(EDA)on PND and peripheral blood C-X-C motif chemokine ligand 13(CXCL13)levels in elderly patients with hip replacement.Methods:A total of 160 elderly patients undergoing hip arthroplasty in Affiliated Dongguan People’s Hospital of Southern Medical University(from March 2016 to March 2018)were randomly and double-blindly categorized into an EDA group and a control group(CON).Group EDA was administered intravenously EDA 30 min before surgery,and group CON was administered intravenously saline.The cognitive function of the two groups was evaluated 1-day before the operation and at 1 and 12 months after surgery,and the incidence of post-operative delirium was tested on days 1,3,and 7 after surgery using the Chinese version of the confusion assessment method.Serum CXCL13 and interleukin(IL)-6 concentrations were measured before anesthesia,during surgery(30 min after skin incision),and on days 1,3,and 7 after surgery.The continuous variables in accordance with normal distribution were tested using the Student’s t test,the continuous variables without normal distribution using the Mann-Whitney U test,and categorical variables by the x 2 test or Fisher exact test.Results:The incidence of post-operative delirium within 7 days after surgery was significantly higher in group CON than that in group EDA(31.3%vs.15.0%,t=-5.6,P<0.001).The modifiedtelephone interview for cognitive status andactivities of daily life scores were significantly higher in the group EDA than those in the group CON at 1 month(39.63±4.35 vs.33.63±5.81,t=-2.13,P<0.05and 74.3±12.6 vs.61.2±13.1,t=-1.69,P<0.05)and 12 months(40.13±5.93 vs.34.13±5.36,t=-3.37,P<0.05 and 79.6±11.7 vs.65.6±16.6,t=-2.08,P<0.05)after surgery;and the incidence of neurocognitive dysfunction was significantly lower in the group EDA than that in the group CON(P<0.05).Serum CXCL13 and IL-6 concentrations were significantly lower in the group EDA than those in the group CON during and after surgery(P<0.05).Conclusion:EDA can significantly reduce the serum concentrations of CXCL13 and IL-6 and improve the PND of patients.展开更多
文摘HIV-associated neurocognitive disorders (HAND) are chronic complications of HIV infection in the central nervous system. Clinical presentations include asymptomatic neurocognitive impairment (ANI), mild neurocognitive impairment (MND), and HIV-associated dementia (HAD). In the era of combination antiretroviral therapy (cART), the prevalence of HAD has significantly decreased, but the rates of ANI and MND have increased, impairing patients’ daily functioning, medical adherence, employment, driving abilities, risk of HIV transmission, overall quality of life, and posing challenges to society, economy, families, and public health. This article reviews the latest research findings regarding the pathogenesis, clinical diagnosis and treatment, neuroimaging, and neuropsychological assessment of HAND, aiming to provide insights into the prevention and management of HAND.
文摘Objective:According to the World Health Organization,the number of infected people with human immunodeficiency virus(HIV)in 2019 was about 38 million.Using combinational antiretroviral therapy in recent years has increased life expectancy in these people and HIV has been changed from a deadly disease to a chronic one.HIV-associated neurological disorders(HAND)include asymptomatic neurological disorders,Motor neurological disorders,and HIV-associated dementia.Methods:We searched 3 databases(PubMed,Science Direct and Scopus databases)from January 2015 to March 2021 for the keywords;HIV associated with a neurocognitive disorder,HAND and combinational antiretroviral therapy to provide careful consideration of various aspects of these disorders,including;risk factors,their diagnostic methods,their epidemiology,and finally the treatment of HAND.Results:In the initial search,we came across 1351 articles.Three authors did the title-abstract screening,and 270 articles were entered into full-text screening from the previous step.Four authors did the full-text screening,and the screening outcome was 21 articles.We categorized the results of our study into sub-categories,including:risk factors,pathogenicity,clinical manifestations,diagnosis,and epidemiology of HAND.Conclusions:Although the HAND subheading has made great strides,many questions about the disease remain unanswered,and many of the diagnosing established methods are not 100%accurate and as a result of that,this epidemy can’t be fully endured yet.We hope to find and apply further advances and more definitive solutions in the coming decades.
基金This study was supported by grants from the Innovation Foundation of Health and Family Planning Commission of Hubei Province(No.WJ2017M036)the National Natural Science Foundation of China(No.81471858).
文摘The intravenous use of nalmefene has been found to exert neuroprotective effect in patients with severe traumatic brain injury and acute cerebral infarction;nonetheless,it is unknown whether nalmefene alleviates delayed neurocognitive recovery.Our purpose of the current research was to clarify the impact of nalmefene on delayed neurocognitive recovery in aged patients experiencing video-assisted thoracic surgery(VATS)with intraoperative use of one lung ventilation(OLV).The present study involved 120 paticents undergoing selective VATS,randomized to accept low-dose nalmefene(N1 group,n=40),high-dose nalmefene(N2 group,1n=40)or equal volume of physiologic saline(control group,1=40).A battery of neuropsychological tests were used to estimate cognitive function I day before surgery(o)and 10 days after surgery or before discharge(t).Regional cerebral oxygen saturation(rSO2)was detected 5 min before induction(t),5 min after induction(1),15 and 60 min after onset of OLV(62 and 13),and 15 min after termination of OLV(4).The plasma values of interleukin(IL)-1β,IL-6,tumor necrosis factor(TNF)-a1 and adiponectin(ADP)were also detected prior to induction of anesthesia(T0),1 h,2 h and 6 h after surgery(TI,T2,T3).On 1,delayed neurocognitive recovery occurred in 5/40(12.5%)patients of NI group,in 5/40(12.5%)patients of N2 group and in 13/40(32.5%)patients of control group(P<0.05).There were no statistical differences in rSO2 among three groups at different time points.At Tl,T2 and T3,IL-1β,IL-6 and TNF-a values significantly increased and ADP value significantly decreased(P<0.05)in control group.In contrast,at TI,T2 and T3,IL-1β,IL-6 and TNF-a values decreased and ADP value decreased less in N1 and N2 groups(P<0.05).At TI,T2 and T3,IL-1β,IL-6 and TNF-a concentrations presented a trend of N2 group<N1 group<control group and ADP presented a trend of N2 group>Nl group>control group(P<0.05).The result of our present research supports the hypothesis that the perioperative intravenous treatment with nalmefene to VATS with OLV ameliorates postoperative cognitive function and decreases the incidence of delayed neurocognitive recovery,most likely by suppression of inflammatory responses.
基金supported by grantsfrom the Department of Human Resources and Social Security of Sichuan Province(No.19058)the subject of Health Commission of Sichuan Province(No.20PJ130)+2 种基金the Science and Technology Strategic Cooperation Programs of Luzhou Municipal People's Government and Southwest Medical University(No.2019LZXNYDJ36)the subject of Affiliated Hospital of Southwest Medical University(No.2017-PT-45)the Doctoral Research Initiation Fund of Affiliated Hospital of Southwest Medical University(No.19023).
文摘Objective:This study aimed to identify microRNAs(miRNAs)involved in the development of perioperative neurocognitive disorders(PND).Methods:Plasma exosomal miRNA expression was examined in patients before and after cardiopulmonary bypass(CPB)using microarray and qRT-PCR and these patients were diagnosed as PND later.Elderly rats were subjected to CPB,and the cognitive functions were examined.Bioinformatics analysis was conducted to predict the targets of miR-214-3p.Rats were administered rno-miR-214-3p agomir before or after CPB to investigate the role of miR-214-3p in PND development.Results:We identified 76 differentially expressed plasma exosomal miRNAs in PND patients after surgery(P<0.05,|log2FC|>0.58),including the upregulated hsa-miR-214-3p(P=0.002399392).Prostaglandin-endoperoxide synthase 2(PTGS2)was predicted as a miR-214-3p target.In rats,CPB reduced the platform crossing numbers and target quadrant stay time,accompanied with hippocampal neuronal necrosis.The rno-miR-214-3p level was significantly increased in plasma exosomes but decreased in rat hippocampus after surgery,exhibiting a negative correlation(P<0.001,r=-0.762).A negative correlation between miR-214-3p and PTGS2 protein expression was also observed in the hippocampus after surgery.Importantly,rno-miR-214-3p agomir treatment,before or after surgery,significantly increased the platform crossing numbers(P=0.035)and target quadrant stay time(P=0.029)compared with negative control.Hippocampal PTGS2 protein level was increased in the untreated surgery group and decreased in response to rno-miR-214-3p agomir treatment before or after surgery(both P<0.05 vs.negative control).Conclusion:These data suggest that miR-214-3p/PTGS2 signaling contributes to the development of PND,serving as a potential therapeutic target for PND.
文摘Objectives:Although effective antiretroviral therapy(ART)has been used for more than two decades,HIV-associated neurocognitive disorder remains prevalent.Thus,whether ART can improve neurocognitive impairment is controversial.This review aims to explore the effects of ART on cognitive impairment in people living with HIV(PLWH).Methods:A systematic literature search was conducted in eight databases(PubMed,Embase,Web of Science,Cochrane Library,CNKI,VIP,China Biology Medicine disc,and WanFang)to identify studies that compare cognitive function between study groups who are administered and not administered ART.We searched for articles published up to April 2019.Article evaluation and data extraction were independently conducted by two reviewers.Results:Sixteen articles(6,694 participants)-14 cross-sectional studies and 2 cohort studies—were included in this meta-analysis.The cross-sectional studies demonstrated that ART group did not perform better than the non-ART group(OR=1.16;95%CI,1.03-1.30).However,the cohort studies reported a significant improvement in cognitive function at three months(OR=4.01;95%CI,2.35-6.85)and six months(OR=9.24;95%CI,1.71-49.96)after ART initiation compared with the baseline data.No significant cognitive improvement was found in participants younger than 55 years old,but the two crosssectional studies showed that ART may improve cognitive function in PLWH under 65 years old with poor physical condition and immune status.Conclusions:ART could improve cognitive function in PLWH with poor physical condition and immune status,but it does not considerably improve cognition in the entire PLWH population.
文摘BACKGROUND Blink and masseter reflexes provide reliable,quantifiable data on the function of the central nervous system:Delayed latencies have been found in patients with neurocognitive disorder(ND)and type 2 diabetes mellitus(T2DM),but this has not been studied in patients with both pathologies.AIM To investigate if older adults with ND plus T2DM have prolonged latencies of blink and masseter-reflex and if they were associated with disease progression.METHODS This cross-sectional study included 227 older adults(>60 years)from Colima,Mexico.Neurocognitive disorder was identified by a neuropsychological battery test,and T2DM identified by medical history,fasting glucose,and glycosylated hemoglobin.Latencies in the early reflex(R1),ipsilateral late(R2),and contralateral late(R2c)components of the blink reflex were analyzed for all subjects,and 183 subjects were analyzed for latency of the masseter reflex.RESULTS In 20.7%of participants,ND was detected.In 37%,T2DM was detected.Latencies in R1,R2,and R2c were significantly prolonged for groups with ND plus T2DM,ND,and T2DM,compared with the control group(P<0.0001).The masseter reflex was only prolonged in older adults(regardless of T2DM status)with ND vs controls(P=0.030).In older adults with ND and without T2DM,the more the cognitive impairment progressed,the more prolonged latencies in R2 and R2c presented(P<0.01).CONCLUSION These findings suggest that blink and masseter reflexes could be used to evaluate possible changes in brainstem circuits in older adults with ND and T2DM.
基金supported by an endowment from The Toral Family Foundation, 13131 SW 19th Street, Davie, Florida 33325, USA (toralfamilyfoundation.org)
文摘Background: Traditionally, neurocognitive testing is performed weeks to months after head injury and is mostly performed on patients who continue to have symptoms or difficulties. In this study, we sought to determine whether these tests, when administered acutely, could assist in predicting short-term outcomes after acute traumatic brain injury(TBI).Methods: This is an IRB-approved prospective study of adult patients who came to the emergency department of our Level-1 trauma center with TBI. Patients were enrolled prospectively after providing written informed consent and underwent three separate neurocognitive tests: the Galveston Orientation Amnesia Test(GOAT), the Rivermead PostConcussion Survey Questionnaire(RPCSQ), and the Mini Mental Status Examination(MMSE).Results: A lower GOAT score was significantly associated with hospitalization(P=0.0212) and the development of post-concussion syndrome(PCS) at late follow-up(P=0.0081). A higher RPCSQ score was significantly associated with hospital admission(P=0.0098), re-admission within 30 days of discharge(P=0.0431) and evidence of PCS at early follow-up(P=0.0004). A higher MMSE score was significantly associated with not being admitted to the hospital(P=0.0002) and not returning to the emergency department(ED) within 72 hours of discharge(P=0.0078). Lower MMSE was also significantly associated with bleeding or a fracture on the brain CT(P=0.0431).Conclusions: While neurocognitive testing is not commonly performed in the ED in the setting of acute head injury, it is both feasible and appears to have value in predicting hospital admission and PCS. These data are especially important in terms of helping patients understand what to expect, thus, aiding in their recovery.
基金funded by a grant from the Faculty of MedicineRamathibodi Hospital,Mahidol University,Bangkok,Thailand
文摘Background Prevalence of neurocognitive disorder with Lewy bodies （NCDLB） is low in Asian populations, which may partially refect its diagnostic diffculty. The Mayo Fluctuations Scale, a short questionnaire that evaluates cognitive fuctuation, has been shown to signifcantly differentiate NCDLB from Alzheimer＇s disease.Aim This study aimed to develop the Mayo Fluctuations Scale-Thai version and assess its validity to screen NCDLB in an elderly population.Methods The Mayo Fluctuations Scale was translated into Thai. The process involved back-translation, cross-cultural adaptation, feld testing of the prefnal version, as well as fnal adjustments. From all patients attending the Psychiatric and Memory Clinic at Ramathibodi Hospital, 135 patients accompanied by their primary caregivers were included. Caregivers were interviewed by research assistants using a four-item scale, and psychiatrists determined patients＇ diagnosis based on the diagnostic and statistical manual of mental disorders （DSM）-5 criteria. Evaluations performed by psychiatrists and research assistants were blinded.Results Seventeen participants had been diagnosed with major NCDLB. At a cut-off score of 2 or over, the Mayo Fluctuations Scale exhibited excellent performance to differentiate major NCDLB from other major neurocognitive disorders （NCDs）, with a sensitivity of 94.1% and a specifcity of 71.4%, and acceptable performance to differentiate mild NCDLB from other mild NCDs, with a sensitivity of 60% and a specifcity of 93.1%.Conclusion The Mayo Fluctuations Scale-Thai version is an excellent screening tool for major NCDLB and an acceptable tool that may be used with other additional tests for mild NCDLB. The tool is practical for use in memory and psychiatric clinics. Further validation studies in participants with other specifc clinical conditions are required.
文摘The future of any population is children. Resource limited settings with a high prevalence of HIV infection notably also have an excessive burden of malnutrition. The advances in prevention of mother to child HIV transmission programmes have led to very effective combination antiretroviral regimens resulting in growing numbers of HIV exposed but uninfected children. The mortality of HIV exposed but uninfected children below 5 years is high in resource limited settings. It is also important to pay particular attention to their longitudinal growth and neurodevelopmental outcomes. In these settings, the contribution of feeding practices, choice of complementary foods and micronutrient deficiencies, to health outcomes of HIV exposed uninfected children are not clearly defined. This review highlights some gaps in research that need to be addressed in areas with increasing numbers of HIV exposed but uninfected children. Interventions to reduce mortality, improve growth and neurodevelopmental outcomes in HIV exposed uninfected children from resource limited areas should be prioritized.
文摘Infection with HIV is one of the deadliest epidemics of our time and its type is widespread in the Central African Republic. It is frequently accompanied by neurological complications. Objective: To contribute to a better understanding of neurocognitive disorders in patients living with HIV (PLHIV) in Bangui, and to identify associated factors using the International HIV Dementia Scale (IHDS) as a screening tool. We conducted a descriptive and analytical cross-sectional study from 1 December 2014 to 30 January 2015, in a cohort of patients seen on one of the supported sites in Bangui. A total of 400 patients were received in follow-up visit during the study period of which 244 met the inclusion criteria. The prevalence of neurocognitive disorders was 25%, 95% CI [19.70 - 30.92]. The mean age of subjects was 42.77 ± 9.58 with extremes ranging from 24 - 64 years. The sex ratio (F/M) was 4.5 in. The average score for different tests was 10.93 ± 1.13 with extremes of 7 and 12. The disorder was more about the gestural sequence. Determinants of neurocognitive disorders in the cohort were older age and lower educational level (p < 0.05). It is useful to conduct further studies to confirm these results by combining a battery of neuropsychological tests to recommend this test for all the support sites of PLHIV in the country.
基金the grants from the National Natural Science Foundation of China to WS(82150710557,82293642).
文摘Peri-operative neurocognitive disorders(PNDs)include postoperative delirium(POD)and postoperative cognitive dysfunction(POCD).Children and the elderly are the two populations most vulnerable to the development of POD and POCD,which results in both high morbidity and mortality.There are many factors,including neuroinflammation and oxidative stress,that are associated with POD and POCD.General anesthesia is a major risk factor of PNDs.However,the molecular mechanisms of PNDs are poorly understood.Dexmedetomidine(DEX)is a useful sedative agent with analgesic properties,which significantly improves POCD in elderly patients.In this review,the current understanding of anesthesia in PNDs and the protective effects of DEX are summarized,and the underlying mechanisms are further discussed.
基金funded by the German Research Foundation(DFG)through the project"Tungiasis in East-Africa-an interdisciplinary approach to understanding the interactions between parasite and host"(project number 405027164KR 2245/7-1)to Jürgen Krücken,Amina Abubakar,Ulrike Fillinger,and Charles Waiswa.
文摘Background Tungiasis,a neglected tropical parasitosis,disproportionately afects children.Few empirical studies have reported neurocognitive and mental health outcomes of children with ectoparasitic skin diseases like tungiasis.Pathophysiology of tungiasis suggests it could detrimentally afect cognition and behaviour.This study pioneered the investigation of neurocognitive and mental health outcomes in children with tungiasis.Methods This was a multi-site cross-sectional study including 454 quasi-randomly sampled school-children aged 8-14 from 48 randomly selected schools in two counties in Kenya and a district in Uganda.The participants were stratifed into infected and uninfected based on the presence of tungiasis.The infected were further classifed into mild and severe infection groups based on the intensity of the infection.Adapted,validated,and standardized measures of cognition and mental health such as Raven Matrices and Child Behaviour Checklist were used to collect data.Statistical tests including a multilevel,generalized mixed-efects linear models with family link set to identity were used to compare the scores of uninfected and infected children and to identify other potential risk factors for neurocognitive and behavioural outcomes.Results When adjusted for covariates,mild infection was associated with lower scores in literacy[adjustedβ(aβ)=−8.9;95%confdence interval(CI)−17.2,−0.6],language(aβ=−1.7;95%CI−3.2,−0.3),cognitive fexibility(aβ=−6.1;95%CI−10.4,−1.7)and working memory(aβ=−0.3;95%CI−0.6,−0.1).Severe infection was associated with lower scores in literacy(aβ=−11.0;95%CI−19.3,−2.8),response inhibition,(aβ=−2.2;95%CI−4.2,−0.2),fne motor control(aβ=−0.7;95%CI−1.1,−0.4)and numeracy(aβ=−3;95%CI−5.5,−0.4).Conclusions This study provides frst evidence that tungiasis is associated with poor neurocognitive functioning in children.Since tungiasis is a chronic disease with frequent reinfections,such negative efects may potentially impair their development and life achievements.
基金supported by the Natural Science Foundation of Zhejiang Province(LZ22H090002,2014C33170)National Natural Science Foundation of China(82171260,81641042,81471240)。
文摘General anesthetic agents can impact brain function through interactions with neurons and their effects on glial cells.Oligodendrocytes perform essential roles in the central nervous system,including myelin sheath formation,axonal metabolism,and neuroplasticity regulation.They are particularly vulnerable to the effects of general anesthetic agents resulting in impaired proliferation,differentiation,and apoptosis.Neurologists are increasingly interested in the effects of general anesthetic agents on oligodendrocytes.These agents not only act on the surface receptors of oligodendrocytes to elicit neuroinflammation through modulation of signaling pathways,but also disrupt metabolic processes and alter the expression of genes involved in oligodendrocyte development and function.In this review,we summarize the effects of general anesthetic agents on oligodendrocytes.We anticipate that future research will continue to explore these effects and develop strategies to decrease the incidence of adverse reactions associated with the use of general anesthetic agents.
基金supported by the National Natural Science Foundation of China,No.82371444(to YZ)the Natural Science Foundation of Hubei Province,No.2022CFB216(to XC)the Key Research Project of Ministry of Science and Technology of China,No.2022ZD021160(to YZ)。
文摘The hypothalamic-pituitary-adrenal axis regulates the secretion of glucoco rticoids in response to environmental challenges.In the brain,a nuclear receptor transcription fa ctor,the glucocorticoid recepto r,is an important component of the hypothalamicpituitary-a d renal axis's negative feedback loop and plays a key role in regulating cognitive equilibrium and neuroplasticity.The glucoco rticoid receptor influences cognitive processes,including glutamate neurotransmission,calcium signaling,and the activation of brain-derived neurotrophic factor-mediated pathways,through a combination of genomic and non-genomic mechanisms.Protein interactions within the central nervous system can alter the expression and activity of the glucocorticoid receptor,there by affecting the hypothalamic-pituitary-a d renal axis and stress-related cognitive functions.An appropriate level of glucocorticoid receptor expression can improve cognitive function,while excessive glucocorticoid receptors or long-term exposure to glucoco rticoids may lead to cognitive impairment.Patients with cognitive impairment-associated diseases,such as Alzheimer's disease,aging,depression,Parkinson's disease,Huntington's disease,stroke,and addiction,often present with dysregulation of the hypothalamic-pituitary-adrenal axis and glucocorticoid receptor expression.This review provides a comprehensive overview of the functions of the glucoco rticoid receptor in the hypothalamic-pituitary-a d renal axis and cognitive activities.It emphasizes that appropriate glucocorticoid receptor signaling fa cilitates learning and memory,while its dysregulation can lead to cognitive impairment.This provides clues about how glucocorticoid receptor signaling can be targeted to ove rcome cognitive disability-related disorders.
文摘Delirium,a complex neurocognitive syndrome,frequently emerges following surgery,presenting diverse manifestations and considerable obstacles,especially among the elderly.This editorial delves into the intricate phenomenon of postoperative delirium(POD),shedding light on a study that explores POD in elderly individuals undergoing abdominal malignancy surgery.The study examines pathophysiology and predictive determinants,offering valuable insights into this challenging clinical scenario.Employing the synthetic minority oversampling technique,a predictive model is developed,incorporating critical risk factors such as comorbidity index,anesthesia grade,and surgical duration.There is an urgent need for accurate risk factor identification to mitigate POD incidence.While specific to elderly patients with abdominal malignancies,the findings contribute significantly to understanding delirium pathophysiology and prediction.Further research is warranted to establish standardized predictive for enhanced generalizability.
文摘In this editorial,we comment on the article by Hu et al entitled“Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique”.We wanted to draw attention to the general features of postoperative delirium(POD)as well as the areas where there are uncertainties and contradictions.POD can be defined as acute neurocognitive dysfunction that occurs in the first week after surgery.It is a severe postoperative complication,especially for elderly oncology patients.Although the underlying pathophysiological mechanism is not fully understood,various neuroinflammatory mechanisms and neurotransmitters are thought to be involved.Various assessment scales and diagnostic methods have been proposed for the early diagnosis of POD.As delirium is considered a preventable clinical entity in about half of the cases,various early prediction models developed with the support of machine learning have recently become a hot scientific topic.Unfortunately,a model with high sensitivity and specificity for the prediction of POD has not yet been reported.This situation reveals that all health personnel who provide health care services to elderly patients should approach patients with a high level of awareness in the perioperative period regarding POD.
文摘Objective: Some studies have investigated the association between oral microbiome and mild cognitive impairment (MCI). However, there needs to be more narrative reviews synthesizing this evidence. This study aimed to bridge this gap in the current knowledge. Methods: A comprehensive search was conducted on PubMed (MEDLINE) to identify studies examining the association between the oral microbiome and MCI. Search parameters and inclusion criteria were clearly defined, encompassing terms related to the oral microbiome, MCI, and their association. Two authors independently selected relevant studies and performed data extraction. Result: Four studies were included. Two cohort studies and two case-control reported an association between the oral microbiome and MCI. Conclusion: Based on the evidence synthesized from the included studies, the review suggests an association between MCI and the oral microbiome. Specifically, all included studies identified significant differences in the abundance of specific microbial species between individuals with MCI and those with normal cognitive function, underscoring the potential role of these species in neuroinflammatory diseases.
基金supported by the National Natural Science Foundation of China,Nos.82171260,81641042,81471240the Natural Science Foundation of Zhejiang Province,Nos.LZ22H090002 and 2014C33170(all to ZH)。
文摘Neuroscientists have recognized the importance of astrocytes in regulating neurological function and their influence on the release of glial transmitters.Few studies,however,have focused on the effects of general anesthetic agents on neuroglia or astrocytes.Astrocytes can also be an important target of general anesthetic agents as they exert not only sedative,analgesic,and amnesic effects but also mediate general anesthetic-induced neurotoxicity and postoperative cognitive dysfunction.Here,we analyzed recent advances in understanding the mechanism of general anesthetic agents on astrocytes,and found that exposure to general anesthetic agents will destroy the morphology and proliferation of astrocytes,in addition to acting on the receptors on their surface,which not only affect Ca^(2+)signaling,inhibit the release of brain-derived neurotrophic factor and lactate from astrocytes,but are even involved in the regulation of the pro-and anti-inflammatory processes of astrocytes.These would obviously affect the communication between astrocytes as well as between astrocytes and neighboring neurons,other neuroglia,and vascular cells.In this review,we summarize how general anesthetic agents act on neurons via astrocytes,and explore potential mechanisms of action of general anesthetic agents on the nervous system.We hope that this review will provide a new direction for mitigating the neurotoxicity of general anesthetic agents.
基金funded by National Nature Science Foundation of China Key Projects(81130024,91332205,and 81630030)the National Key Technology R&D Program of the Ministry of Science and Technology of China(2016YFC0904300)+4 种基金the National Natural Science Foundation of China/Research Grants Council of Hong Kong Joint Research Scheme(8141101084)the Natural Science Foundation of China(8157051859)the Sichuan Science&Technology Department(2015JY0173)the Canadian Institutes of Health Research,Alberta Innovates:Centre for Machine Learningthe Canadian Depression Research&Intervention Network
文摘Neurocognitive deficits are frequently observed in patients with schizophrenia and major depressive disorder(MDD). The relations between cognitive features may be represented by neurocognitive graphs based on cognitive features, modeled as Gaussian Markov random fields. However, it is unclear whether it is possible to differentiate between phenotypic patterns associated with the differential diagnosis of schizophrenia and depression using this neurocognitive graph approach. In this study, we enrolled 215 first-episode patients with schizophrenia(FES), 125 with MDD, and 237 demographically-matched healthy controls(HCs). The cognitive performance of all participants was evaluated using a battery of neurocognitive tests. The graphical LASSO model was trained with aone-vs-one scenario to learn the conditional independent structure of neurocognitive features of each group. Participants in the holdout dataset were classified into different groups with the highest likelihood. A partial correlation matrix was transformed from the graphical model to further explore the neurocognitive graph for each group. The classification approach identified the diagnostic class for individuals with an average accuracy of 73.41% for FES vs HC, 67.07% for MDD vs HC, and 59.48% for FES vs MDD. Both of the neurocognitive graphs for FES and MDD had more connections and higher node centrality than those for HC. The neurocognitive graph for FES was less sparse and had more connections than that for MDD.Thus, neurocognitive graphs based on cognitive features are promising for describing endophenotypes that may discriminate schizophrenia from depression.
基金supported by the grant from the Projects of Guangdong Medical Science and Technology Research Foundation(No.C2018055).
文摘Background:Perioperative neurocognitive disorders(PND)are a series of severe complications in the perioperative and anesthetic periods with a decline in memory,execution ability,and information processing speed as the primary clinical manifestation.This study aimed to evaluate the impact of edaravone(EDA)on PND and peripheral blood C-X-C motif chemokine ligand 13(CXCL13)levels in elderly patients with hip replacement.Methods:A total of 160 elderly patients undergoing hip arthroplasty in Affiliated Dongguan People’s Hospital of Southern Medical University(from March 2016 to March 2018)were randomly and double-blindly categorized into an EDA group and a control group(CON).Group EDA was administered intravenously EDA 30 min before surgery,and group CON was administered intravenously saline.The cognitive function of the two groups was evaluated 1-day before the operation and at 1 and 12 months after surgery,and the incidence of post-operative delirium was tested on days 1,3,and 7 after surgery using the Chinese version of the confusion assessment method.Serum CXCL13 and interleukin(IL)-6 concentrations were measured before anesthesia,during surgery(30 min after skin incision),and on days 1,3,and 7 after surgery.The continuous variables in accordance with normal distribution were tested using the Student’s t test,the continuous variables without normal distribution using the Mann-Whitney U test,and categorical variables by the x 2 test or Fisher exact test.Results:The incidence of post-operative delirium within 7 days after surgery was significantly higher in group CON than that in group EDA(31.3%vs.15.0%,t=-5.6,P<0.001).The modifiedtelephone interview for cognitive status andactivities of daily life scores were significantly higher in the group EDA than those in the group CON at 1 month(39.63±4.35 vs.33.63±5.81,t=-2.13,P<0.05and 74.3±12.6 vs.61.2±13.1,t=-1.69,P<0.05)and 12 months(40.13±5.93 vs.34.13±5.36,t=-3.37,P<0.05 and 79.6±11.7 vs.65.6±16.6,t=-2.08,P<0.05)after surgery;and the incidence of neurocognitive dysfunction was significantly lower in the group EDA than that in the group CON(P<0.05).Serum CXCL13 and IL-6 concentrations were significantly lower in the group EDA than those in the group CON during and after surgery(P<0.05).Conclusion:EDA can significantly reduce the serum concentrations of CXCL13 and IL-6 and improve the PND of patients.
